Prevalence and surgical approach of supravalvular pulmonary stenosis after Jatene operation for transposition of great arteries.

BACKGROUND: The Transposition of the Great Arteries is the most frequent congenital cyanogenic cardiopathy in the neonatal period, corresponding to 7% of all congenital cardiopathies. Among the operations for surgical treatment, the Jatene operation, with arterial correction, is the treatment of choice. During the late postoperative evolution, some problems were observed, with the most common being the occurrence of supravalvular stenosis at the neopulmonary, regardless of the type of surgical technique used. OBJECTIVE: To study and analyze the prevalence of stenosis, as well as describe the surgical treatment and propose technical maneuvers to prevent its onset. METHODS: Of the 553 patients that underwent surgery, 409 were discharged from the hospital and 281 had late follow-up; 59 (20.9%) presented different degrees of supravalvular pulmonary stenosis and 21 had a mean gradient > 60 mmHg, needing surgical treatment. Depending on the location and anatomy of the stenosis, the surgical treatment consisted of the use of different techniques, such as the enlargement of stenosis areas with bovine pericardium patches, resection of stenotic areas and termino-terminal anastomosis, replacement of retracted patches and synthetic tubes. RESULTS: Twenty patients presented good evolution and only one patient died. CONCLUSION: It can be concluded that the supravalvular pulmonary stenosis, post-Jatene operation for Transposition of Great Arteries, had a prevalence of 20.9%; once identified and with indication for treatment, it can be treated surgically with low mortality levels, through different surgical techniques; to prevent the occurrence of stenosis, ample dissection and release of the pulmonary branches, double anastomoses, large patches of autologous pericardium and careful reconstruction of the aorta are proposed, which prevents the compression of the neopulmonary.

Prevalência e abordagem cirúrgica da estenose supravalvar pulmonar pós-operação de jatene para transposição das grandes artérias / Prevalence and surgical approach of supravalvular pulmonary stenosis after jatene operation for transposition of great arteries

FUNDAMENTO: A transposição das grandes artérias é a cardiopatia congênita cianogênica mais freqüente no período neonatal, correspondendo a 7 por cento de todas as cardiopatias congênitas. Dentre as operações para tratamento cirúrgico, a operação de Jatene, com correção arterial, é o tratamento escolhido. Durante a evolução pós-operatória tardia, alguns problemas foram observados, sendo o mais comum a ocorrência de estenose supravalvar na neopulmonar, independentemente do tipo da técnica cirúrgica utilizada. OBJETIVO: Estudar e analisar a prevalência da estenose, bem como descrever o tratamento cirúrgico e propor manobras técnicas para prevenir seu aparecimento. MÉTODOS: Dentre 553 pacientes operados, 409 tiveram alta hospitalar e 281 seguidos tardiamente; 59 (20,9 por cento) apresentaram diferentes graus de estenose supravalvar pulmonar e 21 gradiente médio superior a 60 mmHg, necessitando tratamento cirúrgico. Dependendo da localização e da anatomia da estenose, o tratamento cirúrgico constou de aplicação de diferentes técnicas, como ampliação das áreas de estenose com remendos de pericárdio bovino, ressecção de áreas estenóticas e anastomose término-terminal, substituição de remendos retraídos e de tubos sintéticos. RESULTADOS: Houve boa evolução em 20 pacientes, com óbito em um dos casos. CONCLUSÃO: Conclui-se que a estenose supravalvar pulmonar pós-operação de Jatene para transposição das grandes artérias teve prevalência de 20,9 por cento. Uma vez identificada e com indicação de tratamento, pode ser tratada cirurgicamente com baixa mortalidade, mediante diferentes técnicas cirúrgicas. Para prevenir a ocorrência de estenose, propõem-se ampla dissecção e liberação dos ramos pulmonares, anastomoses amplas, remendos amplos de pericárdio autólogo e cuidado na reconstrução da neoaorta, evitando compressão da neopulmonar.

BACKGROUND: The Transposition of the Great Arteries is the most frequent congenital cyanogenic cardiopathy in the neonatal period, corresponding to 7 percent of all congenital cardiopathies. Among the operations for surgical treatment, the Jatene operation, with arterial correction, is the treatment of choice. During the late postoperative evolution, some problems were observed, with the most common being the occurrence of supravalvular stenosis at the neopulmonary, regardless of the type of surgical technique used. OBJECTIVE: To study and analyze the prevalence of stenosis, as well as describe the surgical treatment and propose technical maneuvers to prevent its onset. METHODS: Of the 553 patients that underwent surgery, 409 were discharged from the hospital and 281 had late follow-up; 59 (20.9 percent) presented different degrees of supravalvular pulmonary stenosis and 21 had a mean gradient > 60 mmHg, needing surgical treatment. Depending on the location and anatomy of the stenosis, the surgical treatment consisted of the use of different techniques, such as the enlargement of stenosis areas with bovine pericardium patches, resection of stenotic areas and termino-terminal anastomosis, replacement of retracted patches and synthetic tubes. RESULTS: Twenty patients presented good evolution and only one patient died. CONCLUSION: It can be concluded that the supravalvular pulmonary stenosis, post-Jatene operation for Transposition of Great Arteries, had a prevalence of 20.9 percent; once identified and with indication for treatment, it can be treated surgically with low mortality levels, through different surgical techniques; to prevent the occurrence of stenosis, ample dissection and release of the pulmonary branches, double anastomoses, large patches of autologous pericardium and careful reconstruction of the aorta are proposed, which prevents the compression of the neopulmonary.

Thickening of the pulmonary artery wall in acute intramural hematoma of the ascending aorta.

BACKGROUND: The occurrence of pulmonary artery obstruction in the course of acute aortic dissection is an unusual complication. The mechanism implicated is the rupture of the outer layer of the aorta and the subsequent hemorrhage into the adventitia of the pulmonary artery that causes its wall thickening and, at times, produces extrinsic obstruction of the vessel. There are no reports of this complication in acute intramural hematoma. CASE PRESENTATION: An 87-year-old woman was admitted to the hospital in shock after having had severe chest pain followed by syncope. An urgent transesophageal echocardiogram revealed the presence of acute intramural hematoma, no evidence of aortic dissection, severe pericardial effusion with cardiac tamponade, and periaortic hematoma that involved the pulmonary artery generating circumferential wall thickening of its trunk and right branch with no evidence of flow obstruction. Urgent surgery was performed but the patient died in the operating room. The post mortem examination, in the operating room, confirmed that there was an extensive hematoma around the aorta and beneath the adventitial layer of the pulmonary artery, with no evidence of flow obstruction. CONCLUSION: This is the first time that this rare complication is reported in the scenario of acute intramural hematoma and with the transesophageal echocardiogram as the diagnostic tool.

La estenosis pulmonar valvular en lactantes menores de 4 meses: la experiencia del Hospital Nacional de Niños de San José, Costa Rica / Pulmonary valve stenosis in infants minor of four months: the experience of the Hospital Nacional de Niños of San Jose, Costa Rica

La estenosis pulmonar valvular crítica en lactantes es una emergencia. El objetivo de este estudio es conocer nuestra casuística en dos centros ( Costa Rica y Guatemala). Método: se revisaron los expedientes de 24 lactantes menores de 4 meses, 12 de ellos menores de un mes, que se presentaron con estenosis pulmonar valvular crítica y que fueron sometidos a valvuloplastía. La edad varió de un ...

Síndrome de Alagille: presentación de un caso y revisión del tema / Alagille syndrome: case report and review

Se presenta un caso de síndrome de Alagille o de escasez de conductos biliares interlobulares; se realiza la descripción de la clínica e histología de nuestro paciente, así como una revisión de esta patología, destacando el interés del tema debido a la escasa frecuencia de observación

Síndrome de Alagille: presentación de un caso y revisión del tema / Alagille syndrome: case report and review

Se presenta un caso de síndrome de Alagille o de escasez de conductos biliares interlobulares; se realiza la descripción de la clínica e histología de nuestro paciente, así como una revisión de esta patología, destacando el interés del tema debido a la escasa frecuencia de observación (AU)

Sindrome de Noonan / Noonan's syndrome

A sindrome de Noonan foi descrita em 1963 por Noonan e Ehmke em pacientes portadores de estenose valvular pulmonar associado a baixa estatura, hipertelorismo, retardo mental moderado entre outras alteracöes. O diagnostico é clínico, baseado no achado dos caracteres fenotipos associado a ausência de alteracöes no cariotipo. A transmissäo parece ser do tipo auto-somica dominante. Também denominada de fenotipo de Turner, sindrome de Ullrich, sindrome de Ullrich-Noonan, sindrome de Bonnevie-Ullrich entre outros

[Right ventricular rhabdomyoma causing pulmonary stenosis]. / Rabdomioma do ventrículo direito causando estenose pulmonar.

The authors report a case of rhabdomyoma of the right ventricular cavity with outlet obstruction in a three-months old infant. The diagnosis was established by echocardiography. Bidimensional echocardiography study showed a polypoid tumor of the right ventricle. During the systole it was projected through the pulmonary valve, obstructing part of it. The Doppler study showed an important gradient between the right ventricle and the pulmonary artery. The resection was performed with success. The diagnosis of cardiac rhabdomyoma was made by microscopic study. It is emphasized the importance of the echocardiographic study in an infant with oligosymptomatic cardiac murmurs.

[Transluminal angioplasty of aortopulmonary anastomosis by the Jatene surgical technique. Report of 2 cases]. / Angioplastia transluminal da anastomose aorto-pulmonar da cirurgia de Jatene. Aplicação em dois casos.

Two patients with transposition of the great arteries submitted to Jatene surgery at ages of 6 days and 6 months respectively, presented in the postoperative period stenosis of the aorto-pulmonary anastomosis. The diagnosis was made three and six years after the surgery. In both patients successful percutaneous transluminal angioplasty (PTA) was performed, respectively six months and immediately after the diagnosis. Pressure gradients decreased from 83 mmHg to 24 mmHg in the first case, and from 76 mmHg to 13 mmHg in the other case, with clear improvement of the angiographic image. Complications of the procedure did not occur in any case. This application for PTA was not previously reported and should be considered as an alternative to the surgical correction of the "new" pulmonary trunk stenosis in the Jatene surgery.