RESUMEN
OBJECTIVES: To elucidate the feasibility and treatment effects of transcatheter occlusion of the azygos/hemiazygos vein in patients with progressive cyanosis after performing the bidirectional Glenn procedure. METHODS: From January 2007 to May 2011, transcatheter closure was performed on 9 patients (7 males and 2 females) aged 5-15 years (median 9 years). RESULTS: A total of 7 azygos veins and 3 hemiazygos veins were occluded successfully. Coils were employed in 4 of the procedures, patent ductus arteriosus (PDA) occluders in 3, atrial septal defect occluders in 2 and a PDA occluder together with coils in 1 procedure. Immediate complete occlusions were achieved in 9 (81.8%) procedures and trivial residual shunt in 2 (18.2%). The femoral artery oxygen saturation (SaO2) rose from 81 [interquartile range (IQR) 75-86%] to 88% (IQR 84-91%). CONCLUSIONS: Patients with superior vena cava azygos vein collateral channels can be treated successfully by transcatheter occlusion with multiple devices. The device for embolization depends on the extent of the severity of the shunt, the size of the lumen of the azygos vein/hemiazygos vein and the candidate location for occlusion.
Asunto(s)
Vena Ácigos/cirugía , Cateterismo Cardíaco/métodos , Embolización Terapéutica/métodos , Procedimiento de Fontan/efectos adversos , Cardiopatías Congénitas/cirugía , Adolescente , Cateterismo Cardíaco/instrumentación , Niño , Preescolar , Circulación Colateral/fisiología , Conducto Arterioso Permeable/cirugía , Embolización Terapéutica/instrumentación , Estudios de Factibilidad , Femenino , Procedimiento de Fontan/métodos , Defectos del Tabique Interatrial/cirugía , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Dispositivo Oclusor Septal , Vena Cava Superior/cirugíaRESUMEN
OBJECTIVES: To evaluate the efficacy and safety of the new device Amplatzer Duct Occluder II (ADO II) for the closure of coronary artery fistulae (CAF) with coronary anomaly. BACKGROUND: Transcatheter device closure is an alternative treatment for selective patients with CAF. The currently available reports regarding the closure of CAF with the ADO II are limited. METHODS: From April 1, 2011 to July 15, 2012, 5 patients (3 males and 2 females) aged from 3 years to 27 years old (median age 5 years old) underwent CAF closure with the ADO II. The immediate and short-term outcomes were evaluated. RESULTS: ADO II was deployed via the femoral vein (2 cases), femoral artery (1 case), brachial artery (1 case), and radial artery (1 case). There were no complications during all the procedures. The median fluoroscopy and procedural times were 20 and 39 minutes, respectively. Immediate trivial and mild residual shunt was present in one patient, respectively, but disappeared 24 hours after the procedure, and there was no recanalization at a median follow-up of 6 months. CONCLUSIONS: The new device ADO II was safely deployed with complete resolution of CAF shunt with tortuous coronary artery to the drainage. The reduced sheath sizes and softer shape of this device allow for venous or arterial approach. The ADO II might be a preferable alternative device for closure of small-tortuous CAFs.
Asunto(s)
Anomalías de los Vasos Coronarios/terapia , Dispositivo Oclusor Septal , Fístula Vascular/terapia , Adulto , Cateterismo Cardíaco , Preescolar , Angiografía Coronaria , Femenino , Hemodinámica , Humanos , Masculino , Diseño de Prótesis , Implantación de Prótesis , Resultado del TratamientoRESUMEN
BACKGROUND: Our preliminary study suggested that patients with chronic myocardial infarction (MI) and heart failure could potentially benefit from CABG combined with aBM-MNC by improving global left ventricular (LV) function. The purpose of this sub-study was to quantitatively evaluate the effectiveness of aBM-MNC transplantation during CABG in patients with chronic MI by intensively analyzing the global and segmental LV function, the scar, and the relationships between the function recovery and the scar transmural extent. METHODS: A randomized, double-blinded, placebo-controlled study was performed in 50 patients with chronic MI. The patients were randomly allocated into CABG with stem cell transplantation (group A) and CABG only (group B) groups. CMR assessments of global and segmental left ventricular function and scar tissue were performed before surgery and repeated at 12 months after CABG and aBM-MNC transplantation. RESULTS: The left ventricular ejection fraction (LVEF) improved by 13.5% and 8.0% in group A and B respectively (P=0.04). Segmental analysis of regional LV function recovery indicated that more improvement in contractility was found in group A within the same degree of the infarct transmurality (P=0.017) and showed a predominant interaction in the most severely affected segments (76-100%, P=0.016). Decrease in infarct size between the two groups did not reach statistical difference (9.4% vs. 6.0%, P=0.100). CONCLUSIONS: CMR assessments revealed reversed ventricular remodeling and improved systolic function and scar reduction in patients who underwent aBM-MNC transplantation during CABG. And the conjunctional use of CABG and stem cell therapy could improve the left ventricular function in patients with chronic MI.
Asunto(s)
Trasplante de Médula Ósea/métodos , Puente de Arteria Coronaria/métodos , Infarto del Miocardio/cirugía , Función Ventricular Izquierda/fisiología , Cicatriz/etiología , Cicatriz/prevención & control , Vasos Coronarios , Método Doble Ciego , Femenino , Humanos , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Proyectos Piloto , Volumen Sistólico , Trasplante Autólogo , Resultado del TratamientoRESUMEN
PURPOSE: To investigate the diagnostic value of T1 mapping imaging of evaluating fibrosis in patients with hypertrophic cardiomyopathy (HCM). MATERIALS AND METHODS: 21 subjects with HCM and 18 healthy volunteers underwent conventional late gadolinium enhancement (LGE) imaging and T1 mapping imaging. The region of myocardium in HCM is divided into remote area of LGE, peri-LGE, LGE (halo-like LGE and typical patchy LGE). These regions combined with normal volunteers' myocardium were calculated by the reduced percent of T1 value (RPTV). RESULTS: The RPTV in healthy volunteers was no significant comparing with that in the remote area of LGE in HCM subjects (3.98 ± 3.19 vs. 3.34 ± 2.75, P>0.05). There were significant statistical differences in pairwise among the remote area of LGE, peri-LGE, halo-like LGE and typical patchy LGE in the RPTV (P<0.0001). ROC curves indicated that the T1 mapping imaging has a greater area under the curve comparing with that of traditional LGE imaging (0.975 ± 0.07 vs. 0.753 ± 0.26, P<0.0001). CONCLUSIONS: HCM has a high prevalence of fibrosis and with varying severity. T1 mapping imaging can be a useful method to evaluate the severity of the fibrosis in HCM.
Asunto(s)
Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/patología , Fibrosis Endomiocárdica/etiología , Fibrosis Endomiocárdica/patología , Interpretación de Imagen Asistida por Computador/métodos , Femenino , Humanos , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Proyectos Piloto , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Stent grafting is a very important treatment for type B dissection. Some patients are unsuitable for endograft repair because of inadequate proximal and/or distal fixation zones. We reviewed our experience of proximal descending thoracic replacement combined with short-stented elephant trunk implantation for type B dissection for patients without adequate fixation zones for endografts. METHODS: Twenty-one patients with type B dissection (10 acute, 11 chronic) underwent this procedure between August 2003 and December 2007. After replacement of the proximal descending thoracic aorta, a short-stented elephant trunk was implanted into the residual descending thoracic aorta. The residual false lumen was evaluated post-operatively using computed tomography (CT) scans. RESULTS: There were no in-hospital deaths. One death was observed during a mean follow-up of 69 ± 15 months. One patient with preoperative shock suffered paraparesis but recovered postoperatively. One patient had paraplegia and was lost to follow-up. Cerebral hemorrhage was observed in 1 patient, but he recovered. Thrombus obliteration of the false lumen around the stented elephant trunk was observed in 19 patients (95%) and at the diaphragmatic level in 17 patients (85%) during follow-up. CONCLUSION: Replacement of the proximal descending thoracic aorta combined with short-stented elephant trunk implantation was a suitable alternative for type B dissection for patients without adequate fixation zones for endografts (particularly for young subjects). This procedure allowed enlargement of the true lumen, re-establishment of the true lumen, induction of thrombosis of the false lumen, and shrinkage of the aorta. Injury to the spinal cord, however, was an intractable problem.
Asunto(s)
Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular , Stents , Adulto , Análisis de Falla de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Radiografía , Resultado del TratamientoRESUMEN
OBJECTIVE: To explore the experiences of aortic valve preservation and root reconstruction in patients with Marfan syndrome. METHODS: From July 2003 to Dec 2007, 22 patients with Marfan syndrome were treated by aortic valve preservation and root reconstruction. There were 12 male and 10 female, the age ranged from 10 to 57 years old with a mean of (28 +/- 10) years. The operation procedures included reimplantation technique in 9 patients, remodeling technique in 8 patients, and patch technique in 2 patients. In addition, reimplantation technique + total aorta replacement in 1 patient, remodeling technique + "aortic arch replacement + stent-elephant trunk" in 1 patient, patch technique + "aortic arch replacement + stent-elephant trunk" in 1 patient. The patients were followed-up by 17 to 64 months with a mean of (46 +/- 16) months. RESULTS: No in-hospital and follow-up period death occurred. There was one reexploration for bleeding 1 d postoperative. No valve-related complication occurred during the follow-up. At the end of follow-up, no aortic regurgitation was demonstrate in 16 patients, but mild regurgitation in 4 patients, moderate regurgitation in 1 patient and severe regurgitation in 1 patient. Two patients with moderate and severe aortic regurgitation need reoperation 1 year postoperative. CONCLUSION: The early and mid-term results of aortic valve preservation and root reconstruction operations in Marfan syndrome were favorable.
Asunto(s)
Aorta/cirugía , Aneurisma de la Aorta/cirugía , Síndrome de Marfan/complicaciones , Adolescente , Adulto , Aneurisma de la Aorta/etiología , Válvula Aórtica/cirugía , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Surgical treatment of chronic Stanford type A aortic dissection using total arch replacement combined with stented elephant trunk implantation is controversial owing to the visceral arteries and intercostal arteries originating from the false lumen. METHODS: Eighty-nine patients (mean age, 45.67 +/- 10.18 years; range, 21-68 years) with chronic type A dissection underwent total arch replacement combined with stented elephant trunk implantation between April 2003 and March 2007. Careful assessment of the visceral arteries and location of entry and re-entry was done before surgery. Postoperative patency of the visceral arteries and diameter of the aortic artery and the residual false lumen were evaluated by computed tomography. RESULTS: One (1.12%) hospital death and 2 (2.25%) late deaths occurred at a mean follow-up of 28.5 months (range, 8-52 months). Visceral malperfusion was not observed. Two patients had spinal cord injury and recovered during follow-up. One patient had a transient neurologic deficit and recovered completely before discharge. One patient underwent thoracoabdominal aortic replacement for aneurysmal dilatation of the residual descending aorta 3 months after the operation. Thrombus obliteration of the false lumen at the distal edge of the stented elephant trunk and at the diaphragmatic level was 94.2% (81/86) and 61.6% (53/86), respectively. CONCLUSIONS: Satisfactory results with low morbidity and mortality were obtained. No visceral malperfusion and a low risk of postoperative spinal cord injury favor this technique in patients with chronic type A dissection.
Asunto(s)
Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular , Prótesis Vascular , Stents , Adulto , Anciano , Anciano de 80 o más Años , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Implantación de Prótesis Vascular/efectos adversos , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
OBJECTIVE: In patients with acute type A dissection, it is controversial whether to use a more aggressive strategy with extended aortic replacement to improve long-term outcome or to use a conventional strategy with limited ascending aortic or hemiarch replacement to circumvent a life-threatening situation. METHODS: Between April 2003 and June 2007, 107 patients (17 women, 90 men; mean age, 45 +/- 11 years; range, 17-78 years) with acute type A dissection underwent total arch replacement combined with stented elephant trunk implantation under hypothermic cardiopulmonary bypass and selective cerebral perfusion. Computed tomography was performed to evaluate the residual false lumen in the descending aorta during follow-up. RESULTS: Thirty-day mortality was 3.74% (4/107 patients), and in-hospital mortality was 4.67% (5/107 patients). Spinal cord injury was observed in 3 patients (1 patient with left lower-extremity paraparesis and 2 patients with paraplegia). Cerebral infarction was observed in 3 patients, ventilator support exceeding 5 days was required in 9 patients, and rebleeding was observed in 4 patients. During a mean follow-up of 35 +/- 14 months, 3 patients died and 3 patients were lost to follow-up. On postoperative computed tomography, complete thrombus formation was observed around the stented elephant trunk in 95% of patients (95/100) and at the diaphragmatic level in 69% of patients (69/100). CONCLUSION: Low morbidity and mortality were achieved using total arch replacement combined with stented elephant trunk implantation. These encouraging surgical results and postoperative outcomes favor this more aggressive procedure for acute type A dissection.
Asunto(s)
Aorta Torácica/cirugía , Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Stents , Enfermedad Aguda , Adolescente , Adulto , Anciano , Disección Aórtica/mortalidad , Aneurisma de la Aorta/mortalidad , Puente Cardiopulmonar/métodos , Femenino , Estudios de Seguimiento , Humanos , Hipotermia Inducida , Masculino , Complicaciones Posoperatorias , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Surgical management of acute type A dissection with the tear in the descending aorta is challenging because of the technical difficulty in managing proximal and distal aortic lesions through a median sternotomy or lateral thoracotomy using a single-stage procedure. METHODS: Thirty-three patients with acute type A dissection with the tear in the descending aorta underwent total arch replacement combined with stented elephant trunk implantation through a median sternotomy from April 2003 to June 2007. Preoperative complications included acute cardiac tamponade (n = 1), acute left heart failure (n = 1), acute myocardial infarction (n = 1), cerebral ischemia (n = 1), acute renal failure (n = 2), chronic renal dysfunction (n = 2), and acute mesenteric ischemia (n = 1) and lower extremity ischemia (n = 3). The residual false lumen was evaluated using postoperative computed tomography. RESULTS: Death at 30 days was 6.06% (2 of 33 patients). One patient with preoperative mesenteric ischemia died of postoperative multiple-organ failure. One patient with preoperative acute renal failure ceased treatment after three reoperations owing to uncontrollable bleeding. Left lower-extremity paraparesis occurred in 1 patient, and transient neurologic dysfunction occurred in 1 patient. Severe complications were not observed at a mean follow-up of 25 +/- 11 months. Thrombus obliteration of the false lumen was observed at the distal end of the stented graft in 29 patients (96.7%) and at the diaphragmatic level in 20 patients (66.7%) during follow-up. CONCLUSIONS: Encouraging outcomes favor this technique in patients with acute type A dissection with the tear in the descending aorta. Simultaneous repair of proximal aortic lesions and thrombosis of the false lumen in the descending aorta could be obtained.
Asunto(s)
Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Adulto , Anciano , Aorta Torácica/cirugía , Prótesis Vascular , Implantación de Prótesis Vascular , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Stents , Adulto JovenRESUMEN
BACKGROUND: The purpose of the study was to assess the efficacy of total arch replacement combined with stented elephant trunk implantation for Marfan patients with acute Stanford type A aortic dissection involving the aortic arch. METHODS: Between January 2004 and April 2006, 13 consecutive Marfan patients (4 female, 9 male) with acute type A aortic dissection involving the aortic arch underwent total arch replacement combined with implantation of a stented elephant trunk. Aortic dissection extending to the iliac artery was seen in 10 patients, and to the abdominal aorta in 3 patients. Ages ranged from 17 to 65 years (mean, 39 +/- 13). Computed tomography was done to evaluate the residual false lumen in the descending aorta. RESULTS: All patients survived and were discharged from hospital. One patient with thrombosis of the innominate artery suffered cerebral infarction and recovered during follow-up. One patient had ischemia of the left upper limb postoperatively, but recovered after axillary to axillary artery bypass. There was 1 death during the mean follow-up period of 27 +/- 10 months. Complete thrombus formation was observed in 84.6% of patients (11 of 13) around the stented elephant trunk, and in 69.2% of patients (9 of 13) at the diaphragmatic level. CONCLUSIONS: Total arch replacement combined with stented elephant trunk implantation for Marfan patients with acute type A aortic dissection involving the aortic arch results in less late dilatation of the dissected descending aorta. That prolongs the reoperation interval or reduces the number of late thoracoabdominal aortic replacements, unless there is a patent false lumen around the stented elephant trunk.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/métodos , Síndrome de Marfan/complicaciones , Stents , Enfermedad Aguda , Adolescente , Adulto , Anciano , Disección Aórtica/diagnóstico por imagen , Angiografía/métodos , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/etiología , Aneurisma de la Aorta Torácica/mortalidad , Implantación de Prótesis Vascular/mortalidad , Puente Cardiopulmonar , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/mortalidad , Persona de Mediana Edad , Diseño de Prótesis , Medición de Riesgo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodos , Adulto JovenRESUMEN
OBJECTIVE: Although deep hypothermic circulatory arrest has been known to induce neuronal injury, the molecular mechanism of this damage has not been identified. We studied the key molecular mediators through cellular energy failure, excitotoxicity, and overactivation of poly(adenosine diphosphate-ribose) polymerase 1 in brain tissues of a rabbit model of deep hypothermic circulatory arrest similar to clinical settings. METHODS: We established 2 models of cardiopulmonary bypass (n = 15) and deep hypothermic circulatory arrest (n = 15) associated with cerebral microdialysis in rabbits. Deep hypothermic circulatory arrest lasted for 60 minutes. The measurements of glucose, lactate, pyruvate, and glutamate collected by means of microdialysis were quantified by using a microdialysis analyzer and high-performance liquid chromatography. The overactivation of poly(adenosine diphosphate-ribose) polymerase 1 was assessed by detecting immunostaining of poly(adenosine diphosphate-ribose). Histologic studies were used to identify neuronal morphologic changes and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling staining and poly(adenosine diphosphate-ribose) polymerase 1 Western blotting were used to identify apoptotic cells and early apoptotic signals. RESULTS: Deep hypothermic circulatory arrest significantly increased the lactate/pyruvate and lactate/glucose ratios and the glutamate value, whereas cardiopulmonary bypass did not (P < .05). Deep hypothermic circulatory arrest significantly increased the numbers of poly(adenosine diphosphate-ribose)-positive and apoptotic neurons compared with cardiopulmonary bypass (P < .05). The cleavage of poly(adenosine diphosphate-ribose) polymerase 1 was only found in the deep hypothermic circulatory arrest group. More injured neurons were found in the deep hypothermic circulatory arrest group (histologic scores, P < .05). CONCLUSIONS: This study demonstrated that deep hypothermic circulatory arrest results in an overactivation of poly(adenosine diphosphate-ribose) polymerase 1, and that there were molecular events consisting of cellular energy failure, excitotoxicity, overactivation of poly(adenosine diphosphate-ribose) polymerase 1, and necrosis and/or apoptosis in neuronal injury.
Asunto(s)
Encefalopatías/metabolismo , Paro Circulatorio Inducido por Hipotermia Profunda/efectos adversos , Neuronas/metabolismo , Poli(ADP-Ribosa) Polimerasas/metabolismo , Animales , Apoptosis , Encéfalo/patología , Encéfalo/fisiopatología , Química Encefálica , Encefalopatías/etiología , Encefalopatías/patología , Encefalopatías/fisiopatología , Puente Cardiopulmonar/efectos adversos , Modelos Animales de Enfermedad , Masculino , Microdiálisis , Necrosis , Neuronas/patología , Poli(ADP-Ribosa) Polimerasas/análisis , ConejosAsunto(s)
Aneurisma Falso/terapia , Aneurisma de la Aorta/terapia , Stents , Adulto , Anciano , Embolización Terapéutica , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To review the results of the valve-sparing operation (David procedure) in patients with aortic root disease. METHODS: Twenty-nine patients with aortic root disease, 20 males and 9 females, aged 39 +/- 17 (10-64), 10 being of heart functional class I, 15 of class II, and 4 of class III, and 15 with gentle, 9 with moderate, and 5 with severe aortic insufficiency underwent David procedure, one undergoing the aortic valve-sparing reimplantation (David I), 25 undergoing aortic valve-sparing remodeling (David II), and 3 undergoing a new modified aortic valve-sparing operation. After the operation the patients were followed up for 29 +/- 15 months (5-74 months). RESULTS: No intra-operative death was found. The mean extracorporeal circulation time was 126 min +/- 25 min, and the aortic crossclamp time was 87 min +/- 22 min. All patients recovered to heart functional class I. Post-operatively 11 patients showed no normal, eight gently and two moderate aortic regurgitation. CONCLUSION: The valve-sparing operation is an ideal operation to the aortic root aneurysm with more or less normal aortic leaflets and valvular ring normal.