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1.
Medicine (Baltimore) ; 98(42): e17615, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626139

RESUMO

BACKGROUND: The Fontan circulation is fragile, which is easily broken down. For now, there is no consensus on the drug treatment for the prevention of failure of the Fontan circulation. METHODS: Studies comparing pulmonary vasodilator and control in Fontan patients were identified by searching the PubMed, EMBASE, Clinical Trials, and the Cochrane Library databases until March 20, 2019. The assessed variables included the change of pulmonary resistance, heart function, exercise capacity, life of quality, mortality, and serials of adverse events before and after drug administration. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence interval (CI). Subgroup analysis stratified by drug was performed. RESULTS: This study will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study will assess the efficacy and safety of pulmonary vasodilators for patients after Fontan procedure, and provide more evidence-based guidance in clinical practice. PROSPERO REGISTRATION NUMBER: CRD42019132135.


Assuntos
Técnica de Fontan/métodos , Cardiopatias Congênitas/cirurgia , Hipertensão Pulmonar/tratamento farmacológico , Circulação Pulmonar/efeitos dos fármacos , Pressão Propulsora Pulmonar/efeitos dos fármacos , Vasodilatadores/uso terapêutico , Cardiopatias Congênitas/fisiopatologia , Humanos , Hipertensão Pulmonar/fisiopatologia
2.
Medicine (Baltimore) ; 98(41): e17333, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593082

RESUMO

Patients with structural heart disease (SHD) are more difficult to ablate than those with a structurally healthy heart. The reason may be technical problems. We compared periprocedural data in unselected patients (including SHD group) recruited for zero-fluoroscopy catheter ablation (ZF-CA) of supraventricular arrhythmias (SVTs).Consecutive adult patients with atrioventricular nodal reentry tachycardia (AVNRT), accessory pathways (AP), atrial flutter (AFL), and atrial tachycardia (AT) were recruited. A 3-dimensional electroanatomical mapping system (Ensite Velocity, NavX, St Jude Medical, Lake Bluff, Illinois) was used to create electroanatomical maps and navigate catheters. Fluoroscopy was used on the decision of the first operator after 5 minutes of unresolved problems.Of the 1280 patients ablated with the intention to be treated with ZF approach, 174 (13.6%) patients with SHD (age: 58.2 ±â€Š13.6; AVNRT: 23.9%; AP: 8.5%; AFL: 61.4%; and AT: 6.2%) were recruited. These patients were compared with the 1106 patients with nonstructural heart disease (NSHD) (age: 51.4 ±â€Š16.4; AVNRT: 58.0%; AP: 17.6%; AFL: 20.7%; and AT: 3.7% P ≤ .001). Procedural time (49.9 ±â€Š24.6 vs 49.1 ±â€Š23.9 minutes, P = .55) and number of applications were similar between groups (P = 0.08). The rate of conversion from ZF-CA to fluoroscopy was slightly higher in SHD as compared to NSHD (13.2% vs 7.8%, P = .02) while the total time of fluoroscopy and radiation doses were comparable in the group of SHD and NSHD (P = .55; P = .48).ZF-CA is feasible and safe in majority of patients with SHD and should be incorporated into a standard approach for SHD; however, the procedure requires sufficient experience.


Assuntos
Arritmias Cardíacas/cirurgia , Ablação por Cateter/métodos , Fluoroscopia/métodos , Cardiopatias Congênitas/cirurgia , Taquicardia Supraventricular/cirurgia , Adulto , Idoso , Arritmias Cardíacas/congênito , Estudos de Viabilidade , Feminino , Cardiopatias Congênitas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taquicardia Supraventricular/congênito , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(40): e17449, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577770

RESUMO

BACKGROUND: Pulmonary artery sling (PAS) is rare, often with tracheal stenosis. And the postoperative mortality is high. For now, there is no consensus on the tracheoplasty for the patients with PAS and tracheal stenosis. METHODS: Studies involving surgical repair of PAS and tracheal stenosis with and without tracheoplasty were identified by searching the PubMed, EMBASE, and the Cochrane Library databases until June 5, 2019. The assessed variables included ventilation time, early and late mortality, and symptom at follow-up. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence interval (CI). RESULTS: This study will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study will assess the safety and efficacy of tracheoplasty for patients with PAS and tracheal stenosis, and provide more evidence-based guidance in clinical practice. PROSPERO REGISTRATION NUMBER: CRD42019139788.


Assuntos
Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Artéria Pulmonar/anormalidades , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal/complicações , Estenose Traqueal/cirurgia , Humanos
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(9): 1035-1040, 2019 Sep 28.
Artigo em Chinês | MEDLINE | ID: mdl-31645494

RESUMO

OBJECTIVE: To analyse the clinical data of reoperations in congenital heart disease and discuss the management strategy of reoperation for congenital heart disease.
 Methods: We retrospectively studied the clinical data for patients underwent reoperation in congenital heart disease in Cardiovascular Surgery, Second Xiangya Hospital, Central South University from January 2007 to December 2015. Demographic and operative details, in-hospital mortality and major postoperative complications were analysed.
 Results: A total of 8 647 congenital heart disease surgery procedures were performed, including 147 (1.7%) reoperations. Among the patients, residual septal defect repair (30 cases, 20.4%), planed staged operation (28 cases, 19.0%), and Fontan procedure (20 cases, 13.6%) were the most common kinds of reoperation. In addition, 140 (95%) operations were through repeat sternotomies, 144 (98%) patients underwent operation with cardiopulmonary bypass, and 100 (68%) with cardiac arrest. Cardiopulmonary bypass and aortic cross clamp were maintained for 21-447 (135.5±87.8) minutes and 0-202 (49.9±49.7) minutes. There were 10 in-hospital deaths with a total mortality of 6.8%. The major complications included low cardiac output syndrome (24 cases, 16.3%), renal dysfunction (7 cases, 4.8%), respiratory insufficiency (14 cases, 9.5%), unplanned reoperations for drainage of haemorrhagic cardiac tamponade (4 cases), and delayed sternal closure (2 cases).
 Conclusion: Repeat sternotomy is the main way of reoperation, but it is not a major risk for operative mortality and morbidity. Improving the management of complex malformation, standardizing the follow-up, choosing the right timing of surgery, and reducing surgical complications will help reduce the risk of reoperation.


Assuntos
Cardiopatias Congênitas/cirurgia , Reoperação , Ponte Cardiopulmonar , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
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.
Methodist Debakey Cardiovasc J ; 15(2): 105-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384373

RESUMO

Patients with a functionally univentricular heart who have had an atriopulmonary Fontan are at risk for atrial dilatation, atrial arrhythmias, and progressive circulatory failure. Between 1994 and 2018, we performed 149 Fontan conversions with arrhythmia surgery and epicardial pacemaker placement at Ann & Robert H. Lurie Children's Hospital of Chicago. This operation converts the atriopulmonary Fontan to an extracardiac Fontan that improves hemodynamics and controls the atrial arrhythmias. Operative mortality during that time was 2%, and freedom from death or heart transplant at 10 years is 84%. For properly selected patients, Fontan conversion improves both survival and quality of life. Patients with an atriopulmonary Fontan constitute an eroding population, as they face many comorbidities and have a decreased life expectancy without treatment; therefore, all patients with an atriopulmonary Fontan should be evaluated for this procedure.


Assuntos
Arritmias Cardíacas/cirurgia , Cardiomegalia/cirurgia , Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Adolescente , Adulto , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Cardiomegalia/etiologia , Cardiomegalia/mortalidade , Cardiomegalia/fisiopatologia , Criança , Pré-Escolar , Tomada de Decisão Clínica , Feminino , Técnica de Fontan/efeitos adversos , Técnica de Fontan/mortalidade , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Intervalo Livre de Progressão , Reoperação , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
7.
Methodist Debakey Cardiovasc J ; 15(2): 145-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384378

RESUMO

Steady advances in the diagnosis and management of congenital heart disease over the last few decades has resulted in a growing population of adults with congenital heart disease (ACHD). Consequently, there has been a parallel increase in the number of ACHD patients plagued with end-stage heart failure. Even so, the transplantation rate for these patients has remained low, at about 3% of all adult heart transplants. This review discusses the scope of transplantation for ACHD, including indications and contraindications, specific challenges and nuances, and post-transplant outcomes.


Assuntos
Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Adulto , Fatores Etários , Tomada de Decisão Clínica , Progressão da Doença , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/efeitos adversos , Transplante de Coração/mortalidade , Humanos , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Listas de Espera
8.
World J Pediatr Congenit Heart Surg ; 10(4): 446-453, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307305

RESUMO

BACKGROUND: Very little is known about clinical and biomarker predictors of readmissions following pediatric congenital heart surgery. The cardiac biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) can help predict readmission in adult populations, but the estimated utility in predicting risk of readmission or mortality after pediatric congenital heart surgery has not previously been studied. Our objective was to evaluate the association between pre- and postoperative serum biomarker levels and 30-day readmission or mortality for pediatric patients undergoing congenital heart surgery. METHODS: We measured pre- and postoperative NT-proBNP levels in two prospective cohorts of 522 pediatric patients <18 years of age who underwent at least one congenital heart operation from 2010 to 2014. Blood samples were collected before and after surgery. We evaluated the association between pre- and postoperative NT-proBNP with readmission or mortality within 30 days of discharge, using multivariate logistic regression, adjusting for covariates based on the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Mortality Risk Model. RESULTS: The Johns Hopkins Children's Center cohort and the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) cohort demonstrate event rates of 12.9% and 9.4%, respectively, for the composite end point. After adjustment for covariates in the STS congenital risk model, we did not find an association between elevated levels of NT-proBNP and increased risk of readmission or mortality following congenital heart surgery for either cohort. CONCLUSIONS: In our two cohorts, preoperative and postoperative values of NT-proBNP were not significantly associated with readmission or mortality following pediatric congenital heart surgery. These findings will inform future studies evaluating multimarker risk assessment models in the pediatric population.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/sangue , Peptídeo Natriurético Encefálico/sangue , Readmissão do Paciente/tendências , Fragmentos de Peptídeos/sangue , Medição de Risco/métodos , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Seguimentos , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Mortalidade Hospitalar/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Maryland/epidemiologia , Alta do Paciente/tendências , Período Pós-Operatório , Prognóstico , Precursores de Proteínas , Estudos Retrospectivos , Taxa de Sobrevida/tendências
9.
Medicine (Baltimore) ; 98(29): e16554, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335738

RESUMO

BACKGROUND: The benefits of fenestration for patients undergoing Fontan procedure seem controversial at early and late postoperative stages. OBJECTIVE: We aimed to compare the outcomes between the fenestrated and non-fenestrated Fontan procedures. METHODS: Studies comparing the fenestrated and non-fenestrated Fontan procedures were identified by searching the PubMed, EMBASE, and Cochrane Library databases until July 2018. The assessed variables included postoperative oxygen saturation (SaO2), pulmonary artery pressure, mortality, cardiopulmonary bypass (CPB) time, ventilation time, intensive care unit stay, hospital stay, chest tube duration, protein-losing enteropathy, arrhythmia, and other follow-up outcomes including reintervention, stroke/thrombosis, and peak oxygen consumption. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/odds ratio (OR) with 95% confidence interval (CI). Subgroup analysis stratified by early and late outcomes was performed. RESULTS: A total of 1929 Fontan patients from 14 studies were included. The early postoperative SaO2 was lower with fenestration than without fenestration (MD -2.52, 95% CI -4.16 to -0.87, P <.05); however, the late postoperative SaO2 showed no difference between the 2 approaches. The CPB time was shorter without fenestration than with fenestration (MD 10.72, 95% CI 2.54-18.9, P <.05); however, the incidence of arrhythmia was lower with fenestration than without fenestration (OR 0.43, 95% CI 0.25-0.75, P <.05). Other variables showed no significant differences between the 2 approaches in Fontan patients. CONCLUSION: Fenestration appears to result in a lower incidence of arrhythmia but with a longer CPB time and lower early SaO2. Other outcomes are comparable between the 2 approaches.


Assuntos
Técnica de Fontan/métodos , Arritmias Cardíacas/etiologia , Ponte Cardiopulmonar , Cuidados Críticos , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Humanos , Tempo de Internação , Oxigênio/sangue , Consumo de Oxigênio , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Respiração Artificial
10.
Herz ; 44(6): 553-572, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31263905

RESUMO

Congenital heart diseases (CHD) are the most common types of congenital organ defects. Thanks to medical progress in congenital cardiology and heart surgery, most children with CHD reach adulthood. Despite primarily successful treatment residual and subsequent conditions as well as (non)cardiac comorbidities can influence the chronic course of the disease and lead to a higher morbidity and mortality. Adults with congenital heart disease (ACHD) in Germany are not tied to the healthcare structure despite the great need for aftercare. According to the results of the medical care of ACHD (MC-ACHD) study, ACHD centers and specialists in Germany are insufficiently perceived despite increased complication rates and the great need for specialist guidance. General practitioners and patients are not adequately informed about existing ACHD facilities. A better awareness of the ACHD problem should be created at the level of primary medical supply in order to optimize care and to reduce morbidity and mortality. Improved future-oriented patient care includes lifelong regular follow-up and the possibility of interdisciplinary, integrated medical care of CHD.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiologia , Cardiopatias Congênitas , Adulto , Cardiologia/tendências , Assistência à Saúde , Alemanha , Cardiopatias Congênitas/cirurgia , Humanos
11.
Pediatr Cardiol ; 40(6): 1238-1246, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31309235

RESUMO

The oral triiodothyronine for infants and children undergoing cardiopulmonary bypass (OTICC) trial showed that Triiodothyronine (T3) supplementation improved hemodynamic and clinical outcome parameters. We tested the validity of low cardiac output syndrome (LCOS), derived using clinical parameters and laboratory data, by comparing the LCOS diagnosis with objective parameters commonly measured in a cardiac intensive care unit (CCU) setting. OTICC, a randomized, placebo-controlled trial included children younger than 3 years with an Aristotle score between 6 and 9. We used the existing trial data set to compare the LCOS diagnosis with echocardiographic hemodynamic parameters. Additionally, we determined if LCOS, prospectively assigned during a clinical trial, served as an early predictor of clinical outcomes. All LCOS subjects at 6 and 12 h after cross-clamp release later showed significantly lower pulse pressure, stroke volume and cardiac output, and higher systemic vascular resistance. These LCOS patients also had significantly longer time to extubation (TTE) and higher mortality rate. LCOS incidence was significantly lower in the T3 treatment group [n = 86 vs. 66, respectively, p < 0.001; OR (95% CI) 0.43 (0.36-0.52)] particularly at 6 h. Also, LCOS patients in the placebo group had significantly lower FT3 serum levels over time. These analyses confirm that early clinically defined LCOS successfully predicts cardiac dysfunction determined later by objective hemodynamic echocardiographic parameters. Furthermore, early LCOS significantly impacts TTE and mortality. Finally, the data support prior clinical trial data, showing that oral T3 supplementation decreases early LCOS in concordance with reducing TTE.


Assuntos
Baixo Débito Cardíaco/tratamento farmacológico , Débito Cardíaco/efeitos dos fármacos , Receptores dos Hormônios Tireóideos/administração & dosagem , Tri-Iodotironina/administração & dosagem , Baixo Débito Cardíaco/etiologia , Baixo Débito Cardíaco/mortalidade , Ponte Cardiopulmonar/efeitos adversos , Criança , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Masculino , Estudos Prospectivos , Resultado do Tratamento
12.
Pediatr Cardiol ; 40(6): 1304-1313, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31338561

RESUMO

This study aimed to evaluate fetal echocardiographic parameters associated with neonatal intervention and single-ventricle palliation (SVP) in fetuses with suspected left-sided cardiac lesions. Initial fetal echocardiograms (1/2002-1/2017) were interpreted by the contemporary fetal cardiologist as coarctation of the aorta (COA), left heart hypoplasia (LHH), hypoplastic left heart syndrome (HLHS), mitral valve hypoplasia (MVH) ± stenosis, and aortic valve hypoplasia ± stenosis (AS). The cohort comprised 68 fetuses with suspected left-sided cardiac lesions (COA n = 15, LHH n = 9, HLHS n = 39, MVH n = 1, and AS n = 4). Smaller left ventricular (LV) length Z score, aortic valve Z score, ascending aorta Z score, and aorta/pulmonary artery ratio; left-to-right shunting at the foramen ovale; and retrograde flow in the aortic arch were associated with the need for neonatal intervention (p = 0.005-0.04). Smaller mitral valve (MV) Z score, LV length Z score, aortic valve Z score, ascending aorta Z score, aorta/pulmonary artery ratio, and LV ejection fraction, as well as higher tricuspid valve-to-MV (TV/MV) ratio, right ventricular-to-LV (RV/LV) length ratio, left-to-right shunting at the foramen ovale, abnormal pulmonary vein Doppler, absence of prograde aortic flow, and retrograde flow in the aortic arch were associated with SVP (p < 0.001-0.008). The strongest independent variable associated with SVP was RV/LV length ratio (stepwise logistical regression, p = 0.03); an RV/LV length ratio > 1.28 was associated with SVP with a sensitivity of 76% and specificity of 96% (AUC 0.90, p < 0.001). A fetal RV/LV length ratio of > 1.28 may be a useful threshold for identifying fetuses requiring SVP.


Assuntos
Ecocardiografia/métodos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Diagnóstico Pré-Natal , Adulto , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Valva Mitral/anormalidades , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Gravidez , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
13.
Pediatr Cardiol ; 40(6): 1296-1303, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31342114

RESUMO

Dysphagia and vocal cord dysfunction are frequent complications after congenital heart surgery. Both are risk factors for aspiration, which can lead to pneumonia, progressive lung disease, and respiratory arrest. A protocol was implemented to promote early detection of aspiration in a high-risk cohort of patients. Retrospective data were collected on all patients under 120 days old who underwent the Norwood procedure, aortic arch repair, Blalock-Taussig shunt placement, or cervical cannulation for extracorporeal membrane oxygenation from 10/2012 to 05/2016 at a single institution. Patients underwent an assessment of symptoms, fiberoptic endoscopic evaluation of swallowing (FEES), and modified barium swallow (MBS) study in the postoperative period prior to initiating oral feeds. Patients with and without aspiration were compared. Of the 96 patients included in the study, one-third (33%) of patients had evidence of vocal cord dysfunction by FEES and just over half (51%) had evidence of aspiration by FEES or MBS. Most (73%) of the patients with aspiration were asymptomatic and a majority (53%) of patients with aspiration had normal vocal cord function. Aspiration is common after congenital heart surgery, and an assessment of vocal cord or swallow function in isolation may lead to underdiagnosis. A comprehensive protocol including MBS and FEES is necessary for the early detection of vocal cord dysfunction and aspiration and may prevent adverse outcomes in high-risk postoperative patients.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/diagnóstico , Aspiração Respiratória/diagnóstico , Estudos de Casos e Controles , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/prevenção & controle , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Aspiração Respiratória/epidemiologia , Aspiração Respiratória/etiologia , Estudos Retrospectivos , Fatores de Risco , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia
14.
World J Pediatr Congenit Heart Surg ; 10(4): 440-445, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307294

RESUMO

BACKGROUND: Dexmedetomidine has been suggested as an arrhythmia prophylactic agent after surgery for congenital heart disease due to its heart rate lowering effect, though studies are conflicting. We sought to study the effect of dexmedetomidine in infants that are at highest risk for arrhythmias. METHODS: Retrospective cohort study of infants less than six months of age undergoing cardiopulmonary bypass for congenital heart disease. The arrhythmia incidence in the first 48 hours after surgery in infants receiving dexmedetomidine for sedation was compared to those that did not receive dexmedetomidine. RESULTS: A total of 309 patients were included, 206 patients who did not receive dexmedetomidine and 103 patients who did. The incidence of tachyarrhythmias was similar between the non-DEX group and the DEX group (19% vs 15%, P = .34). When adjusted for baseline differences, the non-DEX group did not have an increased risk of postoperative tachyarrhythmias (odds ratio [OR]: 1.4, 95% confidence interval [CI]: 0.5-3.8). The non-DEX group had an increased need for treatment for arrhythmias (18% vs 8%, P = .012). The three lesions with baseline higher risk for arrhythmias (tetralogy of Fallot, transposition of the great arteries, and complete atrioventricular canal) had an increased incidence of tachyarrhythmias in the non-DEX group (34% vs 6%, P = .027). This risk was not significant in multivariate analysis (OR: 2.5, 95% CI: 0.4-15.5). CONCLUSIONS: High-risk infants had decreased incidence of tachyarrhythmias when receiving dexmedetomidine, though this was not significant after accounting for baseline differences between groups.


Assuntos
Arritmias Cardíacas/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Dexmedetomidina/uso terapêutico , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Razão de Chances , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologia
15.
World J Pediatr Congenit Heart Surg ; 10(4): 492-498, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307301

RESUMO

The World Database for Pediatric and Congenital Heart Surgery was created to provide a resource for centers to be able to perform complex outcomes analyses of children undergoing repair of a congenital heart defect. In just under two years, the World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has amassed over 13,000 procedures from 55 centers into the database. This Proceedings of the 3rd World Database Symposium held at the 6th Scientific Meeting of the WSPCHS summarizes the presentations of international experts in the fields of outcomes analysis and care of children with congenital heart surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Congressos como Assunto , Cardiopatias Congênitas/cirurgia , Sociedades Médicas , Cirurgia Torácica , Criança , Bases de Dados Factuais , Humanos
16.
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
17.
World J Pediatr Congenit Heart Surg ; 10(4): 454-463, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307308

RESUMO

BACKGROUND: The completeness and accuracy of data contained within clinical databases and registries is critical to the reliability of reports emanating from these platforms. Therefore, vigorous data verification processes are a core competency of any mature database or registry. The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) has conducted audits of participant data for just over ten years. This report documents the validity of data elements within the STS CHSD. METHODS: We review the various elements of a robust audit process, detail the STS CHSD audit methodology, and report completeness and agreement rates for all adjudicated fields in the most recently completed audit. RESULTS: The rate of completeness for general data elements was 97.6% and the rate of agreement was 97.4%. The rate of completeness for variables in the mortality review was 100% and the rate of agreement was 99.3%. CONCLUSIONS: The STS CHSD audit is a highly structured and reproducible process. The most recently completed audit documents a very high level of completeness and accuracy of data variables, particularly those most germane to outcomes measurement.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Auditoria Clínica/estatística & dados numéricos , Cardiopatias Congênitas/cirurgia , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Sistema de Registros , Sociedades Médicas , Cirurgia Torácica/estatística & dados numéricos , Bases de Dados Factuais , Humanos , Cirurgiões/estatística & dados numéricos
18.
Artigo em Inglês | MEDLINE | ID: mdl-31307313

RESUMO

A 38-year-old female with tricuspid atresia and normally related great arteries, initially palliated with Björk modified Fontan, and ultimately converted to extracardiac conduit Fontan, with a history of ventricular tachycardia and hepatitis C virus (HCV) treated with sofosbuvir/ledipasvir, was referred to our center for consideration of combined heart and liver transplantation. The patient's blood group was O with panel reactive antibodies of 52%. She consented to consideration of HCV-positive donors. Fifteen days later, an HCV-positive donor was identified, and she underwent heart transplantation with pulmonary artery reconstruction performed jointly by adult and pediatric transplant surgeons. To our knowledge, this the first time an HCV-positive donor heart has been to transplant an adult with congenital heart disease.


Assuntos
Cardiopatias Congênitas/cirurgia , Transplante de Coração/métodos , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/imunologia , Hepatite C/virologia , Doadores de Tecidos , Adulto , Feminino , Anticorpos Anti-Hepatite C/sangue , Humanos , Transplantados , Carga Viral
19.
World J Pediatr Congenit Heart Surg ; 10(4): 416-423, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307314

RESUMO

BACKGROUND: Investigations of ventricular dominance and outcomes after the Fontan procedure have shown conflicting results. This may be due to the inclusion of multiple modifications of the Fontan or the omission of recently identified complications of the procedure. We examined the association between right ventricular dominance (RVD) and morbidity/mortality in a contemporary cohort following the extracardiac (EC) Fontan. METHODS: We studied all pediatric patients at our center who underwent a predominantly fenestrated EC Fontan from 2004 to 2016. Outcomes assessed were freedom from (1) Fontan failure (death, takedown, listing for transplantation) and (2) complication (arrhythmia requiring medication, postoperative pacemaker, or implantable cardioverter defibrillator requirement, stroke, thrombosis in the Fontan circuit, protein losing enteropathy, plastic bronchitis, New York Heart Association class >2). We defined the perioperative period as occurring before hospital discharge or within 30 days of the Fontan. RESULTS: A total of 137 patients (median age: 34 months, 62% male, 60% RVD) underwent the EC Fontan. Median duration of follow-up was 5.8 years (interquartile range: 2.4-9.0). Freedom from any event was 82.5% (RVD = 77%, LVD = 91%, χ2(1) = 5.03, P = .025) and RVD was associated with reduced event-free survival (hazard ratio: 2.94, P = .02). No confounders were identified. In the perioperative period, RVD was associated with reduced complication-free survival (P = .004). After this period, RVD was associated with reduced failure-free survival (P = .003). CONCLUSIONS: In this contemporary, single-center cohort of EC Fontan patients, RVD was associated with inferior outcomes.


Assuntos
Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Complicações Pós-Operatórias/etiologia , Função Ventricular Direita/fisiologia , Pré-Escolar , Intervalo Livre de Doença , Ecocardiografia , Feminino , Seguimentos , Técnica de Fontan/métodos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Morbidade/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
20.
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
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