ABSTRACT
PURPOSE: The aim of the study was to analyze the surgical outcome of patients with total anomalous pulmonary venous connection (TAPVC) who underwent cardiac surgery. METHODS: A retrospective study was carried out. Patients with diagnosis of TAPVC undergoing cardiac surgery at the National Institute of Cardiology Ignacio Chávez, from January 1, 2003 and June 30, 2019 were included. Descriptive statistics were calculated, as well as a bivariate analysis of the variables associated with mortality. A logistic regression model was included to determine risk factors associated with the main outcome and survival was analyzed using the Kaplan-Meier method. RESULTS: A total of 5314 patients diagnosed with congenital heart disease (CHD) underwent surgery, 414 (7.8%) were patients with TAPVC, with an average age of 17.1 ± 34.6 months, 58.2% were male. It was frequent in infants (61.6%) and preschool (19.6%). Predominant type was supracardiac TAPVC (47.4%). Pulmonary venous obstruction (PVO) occurred in 32.1%. Risk factors associated with mortality were infracardiac TAPVC (odds ratio [OR]: 3.26; 95% confidence interval [CI]: 1.17-9.03; p = .02), PVO (OR: 2.56; 95% CI: 1.05-6.22; p = .03) and postoperative mechanical ventilation (OR: 1.005; 95% CI: 1.002-1.008; p = .01). Overall survival was 87.2%, with better outcomes in adolescents (100%), children (94.1%), mixed TAPVC (96%), and cardiac TAPVC (91.9%; p < .001). CONCLUSIONS: The survival of our institution after surgical correction of TAPVC is similar to that of other referral centers, where patients with infracardiac TAPVC and newborns worse outcomes. All patients must undergo a rigorous evaluation to determine an adequate repair strategy.
Subject(s)
Cardiac Surgical Procedures , Pulmonary Veins , Pulmonary Veno-Occlusive Disease , Scimitar Syndrome , Adolescent , Cardiac Surgical Procedures/adverse effects , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Pulmonary Veins/abnormalities , Pulmonary Veins/surgery , Pulmonary Veno-Occlusive Disease/diagnosis , Pulmonary Veno-Occlusive Disease/etiology , Pulmonary Veno-Occlusive Disease/surgery , Retrospective Studies , Scimitar Syndrome/complications , Treatment OutcomeABSTRACT
Thoracic aneurysms can potentially cause substantial compression of adjacent structures, creating substantial symptoms. We present a case of a 56-year-old woman with fatigue and dyspnea for 6 months. We discuss her initial endovascular treatment, which was insufficient to improve symptoms, and further surgical intervention was needed to solve the issue.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Endovascular Procedures/instrumentation , Heart Diseases/surgery , Pulmonary Veno-Occlusive Disease/surgery , Stents , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortography/methods , Computed Tomography Angiography , Dyspnea/etiology , Fatigue/etiology , Female , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Humans , Middle Aged , Prosthesis Design , Pulmonary Veno-Occlusive Disease/diagnostic imaging , Pulmonary Veno-Occlusive Disease/etiology , Recovery of Function , Reoperation , Treatment OutcomeABSTRACT
Paciente de 13 anos de idade, sexo masculino, submetido à correção de estenose de túnel das veias pulmonares (ETVP) após cirurgia de Senning modificada realizada aos 5 meses. O quadro clínico era de congestão pulmonar e broncopneumonias de repetição e o ecocardiograma confirmou ETVP. Uma angioplastia com balão foi realizada previamente à correção cirúrgica com circulação extracorpórea. A placa de pericárdio bovino empregada para ampliação do átrio direito retraiu-se e calcificou, levando a ETVP. A placa foi removida e o átrio direito foi ampliado com um retalho de politetrafluoretileno. O ecocardiograma transesofágico intraoperatório demonstrou redução significativa da estenose.
A 13-year-old male was admitted to undergoing correction of a pulmonary venous baffle stenosis (PVBS) after a modified Senning procedure was performed by the age of five months. Recurrent Pulmonary congestion and pneumonia episodes were followed by echocardiography and cardiac catheterization that confirmed PVBS. Previous catheter balloon angioplasty was attempted, and a surgical revision was done under cardiopulmonary bypass. The bovine pericardial patch used for augmentation of the right atrium, retracted and calcified producing PVBS. Stenotic area was excised and enlargement was done with polytetrafluoroethylene membrane. Intraoperative transesophageal echocardiogram showed relief of stenosis.
Subject(s)
Humans , Animals , Male , Cattle , Cardiac Surgical Procedures/adverse effects , Heart Atria/surgery , Prostheses and Implants/adverse effects , Pulmonary Veno-Occlusive Disease/surgery , Vascular Surgical Procedures/methods , Membranes, Artificial , Pericardium/transplantation , Polytetrafluoroethylene , Pulmonary Veno-Occlusive Disease/etiologyABSTRACT
FUNDAMENTO: A drenagem anômala total das veias pulmonares (DATVP) é uma doença rara, com incidência aproximada de 0,058 a 0,083:1.000 nascidos vivos. Apresenta mortalidade em torno de 80 por cento a 90 por cento no primeiro ano de vida, se não tratada precocemente. OBJETIVO: Utilizando a experiência de 29 anos de um único serviço, foram testadas possíveis variáveis relacionadas ao óbito hospitalar. MÉTODOS: Análise retrospectiva de 123 pacientes consecutivos operados com o diagnóstico de DATVP entre janeiro de 1979 e março de 2008. Foram incluídos apenas pacientes com DATVP isolada, excluídas as associações complexas. As variáveis foram testadas para a identificação da influência sobre os óbitos e da interferência da evolução temporal. RESULTADOS: As medianas de peso e idade foram de 4,1 kg e 120 dias, respectivamente. O subtipo anatômico supracardíaco foi o mais prevalente em todo o período analisado. Obstrução à drenagem esteve presente em 30 por cento dos casos, sendo o subtipo infracardíaco o mais associado. A taxa de mortalidade geral foi de 27 por cento, chegando a zero nos últimos cinco anos. Tanto na análise univariada quanto na multivariada, a presença de obstrução ao fluxo venoso pulmonar foi a única variável positivamente associada aos óbitos (p=0,005), independentemente da evolução temporal. A mortalidade dentre estes casos foi de 44 por cento. CONCLUSÃO: Após três décadas de evolução, pode-se observar melhora na mortalidade precoce da drenagem anômala total das veias pulmonares em nosso serviço, que atualmente apresenta níveis consistentes com a literatura. A obstrução à drenagem pulmonar continua sendo fator de mau prognóstico em nosso meio.
BACKGROUND: Total anomalous pulmonary venous drainage (TAPVD) is a rare disease, with an approximate incidence of 0.058 to 0.083:1,000 live births. It has a mortality rate of around 80 percent to 90 percent in the first year, if not treated early. OBJECTIVE: Using the 29-year experience of a single center, possible variables related to hospital death were tested. METHODS: Retrospective analysis of 123 consecutive patients with a diagnosis of TAPVD that underwent surgical treatment between January 1979 and March 2008. Only patients with isolated TAPVD were included and the complex associations were excluded. The variables were tested for the identification of their influence on death and of the interference of temporal evolution. RESULTS: The medians of weight and age were 4.1 kg and 120 days, respectively. The supracardiac anatomic subtype was the most prevalent throughout the analyzed period. Obstruction to drainage was present in 30 percent of the cases and the infracardiac subtype was the most frequently associated form. The general mortality rate was 27 percent, being equal to zero in the last five years. At both the univariate and multivariate analysis, the presence of obstruction to pulmonary venous flow was the only variable positively associated to the deaths (p = 0,005), regardless of the temporal evolution. The mortality among these cases was 44 percent. CONCLUSION: After three decades of evolution, an improvement in the early mortality rate of TAPVD can be observed in our service, which currently presents levels consistent with the literature. The obstruction to pulmonary drainage is still a bad prognostic factor in our country.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Pulmonary Veins/abnormalities , Pulmonary Veno-Occlusive Disease/mortality , Epidemiologic Methods , Hospital Mortality/trends , Postoperative Complications/mortality , Pulmonary Veins/surgery , Pulmonary Veno-Occlusive Disease/surgeryABSTRACT
BACKGROUND: Total anomalous pulmonary venous drainage (TAPVD) is a rare disease, with an approximate incidence of 0.058 to 0.083:1,000 live births. It has a mortality rate of around 80% to 90% in the first year, if not treated early. OBJECTIVE: Using the 29-year experience of a single center, possible variables related to hospital death were tested. METHODS: Retrospective analysis of 123 consecutive patients with a diagnosis of TAPVD that underwent surgical treatment between January 1979 and March 2008. Only patients with isolated TAPVD were included and the complex associations were excluded. The variables were tested for the identification of their influence on death and of the interference of temporal evolution. RESULTS: The medians of weight and age were 4.1 kg and 120 days, respectively. The supracardiac anatomic subtype was the most prevalent throughout the analyzed period. Obstruction to drainage was present in 30% of the cases and the infracardiac subtype was the most frequently associated form. The general mortality rate was 27%, being equal to zero in the last five years. At both the univariate and multivariate analysis, the presence of obstruction to pulmonary venous flow was the only variable positively associated to the deaths (p = 0,005), regardless of the temporal evolution. The mortality among these cases was 44%. CONCLUSION: After three decades of evolution, an improvement in the early mortality rate of TAPVD can be observed in our service, which currently presents levels consistent with the literature. The obstruction to pulmonary drainage is still a bad prognostic factor in our country.
Subject(s)
Pulmonary Veins/abnormalities , Pulmonary Veno-Occlusive Disease/mortality , Child , Child, Preschool , Epidemiologic Methods , Female , Hospital Mortality/trends , Humans , Infant , Infant, Newborn , Male , Postoperative Complications/mortality , Pulmonary Veins/surgery , Pulmonary Veno-Occlusive Disease/surgeryABSTRACT
A 13-year-old male was admitted to undergoing correction of a pulmonary venous baffle stenosis (PVBS) after a modified Senning procedure was performed by the age of five months. Recurrent Pulmonary congestion and pneumonia episodes were followed by echocardiography and cardiac catheterization that confirmed PVBS. Previous catheter balloon angioplasty was attempted, and a surgical revision was done under cardiopulmonary bypass. The bovine pericardial patch used for augmentation of the right atrium, retracted and calcified producing PVBS. Stenotic area was excised and enlargement was done with polytetrafluoroethylene membrane. Intraoperative transesophageal echocardiogram showed relief of stenosis.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Heart Atria/surgery , Prostheses and Implants/adverse effects , Pulmonary Veno-Occlusive Disease/surgery , Vascular Surgical Procedures/methods , Animals , Cattle , Humans , Male , Membranes, Artificial , Pericardium/transplantation , Polytetrafluoroethylene , Pulmonary Veno-Occlusive Disease/etiologyABSTRACT
Se analizan los resultados obtenidos entre octubre de 1986 y septiembre de 1992, en relación con el diagnóstico y tratamiento de de 49 niños operados por presentar drenaje anómalo total de venas pulmonares (DATVP). Elpromedio de edad fue de 6 meses. Hubo 23 casos del tipo supracardíco (46,9
), 17del cardíaco (34,7
), 5 mixtos (10,2
) y 4 infracardíacos (8,2
). La mayor edad mediana al operarse fue la del tipo cardíaco (8 meses) y la menor edad la del infracardíaco (o meses) (p<0,01), al igual que la saturación capilar preoperatoria(p<0,0001) y el índice cardiotorácico del telecardiograma (p<0,001) respectivamente. Por el contrario. la presión arterial pulmonar que estuvo moderadamente elevada (49/18 [30] mmHg), fue mayor en el tipo infracardíaco que en los otros 3 tipos (p<0,05) donde el promedio era similar en ellos. Hubo 12 fallecidos para una mortalidad hospitalaria de 24,4
ésta fue mayor en el tipo infracardíaco (100
), seguido del mixto (60
), el supracardíaco (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pulmonary Veno-Occlusive Disease/surgery , Pulmonary Veno-Occlusive Disease/diagnosisABSTRACT
Se analizan los resultados obtenidos entre octubre de 1986 y septiembre de 1992, en relación con el diagnóstico y tratamiento de de 49 niños operados por presentar drenaje anómalo total de venas pulmonares (DATVP). Elpromedio de edad fue de 6 meses. Hubo 23 casos del tipo supracardíco (46,9 por ciento ), 17del cardíaco (34,7 por ciento ), 5 mixtos (10,2 por ciento ) y 4 infracardíacos (8,2 por ciento ). La mayor edad mediana al operarse fue la del tipo cardíaco (8 meses) y la menor edad la del infracardíaco (o meses) (p<0,01), al igual que la saturación capilar preoperatoria(p<0,0001) y el índice cardiotorácico del telecardiograma (p<0,001) respectivamente. Por el contrario. la presión arterial pulmonar que estuvo moderadamente elevada (49/18 [30] mmHg), fue mayor en el tipo infracardíaco que en los otros 3 tipos (p<0,05) donde el promedio era similar en ellos. Hubo 12 fallecidos para una mortalidad hospitalaria de 24,4 por ciento ésta fue mayor en el tipo infracardíaco (100 por ciento ), seguido del mixto (60 por ciento ), el supracardíaco