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1.
Mov Disord ; 2019 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-31872915

RESUMO

BACKGROUND: Autonomic dysfunction is a well-known dominant symptom in the advanced stages of Parkinson's disease. However, the role of cardiac sympathetic nerves still needs to be elucidated. OBJECTIVES: To evaluate cardiac sympathetic response in Parkinsonian and dyskinetic monkeys. METHODS: Adult male monkeys were divided into 1 of the following 3 groups: controls, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-treated monkeys, and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine+levodopa-treated animals. Noradrenaline, its metabolite normetanephrine, and phospho-Heat shock proten 27 (p-Hsp27) at serine 82 levels were analyzed in the left and right ventricles of the heart. Tyrosine hydroxylase immunohistochemistry was performed in the ventral mesencephalon. RESULTS: The results were the following: (1) 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine intoxication significantly increased normetanephrine levels and decreased noradrenaline turnover in the right ventricle without changes in the left ventricle; however, (2) levodopa treatment decreased noradrenaline levels and enhanced the normetanephrine/noradrenaline ratio in parallel with a very significant increase of Hsp27 activity in both ventricles. CONCLUSIONS: Levodopa treatment could induce protective cardiac effects through the increased Hsp27 activity. © 2019 International Parkinson and Movement Disorder Society.

2.
An Pediatr (Barc) ; 91(5): 352.e1-352.e9, 2019 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-31694800

RESUMO

Since the first successful palliation was performed by Norwood et al. in 1983, there have been substantial changes in diagnosis, management, and outcomes of hypoplastic left heart syndrome, Survival for stage 1 palliation has increased to 90% in many centres, with patients potentially surviving into adulthood. However, the associated morbidity and mortality remain substantial. Although the principles of staged surgical palliation of hypoplastic left heart syndrome are well established, there is significant variability in surgical procedure and management between centres, and several controversial aspects remain unresolved. In this review, we summarize the current surgical and management options for newborns with hypoplastic left heart syndrome and their outcomes.

3.
An. pediatr. (2003. Ed. impr.) ; 91(5): 352.e1-352.e9, nov. 2019. ilus
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-3994

RESUMO

Desde que Norwood et al. efectuaron la primera paliación exitosa en 1983, ha habido cambios sustanciales en el diagnóstico, el manejo y el pronóstico del síndrome de corazón izquierdo hipoplásico. La supervivencia en el estadio i de la paliación quirúrgica ha aumentado hasta el 90% en muchas instituciones, con la posibilidad de sobrevivir hasta la vida adulta. No obstante, la morbimortalidad asociada continúa siendo sustancial. Aunque la premisa de la paliación quirúrgica por etapas del síndrome de corazón izquierdo hipoplásico está bien establecida, hay variaciones significativas en la técnica quirúrgica y el manejo entre distintos centros, y varios aspectos controvertidos siguen sin resolverse. En esta revisión resumimos las opciones quirúrgicas y de manejo disponibles actualmente para neonatos con síndrome de corazón hipoplásico, así como sus resultados


Since the first successful palliation was performed by Norwood et al. in 1983, there have been substantial changes in diagnosis, management, and outcomes of hypoplastic left heart syndrome, Survival for stage 1 palliation has increased to 90% in many centres, with patients potentially surviving into adulthood. However, the associated morbidity and mortality remain substantial. Although the principles of staged surgical palliation of hypoplastic left heart syndrome are well established, there is significant variability in surgical procedure and management between centres, and several controversial aspects remain unresolved. In this review, we summarize the current surgical and management options for newborns with hypoplastic left heart syndrome and their outcomes

6.
Semin Thorac Cardiovasc Surg ; 31(4): 828-834, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31005576

RESUMO

Deleterious long-term effects of chronic pulmonary regurgitation after repair of tetralogy of Fallot have become evident during the last decades. Subsequently, some groups have developed strategies to spare the pulmonary valve function at the time of repair with good early results. However, mid-term outcomes are scarce in the literature and in some cases controversial. The aim of our study is to report our results mid-term with valve-sparing repair of tetralogy of Fallot. We retrospectively reviewed patients undergoing tetralogy of Fallot repair and having preservation of the pulmonary valve with intraoperative dilation at our institution. From June 2009 through June 2017, 42 patients underwent valve-sparing tetralogy of Fallot repair. Median age and weight at surgery were 5.2 months and 7.2 kg. Median preoperative pulmonary valve diameters and Z scores by echocardiography were 6.4 mm (range 4.5-11 mm) and -2.3 (range -1.3 to -4.5). No patient died in our series. For a median follow-up of 45 months, the pulmonary valve has grown by Z score (P < 0.0001) as well as the pulmonary trunk (P= 0.00216). Significant pulmonary regurgitation has developed in 9 patients (21.4%). No patient has required reintervention/reoperation for recurrent right ventricular outflow tract obstruction. Patients with tetralogy of Fallot who had valve-sparing repair with intraoperative dilation of the pulmonary valve show good early and mid-term results with respect to right ventricular outflow tract obstruction. The pulmonary valve annulus and the pulmonary trunk grow through follow-up. Progressive development of significant pulmonary regurgitation is seen in more than 20% of patients. Long-term data with this approach and comparison with a population of patients undergoing a transannular patch repair are required to establish the real utility of this approach.


Assuntos
Valvuloplastia com Balão , Procedimentos Cirúrgicos Cardíacos , Valva Pulmonar/fisiopatologia , Tetralogia de Fallot/cirurgia , Valvuloplastia com Balão/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ecocardiografia , Feminino , Humanos , Lactente , Masculino , Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-30873579

RESUMO

INTRODUCTION: Mitochondrial DNA (mtDNA) is gaining increasing interest as a marker of cellular damage and could also act as an inflammatory mediator in cardiopulmonary bypass induced postoperative inflammatory response. Although minimally invasive heart valve surgery reportedly reduces inflammation, the mtDNA and cytokine profile in this context remains unclear. MATERIALS AND METHODS: Here, we report a prospective series of 40 elderly patients with aortic stenosis who underwent bioprosthetic aortic valve replacement (AVR) through upper ministernotomy with either a sutureless (n = 20) or a conventional (n = 20) valve. Primary end points included serial plasma levels of mtDNA (T1: at baseline; T2: 4 hours after surgery; and T3: 24s hour after surgery), cytokines (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), and myocardial necrosis biomarkers (MNBs), whereas secondary end points included clinical and echocardiographic data. RESULTS: Significant increases in the postoperative plasma levels (T2) of mtDNA, cytokines, and MNBs were observed in all patients. The postoperative plasma levels of mtDNA, TNF-α, and MNBs showed no significant differences between the treatment groups, although there was a trend toward lower levels in the sutureless group. The decreases in aortic cross-clamp and cardiopulmonary bypass times seen in the sutureless group were associated with significant lower postoperative levels (T2 and T3) of IL-6. CONCLUSION: AVR through upper ministernotomy was associated with a significant increase in postoperative plasma levels of mtDNA and cytokines. There was no difference in the mtDNA levels between the sutureless and conventional valve groups, suggesting a similar level of inflammation in both groups. However, the shorter operation time observed in the sutureless valve group was associated with significantly lower postoperative levels of IL-6, indicating potential clinical benefits.

8.
Asian Cardiovasc Thorac Ann ; 27(4): 265-270, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30791694

RESUMO

BACKGROUND: Pulmonary valve replacement is one of the most common procedures in patients with congenital heart disease. Little is known about prosthetic valve endocarditis in this population. OBJECTIVES: To review management and outcomes of pediatric and adult patients with a prosthetic pulmonary valve or right ventricle-to-pulmonary artery conduit infective endocarditis. METHODS AND RESULTS: A multiinstitutional cohort of 10 patients is reported. Median age at endocarditis was 24 years (range 8-41 years). The most common causative organisms were Staphylococcus ( n = 4) and Streptococcus species ( n = 2). In addition to medical treatment, 5 patients required surgery. Majors complications such as renal damage, life-threatening hemoptysis, and septic shock were observed. No patient died in hospital or during follow-up. CONCLUSIONS: Pulmonary prosthetic valve endocarditis is a rare condition associated with significant morbidity and a high risk of requiring operative intervention. Larger studies are required to optimize the management.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Endocardite Bacteriana/microbiologia , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Valva Pulmonar/cirurgia , Adolescente , Adulto , Criança , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Valva Pulmonar/diagnóstico por imagem , Reoperação , Estudos Retrospectivos , Fatores de Risco , Espanha , Resultado do Tratamento
9.
Asian Cardiovasc Thorac Ann ; 27(1): 5-10, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30409026

RESUMO

AIM: The underlying pathophysiologic mechanisms of aortic stenosis are not clear. Mitochondrial dysfunction plays a role in many pathological conditions including cardiac diseases. We aimed to analyze the mitochondrial DNA haplogroups in a group of patients undergoing valve replacement surgery due to severe aortic stenosis. METHODS: Mitochondrial DNA haplogroups were assessed in 176 patients with severe aortic stenosis and 308 control subjects. Cardiovascular risk factors and demographics were similar in both groups. RESULTS: Patients carrying haplogroup Uk had a lower risk of developing aortic stenosis, especially compared to patients carrying haplogroup H (odds ratio = 0.507; 95% confidence interval: 0.270-0.952, p = 0.035). CONCLUSIONS: Mitochondrial DNA haplogroups could be involved in the development of severe aortic stenosis. Specifically, haplogroup H could be a risk factor and Uk a protective factor for severe aortic stenosis in a population from Spain.


Assuntos
Estenose da Valva Aórtica/genética , DNA Mitocondrial/genética , Haplótipos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Estudos de Casos e Controles , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Espanha
10.
Asian Cardiovasc Thorac Ann ; 26(2): 142-145, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29338299

RESUMO

Dextrocardia with situs solitus and severe mitral regurgitation is a rare clinical presentation which posse a surgical challenge and requires specific preoperative planning. A 54-year-old women with this anatomy, multiple thoracic procedures, and severe mitral valve regurgitation underwent successful mitral valve replacement with a 27-mm mechanical prosthesis through a left thoracotomy under ventricular fibrillation, on the basis of computed tomography findings. We emphasize the importance of preoperative planning and a surgical approach through a left thoracotomy and under ventricular fibrillation.


Assuntos
Dextrocardia/complicações , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Situs Inversus/complicações , Toracotomia , Dextrocardia/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Situs Inversus/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fibrilação Ventricular
12.
An. pediatr. (2003. Ed. impr.) ; 86(5): 277-283, mayo 2017. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-162284

RESUMO

Introducción: El cierre quirúrgico del ductus arterioso persistente en el prematuro es una técnica agresiva y no exenta de complicaciones. Diseñamos un estudio con el objetivo de describir nuestra experiencia con una técnica menos invasiva, el abordaje extrapleural vía minitoracotomía posterior, y de comparar sus resultados con los del abordaje clásico transpleural. Pacientes y métodos: Estudio de cohortes retrospectivo de los neonatos prematuros a los que se les realizó cierre quirúrgico del ductus en un periodo de 10 años (marzo de 2005-marzo de 2015). Se compararon las complicaciones agudas, los resultados al alta y en el seguimiento entre los grupos de abordaje extrapleural y abordaje clásico transpleural. Se incluyó a 48 pacientes, 30 en el grupo de abordaje clásico y 18 en el grupo extrapleural. Resultados: Las características demográficas y preoperatorias fueron similares en ambos grupos. No se encontraron diferencias entre los 2 grupos en la incidencia de complicaciones postoperatorias agudas (56,6 vs. 44,4%), en la dependencia de oxígeno a las 36 semanas (33,3 vs. 55,5%), ni en la mortalidad hospitalaria (10 vs. 16,6%). En la evolución a corto plazo, el grupo extrapleural precisó menos días hasta la retirada del oxígeno suplementario (36,3 vs. 28,9) y hasta el alta hospitalaria (67,5 vs. 53,2), aunque solo el tiempo hasta la extubación alcanzó una diferencia estadísticamente significativa (11,5 vs. 2,7, p = 0,03). Conclusiones: El abordaje extrapleural por minitoracotomía posterior para el cierre quirúrgico del ductus en el prematuro es factible y podría conllevar algunos beneficios clínicos a corto plazo (AU)


Introduction: Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. Patients and methods: A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. Results: The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). Conclusions: The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term (AU)


Assuntos
Humanos , Permeabilidade do Canal Arterial/cirurgia , Toracotomia , Procedimentos Cirúrgicos Cardíacos/métodos , Estudos Retrospectivos , Doenças do Prematuro/cirurgia , Resultado do Tratamento
13.
J Thorac Cardiovasc Surg ; 153(6): 1275-1284.e7, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28291607

RESUMO

OBJECTIVES: The enlargement of the left atrium has been identified as a marker of chronically increased left ventricular filling pressure and left ventricular diastolic dysfunction. This study aims to evaluate the association of indexed left atrial diameter with stroke, cardiovascular mortality, the combined event, and all-cause mortality in patients who underwent aortic valve surgery. METHODS: Indexed left atrial diameter was measured in 2011 adult patients (mean age, 70.9 ± 10.8 years; 58.7% were men) who underwent aortic valve surgery between January 2008 and March 2016. RESULTS: On the basis of the criteria of the American Society of Echocardiography, indexed left atrial diameter was normal in 64% of patients, mildly enlarged in 12.4% of patients, moderately enlarged in 9.2% of patients, and severely enlarged in 14.3% of patients. Over a mean follow-up period of 3.2 ± 2.1 years, there were 334 deaths and 97 strokes. Cardiovascular mortality survival at 5 years among patients with normal, mild, moderate, and severe left atrial enlargement was 91.6%, 86.8%, 77.9%, and 77.4%, respectively (P < .001). After covariable adjustment, Cox regression analysis showed indexed left atrial diameter as an independent predictor of all-cause mortality (hazard ratio per 1-cm/m2 increment, 1.545; 95% confidence interval, 1.252-1.906, P < .001), cardiovascular death (hazard ratio per 1-cm/m2 increment, 1.971; 95% confidence interval, 1.541-2.520; P < .001), and the combined event (hazard ratio per 1-cm/m2 increment, 1.673; 95% confidence interval, 1.321-2.119; P < .001). CONCLUSIONS: Indexed left atrial diameter is a strong predictor of long-term outcomes in patients with aortic valve diseases who undergo surgery.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/mortalidade , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Função do Átrio Esquerdo , Remodelamento Atrial , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
BMJ Open ; 7(1): e011437, 2017 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-28073791

RESUMO

INTRODUCTION: Rapid deployment valves (RDV) represent a newly introduced approach to aortic valve replacement which facilitates surgical implantation and minimally invasive techniques, shortens surgical times and shows excellent haemodynamic performance. However, evidence on their safety, efficacy and potential complications is mostly fitted with small-volume and retrospective studies. Moreover, no current guidelines exist. To improve our knowledge on this technology, The Rapid Deployment Aortic Replacement (RADAR) Registry will be established across Spain with the aim of assessing RDV outcomes in the real-world setting. METHODS AND ANALYSIS: The RADAR Registry is designed as a product registry that would provide information on its use and outcomes in clinical practice. This multicentre, prospective, national effort will initially involve 4 centres in Spain. Any patient undergoing cardiac surgery for aortic valve replacement and receiving an RDV as an isolated operation or in combination with other cardiac procedures may be included. Participation is voluntary. Data collection is equal to information obtained during standard care and is prospectively entered by the participating physicians perioperatively and during subsequent follow-up visits. The primary outcome assessed is in-hospital and up to 5 years of follow-up, prosthetic valve functioning and clinical status. Secondary outcomes are to perform subgroup analysis, to compare outcomes with other existing approaches and to develop future clinical guidelines. The follow-up assessments are timed with routine clinical appointments. Dissociated data will be extracted and collectively analysed. Initial target sample size for the registry is 500 participants entered with complete follow-up information. Different substudies will be implemented within the registry to investigate specific populations undergoing aortic valve replacement. ETHICS AND DISSEMINATION: The protocol is approved by all local institutional ethics committees. Findings will be shared by the participant hospitals, policymakers and the academic community to promote quality monitoring and efficient use of this technology.


Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Sistema de Registros/estatística & dados numéricos , Estenose da Valva Aórtica/mortalidade , Protocolos Clínicos , Coleta de Dados , Seguimentos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Formulação de Políticas , Estudos Prospectivos , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Resultado do Tratamento
15.
An Pediatr (Barc) ; 86(5): 277-283, 2017 May.
Artigo em Espanhol | MEDLINE | ID: mdl-26826760

RESUMO

INTRODUCTION: Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. PATIENTS AND METHODS: A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. RESULTS: The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). CONCLUSIONS: The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term.


Assuntos
Permeabilidade do Canal Arterial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Retrospectivos , Resultado do Tratamento
16.
Pediatr Transplant ; 20(2): 321-4, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26821845

RESUMO

We report a case of a 12-yr-old boy referred to our unit with congenital generalized lipodystrophy and dilated cardiomyopathy related to a lamin gene mutation. He progressively developed end-stage heart failure and was referred for heart transplant evaluation. The patient's lipid profile, glucose level, and renal function were normal, and vascular retinopathy was ruled out. He underwent orthotopic bicaval HT and had an uneventful recovery. He was discharged home two wk after surgery with good graft function. During follow-up, he developed hyperglycemia and dyslipidemia, which were controlled by increasing leptin dose and starting oral antidiabetic drugs. The patient is currently doing well two yr after transplantation.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Transplante de Coração , Lipodistrofia Generalizada Congênita/cirurgia , Administração Oral , Angiografia , Glicemia/análise , Índice de Massa Corporal , Cardiomiopatia Dilatada/complicações , Criança , Constrição Patológica , Dislipidemias/complicações , Insuficiência Cardíaca/cirurgia , Humanos , Hiperglicemia/complicações , Hipoglicemiantes/uso terapêutico , Testes de Função Renal , Lamina Tipo A/genética , Lipodistrofia Generalizada Congênita/complicações , Masculino , Mutação , Resultado do Tratamento
17.
Eur J Cardiothorac Surg ; 49(2): 546-51; discussion 551-2, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25838456

RESUMO

OBJECTIVES: Parachute left atrioventricular (AV) valve can complicate repair of common atrioventricular canal (CAVC), and single-ventricle palliation is sometimes preferred. The goal of this study is to review our single institutional experience in biventricular repair in this patient group. METHODS: The demographic, procedural and outcome data were obtained for all children who underwent biventricular repair for complete CAVC with parachute [single left ventricular (LV) papillary muscle] or forme fruste parachute left AV valve (closely spaced LV papillary muscles) from 2001 to 2012. Primary outcomes were survival, freedom from left AV valve stenosis (defined as an inflow gradient ≥7 mmHg and post-capillary pulmonary hypertension) and freedom from left AV valve replacement. RESULTS: A total of 24 patients were included (21 parachutes, 3 forme frustes). There was 1 early death (4.2%). At discharge, no patient had more-than-mild regurgitation and 1 had stenosis. During a median follow-up of 3.7 years (IQR 4 months to 5 years), there were 2 late deaths (8.3%), 6 patients (25%) presented significant left AV valve stenosis and 2 patients (8.3%) required valve replacement. Freedom from stenosis was 95 ± 4.9% at 1 year, 83.1 ± 8.9% at 3 years, 64.7 ± 13.5% at 5 years and 51.7 ± 15.8% at 10 years. Complete cleft closure was not associated with a significantly different freedom from left AV valve reoperation (log-rank test, P = 0.89) or significant stenosis (P = 0.47). CONCLUSION: Biventricular repair in parachute left AV valve and CAVC is feasible with acceptable mortality and freedom from stenosis. The burden of reoperation remains significant in this patient group.


Assuntos
Insuficiência da Valva Mitral/cirurgia , Feminino , Seguimentos , Defeitos dos Septos Cardíacos , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Insuficiência da Valva Mitral/mortalidade , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
18.
J Thorac Cardiovasc Surg ; 151(1): 131-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26410005

RESUMO

OBJECTIVE(S): To assess the impact of univentricular versus biventricular pacing (BiVP) on systemic ventricular function in patients with congenitally corrected transposition of the great arteries (ccTGA). METHODS: We performed a retrospective review of all patients with a diagnosis of ccTGA who underwent pacemaker insertion. From 1993 to 2014, 53 patients were identified from the cardiology database and surgical records. RESULTS: Overall mortality was 7.5% (n = 4). One patient required transplantation and 3 late deaths occurred secondary to end-stage heart failure. Median follow-up was 3.7 years (range, 4 days to 22.5 years). Twenty-five (47%) underwent univentricular pacing only, of these, 8 (32%) developed significant systemic ventricular dysfunction. Twenty-eight (53%) received BiVP, 17 (26%) were upgraded from a dual-chamber system, 11 (21%) received primary BiVP. Fourteen (82%) of the 17 undergoing secondary BiVP demonstrated systemic ventricular dysfunction at the time of pacer upgrade, with 7 (50%) demonstrating improved systemic ventricular function after pacemaker upgrade. Overall, 42 (79%) patients underwent univentricular pacing, with 22 (52%) developing significant systemic ventricular dysfunction. In contrast, the 11 (21%) who received primary BiVP had preserved systemic ventricular function at latest follow-up. CONCLUSIONS: Late-onset systemic ventricular dysfunction is a major complication associated with the use of univentricular pacing in patients with ccTGA. All patients with ccTGA who develop heart block should undergo primary biventricular pacing, as this prevents late systemic ventricular dysfunction. Preemptive placement of BiVP leads at the time of anatomical repair or other permanent palliative procedure will facilitate subsequent BiVP should heart block develop.


Assuntos
Estimulação Cardíaca Artificial/métodos , Terapia de Ressincronização Cardíaca , Bloqueio Cardíaco/terapia , Transposição dos Grandes Vasos/complicações , Disfunção Ventricular Esquerda/prevenção & controle , Disfunção Ventricular Direita/prevenção & controle , Função Ventricular Esquerda , Função Ventricular Direita , Adolescente , Adulto , Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/mortalidade , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Criança , Pré-Escolar , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/mortalidade , Bloqueio Cardíaco/fisiopatologia , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Transposição dos Grandes Vasos/diagnóstico , Transposição dos Grandes Vasos/mortalidade , Transposição dos Grandes Vasos/fisiopatologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia , Adulto Jovem
19.
Curr Vasc Pharmacol ; 14(1): 48-57, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26463985

RESUMO

Postoperative low cardiac output syndrome has been shown to have both a central and a peripheral vascular involvement. Therefore, inodilators which provide with a combination of positive inotropic and vasodilating therapy, conceptually should be an ideal form of treatment. However, contradictory data on these drugs exist. Phosphodiesterase inhibitors (e.g., milrinone) and more recently calcium sensitizers (e.g., levosimendan) have been most commonly used groups in the clinical setting. This review will summarize the pharmacology of inodilators with a special foccus on current clinical evidence. This article addresses the sixth of eight topics comprising the special issue entitled "Pharmacologic strategies with afterload reduction in low cardiac output syndrome after pediatric cardiac surgery".


Assuntos
Baixo Débito Cardíaco/tratamento farmacológico , Cardiotônicos/uso terapêutico , Vasodilatadores/uso terapêutico , Animais , Baixo Débito Cardíaco/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiotônicos/farmacologia , Criança , Humanos , Hidrazonas/farmacologia , Hidrazonas/uso terapêutico , Milrinona/farmacologia , Milrinona/uso terapêutico , Inibidores de Fosfodiesterase/farmacologia , Inibidores de Fosfodiesterase/uso terapêutico , Piridazinas/farmacologia , Piridazinas/uso terapêutico , Simendana , Vasodilatadores/farmacologia
20.
Curr Vasc Pharmacol ; 14(1): 37-47, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26463986

RESUMO

Pulmonary hypertension is among the causes of low cardiac output syndrome after neonatal and pediatric cardiac surgery. In the setting of transient postoperative myocardial dysfunction, even a moderate elevation of pulmonary pressure can result in heart dysfunction and circulatory collapse. Although, specific pharmacological manipulation of pulmonary vascular resistance is frequently required in the perioperative period, there is no widely standardized management. In this review, a systematic literature search of PubMed and MEDLINE databases using relevant terms was performed. All clinical trials and relevant manuscripts, along with important physiological, pharmacological, and evidence-based considerations involving the use of pulmonary vasodilators in the management of low cardiac output syndrome after cardiac surgery were reviewed. This article addresses the fifth of eight topics comprising the special issue entitled "Pharmacologic strategies with afterload reduction in low cardiac output syndrome after pediatric cardiac surgery".


Assuntos
Baixo Débito Cardíaco/tratamento farmacológico , Hipertensão Pulmonar/tratamento farmacológico , Vasodilatadores/uso terapêutico , Animais , Baixo Débito Cardíaco/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/etiologia , Recém-Nascido , Choque/etiologia , Choque/prevenção & controle , Resistência Vascular/efeitos dos fármacos , Vasodilatadores/administração & dosagem
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