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1.
Khirurgiia (Mosk) ; (1): 85-88, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994505

RESUMO

Mini-thoracotomy is one of the most popular minimally invasive approaches. This approach is used in the treatment of congenital and acquired heart diseases and characterized less surgical trauma, intraoperative blood loss, pain syndrome severity, risk of infectious complications and better cosmetic results. Successful correction of atrial septal defect (ASD) through right-sided mini-thoracotomy is reported in the article.


Assuntos
Comunicação Interatrial/cirurgia , Veias Pulmonares/cirurgia , Toracotomia/métodos , Cardiopatias/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Veias Pulmonares/anormalidades , Resultado do Tratamento
2.
J Cardiothorac Surg ; 15(1): 9, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915066

RESUMO

BACKGROUND: Transcatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect (ASD). However, for young infants with ASD, device closure remains controversial, and such treatment features limited data. We compared the clinical data and follow-up results of percutaneous and intraoperative device closure for ASD to evaluate the feasibility, safety, and efficacy of both treatments in infants under 3 years of age. METHODS: From September 2010 to September 2018, 186 children under 3 years of age with significant secundum ASD were included in this study. A total of 88 and 98 patients were divided into groups A (transcatheter device closure) and B (intraoperative device closure), respectively. The clinical data and follow-up results of the two groups were analyzed retrospectively. RESULT: The mean age and weight of patients in group A were significantly higher than those in group B. The proportion of complex ASDs (multiples or rims deficiency) and the device/weight ratio in group B were significantly higher than those in group A. Successful closure was obtained in 86 (97.7%) and 96 (98.0%) infants in groups A and B, respectively, with two failed cases in each group (2.3% vs 2%). The rate of periprocedural complications reached 13.6 and 26.5% for groups A and B (P = 0.058), respectively. The durations of the procedure and postoperative hospital stay in group A were significantly shorter than those in group B (P < 0.05). Excellent follow-up results were observed in both groups. At present, no death nor major complications have occurred. Symptoms either resolved completely or improved significantly for all symptomatic infants. No residual shunts at the 6th month of follow-up evaluation were observed. Patients with failure to thrive gained weight appropriately for age, and the structure and hemodynamic parameters significantly improved during follow-up. CONCLUSION: Transcatheter and intraoperative device closure are feasible, effective, and safe methods for the treatment of ASDs in infants under 3 years of age. Considering improved cosmetic effect and the short duration of the procedure and postoperative hospital stay, transcatheter is preferred for patients with appropriate conditions. Intraoperative device closure can be performed as an alternative to percutaneous closure, particularly for infants with large, complex ASDs, young age, or low-body weight.


Assuntos
Comunicação Interatrial/cirurgia , Implantação de Prótese/métodos , Dispositivo para Oclusão Septal , Cateterismo Cardíaco , Pré-Escolar , Feminino , Seguimentos , Comunicação Interatrial/fisiopatologia , Humanos , Lactente , Complicações Intraoperatórias/etiologia , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
3.
Int Heart J ; 61(1): 183-185, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956133

RESUMO

Transcatheter closure of ostium secondum atrial septal defect has become an alternative method to surgical closure. However, the incidence of complications and long-term results of using large size (> 40 mm) Amplatzer septal occluders are unknown. This case reported a 59 years old woman, whom received transcatheter closure of atrial septal defect (36 mm) with a 40 mm Amplatzer septal occluder 10 years ago and was diagnosed with heart failure. Transthroacic echocardiography showed severe mitral valve regurgitation. Intra-operatively, we confirmed and removed the large device, but we found that the mitral annulus was badly damaged. Mitral valve replacement was performed. We believe large size devices need to be implanted cautiously, especially for the large defect with insufficient rims, and also routinely follow-up is necessary.


Assuntos
Comunicação Interatrial/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Dispositivo para Oclusão Septal/efeitos adversos , Remoção de Dispositivo , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Resultado do Tratamento
4.
Int Heart J ; 61(1): 83-88, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956134

RESUMO

Percutaneous occlusion of atrial septal defect (ASD) has recently become a standard therapeutic strategy, but little is known about left atrial (LA) function thereafter. The present study aimed to determine LA function in 43 children with ASD and 13 controls based on LA strain measured by two-dimensional echocardiographic speckle tracking (2DE-ST). Among these children, 12 underwent surgery (ASD-S), 31 had device closure (ASD-D), and 13 were included as controls. LA strain was significantly decreased after ASD-D but was not significantly altered after ASD-S, indicating that percutaneous occlusion of an ASD might decrease LA function. Furthermore, the size of the ASD device negatively correlated with LA strain. These results imply that ASD occlusion devices negatively influence LA function and might be important when decided therapeutic strategies for ASD. LA strain measured by 2DE-ST should become a good indicator of LA function after ASD treatment in children.


Assuntos
Átrios do Coração/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Função do Átrio Esquerdo , Procedimentos Cirúrgicos Cardíacos , Estudos de Casos e Controles , Criança , Ecocardiografia , Feminino , Átrios do Coração/fisiopatologia , Comunicação Interatrial/fisiopatologia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
5.
Braz J Cardiovasc Surg ; 34(6): 765-768, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31364828

RESUMO

CLINICAL DATA: Infant, 7 months, female, referred to our department at one month of age, suspecting of congenital heart disease for further investigation. CHEST RADIOGRAPHY: Demonstrates cardiomegaly and prominent pulmonary vascular markings. ELECTROCARDIOGRAPHY: Shows right ventricular hypertrophy and left anterior fascicular block. ECHOCARDIOGRAPHY: Evidenced common atrioventricular valve with two orifices and the left superior pulmonary vein draining on the brachiocephalic vein. COMPUTED TOMOGRAPHY ANGIOGRAPHY: This complementary imaging exam was performed to confirm the diagnosis. DIAGNOSIS: The patient presented an association between AVSD and PAPVC, a rare combination. The clinical picture of heart failure was preponderant, characterized by need for diuretics and complementary exams findings, and early surgical treatment was indicated. OPERATION: The operation was performed through a median sternotomy with 123 minutes of cardiopulmonary bypass and 89 minutes of cross-clamping time. The patient had no postoperative complications, remaining 10 days hospitalized.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Ponte Cardiopulmonar , Angiografia por Tomografia Computadorizada , Eletrocardiografia , Feminino , Cardiopatias Congênitas/cirurgia , Comunicação Interatrial/cirurgia , Humanos , Lactente , Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Malformações Vasculares/cirurgia
7.
Medicine (Baltimore) ; 98(48): e18074, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770224

RESUMO

INTRODUCTION: An atrial septal aneurysm (ASA) is a rare congenital cardiac deformity characterized by interatrial septum protruding into atria forming a saccular structure. PATIENT CONCERNS: In our case, a 42-year-old female patient presented to our hospital complained of palpitation. DIAGNOSIS: Transthoracic echocardiography detected a 3.4 × 3.4 cm circular mass attached to the interatrial septum in right atrium complicated with a 6 mm secundum atrial septal defects (ASD). INTERVENTIONS: The patient received a cardiopulmonary bypass surgery to remove the mass and close the ASD. OUTCOMES: The mass turned out to be an organized thrombus with calcium deposition and fibrinoid necrosis. CONCLUSION: ASA is a potential location of atrial thrombus because of the stagnation of blood. Systemic embolism events are the main complications of ASA. Surgery or anticoagulation is both recommended in patients with ASA with thrombus.


Assuntos
Aneurisma Cardíaco/congênito , Átrios do Coração/anormalidades , Comunicação Interatrial/complicações , Trombose/congênito , Adulto , Ponte Cardiopulmonar/métodos , Ecocardiografia , Feminino , Aneurisma Cardíaco/cirurgia , Comunicação Interatrial/cirurgia , Humanos , Trombose/cirurgia
8.
J Interv Cardiol ; 2019: 6598637, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772540

RESUMO

Objective: The aim of this study was to compare feasibility, effectiveness, safety, and outcome of atrial septal defect (ASD) device closure in children with and without fluoroscopy guidance. Methods and Results: Children undergoing transcatheter ASD closure between 2002 and 2016 were included into this single center, retrospective study. Patients were analysed in two groups [1: intraprocedural fluoroscopy ± transoesophageal echocardiography (TOE) guidance; 2: TOE guidance alone]. Three-hundred-ninety-seven children were included, 238 (97 male) in group 1 and 159 (56 male) in group 2. Two-hundred-twenty-nine of 238 (96%) patients underwent successful fluoroscopy guided ASD closures versus 154/159 (97%) successful procedures with TOE guidance alone. Median weight (IQR) at intervention was 20kg (16.0-35.0) in group 1 versus 19.3kg (16.0-31.2) in group 2. Mean (SD) preinterventional ASD diameter was 12.4mm (4.4) in group 1 versus 12.2mm (3.9) in group 2. There was no significant difference in number of defects or characteristics of ASD rims. Median procedure time was shorter in group 2 [60min (47-86) versus 34min (28-44)]. Device-size-to-defect-ratio was similar in both groups [group 1: 1.07 versus group 2: 1.09]. There were less technical intraprocedural events in group 2 [10 (6.3%) versus 47 (20%)]. Intraprocedural complications were less frequent in group 2 [1 (0.6%) versus 8 (3.3%)]. Conclusion: Transcatheter ASD device closure with TOE guidance alone (i.e., without fluoroscopy) is as effective and safe as ASD closure with fluoroscopy guidance. As fluoroscopy remains an important adjunct to transoesophageal echocardiography, especially in complex defects and complications, procedures are always performed in a fully equipped cardiac catheterization laboratory.


Assuntos
Comunicação Interatrial , Implantação de Prótese , Dispositivo para Oclusão Septal , Cirurgia Assistida por Computador/métodos , Criança , Pré-Escolar , Ecocardiografia Transesofagiana/métodos , Estudos de Viabilidade , Feminino , Fluoroscopia/métodos , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/epidemiologia , Comunicação Interatrial/cirurgia , Humanos , Masculino , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Estudos Retrospectivos , Suíça/epidemiologia
9.
Medicine (Baltimore) ; 98(38): e17270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568005

RESUMO

BACKGROUND: Atrial septal defect (ASD) is one of the most common congenital heart diseases, with an average of 1.64 per 1000 newborns with the ASD. Empirical studies suggest that surgery should be performed early in the presence of right atrium and or right ventricular enlargement, even for asymptomatic patients. Many surgical procedures can be used to treat ASD. But which method is the best choice remains unclear. This study aims to compare the efficacy and safety of standard median sternotomy, right minithoracotomy, totally thoracoscopic surgery, percutaneous closure, transcutaneous by echocardiography, and transcutaneous by radiotherapy for ASDs in children using Bayesian network meta-analysis (NMA). METHODS: We will perform a comprehensive literature search using PubMed, EMBASE.com, the Cochrane Library, Web of Science, and Chinese Biomedical Literature Database to identify relevant studies from inception to April 2019. Randomized controlled trials, prospective or retrospective cohort studies that reported the efficacy and safety of surgical procedures for the treatment of atrial septal defects will be included. Risk of bias of the included randomized controlled trials and prospective or retrospective cohort studies will be evaluated according to the Cochrane Handbook 5.1.0 and the risk of bias in non-randomized studies of interventions, respectively. A Bayesian NMA will be performed using R 3.4.1. RESULTS: The results of this NMA will be submitted to a peer-reviewed journal for publication. CONCLUSION: This NMA will summarize the direct and indirect evidence to assess the efficacy and safety of different surgical procedures for the treatment of ASDs. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required as this study is a network meta-analysis based on published trials. PROSPERO REGISTRATION NUMBER: CRD42019130902.


Assuntos
Comunicação Interatrial/cirurgia , Esternotomia , Toracoscopia , Toracotomia , Técnicas de Fechamento de Ferimentos , Criança , Humanos
11.
J Cardiothorac Surg ; 14(1): 159, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492164

RESUMO

BACKGROUND: Aortic erosion is a serious complication that usually occurs shortly after Amplazter Septal Occluder (ASO) implantation for atrial septal defect (ASD). CASE PRESENTATION: A seven-year-old girl was diagnosed with secundum ASD without symptoms. Transesophageal echocardiography (TEE) showed a defect of 20 mm in diameter in the fossa ovalis without aortic rim. An ASO device of 24 mm in diameter was selected and electively implanted. The "A-shape" of the device was confirmed by intraoperative TEE, a landmark finding indicating the proper implantation of ASO in patients without aortic rim. After an uneventful postoperative course of 5 years and 10 months, she was transferred to our unit due to cardiogenic shock. Her echocardiogram in emergency room showed pericardial effusion with collapsed right ventricle. Given her history of ASO and the observation of the sequentially increasing pericardial effusion, we diagnosed her with acute cardiac tamponade due to aortic erosion. Emergency pericardiotomy was then performed to improve the hemodynamic condition. Fresh clots were found, so we immediately prepared the cardiopulmonary bypass circuit and explored the damage to the aorta, in which the clots had accumulated. Bleeding suddenly started when the clots were removed. We then inserted the cannulae for perfusion and venous drainage. The clots were removed, and tears were found in both the lateral side of the ascending aorta and the right atrial wall. Intraoperative TEE showed that an edge of the ASO device was directly touching the aortic wall and the Doppler color-flow imaging showed blood flow through this lesion. The erosive lacerations of both the ascending aorta and right atrium were detected from the inside after achieving cardioplegic cardiac arrest. The ascending aorta was obliquely incised, and the laceration was closed from inside the aortic root. The postoperative course was uneventful. She has been doing well for 5 years since the surgery. CONCLUSIONS: We experienced and successfully treated a rare case of acute cardiac tamponade caused by aortic erosion 5 years and 10 months after ASO implantation.


Assuntos
Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/etiologia , Comunicação Interatrial/cirurgia , Complicações Pós-Operatórias/etiologia , Dispositivo para Oclusão Septal/efeitos adversos , Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Cateterismo Cardíaco/métodos , Criança , Remoção de Dispositivo , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Comunicação Interatrial/diagnóstico , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares/métodos
12.
Cardiol Young ; 29(10): 1310-1312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475660

RESUMO

Femoral vein access is the first choice for percutaneous atrial septal defect closure, and when it cannot be used due to anatomic reasons, the alternative sites should be considered, frequently increasing the complexity of the procedure. Here we report the case of a 3-year-old boy, with situs inversus and dextrocardia, electively referred for percutaneous closure of an ostium secundum atrial septal defect. During the procedure, agenesis of the infra-hepatic segment of the inferior caval vein was diagnosed, and no double inferior caval vein or right superior caval vein were identified by ultrasound or angiography. Therefore, we opted to perform the procedure through the left internal jugular vein, with fluoroscopy and transesophageal echocardiographic guidance. Catheters were navigated through a hydrophilic guidewire, and a Stiff guidewire was positioned in the left ventricle for better support. An Amplatzer septa occluder 19 was successfully deployed without major difficulties and the patient was discharged after 24 hours in good clinical condition. Percutaneous atrial septal defect closure through alternative access sites, especially in the presence of situs inversus, may pose significant challenges to the interventional team. In this case, the left internal jugular vein has shown to be a feasible option, allowing the navigation and manipulation of devices without complications. Provided the expertise of the interventional team, and awareness of the risks involved, alternative access sites can be successfully used for paediatric structural interventions.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Situs Inversus/diagnóstico , Cirurgia Assistida por Computador/métodos , Veia Cava Inferior/anormalidades , Pré-Escolar , Ecocardiografia Transesofagiana , Fluoroscopia , Comunicação Interatrial/diagnóstico , Humanos , Veias Jugulares , Masculino
13.
World J Pediatr Congenit Heart Surg ; 10(5): 539-542, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496402

RESUMO

BACKGROUND: Catheter-based interventions for treating congenital cardiac defects have gained wide acceptance as they reduce the risks associated with surgery. However, these procedures are associated with some complications, such as the embolization of devices or stents and the injury of surrounding structures, which might need a rescue surgical intervention. METHODS: Data from 25 patients who needed rescue surgery following interventional catheterization between January 2008 and January 2018 were retrospectively collected and statistically analyzed to review the decision and timing of surgery as well as the surgical techniques and results. RESULTS: There were 24 cases of rescue surgery after device embolization, including 9 cases of atrial septal defect closure, 8 cases of patent ductus arteriosus closure, 4 cases of pulmonary artery balloon dilatation with stenting, 3 cases of muscular ventricular septal defect closure, and 1 case of right ventricular outflow tract injury during balloon valvuloplasty. Median age was 4 years (range, 2 months to 12 years). All rescue surgeries were done via median sternotomy. The mean time interval between the decision to remove the device surgically and the actual surgical procedure was 75 ± 14 minutes. There were no reported cases of postoperative complications or mortality among the patients who underwent surgery. CONCLUSION: Our single-center experience confirms that early rescue cardiac surgery to correct adverse events after pediatric transcatheter interventions is safe and effective. Surgical strategies should be tailored according to the situation in each case.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Comunicação Interatrial/cirurgia , Comunicação Interventricular/cirurgia , Reoperação , Dispositivo para Oclusão Septal/efeitos adversos , Adolescente , Valvuloplastia com Balão/efeitos adversos , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Esternotomia/efeitos adversos
14.
World J Pediatr Congenit Heart Surg ; 10(5): 645-647, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496412

RESUMO

A 46-year-old man who had undergone atrial septal defect closure during childhood was referred for surgery for residual partial anomalous pulmonary venous connection. The anomalous pulmonary veins were connected to the higher (cephalad) segment of the superior vena cava. As the usual caval division technique was not applicable, we chose to utilize the anterior wall of the superior vena cava as a flap for anomalous pulmonary vein rerouting. Bovine pericardium was used to reconstruct the systemic venous pathway. Systemic or pulmonary venous stenosis was not detected. The patient was discharged with a sinus rhythm.


Assuntos
Cardiopatias Congênitas/cirurgia , Comunicação Interatrial/cirurgia , Pericárdio/cirurgia , Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Retalhos Cirúrgicos , Veia Cava Superior/cirurgia , Anastomose Cirúrgica/métodos , Animais , Bovinos , Humanos , Masculino , Pessoa de Meia-Idade , Transplante Heterólogo , Malformações Vasculares
15.
BMC Res Notes ; 12(1): 491, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391105

RESUMO

OBJECTIVES: The purpose of this study to determine the clinical pattern and prevalence of heart disease in pregnancy at the first established cardio-maternal unit in Iraq over the last 4 years; since January 2015 till May 2019. Data are presented as number and percentage. RESULTS: A total of 252 pregnant women presented to cardio-maternal unit included in this study. According to the collected data, among the main diagnosis of heart disease during pregnancy was valvular heart disease 34.1%, followed by congenital heart disease 30.5%, cardiomyopathy 29.8%, pulmonary hypertension 4%, and ischemic heart disease 1.6%. Among subtypes of the main heart diseases in pregnant women, the most clinical pattern was: the prosthetic heart valve (26.7%) in valvular heart disease, both atrial septal defect and ventricular septal defect (35%) in congenital heart disease, and peripartum cardiomyopathy (76%) among cardiomyopathies.


Assuntos
Cardiomiopatias/epidemiologia , Comunicação Interatrial/epidemiologia , Comunicação Interventricular/epidemiologia , Doenças das Valvas Cardíacas/epidemiologia , Hipertensão Pulmonar/epidemiologia , Isquemia Miocárdica/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Cardiomiopatias/diagnóstico , Feminino , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/cirurgia , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/cirurgia , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/estatística & dados numéricos , Unidades Hospitalares , Humanos , Hipertensão Pulmonar/diagnóstico , Iraque/epidemiologia , Isquemia Miocárdica/diagnóstico , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/cirurgia , Prevalência
16.
Cardiol Young ; 29(9): 1202-1205, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31379319

RESUMO

Secundum atrial septal defect is the most common form of interatrial communication. Atrial septal defects can present in young adults with a variety of clinical presentations, including breathlessness on effort, palpitations, or stroke. Clinical heart failure and resting desaturation are both rarely seen in young patients. We present a case of a young man with a secundum atrial septal defect and a diagnosis of constrictive pericarditis, only made after two attempts at surgical correction of the atrial septal defect, with pericardiectomy at the third attempt and subsequent symptomatic improvement.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interatrial/diagnóstico , Pericardite Constritiva/diagnóstico , Adolescente , Diagnóstico Diferencial , Ecocardiografia Transesofagiana/métodos , Eletrocardiografia , Comunicação Interatrial/complicações , Comunicação Interatrial/cirurgia , Humanos , Masculino , Pericardiectomia/métodos , Pericardite Constritiva/complicações , Pericardite Constritiva/cirurgia
17.
J Card Surg ; 34(10): 1123-1126, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31374583

RESUMO

Primary cardiac tumors are very rare and generally benign. The most common type, cardiac rhabdomyoma, comprises 45% to 75% of primary cardiac tumors. Cardiac rhabdomyoma is a rare benign tumor that commonly presents with tuberous sclerosis. We present a case of an infant with multifocal cardiac rhabdomyomas with an atrial septal defect and tricuspid insufficiency and no sign of tuberous sclerosis. She was successfully treated with an operation, the treatment plan included mass resection, tricuspid annuloplasty, and closure of the patent foramen ovale. The right atrial lesion was resected entirely, while the lobulated lesion in the right ventricle was resected as two pieces. There was no evidence of recurrence 1 year after the surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/diagnóstico , Comunicação Interatrial/cirurgia , Rabdomioma/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Diagnóstico Diferencial , Ecocardiografia , Feminino , Seguimentos , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico , Ventrículos do Coração , Humanos , Lactente , Imagem Cinética por Ressonância Magnética , Rabdomioma/complicações , Rabdomioma/diagnóstico , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico
19.
J Cardiothorac Surg ; 14(1): 130, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272459

RESUMO

BACKGROUND: There are no unanimous reports on different layouts and classifications of multi-hole secundum atrial septal defects (MHASD) and subsequent standardized occlusion techniques. The MHASD can be isolated or cribriform with variable inter-defects distance. In this retrospective study, experience-based classification and two approaches-based occlusion results are presented. METHODS: We retrospectively collected and analyzed data of 150 MHASD patients from 1320 patients who underwent atrial septal defect occlusion in our institute. The MHASD patients were categorized into 4 types; type A, B, C and D and occluded under exclusive transesophageal echocardiographic guidance. According to different types, 122 patients were occluded using peratrial approach and 28 patients via percutaneous approach. In type A, single device implantation is performed to occlude the large hole and squeeze the small one. For type B single or double-device deployment was performed depending on an inter-defects distance. In type C and D, a patent foramen-ovale (PF) device was selectively positioned to the central defect to occlude the central defect and cover the peripheral ones. In peratrial approach, 8 patients underwent inter-defects septal puncture technique to achieve single-device occlusion. The intracardiac manipulation time, procedural time, double device deployment, redeployment rate, residual shunt, and proportions were analyzed between (and within peratrial technique) two techniques. RESULTS: Successful occlusion was achieved in all 150 patients. Single device occlusion was applied in 78/84 type A and 22/37 type B patients (p < 0.05). Double device occlusion was more applicable to type B than A patients (p < 0.01). Sixteen of 21 type C and all type D patients used PF device for a satisfactory occlusion. Redeployment of the device occurred frequently in type B patients than A (p < 0.01). The intracardiac manipulation time and procedural time were shorter in type A than B (p < 0.05). The intracardiac manipulation time was also shortened in type A peratrial than type A percutaneous group (p < 0.05). Complete occlusion rate for all patients at discharge was 70% and rose to 82% at 1 year follow up. CONCLUSIONS: The diverse layouts and classification of MHASDs can help to choose different techniques and proper devices of different kinds to achieve better occlusion results.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interatrial/classificação , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/instrumentação , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Comunicação Interatrial/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
J Cardiothorac Surg ; 14(1): 136, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324190

RESUMO

BACKGROUND: Transcatheter and intraoperative device closure for atrial septal defect (ASD) are widely applied to reduce the incision size and the potential for injury during cardiopulmonary bypass (CPB) in conventional surgical repair. No studies had been conducted to compare the safety and efficiency of these three treatments. METHODS: From January 2018 to April 2018, 87 patients with an isolated ASD who had undergone transcatheter device closure (n = 45), intraoperative device closure (n = 22) and surgical repair (n = 20) were retrospectively reviewed and further analyzed to compare these three treatments. RESULTS: The successful closure rate was similar in the three groups. There was a significant difference in aortic cross-clamping time, CPB duration and operative time between the surgical group and the device groups. The length of intensive care unit stay, postoperative mechanical ventilation time and length of hospital stay were shorter in the two device groups than in the surgical group. The incision was the most extended in the surgical group. Regarding major adverse events, no significant differences were found among the three groups. CONCLUSIONS: Transcatheter and intraoperative device closure and surgical repair for ASD are all safe and effective. Considering their respective disadvantages and advantages, the transcatheter approach may be the first choice for an isolated secundum ASD, the intraoperative approach may be the second choice, and surgical repair may be the last resort.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Cateterismo Cardíaco/instrumentação , Ponte Cardiopulmonar , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
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