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1.
Int Heart J ; 61(4): 851-855, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32728004

RESUMO

Protein-losing enteropathy (PLE) is one of the major complications after a Fontan operation. Some PLE patients suffer from concurrent gastrointestinal bleeding. An effective treatment regimen for such patients has not been established yet. Further, it remains unknown whether PLE and gastrointestinal bleeding coexist independently, or protein losing is associated with gastrointestinal bleeding. We report a 7-year-old steroid-refractory post-Fontan PLE case suggesting the latter pathogenesis together with a literature review.


Assuntos
Técnica de Fontan/efeitos adversos , Hemorragia Gastrointestinal/complicações , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Enteropatias Perdedoras de Proteínas/etiologia , Administração Oral , Anemia Refratária/etiologia , Cateterismo Cardíaco/métodos , Criança , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Hipoalbuminemia/etiologia , Masculino , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Enteropatias Perdedoras de Proteínas/tratamento farmacológico , Remissão Espontânea , Resultado do Tratamento
2.
J Invasive Cardiol ; 32(7): E178-E181, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32610270

RESUMO

BACKGROUND: COVID-19 has led to major changes in hospital systems across the world. In an effort to reduce viral transmission, conserve resources, and in accordance with institutional and state mandates, all elective procedures and surgeries were postponed during the initial outbreak. Guidelines for case selection are limited and management for pediatric catheterization laboratories during this crisis is unprecedented. OBJECTIVES: To report the protocols and case selection of a high-volume pediatric cardiac catheterization laboratory in the epicenter of the novel coronavirus (COVID-19) pandemic. METHODS: All pediatric cardiac catheterization procedures from March 16, 2020 through May 10, 2020 were reviewed. Changes to case selection and periprocedural workflow are described. Data were collected on COVID-19 testing status and primary procedure type, and all procedures were classified by urgency. RESULTS: There were 52 catheterizations performed on 50 patients. Endomyocardial biopsies were the most common procedure (n = 27; 52%). Interventional and diagnostic procedures represented 27% (n = 14) and 21% (n = 11) of cases, respectively. Two emergent procedures (3.8%) were performed on patients with positive COVID-19 testing. Most cases were performed on patients with negative COVID-19 testing (n = 33; 94%). CONCLUSIONS: Adjusting to the COVID-19 pandemic in a high-volume pediatric cardiac catheterization laboratory can be safely and effectively managed by prioritizing emergent and urgent cases and modifying workflow operations. The experience of this center may assist other pediatric cardiac catheterization laboratories in adapting to similar practice changes as the pandemic continues to evolve.


Assuntos
Cateterismo Cardíaco , Doenças Cardiovasculares , Infecções por Coronavirus , Procedimentos Clínicos , Controle de Infecções , Pandemias , Seleção de Pacientes , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/estatística & dados numéricos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/cirurgia , Criança , Protocolos Clínicos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Masculino , New York/epidemiologia , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia
7.
Pediatr Cardiol ; 41(6): 1135-1144, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32363434

RESUMO

The objectives of this study were to construct femoral artery (FA) and femoral vein (FV) nomograms in children aged 0-4 years and to construct probability curves for the occurrence of arterial access complications based on the size of the FA. The FV and FA are commonly accessed during cardiac catheterizations in children with congenital heart diseases (CHD). However, nomograms for vessel dimensions based on child's age or size are not available. This knowledge may be helpful for interventional planning. A prospective study was performed on 400 children (age 0-4 years) with CHD undergoing cardiac catheterizations over a 3-year period. Ultrasound evaluation of the right and left FA and FV was performed under anesthesia prior to vascular access. Regression modeling was applied to derive nomograms based on quantile polynomial regression, which yielded good fit to the data judged by R-squared. GAMLSS transformation method was used to formulate smoothed percentiles. A separate prospective evaluation of FA to determine the size below which loss of pulse (LOP) are likely to occur was performed. Nomograms for FA and FV diameter and cross-sectional area against age and body surface area and probability curves for FA LOP were constructed. It is now possible to examine ultrasound-based normal sizes of femoral vein and artery in children 0-4 years of age. Femoral vessel nomograms and LOP probability curves may help with interventional planning. Future studies with larger sample size, including children of other ages may be useful.


Assuntos
Artéria Femoral/diagnóstico por imagem , Nomogramas , Cateterismo Cardíaco/métodos , Pré-Escolar , Feminino , Artéria Femoral/patologia , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Ultrassonografia
8.
Pediatr Cardiol ; 41(6): 1115-1124, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32388668

RESUMO

Elective closure of atrial septal defect (ASD) is usually recommended during preschool ages. However, ASD may contribute to deteriorating health in the presence of significant comorbidity and, thus, may need earlier closure. There is a lack of clarity regarding the indications for and outcomes after ASD closure in infancy and early childhood. We investigated the benefits and safety of surgical ASD closure in symptomatic patients under 2 years of age. Retrospective chart review was conducted in patients who underwent surgical ASD closure within the first 2 years of life. Of 31 symptomatic ASD patients, 22 had persistent respiratory symptoms, 24 failure to thrive, and 9 pulmonary hypertension. Overall, 26 patients (84.0%) showed clinical improvement after ASD closure, including improved respiratory status (17/22; 77.3%), resumption of normal growth (15/24; 62.5%), and resolution of pulmonary hypertension (7/7; 100%, 2 patients unable to assess postoperatively). Two medically complicated patients died a few months after surgery unrelated to surgical complications. Four out of 8 ventilator-dependent patients were weaned from mechanical ventilation within 1 month after ASD closure. Closure of ASD did not improve those patients with highly advanced lung disease and/or medically complex conditions including underlying genetic abnormalities. Surgical complications were uncommon. Postoperative hospital stay was 4 to 298 days (median 8 days). The majority of our patients demonstrated significant clinical improvement after ASD closure. Early ASD closure is safe and beneficial for symptomatic infants and young children with associated underlying pulmonary abnormalities, especially bronchopulmonary dysplasia.


Assuntos
Comunicação Interatrial/cirurgia , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/fisiopatologia , Cateterismo Cardíaco/métodos , Pré-Escolar , Feminino , Comunicação Interatrial/complicações , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/fisiopatologia , Lactente , Tempo de Internação , Masculino , Estudos Retrospectivos , Resultado do Tratamento
9.
Pediatr Cardiol ; 41(5): 877-884, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32377891

RESUMO

BACKGROUND: There are many challenges facing Syrian refugee children with heart disease. In this report, we present the spectrum, management, and outcome of heart disease in Syrian refugee children over six-year period, highlighting challenges in management and availability of funding. METHODS: Data on Syrian refugee children with heart disease diagnosed between 2012 and 2017 were collected. Patients were followed until January 2019. Data reported included age, diagnosis, recommended treatment, types of procedures done, mortality, cost, financial sources for procedures, and outcome. RESULTS: 415 Syrian refugee children were diagnosed with heart disease at our institution. Median age was 1·9 years (0·4-6·05) years. Children were either born in Syria and fled to Jordan with their families (224, 54%), or born in Jordan to refugee parents (191, 46%). Follow-up was established for 335 patients (81%). Of 196 patients needing surgery, 130 (72%) underwent Surgery, and of 97 patients needing interventional catheterization, 95 underwent the procedure. Waiting time was 222(± 272) days for surgery and 67(± 75) days for catheterizations. Overall mortality was 17% (56 patients), of which 28 died while waiting for surgery. Cost of surgical and interventional catheterization procedures was $7820 (± $4790) and $2920 (± $2140), respectively. Funding was obtained mainly from non-government organizations, private donors, and United Nations fund. CONCLUSION: Despite local and international efforts to manage Syrian refugee children with heart disease, there is significant shortage in providing treatment resulting in delays and mortality. More organized efforts are needed to help with this ongoing crisis.


Assuntos
Cardiopatias/epidemiologia , Cardiopatias/terapia , Refugiados , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/terapia , Cardiopatias/economia , Cardiopatias/mortalidade , Hospitais Universitários , Humanos , Lactente , Jordânia/epidemiologia , Masculino , Síria/epidemiologia , Resultado do Tratamento
10.
J Cardiothorac Surg ; 15(1): 107, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448306

RESUMO

BACKGROUND: For many years, percutaneous interventional occlusion of congenital patent ductus arteriosus (PDA) has been completed using radiation and contrast agents. In this study, transthoracic echocardiography without radiation and contrast agents was used to complete percutaneous occlusion of pediatric PDA. METHODS: Thirty-two children (8 males and 24 females) with normal heart function and no other intracardiac deformities were diagnosed with PDA (20 funnel type; 12 tube type), One patient had peripheral facial paralysis, 1 patient had epilepsy, and 1 case had multiple cervical deformities. All procedures were performed in the surgical operating room (without Digital Subtraction Angiography (DSA) equipment) under basic anesthesia through the femoral artery pathway. The procedures were guided by transthoracic echocardiography (TTE) by establishing an orbit with a catheter through the femoral artery to thepatent ductus arteriosus,pulmonary artery and right ventricle. A suitable ventricular septal defect occluder was placed using the femoral artery approach,and the treatment effect was evaluated by echocardiography after occlusion. The Outpatient follow-up was performed at 1, 3 months after the operation. RESULTS: All cases had successful closure of PDA, which took only 35.6 ± 6.4 min. The diameter of the device was 4.8 ± 2.3 mm, and the heart murmur disappeared. There was no shunt between the left pulmonary artery and the descending aortic artery, and the length of hospitalization was 3.4 ± 0.5 days. No other incisions were needed in 32 cases. No occluder was removed, and no residual shunt was found after operation; moreover, no ICU stay was needed, and the mean hospital stay was 3.4 ± 0.5 days. No residual shunt was found at the 1-, 3-month follow-up visit. CONCLUSIONS: PDA closure guided by transthoracic echocardiography via femoral artery puncture is a minimally invasive procedure that avoids injuries due to radiation and contrast agents. This method has wider application prospects in pediatrics.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Meios de Contraste/farmacologia , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia/métodos , Dispositivo para Oclusão Septal , Cirurgia Assistida por Computador/métodos , Criança , Pré-Escolar , Permeabilidade do Canal Arterial/diagnóstico , Feminino , Artéria Femoral , Humanos , Lactente , Masculino , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(19): e20120, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384490

RESUMO

INTRODUCTION: Aortic regurgitation (AR) was recognized as a major, but rare complication after device closure for perimembranous ventricular septal defects (PmVSD). Most of them are temporary and non-significant. Infectious endocarditis (IE) is another extremely rare post-procedure complication of PmVSD. Theoretically, AR could increase risk for post-interventional IE. However, no cases have been documented thus far. We firstly described a case of very late-onset IE associated with non-significant AR after transcatheter closure of PmVSD with modified symmetrical double-disk device, underscoring the need for reassessing long-term prognostic implications of non-significant post-procedure AR after PmVSD occlusion and the most appropriate treatment strategy. PATIENT CONCERNS: A 15-year old male received transcatheter closure of a 6.4 mm sized PmVSD with a 9-mm modified symmetric double-disk occluder (SHAMA) 11 years ago in our hospital. A new-onset mild eccentric AR was noted on transthoracic echocardiography (TTE) examination 1-year post procedure, without progression and heart enlargement. At this time, the child was admitted with a complaint of persistent fever for 16 days and nonresponse to 2-weeks course of amoxicillin and cefoxitin. DIAGNOSIS: The diagnosis of post-procedure IE was established since a vegetation (14 × 4 mm) was found to be attached to the tricuspid valve, an anechoic area (8 × 7 mm) on left upper side of ventricular septum and below right aortic sinus, and severe eccentric AR as well as the isolation of Staphylococcus aureus from all three-blood cultures. INTERVENTIONS: Treatment with vancomycin was initially adopted. However, surgical interventions including removal of vegetation, abscess and occluder, closure of VSD with a pericardial patch, tricuspid valvuloplasty, and aortic valvuloplasty were ultimately performed because of recurrent fever and a new-onset complete atrioventricular block 12-days later. The child continued with antibiotic therapy up to six weeks post operation. OUTCOMES: The child's temperature gradually returned to normal with alleviation of AR (mild) and heart block (first degree). The following course was uneventful. CONCLUSION: Late-onset IE could occur following device closure of PmVSD and be associated with post-procedure AR. For non-significant AR after device closure of PmVSD, early surgical intervention could be an alternative for reducing the aggravation of aortic valve damage and the risk of associated IE.


Assuntos
Insuficiência da Valva Aórtica/complicações , Endocardite/complicações , Infecções Estafilocócicas/complicações , Adolescente , Cateterismo Cardíaco/métodos , Endocardite/tratamento farmacológico , Endocardite/cirurgia , Comunicação Interventricular/cirurgia , Humanos , Masculino , Dispositivo para Oclusão Septal , Valva Tricúspide/patologia
12.
EuroIntervention ; 16(3): 251-258, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32287036

RESUMO

AIMS: The high frequency of screening failure for anatomical reasons in patients with severe mitral valve regurgitation (MR) is a limiting factor in the screening process for transcatheter mitral valve replacement (TMVR). However, data on optimal patient selection are scarce. The present study aimed to develop a screening algorithm based on TMVR screening data. METHODS AND RESULTS: A total of 195 screenings for six different TMVR devices were performed in 94 high-risk patients with severe MR. We compared baseline echocardiographic and multislice computed tomography (MSCT) parameters between the subgroups of patients accepted (N=33) and rejected for TMVR (N=61). Reasons for screening failure were assessed, and a decision tree algorithm was statistically derived. Reasons for screening failure were small LV dimensions (30.6%), small (7.5%) or large (22.5%) annular size, potential risk of LVOT obstruction (22.0%) or mitral annulus calcification (15.6%). A four-step decision tree algorithm to assess TMVR eligibility was developed resulting in an AUC of 0.80 (95% CI: 0.71, 0.89, p<0.0001). CONCLUSIONS: This study presents the first screening algorithm to assess anatomical eligibility for TMVR in patients with severe MR, based on simple MSCT criteria. Given the high rate of TMVR screening failure, this algorithm may facilitate the identification of potential TMVR candidates.


Assuntos
Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Algoritmos , Árvores de Decisões , Humanos , Valva Mitral , Resultado do Tratamento
13.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32269136

RESUMO

Systemic sclerosis sine scleroderma (ssSSc) is a rare variant of systemic sclerosis, with only one pediatric case reported in the medical literature to date. Pulmonary arterial hypertension as the presenting feature of ssSSc is extremely rare, even in adults, and so far has never been reported in children. We report, for the first time, a case of pediatric ssSSc in a 3-year-old girl, who presented with interstitial lung disease and pulmonary hypertension. The patient was prescribed early aggressive pulmonary vasodilators combined with anti-inflammatory medications. The clinical response was good, and her current condition at 12 years of age is remarkable, considering the high mortality rates reported in adults. We underscore the importance of early aggressive treatment in future cases of similar presentation.


Assuntos
Hipertensão Arterial Pulmonar/complicações , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico por imagem , Cateterismo Cardíaco/métodos , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão Arterial Pulmonar/terapia , Escleroderma Sistêmico/terapia
14.
J Interv Cardiol ; 2020: 9813038, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32265599

RESUMO

Background: A patent foramen ovale (PFO) is a rare cause of hypoxemia and clinical symptoms of dyspnea. Due to a right-to-left shunt, desaturated blood enters the systemic circulation in a subset of patients resulting in dyspnea and a subsequent reduction in quality of life (QoL). Percutaneous closure of PFO is the treatment of choice. Objectives: This retrospective multicentre study evaluates short- and long-term results of percutaneous closure of PFO in patients with dyspnea and/or reduced oxygen saturation. Methods: Patients with respiratory symptoms were selected from databases containing all patients percutaneously closed between January 2000 and September 2018. Improvement in dyspnea, oxygenation, and QoL was investigated using pre- and postprocedural lung function parameters and two postprocedural questionnaires (SF-36 and PFSDQ-M). Results: The average follow-up period was 36 [12-43] months, ranging from 0 months to 14 years. Percutaneous closure was successful in 15 of the 16 patients. All patients reported subjective improvement in dyspnea immediately after device deployment, consistent with their improvement in oxygen saturation (from 90 ± 6% to 94 [92-97%] on room air and in upright position) (p < 0.05). Both questionnaires also indicated an improvement of dyspnea and QoL after closure. The two early and two late deaths were unrelated to the procedure. Conclusion: PFO-related dyspnea and/or hypoxemia can be treated successfully with a percutaneous intervention with long-lasting benefits on oxygen saturation, dyspnea, and QoL.


Assuntos
Dispneia , Forame Oval Patente , Hipóxia , Efeitos Adversos de Longa Duração , Qualidade de Vida , Adulto , Cateterismo Cardíaco/métodos , Dispneia/etiologia , Dispneia/psicologia , Dispneia/terapia , Exercício Físico/fisiologia , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/metabolismo , Forame Oval Patente/psicologia , Forame Oval Patente/cirurgia , Humanos , Hipóxia/etiologia , Hipóxia/psicologia , Hipóxia/terapia , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/psicologia , Efeitos Adversos de Longa Duração/cirurgia , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Implantação de Prótese/métodos , Descanso/fisiologia , Estudos Retrospectivos , Dispositivo para Oclusão Septal , Resultado do Tratamento
15.
J Card Surg ; 35(5): 1062-1071, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32237166

RESUMO

BACKGROUND AND AIM OF THE STUDY: Ventricular septal defect (VSD) following myocardial infarction (MI) is a relatively infrequent complication with high mortality. We sought to investigate the effect of concomitant coronary artery bypass graft (CABG) on outcomes following post-MI VSD repair. METHODS: Electronic search was performed to identify all relevant studies published from 2000 to 2018. Sixty-seven studies were selected for the analysis comprising 2174 patients with post-MI VSD. Demographic information, perioperative variables, and outcomes including survival data were extracted and pooled for systematic review and meta-analysis. RESULTS: Single-vessel disease was most common (47%, 95% confidence interval [CI], 42-52), left anterior descending coronary artery was the most commonly involved vessel (55%, 95% CI, 46-63), and anterior wall was the most commonly affected territory (57%, 95% CI, 51-63). Concomitant CABG was performed in 52% (95% CI, 46-57) of patients. Of these, infarcted territory was re-vascularized in 54% (95% CI, 23-82). A residual/recurrent shunt was present in 29% (95% CI, 24-34) of patients. Of these, surgical repair was performed in 35% (95% CI, 28-41) and transcatheter repair in 11% (95% CI, 6-21). Thirty-day mortality was 30% (95% CI, 26-35) in patients who had preoperative coronary angiogram, and 58% (95% CI, 43-71) in those who did not (P < .01). No significant survival difference observed between those who had concomitant CABG vs those without CABG. CONCLUSIONS: Concomitant CABG did not have a significant effect on survival following VSD repair. Revascularization should be weighed against the risks associated with prolonged cardiopulmonary bypass.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte de Artéria Coronária , Comunicação Interventricular/cirurgia , Ponte Cardiopulmonar/efeitos adversos , Feminino , Comunicação Interventricular/etiologia , Comunicação Interventricular/mortalidade , Humanos , Masculino , Infarto do Miocárdio/complicações , Taxa de Sobrevida , Resultado do Tratamento
16.
Expert Rev Cardiovasc Ther ; 18(4): 209-218, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32248715

RESUMO

Introduction: Moderate to severe tricuspid regurgitation (TR) is a poor prognostic factor regardless of right ventricular function. However, a majority of patients are managed medically rather than undergoing isolated tricuspid valve surgery due to high in-hospital mortality. Percutaneous therapy in the form of transcatheter tricuspid valve repair or replacement is an attractive option for this high risk multimorbid cohort.Areas covered: A literature search was performed for tricuspid valve repair or replacement using MEDLINE, Current Contents Connect, Google Scholar, EMBASE, Cochrane library, PubMed, ScienceDirect, and Web of Science (Till 10/19). This review outlines the anatomical challenges specific to the tricuspid valve, provides an insight into patient selection for percutaneous treatment, and summarizes the current evidence for the available devices.Expert opinion: With the recent understanding that percutaneous repair of TR is feasible and provides better patient outcomes, we must more closely evaluate our patients with tricuspid regurgitation and consider treatment. MitraClip in the tricuspid position (TriClip) is the most widely used TV repair device, and several prospective trials are currently investigating various devices in this arena that hopefully will hopefully provide greater insight into patient selection and anatomically specific device choice.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Cateterismo Cardíaco/métodos , Mortalidade Hospitalar , Humanos , Seleção de Pacientes , Resultado do Tratamento , Insuficiência da Valva Tricúspide/fisiopatologia
17.
Mutat Res ; 852: 503163, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32265037

RESUMO

Cardiac catheterization procedures are performed on about 20,000 children with congenital heart disease (CHD) annually in China. The procedure, which involves exposure to ionizing radiation, causes DNA damage and may lead to increased cancer risk. We have studied chromosomal aberrations (CA) in peripheral lymphocytes of CHD children. CA frequencies were assessed in an interventional group of 70 children who underwent cardiac catheterization and a control group of 51 children receiving open-heart surgery. Total CA and all chromosome-type aberrations were higher in the exposed children than in the control group. With respect to the type of septal defect, the translocation frequency was higher in patients with ventricular rather than atrial defects. Cardiac catheterization procedures increase CA frequencies and may also increase the risk of cancer.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Aberrações Cromossômicas/efeitos da radiação , Cardiopatias Congênitas/cirurgia , Linfócitos/efeitos da radiação , Radiação Ionizante , Adolescente , Cateterismo Cardíaco/métodos , Estudos de Casos e Controles , Criança , Pré-Escolar , China , Feminino , Cardiopatias Congênitas/patologia , Humanos , Linfócitos/imunologia , Masculino , Duração da Cirurgia , Cultura Primária de Células , Risco
18.
Br J Radiol ; 93(1110): 20190869, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32242740

RESUMO

OBJECTIVES: To estimate risk for exposure-induced cancer death (REID), organ-specific risks of exposure-induced cancer death (REIDHT) and associated conversion coefficients (CCREID:KAP=REID/kerma-area product (KAP), CCREIDHT:KAP=REIDHT/KAP) in paediatric cardiac catheterizations using data from radiation dose structured reports (RDSR). A novel risk surveillance tool consisting of age-specific and gender-specific risk reference values (RRVs) related to population cancer risk is suggested. METHODS: The PCXMC v.2.0 code is used together with exposure-related information from RDSR from a cohort of 238 children to assess cancer risks and related conversion coefficients. The KAP corresponding to 1 in 1000 of increased REID is used to define age-specific and gender-specific KAP values to monitor risk in such patient cohorts, here denoted as RRVs. RESULTS: The REID estimates ranged from below 1 up to 300 in 100,000, and the RRVs for the different age groups and gender ranged from 0.77 Gycm2 and 2.1 Gycm2 for neonates (female, male) to 11 Gycm2 and 25 Gycm2 for 15-year-olds (female, male). The CCREID:KAP and CCREIDHT:KAP decreased biexponentially with increased age, being notably higher for female patients. CONCLUSIONS: Prominent risk contributing organs were the lungs and the (female) breast. The concept of age-specific and gender-specific RRVs related to population cancer risk is introduced and is intended to be used as a supporting tool for physicians performing such interventions. ADVANCES IN KNOWLEDGE: Age-related and gender-related conversion coefficients for radiation risk, CCREID:KAP and CCREIDHT:KAP, are introduced and a novel risk surveillance concept, the RRV, is suggested for paediatric cardiac catheterizations.


Assuntos
Fatores Etários , Cateterismo Cardíaco/efeitos adversos , Cardiopatias Congênitas/diagnóstico por imagem , Neoplasias Induzidas por Radiação/mortalidade , Exposição à Radiação/efeitos adversos , Fatores Sexuais , Adolescente , Angiografia , Neoplasias da Mama/etiologia , Neoplasias da Mama/mortalidade , Cateterismo Cardíaco/métodos , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/radioterapia , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/mortalidade , Masculino , Neoplasias Induzidas por Radiação/etiologia , Especificidade de Órgãos/efeitos da radiação , Imagens de Fantasmas , Doses de Radiação , Valores de Referência , Risco
19.
J Invasive Cardiol ; 32(5): E103-E109, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32269177

RESUMO

BACKGROUND: The novel coronavirus (COVID-19) pandemic has placed severe stress on healthcare systems around the world. There is limited information on current practices in pediatric cardiac catheterization laboratories in the United States (US). OBJECTIVES: To describe current practice patterns and make recommendations regarding potential resource allocation for congenital cardiac catheterization during the COVID-19 pandemic. METHODS: A web-based survey was distributed regarding case candidacy and catheterization laboratory preparedness. Centers were categorized based on the current degree of disease burden in that community (as of April 1, 2020). Data and consensus opinion were utilized to develop recommendations. RESULTS: Respondents belonged to 56 unique US centers, with 27 (48.2%) located in counties with a high number of COVID-19 cases. All centers have canceled elective procedures. There was relative uniformity (>88% agreement) among centers as to which procedures were considered elective. To date, only three centers have performed a catheterization on a confirmed COVID-19 positive patient. Centers located in areas with a higher number of COVID-9 cases have been more involved in a simulation of donning and doffing personal protective equipment (PPE) than low-prevalence centers (46.7% vs 10.3%, respectively; P<.001). Currently, only a small fraction of operators has been reassigned to provide clinical services outside their scope of practice. CONCLUSIONS: At this stage in the COVID-19 pandemic, pediatric/congenital catheterization laboratories have dramatically reduced case volumes. This document serves to define current patterns and provides guidance and recommendations on the preservation and repurposing of resources to help pediatric cardiac programs develop strategies for patient care during this unprecedented crisis.


Assuntos
Cateterismo Cardíaco/métodos , Infecções por Coronavirus/complicações , Alocação de Recursos para a Atenção à Saúde/métodos , Pneumonia Viral/complicações , Betacoronavirus , Criança , Infecções por Coronavirus/epidemiologia , Tomada de Decisões , Cardiopatias Congênitas , Humanos , Unidades de Terapia Intensiva Pediátrica , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Alocação de Recursos , Inquéritos e Questionários , Estados Unidos/epidemiologia
20.
Ann Thorac Surg ; 110(2): 670-675, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32199821

RESUMO

PURPOSE: In children with a mitral annulus too small to accommodate traditional prostheses, surgical implantation of stent-based valves is a promising option. However no reliable preoperative methods exist to guide patient selection, device sizing, and positioning. We describe a novel methodology to visualize and quantify device fit in 3-dimensional echocardiogram (3DE)-derived heart models. DESCRIPTION: Heart models were created from existing preoperative 3DEs using custom software. Valve models were virtually implanted into the models, and both device fit and left ventricular outflow tract (LVOT) area were quantified. EVALUATION: The 3DEs of 3 patients who underwent Melody valve placement in the mitral position were retrospectively modeled: 1 with LVOT obstruction, 1 with perivalvar leak, and 1 without complications. In all cases 2-dimensional measurements underestimated 3D annular dimensions, and the patient with clinical LVOT obstruction had the lowest predicted LVOT area-to-aortic area ratio (0.5). CONCLUSIONS: 3DE-based preoperative modeling of surgical implantation of stent-based valves in the mitral position may improve quantification of mitral valve dimensions and inform risk stratification for potential LVOT obstruction.


Assuntos
Cateterismo Cardíaco/métodos , Ecocardiografia Tridimensional/métodos , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Feminino , Humanos , Lactente , Masculino , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Desenho de Prótese , Estudos Retrospectivos
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