RESUMO
Left ventricular tumour is a rare condition in children. The causes include vegetations, thrombus, and fibroma. 2-year-old asymptomatic female presented with an innocent heart murmur at 6 months of age. Subsequent follow-ups at 18 months of age showed left ventricular mass. Surgical pathology revealed "nodular fasciitis." This type of tumour has never been described in the heart before.
Assuntos
Fasciite , Fibroma , Neoplasias Cardíacas , Criança , Humanos , Feminino , Pré-Escolar , Fasciite/diagnóstico , Fasciite/cirurgia , Fasciite/etiologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Neoplasias Cardíacas/complicações , Fibroma/diagnóstico , Fibroma/cirurgia , Fibroma/complicações , Ventrículos do Coração/patologia , Sopros CardíacosRESUMO
Achieving a safe and accurate coronary transfer in the context of the precise geometry of the realigned great arterial connections is the essence of the arterial switch operation for transposition. Because the incidence of variant coronary patterns is not low, one needs to be familiar with techniques to transfer all types of coronary patterns when performing the arterial switch operation. Both closed and open techniques for coronary transfer have been widely adopted for the arterial switch operation. We routinely use the open technique for coronary transfer combined with a liberal use of trapdoor incisions. We demonstrate that this technique, with appropriate technical modifications, serves as a template for achieving accurate coronary transfer even in the context of complex looping and intramural variants.
Assuntos
Transposição das Grandes Artérias , Anomalias dos Vasos Coronários , Transposição dos Grandes Vasos , Humanos , Transposição das Grandes Artérias/métodos , Transposição dos Grandes Vasos/cirurgia , Vasos Coronários/cirurgia , Anomalias dos Vasos Coronários/cirurgiaAssuntos
Veias Pulmonares/anormalidades , Síndrome de Cimitarra/diagnóstico por imagem , Anormalidades Múltiplas , Constrição Patológica/complicações , Constrição Patológica/diagnóstico por imagem , Insuficiência de Crescimento/etiologia , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Lactente , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/patologia , Síndrome de Cimitarra/cirurgiaRESUMO
We demonstrate the repair in an infant of tetralogy of Fallot with complete atrioventricular canal defect using a 2-patch technique with transannular reconstruction of the right ventricular outflow tract due to a diminutive pulmonary valve annulus. This approach is reproducible and particularly valuable to surgeons who routinely use a 2-patch technique to repair an isolated complete atrioventricular canal defect.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Defeitos dos Septos Cardíacos/cirurgia , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Ventrículos do Coração/fisiopatologia , Humanos , Lactente , Resultado do TratamentoRESUMO
We present a four-year-old female with an incidental finding of a congenital left atrial appendage aneurysm who underwent surgical resection with excellent results. This case highlights the importance of multimodal imaging in the diagnosis and characterization of this rare condition.
Assuntos
Apêndice Atrial/anormalidades , Ecocardiografia/métodos , Aneurisma Cardíaco/diagnóstico , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Pré-Escolar , Diagnóstico Diferencial , Feminino , Aneurisma Cardíaco/cirurgia , HumanosRESUMO
In this video tutorial, we present our surgical technique for single-stage complete repair of an interrupted aortic arch with ventricular septal defect. The key operative steps, which include dual cannulation, the arch repair, and the intra-cardiac repair, are clearly demonstrated.
Assuntos
Aorta Torácica , Procedimentos Cirúrgicos Cardíacos/métodos , Síndrome de DiGeorge , Permeabilidade do Canal Arterial/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Síndrome de DiGeorge/diagnóstico , Síndrome de DiGeorge/cirurgia , Comunicação Interventricular/cirurgia , Humanos , Recém-Nascido , Estudos RetrospectivosRESUMO
Planning corrective and palliative surgery for patients who have complex congenital heart disease often relies on the assessment of cardiac anatomy using two-dimensional noninvasive cardiac imaging modalities (echocardiography, cardiac magnetic resonance imaging, and computed tomography scan). Advances in cardiac noninvasive imaging now include the use of three-dimensional (3D) reconstruction tools that produce 3D images and 3D printouts. There is scant evidence available in the literature as to what effect the availability of 3D printouts of complex congenital heart defects has on surgical outcomes. Surgical outcomes of study subjects with a 3D cardiac printout available and their paired control subject without a 3D cardiac printout available were compared. We found a trend toward shorter surgical times in the study group who had the benefit of 3D models, but no statistical significance was found for bypass time, cross-clamp time, total time, length of stay, or respiratory support. These preliminary results support the proposal that 3D modeling be made readily available to congenital cardiac surgery teams, for use in patients with the most complex congenital heart disease.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Imageamento Tridimensional , Impressão Tridimensional , Pré-Escolar , Feminino , Coração/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Modelos Cardiovasculares , Projetos Piloto , Tomografia Computadorizada por Raios XRESUMO
Double outlet right ventricle with subpulmonic ventricular septal defect is a very rare form of congenital heart disease. Surgical correction involves closure of the ventricular septal defect with baffling of blood flow from the left ventricle to the pulmonic valve and arterial switch of the usually side-by-side great arteries. In this tutorial, we present our surgical technique for single-stage repair of this complex anomaly.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Dupla Via de Saída do Ventrículo Direito/cirurgia , Comunicação Interventricular/cirurgia , Humanos , Recém-NascidoRESUMO
Orthotopic heart transplantation in patients with an isolated persistent left superior vena cava is extremely rare, and the anastomotic connection between a right-sided donor superior vena cava and left-sided recipient superior vena cava can be challenging to perform. We present a novel technique used in an infant female, using the left atrial appendage to extend the superior vena cava anastomosis.
Assuntos
Apêndice Atrial/cirurgia , Transplante de Coração/métodos , Veia Cava Superior/anormalidades , Veia Cava Superior/cirurgia , Feminino , Humanos , LactenteRESUMO
Penetrating cardiac injuries with extensive intracardiac components and minimal epicardial components are a rare presentation. A 31-year-old male presented with complex mitral valve and ventricular septal injuries with partial atrioventricular disruption but with hardly visible epicardial injuries; the patient's presentation, progression of injuries and successful management are discussed.
Assuntos
Valva Mitral/lesões , Septo Interventricular/lesões , Ferimentos Perfurantes/cirurgia , Adulto , Humanos , Masculino , Valva Mitral/cirurgia , Septo Interventricular/cirurgia , Ferimentos Perfurantes/diagnósticoRESUMO
In patients undergoing repeat sternotomy, the risk of injury to cardiac structures can be reduced by utilizing a technique that provides sustained visualization of structures adherent to underside of the sternum. We discuss the use of a retractor specifically designed for this purpose: the Rultract Resternotomy Retractor™.
Assuntos
Desenho de Equipamento , Cardiopatias/cirurgia , Traumatismos Cardíacos/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Reoperação/instrumentação , Esternotomia/instrumentação , Traumatismos Cardíacos/etiologia , Humanos , Complicações Intraoperatórias/etiologia , Reoperação/efeitos adversos , Reoperação/métodos , Esternotomia/efeitos adversos , Esternotomia/métodos , Esterno/anatomia & histologiaRESUMO
We report the first use of NiO, Fe3O4, TiO2, and Co3O4 nanoparticles as surfaces for surface-assisted laser desorption/ionization (SALDI) mass spectrometry of asphaltenes. Higher signal-to-noise ratios (S/Ns) for asphaltene species were observed using NiO and Fe3O4 nanoparticles for SALDI as compared to LDI, where both surfaces consistently provided 2- to 3-fold improved S/Ns. The new SALDI detection method showed reliable adsorption data measuring supernatant solutions after 24 hour asphaltene adsorption on NiO, Fe3O4, and Co3O4. These results indicated that NiO has a higher adsorption affinity than Fe3O4 and Co3O4 for asphaltene molecules, corroborating reported asphaltene adsorption on metal oxide nanoparticles.
RESUMO
Truncus arteriosus is an extremely rare and complex form of congenital heart disease. Surgical strategies vary depending on anatomic subtype. In this tutorial, we present our surgical technique for single stage repair of a truncus arteriosus with interrupted aortic arch (Van Praagh type A4).
Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Persistência do Tronco Arterial/cirurgia , HumanosRESUMO
In patients with partial anomalous pulmonary venous return of the right superior pulmonary veins to the superior vena cava, surgical repair generally consists of either intraatrial baffle with or without caval enlargement, or superior caval transection and cavoatrial anastomosis to the right atrial appendage. We discuss here a novel technique of superior caval enlargement without need for patch material or reimplantation.
Assuntos
Apêndice Atrial/cirurgia , Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Síndrome de Cimitarra/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Superior/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Feminino , Humanos , Masculino , Segurança do Paciente , Esternotomia/métodos , Resultado do Tratamento , Malformações Vasculares/cirurgia , Veia Cava Superior/anormalidadesRESUMO
BACKGROUND: Left ventricular outflow tract obstruction after neonatal repair of interrupted aortic arch with ventricular septal defect may warrant reintervention. We sought to identify clinical and preoperative echocardiographic predictors of reintervention for postoperative left ventricular outflow tract obstruction. METHODS: Retrospective data were collected on neonates with interrupted aortic arch with ventricular septal defect who underwent single-stage repair from 1995 to 2009. Univariate and multivariate analyses were performed to identify predictors of reintervention. RESULTS: Seventy patients underwent repair, with 16 patients requiring reintervention: 8 underwent surgical reintervention, 5 underwent percutaneous reintervention, and 3 underwent both. The median time to reintervention was 1.2 years (range, 0.2 to 7.7). All surgical reoperations involved subaortic resection, and all percutaneous reinterventions included balloon aortic valve dilation. Several preoperative echocardiographic measurements were significant by univariate analysis; however, smaller preoperative aortic root size was an independent predictor (p = 0.02) by multivariate analysis. Patients with an aortic root size less than 6.5 mm were at greater risk for reintervention compared with patients with a root size greater than 6.5 mm (reintervention rate 44% and 12%, respectively; p < 0.001). Postoperative left ventricular outflow tract gradient by echocardiogram before discharge was significantly higher in the reintervention group. CONCLUSIONS: Preoperative aortic root size predicts reintervention for postoperative left ventricular outflow tract obstruction after single-stage repair of interrupted aortic arch with ventricular septal defect. Patients with elevated left ventricular outflow tract gradients at discharge are at higher risk of having progressive obstruction and require closer follow-up to ensure early identification and management.
Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Comunicação Interventricular/complicações , Comunicação Interventricular/cirurgia , Complicações Pós-Operatórias/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Aorta Torácica/diagnóstico por imagem , Feminino , Comunicação Interventricular/diagnóstico por imagem , Humanos , Lactente , Masculino , Prognóstico , Reoperação , Estudos Retrospectivos , UltrassonografiaRESUMO
In patients with tetralogy of Fallot (TOF) repair and a borderline pulmonary valve annulus (PVA) size, surgical repair often necessitates a transannular incision and subsequent placement of a patch with or without a monocusp or, alternatively, a right ventricle-to-pulmonary artery conduit. We discuss here a technique in which the pulmonary valve annulus can be safely preserved, with infrequent postoperative issues as well as the potential for less incidence of right ventricular outflow intervention in the long term.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Valva Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Obstrução do Fluxo Ventricular Externo/prevenção & controle , Anuloplastia da Valva Cardíaca , Ponte Cardiopulmonar/métodos , Seguimentos , Comunicação Interventricular/cirurgia , Humanos , Polietilenotereftalatos/uso terapêutico , Artéria Pulmonar/cirurgia , Valva Pulmonar/patologia , Medição de Risco , Esternotomia/métodos , Tetralogia de Fallot/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia Doppler/métodosRESUMO
The first successful stage I palliation for hypoplastic left heart syndrome (HLHS) in a four-day-old female in the Philippines is reported, along with a discussion of the particular dynamics and challenges of performing this kind of surgery in a developing nation. Challenges met were not limited to the preoperative and perioperative period but involved the interstage period as well. In the face of such challenges, our experience, reported here, is the cause for cautious optimism.