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Background: Reoperation is an important cause of morbidity and mortality in congenital heart surgery. The aim of this study was to assess whether the presence of barrier during resternotomy affected the outcomes of infants and children who underwent congenital heart surgery. Methods: A total of 110 (7.6%) patients who underwent reoperations among 1445 consecutive patients between February 2018 and June 2023 were evaluated. The patients were divided into two groups: those with barrier (n = 72) and those without barrier (n = 38). Demographic, intraoperative and postoperative data were retrospectively analyzed. Results: Among the 110 patients, the age at reoperation was 10.1 ± 1.4 years in the group with barrier and 10.9 ± 2.8 years in the group without barrier. There were no statistically significant differences in the age at surgery, preoperative saturation, interval since preceding surgery (years), and aortic cross clamp time (minutes) between the groups. However, there were significantly higher rates of injuries during dissection (p = 0.001) and adverse events (p = 0.002) during dissection in the non-barrier group. One patient in the group without barrier underwent reoperation but subsequently died. Conclusions: The usage of any barrier in front of the right ventricle can decrease the incidence of adverse events, morbidity and mortality.
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Achieving a neutral/positive energy balance without compromising discharge standards is one of the main goals of wastewater treatment plants (WWTPs) in terms of sustainability. Aerobic granular sludge (AGS) technology promises high treatment performance with low energy and footprint requirement. In this study, high-rate activated sludge (HRAS) process was coupled to AGS process as an energy-efficient pre-treatment option in order to increase energy recovery from municipal wastewater and decrease the particulate matter load of AGS process. Three different feeding strategies were applied throughout the study. AGS system was fed with raw municipal wastewater, with the effluent of HRAS process, and with the mixture of the effluent of HRAS process and raw municipal wastewater at Stage 1, Stage 2 and Stage 3, respectively. Total suspended solids (TSS), chemical oxygen demand (COD), ammonia nitrogen (NH4+-N), and total phosphorus (TP) concentrations in the effluent were less than 10 mg/L, 60 mg/L, 0.4 mg/L, and 1.3 mg/L respectively at all stages. Fluctuations were observed in the denitrification performance due to changes in the influent COD/total nitrogen (TN) ratio. This study showed that coupling HRAS process with AGS process by feeding the AGS process with the mixture of HRAS process effluent and raw municipal wastewater could be an appropriate option for both increasing the energy recovery potential of WWTPs and enabling high effluent quality.
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Esgotos , Purificação da Água , Águas Residuárias , Reatores Biológicos , NitrogênioRESUMO
PURPOSE: The aim of this study was to assess the surgical and follow-up outcomes in children who operated for aberrant innominate artery. METHODS: A total of 15 consecutive patients (12 males, 3 females; mean age 16.3 ± 19.0 months; range 3 months to 6 years) who underwent aortopexy between February 2018 and December 2021 were evaluated. Demographic data, preoperative and postoperative clinical status and postoperative outcomes were retrospectively analyzed. RESULTS: The mean age at operation was 16.3 ± 19.0 months. The median weight was 8.3 kg (range, 7-14.5 kg).There was no complications at intraoperative period. The mean percent degree of tracheal stenosis was 0.68 ± 0.12. The median (range) MV duration, PICU stay, and ward stay of the patients were 2 h (0-3 h), 2.5 days (1-4 days), and 5 days (3-8 days), respectively. The mean patients' number of emergency service applications and hospitalization at the preoperative period was 6.2 ± 3.9/2.3 ± 1.6 and, at the postoperative period was 3.3 ± 2.2/0.9 ± 0.8. In comparison of the preoperative and postoperative service application number and hospitalization number, there was significant difference (p < 0.005 and 0.006, respectively). No reoperation was required. There was no mortality. CONCLUSION: Aberrant innominate artery is rarely seen. These pathologies misdiagnosis with different reactive airways. Following the diagnosis, treatment can be achieved by surgery successfully.
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Tronco Braquiocefálico , Estenose Traqueal , Criança , Masculino , Feminino , Humanos , Lactente , Pré-Escolar , Tronco Braquiocefálico/cirurgia , Estudos Retrospectivos , Estenose Traqueal/cirurgia , ReoperaçãoRESUMO
In this study, fate of micropollutants was investigated in a membrane bioreactor (MBR) having dynamic membrane (DM) and ultrafiltration (UF) membrane for the treatment of raw municipal wastewater. Removal efficiencies of different micropollutants including sulfamethoxazole, ciprofloxacin, trimethoprim, caffeine and acetaminophen were assessed. A commercial hollow fiber UF membrane was used in parallel with a DM that was formed on a low-cost hollow fiber support material, made of polyester. MBR was operated at a flux of 10 L/m2·h. High total suspended solids (>99%) and chemical oxygen demand (>91%) removal efficiencies were achieved with each membrane. Besides, high removal efficiencies of micropollutants (>68.3->99.7%) were achieved. Morphological analyses were conducted for each membrane in order to get insight to the cake (dynamic) layer that was accumulated on the membrane. DM technology provides an effective alternative to the conventional membrane systems for micropollutant removal from municipal wastewater.
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Águas Residuárias , Purificação da Água , Reatores Biológicos , Membranas Artificiais , Ultrafiltração , Eliminação de Resíduos LíquidosRESUMO
Aerobic granules contain microorganisms that are responsible for carbon, nitrogen, and phosphorus removal in aerobic granular sludge (AGS) process in which aerobic/anoxic/anaerobic layers (from surface to core) occur in a single granule. Optimizing the aerobic granular sludge (AGS) process for granulation and efficient nutrient removal can be challenging. The aim of this study was to examine the impact of settling prior to AGS process on granulation and treatment performance of the process. For this purpose, synthetic wastewater mimicking municipal wastewater was fed directly (Stage 1), and after primary sedimentation (Stage 2) to a laboratory-scale AGS system. In full-scale wastewater treatment plants, primary sedimentation is used to remove particulate organic matter and produce primary sludge which is sent to anaerobic digesters to produce biogas. Performances obtained in both stages were compared in terms of treatment efficiency, granule settling behavior, and granule morphology. Granulation was achieved in both stages with more than 92% chemical oxygen demand (COD) removal efficiencies in each stage. High nutrient removal was obtained in Stage 1 since anaerobic phase was long enough (i.e., 50 min) to hydrolyze particulate matter to become available for PAOs. Primary sedimentation caused a decrease in influent organic load and COD/N ratio, as a result, low nitrogen and phosphorus removal efficiencies were observed in Stage 2 compared to Stage 1. With this study, the effect of the primary sedimentation on the biological removal performance of AGS process was revealed. COD requirement for nutrient removal in AGS systems should be assessed by considering energy generation via biogas production from primary sedimentation sludge.
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Esgotos , Águas Residuárias , Aerobiose , Biocombustíveis , Reatores Biológicos , Nitrogênio , Fósforo , Esgotos/química , Eliminação de Resíduos LíquidosRESUMO
OBJECTIVE: The objective of this study was to assess the effectiveness of transversus thoracic muscle plane block (TTPB) as a novel technique for postoperative analgesia in pediatric cardiac surgery. DESIGN: A retrospective study. SETTING: A tertiary care teaching hospital. PARTICIPANTS: Children who underwent congenital heart surgery through median sternotomy between January 2018 and March 2019. INTERVENTIONS: Bilateral ultrasound-guided TTPB was performed as a single-shot technique before the sternal incision. A total dose of bupivacaine 0.25% (0.5 ml/kg) was injected between the fourth and fifth ribs just lateral to the sternum. Patients who received TTPB were designated as the TTPB group, and the other group was named the non-TTPB group MEASUREMENTS AND MAIN RESULTS: Thirty-three patients underwent intraoperative bilateral TTPB before the sternal incision and 37 did not. The groups were comparable as for demographic and intraoperative clinical characteristics. Pain scores were significantly lower in the TTPB group compared with the non-TTPB group (p < 0.001). Intraoperatively, non-TTPB patients received significantly higher doses of fentanyl (p < 0.001). Moreover, the total fentanyl dose during a 24-hour period was also higher in the non-TTPB group (p < 0.001). The time to extubation was significantly lower in the TTPB group than in the non-TTPB group (p < 0.001). CONCLUSIONS: TTPB appeared to be an effective technique for postoperative analgesia in pediatric patients undergoing cardiac surgery using a median sternotomy approach.
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Analgesia , Procedimentos Cirúrgicos Cardíacos , Bloqueio Nervoso , Músculos Abdominais/diagnóstico por imagem , Analgésicos Opioides , Criança , Humanos , Músculos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: Patent ductus arteriosus (PDA) is an important cause of morbidity and mortality, especially in very-low-birth-weight infants. The aim of the present study was to evaluate the outcomes of bedside surgical ligation of PDA via limited upper ministernotomy as an alternative approach to thoracotomy. MATERIALS AND METHODS: A total of 23 low-birth-weight premature infants, who underwent bedside ligation of PDA in the neonatal intensive care unit between January 2017 and April 2020, were enrolled. The patients were divided into two groups: those with thoracotomy (n = 13) and those with limited upper ministernotomy (n = 10). These patients were evaluated retrospectively in terms of clinical and preoperative, intraoperative, postoperative parameters between the groups. RESULTS: Mean birth weight was 1059 ± 275 g in the thoracotomy group and 1035 ± 285 g in the ministernotomy group. There was no statistically significant difference in the age at surgery, weight at surgery, preoperative mechanical ventilation (MV) support, inotropic score onset of surgery, and total procedure time between the groups. There was a statistically significant difference in the hospital length of stay, postoperative MV time, and complications in the intensive care unit in favor of the ministernotomy group (p = .04, p = .03, p = .034, respectively). The study showed no statistically significant difference in the mortality rate between the two groups (two patients in the thoracotomy group and one patient in the ministernotomy group). CONCLUSION: The limited upper ministernotomy is an anatomically and technically feasible alternative to classical left posterolateral thoracotomy for bedside surgical PDA ligation.
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Permeabilidade do Canal Arterial , Permeabilidade do Canal Arterial/cirurgia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Ligadura , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, causes endothelial dysfunction which is an important risk factor for mortality in adult cardiovascular diseases. We aimed to investigate whether there was a relationship between the aortic cross-clamping (ACC) time and serum ADMA level in aortic coarctation surgery and importance of the serum ADMA level as a marker of mortality and morbidity. METHOD: Twenty-two patients undergoing surgery for aortic coarctation in the neonatal and early infant period were included in the study, and the patients were divided into two groups according to the aortic cross-clamping time (Group I: <20-min, Group II: >20-min). RESULTS: In Group I, preoperative and postoperative mean ADMA values of the patients were 0.57 ± 0.78 and 0.54 ± 0.83 µmol/L, respectively. In Group II, preoperative and postoperative mean ADMA values of the patients were 0.69 ± 0.93 and 1.10 ± 0.30 µmol/L, respectively. Preoperative-postoperative change of ADMA correlates with ACC time (r = .802, p < .005) and duration of postoperative inotropic support (r = .719, p < .05). Also a high correlation has been found between the ACC time and duration of inotropic support in both groups (r = .689, p < .05). CONCLUSION: Perioperative serum ADMA levels could be used as a prognostic bio-marker in the patients undergoing aortic coarctation repair. Treatments to reduce serum ADMA levels can be valuable for preventing mortality and morbidity which develop after surgeries in a transient ischemia setting by clamping the aorta.
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Coartação Aórtica , Adulto , Aorta , Coartação Aórtica/cirurgia , Arginina/análogos & derivados , Humanos , Recém-Nascido , Óxido Nítrico SintaseRESUMO
Background/aim: Hypoplastic left heart syndrome (HLHS) is a rare pathology with a very high mortality rate. The present study aimed to share our initial experience with the ductus arteriosus stenting procedure using the pulmonary trunk approach in the treatment of HLHS, as well as provide some technical suggestions and discuss complications and their management. Materials and methods: The medical records of 9 neonates (age range: 18 days) with HLHS, who were operated on within a 12-month period, were reviewed retrospectively. Preprocedural planning was performed by computed tomography angiography and echocardiography. The operations were performed in a hybrid surgery room by interventional radiologists and pediatric vascular surgeons. Balloon-expandable stents were used in all of the operations. Results: All operations were successfully completed without any intraoperative mortality. All intraoperative complications were managed successfully during the stenting procedure. Conclusion: Stage 1 hybrid palliation for HLHS is a safe and effective procedure when several key points are kept in mind.
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Implante de Prótese Vascular/métodos , Canal Arterial/cirurgia , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Stents , Prótese Vascular , Angiografia por Tomografia Computadorizada , Canal Arterial/diagnóstico por imagem , Ecocardiografia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico por imagem , Recém-Nascido , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: The inadvertent ligation of the left pulmonary artery (LPA) is a rarely seen surgical complication that has been presented in the literature in a limited number of cases after patent ductus arteriosus (PDA) ligation surgery. Case Report: A PDA closure operation was performed on our patient, a 28-week-old preterm. In the postoperative follow-up, we identified on echocardiography taken on the same postoperative day that the ductus space was still present. On CT angiography, we determined that not only was the ductus space still continuing, but, in addition, ligation of the LPA had been performed inadvertently. An LPA reconstruction operation was performed on the patient 46 days after the first operation. However, owing to severe tissue damage in LPA, LPA reperfusion did not occur in the postoperative period. Conclusion: Although inadvertent ligation of the left pulmonary artery during PDA ligation surgery is rarely seen in patients who have undergone closure surgery, this complication should be kept in mind in the postoperative follow-up period. Patient findings such as physical examination, lung angiography and postoperative echocardiography should be assessed with this in mind.
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Permeabilidade do Canal Arterial/cirurgia , Complicações Pós-Operatórias , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Angiografia por Tomografia Computadorizada , Permeabilidade do Canal Arterial/diagnóstico , Ecocardiografia , Evolução Fatal , Humanos , Recém-Nascido , Ligadura/efeitos adversos , Artéria Pulmonar/diagnóstico por imagemRESUMO
OBJECTIVE: As a highly rare congenital defect, cor triatriatum sinister represents only 0.1% of congenital cardiac anomalies. Depending on the degree of obstruction and the accompanying symptoms, cor triatriatum can be diagnosed at any age. This case series described 5 patients with cor triatriatum sinister who underwent operation. METHODS: Five patients with cor triatriatum sinister were seen at our institution between 2007 and 2013. The demographic characteristics and surgical results of these patients are outlined in this retrospective review. RESULTS: The surgical approach consists of left or right atriotomy, excision of the obstructing membrane, and repair of the associated intracardiac anomalies. After an uneventful postoperative hospital stay, all patients were discharged 5-10 days postoperatively. There were no instances of recurrent constriction after surgical treatment of the cor triatriatum membrane. Patients were followed up for a median of 4 years and were symptom free. CONCLUSION: In the surgical management of this easily and fully treatable congenital cardiac anomaly, it is difficult to determine which atriotomy approach is comparatively more advantageous. However, in the management of cor triatriatum sinister, priority should be given to confirmation of the diagnosis and full resection of the membrane. Thus, the surgeon should not hesitate to perform additional incisions if deemed necessary.
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Coração Triatriado , Adolescente , Criança , Pré-Escolar , Coração Triatriado/diagnóstico por imagem , Coração Triatriado/patologia , Coração Triatriado/cirurgia , Feminino , Humanos , Lactente , Masculino , Radiografia , Estudos RetrospectivosRESUMO
BACKGROUND AND AIM: The aim of this study was to assess the cosmetic results and the impact on the breast development of a right anterolateral thoracotomy (RALT) in pre-pubertal children who underwent RALT for correction of atrial septal defects. METHODS: From December 2002 to July 2010, 25 female patients with a mean age of 8.5 ± 1.3 years underwent repair of atrial septal defects with a right anterolateral thoracotomy. Breast symmetry was described by a clinical index. The degree of scoliosis was measured by clinical examination. The subjective evaluation in breast asymetry, size, and shape was assessed by a survey obtained by the patients. RESULTS: There was no intraoperative or postoperative complication or late mortality in the thoracotomy approach or in the long-term follow-up (7.5 ± 2.2 years). According to the survey, breast asymmetry and differences between both breast size or shape were found in 15 (60%) and seven (28%) patients, respectively. One patient (4%) complained of a keloid scar. Mild sensitive skin deficit in the mammary area was determined in four patients (16%). According to the objective assessment, breast asymmetry was found 12 patients (48%) with index 1 and 13 patients (52%) with index 2. CONCLUSION: Although it is safe, the RALT is associated with the potential to effect unilateral breast development.
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Mama/anormalidades , Mama/crescimento & desenvolvimento , Comunicação Interatrial/cirurgia , Satisfação do Paciente , Toracotomia/efeitos adversos , Toracotomia/métodos , Mama/patologia , Criança , Feminino , Seguimentos , Humanos , Inquéritos e Questionários , Fatores de TempoRESUMO
Double-chambered right ventricle is a rare heart defect causing right ventricular outflow tract (RVOT) obstruction. In this malformation, the right ventricle is divided into two chambers by a fibromuscular band. A 12-year old female patient who had undergone repair of a ventricular septal defect at 5 months old was admitted to our hospital with complaints of dyspnea and fatigue. The patient was diagnosed with an isolated double-chambered right ventricle and surgical correction was successfully performed. Post-operative transesophageal echocardiography showed no residual gradients across the RVOT. Following an uneventful recovery, the patient was discharged five days after surgery.
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Dupla Via de Saída do Ventrículo Direito/diagnóstico , Criança , Angiografia Coronária , Diagnóstico Diferencial , Dupla Via de Saída do Ventrículo Direito/diagnóstico por imagem , Dupla Via de Saída do Ventrículo Direito/cirurgia , Ecocardiografia Transesofagiana , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Comunicação Interventricular/cirurgia , HumanosRESUMO
Background: This study aims to present our experience and results in terms of reconstruction with bovine jugular vein conduit in re-redo patients who developed severe homograft degeneration with pulmonary homograft valve replacement. Methods: Between May 2018 and May 2021, a total of 10 re-redo patients (4 males, 6 females; mean age: 16.5±3.0 years; range, 12 to 21 years) who underwent bovine jugular vein conduit replacement due to homograft degeneration were retrospectively analyzed. The clinical, pre-, intra-, and postoperative data of the patients were recorded. Results: The mean age of the second operation (homograft replacement) was 8.5±3.8 (range, 4 to 14) years in the patients who underwent homograft replacement. No postoperative mortality was observed. When the pre- and postoperative findings were compared, the right ventricular outflow tract gradient, the degree of pulmonary and tricuspid regurgitation, and right ventricular dilatation were regressed (p<0.05). A significant improvement in the New York Heart Association functional class was observed in all patients after surgery. Conclusion: After tetralogy of Fallot corrective surgery, repetitive surgical interventions are inevitable due to pulmonary valve deterioration. Therefore, a bovine jugular vein conduit may be a good alternative for conduit preference after pulmonary homograft failure in re-redo cases.
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OBJECTIVES: The optimal choice of surgery in coarctation of the aorta (CoA) remains controversial but it needs to be individualised. However, in most conditions, a surgical approach through thoracotomy maintains adequate exposure to create aortic patency. This study aimed to assess the efficiency and reliability of thoracal approaches in the treatment of CoA by examining the mid- and late-term outcomes, and determining the predictive factors for re-intervention. METHODS: Patients who underwent CoA repair through thoracotomy between September 2015 and February 2023 were included in the study, except for those with complex cardiac diseases. Medical records were retrospectively analysed and peri-operative course, follow-up findings on echocardiogram and physical examinations were obtained. The complication rate, postoperative arch gradient, need for antihypertensive medication use, and freedom from re-intervention were evaluated and then compared in terms of age at surgery. RESULTS: Overall, 98 patients including 50 neonates were reviewed. The most common surgical method was extended end-to-end anastomosis, performed in 53 patients. The median follow-up time was 4.6 years. There was one death in hospital and one late mortality in the cohort. Eight complications were observed in the cohort but all recovered well. Overall, 13 re-interventions, six redo surgeries and seven balloon angioplasties were carried out in 12 patients. Ten of the re-interventions were carried out within the first year of the initial surgery. One- and three-year freedom from re-intervention rates were 89.5 and 86.4%, respectively. However, there was no significant predictive factor for re-intervention. Comparisons according to the age at surgery did not differ, except for intensive care unit stay. The need for hypertensive medication was initially in 14 (14.2%) patients and then reduced to eight (8%) patients. The mean peak residual gradient on postoperative examination was 9 mmHg. CONCLUSION: Thoracotomy provided feasible surgical access that led to satisfactory results with a low complication rate, negligible residual gradient, low incidence of hypertension and excellent rate for freedom from re-intervention in the treatment of CoA.
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Negative-pressure pulmonary edema (NPPE) is a rare but life-threatening postoperative complication that occurs due to the acute obstruction of the upper airway. In our case report, we present a 25-year-old female patient who underwent elective mammoplasty under general anesthesia and developed NPPE 4 hours after extubation. The patient had a preoperative mallampati score of 3. After routine anesthesia induction, the patient was intubated with an endotracheal tube with a guide wire. Aspiration wasn't observed during extubation. The patient was followed in the post-anesthesia care unit (PACU) for 30 minutes with a saturation of 95% and was subsequently transferred to the service. Four hours after the operation, the patient was re-examined due to dyspnea and shortness of breath. Due to oxygen saturation of 88% and pO2of 56mmHg despite mask ventilation, the patient was admitted to the intensive care unit (ICU). A computed tomography (CT) scan revealed extensive diffuse ground-glass opacities and consolidations in both lungs. She did not respond to mask ventilation and was given non-invasive ventilation with continuous positive airway pressure (CPAP). Forced diuresis was induced with furosemide. Tachypnea resolved within 2 hours after CPAP was initiated, the patient did not require oxygen support and COVID-19 polymerase chain reaction (PCR) testing was negative. Subsequently, the patient was discharged to the clinical ward on postoperative day 1. When considering NPPE, early diagnosis and respiratory support are associated with reduced mortality and rapid recovery. Patients who develop laryngospasm during extubation must be closely monitored, and in the case of pulmonary edema, NPPE should be considered in the differential diagnosis.
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COVID-19 , Laringismo , Mamoplastia , Edema Pulmonar , Adulto , Anestesia Geral/efeitos adversos , Feminino , Humanos , Laringismo/complicações , Mamoplastia/efeitos adversos , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Edema Pulmonar/terapiaRESUMO
BACKGROUND: The mini-sternotomy has become a common approach of choice for a wide range of congenital defects requiring minimally invasive surgery. Here, we aimed to present closed heart surgery results via limited upper mini-sternotomy in the newborn and infants. METHODS: A total of 46 infants who underwent pulmonary artery banding, patent ductus arteriosus ligation, and aortopexy via limited upper mini-sternotomy between December 2017 and October 2020 were enrolled. Patients included 26 males and 20 females with ages ranging from 2 days to 12 months (median age 3.25 ± 0.9 months). The weight ranged from 0.7 kg to 8 kg (median weight 3.6 ± 1.8 kg). These patients were evaluated retrospectively in terms of clinical, preoperative, intraoperative, and postoperative parameters. RESULTS: Closed heart surgery procedures were corrected successfully without adverse events intraoperatively. The median operation time was 32 min (32 ± 7 min). The limited upper mini-sternotomy was performed on 46 patients, including the pulmonary banding (18 patients), PDA ligation (16 patients), and aortopexy (12 patients). No patients required conversion to full sternotomy or to extend the incision. Re-intervention to adjust the tightness of the band was required in 1 patient. There were 4 cases of mortality (8.6%). All four death cases had comorbidity and low birth weight (2500 g or less). CONCLUSION: Limited upper mini-sternotomy is a technically feasible, safe, and effective approach that providing an adequately surgical view in closed heart surgery to reduce the invasiveness of the closed heart surgical repair via median sternotomy or thoracotomy approach.
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Procedimentos Cirúrgicos Cardíacos , Esternotomia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Toracotomia , Resultado do TratamentoRESUMO
Pulmonary arterial sling (PAS) is a relatively rare congenital anomaly in which left pulmonary artery branch originates abnormally from the right pulmonary artery, eventually resulting with respiratory symptoms, due to airway obstruction. In this report, we present a PAS in a neonate who showed progressive respiratory distress in the second week following delivery. At 25 days of age, the patient underwent total surgical correction of the anomaly, during which left pulmonary artery reimplantation to main pulmonary artery without the use of cardiopulmonary bypass was employed. Following an uneventful recovery, the patient was discharged eighteen days after surgery.
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In rare cases, levoatrial cardinal vein may occur as an isolated condition without additional congenital anomalies. Depending on the direction and flow of the shunt, this pathology may produce symptoms; alternatively, it may be asymptomatic, as in the case presented in this study. In asymptomatic cases, complications, such as paradoxical embolism and brain abscess, can arise later. In the 11-year-old patient whose case is presented here, the levoatrial cardinal vein was asymptomatic and incidentally detected. The percutaneous closure method was applied first. However, by 16 hours after the procedure, the occluder device had embolized to the iliac artery. Emergency surgery was performed; first, the occluder device was removed, and levoatrial cardinal vein ligation was then performed via a mini-thoracotomy. The symptoms, diagnosis, and treatment modalities of isolated levoatrial cardinal vein are discussed in the context of this case described herein.
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Cardiac rhabdomyoma is the most common primary heart tumor in childhood. This tumor, which is frequently associated with tuberous sclerosis complex, mostly disappears in childhood with spontaneous regression. Surgical resection is required in case of outflow obstruction and arrhythmia and when protruding to disrupt the filling of the heart cavities. There are very few case series in the literature about rhabdomyoma, whose relationship with other congenital heart defects has not been clearly verified. In this study, we report our approach to the tumor during the corrective surgery of the infant, who was diagnosed with an atrioventricular septal defect and patent ductus arteriosus, and rhabdomyoma accompanying these malformations. We treated this asymptomatic rhabdomyoma with everolimus in line with the current literature, without excision.