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1.
Artigo em Inglês | MEDLINE | ID: mdl-31688622

RESUMO

Extraosseous Ewing sarcoma of primary cardiac origin is an extremely rare variety among pediatric cardiac neoplasms. We report a case of extraosseous Ewing sarcoma of primary cardiac origin in a 9-year-old girl, treated with debulking surgery, adjuvant chemotherapy, and radiotherapy.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31420313

RESUMO

Delayed sternal closure after pediatric cardiac surgery is a management option for the treatment of patients with severely impaired heart function. The optimal antimicrobial treatment strategy for this condition is unknown. The aim of this systematic review was to evaluate the current antibiotic administration attitudes in pediatric cardiac surgery patients needing an open chest in terms of infection with a focus on surgical site infection rate. The authors performed a systematic review and meta-analysis of all articles, which described the antibiotic administration strategy and surgical site infection rate in pediatric patients with an open chest after cardiac surgery. The authors performed a subgroup analysis on "standard" versus "non-standard" (defined as any antimicrobial drugs different from the adult guidelines recommendations) therapy for one-proportion meta-analysis with a random effect model. The authors identified 12 studies published from January 1, 2000 to July 1, 2019 including a total of 2,203 patients requiring an open chest after cardiac surgery, 350 of whom (15.9%) developed infections and 182 (8.3%) developed a surgical site infection. The surgical site infection rate in patients with "non-standard" strategy was higher than in patients with "standard" strategy: 8.8% (140 reported infections/1,582 patients) versus 6.8% (42 reported infections/621 patients), p = 0.001. The "standard" antibiotic management proposed by guidelines for adult cardiac surgery patients could be used an acceptable strategy to treat pediatric patients with an open chest after cardiac surgery.

3.
Cardiol Young ; 28(11): 1345-1347, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29998810

RESUMO

Disconnection of a pulmonary artery needs early surgical treatment in order to support the growth of the vessel. However, owing to the high rate of re-stenosis after traditional surgical reconstruction, we developed a hybrid approach involving the creation of pulmonary artery continuity by using autologous or heterologous tissue supported by stent implantation.


Assuntos
Prótese Vascular , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Artéria Pulmonar/anormalidades , Stents , Angiografia , Ecocardiografia , Cardiopatias Congênitas/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia
4.
Cardiol Young ; 27(2): 398-401, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28181900

RESUMO

Several surgical approaches for completion of a total cavopulmonary connection have been established for patients with anomalies of systemic venous connection in association with a functionally univentricular heart. We report an alternative technique designed to address the problem of widely separated inferior systemic veins, in which two extracardiac conduits were used. This technique was performed on three patients and yielded excellent short-term results, allowing us to operate on a beating heart with no need for cardioplegic arrest and aortic cross-clamping.


Assuntos
Técnica de Fontan/métodos , Átrios do Coração/anormalidades , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/anormalidades , Artéria Pulmonar/anormalidades , Veia Cava Superior/cirurgia , Anastomose Cirúrgica/métodos , Pré-Escolar , Seguimentos , Átrios do Coração/cirurgia , Cardiopatias Congênitas/diagnóstico , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Artéria Pulmonar/cirurgia
5.
Cardiol Young ; 27(2): 273-283, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27086665

RESUMO

BACKGROUND: In 2007, a partnership was initiated between a small-volume paediatric cardiac surgery unit located in Las Palmas de Gran Canaria, Spain, and a large-volume cardiac surgery unit located in Milan, Italy. The main goal of this partnership was to provide surgical treatment to children with CHD in the Canary Islands. METHODS: An operative algorithm for performing surgery in elective, urgent, and emergency cases was adopted by the this joint programme. Demographic and in-hospital variables were collected from the medical records of all the patients who had undergone surgical intervention for CHD from January, 2009 to March, 2013. Data were introduced into the congenital database of the European Congenital Heart Surgeons Association Congenital Database and the database was interrogated. RESULTS: In total, 65 surgical mission trips were performed during the period of this study. The European Congenital Heart Surgeons Association Congenital Database documented 214 total patients with a mean age at operation of 36.45 months, 316 procedures in total with 198 cardiopulmonary bypass cases, 46 non-cardiopulmonary bypass cases, 26 cardiovascular cases without cardiopulmonary bypass, 22 miscellaneous other types of cases, 16 interventional cardiology cases, six thoracic cases, one non-cardiac, non-thoracic procedure on a cardiac patient with cardiac anaesthesia, and one extracorporeal membrane oxygenation case. The 30-day mortality was 6.07% (13 patients). CONCLUSIONS: A joint programme between a small-volume centre and a large-volume centre may represent a valid and reproducible model for safe paediatric cardiac surgery in the context of a peripheral region.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiologia/organização & administração , Cardiopatias Congênitas/cirurgia , Sociedades Médicas , Especialidades Cirúrgicas/organização & administração , Pré-Escolar , Europa (Continente) , Feminino , Humanos , Masculino , Estudos Retrospectivos
6.
Rom J Morphol Embryol ; 57(2): 559-62, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27516034

RESUMO

Abnormal connection of the right superior caval vein to the left atrium is an uncommon systemic vein drainage anomaly, with only a few cases reported among congenital heart disease (CHD), around 20 cases published in the medical literature. The inferior vena cava connection with the left atrium, also very rare, can appear directly or in heterotaxy. Clinical suspicion arises due to the presence of cyanosis in the absence of other specific clinical signs (without other associated CHD). We present the cases of two children with abnormal superior and inferior systemic venous return. The first case is an abnormal connection of right superior vena cava to the left atrium associated with persistent left superior vena cava draining into the right atrium through the coronary sinus. The second case is an interruption of the inferior vena cava with hemiazygos continuation, drained into the left superior vena cava, which drained into the left atrium. The diagnosis was imagistic - echocardiography and angiography. Surgical treatment solutions vary from one case to another, usually following anatomic correction. Hypoxia accompanied by cyanosis must bring into question the pathology of systemic venous drainage anomaly, after other common causes have been excluded. Surgery is indicated in all cases due to the risk associated with the presence of right-to-left shunt.


Assuntos
Átrios do Coração/patologia , Veia Cava Inferior/anormalidades , Veia Cava Superior/anormalidades , Angiografia , Pré-Escolar , Seio Coronário/diagnóstico por imagem , Seio Coronário/patologia , Dilatação Patológica , Drenagem , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Lactente , Masculino , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/patologia
7.
Eur J Cardiothorac Surg ; 50(4): 642-649, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27013073

RESUMO

OBJECTIVES: The existing risk stratification scores for paediatric patients undergoing cardiac surgery include the Aristotle Basic Complexity (ABC) Score, the Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) Score and the Aristotle Comprehensive Complexity (ACC) Score. They are all based on the nature of the surgical operation (ABC and RACHS-1 Scores) with possible adjustment for a number of patient conditions (ACC Score). The present study investigates if the early postoperative parameters may be used to improve the preoperative mortality risk prediction. METHODS: A retrospective study on 1392 consecutive patients aged ≤12 years old, undergoing cardiac surgery with cardiopulmonary bypass and without a residual right-to-left shunt was conducted. The ABC Score and metabolic and respiratory postoperative parameters at arrival in the intensive care unit were tested for association and discriminative power for operative mortality. RESULTS: The ABC yielded a c-statistic of 0.746. Additional independent predictors of operative mortality were postoperative hypoxia [Formula: see text] and arterial blood lactates. In a multivariable model including the ABC Score, postoperative hypoxia and arterial blood lactates remained independently associated with operative mortality. A modified ABC Score was created, consisting of the ABC Score plus 1.5 points in case of postoperative hypoxia plus 1 point per each 1 mmol/l of arterial blood lactates. The new model was significantly (P = 0.043) more discriminative than the ABC Score, with a c-statistic of 0.803. CONCLUSIONS: Early postoperative respiratory and metabolic parameters increased the accuracy and discrimination of the ABC Score. An external validation is needed to confirm our results.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Medição de Risco/métodos , Pré-Escolar , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Hipóxia/etiologia , Lactente , Lactatos/sangue , Masculino , Modelos Estatísticos , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco
8.
G Ital Cardiol (Rome) ; 17(12): 1008-1011, 2016 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-28151505

RESUMO

A 56-year-old man presented to the Outpatient Cardiology Unit for dyspnea that had been lasting 6 months and an occasional episode of cold perspiration on climbing a flight of stairs. In the suspicion of coronary artery disease, he was prescribed a complete blood panel, an echocardiogram and a treadmill stress test. The echocardiogram, performed as late as 78 days after the first evaluation and only by chance scheduled 2 days before the stress test, enabled a diagnosis of left atrial myxoma for which the patient successfully underwent cardiac surgery. The authors discuss the aspecific and potentially misleading nature of myxoma symptoms and highlight the latency between cardiological evaluation and diagnostic echocardiography.


Assuntos
Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Diagnóstico Tardio , Dispneia/etiologia , Ecocardiografia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Fatores de Tempo
9.
Eur Heart J Suppl ; 18(Suppl E): E15-E18, 2016 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-28533710

RESUMO

Thanks to the improvement of surgical and interventional cardiac procedures, the majority of children with congenital heart defects (CHD) can now be expected to reach adulthood. The number of adults with congenital heart disease (ACHD) will inevitably increase, and recent data affirm that in Europe, we are actually faced with an estimated patient population of 2.3 million. These patients, particularly the adults with moderate and highly complex CHD, can be very difficult to manage, and should be treated in few experienced and specialized 'grown-up congenital heart disease' (GUCH) units, concentrating resources, patients, funding, and professional experiences. On 2000, we created a GUCH unit in our hospital that rapidly became a referral centre in Italy for number and complexity of patients treated. The present study is a presentation of how is organized our GUCH unit and a brief overview of our more recent experience with ACHD patients.

10.
Eur Heart J Suppl ; 18(Suppl E): E72-E78, 2016 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-28533720

RESUMO

Cooperation activity in training programmes promoted by IRCCS Policlinico San Donato and Bambini Cardiopatici nel Mondo Association is a model of cooperation between people as an alternative intervention in promoting the right to healthcare, especially offering programmes of training and medical care on cardiovascular and congenital heart disease. This new strategy, implemented in several developing countries, has absolutely contributed to the improvement of the medical services concerning the diagnostic and surgical approach in the treatment of paediatric and adult cardiovascular disease. To strengthen this kind of activity, both IRCCS Policlinico San Donato and Bambini Cardiopatici nel Mondo have introduced a global perspective aiming at the realization of surgical missions 'in situ', building new cardiac surgery units in collaboration with the local partners, which are mainly university hospitals. They, furthermore, support financially the scholarship and accommodation in favour of medical and paramedical staff.

11.
World J Pediatr Congenit Heart Surg ; 3(2): 251-4, 2012 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-23804784

RESUMO

The extracardiac conduit type of total cavopulmonary connection (TCPC) is the most common variation of the modified Fontan operation in current use. For patients with some forms of complex anatomy (eg, dextrocardia in situs solitus or asplenia syndrome), we have adopted a different technique: interposition of an intra-atrial conduit between the inferior vena cava (IVC) and the superior vena cava-right pulmonary artery (SVC-RPA) connection. We report our experience with six patients.

12.
Interact Cardiovasc Thorac Surg ; 14(3): 330-2, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22159265

RESUMO

Cor triatriatum dexter is a rare congenital anomaly, caused by the persistence of the right valve of the sinus venosus, which divides the right atrium into two chambers and its diagnosis is rather difficult, due to the features often mimicking Ebstein's anomaly. We describe a case followed from the foetal age for a relative right ventricular hypoplasia and suspicious pulmonary stenosis and diagnosed after birth to have cor triatriatum dexter with an obstructing membrane in the right atrium, needing surgical correction, done successfully.


Assuntos
Anormalidades Múltiplas , Procedimentos Cirúrgicos Cardíacos/métodos , Coração Triatriado/diagnóstico , Ecocardiografia Doppler/métodos , Doenças Fetais/diagnóstico , Ultrassonografia Pré-Natal/métodos , Adulto , Coração Triatriado/cirurgia , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez
13.
Ann Thorac Surg ; 90(4): 1278-85, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20868828

RESUMO

BACKGROUND: The Ross operation in children and adolescents offers many potential advantages. Concerns have been raised about the long-term development of the neoaortic complex and the risk of dilation. METHODS: Retrospective analysis of prospectively collected follow-up data in a population of patients who underwent Ross operations when they were younger than 18 years old was conducted. Echocardiographic and clinical data, including survival, need for reoperations, and quality of life, were analyzed in 95 patients for a median follow-up of 84 months. RESULTS: The neoaortic root and sinotubular junction demonstrated dilation that exceeded somatic growth. The neoaortic valve grew in a manner that reflected somatic proportions. Freedom from moderate neoaortic root dilation was 100% at 5 years and 77% after 10 years. Freedom from moderate neoaortic valve insufficiency was 86% at 5 years after the Ross procedure and 63% after 10 years. The use of a proximal anastomosis running suture (p = 0.005) and the degree of neoaortic valve insufficiency (p = 0.032) at discharge were independently associated with the degree of neoaortic valve insufficiency at follow-up. Freedom from neoaortic reintervention was 96% at the 5-year follow-up and 80% at the 10-year follow-up. Predictors of neoaortic reintervention were the use of an operative technique other than aortic root replacement (p = 0.002) and the degree of neoaortic valve insufficiency at discharge (p = 0.005). CONCLUSIONS: The Ross operation remains a viable option for children and adolescents with severe aortic valve disease; neoaortic complex dilation occurs but is not directly responsible for neoaortic valve insufficiency, which is the main cause for reoperation.


Assuntos
Insuficiência da Valva Aórtica/etiologia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Adolescente , Adulto , Valva Aórtica/patologia , Insuficiência da Valva Aórtica/cirurgia , Criança , Pré-Escolar , Dilatação Patológica , Feminino , Seguimentos , Humanos , Lactente , Masculino , Valva Pulmonar/transplante , Reoperação , Estudos Retrospectivos , Adulto Jovem
14.
J Invasive Cardiol ; 20(12): E327-8, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19057038

RESUMO

The hybrid approach to the therapy of congenital heart disease consists of the combination of surgical and interventional techniques in order to improve safety and to achieve better results. Here we report on a new application of this concept: the use of cutting-balloon angioplasty in a hybrid setting. After failure of conventional angioplasty by using high-pressure balloons, a 2-year-old girl with a diagnosis of tetralogy of Fallot with pulmonary atresia and hypoplasia of the pulmonary arteries underwent cutting-balloon angioplasty of a tight stenosis of the left pulmonary artery in the operating room. The procedure allowed the salvage of the left pulmonary artery and the result was stable during follow up.


Assuntos
Angioplastia Coronária com Balão/métodos , Atresia Pulmonar/terapia , Tetralogia de Fallot/cirurgia , Cateterismo Cardíaco , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Artéria Pulmonar
15.
Am Heart J ; 156(4): 706-12, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18926151

RESUMO

BACKGROUND: Percutaneous closure of atrial septal defect (ASD) is a valid alternative to surgical approach. Current device has significantly improved the success rate also in complex cases. The aim of this study is to assess the impact of age, defect size, and morphologic features on successfully percutaneous ASD closure. METHODS: Between January 2000 and September 2004, 1,013 consecutive patients underwent closure of an isolated type II ASD at our institution. The following outcomes have been evaluated: (1) role of percutaneous ASD closure as alternative to surgical repair, in current daily practice; (2) impact of age on the selected closure approach; (3) analysis of morphologic variety of ASD and its effect on the closure technique; (4) possible role of specific device selection according to ASD morphology to improve procedural success. RESULTS: During the study period, up to 80% of secundum ASDs were suitable for percutaneous closure with the currently available devices. Need for surgical ASD closure was more common in pediatric patients, likely reflecting the more frequent diagnosis of larger and complex defects at a young age. Accurate ADS morphology assessment and appropriate device selection are key elements to obtain procedural success. In particular, among all the ASD characteristics, the rim absence is the main limiting factor to a successful percutaneous ASD closure. A trend of reduction in peri-procedural adverse events was observed during the study period, with complications needing immediate cardiac surgery occurred only in 1% of cases. CONCLUSIONS: Percutaneous ASD closure is feasible and associated with low complication rate. A thorough analysis of morphologic aspects is mandatory in order to select the appropriate device and the optimal approach. Surgical closure remains the treatment of choice in selected patients.


Assuntos
Comunicação Interatrial/patologia , Comunicação Interatrial/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Angiografia Coronária , Ecocardiografia Transesofagiana , Feminino , Comunicação Interatrial/diagnóstico por imagem , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próteses e Implantes , Desenho de Prótese , Resultado do Tratamento
16.
J Cardiovasc Med (Hagerstown) ; 8(3): 197-200, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17312438

RESUMO

Percutaneous closure of secundum atrial septal defects may be complicated by immediate or late device embolization. Percutaneous retrieval techniques are usually successful even if sometimes surgery is required. The optimal selection of an atrial septal defect and the choice of appropriate device sizes are fundamental to reduce the incidence of embolization. We describe a case of late device embolization occurring two years after transcatheter atrial septal defect closure and for which percutaneous retrieval was unsuccessfully attempted.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos , Remoção de Dispositivo/métodos , Comunicação Interatrial/terapia , Embolia Pulmonar/terapia , Adulto , Feminino , Humanos , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia
18.
Am Heart J ; 151(1): 228-34, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16368323

RESUMO

BACKGROUND: Surgical closure of atrial septal defect (ASD) provides excellent results. Given the increasing popularity of percutaneous techniques, a comparison between the 2 methods is needed. METHODS: Between December 1988 and June 2003, we performed 1284 procedures in 1268 consecutive patients with isolated secundum ASD. Five hundred and thirty-three patients underwent surgical repair of ostium secundum ASD (group A). Seven hundred and fifty-one consecutive patients underwent percutaneous ASD closure (group B). The following outcomes were studied: mortality, morbidity, hospital stay, and efficacy. RESULTS: There were no postoperative deaths. The overall rate of complications was higher in group A than in group B: 44% (95% CI 39.8%-48.2%) versus 6.9 % (95% CI 5%-8.7%) (P < .0001). Major complications were also more frequent in group A: 16% (95% CI 13%-19%) versus 3.6% (95% CI 2.2%-5.0%) (P = .002). Multiple logistic regression analysis showed that surgery was independently strongly related to the occurrence of total complication (odds ratio [OR] 8.13, 95% CI 5.75-12.20) and of major complications (OR 4.03, 95% CI 2.38-7.35). The occurrence of minor complications was independently related to surgery (OR 7.33, 95% CI 4.75-11.02), childhood (OR 1.52, 95% CI 1.01-2.34), and presence of systemic hypertension (OR 1.35, 95% CI 1.01-4.41). Hospital stay was shorter in group B (3.2 +/- 0.9 vs 8.0 +/- 2.8 days, P < .0001). CONCLUSIONS: Percutaneous ASD closure provides, in experienced hands and in highly specialized centers, excellent results with a lower complication rate and requires a shorter stay in hospital.


Assuntos
Comunicação Interatrial/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Tempo
19.
Ann Thorac Surg ; 79(6): 2150-1, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15919334

RESUMO

We describe the cases of 2 infants aged 6 and 2 1/2 months, respectively, affected by mitral valve dysplasia that caused severe valvular insufficiency and heart failure in which a surgical correction was indicated because of critical general conditions. In both patients the anatomic characteristics of the valves were not suitable for repair, and an implant of a mechanical prosthesis was excluded because of the very young age of the infants and the impossibility of maintaining an adequate anticoagulant therapy. Therefore a Ross-Kabbani intervention was performed with an implant of a pulmonary autograft (in the mitral position) and an insertion of a pulmonary homograft. The postoperative course was free of major complications and good function of the autograft was present at short-term follow-up in both cases.


Assuntos
Insuficiência da Valva Mitral/cirurgia , Valva Pulmonar/transplante , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar , Humanos , Lactente , Masculino , Insuficiência da Valva Mitral/complicações , Transplante Autólogo , Resultado do Tratamento
20.
Ital Heart J ; 4(3): 211-3, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12784749

RESUMO

Tricuspid valve dysplasia, other than Ebstein's anomaly, is a very rare congenital heart defect. During the prenatal and/or the neonatal periods the clinical picture is very critical. We here report on a newborn infant with severe tricuspid valve dysplasia and 4/4 tricuspid regurgitation, giant right atriomegaly, functional pulmonary atresia with ductal-dependent pulmonary blood flow. The child was successfully submitted to implantation of a 15 mm pulmonary stentless heterograft valve using the top-hat technique.


Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide/congênito , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/anormalidades , Valva Tricúspide/cirurgia , Ponte Cardiopulmonar , Ecocardiografia , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Humanos , Recém-Nascido , Masculino , Atresia Pulmonar/diagnóstico , Atresia Pulmonar/cirurgia , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico , Ultrassonografia Pré-Natal
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