Subject(s)
Humans , Female , Adult , Pulmonary Valve Stenosis/diagnostic imaging , Double Outlet Right Ventricle/diagnostic imaging , Heart Septal Defects, Ventricular/diagnostic imaging , Aorta/diagnostic imaging , Pulmonary Valve Stenosis/physiopathology , Double Outlet Right Ventricle/physiopathology , Echocardiography , Magnetic Resonance Spectroscopy , Radiography, Thoracic , Diagnosis, Differential , Electrocardiography , Heart Septal Defects, Ventricular/physiopathologyABSTRACT
AbstractIntroduction:Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defects.Objective:To determine factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of surgical repair of complete atrioventricular septal defect.Methods:We assessed the results of 53 consecutive patients 3 years-old and younger presenting with complete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. Median age was 6.7 months; median weight was 5.3 Kg; 86.8% had Down syndrome. At the time of preoperative evaluation, there were 26 cases with moderate or severe left atrioventricular valve regurgitation (49.1%). Abnormalities on the left atrioventricular valve were found in 11.3%; annuloplasty was performed in 34% of the patients.Results:At the time of postoperative evaluation, there were 21 cases with moderate or severe left atrioventricular valve regurgitation (39.6%). After performing a multivariate analysis, the only significant factor associated with moderate or severe left atrioventricular valve regurgitation was the absence of Down syndrome (P=0.03).Conclusion:Absence of Down syndrome was associated with moderate or severe postoperative left atrioventricular valve regurgitation after surgical repair of complete atrioventricular septal defect at our practice.
ResumoIntrodução:A insuficiência da valva atrioventricular esquerda é a lesão residual mais preocupante após o tratamento cirúrgico do defeito de septo atrioventricular.Objetivo:Determinar fatores associados à insuficiência da valva atrioventricular esquerda de grau moderado ou importante nos primeiros 30 dias após correção de defeito de defeito de septo atrioventricular total.Métodos:Avaliamos os resultados em 53 pacientes consecutivos menores de 3 anos com defeito de septo atrioventricular total, operados em nosso serviço entre 2002 e 2010. Avaliamos as seguintes variáveis: idade, peso, ausência de síndrome de Down, grau de insuficiência da valva atrioventricular esquerda antes da correção, anormalidades na valva atrioventricular e uso de anuloplastia. A mediana da idade foi de 6,7 meses e a do peso de 5,3 Kg; 86,8% tinham síndrome de Down. Antes da operação, 26 apresentavam insuficiência da valva atrioventricular esquerda pelo menos moderada (49,1%). Anormalidades na valva atroventricular foram encontradas em 11,3% dos casos; anuloplastia foi realizada em 34% dos pacientes.Resultados:Após a correção, houve 21 casos com insuficiência moderada ou grave da valva atrioventricular esquerda (39,6%). Após realização de análise multivariada, o único fator associado com esses graus de insuficiência foi a ausência da síndrome de Down (P=0,03).Conclusão:Ausência de síndrome de Down esteve associada com insuficiência moderada ou grave da valva atrioventricular esquerda após correção cirúrgica de defeito de septo atrioventricular total em nosso serviço.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Heart Septal Defects, Ventricular/surgery , Mitral Valve Insufficiency/etiology , Age Factors , Body Weight , Down Syndrome/physiopathology , Heart Septal Defects, Ventricular/physiopathology , Mitral Valve Insufficiency/physiopathology , Postoperative Period , Postoperative Complications/etiology , Reoperation , Retrospective Studies , Risk Factors , Severity of Illness Index , Statistics, Nonparametric , Time Factors , Treatment OutcomeSubject(s)
Humans , Male , Adolescent , Heart Septal Defects, Ventricular/physiopathology , Echocardiography/methods , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/therapy , Fever/diagnosis , Radiography, Thoracic/methods , Cough/diagnosis , Heart Valves/methods , Cardiomyopathy, Dilated/etiology , Regional Blood Flow , VenezuelaABSTRACT
A prospective observational study was carried out in the department of cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with the department of cardiology, Combined Military Hospital (CMH), Dhaka from January 2000 to October 2001. All the patients were clinically evaluated. ECG & Doppler echocardiography were done.All the patients underwent cardiac catheterization. Complex congenital heart disease & cyanotic heart disease patients were excluded from the study. Doppler estimated pulmonary to systemic blood flow ratio (Qp/Qs) was done by conventional (velocity time integral method) method. In cardiac catheterization Qp/Qs ratio derived from oximetric data which has become a well established part of clinical practice. Doppler derived Qp/Qs were compared with catheter derived Qp/Qs. 30 patients with VSD were included. In those patients Doppler derived Qp/Qs ranged from maximum 4.5 to minimum 1.10. Mean (+/-SD) was 1.88+/-0.86 In patients with VSD mean (+/-SD) Qp/Qs at catheterization was 1.80+/-0.80. Qp/Qs ranged from maximum 4.10 to minimum 1.1 In those patients the correlation coefficient for invasively determined Qp/Qs versus Doppler estimated Qp/Qs was .92 (standard error of estimate [SEE] = 0.19) & the line of regression passed close to the origin. The results of this study demonstrate that The Doppler technique allows the noninvasive evaluation of Qp/Qs with a high degree of accuracy & allows determination of the stage of VSD by the consecutive assessment of shunt magnititude.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Coronary Circulation/physiology , Echocardiography, Doppler , Female , Cardiac Catheterization , Heart Septal Defects, Ventricular/physiopathology , Humans , Infant , Male , Middle AgedABSTRACT
La ruptura del septo interventricular después de infarto es usualmente fatal, sin corrección quirúrgica. La tendencia actual es hacia una conducta más agresiva desde el punto de vista quirúrgico en todos los pacientes con inestabilidad hemodinámica. Se reporta el caso de un hombre de 51 años con antecedentes de hipertensión arterial, diabetes mellitus e infarto agudo anterior del miocardio, con oclusión completa proximal de la arteria descendente anterior y lesión significativa de la coronaria dercha, más ruptura del septo interventricular en su porción distal. Por signos de edema agudo del pulmón, se llevó a cirugía previa colocación de balón de contrapulsación aórtico. Se le colocó un puente aorto coronario de vena safena a la arteria coronaria derecha y se cerró el defecto interventricular con un parche de Sauvage, 22 horas después del evento. La fracción de expulsión fue del 40 por ciento antes de cirugía y del 35 por ciento al décimo día postoperatorio. Tres meses después del evento el paciente está en clase funcional I de la NYHA y fracción de expulsión del ventriculo izquierdo del 40 por ciento.
Subject(s)
Humans , Heart Septal Defects, Ventricular/diagnosis , Heart Septal Defects, Ventricular/etiology , Heart Septal Defects, Ventricular/physiopathology , Myocardial Infarction/complicationsSubject(s)
Humans , Heart Defects, Congenital/physiopathology , Ductus Arteriosus/physiopathology , Eisenmenger Complex/diagnosis , Eisenmenger Complex/therapy , Pulmonary Valve Stenosis/diagnosis , Heart Septal Defects, Ventricular/diagnosis , Heart Septal Defects, Ventricular/physiopathology , Heart Septal Defects, Ventricular/therapyABSTRACT
Hemodynamic data of 167 patients of isolated ventricular septal defect (VSD) was retrospectively analyzed for the presence of left ventricular inflow gradients. End diastolic gradients of > 5 mm Hg between the pulmonary artery wedge pressure and the left ventricular end diastolic pressure were recorded in 40 of these patients. In three of these cases, left atrium was also entered and identical pressure gradients were recorded between the left atrial pressure and the left ventricular end diastolic pressure. Two dimensional and Doppler echocardiographic or operative findings were available in 32 of the 40 patients. No statistical correlation was found between the presence and degree of left ventricular inflow gradients at end diastole and the degree of left to right shunt. Out of a total of 40 patients with left ventricular inflow gradients, gradients of 6-10 mm Hg were present in 24 patients. Echocardiographic or operative findings available in 19 of these did not show any left ventricular inflow obstruction. Enddiastolic gradients of 11-15 mm Hg were present in 14 patients. Echocardiographic or operative findings were available in 11 of these and one of these had congenital mitral stenosis at surgery. End diastolic gradients of more than 15 mm Hg were present in 2 patients and one of these had congenital mitral stenosis at surgery. Thus organic left ventricular inflow obstruction is rare with inflow mitral gradients of upto 15 mm Hg in patients of VSD.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Heart Septal Defects, Ventricular/physiopathology , Hemodynamics , Humans , Infant , Male , Mitral Valve Stenosis/congenital , Pulmonary Wedge Pressure , Retrospective Studies , Ventricular PressureABSTRACT
O autor relata os defeitos do Septo Ventricular, discorrendo resumidamente sobre o histórico do tratamento cirúrgico, embriologia, patogenia, morfologia dos defeitos, sua associaçäo com doença vascular pulmonar, fisiopatologia e principais complicaçöes. Dá especial atençäo a sintomatologia clínica e diagnostico armado, ao tratamento cirúrgico e enfatiza aspectos especiais do mesmo