RESUMO
BACKGROUND: In this article, we report mid-term follow-up results of the Solysafe® septal occluder for percutaneous closure of secundum atrial septal defects. METHODS: A total of 25 patients (8 males, 17 females; mean age 8.4±3.6 years; range 5 to 12 years) who underwent percutaneous closure of secundum atrial septal defect between July 2008 and June 2010 were included in this study. RESULTS: The mean follow-up was 6.1±0.5 (range, 5.2 to 7.2) years. The device was successfully implanted in 22 of 25 patients. The mean stretched diameter of the atrial septal defect as assessed by balloon sizing was 13.6±4.4 (range, 8 to 26) mm. Nine 15-mm devices, eight 20-mm devices, six 25-mm devices, and two 35-mm devices were used. A 20-mm and two 35-mm devices were used in three patients and the procedure failed in these patients. Among the remaining 22 patients, no pericardial effusion, endocarditis, hemolysis, electrocardiographic changes, valvular problems, or suspicious echocardiographic findings were observed during or after the procedure. Only in one patient, a wire fraction was seen at six years, while another patient had a residual shunt during a six-year follow-up. Device embolization (n=1) and hemiparesis (n=1) were the early major complications related to the procedure. CONCLUSION: Although percutaneous closure of secundum atrial septal defects is successful, it would be wiser to check the device regularly, at least once a year, as the manufacturing of the device has been discontinued due to wire fractions.
RESUMO
Yildirim SV, Yildirim A. Truncus arteriosus with double aortic arch: A rare association. Turk J Pediatr 2017; 59: 221-223. Truncus arteriosus (TA) is a congenital heart defect often diagnosed in neonatal period; it represents 0.7% of all congenital heart lesions. The pulmonary arteries originate generally above the coronary ostium. Aorto-pulmonary and interventricular defects are believed to represent an abnormality of conotruncal septation. TA is classified into four types, according to Van Praagh and Colette Edwards. Some of congenital heart defects may be associated with TA, such as aortic interruption. In literature, TA with a double aortic arch is observed as a very rare condition. We present here a newborn diagnosed with a combination of TA type 1 and double aortic arch.
Assuntos
Aorta Torácica/anormalidades , Persistência do Tronco Arterial/diagnóstico , Anel Vascular/diagnóstico , Angiografia , Aorta Torácica/diagnóstico por imagem , Ecocardiografia , Evolução Fatal , Feminino , Humanos , Recém-Nascido , Doenças RarasRESUMO
BACKGROUND: Additional antegrade pulsatile pulmonary blood flow obtained by leaving the main pulmonary artery patent during bidirectional cavopulmonary shunt has been shown to give additional benefits to the bidirectional Glenn cavopulmonary anastomosis. We retrospectively evaluated our 20-patient pulsatile Glenn series in order to find out whether these salutary effects were valid or not. METHODS: Between June 2007 and November 2011, 20 patients (11 girls and 9 boys) with single-ventricle physiology underwent bidirectional cavopulmonary anastomosis. The additional source of blood flow was through the unligated main pulmonary artery in all patients. A retrospective review of our surgical experience was performed focusing on the role of additional pulmonary flow. Medical records and perioperational and postoperative follow-up data including clinical outcomes were retrospectively retrieved and analyzed. RESULTS: Two patients died in the early postoperative period. One patient died in the follow-up period. Mean follow-up time was 23.9 ± 15.7 months. No superior vena cava syndrome and no increase in pulmonary vascular resistance were observed. Improvement of partial oxygen pressure after pulsatile Glenn has been shown in all patients (P = .00). At a mean interval of 22.9 months, main pulmonary artery size continued to increase after pulsatile Glenn cavopulmonary anastomosis (P = .028). Only 1 patient was converted to Fontan type circulation after pulsatile Glenn cavopulmonary anastomosis. CONCLUSIONS: The pulsatile cavopulmonary shunt is a useful procedure in the early and intermediate term management of patients with a functional univentricular heart. It improves partial oxygen pressure and the impact of pulsatility on the main pulmonary artery.
Assuntos
Técnica de Fontan/métodos , Derivação Cardíaca Direita/métodos , Artéria Pulmonar/crescimento & desenvolvimento , Artéria Pulmonar/fisiopatologia , Fluxo Pulsátil , Síndrome da Veia Cava Superior/fisiopatologia , Síndrome da Veia Cava Superior/cirurgia , Adulto , Velocidade do Fluxo Sanguíneo , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Síndrome da Veia Cava Superior/diagnóstico , Resultado do TratamentoRESUMO
Persistent left and absent right superior vena cava is a rare congenital anomaly, which is usually asymptomatic. Persistent left superior vena cava (PLSVC) is generally coexistent with right superior vena cava (RSVC), but rarely associated with absent RSVC. Herein, we report two children referred to our department because of ventricular septal defect. We determined PLSVC with absent RSVC during the angiography.
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Malformações Vasculares/diagnóstico , Veia Cava Superior/anormalidades , Pré-Escolar , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Masculino , Flebografia , Veia Cava Superior/diagnóstico por imagemRESUMO
BACKGROUND: The aim of this study was to investigate the incidence, origins and courses of coronary artery anomalies using a combination of angiographic and surgical methods in Turkish children with tetralogy of Fallot (ToF). METHODS: Seventy-seven patients in whom coronary artery anomalies had been identified by angiography and/or at operation out of 549 ToF and 58 Fallot-type double outlet right ventricle (total 607) patients, were enrolled in the study. RESULTS: Coronary artery anomalies were identified in 12.7% of the patients. The incidence was 12.2% (67/549) in patients with aortic overriding 50%, and 17.2% (10/58) with aortic overriding ã 50% (p ã 0.05). The incidence of anomalous coronary arteries crossing the right ventricular outflow tract (RVOT) was 7.91%. The commonest anomaly was the left anterior descending artery (LAD) or accessory LAD arising from the right coronary artery (RCA; n = 25). Other frequent anomalies were single coronary ostium (n = 21) and enlarged conal branch of RCA (n = 18). In 62.3% (48/77) of the patients with a coronary anomaly, the anomalous vessels were crossing the RVOT. The ratio of crossing the RVOT was 92.0% for LAD arising from the RCA, 66.7% for conal branch, and 42.9% for single coronary ostium. CONCLUSIONS: Two thirds of the anomalous coronary arteries were crossing the RVOT, and had surgical importance. The most frequent coronary artery anomaly that crossed the RVOT was the LAD or the accessory LAD arising from the RCA. Also, an enlarged conus artery should be considered as an anomaly because of its surgical importance, given its high rate of crossing the RVOT.
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Anomalias dos Vasos Coronários/complicações , Seio Aórtico/anormalidades , Tetralogia de Fallot/complicações , Adolescente , Procedimentos Cirúrgicos Cardíacos , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Valor Preditivo dos Testes , Seio Aórtico/diagnóstico por imagem , Tetralogia de Fallot/epidemiologia , Tetralogia de Fallot/cirurgia , Turquia/epidemiologiaRESUMO
Stent implantation into a ductus arteriosus or systemic-pulmonary shunt is a relatively new but infrequent approach for palliation. A 22-month-old boy with a modified Blalock-Taussig shunt for tetralogy of Fallot was admitted with severe cyanosis. Echocardiographic examination showed complete occlusion of the shunt. Initial balloon angioplasty resulted in reocclusion of the shunt by acute thrombosis. Finally, recanalization was achieved by stent implantation. Oxygen saturation of the patient increased from 32% to 92% following stenting. He was discharged on aspirin therapy.
Assuntos
Procedimento de Blalock-Taussig/efeitos adversos , Cianose/etiologia , Oclusão de Enxerto Vascular/terapia , Stents , Tetralogia de Fallot/terapia , Cianose/terapia , Oclusão de Enxerto Vascular/complicações , Humanos , Lactente , Masculino , Oxigênio/sangueRESUMO
Cardiac complications of the pediatric patients with acute leukemia are common. Most of the cardiac complications may be due to chemotherapeutics such as antracyclins, besides anemia, infections, or direct leukemic infiltrations of the heart. It is reported that leukemic infiltration is frequent in the postmortem examination of the myocardium and pericardium. However, at the antemortem examination, pericardial involvement is rare and there is no myocardial involvement reported at the time of diagnosis in patients with acute leukemia in the English literature. Here, the authors report an adolescent with acute lymphoblastic leukemia who had myocardial infiltration at the time of diagnosis.
Assuntos
Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Taquicardia Supraventricular/etiologia , Adolescente , Ablação por Cateter , Movimento Celular , Evolução Fatal , Humanos , Linfócitos/patologia , Masculino , Miocárdio/patologia , Derrame Pericárdico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Recidiva , Taquicardia Supraventricular/cirurgiaRESUMO
Despite the relatively recent introduction of propranolol in the treatment of infantile hemangiomas, there can be little doubt of its efficacy. With regard to safety issues, there are no prior data for very low weight infants. In this study, we used propranolol in preterm and very low weight infants. We used clinical criteria to assess the response to the therapy. We noted all side effects expected from beta-adrenergic blocking drugs, and followed the patients' weight gain during propranolol treatment. Objective, clinical evidence of hemangioma regression was seen after two months in all patients. None of the patients required treatment discontinuation due to adverse side effects. During the propranolol treatment, weight gain was normal in all patients. To the best of our knowledge, this is the first report on the use of propranolol in preterm and very low weight infants, and also the first report from Turkey on the use of propranolol in infantile hemangiomas.
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Antagonistas Adrenérgicos beta/uso terapêutico , Hemangioma/tratamento farmacológico , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Neoplasias Hepáticas/tratamento farmacológico , Propranolol/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Antagonistas Adrenérgicos beta/efeitos adversos , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Projetos Piloto , Propranolol/efeitos adversos , Turquia , Aumento de Peso/efeitos dos fármacosRESUMO
Duplication of mitral valve is a very rare anomaly. It is characterized by two independent mitral valve apparatuses (leaflets and annulus) and subvalvular apparatuses (chordae and papillary muscles) that function well by themselves. In this report, we present duplicate mitral valve with parachute chordal attachment and mitral stenosis in an infant. The patient was successfully treated with the reconstruction of the larger valve without any intervention to the smaller one.
Assuntos
Anormalidades Múltiplas , Cardiopatias Congênitas , Valva Mitral/anormalidades , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , UltrassonografiaAssuntos
Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Endocardite/diagnóstico por imagem , Endocardite/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Criança , Diagnóstico Diferencial , Feminino , Humanos , UltrassonografiaRESUMO
Quadricuspid aortic valve is a rare congenital condition that occurs not only as an isolated anomaly, but also with other cardiac defects. We describe a 10-year-old boy whose aortic stenosis was diagnosed during infancy. Transthoracic echocardiography revealed dilation of the left ventricle, valvular and subvalvular aortic stenosis, bicuspid aortic valve, aortic regurgitation, and mitral valve prolapse. The results of cardiac catheterization and aortography showed severe aortic regurgitation, an aortic valve gradient of 76 mmHg, a bicuspid aortic valve, a subaortic membrane, and an ascending aortic aneurysm. The patient underwent elective valve replacement with a mechanical prosthesis, and during surgery, the valve was noted to be quadricuspid. The patient was diagnosed as having a quadricuspid aortic valve associated with aortic regurgitation, severe aortic stenosis, and an ascending aortic aneurysm.
Assuntos
Insuficiência da Valva Aórtica/congênito , Estenose da Valva Aórtica/congênito , Valva Aórtica/anormalidades , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Criança , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Seguimentos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Radiografia TorácicaRESUMO
Cardiofaciocutaneous (CFC) syndrome is a rare disorder characterized by psychomotor and growth retardation, a typical facial dysmorphism, congenital heart defects, and ectodermal abnormalities. Pulmonic stenosis, atrial and ventricular septal defects, patent ductus arteriosus, and hypertrophic cardiomyopathy are cardiac findings identified in patients with this syndrome; however, tetralogy of Fallot has never been associated with CFC syndrome. CFC should be considered in patients with skin abnormalities in addition to phenotypic features and a congenital heart defect, including tetralogy of Fallot.
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Cardiomiopatia Hipertrófica/complicações , Transtornos do Crescimento/complicações , Cardiopatias Congênitas/complicações , Transtornos Psicomotores/complicações , Tetralogia de Fallot/complicações , Displasia Ectodérmica/complicações , Fácies , Humanos , Lactente , Masculino , SíndromeRESUMO
Kawasaki disease (KD) is an acute, febrile, and multisystem vasculitis of early childhood with a striking predilection for the coronary arteries. The most significant complication is coronary artery abnormalities, including coronary aneurysms. The etiology of KD remains unknown. Many infectious agents including viruses have been postulated as possible causes of KD. But standard microbiologic techniques, molecular methods and serologic investigations have failed to identify an etiologic agent. We described a patient with atypical KD during cytomegalovirus infection.
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Infecções por Citomegalovirus/complicações , Síndrome de Linfonodos Mucocutâneos/virologia , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticorpos Antivirais/sangue , Aspirina/uso terapêutico , Ceftriaxona/uso terapêutico , Citomegalovirus/genética , Citomegalovirus/imunologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/diagnóstico por imagem , Infecções por Citomegalovirus/tratamento farmacológico , DNA Viral/sangue , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Lactente , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Resultado do Tratamento , UltrassonografiaRESUMO
Rhythm disturbances that develop after pediatric surgery for heart disease significantly increase mortality and morbidity risk. The aim of this study was to determine incidence rates of different arrhythmias and identify risk factors for these disturbances in this patient group. The study involved 580 children in the pediatric cardiovascular intensive care unit who had undergone cardiac surgery between May 2001 and December 2002. Each was followed until discharge. The patient who sustained arrhythmia was recorded. Fifty-one of the patients (8.8%, mean age 1.7+/-2.3 years) developed arrhythmias. Twenty-one (41.1%) had supraventricular tachycardia, 12 (23.5%) had junctional ectopic tachycardia, 10 (19.6%) had complete atrioventricular block, 3 (5.8%) had ventricular arrhythmias, and 5 (9.8%) had atrial fibrillation and atrioventricular dissociation. There was a trend toward higher incidence of arrhythmia (rate, 43.1%) in the 0-6 months age group. The incidence rates of arrhythmia after certain procedures were as follows: 75% after Rastelli operation, 16.7% after total anomalous pulmonary venous return repair, 13.8% after ventricular septal defect repair, 12.8% after the arterial switch operation or arterial switch with ventricular septal defect closure for transposition of the great arteries, 12.5% after atrioventricular septal defect repair, 12.1% after total correction of tetralogy of Fallot, 9.1% after bidirectional cava-pulmonary connection and Fontan procedure, and 6.6% after other miscellaneous procedures. The mean cardiopulmonary bypass time was 105.4+/-54.1 min. At the time of arrhythmia appearance, the mean values for electrolyte (sodium 144+/-5 mEq/L, potassium 3.78+/-0.91 mEq/L, ionized calcium 1.15+/-0.33 mmol/L) and arterial blood gas parameters (pH 7.40+/-0.12 and HCO3 24.7+/-6.3 mmol/L) were all in the normal range. Fifteen (29.4%) of the patients with arrhythmias died and in 7 of these cases, the death was directly linked to resistant arrhythmia. Arrhythmias can be life-threatening especially in the early period after pediatric heart surgery. The incidence of arrhythmia in this series was 8.8%. The results identified type of operation as a major risk factor for arrhythmia after pediatric heart surgery and they also suggest that age may be important as well.
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Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Procedimentos Cirúrgicos Cardíacos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Fatores de RiscoRESUMO
INTRODUCTION: The first step in diagnosing congenital cardiac malformations is to assess the arrangement of the atrial appendages. In patients with abnormal lateralization of the organs of the body, the arrangement of atrial appendages is neither normal, nor a mirror image of normal. There are 2 categories of abnormal arrangement based on the morphology of the atrial appendices, namely right isomerism and left isomerism, and in almost all instances these are found in the setting of so-called heterotaxy syndromes. OBJECTIVE: To evaluate the various congenital cardiac malformations those are associated with abnormalities of lateralization, and to discuss the diagnostic tools, therapeutic options, and outcome for these patients. PATIENTS AND METHODS: We studied 134 patients, who had been admitted to our department of paediatric cardiology with known abnormalities of lateralization and congenital cardiac defects between 1990 and 2003. The data relating to each patient was evaluated retrospectively. The arrangement of the atrial appendages was established echocardiographically, and/or angiographically, and/or on the basis of morphologic investigations during the operation. These studies showed that 43 (32.1%) of the patients had right isomerism, and 88 (65.7%) had left isomerism. In 2 (1.5%), there was mirror-imaged arrangement, while in the final patient (0.07%), we were unable to determine sidedness with certainty. The median age at diagnosis was 0.66 years, and the females outnumbered the males in a ratio of 3 to 1. Patients in the 2 isomeric groups were compared with regard to age, cardiac defects, diagnostic tools and outcomes. RESULTS: The difference in mean ages of the two groups of patients was statistically significant, those with right isomerism being 1.0 minus or plus 1.5 years, as opposed to those with left isomerism being 3.3 minus or plus 4.7 years (P is less than 0.005). Of the patients with right isomerism, 32 (74.4%) had left-sided, and 11 (25.6%) right-sided hearts, whereas in those with left isomerism, the hearts were left-sided in 65 (73.9%), and right-sided in 21 (23.9%), with 2 (2.2%) positioned in the midline. Extracardiac totally anomalous pulmonary venous connection was more common in those with right isomerism, being found in 13 patients (30.2%) as opposed to 5 patients (5.7%) with left isomerism. In only 8 of those with right isomerism did we find two perforate atrioventricular valves (18.6%), this arrangement being found in 34 (38.6%) of those with left isomerism. Pulmonary atresia and stenosis were present in 40 (93.0%) of those with right isomerism, but also in 41 (46.6%) of the patients with left isomerism. Angiographic and echocardiographic investigations were concordant in about three-quarters of patients with both right and left isomerism. All patients with extracardiac totally anomalous pulmonary venous connection died. Overall, 22 of the patients with right isomerism died (51.2%), as opposed to 20 (22.7%) of those with left isomerism. CONCLUSION: Our experience confirms that patients with right isomerism have more complex cardiac defects than those with left isomerism. Overall, the presence of isomerism carries a poor prognosis, the more so for right isomerism, with this related to the complex cardiac abnormalities. In our cohort, extracardiac totally anomalous pulmonary venous connection with pulmonary arterial obstruction was always a fatal combination. The mapping of cardiac and abdominal morphologies is still essential for proper diagnosis of these syndromes, especially in fetal life.
Assuntos
Padronização Corporal/fisiologia , Cardiopatias Congênitas/fisiopatologia , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Humanos , Lactente , Masculino , Estudos RetrospectivosRESUMO
Cerebral venous angioma is a congenital anomaly of the medullary vein, the vessel that drains into the transparenchymal venous stem. This lesion is also referred to as a developmental venous anomaly. A few reports in the literature have documented developmental venous anomaly-related epilepsy, neurologic deficits, and intracranial hemorrhage. A 3-year-old boy was referred to our hospital after he sustained an afebrile, tonic-clonic, focal seizure of 15 minutes' duration that affected his right arm, leg, and eyebrow. Cerebral digital subtraction angiography showed a bilateral, large periventricular developmental venous anomaly. This report describes the clinical and radiologic findings for this large venous angioma that caused seizures in a child.