RESUMEN
Partial anomalous pulmonary venous return into the azygous vein is a rare pathological finding. We describe the case of a 28-year-old girl who had a successful staged approach to treat this rare congenital heart disease. To avoid potential connection of a systemic venous return to the left atrium, the proximal part of the azygous vein was occluded with a percutaneous approach, then the azygous vein flow was redirected into the left atrium with a surgical procedure.
Asunto(s)
Cardiopatías Congénitas , Venas Pulmonares , Síndrome de Cimitarra , Adulto , Vena Ácigos/diagnóstico por imagen , Vena Ácigos/cirugía , Femenino , Atrios Cardíacos , Humanos , Venas Pulmonares/diagnóstico por imagen , Venas Pulmonares/cirugía , Síndrome de Cimitarra/diagnóstico por imagen , Síndrome de Cimitarra/cirugíaRESUMEN
BACKGROUND: The extracardiac conduit technique is a valid option for completing total cavopulmonary anastomosis (TCPC) in patients with a single ventricle. The technique allows for beating heart surgery, optimal flow dynamics, and reduced postoperative atrial arrhythmia. Different types of conduit have been proposed. This study reported a single-centre experience with two different types of conduit. METHODS: Consecutive patients referred for TCPC at the current institution between January 2001 and September 2013 were included. Retrospective extraction of pertinent variables was accomplished through electronic patient chart review. Patients were stratified based on the type of conduit used to perform the TCPC: polytetrafluoroethylene (PTFE) conduit (Group A) and polyethylene-terephthalate (Dacron) conduit (Group B). RESULTS: The patient population included 105 patients: Group A had 80 patients, and Group B had 25 patients. The two groups were similar in major clinical and procedural variables, including conduit size and Nakata index. Eighteen patients (Group A: one [1.25%]; Group B: 17 [68%]) had conduit occlusion or severe stenosis requiring intervention after a mean 46.9±35months after the operation. The percentage of patients in Group A who were free of conduit obstruction at 3, 5, and 10 years was 100%, 100%, and 96%, respectively, whereas these figures were 68%, 52%, and 35% in Group B (log-rank <0.000). Conduit re-intervention was associated with an increased risk of overall mortality after primary intervention (p<0.004). Dacron tube was found to be an independent risk factor for mid-term stenosis or obstruction (hazard ratio, 62.9; 95% CI, 8.2-482.2; p=0.000). CONCLUSION: Dacron conduit for TCPC surgery was associated with a higher risk of obstruction and need for early re-intervention compared with PTFE conduit. Surgical or percutaneous re-interventions for conduit obstruction increased the risk of late mortality.
Asunto(s)
Procedimiento de Fontan , Tereftalatos Polietilenos , Adolescente , Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , Arritmias Cardíacas/prevención & control , Niño , Preescolar , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/fisiopatología , Cardiopatías Congénitas/cirugía , Humanos , Masculino , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/prevención & control , Estudios RetrospectivosRESUMEN
Objectives: Isolated tricuspid valve dysplasia is a rare disease characterized by a wide spectrum of possible anomalies. We describe the use of the Cone concept to treat a patient with a double-orifice tricuspid valve with massive regurgitation and severe deficit of coaptation. Methods: Three adult patients with congenital non-Ebstein tricuspid valve anomaly characterized by severe coaptation deficiency underwent tricuspid valve repair applying the Cone technique. In particular, we describe the case of a symptomatic 21-year-old woman with a double-orifice tricuspid valve, with massive regurgitation and severe right ventricular dilatation. The tricuspid valve was transformed from a double-orifice valve into a single-orifice valve. The most superior orifice was opened, and the tissue surrounding the orifice was used to extend the leaflet of the inferior orifice. A Cone was created, and a ring annuloplasty was used to stabilize the result. Results: The patient was discharged home after 7 days with trivial residual tricuspid regurgitation and no significant antegrade gradient. The final coaptation height was 2.8 cm. The cardiothoracic ratio decreased from 0.77 to 0.59 after 2 months, and symptoms promptly improved. Conclusions: Over the past 2 years, we have applied the Cone creation concept to patients with a severely dysplastic tricuspid valve with excellent early results. One patient had a double-orifice tricuspid valve, and a Cone repair concept was adopted anyway. One orifice was sacrificed, and surrounding tissue was used to augment the leaflets of the other orifice. A Cone was created to improve central coaptation with a good initial result.
RESUMEN
We report a case of endocarditis months after a Bentall procedure. This was caused by Candida Lusitaniae, in an immunocompetent patient with a recent SARS-CoV-2 infection. The patient underwent a new Bentall procedure. SARS-CoV-2 has been associated with co-infection by Candida species since the beginning of the pandemic, nevertheless, Candida Lusitaniae remains a very uncommon causative agent of prosthetic endocarditis. We suggest a possible role of the SARS-CoV-2, which may have delayed the diagnosis of endocarditis and the appropriate therapy.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Endocarditis , Saccharomycetales , COVID-19/epidemiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Endocarditis/diagnóstico , Endocarditis/microbiología , Humanos , Huésped Inmunocomprometido , Saccharomycetales/aislamiento & purificaciónRESUMEN
A newborn with situs solitus, normally related great arteries and intact atrial septum, underwent surgical repair at our institution for anomalous drainage of the right superior vena cava in the left atrium at the level of the right superior pulmonary veins. This rare cyanotic congenital cardiac malformation is herein described with special regard to its anatomical and diagnostic features. A novel surgical approach for achieving correction is also described.
Asunto(s)
Atrios Cardíacos/cirugía , Vena Cava Superior/anomalías , Vena Cava Superior/cirugía , Anastomosis Quirúrgica/métodos , Cianosis/etiología , Ecocardiografía , Atrios Cardíacos/diagnóstico por imagen , Humanos , Lactante , Oxígeno/sangre , Venas Pulmonares , Tomografía Computarizada por Rayos X , Vena Cava Superior/diagnóstico por imagenRESUMEN
Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries is a rare congenital heart lesion in which pulmonary blood supply may arise from different segments of the aorta. We report an unusual case of a newborn with a major collateral artery originating from the proximal ascending aorta. Successful reparative surgery was undertaken.
Asunto(s)
Aorta/anomalías , Circulación Colateral , Arteria Pulmonar/anomalías , Malformaciones Vasculares/diagnóstico , Angiografía , Aorta/diagnóstico por imagen , Ecocardiografía , Humanos , Recién Nacido , Masculino , Arteria Pulmonar/fisiopatología , Arteria Pulmonar/cirugía , Malformaciones Vasculares/fisiopatologíaRESUMEN
The anomalous origin of the right coronary artery from the pulmonary artery is a rare congenital coronary anomaly with a reported incidence of approximately 0.002%. Usually, the diagnosis is made by echocardiography leaving computed tomography or angiography only to diagnostic completion in doubtful cases or for interventional procedures.Herein we report a doubtful case of a patient with a diagnosis of coronary fistula between the right coronary and the pulmonary artery that proved to be an anomalous origin of the coronary artery from the pulmonary artery. The patient underwent corrective surgery with translocation of the coronary artery on the aorta.
Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico , Arteria Pulmonar/anomalías , Fístula Vascular/diagnóstico , Preescolar , Angiografía Coronaria , Anomalías de los Vasos Coronarios/patología , Anomalías de los Vasos Coronarios/cirugía , Ecocardiografía , Femenino , Humanos , Arteria Pulmonar/patología , Arteria Pulmonar/cirugía , Fístula Vascular/patología , Fístula Vascular/cirugíaRESUMEN
BACKGROUND: Epicardial adipose tissue (EAT) is an atypical fat depot surrounding the heart with a putative role in the development of atherosclerosis. METHODS AND RESULTS: We profiled genes and miRNAs in perivascular EAT and subcutaneous adipose tissue (SAT) of metabolically healthy patients without coronary artery disease (CAD) vs. metabolic patients with CAD. Compared with SAT, a specific tuning of miRNAs and genes points to EAT as a tissue characterized by a metabolically active and pro-inflammatory profile. Then, we depicted both miRNA and gene signatures of EAT in CAD, featuring a down-regulation of genes involved in lipid metabolism, mitochondrial function, nuclear receptor transcriptional activity, and an up-regulation of those involved in antigen presentation, chemokine signalling, and inflammation. Finally, we identified miR-103-3p as candidate modulator of CCL13 in EAT, and a potential biomarker role for the chemokine CCL13 in CAD. CONCLUSION: EAT in CAD is characterized by changes in the regulation of metabolism and inflammation with miR-103-3p/CCL13 pair as novel putative actors in EAT function and CAD.
Asunto(s)
Tejido Adiposo/metabolismo , Aterosclerosis/genética , Regulación de la Expresión Génica/genética , Predisposición Genética a la Enfermedad/genética , Metabolismo de los Lípidos/genética , MicroARNs/genética , Adulto , Anciano , Anciano de 80 o más Años , Quimiocinas/metabolismo , Genoma Humano , Estudio de Asociación del Genoma Completo , Humanos , Inflamación/genética , Masculino , Persona de Mediana EdadAsunto(s)
Aneurisma Falso/cirugía , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Coartación Aórtica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares , Adulto , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aorta Torácica/anomalías , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/etiología , Coartación Aórtica/diagnóstico por imagen , Aortografía/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Stents , Resultado del TratamientoAsunto(s)
Implantación de Prótesis Vascular/instrumentación , Angiografía Coronaria , Anomalía de Ebstein/cirugía , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Tricúspide/cirugía , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Anciano , Anomalía de Ebstein/diagnóstico por imagen , Anomalía de Ebstein/fisiopatología , Humanos , Masculino , Valor Predictivo de las Pruebas , Diseño de Prótesis , Factores de Tiempo , Resultado del Tratamiento , Válvula Tricúspide/anomalías , Válvula Tricúspide/fisiopatología , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/fisiopatologíaRESUMEN
Primary cardiac tumours are relatively rare in the paediatric population, and they may occur with different signs and symptoms in foetal or post-natal life. The clinical manifestations of cardiac tumours in foetal life may include arrhythmias, congestive heart failure and hydrops. In post-natal life, cardiac tumours may cause cyanosis, respiratory distress, myocardial dysfunction, valvular insufficiency, arrhythmias, inflow or outflow tract obstructions and sudden death. Surgical treatment is essential when symptoms are present, while the role of medical therapy can merely be palliative. Results are various and related to the patients' and tumour characteristics. Primary benign heart tumours mainly have a good prognosis, while malignant neoplasms usually have a poor prognosis; in both cases, however, a strict follow-up is always mandatory in order to detect the recurrence of cardiac neoplasms after surgery.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Adyuvante , Niño , Preescolar , Femenino , Neoplasias Cardíacas/complicaciones , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pericardio/cirugía , Radioterapia Adyuvante , Adulto JovenRESUMEN
BACKGROUND: Limited data exist on renal complications of transcatheter aortic valve implantation (TAVI) within a comprehensive program using different valves with transfemoral, transapical, and trans-subclavian approach. METHODS: Prospective single-center registry of 102 consecutive patients undergoing TAVI using both approved bioprostheses and different access routes. The main objective was to assess the incidence, predictors and the clinical impact of acute kidney injury (AKI). AKI was defined according to the valve academic research consortium (VARC) indications. RESULTS: Mean age was 83.7 ± 5.3 years, logistic EuroSCORE 22.6 ± 12.4%, and STS score 8.2 ± 4.1%. Chronic kidney disease at baseline was present in 87.3%. Periprocedural AKI developed in 42 patients (41.7%): 32.4% stage 1, 4.9% stage 2 and 3.9% stage 3. The incidence of AKI was 66.7% in transapical, 30.3% in transfemoral, and 50% in trans-subclavian procedures. The only independent predictor of AKI was transapical access, with a hazard ratio (HR) between 4.57 and 5.18 based on the model used. Cumulative 1-year survival was 88.2%. At Cox regression analysis, the only independent predictor of 30-day mortality was diabetes mellitus (HR 7.05, 95% CI 1.07-46.32; p=0.042), whilst the independent predictors of 1-year death were baseline glomerular filtration rate<30 mL/min (HR 5.74, 95% CI 1.42-23.26; p=0.014) and post-procedural AKI 3 (HR 8.59, 95% CI 1.61-45.86, p=0.012). CONCLUSIONS: TAVI is associated with a high incidence of AKI. Although in the majority of the cases AKI is of mild entity and reversible, AKI 3 holds a strong negative impact on 1-year survival. The incidence of AKI is higher with transapical access.
Asunto(s)
Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Cateterismo Cardíaco/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sistema de Registros , Resultado del TratamientoRESUMEN
Transapical aortic valve implantation is being employed as a less invasive alternative to open heart surgery in high-risk patients with severe aortic stenosis. Here we report the case of an awake transapical aortic valve implantation in a patient with severe chronic obstructive pulmonary disease.
Asunto(s)
Anestesia Epidural , Estenosis de la Válvula Aórtica/terapia , Cateterismo Cardíaco , Implantación de Prótesis de Válvulas Cardíacas/métodos , Vigilia , Anciano , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico , Bioprótesis , Cateterismo Cardíaco/instrumentación , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Masculino , Diseño de Prótesis , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Patients with dissecting or aneurysmal disease of the aortic arch represent a unique challenge for the cardiac surgeon, and the employment of valid surgical and endovascular techniques and appropriate methods of cerebral protection is crucial for obtaining satisfactory postoperative results. Open surgical repair remains the approach of choice, even if supported by increasingly improved endovascular procedures. At present, a wide range of surgical, endovascular and hybrid procedures is available for the treatment of these high-risk patients. The aim of this review is to describe the different procedures used in patients with aortic arch pathology and to review the main results available in the literature.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Síndromes del Arco Aórtico/cirugía , Disección Aórtica/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Implantación de Prótesis Vascular/métodos , Procedimientos Endovasculares/métodos , Humanos , Factores de Riesgo , Stents , Resultado del Tratamiento , Injerto Vascular/métodos , Procedimientos Quirúrgicos Vasculares/tendenciasRESUMEN
BACKGROUND: The aim of this study was to report results of aortic root reoperations and to identify predictors of in-hospital and long-term mortality. METHODS: Between 1986 and 2011, 111 consecutive patients (mean age 55.4 years, 85 male [76.6%]) were reoperated on the aortic root after previous aortic surgery at our institution. An urgent/emergent operation was performed in 24 patients (21.6%). Indications for reoperation were degenerative aneurysm (n = 56), chronic post-dissection aneurysm (n = 27), active prosthetic infection (n = 14), false aneurysm (n = 10) and acute dissection (n = 4). Surgical procedures were limited to the aortic root in 68 patients (61.3%), and involved the entire proximal thoracic aorta in 43 patients (38.7%). RESULTS: In-hospital mortality was 12.6%, being 6.9% and 33.3% in elective and urgent cases, respectively (p=0.002). On multivariate analysis, cardiopulmonary bypass time (odds ratio 1.029/min; p=0.011) and urgent/emergent status (odds ratio 8.486; p=0.044) were independent predictors of in-hospital mortality. Follow-up was 99.1% complete. Estimated 1-, 5-, and 10-year survival rates were 82.5%, 71.9% and 50.6%, respectively. Six redo procedures were performed during follow-up. Freedom from reoperation at 1, 5, and 10 years was 100%, 91.7% and 86.1%, respectively. On Cox regression analysis, chronic aortic dissection (hazard ratio 21.2; p=0.009) was an independent predictor of reintervention at follow-up. CONCLUSIONS: Reoperation on the aortic root can be performed with acceptable mortality and good mid- and long-term outcomes, in particular when carried out on an elective basis. Cardiopulmonary bypass time and urgent/emergent status remain the most important risk factors for reduced survival in aortic surgery.