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1.
Cardiol Young ; 34(2): 439-441, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38088365

RESUMEN

A 50-year-old woman who had atrial septal defect surgery at 11 months old underwent ascending aortic aneurysm resection and two attempts at closure of a residual atrial septal defect. Post-operatively, she had severe cyanosis. She was referred to our centre where a transesophageal echocardiogram and cardiac catheterisation showed an iatrogenic interatrial tunnel-type communication that was closed with an Amplatzer Vascular Plug.


Asunto(s)
Defectos del Tabique Interatrial , Femenino , Humanos , Persona de Mediana Edad , Cateterismo Cardíaco , Ecocardiografía Transesofágica , Defectos del Tabique Interatrial/cirugía , Enfermedad Iatrogénica , Resultado del Tratamiento
2.
Cardiol Young ; : 1-8, 2024 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-38572557

RESUMEN

BACKGROUND: Invasive haemodynamics are often performed for initiating and guiding pulmonary artery hypertension therapy. Little is known about the predictive value of invasive haemodynamic indices for long-term outcomes in children with pulmonary artery hypertension. We aimed to evaluate invasive haemodynamic data to help predict outcomes in paediatric pulmonary artery hypertension. METHODS: Patients with pulmonary artery hypertension who underwent cardiac catheterisation (2006-2019) at a single centre were included. Invasive haemodynamic data from the first cardiac catheterisation and clinical outcomes were reviewed. The combined adverse outcome was defined as pericardial effusion (due to right ventricle failure), creation of a shunt for pulmonary artery hypertension (atrial septal defect or reverse Pott's shunt), lung transplant, or death. RESULTS: Among 46 patients with a median [interquartile range (IQR)] age of 13.2 [4.1-44.7] months, 76% had CHD. Median mean pulmonary artery pressure was 37 [28-52] mmHg and indexed pulmonary vascular resistance was 6.2 [3.6-10] Woods units × m2. Median pulmonary artery pulsatility index was 4.0 [3.0-4.7] and right ventricular stroke work index was 915 [715-1734] mmHg mL/m2. After a median follow-up of 2.4 years, nine patients had a combined adverse outcome (two had a pericardial effusion, one underwent atrial level shunt, one underwent reverse Pott's shunt, and six died). Patients with an adverse outcome had higher systolic and mean pulmonary artery pressures, higher diastolic and transpulmonary pressure gradients, higher indexed pulmonary vascular resistance, higher pulmonary artery elastance, and higher right ventricular stroke work index (p < 0.05 each). CONCLUSION: Invasive haemodynamics (especially mean pulmonary artery pressure and diastolic pressure gradient) obtained at first cardiac catheterisation in children with pulmonary artery hypertension predicts outcomes.

3.
Pediatr Cardiol ; 44(7): 1546-1551, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37173579

RESUMEN

To evaluate existing scoring systems and develop a new model to predict intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD). A retrospective cohort study performed between 2004 and 2017 identified 115 patients treated with IVIG for classic or incomplete KD. In our practice, IVIG resistance was defined as fever for > 24 h and patients were divided into responders and non-responders. A univariate analysis was performed to identify independent predictors of IVIG resistance. The predictors were combined into a new scoring system and compared with existing scoring systems. Sixty-five patients had classic KD and 50 had incomplete KD. Among the 115 patients, 80 (69.6%) responded and the remaining 35 were resistant (30.4%) to IVIG. Of the 35 resistant patients, 16 patients had incomplete KD. Hispanic children comprised 43% of our sample population. Coronary artery abnormalities developed in 14 of the 35 IVIG-resistant patients (39%). Univariate analysis showed that IVIG-resistant patients were older and present with lower platelets, potassium, and creatinine (P < 0.05). Multivariate logistic regression analysis used platelets, potassium, body surface area (BSA), and creatinine to devise the Las Vegas Scoring System (LVSS), which demonstrated a sensitivity of 76.2% and a specificity of 68.6%. Compared to published data, we observed a higher rate of IVIG resistance and coronary artery abnormalities in our patient population. The LVSS (using platelets, potassium, BSA, and creatinine) showed higher specificity and comparable sensitivity to other scoring systems devised to predict IVIG resistance.


Asunto(s)
Enfermedad de la Arteria Coronaria , Síndrome Mucocutáneo Linfonodular , Niño , Humanos , Lactante , Inmunoglobulinas Intravenosas/uso terapéutico , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico , Síndrome Mucocutáneo Linfonodular/epidemiología , Estudios Retrospectivos , Creatinina , Resistencia a Medicamentos
4.
J Card Surg ; 37(11): 3705-3710, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36047366

RESUMEN

OBJECTIVE: We reviewed our center's experience with neonatal and infant hypoplastic aortic arch, unassociated with intracardiac malformations, and investigated changes in prenatal detection rates over time for those requiring therapeutic procedures. METHODS: We identified all prenatal diagnoses of hypoplastic aortic arch with situs solitus, unassociated with intracardiac malformations, made in Nevada between May 2017 and April 2022. In addition, we identified all those 0-180 days old, with prenatal care, that underwent a surgical or interventional cardiac catheterization aortic arch procedure, whether prenatally or postnatally diagnosed. We excluded those with ventricular septal defects, functionally univentricular hearts, interrupted aortic arches, or any associated malformation requiring an additional surgical or interventional procedure ≤6 months old. Additionally, we calculated prenatal detection rates for those undergoing a surgical or interventional catheterization procedure for each of the 5 years. RESULTS: We identified 107 patients prenatally and postnatally. Of the 107 patients, 56 (34 prenatally diagnosed and 22 postnatally diagnosed) underwent an aortic arch procedure, and 51 additionally prenatally diagnosed, live-born infants did not undergo a procedure. Of the 56 procedures, 2 were by interventional catheterization, and 54 underwent a surgical repair. Prenatal detection for those undergoing a procedure statistically significantly increased over the 5 years from 38% to 82%, rho = 0.95 (p = .04). CONCLUSIONS: Currently in Nevada, our prenatal detection rate is >80% in the general population for those between 0 and 6 months old who require a therapeutic procedure for aortic arch obstruction without intracardiac malformations.


Asunto(s)
Coartación Aórtica , Cardiopatías Congénitas , Aorta Torácica/anomalías , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Coartación Aórtica/diagnóstico por imagen , Coartación Aórtica/epidemiología , Femenino , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/epidemiología , Humanos , Lactante , Recién Nacido , Nevada , Embarazo , Diagnóstico Prenatal , Estudios Retrospectivos
5.
J Card Surg ; 36(11): 4090-4094, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34462970

RESUMEN

OBJECTIVE: We reviewed our center's experience with common arterial trunk. METHODS: We included those with common arterial trunk in Nevada with estimated delivery dates or birth dates between June 2006 and May 2021. We excluded patients with functionally univentricular hearts. RESULTS: We identified a total of 39: 32 prenatally and 7 postnatally. Of the 32 prenatally detected, 2 had elective termination, 2 had fetal demise, and 28 were live-born. Of the 7 postnatally diagnosed, 6 had prenatal care without a fetal echocardiogram, and 1 had no prenatal care. Overall, live-born prenatal detection was 28/34 (82%). Prenatal detection for 2006-2009 was 2/6 (33%) and for 2010-2021 was 26/28 (93%) p = .049. Of the 35 live-born infants, 1 died preoperatively, and 34 underwent neonatal surgery. Of the 34, 8 had palliation (birth weight 1.9±0.7 kg, range 0.8-2.6 kg), and 26 had a primary repair (birth weight 3.0±0.3 kg, range 2.6-4.0 kg) p = .0004. For all 34 neonatal surgical procedures, there were 2 (5.9%) deaths; however, there were no subsequent surgical or interventional catheterization mortalities. CONCLUSIONS: In Nevada, current state-wide, general population prenatal detection of the common arterial trunk was more than 90%. By employing a combination of neonatal palliation and primary repair, surgical mortality was less than 6% in a cohort that included those with birth weights less than 2.5 kg, truncal valve surgery, and interrupted aortic arches.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas , Tronco Arterial Persistente , Ecocardiografía , Femenino , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Cuidados Paliativos , Embarazo , Estudios Retrospectivos
6.
J Card Surg ; 36(7): 2329-2335, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33834526

RESUMEN

OBJECTIVE: We investigated a relationship between a composite index comprised of Fontan-circuit anatomical features and hepatic fibrosis scores from biopsy. METHODS: We identified living extracardiac Fontan patients, ≥7 years old and ≥5 but <20 years postoperative, that underwent cardiac catheterization and transvenous liver biopsy between March 2012 and September 2020. We divided patients into anatomical groups and applied a risk score to each patient. We compared average anatomical risk scores with average hepatic total fibrosis scores by group. RESULTS: We identified 111 patients that met inclusion criteria. After excluding four patients, we assigned 107 to one of 12 anatomical variant groups (n ≥ 3). For the 107, the average age at liver biopsy was 14 ± 6 years old. Of the 107, 105 (98%) were New York Heart Association Class 1. We found average anatomical risk scores by group correlated with average total fibrosis scores by group (R = 0.8; p = .005). An average Fontan duration to biopsy of 10 ± 1 years was similar for all 12 anatomical groups. We found no other clinical variables, laboratory, or hemodynamic values that trended with anatomical risk scores or hepatic total fibrosis scores. CONCLUSIONS: In a cohort of relatively young, stable extracardiac Fontan patients, average composite anatomical risk scores strongly correlated with average hepatic total fibrosis scores by anatomical group. These findings suggest that some anatomical variants in extracardiac Fontan patients are associated with higher Fontan-associated liver disease (FALD)-related hepatic total fibrosis scores than others, despite similar Fontan durations.


Asunto(s)
Procedimiento de Fontan , Cardiopatías Congénitas , Hepatopatías , Adolescente , Adulto , Biopsia , Cateterismo Cardíaco , Niño , Cardiopatías Congénitas/patología , Cardiopatías Congénitas/cirugía , Humanos , Hígado , Cirrosis Hepática/etiología , Adulto Joven
7.
Pediatr Cardiol ; 41(5): 905-909, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32125444

RESUMEN

This investigation analyzed the rate of hepatic fibrosis progression in post-Fontan patients that underwent hepatic biopsy. The study cohort comprised post-Fontan patients that underwent cardiac catheterization and transvenous liver biopsy between March 2012 and September 2019. We identified 126 patients that met inclusion criteria. Of the 126, 27 (21%) had a lateral tunnel Fontan, and 99 (79%) had an extracardiac Fontan. For the 27 lateral tunnel Fontan patients, age at Fontan was 4 ± 2 years, and for the 99 extracardiac Fontan patients age at Fontan was 4 ± 2 years (p = 0.98). For the 27 lateral tunnel Fontan patients, the average total fibrosis score was 3.0 ± 1.5; and for the 99 extracardiac Fontan patients, the average total fibrosis was 2.7 ± 1.7 (p = 0.48). For the lateral tunnel Fontan patients, the average Fontan duration was 20 ± 6 years; and for the 99 extracardiac Fontan patients, the average Fontan duration was 11 ± 5 years (p < 0.001). For the 27 lateral tunnel Fontan patients, the average rate of fibrosis progression was 0.16 ± 0.10 total fibrosis score/year; and for the 99 extracardiac Fontan patients, the average rate of fibrosis progression was 0.30 ± 0.23 total fibrosis score/year (p < 0.001). In conclusion, our findings suggest that those with extracardiac Fontans have a faster rate of hepatic fibrosis progression than those with lateral tunnel Fontans. More extensive or multi-institutional studies will be needed to confirm these findings and define the clinical significance of discrepant rates of hepatic fibrosis in post-Fontan patients.


Asunto(s)
Procedimiento de Fontan/métodos , Cardiopatías Congénitas/cirugía , Cirrosis Hepática/epidemiología , Adolescente , Adulto , Biopsia , Cateterismo Cardíaco , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Procedimiento de Fontan/efectos adversos , Humanos , Hígado/patología , Cirrosis Hepática/etiología , Masculino , Adulto Joven
8.
J Card Surg ; 35(11): 2974-2978, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32789925

RESUMEN

OBJECTIVE: We hypothesized that a relationship might exist between angiographically demonstrable, post-Fontan venovenous collaterals, and hepatic fibrosis. METHODS: We analyzed data from post-Fontan patients that underwent cardiac catheterization and transvenous-hepatic biopsy procedures between March 2012 and March 2020. From innominate vein angiography, we determined those that either had or lacked venovenous collaterals. Additionally, we examined data from post-Fontan patients that underwent hepatic ultrasound, shear-wave elastography between January 2017 and March 2020. RESULTS: We identified 164 patients that met inclusion criteria. Of the 164, 101 (62%) had venovenous collaterals. Of the 101 with collaterals, average total fibrosis score (TFS) was 3.2 and the average rate of fibrosis progression was 0.28 vs an average TFS of 2.1 and an average fibrosis progression rate of 0.22 for those without collaterals (P = .00001 and P = .01, respectively). Of the 101 with collaterals, oxygen saturation was 91% ± 4% vs 93% ± 3% (P = .048) without collaterals. Of the 164, 86 (52%) underwent ultrasound shear-wave elastography. Of the 86 patients undergoing elastography, 50 (58%) were performed in those with collaterals, and 36 (42%) in those without collaterals. For the 50 with collaterals, average elastography values were 13.3 vs 11.2 kPa for the 36 without collaterals (P = .006). We found no statistically significant differences for age at biopsy, Fontan duration, Fontan-type, type of functional univentricle, laboratory, clinical, or hemodynamic values between those with or without collaterals. CONCLUSIONS: The presence of angiographically demonstrated venovenous collaterals was associated with statistically, significantly more advanced liver fibrosis than those without collaterals.


Asunto(s)
Circulación Colateral , Procedimiento de Fontan/efectos adversos , Cirrosis Hepática/etiología , Adolescente , Adulto , Angiografía , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/fisiopatología , Cateterismo Cardíaco , Niño , Progresión de la Enfermedad , Diagnóstico por Imagen de Elasticidad , Femenino , Cardiopatías Congénitas/cirugía , Humanos , Cirrosis Hepática/diagnóstico , Masculino , Pronóstico , Estudios Retrospectivos , Adulto Joven
9.
Catheter Cardiovasc Interv ; 93(2): 324-329, 2019 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30351525

RESUMEN

OBJECTIVES: To describe a multicenter experience of percutaneous transcatheter pulmonary valve replacement (TPVR) using the Edwards SAPIEN S3 valve without the use of a prior stent ("pre-stenting"). BACKGROUND: The SAPIEN S3 and XT valves have durable cobalt-chromium stent frames which may allow for TPVR in large diameter dysfunctional right ventricular outflow tracts (RVOTs) without pre-stenting the landing zone. METHODS: A retrospective review was performed of all patients with Congenital Heart Disease and dysfunctional RVOT who underwent TPVR using the SAPIEN valve without the use of a pre-stent. Imaging data, procedural elements, and clinical follow-up data were collected to evaluate short and intermediate-term results. RESULTS: Fifty-seven patients underwent percutaneous placement of the SAPIEN valve in the pulmonary position without the use of pre-stenting. The anatomical substrate varied: native RVOTs (n = 41), conduits (n = 10), and bioprosthetic valves (n = 6). There were no cases in which the valve could not be implanted and no cases of valve embolization or misplacement. On follow-up (range 1 month to 2.2 years, median 5.3 months), no patients had significant obstruction or regurgitation around the valve. There were no frame fractures. There were no procedural deaths. Major complications included severe aortic compression (n = 1) requiring surgical explantation and tricuspid valve injury requiring surgical intervention (n = 2). CONCLUSIONS: This limited multi-institutional experience demonstrates that the SAPIEN valve can be used for TPVR without the use of a pre-stent without medium-term risk of frame fracture, paravalvar leak, or embolization. Longer term follow-up is required to fully assess this method.


Asunto(s)
Cateterismo Cardíaco/instrumentación , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Válvula Pulmonar/cirugía , Stents , Obstrucción del Flujo Ventricular Externo/cirugía , Adolescente , Adulto , Anciano , Cateterismo Cardíaco/efectos adversos , Niño , Preescolar , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/fisiopatología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/fisiopatología , Recuperación de la Función , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/fisiopatología , Adulto Joven
11.
Pediatr Cardiol ; 38(6): 1162-1168, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28534239

RESUMEN

Candidates for the subcutaneous implantable cardioverter-defibrillator (S-ICD) are screened using an electrocardiogram (S-ECG) tool to measure appropriate detection. We sought to define the S-ICD candidacy of congenital heart disease patients using the S-ECG tool. We also analyzed the reliability of the (S-ECG) tool between measurers in this population. Patients above the age of 12 and with a diagnosis associated with either a higher incidence of cardiac arrest or vascular access challenges were asked to undergo screening. S-ECGs were then analyzed by a pediatric electrophysiologist, an S-ICD device engineer, and an S-ICD clinical representative for candidacy. Results were compared for interobserver variability and S-ECGs were analyzed by t test to determine variables that differ among passing and failing leads. Thirty-one patients underwent screening. Two of the 31 (6.5%) patients failed S-ICD screening. Analysis of the screening leads demonstrated the highest passing rates using lead III at a 5 mm/mV amplitude setting with 71 and 62% pass rate in the supine and standing positions, respectively. Interobserver analysis correlated well among the three measurers. There was a higher amplitude difference between QRS and T waves among passing versus failing S-ECG. Congenital heart disease patients have acceptable passage rates utilizing the S-ECG algorithm. Interobserver measurements were well correlated and these data suggest that the proximal coil to device (lead III) vector would be best utilized in this patient population. A larger difference between QRS and T wave amplitudes was associated with a higher S-ECG passing rate.


Asunto(s)
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Electrocardiografía , Cardiopatías Congénitas/complicaciones , Adulto , Arritmias Cardíacas/etiología , Muerte Súbita Cardíaca/etiología , Cardioversión Eléctrica , Femenino , Humanos , Masculino , Tamizaje Masivo , Selección de Paciente , Reproducibilidad de los Resultados , Factores de Riesgo , Adulto Joven
13.
Pediatr Cardiol ; 37(1): 30-6, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26187516

RESUMEN

We previously noted, in a small group of post-Fontan patients, a possible association between hepatic fibrosis scores and the status of pulmonary blood flow at birth. To further explore this observation, we examined data from all Fontan patients seen in our center from July 2010 to March 2015. We identified 200 patients for analysis. Of the 200 patients, 56 underwent transvenous-hepatic biopsy. Of the 200 patients, 13 (6.5%) had protein-losing enteropathy. We divided both the 56 biopsy patients and the entire cohort of 200 patients into 4 groups: (1) unobstructed pulmonary blood flow at birth with functional left ventricles, (2) unobstructed pulmonary blood flow at birth with functional right ventricles, (3) obstructed pulmonary blood flow at birth with functional left ventricles, and (4) obstructed pulmonary blood flow at birth with functional right ventricles. Analysis of the 56 liver-biopsy patient groups showed median hepatic total-fibrosis scores for the 4 groups of 2 (0-6), 2 (0-8), 3 (2-6), and 4 (1-8), respectively, with statistical significance between groups 4 and 1 (p = 0.031). For the entire cohort of 200 patients, we analyzed the incidence of protein-losing enteropathy for each of the four groups and found protein-losing enteropathy percent occurrences of 0, 2.9, 8.8, and 16.1, respectively, with statistical significance between groups 4 and 2 (p = 0.031) and between groups 4 and 1 (p = 0.025). A history of obstructed pulmonary blood flow at birth, coupled with a functional right ventricle, may predict a poorer long-term Fontan outcome.


Asunto(s)
Procedimiento de Fontan , Cirrosis Hepática/etiología , Hígado/patología , Complicaciones Posoperatorias , Enteropatías Perdedoras de Proteínas/etiología , Arteria Pulmonar/fisiopatología , Circulación Pulmonar/fisiología , Adolescente , Adulto , Niño , Preescolar , Femenino , Hemodinámica , Humanos , Masculino , Estudios Retrospectivos , Adulto Joven
14.
Pediatr Cardiol ; 37(6): 1119-22, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27160101

RESUMEN

This brief report describes an observation from liver biopsy results in nonfailing Fontan patients, currently in their second postoperative decade. In three patients, with either atriopulmonary or atrioventricular connections and functional left ventricles, we found no portal fibrosis. In contrast, we found portal fibrosis in three clinically similar, nonfailing Fontan patients with lateral tunnel connections and functional left ventricles. We recognize the results may be secondary to chance; nevertheless, we speculate about possible relevancy.


Asunto(s)
Hígado , Biopsia , Procedimiento de Fontan , Cardiopatías Congénitas , Ventrículos Cardíacos , Humanos , Periodo Posoperatorio
15.
Pediatr Cardiol ; 37(7): 1274-7, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27300556

RESUMEN

We tested the hypothesis that MELD-XI values correlated with hepatic total fibrosis scores obtained in 70 predominately stable, post-Fontan patients that underwent elective cardiac catheterization. We found a statistically significant correlation between MELD-XI values and total fibrosis scores (p = 0.003). Thus, serial MELD-XI values may be an additional useful clinical parameter for follow-up care in post-Fontan patients.


Asunto(s)
Cirrosis Hepática , Biopsia , Cateterismo Cardíaco , Fibrosis , Humanos
16.
Pediatr Cardiol ; 37(5): 868-77, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26932364

RESUMEN

We reviewed our hybrid palliation experience for 91 neonates, with ductal-dependent systemic circulation, born between August 2007 and October 2015. For analysis, we stratified the 91 patients by a risk factor (RF) score and divided them into three groups: (1) high-risk two-functional ventricles (2V) median RF score of 3 (N = 20); (2) low-risk one-functional ventricle (1V) RF score 0-1 (N = 32); and (3) high-risk 1V RF score ≥2 (N = 39). Midterm survival (median 4 years) by group was: (1) 95 %, (2) 91 %, and (3) 15 %, (p = 0.001). In conclusion, hybrid palliation was associated with excellent midterm results for high-risk 2V and low-risk 1V patients with ductal-dependent systemic circulation. In contrast, high-risk 1V patients had significantly worse outcomes.


Asunto(s)
Cuidados Paliativos , Circulación Sanguínea , Ventrículos Cardíacos , Humanos , Síndrome del Corazón Izquierdo Hipoplásico , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
18.
Echocardiography ; 32(7): 1073-9, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25363190

RESUMEN

OBJECTIVES: The aim of this study was to determine and quantify the relationship between Doppler echocardiography and cardiac catheterization measurements of the peak right ventricle-pulmonary artery (RV-PA) pressure gradient in patients within 24 hours of Melody valve implantation for treatment of a dysfunctional RV outflow tract (RVOT) conduit or bioprosthetic valve (BPV). BACKGROUND: Patients with a dysfunctional RVOT conduit or BPV are now routinely treated percutaneously with implantation of a Melody valve. However, often the postimplantation catheter measurements of the RV-PA peak gradient do not match the postimplant echo-derived gradients obtained after completion of the procedure. Importantly, these echo gradients are commonly used to monitor patients after implantation over time. METHODS: Medical records of 42 patients with Melody valve implantation were reviewed (men: 25/42; mean age: 22.4 ± 11.2 years; RVOT conduit: 23/42; BPV: 18/42; pulmonic stenosis: 6/42, pulmonic regurgitation: 3/42, both: 33/42). RESULTS: The postimplantation RV-PA peak gradient measured by Doppler echocardiography (within 24 hours of valve implantation) was significantly higher than the measurements acquired by catheterization immediately following implantation (24.2 ± 16.3 mmHg vs. 11.6 ± 8.5 mmHg, P < 0.0001). The relationship showed a moderate-strong correlation (r = 0.65, P < 0.0001) with regression analysis suggesting a linear association in both directions (echo gradient = 1.24 × cath gradient + 9.8, P<0.0001 vs. cath gradient = 0.34 × echo gradient + 3.4, P<0.0001). CONCLUSION: The Doppler echocardiography-derived RV-PA peak gradient within 24 hours of valve implantation is predictably higher than the catheter measured peak gradient immediately following valve implantation. A regression equation was derived to define this important relationship.


Asunto(s)
Cateterismo Cardíaco , Ecocardiografía Doppler , Implantación de Prótesis de Válvulas Cardíacas , Ventrículos Cardíacos/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Disfunción Ventricular Derecha/cirugía , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento , Disfunción Ventricular Derecha/diagnóstico por imagen , Adulto Joven
19.
Pediatr Cardiol ; 36(3): 657-61, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25381625

RESUMEN

Fontan patients are at risk for hepatic fibrosis; however, risk factors are unclear. We performed a multivariate analysis in a small cohort of 14 patients (7-24 years old, mean 15) with Fontan circulation, undergoing cardiac catheterization and transvenous liver biopsies, all demonstrating fibrosis. We found by stepwise regression analysis that the history of pulmonary atresia was a predictor of higher total hepatic fibrosis scores than a history of unobstructed pulmonary blood flow (p = 0.002). Other variables including age, time from Fontan, hemodynamic measurements, and laboratory values were not predictive of total fibrosis scores at p values <0.05. Hepatic fibrosis scores between those born with pulmonary atresia versus unrestricted pulmonary blood flow may reflect differences in pulmonary circulatory physiology, resulting from differences in pulmonary vascular development.


Asunto(s)
Procedimiento de Fontan/efectos adversos , Hemodinámica , Cirrosis Hepática/etiología , Atresia Pulmonar/complicaciones , Circulación Pulmonar , Adolescente , Factores de Edad , Niño , Femenino , Humanos , Cirrosis Hepática/epidemiología , Cirrosis Hepática/fisiopatología , Masculino , Factores de Riesgo , Adulto Joven
20.
Pediatr Cardiol ; 36(2): 281-8, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25103855

RESUMEN

This study compares the current, prenatal detection rate for critical congenital heart disease in Southern Nevada with the previously reported rate, after developing and expanding a comprehensive, community-wide fetal cardiology program. For the current-period analysis, we inquired our database and electronic health records for patients born in Clark County, Nevada, with critical congenital heart disease between May 2012 and April 2014, and we compared the results with the previous period between May 2003 and April 2006. The major components of the community-wide program include fetal congenital heart disease screening via general obstetric ultrasound studies performed in obstetrician's offices, radiology imaging centers, or maternal-fetal medicine specialty practices; subsequent referral for comprehensive fetal echocardiography performed in maternal-fetal medicine offices under the on-site supervision by fetal cardiologists; and recurring community educational programs teaching the 5-axial plane, fetal echocardiographic screening protocol to general obstetric sonographers and instructing perinatal sonographers in advanced imaging topics. For the current period, the prenatal detection rate for critical congenital heart disease in Southern Nevada was 71 versus 36% for the previous period (p < 0.001). The temporal improvement in prenatal detection of critical congenital heart disease may be related to our expanded decentralized, community-wide fetal cardiology program, and our experiences may be applicable to other metropolitan areas.


Asunto(s)
Enfermedades Fetales/diagnóstico , Cardiopatías Congénitas/diagnóstico , Diagnóstico Prenatal/estadística & datos numéricos , Adulto , Coartación Aórtica/diagnóstico , Servicios de Salud Comunitaria , Ecocardiografía/estadística & datos numéricos , Enfermedades Fetales/diagnóstico por imagen , Cardiopatías Congénitas/diagnóstico por imagen , Ventrículos Cardíacos/anomalías , Humanos , Tamizaje Masivo/organización & administración , Tamizaje Masivo/estadística & datos numéricos , Nevada , Tetralogía de Fallot/diagnóstico , Transposición de los Grandes Vasos/diagnóstico , Ultrasonografía Prenatal/estadística & datos numéricos
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