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1.
Zhonghua Wai Ke Za Zhi ; 57(12): 939-943, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826600

RESUMO

Objective: To examine the early- and midterm outcomes of pulmonary artery banding as an initial palliation in patients with single ventricle associated with unrestricted pulmonary blood flow. Methods: Between January 2008 and December 2017, 49 patients with single ventricle and unrestricted pulmonary blood flow underwent pulmonary artery banding at Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University. There were 29 males and 20 females. The age at the time of surgery was 5.6 (11.5) months (M(Q(R))), and the weight was 5.2 (3.9) kg. The medical records and results after pulmonary artery banding (death/reoperation, transition to the Glenn procedure) and subsequently after the Glenn procedure (death, transition to the Fontan procedure) were reviewed retrospectively. Actuarial survivals were estimated by the Kaplan-Meier curve. Relative factors for affecting outcomes were analyzed using the Cox regression hazard model. Results: There were 8 early deaths, with a mortality of 16.3%, including 4 cases who received simultaneous arch repair. There were 5 late deaths. During the follow-up of 47(62) (M(Q(R))) months, 11 patients (22.4%) underwent pulmonary artery banding adjustment, 29 patients (59.2%) underwent the Glenn procedure, 21 patients (42.8%) underwent the Fontan procedure. The survival of patients after the initial pulmonary artery banding were 77.4% (95%CI: 65.6% to 89.2%) and 72.6% (95%CI: 59.9% to 85.3%) at 1 year and 5 years, respectively. Multivariate Cox regression analysis revealed that systemic ventricular outflow tract obstruction (HR=4.25, 95%CI: 1.50 to 12.03, P=0.006) and total anomalous pulmonary venous connection (HR=6.49, 95%CI: 3.24 to 12.98, P=0.000) were relative factors for death. Conclusions: The early and midterm outcomes of pulmonary artery banding as an initial palliative strategy is not satisfactory. Systemic ventricular outflow tract obstruction and total anomalous pulmonary venous connection are associated with high mortality.


Assuntos
Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Cuidados Paliativos/métodos , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Vasculares/mortalidade , Feminino , Seguimentos , Ventrículos do Coração/anormalidades , Humanos , Lactente , Recém-Nascido , Masculino , Circulação Pulmonar , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
2.
Tex Heart Inst J ; 46(3): 225-228, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708710

RESUMO

Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. Four months after corrective surgery, she was doing well. We discuss the reperfusion phenomenon in our patient's case, as well as other considerations in this combination of congenital defects.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Síndrome de Turner/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Cateterismo Cardíaco , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Ecocardiografia , Feminino , Fluoroscopia , Humanos , Recém-Nascido , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia
3.
J Cardiothorac Surg ; 14(1): 196, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718656

RESUMO

BACKGROUND: Primary thrombosis of the pulmonary vasculatures without extra-pulmonary sources of embolism are uncommon. Here, we report 2 cases of thrombosis of the stump of the remnant pulmonary vasculatures after lung resection complicated by embolic events with review of the literature. CASE PRESENTATION: A 75-year-old female was consulted to evaluate cardiac source of embolism for acute cerebral infarction. The patient underwent left upper lobectomy because of lung cancer 2 years ago. Cardiovascular imaging revealed about 1.6 cm × 1.4 cm sized thrombus within the remnant stump of the left superior pulmonary vein. The patient was treated by anticoagulation with warfarin, because the patients refused surgical removal of thrombus. A 57-year-old female who had a history of right pneumonectomy 10 years ago presented with dyspnea. Cardiovascular imaging revealed 1.7 × 1.5 cm sized thrombus in the right pulmonary artery stump and small pulmonary embolism in the left lower segmental pulmonary artery. The patient was treated by long-term anticoagulation with warfarin, and the thrombus and pulmonary embolism were resolved. CONCLUSION: The present cases demonstrated that very late thrombosis of the remnant pulmonary vascular structures and subsequent fatal embolic complications can develope even several years later after lung resection. Therefore, the dead space of the remnant vascular structures should be minimized during lung resection surgery, and the developement of delayed thromboembolic complications associated with vascular stump thrombosis should be carefully monitored.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Embolia Pulmonar/etiologia , Veias Pulmonares/diagnóstico por imagem , Trombose Venosa/etiologia , Idoso , Infarto Encefálico/etiologia , Dispneia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Veias Pulmonares/cirurgia , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem
4.
J Vet Cardiol ; 25: 32-40, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31542555

RESUMO

Pulmonary artery banding (PAB) is a viable but underreported palliative option for hemodynamically significant ventricular septal defect in small animals. A significant challenge associated with PAB is judging the degree of band tightening, which can be further complicated when animals are immature and still growing at the time of PAB. If a pulmonary artery band is overtightened or becomes progressively too tight after surgery, the result can be reversal of shunt flow with potentially devastating consequences. Placement of a band that could be percutaneously dilated using a balloon catheter affords a minimally invasive option for partially or completely relieving the band should it become too tight after PAB. This report describes a surgical technique for placement of a dilatable pulmonary artery band, reviews guidelines for tightening the band, and reports the outcome of three cats undergoing the procedure. All three cats showed evidence of reduced hemodynamic load after PAB for a period of up to three years after PAB.


Assuntos
Doenças do Gato/cirurgia , Comunicação Interventricular/veterinária , Artéria Pulmonar/cirurgia , Animais , Gatos , Comunicação Interventricular/cirurgia , Hemodinâmica , Masculino , Equipamentos Cirúrgicos , Toracotomia/veterinária
5.
Rev Port Cir Cardiotorac Vasc ; 26(2): 147-149, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476817

RESUMO

We report the case of a 44 year-old patient with complex ACHD, admitted with acute decompensated heart failure (ADHF) in hemodynamic profile B. He had a single ventricle with pulmonary atresia, previously submitted to three modified Blalock-Taussig shunts (mBTs) at the age of 2, 12 and 19 years old. Despite conventional treatment with diuretics, ß-blockers (BB) and isosorbide dinitrate the patient progressed to profile C and the transthoracic echocardiogram disclosed a reduced systolic function. Likewise, levosimendan was commenced and an appropriate decongestion and a marked reduction in the NT-proBNP were seen. Treatment with angiotensin-converting-enzyme inhibitor, BB, ivabradine and mineralocorticoid receptor was optimized. The patient was discharged home after 26 days in NYHA class III and referred for heart transplant after right heart catheterization. To our knowledge, this is the first report of successful levosimendan's use in ADHF in a mBTs long-term survivor.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/tratamento farmacológico , Ventrículos do Coração/anormalidades , Simendana/uso terapêutico , Adulto , Procedimento de Blalock-Taussig , Cardiopatias Congênitas/complicações , Insuficiência Cardíaca/etiologia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Artéria Pulmonar/anormalidades , Artéria Pulmonar/cirurgia , Resultado do Tratamento
6.
Isr Med Assoc J ; 21(8): 528-531, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474014

RESUMO

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, which is caused by chronic obstruction of major pulmonary arteries. CTEPH can be cured by pulmonary endarterectomy (PEA). PEA for CTEPH is a challenging procedure, and patient selection and the perioperative management are complex, requiring significant experience. OBJECTIVES: To describe the establishment of a national CTEPH-PEA center in Israel and present results of surgery. METHODS: In this study, we reviewed the outcomes of PEA in a national referral, multi-disciplinary center for CTEPH-PEA. The center was established by collaborating with a high-volume center in Europe. A multidisciplinary team from our hospital (pulmonary hypertension specialist, cardiac surgeon, cardiac anesthesiologist and cardiac surgery intensivist was trained under the guidance of an experienced team from the European center. RESULTS: A total of 38 PEA procedures were performed between 2008 and 2018. We included 28 cases in this analysis for which long-term follow-up data were available. There were two hospital deaths (7%). At follow-up, median New York Heart Association (NYHA) class improved from III to I (P < 0.0001), median systolic pulmonary pressure decreased from 64 mmHg to 26 mmHg (P < 0.0001), and significant improvements were seen in right ventricular function and exercise capacity. CONCLUSIONS: A national center for performance of a rare and complex surgical procedure can be successfully established by collaboration with a high-volume center and by training a dedicated multidisciplinary team.


Assuntos
Endarterectomia/métodos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/cirurgia , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgia , Encaminhamento e Consulta , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
7.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401571

RESUMO

A woman with asymptomatic pulmonary arteriovenous malformation (PAVM) discovered incidentally on admission developed recurrent generalised seizures. Immediately after, the PAVM demonstrated marked expansion, and was safely resected. Congenital PAVMs (associated with hereditary haemorrhagic telangiectasia or sporadic) are considered stable lesions that exhibit very slow growth if at all. A review of the literature reveals all circumstances of accelerated growth of PAVM (puberty, pregnancy, postpartum, pulmonary hypertension) and suggests a novel mechanism of seizure-associated expansion. This is important because the size and rapid growth of PAVMs correlate with the potential for rupture and other ominous complications such as right to left shunt and paradoxical emboli. The new seizures-PAVM progression association mandates recognition since the risk of seizures in patients with PAVM is substantial. Our observations strongly suggest the need to monitor PAVM in patients with or without haemorrhagic telangiectasis by repeated imaging after generalised seizures to evaluate potential expansion and risk.


Assuntos
Fístula Arteriovenosa/complicações , Pulmão/patologia , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Convulsões/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/cirurgia , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Tomografia Computadorizada por Raios X
8.
J Vet Cardiol ; 24: 20-27, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405551

RESUMO

A 9-month-old kitten with increased resting respiratory rate and exercise intolerance was diagnosed with a congenital partial atrioventricular septal defect causing pulmonary over circulation and presumed pulmonary hypertension based on echocardiogram. Invasive pressure measurements and contrast angiography confirmed this diagnosis. The cat underwent pulmonary artery banding under general anesthesia. Findings of echocardiogram 10 days postoperatively suggested reduced left-to-right shunt volume. Echocardiographic findings were static 4 months postoperatively.


Assuntos
Doenças do Gato/diagnóstico , Comunicação Interventricular/veterinária , Artéria Pulmonar/anormalidades , Animais , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/cirurgia , Gatos , Diagnóstico Diferencial , Ecocardiografia/veterinária , Comunicação Interventricular/diagnóstico , Masculino , Artéria Pulmonar/cirurgia
9.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352379

RESUMO

We report the case of a patient diagnosed with extreme tetralogy of Fallot who received subclavian-pulmonary artery shunt at the age of 3 years and underwent corrective surgery at the age of 16 years. The patient developed progressive effort dyspnea and left ventricular dysfunction from the age of 40 years. The exploratory finding of a continuous jugular and left subclavian murmur prompted an echocardiographic study that evidenced a continuous flow in the suprasternal view. CT study confirmed the patency of the surgical subclavian-pulmonary artery shunt, which was percutaneously embolised with the implantation of an Amplatzer plug, with a good final outcome and no residual flow. The patient showed a satisfactory development with clinical improvement, decreased left ventricular volume and enhanced left ventricular function.


Assuntos
Procedimento de Blalock-Taussig , Dispneia/etiologia , Embolização Terapêutica , Tetralogia de Fallot/complicações , Grau de Desobstrução Vascular/fisiologia , Disfunção Ventricular Esquerda/etiologia , Adulto , Eletrocardiografia , Humanos , Masculino , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Artéria Subclávia/fisiopatologia , Artéria Subclávia/cirurgia , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/cirurgia
10.
Kyobu Geka ; 72(8): 581-585, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31353348

RESUMO

Right pulmonary arteriovenous fistula(PAVF) developed in a 18-month-old girl after total cavopulmonary shunt(TCPS) operation. The patient was diagnosed as polysplenia, single atrium, single ventricle, dextrocardia, pulmonary atresia, congenitally complete atrioventricular block, and absent infrahepatic segment of the inferior vena cava with azygous continuation to the right superior vena cava. The hepatic veins were connected to the left-side atrium. At age of 7 month, TCPS operation was performed. Arterial oxygen saturation decreased to 70% at 8 months after TCPS operation. We performed total right heart bypass operation with connected hepatic vein to the azygous vein using a 8-mm ePTFE tube graft, combined with dilatable right pulmonary artery banding( PAB). With PAB on the right pulmonary artery adjacent to the Glenn anastomosis, arterial saturation was 80% and the patient was successfully weaned off cardiopulmonary bypass. At 3 months after TRHB operation, systemic saturation increased to 90%.The right pulmonary artery banding site was successfully dilated by balloon angioplasty.


Assuntos
Anastomose Cirúrgica , Fístula Arteriovenosa/complicações , Derivação Cardíaca Direita , Cardiopatias Congênitas , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Fístula Arteriovenosa/cirurgia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Veias Hepáticas , Humanos , Lactente , Artéria Pulmonar/cirurgia , Veias Pulmonares/cirurgia , Veia Cava Inferior
11.
World J Pediatr Congenit Heart Surg ; 10(4): 499-501, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307304

RESUMO

BACKGROUND: Several modifications of the Norwood procedure utilizing valved right ventricle to pulmonary artery conduits have recently been reported. Our group has been using aortic or pulmonary valved homografts combined with PTFE tube grafts for now 16 years. METHODS: In this report, we review our technique in detail and describe any changes that have occurred over the years. We provide detailed illustrations of our preferred surgical technique, report outcome data, and compare it to the other conduit options available. RESULTS: Between 2006 and 2015, 130 stage I Norwood procedures were performed at our institution, 100 of them using valved conduits. Our technique is described and illustrated in detail. Early mortality was 15%. Postoperative percutaneous intervention on the conduit was required in 29% of cases. CONCLUSIONS: While a randomized trial comparing different valved conduits is lacking, we believe a composite conduit made from homograft aortic or pulmonary valves and PTFE tube grafts is an excellent choice in stage I Norwood procedure.


Assuntos
Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Procedimentos de Norwood/métodos , Artéria Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Transplante Homólogo , Resultado do Tratamento
12.
Kyobu Geka ; 72(5): 349-353, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31268031

RESUMO

We report a case of a 73-year-old woman who was diagnosed with anomalous origin of the left coronary artery(LCA) from the pulmonary artery(ALCAPA) by coronary angiography. Drug stress myocardial perfusion scintigraphy demonstrated myocardial ischemia in the left anterior descending coronary artery (LAD) region. She underwent single coronary artery bypass grafting to LAD using left internal thoracic artery (LITA) and direct closure of the origin of the anomalous LCA. Postoperative coronary catheterization revealed a patent graft showing no residual shunt from the pulmonary artery into the left coronary artery. Myocardial scintigraphy proved improvement of the ischemia. In general, once ALCAPA is diagnosed, early surgical intervention is recommended. However, since there are few reports regarding surgical treatment for ALCAPA in elderly patients, the optimal treatment strategy is not completely established. Therefore careful long-term follow-up is mandatory.


Assuntos
Síndrome de Bland-White-Garland , Artéria Pulmonar , Idoso , Angiografia Coronária , Ponte de Artéria Coronária , Feminino , Humanos , Artéria Pulmonar/cirurgia
13.
Anaesthesia ; 74(10): 1282-1289, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31273760

RESUMO

The measurement of extravascular lung water is a relatively new technology which has not yet been well validated as a clinically useful tool. We studied its utility in patients undergoing pulmonary endarterectomy as they frequently suffer reperfusion lung injury and associated oedematous lungs. Such patients are therefore ideal for evaluating this new monitor. We performed a prospective observational cohort study during which extravascular lung water index measurements were taken before and immediately after surgery and postoperatively in intensive care. Data were analysed for 57 patients; 21 patients (37%) experienced severe reperfusion lung injury. The first extravascular lung water index measurement after cardiopulmonary bypass failed to predict severe reperfusion lung injury, area under the receiver operating characteristic curve 0.59 (95%CI 0.44-0.74). On intensive care, extravascular lung water index correlated most strongly at 36 h, area under the receiver operating characteristic curve 0.90 (95%CI 0.80-1.00). Peri-operative extravascular lung water index is not a useful measure to predict severe reperfusion lung injury after pulmonary endarterectomy, however, it does allow monitoring and measurement during the postoperative period. This study implies that extravascular lung water index can be used to directly assess pulmonary fluid overload and that monitoring patients by measuring extravascular lung water index during their intensive care stay is useful and correlates with their clinical course. This may allow directed, pre-empted therapy to attenuate the effects and improve patient outcomes and should prompt further studies.


Assuntos
Endarterectomia/efeitos adversos , Água Extravascular Pulmonar , Lesão Pulmonar/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Artéria Pulmonar/cirurgia , Traumatismo por Reperfusão/diagnóstico , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Curva ROC , Termodiluição
14.
Khirurgiia (Mosk) ; (7): 10-14, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355808

RESUMO

Surgical treatment of a patient with primary sarcoma of pulmonary trunk is presented in the article. This rare disease is characterized by poor prognosis if early diagnosis and adequate surgical treatment are absent.


Assuntos
Neoplasias Pulmonares/cirurgia , Artéria Pulmonar/cirurgia , Sarcoma/cirurgia , Neoplasias Vasculares/cirurgia , Diagnóstico Precoce , Humanos , Artéria Pulmonar/patologia , Sarcoma/diagnóstico , Neoplasias Vasculares/diagnóstico
15.
J Cardiothorac Surg ; 14(1): 99, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159878

RESUMO

BACKGROUND: There is great discussion about non-confluent pulmonary artery (PA) reconstruction, and several materials have been used. Autologous pericardium is considered feasible for infectious resistance, autoimmune response, extensibility, and growth potential. CASE PRESENTATION: The patient was born at 39 weeks (body mass = 2550 g). He was diagnosed with tetralogy of Fallot, pulmonary atresia, non-confluent PA, and bilateral patent ductus arteriosus. Right and left Blalock-Taussig shunts with patent ductus arteriosus ligations were placed on day 27 and 3 months, respectively. At 19 months (8.8 kg), definitive repair was performed with tricuspid valved conduit concurrent with PA reconstruction using an autologous pericardium roll conduit. The autologous pericardium was treated with glutaraldehyde (autologous pericardium fixed with 0.4% glutaraldehyde for 7 min and rolled as conduit - 12 mm in diameter and 30 mm in length). Following an incision on the visceral side of the PAs before the 1st branch, the autologous pericardial roll conduit was anastomosed. Follow-up angiographies on postoperative months 9 and 57 demonstrated that the PA, including the autologous pericardium roll conduit, had spontaneously enlarged. CONCLUSION: Particularly for non-confluent PA, the patients require increased pulmonary beds at an early age because of hypoplastic PA. While size mismatch between the graft and native PA develops as the child grows, size-adjustable extensibility of the PA graft should be noted.


Assuntos
Pericárdio/transplante , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Anormalidades Múltiplas/cirurgia , Pré-Escolar , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/cirurgia , Humanos , Lactente , Masculino , Artéria Pulmonar/anormalidades , Atresia Pulmonar/complicações , Atresia Pulmonar/cirurgia , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia , Transplante Autólogo
16.
Ann Thorac Surg ; 108(3): 785-791, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31152733

RESUMO

BACKGROUND: Successful repair of anomalous origin of coronary artery from the pulmonary artery (ACAPA) is generally associated with a good prognosis. However, risk factors for poor postoperative outcomes have not been well characterized. This study used a multicenter data set to determine predictors of mortality after ACAPA repair. METHODS: A retrospective analysis was performed using The Society of Thoracic Surgeons Congenital Heart Surgery Database's Participant User File. After identification of all patients with ACAPA who underwent repair from 2007 to 2016, demographics, preoperative and intraoperative variables, and postoperative complications were compared between survivors and nonsurvivors. The primary outcomes included (1) in-hospital mortality and (2) the need for postoperative extracorporeal membrane oxygenation (ECMO) support. Multivariable logistic regression was used to determine preoperative and intraoperative risk factors for these outcomes. RESULTS: Of the 703 patients who underwent ACAPA repair, 20 (2.8%) died during the same hospitalization. The odds of mortality were increased if preoperative shock was present (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.4 to 15.1; P = .01) and if postoperative ECMO was required (OR, 11.8; 95% CI, 3.6 to 38.4; P < .001). The odds of postoperative ECMO use were increased if preoperative shock was present (OR, 3.6; 95% CI, 1.6 to 7.6; P = .001). Lower weight was also a risk factor for both mortality and postoperative ECMO. CONCLUSIONS: Lower weight, preoperative shock, and postoperative ECMO use were identified as risk factors for in-hospital mortality in patients undergoing ACAPA repair. These important perioperative factors likely reflect the clinical severity of presentation and suggest a role for early consideration of postoperative mechanical circulatory support to improve outcomes.


Assuntos
Anomalias dos Vasos Coronários/cirurgia , Cardiopatias Congênitas/cirurgia , Mortalidade Hospitalar , Complicações Pós-Operatórias/mortalidade , Artéria Pulmonar/anormalidades , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Causas de Morte , Estudos de Coortes , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/mortalidade , Bases de Dados Factuais , Educação Médica Continuada , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/mortalidade , Humanos , Recém-Nascido , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Análise Multivariada , América do Norte , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Medição de Risco , Sociedades Médicas , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(23): e15874, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169692

RESUMO

RATIONALE: Pulmonary artery sarcomas (PAS) are easily misdiagnosed as thromboembolic disease of pulmonary arteries, because of rarity and presenting with nonspecific signs, symptoms, or imaging findings. PATIENT CONCERNS: A 26-year-old man was admitted to the department of invasive technology with fever and dyspnea. Blood tests showed inflammatory activity, a slight increase of D-dimer and Fibrin Degradation Product. A chest enhanced computed tomography (CT) scanning revealed multiple filling defects occurred in the main trunk of both pulmonary arteries and branches of the left pulmonary artery DIAGNOSES:: It was initially diagnosed with pulmonary embolism (PE) and deep vein thrombosis (DVT), but was eventually diagnosed with pulmonary artery sarcoma that was confirmed by biopsy. INTERVENTIONS: The transcatheter thrombolysis therapy, inferior vena cava filter implantation, and operation were performed. OUTCOMES: The Organized mass was removed by the operation and was pathologically diagnosed as pulmonary artery sarcoma, the patient received postoperative chemotherapy according to the recommendation of oncology department. LESSONS: Coagulation markers have been reported to differentiate PAS from PE, but this case suggested that PAS can be associated with DVT and abnormal coagulation-fibrinolysis system.


Assuntos
Artéria Pulmonar/patologia , Sarcoma/diagnóstico , Neoplasias Vasculares/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Erros de Diagnóstico , Humanos , Masculino , Trombólise Mecânica , Artéria Pulmonar/cirurgia , Sarcoma/patologia , Sarcoma/cirurgia , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgia , Filtros de Veia Cava , Trombose Venosa/terapia
20.
Pediatr Cardiol ; 40(6): 1317-1319, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31240369

RESUMO

Pulmonary artery banding may benefit infants with dilated cardiomyopathy. We present the case of an infant with end-stage dilated cardiomyopathy and intractable heart failure who received pulmonary artery banding. Serial follow-up through two-dimensional and three-dimensional echocardiography revealed gradual improvement in the left ventricular ejection fraction and favorable remodeling. The result of three-dimensional speckle tracking suggested that this benefit is associated with improvements in global strain and intraventricular dyssynchrony.


Assuntos
Ecocardiografia Tridimensional/métodos , Artéria Pulmonar/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Feminino , Insuficiência Cardíaca/complicações , Humanos , Lactente , Cuidados Paliativos/métodos , Artéria Pulmonar/cirurgia , Disfunção Ventricular Esquerda/diagnóstico por imagem
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