RESUMO
Coarctation of the aorta is a well-known congenital cardiovascular disorder that typically occurs within proximity to the ductus arteriosus. The ascending aorta, distal descending aorta, and abdominal aorta are segments which are prone to development of an atypical coarctation. The etiologies of atypical cases are usually associated with various types of vasculitis syndromes or underlying genetic disorders. In this report, we present a 24-year-old female patient with an ascending aortic coarctation which developed secondary to an atherosclerotic process.
Assuntos
Coartação Aórtica , Doenças Cardiovasculares , Permeabilidade do Canal Arterial , Arterite de Takayasu , Humanos , Feminino , Adulto Jovem , Adulto , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico por imagem , Aorta Abdominal , Aorta TorácicaRESUMO
Pulmonary artery pseudoaneurysms are uncommon. They may occur secondary to trauma, infectious diseases, vasculitis syndromes, neoplasms, congenital diseases, and pulmonary hypertension. Due to increasing number of cardiac interventions, iatrogenic complications are among the major causes of pulmonary artery pseudoaneurysms.In this report, we present a 6-month-old patient with pulmonary pseudoaneurysm that occurred following pulmonary balloon angioplasty for the relief of a pulmonary band.
Assuntos
Falso Aneurisma , Angioplastia Coronária com Balão , Angioplastia com Balão , Humanos , Lactente , Falso Aneurisma/etiologia , Artéria Pulmonar/cirurgia , Dilatação/efeitos adversos , Angioplastia com Balão/efeitos adversos , Angioplastia Coronária com Balão/efeitos adversosRESUMO
ABSTRACT Coarctation of the aorta is a well-known congenital cardiovascular disorder that typically occurs within proximity to the ductus arteriosus. The ascending aorta, distal descending aorta, and abdominal aorta are segments which are prone to development of an atypical coarctation. The etiologies of atypical cases are usually associated with various types of vasculitis syndromes or underlying genetic disorders. In this report, we present a 24-year-old female patient with an ascending aortic coarctation which developed secondary to an atherosclerotic process.
RESUMO
Congenital rupture of tricuspid chordae tendinea leading to severe tricuspid insufficiency is an extremely rare pathology associated with signs and symptoms of congestive heart failure presenting at birth. If the diagnosis and treatment of this pathology are not made early in life fetal demise may become inevitable.We herein present a neonate with central cyanosis and congestive heart failure due to rupture of an anterior leaflet chordae resulting in severe insufficiency of the tricuspid valve who was treated with appropriate surgery.
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Aneurysms and occlusive pathologies of the aorta are frequently associated with atherosclerosis; however, thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare condition with challenging treatment strategy and without established surgical treatment protocols. In this report, we present our treatment strategy in a 64-year-old male patient with ischemic heart disease and type 5 thoracoabdominal aortic aneurysm accompanied by Leriche syndrome.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Síndrome de Leriche/cirurgia , Veia Safena/transplante , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , COVID-19/complicações , COVID-19/diagnóstico , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Evolução Fatal , Humanos , Síndrome de Leriche/complicações , Síndrome de Leriche/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos , Resultado do TratamentoRESUMO
INTRODUCTION: The coronary arteries, which have to originate from the aorta, may sometimes rise from the pulmonary artery. This study evaluated clinical and diagnostic findings, treatment methods, and follow up of cases with anomalous coronary arteries arising from the pulmonary artery. PATIENTS AND METHODS: Eight patients with the diagnosis of anomalous left coronary artery from the pulmonary artery (ALCAPA) (N = 6) and anomalous right coronary artery from the pulmonary artery (ARCAPA) (N = 2), between January 2014 and January 2020 from a single center university hospital, were included in the study. Data from patients' demographic characteristics, electrocardiography, echocardiography, angiographic findings, operation, hospitalization, and follow up were evaluated. RESULTS: The study included eight patients (six females and two males) - six patients with ALCAPA and two with ARCAPA. The ages of the patients ranged between 3-135 (average: 53.25) months. The median body weight was calculated as 17.4 kg. Severe mitral valve insufficiency was detected in two patients and two other patients had a moderate degree of mitral insufficiency on echocardiography. Ejection fractions ranged between 16-74%. One patient had perimembranous malalignment large ventricular septal defect with pulmonary stenosis. Operative techniques were Takeuchi procedure (three patients), direct implantation (four patients), and left internal thoracic artery to left main coronary artery bypass (one patient). Mechanical cardiac support was not required in the postoperative period. Mortality did not occur. Mitral insufficiency and ejection fractions improved following correction of the coronary anatomy. CONCLUSION: It is important to diagnose the ALCAPA or ARCAPA, where the coronary artery originates from the pulmonary artery. Patients should be treated before congestive heart failure and fatal complications occur. Surgical correction should be planned regardless of symptom status, even though some of patients reach adulthood with an increased number of collaterals.
Assuntos
Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Artéria Pulmonar/anormalidades , Procedimentos Cirúrgicos Vasculares/métodos , Pré-Escolar , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Rheumatic heart disease is still an important pathology affecting young people. When valve repair techniques are not possible, valve replacement is inevitable in pediatric patients despite the risk of patient prosthesis mismatch with the growing child. In this report, we present aortomitral fibrous body remodeling, Commando procedure, in a 12-year-old male patient with rheumatic aortic and mitral valve disease to provide adult size mechanical double valve replacement.
Assuntos
Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Cardiopatia Reumática , Adolescente , Adulto , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Criança , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Reoperação , Cardiopatia Reumática/cirurgiaRESUMO
OBJECTIVE: To compare peripheral and central cannulation techniques in cardiac reoperation. METHODS: This retrospective study included 258 patients undergoing cardiac reoperation between January 2013 and July 2018. Patients were divided into two groups according to the cannulation type. The first group included 145 (56.2%) patients operated with standard central cannulation through aorta and right atrium or bicaval cannulation. In this group, cardiopulmonary bypass was instituted after sternotomy. The second group consisted of 113 (43.8%) patients operated with peripheral cannulation through femoral artery, vein, and internal jugular vein. In this group, cardiopulmonary bypass was started before sternotomy and after systemic heparinisation. The two groups' operative complications and postoperative outcomes were compared. RESULTS: Procedure-related injury was higher in the central cannulation group than in the peripheral cannulation group (8.3% vs. 1.8%, respectively, P=0.038). Cardiopulmonary bypass time was shorter in the central cannulation group (P=0.008) and total operation time was similar between the groups (P=0.115). Postoperative red blood cell requirement was higher with central cannulation (P=0.004). Operative mortality (2.8% vs. 0, P=0.186), hospital mortality (4.3% vs. 2.7%, P=0.523), and one-year survival rate (90.3% vs. 94.7%, P=0.202) were similar between the groups. CONCLUSION: Peripheral cannulation reduces cardiac injury and blood transfusion in cardiac reoperation. The cannulation type does not affect postoperative complication, mortality, and one-year survival.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Idoso , Cateterismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
Abstract Aneurysms of the sinuses of Valsalva are defined as dilatation of the aortic root region between the aortic annulus and the sinotubular junction. Isolated aneurysms of the sinus of Valsalva are rare cardiovascular pathologies. They may be congenital, especially secondary to connective tissue disorders or in conjunction with congenital cardiac defects, or acquired such as secondary to infections or trauma. Small sized aneurysm without rupture in asymptomatic patients may be followed; however, latter cases require intervention and surgery is the gold standard treatment modality. In this report, a 41-year-old male patient was reported with giant aneurysm of the non-coronary sinus of Valsalva whom underwent aortic root sparing surgical aortic sinus of Valsalva reconstruction.
Assuntos
Humanos , Masculino , Adulto , Aneurisma Aórtico/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Seio Aórtico/cirurgia , Seio Aórtico/diagnóstico por imagem , Cardiopatias Congênitas , Aorta , Dilatação PatológicaRESUMO
Abstract Objective: To compare peripheral and central cannulation techniques in cardiac reoperation. Methods: This retrospective study included 258 patients undergoing cardiac reoperation between January 2013 and July 2018. Patients were divided into two groups according to the cannulation type. The first group included 145 (56.2%) patients operated with standard central cannulation through aorta and right atrium or bicaval cannulation. In this group, cardiopulmonary bypass was instituted after sternotomy. The second group consisted of 113 (43.8%) patients operated with peripheral cannulation through femoral artery, vein, and internal jugular vein. In this group, cardiopulmonary bypass was started before sternotomy and after systemic heparinisation. The two groups' operative complications and postoperative outcomes were compared. Results: Procedure-related injury was higher in the central cannulation group than in the peripheral cannulation group (8.3% vs. 1.8%, respectively, P=0.038). Cardiopulmonary bypass time was shorter in the central cannulation group (P=0.008) and total operation time was similar between the groups (P=0.115). Postoperative red blood cell requirement was higher with central cannulation (P=0.004). Operative mortality (2.8% vs. 0, P=0.186), hospital mortality (4.3% vs. 2.7%, P=0.523), and one-year survival rate (90.3% vs. 94.7%, P=0.202) were similar between the groups. Conclusion: Peripheral cannulation reduces cardiac injury and blood transfusion in cardiac reoperation. The cannulation type does not affect postoperative complication, mortality, and one-year survival.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Procedimentos Cirúrgicos Cardíacos , Volume Sistólico , Cateterismo , Estudos Retrospectivos , Função Ventricular Esquerda , Resultado do TratamentoRESUMO
INTRODUCTION: In this report, we aim to present our algorithm and results of patients with congenital cardiac disorders who underwent surgical or interventional procedures during the peak phase of the pandemics in our country. PATIENTS AND METHODS: The first COVID-19 case was diagnosed in Turkey on 11 March, 2020, and the peak phase seemed to end by the end of April. All the patients whom were referred, treated, or previously operated but still at the hospital during the peak phase of COVID-19 pandemics in the country were included into this retrospective study. Patient's diagnosis, interventions, adverse events, and early post-procedural courses were studied. RESULTS: Thirty-one patients with various diagnoses of congenital cardiovascular disorders were retrospectively reviewed. Ages of the patients ranged between 2 days and 16 years. Seventeen cases were males and 14 cases were females. Elective cases were postponed. Priority was given to interventional procedures, and five cases were treated percutaneously. Palliative procedures were preferred in patients whom presumably would require long hospital stay. Corrective procedures were not hesitated in prioritised stable patients. Mortality occurred in one patient. Eight patients out of 151 ICU admissions were diagnosed with COVID-19, and they were transferred to COVID-19 ICU immediately. Three nurses whom also took care of the paediatric cases became infected with SARS-CoV-2; however, the children did not catch the disease. CONCLUSION: Mandatory and emergent congenital cardiac percutaneous and surgical procedures may be performed with similar postoperative risks as there are no pandemics with meticulous care and preventive measures.
Assuntos
Procedimentos Cirúrgicos Cardiovasculares , Infecções por Coronavirus , Cardiopatias Congênitas , Controle de Infecções/organização & administração , Pandemias , Pneumonia Viral , Complicações Pós-Operatórias , Adolescente , COVID-19 , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Procedimentos Cirúrgicos Cardiovasculares/estatística & dados numéricos , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/cirurgia , Humanos , Recém-Nascido , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Turquia/epidemiologiaRESUMO
Treatment of the aneurysms comprising the aortic arch is challenging. Surgical reconstruction usually requires aortic cross-clamping, cardiac arrest, and even deep hypothermia for a bloodless field. In this report, we present our surgical technique providing normothermic ascending aorta, aortic arch, and proximal descending aorta replacement with selective cannulation and perfusion of the whole body.
Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Cateterismo , Parada Circulatória Induzida por Hipotermia Profunda , Feminino , Humanos , Hipotermia Induzida , Imageamento Tridimensional , Lactente , Recém-Nascido , Masculino , Tomografia Computadorizada por Raios XRESUMO
Aneurysms of the sinuses of Valsalva are defined as dilatation of the aortic root region between the aortic annulus and the sinotubular junction. Isolated aneurysms of the sinus of Valsalva are rare cardiovascular pathologies. They may be congenital, especially secondary to connective tissue disorders or in conjunction with congenital cardiac defects, or acquired such as secondary to infections or trauma. Small sized aneurysm without rupture in asymptomatic patients may be followed; however, latter cases require intervention and surgery is the gold standard treatment modality. In this report, a 41-year-old male patient was reported with giant aneurysm of the non-coronary sinus of Valsalva whom underwent aortic root sparing surgical aortic sinus of Valsalva reconstruction.
Assuntos
Aneurisma Aórtico , Cardiopatias Congênitas , Seio Aórtico , Adulto , Aorta , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Dilatação Patológica , Humanos , Masculino , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/cirurgiaRESUMO
In chronic myeloid leukemia (CML), the occurrence of blastic transformation is rare. Treatment outcome is generally poor. Allogeneic stem cell transplantation (allo-SCT) is the only potentially curative treatment option for advanced-phase CML. Infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates are associated with high morbidity and mortality rates, particularly in patients with haematological malignancies. Infection and colonization by these multiresistant bacteria may represent a challenge in SCT recipients for the management of post-transplantation complications, as well as for the eligibility to receive a transplant in patients who acquire the pathogen prior to the procedure. We herein report the case of a blast-phase CML patient with a highly resistant, CRKP-associated tricuspid valve endocarditis, who was treated with a combination of systemic antimicrobial therapy and surgical valve repair, and subsequently underwent a successful allo-SCT.
RESUMO
El síndrome de Nicolau (SN) es una complicación rara de la inyección de ciertos fármacos por vía intramuscular, intrarticular o subcutánea, que produce necrosis isquémica de la piel, las partes blandas y el tejido muscular circundante. La bencilpenicilina benzatínica es uno de los antibióticos más ampliamente empleados para las infecciones de las vías respiratorias altas y raramente se ha notificado que produzca SN. En este artículo presentamos el caso de un niño de sexo masculino de cuatro años de edad diagnosticado con SN tras la inyección de bencilpenicilina benzatínica tratado satisfactoriamente con heparina fraccionada (enoxaparina) y pentoxifilina. Los médicos deben estar atentos al uso innecesario de bencilpenicilina benzatínica para evitar las probables complicaciones.
Nicolau syndrome (NS) is a rare complication of intramuscular, intraarticular or subcutaneous injection of particular drugs leading to ischemic necrosis of the surrounding skin, soft tissue and muscular tissue. Benzathine penicilin one of the most widely used antibiotic for upper respiratory tract infections and has been rarely reported to cause NS. Here we describe a 4 year old boy with diagnosis of NS after the injection of benzathine penicillin who was successfuly treated with unfractionized heparin (enoxaparine) and pentoxifylline. The practitioners should pay attention for unnecessary use of benzathine penicillin to avoid from probable complications.
Assuntos
Humanos , Masculino , Pré-Escolar , Penicilina G Benzatina/administração & dosagem , Vasodilatadores/uso terapêutico , Síndrome de Nicolau/etiologia , Síndrome de Nicolau/tratamento farmacológico , Antibacterianos/administração & dosagem , Anticoagulantes/uso terapêutico , Injeções Intramusculares/efeitos adversosRESUMO
BACKGROUND: Near-infrared spectroscopy (NIRS) is a useful non-invasive tool for monitoring infants undergoing cardiac surgery. In this study, we aimed to determine the NIRS values in cyanotic and acyanotic patients who underwent corrective cardiac surgery for congenital heart diseases. METHODS: Thirty consecutive infants who were operated on with the diagnosis of ventricular septal defect (n=15) and tetralogy of Fallot (n=15) were evaluated retrospectively. A definitive repair of the underlying cardiac pathology was achieved in all cases. A total of six measurements of cerebral and renal NIRS were performed at different stages of the perioperative period. The laboratory data, mean urine output and serum lactate levels were evaluated along with NIRS values in each group. RESULTS: The NIRS values differ in both groups, even after the corrective surgical procedure is performed. The recovery of renal NIRS values is delayed in the cyanotic patients. CONCLUSION: Even though definitive surgical repair is performed in cyanotic infants, recovery of the renal vasculature may be delayed by up to two days, which is suggestive of a vulnerable period for renal dysfunction.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Defeitos dos Septos Cardíacos , Monitorização Intraoperatória/métodos , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Tetralogia de Fallot , Feminino , Defeitos dos Septos Cardíacos/sangue , Defeitos dos Septos Cardíacos/fisiopatologia , Defeitos dos Septos Cardíacos/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Tetralogia de Fallot/sangue , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/cirurgiaRESUMO
BACKGROUND: We present the early results of looped epicardial cardioverter defibrillator coil implantation on the anterior surface of right ventricular outflow tract in infants and children. METHODS: Patients with a surgical history of an epicardial implantable cardioverter defibrillator system between 2013 and 2014 were included in the study. Patient age, gender, body weight, indications for a cardioverter defibrillator system implantation, defibrillation threshold values, and defibrillation therapies were retrospectively evaluated. RESULTS: There were eight patients with a mean age of 4.4 ± 2.9 years and a mean body weight of 19.5 ± 11.7 kg. Five of the patients had been diagnosed with long QT syndrome, one patient had been diagnosed with genetic channelopathy and noncompaction of the left ventricle, and two patients had been diagnosed with univentricle physiology. The implantable cardioverter defibrillator system was composed of pace-sense leads, an abdominal active can, and a defibrillation coil placed below the pulmonary valve annulus on the anterior surface of the heart. The mean defibrillation threshold was 6.6 ± 2.3 joules. There were four appropriate therapies in two patients in a mean follow-up of 9 ± 6.5 months. CONCLUSION: The significantly low defibrillation thresholds with the defibrillation coils located below the pulmonary valve annulus are encouraging. However, a larger patient series will be necessary to evaluate the safety and reliability of this technique.
Assuntos
Desfibriladores Implantáveis , Ventrículos do Coração , Displasia Arritmogênica Ventricular Direita/terapia , Peso Corporal , Criança , Pré-Escolar , Feminino , Seguimentos , Comunicação Interventricular/terapia , Humanos , Lactente , Síndrome do QT Longo/terapia , Masculino , Pericárdio , Atresia Pulmonar/terapia , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
The objective of this clinical study is to determine whether correlation exists among cerebral and renal near-infrared spectroscopy (NIRS) measurements, renal Doppler ultrasonography parameters (resistive index, peak systolic velocity), and early postoperative clinical outcomes following cardiac surgery in neonates and infants. Thirty-seven patients undergoing surgery for congenital heart defects with an age of less than 3 months, all of whom were in the high-risk group according to Aristotle Basic Complexity risk stratification score, were enrolled in our study. Cerebral, renal NIRS values and renal Doppler ultrasonography measurements were recorded for each patient at the 4th postoperative hour. The renal resistive indices were calculated for each case, and the patients were divided into two groups according to renal resistive index (RI) values. Group I included the patients with a RI of greater than 0.8 (n = 25) and Group II included the patients with a RI of less than 0.8 (n = 12). The postoperative outcome parameters were compared in between two groups. Group I (RI >0.8) had lower postoperative mean urine output than Group II (RI <0.8) (P = 0.041). The lactate levels were significantly higher in Group I (P = 0.049), as well. The postoperative intensive care unit and hospital stay of Group I was significantly higher than Group II (P = 0.048). Both cerebral and renal NIRS values and the assessment of renal RI as well as peak systolic values can be used in order to predict the early clinical outcome in cardiac surgery patients in early infantile and neonatal period.