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1.
JAMA ; 325(6): 561-567, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33560321

RESUMO

Importance: The prevalence and characteristics of bicuspid aortic valve (BAV) are mainly reported from selected cohorts. BAV is associated with aortopathy, but it is unclear if it represents a fetal developmental defect or is secondary to abnormal valve dynamics. Objective: To determine the prevalence of BAV and BAV subtypes and to describe the associated aortopathy in a large, population-based cohort of newborns. Design, Setting, and Participants: The Copenhagen Baby Heart Study was a cross-sectional, population-based study open to all newborns born in Copenhagen between April 1, 2016, and October 31, 2018. Newborns with BAV were matched 1:2 to newborns with a tricuspid aortic valve (non-BAV group) on sex, singleton/twin pregnancy, gestational age, weight, and age at time of examination. Exposures: Transthoracic echocardiography within 60 days after birth. Main Outcomes and Measures: Primary outcome was BAV prevalence and types, ie, number of raphes and spatial orientation of raphes or cusps (no raphes), according to the classification system of Sievers and Schmidtke (classified as type 0, 1, or 2, with numbers indicating the number of raphes). Secondary outcome was valve function and BAV-associated aortopathy, defined as aortic diameter z score of 3 or greater or coarctation. Results: In total, 25 556 newborns (51.7% male; mean age, 12 [SD, 8] days) underwent echocardiography. BAV was diagnosed in 196 newborns (prevalence, 0.77% [95% CI, 0.67%-0.88%]), with male-female ratio 2.1:1. BAV was classified as type 0 in 17 newborns (8.7% [95% CI, 5.5%-13.5%]), type 1 in 178 (90.8% [95% CI, 86.0%-94.1%]) (147 [75.0% {95% CI, 68.5%-80.5%}] right-left coronary raphe, 27 [13.8% {95% CI, 9.6%-19.3%}] right coronary-noncoronary raphe, 4 [2.0% {95% CI, 0.8%-5.1%}] left coronary-noncoronary raphe), and type 2 in 1 (0.5% [95% CI, 0.1%-2.8%]). Aortic regurgitation was more prevalent in newborns with BAV (n = 29 [14.7%]) than in those without BAV (1.3%) (absolute % difference, 13.4% [95% CI, 7.8%-18.9%]; P < .001). Newborns with BAV had higher flow velocities across the valve (0.67 [95% CI, 0.65-0.69] m/s vs 0.61 [95% CI, 0.60-0.62] m/s; mean difference, 0.06 m/s [95% CI, 0-0.1]) and larger aortic root and tubular ascending aortic diameters than those without BAV (10.7 [95% CI, 10.7-10.9] mm vs 10.3 [95% CI, 10.2-10.4] mm; mean difference, 0.43 mm [95% CI, 0.2-0.6 mm] and 9.8 [95% CI, 9.6-10.0] mm vs 9.4 [95% CI, 9.3-9.5] mm; mean difference, 0.46 mm [95% CI, 0.30-0.70], respectively) (P < .001 for all). Aortopathy was seen in 65 newborns (33.2%) with BAV (62 with aortic z score ≥3; 3 with coarctation). Conclusions and Relevance: Among newborns in Copenhagen, the prevalence of BAV was 0.77%. Aortopathy was common in newborns with BAV, suggesting that it also represents a fetal malformation.


Assuntos
Anormalidades Múltiplas/epidemiologia , Aorta/anormalidades , /epidemiologia , Coartação Aórtica/epidemiologia , Valva Aórtica/diagnóstico por imagem , /diagnóstico por imagem , Estudos Transversais , Dinamarca/epidemiologia , Ecocardiografia , Feminino , Humanos , Recém-Nascido , Masculino , Prevalência , Distribuição por Sexo
2.
Kardiologiia ; 60(8): 54-64, 2020 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-33155959

RESUMO

Aim      Comprehensive evaluation of blood flow in the thoracic aorta using a software for 4D processing of magnetic resonance (MR) images of the heart and blood vessels (4D Flow) in patients with aortic coarctation in the late postoperative period.Materials and methods The MR study of the heart was performed for 10 patients (7 boys and 3 girls) aged 8 to 13 years (median, 9.5 [8.3; 10.8] years) who underwent resection with end-to-end anastomosis for aortic coarctation at age of 2 weeks to 10 months. MR tomography was performed on a 1.5 T MR scanner using a multichannel surface coil for scanning, electrocardiographic synchronization, and a specialized package of pulse sequences for scanning of the heart. Blood flow was evaluated with a 4D data handling software for processing of MR images of heart and blood vessels (4D Flow). The following blood flow parameters were analyzed: blood flow volume per second, peak blood flow velocity, peak and minimum blood flow area at the levels of ascending aorta, arch, isthmus, and descending aorta, and pressure gradient at the level of maximum narrowing of the aorta. 3D-MR images were used for evaluation of aortic geometry. Blood flow formation, distribution, and trajectories were analyzed by maps of vectors, particle trace, and stream lines. Statistical analysis was performed with a Statistica (v. 6.0 StatSoft Inc.) package.Results Accelerated flow in the region of residual aortic stenosis in systole was observed in all patients; 4 patients had an additional vortex flow below the aortic stenosis and a spiral flow in the descending aorta. The pressure gradient on the aortic isthmus was directly correlated with the left ventricular myocardial mass index (r=0.65; р=0.04) and indexes of blood flow in the ascending and descending aorta (р=0.03; р=0.026). No significant correlation was found for blood flow indexes and geometry of the aortic arch (H / L). Delayed contrast enhancement MR imaging did not detect any fibrotic changes in the myocardium in only one patient. The fibrosis severity inversely correlated with the right ventricular ejection fraction (r=0.65; р=0.04) and directly correlated with the pressure gradient at the aortic isthmus (r=0.63; p=0.05).Conclusion      The 4D MR image processing software for the heart and blood vessels allows studying the blood flow in detail under natural conditions, provides potential advantages in comprehensive evaluation of patients with aortic coarctation during a dynamic follow-up. For a definitive conclusion about the relationship between the altered blood flow in the thoracic aorta and markers of residual, post-correction pathology, larger studies are required as well as long-term follow-up of patients with documented pathological patterns of blood flow (changes in blood flow velocity and volume throughout the entire thoracic aorta in combination with disorders in the normal flow geometry during the cardiac cycle).


Assuntos
Coartação Aórtica , Adolescente , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Velocidade do Fluxo Sanguíneo , Criança , Feminino , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Volume Sistólico , Função Ventricular Direita
3.
Khirurgiia (Mosk) ; (9): 38-42, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030000

RESUMO

OBJECTIVE: To report treatment outcomes in patients with congenital aortic arch disease. MATERIAL AND METHODS: There were 65 patients (45 boys and 20 girls) for the period from 2005 to 2019. Mean age of patients was 53±12 days (range 1-98), weight - 3,3±1,3 kg (range 2.2-4.6). All patients were divided into 2 groups depending on the method of surgical repair. The 1st group included 33 patients who underwent patch repair, the 2nd group (n=32) - anastomosis in end-to-side fashion. RESULTS: In group I, recurrent aortic arch coarctation was observed in 16.8% of cases, in group II - only in 4% of cases (p=0.02). Analysis of systolic pressure in both groups revealed that arterial hypertension was detected in 39% of cases in group I and only in 9,1% of cases in group II (p=0,0025). CONCLUSION: Surgical treatment of aortic arch disease using anastomosis in end-to-side fashion is associated with reduced risk of recurrent aortic arch coarctation and residual arterial hypertension in long-term postoperative period.


Assuntos
Aorta Torácica , Coartação Aórtica , Anastomose Cirúrgica , Pressão Sanguínea , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2295-2298, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018466

RESUMO

This paper proposes a novel method to noninvasively measure the peak systolic pressure difference (PSPD) across coarctation of the aorta for diagnosing the severity of coarctation. Traditional non-invasive estimates of pressure drop from the ultrasound can underestimate the severity and invasive measurements by cardiac catheterization can carry risks for patients. To address the issues, we employ computational fluid dynamics (CFD) computation to accurately predict the PSPD across a coarctation based on cardiac magnetic resonance (CMR) imaging data and cuff pressure measurements from one arm. The boundary conditions of a patient-specific aorta model are specified at the inlet of the ascending aorta by using the time-dependent blood velocity, and the outlets of descending aorta and supra aortic branches by using a 3-element Windkessel model. To estimate the parameters of the Windkessel model, steady flow simulations were performed using the time-averaged flow rates in the ascending aorta, descending aorta, and two of the three supra aortic branches. The mean cuff pressure from one arm was specified at the outlet of one of the supra aortic branches. The CFD predicted PSPDs of 5 patients (n=5) were compared with the invasively measured pressure drops obtained by catheterization. The PSPDs were accurately predicted (mean µ=0.3mmHg, standard deviation σ =4.3mmHg) in coarctation of the aorta using completely non-invasive flow and cuff pressure data. The results of our study indicate that the proposed method could potentially replace invasive measurements for estimating the severity of coarctations.Clinical relevance-Peak systolic pressure drop is an indicator of the severity of coarctation of the aorta. It can be predicted without any additional risks to patients using non-invasive cuff pressure and flow data from CMR.


Assuntos
Coartação Aórtica , Aorta/diagnóstico por imagem , Coartação Aórtica/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Humanos , Hidrodinâmica
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2319-2323, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018472

RESUMO

This paper proposes a computational framework for automatically optimizing the shapes of patient-specific tissue engineered vascular grafts. We demonstrate a proof-of-concept design optimization for aortic coarctation repair. The computational framework consists of three main components including 1) a free-form deformation technique exploring graft geometries, 2) high-fidelity computational fluid dynamics simulations for collecting data on the effects of design parameters on objective function values like energy loss, and 3) employing machine learning methods (Gaussian Processes) to develop a surrogate model for predicting results of high-fidelity simulations. The globally optimal design parameters are then computed by multistart conjugate gradient optimization on the surrogate model. In the experiment, we investigate the correlation among the design parameters and the objective function values. Our results achieve a 30% reduction in blood flow energy loss compared to the original coarctation by optimizing the aortic geometry.


Assuntos
Coartação Aórtica , Aorta , Coartação Aórtica/cirurgia , Prótese Vascular , Hemodinâmica , Humanos , Procedimentos Cirúrgicos Vasculares
6.
Georgian Med News ; (304-305): 85-90, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32965255

RESUMO

Aortic arch hypoplasia is a congenital anomaly of the development of the aortic arch, characterized by hemodynamically significant narrowing of one or more segments of the aortic arch. The combination of simple transposition of the great arteries (TGA) and obstruction at the level of the aortic arch is not very common. However, when transposition is combined with the VSD, Taussig-Bing anomaly, this combination is more common. The degree of obstruction at the level of the aortic arch may vary from discrete coarctation of the aorta, tubular hypoplasia of the aortic arch, to interruption. Despite the improvement in the results of surgical treatment of this pathology in recent years, the question of the stage of treatment remains debatable.; The objective of the study was to analyze immediate and long-term results of the correction of transposition of the great arteries and aortic arch hypoplasia.; From 2010 to 2019 at the "Amosov National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine" and "Scientific Center For Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine" 76 infants underwent repair of TGA and aortic arch hypoplasia. The study included only patients with two-ventrical physiology and subsequent two-ventrical repair. There were 49 (64%) male patients and 27 (36%) female patients. The mean age of patients was 1.1 ± 0.5 months, mean body weight was 3.7 ± 1.4 kg. The average body surface area was 0.23 ± 0.05 m². Patients were divided into two groups: group I involved 52 (68%) individuals - patients who underwent one-stage repair of TGA and aortic arch hypoplasia, group II included 24 (32%) patients with two-stage repair, consisting of aortic arch reconstruction and pulmonary banding at the first stage and correction of TGA at the second stage. Antegrade selective cerebral perfusion was performed in 24 (46%) patients during reconstruction of the aortic arch.; The in-hospital mortality rate was 5.3% (n= 4). In group I, in-hospital mortality was 3.8% (n=2), and was significantly lower compared to the group II - 8.3% (n=2), p<0.05. Eight patients (14.5%) had delayed sternal closure in the early postoperative period. The average long-term follow-up was 3.7±2.8 years (from one months to 9.1 years). One late death occurred in group II. Aortic arch restenosis developed in 11 (14.4%) patients: 7 (13.4%) patients in group I and 4 (16.6%) patients in group II. Right ventricle outflow tract and pulmonary artery obstruction occurred in 9 (11.8%) patients: in 2 (3.8%) patients from group I and in 7 (29.1%) patients from group II. In the long term follow-up there were no neurological complications and compression of the trachea.; Surgical treatment of TGA with aortic arch hypoplasia is effective in infants with good immediate and long-term results. The study indicates that one-stage repair has better immediate and long-term results, compared to two-stage treatment and may be the method of choice in the treatment of this complex pathology.


Assuntos
Coartação Aórtica/cirurgia , Transposição dos Grandes Vasos/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Criança , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento , Ucrânia
8.
Wiad Lek ; 73(4): 789-791, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32731718

RESUMO

OBJECTIVE: The aim of the study to evaluate the peculiarities of the aortic wall structure at the place of coarctation. PATIENTS AND METHODS: Materials and methods: Studying of the aortic sections removed during operative correction at the place of constriction. 10 children at the age between 1 to 6 months were undergone the operation. Intraoperative aortic biopsy specimens were observed in 10% neutral formalin. Histologic sections were prepared in a conventional way followed by staining them with hematoxylin-eosin. RESULTS: Results: Histological examination in the areas of constriction revealed that the endothelium in all the preparations had poor expressiveness. The most significant changes were recorded in the middle layer of the aorta in the form of reduced development of elastic fibers, their fragmentation and chaotic arrangement. Angiomatosis with the formation of thin-layer small vessels by capillary type was found out. In all the preparations, areas of emptying of cells and fibers of the middle cover with the formation of cystic structures were revealed. CONCLUSION: Conclusions: The histological examination has revealed changes in the structure of the aorta wall, which may indicate the systemic nature of the lesion and make it possible to consider coarctation of the aorta to be a manifestation of systemic vasculopathy. The above-mentioned facts determine the need for a more detailed examination of children with the specified pathology at different stages of observation.


Assuntos
Coartação Aórtica , Aorta , Constrição Patológica , Técnicas Histológicas , Humanos , Lactente , Coloração e Rotulagem
10.
Am J Cardiol ; 130: 137-142, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32703525

RESUMO

Patients with Shone complex (SC) have multiple left-sided obstructive lesions and thus are at risk for left ventricular (LV) remodeling, LV diastolic dysfunction and pulmonary hypertension. Yet, to date, there has been no description of hemodynamics in adults with SC. Retrospective chart review of 25 patients with SC who underwent cardiac catheterization at Mayo Clinic, MN between 2002 and 2019 was performed. SC was defined as multiple left-sided obstructive lesions in the presence of an anatomically abnormal mitral valve. Median age was 32 years (22.5, 42) and 15 patients (60%) were female. The majority of patients (84%) had history of coarctation of the aorta, 10 (40%) had subaortic stenosis, 11 (44%) had prior aortic valve replacement, and 10 (40%) had prior mitral valve replacement. Structural disease at the time of catheterization which warranted intervention within the next year was present in 13 patients (52%). The mean LV end-diastolic pressure was 21.3 ± 9.0 mm Hg (>15 mm Hg in 71%), pulmonary artery peak systolic pressure was 55.4 ± 13.4 mm Hg, and the pulmonary artery mean pressure was 37.0 ± 9.4 mm Hg (>20 mm Hg in 96%). During a mean follow-up of 8.3 ± 4.4 years, there were 7 deaths (28%) and 3 additional patients (12%) underwent cardiac transplantation. In conclusion, adults with SC who underwent catheterization showed significant left-sided heart and pulmonary vascular remodeling. Elevated LV end-diastolic pressure and pulmonary artery pressures were highly prevalent. There were high mortality and cardiac transplant rates in our cohort.


Assuntos
Coartação Aórtica/fisiopatologia , Estenose da Valva Aórtica/fisiopatologia , Hemodinâmica , Valva Mitral/anormalidades , Valva Mitral/fisiopatologia , Adulto , Coartação Aórtica/complicações , Estenose da Valva Aórtica/complicações , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
11.
J Postgrad Med ; 66(3): 169-171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32675455

RESUMO

This retrospective study analyzed the level of concordance between clinical and autopsy diagnosis of coarctation of aorta over 10 years. Utilizing the Goldmann classification, the concordance rate was found to be 16%. Major discrepancies (Class I and II) were found in 56% cases and minor discrepancies (Class III and IV) in 28% cases.


Assuntos
Coartação Aórtica/patologia , Auditoria Médica , Autopsia , Causas de Morte , Erros de Diagnóstico , Ecocardiografia , Feminino , Humanos , Masculino , Estudos Retrospectivos
13.
Am Heart J ; 225: 78-87, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32474207

RESUMO

BACKGROUND: The severity of aortic coarctation (CoA) may be underestimated during cardiac catheterization. We aimed to investigate whether epinephrine stress testing improves clinical decision making and outcome in CoA. METHODS: We retrospectively evaluated CoA patients >50 kg with a peak systolic gradient (PSG) ≤20 mm Hg during cardiac catheterization who underwent epinephrine stress testing. Subsequent interventional management (stenting or balloon dilatation), complications, and medium-term clinical outcome were assessed. RESULTS: Fifty CoA patients underwent cardiac catheterization with epinephrine stress testing. Patients with a high epinephrine PSG (>20 mm Hg; n = 24) were younger and more likely to have a hypertensive response to exercise compared to patients with a low epinephrine PSG (≤20 mm Hg; n = 26). In total, 21 patients (88%) with a high epinephrine PSG underwent intervention, and 20 patients (77%) with a low epinephrine PSG were treated conservatively. After a mean follow-up of 25 ±â€¯18 months, there was a lower prevalence of hypertension in patients with a high epinephrine PSG who underwent intervention compared to patients with a low epinephrine PSG treated conservatively (19% vs. 76%; P = .001). In a multivariate model, intervention was independently associated with a 14.3-mm Hg reduction in systolic blood pressure (P = .001) and a decrease in the use of antihypertensive agents. CONCLUSIONS: In CoA patients with a low baseline PSG but high epinephrine PSG, percutaneous intervention is associated with a substantial reduction in systemic blood pressure and the use of antihypertensive medication. Accordingly, epinephrine stress testing may be a useful addition in the evaluation of CoA.


Assuntos
Agonistas Adrenérgicos beta/farmacologia , Coartação Aórtica/cirurgia , Pressão Sanguínea/efeitos dos fármacos , Cateterismo Cardíaco , Epinefrina/farmacologia , Adolescente , Adulto , Coartação Aórtica/diagnóstico , Coartação Aórtica/fisiopatologia , Tomada de Decisão Clínica , Teste de Esforço/métodos , Feminino , Humanos , Hipertensão/etiologia , Masculino , Estudos Retrospectivos , Sístole/fisiologia , Adulto Jovem
14.
Am J Cardiol ; 129: 87-94, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32593432

RESUMO

Several studies have reported aortic dilation and increased stiffness of the ascending aorta in patients after repair of congenital heart disease (CHD), which may be a predominant cardiovascular risk. However, the clinical significance has not been described in detail. In this retrospective study, 175 repaired patients with complex CHD achieving biventricular circulation and age-matched 39 control subjects were reviewed (median age: 14.9 and 15.7 years, respectively). We measured the diameters of the ascending aorta and descending aorta from catheterization angiograms to yield Z-scores and stiffness indexes (ß) using diameter fluctuations corresponding to pulsatile pressures. Clinical profile, peak oxygen uptake during the cardiopulmonary exercise test, and incidence of unscheduled hospitalization during follow-up was also reviewed. Compared with controls, patients with complex CHD, except for those with aortic coarctation, exhibited significant dilation and increased stiffness of the aortic root and ascending aorta, but not of the descending aorta. In this CHD population (n = 147, including 112 conotruncal anomalies), exercise capacities correlated independently with the diameter Z-score and stiffness index of the ascending aorta along with the history of repetitive thoracotomies, reduced forced vital capacity, and right ventricular hypertension. During a follow-up period (median 15.6 years), either dilation (Z-score >3.5) or increased stiffness (ß >6.0) of the ascending aorta stratified morbidity, but no synergistic impact was detected. In conclusion, in repaired patients with complex CHD, a stiffened and dilated ascending aorta was frequently found, exerting significant adverse impacts on diminished exercise capacity and morbidity.


Assuntos
Aorta/fisiopatologia , Doenças da Aorta/fisiopatologia , Tolerância ao Exercício/fisiologia , Cardiopatias Congênitas/fisiopatologia , Rigidez Vascular/fisiologia , Adolescente , Coartação Aórtica/fisiopatologia , Coartação Aórtica/cirurgia , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/fisiopatologia , Transposição das Grandes Artérias , Procedimentos Cirúrgicos Cardíacos , Estudos de Casos e Controles , Criança , Dilatação Patológica/fisiopatologia , Dupla Via de Saída do Ventrículo Direito/fisiopatologia , Dupla Via de Saída do Ventrículo Direito/cirurgia , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/cirurgia , Transposição dos Grandes Vasos/fisiopatologia , Transposição dos Grandes Vasos/cirurgia , Persistência do Tronco Arterial/fisiopatologia , Persistência do Tronco Arterial/cirurgia
15.
J Card Surg ; 35(7): 1714-1716, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32557775

RESUMO

OBJECTIVE: This study highlights the management strategy in simultaneous bicuspid aortic valve infective endocarditis and mycotic pseudoaneurysm of an aortic coarctation. METHODS: A staged repair of mycotic pseudoaneurysm of aortic coarctation and infective bicuspid aortic valve endocarditis. RESULTS: We present a 19-year old gentleman who was admitted with aching pain in his bilateral lower extremities with associated purpuric rash and fevers. Work-up was significant for severe aortic valve regurgitation and a pseudoaneurysm in the distal aortic arch. He underwent operative repair through a left posterior-lateral thoracotomy with femoral-femoral partial cardiopulmonary bypass. Intraoperative findings were significant for a juxta-ductal coarctation and pseudoaneurysm. The mycotic pseudoaneurysm and remnant ligamentum arteriosum were completely resected and were replaced with a 18 mm Gelweave graft (Terumo Cardiovascular Group, Ann Arbor, MI) from the distal arch to the descending thoracic aorta. The patient underwent a planned secondary washout and omental flap for biologic coverage of the graft. Subsequently, a staged aortic valve replacement was completed 1 week later. The patient's postoperative course was uncomplicated, and he was discharged with intact motor and sensory function. CONCLUSIONS: A staged approach is a prudent strategy to manage a patient with simultaneous endocarditis and aortic mycotic pseudoaneurysm, with precedence toward the most critical lesion.


Assuntos
Falso Aneurisma/cirurgia , Coartação Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Falso Aneurisma/complicações , Coartação Aórtica/complicações , Ponte Cardiopulmonar , Endocardite/complicações , Humanos , Masculino , Reoperação , Retalhos Cirúrgicos , Toracotomia , Resultado do Tratamento , Adulto Jovem
17.
J Cardiovasc Surg (Torino) ; 61(4): 478-488, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32352247

RESUMO

INTRODUCTION: Neonatal management of aortic coarctation with ventricular septal defect is still under debate between the one-stage full repair by sternotomy versus the staged repair of the coarctation first by thoracotomy (with or without banding the pulmonary artery) followed later by subsequent closure of the ventricular septal defect. EVIDENCE ACQUISITION: The aim of this review was to synthesize the evidence in literature since 1980 for the neonatal population. A meta-analysis compared mortality between the two strategies. EVIDENCE SYNTHESIS: The analysis did not find a superiority of a strategy over the other regardless of the surgical era studied. Recoarctation rates of both strategies are presented and a management algorithm is suggested. CONCLUSIONS: Instead of comparing between the two strategies, a case-adapted management considering the anatomy of the ventricular septal defect and of the aortic arch is discussed to address this association of lesions though presenting with a wide range of settings.


Assuntos
Coartação Aórtica/cirurgia , Comunicação Interventricular/cirurgia , Algoritmos , Aorta Torácica/cirurgia , Coartação Aórtica/mortalidade , Comunicação Interventricular/mortalidade , Humanos , Recém-Nascido , Artéria Pulmonar/cirurgia , Esternotomia , Toracotomia
18.
BMC Cardiovasc Disord ; 20(1): 216, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393237

RESUMO

BACKGROUND: Jehovah's Witnesses refuse allogeneic blood transfusions, which makes cardiovascular surgery challenging. Surgeons must minimize blood and fluid loss within one procedure. CASE PRESENTATION: We herein describe a 17-year-old male Jehovah's Witness with bicuspid aortic valve regurgitation and coarctation of the aorta. The procedures were performed in the following order: aortic valve replacement combined with Nick's aortic root enlargement, right axillary artery-bilateral external iliac artery bypass, and distal arch-descending aorta bypass. CONCLUSIONS: Axillary artery-bilateral external iliac artery bypass maintained distal perfusion and reduced the amount of heparin during distal arch-descending aorta bypass surgery.


Assuntos
Coartação Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Transposição das Grandes Artérias , Perda Sanguínea Cirúrgica/prevenção & controle , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Testemunhas de Jeová , Recuperação de Sangue Operatório , Religião e Medicina , Adolescente , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Resultado do Tratamento
19.
Orv Hetil ; 161(21): 861-866, 2020 05.
Artigo em Húngaro | MEDLINE | ID: mdl-32427570

RESUMO

The surgical management of congenital heart defects is changing continuously due to technical development. Aortic coarctation is one of the most frequent congenital heart diseases often with serious symptoms. The authors review the different surgical techniques (end-to-end anastomosis, pathplasty, interposition) and present the up-to-date procedures from infancy to adulthood. We assess the results, the benefits and disadvantages of the different procedures based on our and international experiences. The greatest surgical challenges are the management of the serious hypoplastic aortic arch in infancy and later evolving restenosis and complications (aneurysm, dissection). Nowadays, the management of aortic coarctation is very difficult because the surgical procedures are different in infancy, childhood and adult age. In the latter two cases, it is necessary to apply catheter interventions, too, the correct timing of which also present great challenges nowadays. Orv Hetil. 2020; 161(21): 861-866.


Assuntos
Anastomose Cirúrgica/métodos , Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Adulto , Aorta , Criança , Humanos , Lactente , Procedimentos Cirúrgicos Vasculares/métodos
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