RESUMEN
OBJECTIVE: To describe a monthly outreach pediatric cardiology clinic established to better understand the cardiac needs of immigrant/resettled refugee children. STUDY DESIGN: Data obtained between 2014 and 2017 from a monthly pediatric cardiology clinic at a Federally Qualified Health Center were analyzed using descriptive statistics. RESULTS: A total of 366 patients (222 male, 61%) were evaluated. Indications for referral included murmur (242, 66%), nonexertional symptoms (31, 9%), exertional symptoms (16, 4%), history of cardiac surgery/transcatheter interventions (15, 4%), previous diagnosis of heart conditions without intervention (13, 4%), arrhythmia/bradycardia (13, 4%), and others (36, 10%). Echocardiograms were performed on 136 patients (67 were abnormal, 49%). The most common final diagnoses include innocent murmur in 201 (55%), simple congenital heart disease in 61 (16%), complex congenital heart disease in 3 (1%), and acquired heart disease in 3 (1%). A total of 15 patients (4%) were ultimately determined to require surgical or cardiac catherization as an intervention. Patients have been followed for a median of 0.7 years (range 0-3.3 years). CONCLUSIONS: Rates of abnormal echocardiograms suggest a greater likelihood of congenital or acquired heart disease at time of initial consultation compared with nonimmigrant/refugee populations. The most common indication for referral to the outreach pediatric cardiology clinic was a murmur. Collaborative efforts between physicians and support services are essential in assisting this vulnerable population access pediatric subspecialty care.
Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Cardiopatías Congénitas/diagnóstico , Soplos Cardíacos/diagnóstico , Refugiados/estadística & datos numéricos , Adolescente , Niño , Preescolar , Ecocardiografía/estadística & datos numéricos , Femenino , Cardiopatías Congénitas/epidemiología , Soplos Cardíacos/epidemiología , Humanos , Lactante , Masculino , Área sin Atención Médica , Estudios Retrospectivos , Texas/epidemiologíaRESUMEN
Papillary fibroelastomas are benign primary cardiac tumors that usually arise from the valve apparatus and are rare in the pediatric population. Involvement of the tricuspid valve is even less common with only a few cases reported in the literature. Cardiac magnetic resonance imaging is a valuable examination that aids in differentiating a tumor from a thrombus. We present the case of an 11-month-old girl referred by her pediatrician to investigate a murmur noted since birth. To our knowledge, this is the first report of a pathologically proven papillary fibroelastoma arising from the tricuspid valve characterized by magnetic resonance imaging in an infant.
RESUMEN
Atrioventricular septal defects represent a class of congenital cardiac malformations that vary in presentation and management strategy depending upon the severity of the particular lesions present. We present the case of a premature neonate who had a partial atrioventricular septal defect and an accessory mitral (or left atrioventricular) valve leaflet. The latter caused severe left ventricular outflow tract obstruction and severely depressed left ventricular function. We found only one other report of this atrioventricular valve abnormality in association with atrioventricular septal defect. To our knowledge, our patient (at a body weight of 1,800 g) is the smallest to survive corrective surgery of an accessory mitral valve leaflet with severe left ventricular outflow tract obstruction. In addition to our patient's case, we discuss the relevant medical literature.
Asunto(s)
Defectos del Tabique Interventricular/complicaciones , Recien Nacido Prematuro , Válvula Mitral/anomalías , Obstrucción del Flujo Ventricular Externo/etiología , Procedimientos Quirúrgicos Cardíacos , Ecocardiografía , Edad Gestacional , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/fisiopatología , Defectos del Tabique Interventricular/cirugía , Humanos , Recién Nacido , Masculino , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Válvula Mitral/cirugía , Resultado del Tratamiento , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/fisiopatología , Obstrucción del Flujo Ventricular Externo/cirugíaRESUMEN
Paravalvular leak following prosthetic valve surgery has the potential to cause serious complications such as hemolysis and congestive heart failure. Successful percutaneous closures of prosthetic mitral and aortic paravalvular leaks have been performed as an alternative to reoperation. This case represents the first known report of successful percutaneous closure of a prosthetic pulmonary paravalvular leak in an adult patient with a history of congenital heart disease using two muscular ventricular septal defect occluder devices.
Asunto(s)
Bioprótesis , Cateterismo Cardíaco , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Falla de Prótesis , Insuficiencia de la Válvula Pulmonar/cirugía , Válvula Pulmonar/cirugía , Adulto , Cateterismo Cardíaco/instrumentación , Femenino , Humanos , Diseño de Prótesis , Válvula Pulmonar/fisiopatología , Insuficiencia de la Válvula Pulmonar/diagnóstico , Insuficiencia de la Válvula Pulmonar/etiología , Insuficiencia de la Válvula Pulmonar/fisiopatología , Dispositivo Oclusor Septal , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to analyze our experience with the cryopreserved femoral vein homograft in comparison with standard biomaterials for neoaortic reconstruction in the Norwood stage 1 operation. METHODS: All patients who underwent the Norwood operation from September 2004 to April 2011 were analyzed retrospectively (n = 107). Patients were grouped into group A (cryopreserved femoral vein homograft; n = 72) or group B (other; n = 35). Intergroup comparisons and dimensional analyses of all available angiograms were performed. Two surgical techniques, "standard homograft cuff" and "homograft tube," were compared. RESULTS: Multivariable Cox regression analysis revealed use of biomaterial other than femoral vein (P = .01; hazard ratio, 3.0; 95% confidence interval [CI], 1.4-6.4), weight less than 2.5 kg at the time of stage 1 (P = .01; hazard ratio, 3.7; 95% CI, 1.7-7.8), and need for extracorporeal membrane oxygenator support after stage 1 (P < .001; hazard ratio, 13.8; 95% CI, 5.9-31.9) as significant independent predictors of overall mortality. Improved late survival at 48 months was seen with the femoral vein homograft compared with other biomaterials when a "homograft tube with end-to-side ascending aortic reimplantation technique" was used (group A [75%] vs group B [44%]; P = .03). With the use of the "homograft cuff technique," survival was similar for femoral vein homografts and other biomaterials (group A [67%] vs group B [61%]; P = .85). Similar neoaortic coarctation rates were seen in both groups (A: 25/59 [42%] vs B: 12/26 [46%]; P = .81). A progressive increase in the diameter of the neoaorta was seen over time in both groups with both technical modifications (tube grafts pre-stage 2 vs pre-stage 3: group A [10.61 mm ± 1.93 vs 13.74 mm ± 3.16] [P < .001] and group B [13.93 mm ± 6.71 vs 17.38 mm ± 5.92] [P = .049]); cuff repair pre-stage 2 to pre-stage 3: group A [13.98 mm ± 2.13 vs 19.09 mm ± 4.18] [P = .002] and group B [16.06 mm ± 3.05 vs 19.73 mm ± 2.93] [P < .001]). The neoaortic Z-scores were generous with the use of homograft cuffs and modest when homograft tubes were used and maintained in range over the follow-up time. CONCLUSIONS: Survivals are improved with the use of femoral vein homograft for neoaortic reconstruction for Norwood stage 1 operation, especially when used as a homograft tube with end-to-side aortic reimplantation. Femoral vein homografts have similar recoarctation rates compared with standard biomaterials. Progressive growth/dilation of the neoaorta in proportion to somatic growth is seen with femoral vein tube grafts.
Asunto(s)
Aorta/cirugía , Implantación de Prótesis Vascular/métodos , Vena Femoral/trasplante , Procedimientos de Norwood , Procedimientos de Cirugía Plástica/métodos , Aortografía , Bioprótesis , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Criopreservación , Femenino , Vena Femoral/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Análisis Multivariante , Procedimientos de Norwood/efectos adversos , Procedimientos de Norwood/mortalidad , Modelos de Riesgos Proporcionales , Diseño de Prótesis , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/mortalidad , Reimplantación , Estudios Retrospectivos , Factores de Tiempo , Trasplante Homólogo , Resultado del TratamientoRESUMEN
In 1999, we noted the development of inflammation and/or abscesses at the site of radial access in a group of patients. Over a 3-year period, we noted this inflammation in 33 patients out of 2,038 (1.6%) who had catheterization via the radial approach. The radial abscesses occurred in 30 patients out of 1,063 (2.8%) in whom we could confirm the use of a hydrophilic-coated sheath, but in no patient for whom we can document that an uncoated sheath was used. No infectious agent could be implicated, and the time course for the development of the abscess, typically 2 to 3 weeks, seemed long for a bacterial infection. Later patients had biopsies, and granulomatous reactions were seen in most. Additionally, a few of the biopsies showed an amorphous extravascular substance consistent with the catheter coating. All patients had good long-term outcomes.