Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.443
Filtrar
1.
Kyobu Geka ; 72(10): 799-804, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582699

RESUMO

Ventricular septal defect is the most frequent congenital heart disease and it exists as an isolated form or combines with other complex cardiovascular malformations. Soto's classification is based on the location and extension of the defect and it is most useful and comprehensive for a surgeon. Ventricular septal defect closure is one of the basic surgical procedures that a congenital heart surgeon must master first. In order to perform a perfect patch closure of the defect without making complications such as residual interventricular shunt, tricuspid valve regurgitation, or atrioventricular block, surgeon must acquire, ① preoperative and intraoperative accurate assessment and understanding of the anatomical features of the defect, ② effective intraoperative exposure of the defect, and ③ safe and assured stitch and ligation.


Assuntos
Comunicação Interventricular , Insuficiência da Valva Tricúspide , Comunicação Interventricular/cirurgia , Humanos , Próteses e Implantes
2.
Medicine (Baltimore) ; 98(42): e17347, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626092

RESUMO

RATIONALE: Non-significant residual shunt is a relatively common complication after device closure of perimembranous ventricular septal defects (Pm-VSD). Lifelong antibiotic prophylaxis has been recommended in guidelines to avoid infectious endocarditis (IE) if residual shunt remains. Clinicians, however, rarely follow it in their practice and regular follow-up was the most common option since post-procedure IE after transcatheter closure of PmVSD is rarely reported. We firstly described a case of IE after transcatheter closure of PmVSD with modified symmetrical double-disk device with a residual shunt, highlighting the need for reassessing the prognostic implications of post-procedure non-significant residual shunt and the most appropriate treatment strategy. PATIENT CONCERNS: A 3-year old female received transcatheter closure of PmVSD sized 5.0 mm on left ventricular angiography with an 8-mm modified symmetric double-disk occluder (SHAMA) owing to a history of recurrent lower respiratory tract infections. Post-procedure echocardiography documented a non-significant residual shunt, but no additional interventions were performed. Two months post procedure, the child was re-admitted into our department with a complaint of persistent fever up to 41°C for 11 days and nonresponse to 1-week course of amoxicillin. DIAGNOSES: The diagnosis of post procedure IE was established since a vegetation (13 × 9 mm) was found to be attached to the tricuspid valve and the occluder, and Staphylococcus aureus was isolated from all three-blood cultures. INTERVENTIONS: After 6 weeks of vancomycin treatment, the vegetation disappeared with no sign of valvular dysfunction. Three weeks after discharge, a second device was implanted to abolish persistent residual flow. OUTCOMES: Unfortunately, the child was ultimately transferred to surgical department due to severe hemolysis after the second device implantation. The occluders were removed and the VSD was closed with a pericardial patch. Tricuspid valvuloplasty was also performed and the following course was uneventful. LESSONS: For non-significant residual shunt after device closure of PmVSD, implantation of a second device or surgical repair may be a better and more satisfactory alternative compared with lifelong antibiotic prophylaxis or no interventions, since associated IE can indeed occur despite its rarity and the risk of antibiotic-associated adverse events may outweigh the benefits.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Endocardite Bacteriana/etiologia , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Pré-Escolar , Endocardite Bacteriana/terapia , Feminino , Humanos , Reoperação/métodos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/isolamento & purificação , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/patologia
3.
Pediatr Cardiol ; 40(6): 1247-1252, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31338560

RESUMO

To evaluate the feasibility and efficacy of the right subaxillary vertical mini-incision (RAVI) used for the closure of doubly committed subarterial ventricular septal defect (SAVSD) through tricuspid approach only. From June 2015 to September 2016, 32 SAVSD patients (mean age 2.4 ± 1.9 years, range 0.7-8 years) underwent surgical repair with either RAVI (incision length 3-4 cm) through tricuspid (group A, n = 16) or conventional median sternotomy incision through the main pulmonary artery approach (group B, n = 16). A retrospective 1:1 matched-pair analysis was performed with the group B matched for defect size, body weight, gender, patching, and operation year. The demographic characteristics in both groups were similar. No patient died and only 1 patient in group B needed reoperation for sternal infection. The mean cardiopulmonary bypass (CPB) time and aortic cross-clamp time were 48.6 ± 12.6 min, 29.3 ± 8.5 min in the group A and 57.8 ± 14.1 min (p = 0.03), 34.3 ± 12.1 min ( p = 0.18) in the group B. There was no significant difference between the two groups in the ICU stay (17.8 ± 8.9 h in group A, 18.7 ± 9.5 h in group B, p = 0.79), mechanical ventilation support time (2.7 ± 1.7 h in group A, 3.6 ± 1.5 h in group B, p = 0.11), postoperative hospital stay (6.3 ± 1.5 days in group A, 7.4 ± 1.7 days in group B, p = 0.06), and chest tube drainage (6.4 ± 4.3 ml/kg in group A, 8.5 ± 3.8 ml/kg in group B, p = 0.16). No significant residual defects were found in both groups. The post-operation pressure gradient across the right ventricular outflow tract (RVOT) was significantly different between the two groups with 4.6 ± 1.8 mmHg in group A and 10.0 ± 6.8 mmHg in group B (p = 0.004) even if no significant difference was found between both groups before operation. No arrhythmia was found after operation. All the patients or the parents (100%) in the group A were satisfied with the cosmetic results, while the number in B group was 7 (43.8%) in questionnaire. The RAVI through tricuspid approach to repair doubly committed subarterial ventricular septal defect is a safe and feasible procedure with better hemodynamic performance of RVOT and less CPB time because of keeping pulmonary artery intact comparing to conventional approach. More importantly, the RAVI through tricuspid approach can be performed with favorable cosmetic results.


Assuntos
Comunicação Interventricular/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Análise por Pareamento , Duração da Cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/cirurgia
4.
Kyobu Geka ; 72(4): 263-268, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-31266911

RESUMO

Pulmonary atresia, ventricular septal defect, and major aorto-pulmonary collateral arteries are deemed unrepairable in some patients. Reportedly, 39% to 63% of patients treated by the staged unifocalization pathway, and 25% to 51% of patients treated by the pulmonary artery rehabilitation strategy were deemed unsuitable to undergo total repair. Single-stage complete unifocalization with intracardiac repair can be performed in some older patients with pulmonary atresia, ventricular septal defect, and major aorto-pulmonary collateral arteries that were previously deemed unrepairable. We report four such patients with ages between 12 years and 28 years at surgery. Bosentan hydrate was administered pre-operatively in one female patient for 14 months to ameliorate regional pulmonary hypertension. Seventeen months after repair, she delivered a baby by cesarean section. One patient underwent aortic valve replacement concomitant with repair due to severe aortic regurgitation caused by healed infective endocarditis. All patients were discharged home 9 to 18 days after surgery. After 72 to 100 months of follow-up, three patients are in New York Heart Association (NYHA) class Ⅰ, and the remaining patient are in NYHA class Ⅱ. Single-stage complete unifocalization can allow total repair in adolescents and adults with pulmonary atresia, ventricular septal defect, and major aorto-pulmonary collateral arteries that were previously deemed unrepairable.


Assuntos
Cardiopatias Congênitas , Comunicação Interventricular , Atresia Pulmonar , Adolescente , Adulto , Cesárea , Criança , Circulação Colateral , Feminino , Cardiopatias Congênitas/cirurgia , Comunicação Interventricular/cirurgia , Humanos , Gravidez , Artéria Pulmonar , Atresia Pulmonar/cirurgia , Adulto Jovem
5.
World J Pediatr Congenit Heart Surg ; 10(4): 426-432, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307296

RESUMO

BACKGROUND: Single-stage biventricular repair remains a challenging and difficult decision in high-risk newborns and early infants with the presence of left ventricular outflow tract obstruction (LVOTO) or borderline hypoplasia of the left ventricle (LV). METHODS: Six high-risk patients underwent the initial hybrid procedure (bilateral pulmonary banding + ductal stenting) for staged biventricular repair. Their median age was 17 days (range: 7-55 days). The diagnosis was interrupted aortic arch (IAA), ventricular septal defect (VSD), and LVOTO (n = 3); IAA and VSD (n = 1); and aortic annular hypoplasia, aortic arch hypoplasia, VSD, and LVOTO (n = 1). The last patient had borderline LV with large atrial septal defect (ASD) and aortic arch hypoplasia. The patient with borderline LV had also ASD closure with small fenestration. RESULTS: One patient died of sepsis after the hybrid procedure. Other patients underwent biventricular repair 8 to 13 months later. Three patients had conventional repair with conal septum resection. The other patient with IAA, in whom LVOTO was considered nonresectable, underwent Yasui operation. The last patient with borderline LV had enough development of left heart structures during follow-up and underwent aortic arch repair. One patient who had conal septum resection died after biventricular repair. One patient needed a tracheostomy; four patients were discharged uneventfully and their clinical conditions were good on postoperative year 1. CONCLUSION: Staged biventricular repair with the initial hybrid procedure may be a feasible and safe alternative in high-risk neonates and early infants. Hybrid intervention may provide the development of cardiac structures in time and a better evaluation for the possibility of biventricular repair in borderline patients.


Assuntos
Coartação Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Ventrículos do Coração/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico , Ecocardiografia , Feminino , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico , Ventrículos do Coração/anormalidades , Humanos , Lactente , Recém-Nascido , Masculino , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/etiologia
6.
Braz J Cardiovasc Surg ; 34(3): 335-343, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310473

RESUMO

OBJECTIVE: To reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure. METHODS: We reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as "prolonged". Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE). RESULTS: VSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) (P-value<0.001) and prolonged cardiopulmonary bypass time (P=0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE (P=0.03). CONCLUSION: Higher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.


Assuntos
Comunicação Interventricular/cirurgia , Complicações Pós-Operatórias/etiologia , Técnicas de Fechamento de Ferimentos/efeitos adversos , Fatores Etários , Peso Corporal , Ponte Cardiopulmonar/métodos , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Gravidez , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo
7.
Braz J Cardiovasc Surg ; 34(3): 344-351, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310474

RESUMO

OBJECTIVES: To compare the advantages and disadvantages of perventricular and percutaneous procedures for treating isolated ventricular septal defect (VSD). METHODS: A total of 572 patients with isolated VSD were selected in our hospital between January 2015 and December 2016. The patients' median age and weight were five years (1-26 years) and 29 kg (9-55 kg), respectively. The median diameter of VSD was 6.0 mm (5-10 mm). Patients were divided into two groups. In group A, perventricular device closure was performed in 427 patients; in group B, 145 patients underwent percutaneous device closure. RESULTS: Four hundred twelve patients in group A and 135 patients in group B underwent successful closure. The total occlusion rate was 98.5% (immediately) and 99.5% (3-month follow-up) in group A, which were not significantly different from those in group B (97.7% and 100%, respectively). Patients in group A had longer intensive care unit (ICU) stay than those in group B, but patients in group B experienced significantly longer operative times than those in group A. The follow-up period ranged from 8 months to 1.5 year (median, 1 year). During the follow-up period, late-onset complete atrioventricular block occurred in two patients. No other serious complications were noted in the remaining patients. CONCLUSION: Both procedures are safe and effective treatments for isolated VSD. The percutaneous procedure has obvious advantages of shorter ICU stay and less trauma than the perventricular procedure. However, the perventricular procedure is simpler to execute, results in a shorter operative time, and avoids X-ray exposure.


Assuntos
Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal/normas , Adolescente , Adulto , Angiografia/métodos , Insuficiência da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/cirurgia , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Ecocardiografia/métodos , Desenho de Equipamento , Feminino , Comunicação Interventricular/diagnóstico por imagem , Humanos , Lactente , Tempo de Internação , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
J Cardiothorac Surg ; 14(1): 104, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31186037

RESUMO

BACKGROUND: The purpose of this study was to describe our experience with patients who underwent transcatheter closure of a post-operative ventricular septal defect (VSD). METHODS: All patients who underwent transcatheter closure of a VSD after total correction of congenital heart disease since 2012 were enrolled. Medical records were retrospectively reviewed to determine the patients' initial diagnosis, closure device used, and final outcome after device closure. RESULTS: Six patients with a median age of 17.7 years (range: 7 months-48 years) underwent transcatheter closure of an unresolved VSD. The median time interval from the initial corrective surgery to the percutaneous closure procedure was 10.4 years (range: 0.3-33.0 years). The initial diagnoses included tetralogy of Fallot (one patient), VSD (two patients), double outlet of the right ventricle (two patients), and aortic valve stenosis (one patient). The reasons for unresolved VSD (other than leakage) after corrective surgery included previous fenestration (in two patients), and iatrogenic Gerbode shunt (in one patient). Various devices were used, including the Amplatzer duct occluder I, Amplatzer duct occluder II, Amplatzer vascular plug II, and Cocoon membranous VSD occluder. Only one device was used in each patient. There were no major complications associated with the closure procedures. The immediate results were satisfactory. The median follow-up duration was 2.75 years. All cases were successful, with the exception of minimal leak in one patient. CONCLUSIONS: Transcatheter device closure of post-operative VSD can be performed using various device types of devices and is safe and effective. But more experiences are mandatory.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiopatias Congênitas/cirurgia , Comunicação Interventricular/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/complicações , Comunicação Interventricular/etiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Dispositivo para Oclusão Septal , Resultado do Tratamento , Adulto Jovem
9.
J Cardiothorac Surg ; 14(1): 106, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31186038

RESUMO

BACKGROUND: Partial atrioventricular canal defects (PAVC) are preferred to be repaired when diagnosed and before an operation would interfere with school. There were rare previous studies about partial atrioventricular canal defect operations in adult patients. In this single-center retrospective study, we mean to review the mid-term follow-up outcomes of late diagnosed and repaired partial atrioventricular canal defects in adult patients. METHODS: 46 adult partial atrioventricular canal defect patients who underwent operation in West China Medical Center from 2009 to 2017 were included. Required data were obtained from operation notes, patient charts and the outpatient records. RESULTS: Among 46 patients, 10(21.7%)were male and mean age at operation was 37.6 ± 12.4 years. 11 patients had prior arrythmia, including 8 atrial fibrillations, 2 atrioventricular blocks and 1 left bundle branch block. There were 41 patients with tricuspid valve regurgitation and 22 underwent tricuspid valvuloplasty. All the patients had mitral regurgitation. 6 patients with valve incrassation and shrinkage underwent mitral valve replacement, and the rest underwent mitral repair surgery. There was one early death post operation and no more mortalities in the following follow-up years. According to the follow-up outcomes, heart function of the patients recovered significantly, dilation of atriums and ventricles, except for left atriums, were reversed to a large extent and all but one patients' tricuspid valve regurgitations were reduced to mild and below. 4(8.7%) patients underwent reoperation and the main reasons were arrythmia and recurrent severe mitral valve regurgitation. CONCLUSION: Partial atrioventricular canal defect repair in adult patients can achieve good results. Compared with the results of patients underwent operations in preschool years, though delayed surgery timing seems to bring more preoperative complications and influences heart function, the mortality and reoperation rate are excellent.


Assuntos
Comunicação Interventricular/cirurgia , Adulto , Arritmias Cardíacas/complicações , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , China , Diagnóstico Tardio , Feminino , Seguimentos , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/cirurgia
10.
J Cardiothorac Surg ; 14(1): 119, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248430

RESUMO

BACKGROUND: To investigate the safety and efficacy of perventricular device closure of perimembranous VSD (pmVSD). METHODS: PubMed and Scopus were searched for studies in English focusing on perventricular device closure of pmVSD published up to the end of March 2019. We used a random-effects model to obtain pooled estimates of the success and complication rates. RESULTS: A total of 15 publications comprising 1368 patients with pmVSD were included. The median follow-up duration was 2 months to 5 years, with a mean patient age ranging from 2 months to 56 years. The pooled success rate was 0.95 (I2 = 86.2%, P = 0.000). The pooled rate of postoperative residual shunting was 0.02 (95% CI: 0.01-0.03, I2 = 87.3%, P < 0.001). The pooled rate of residual shunting in the follow-up period was 0.001 (95% CI:-0.001-0.002, I2 = 30.5%, P = 0.126). The pooled estimated rate of severe complications was 0.074 (95% CI: 0.046-0.102, I2 = 30.5%, P = 0.126). The pooled incidence of complete atrioventricular block (cAVB) was 0.002 (95% CI: 0.000-0.005, I2 = 0.0%, P = 0.577). CONCLUSIONS: Perventricular device closure may be an alternative to conventional surgical repair in selected patients with pmVSD. The success rate was stable regarding the publication year and sample size and suggested both the short learning curve of this technology and its potential for wide application. The incidence of severe arrhythmia, especially cAVB, was low. These good results may be limited by the number of enrolled patients, and a more detailed and larger sample is required for further analysis.


Assuntos
Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal , Adolescente , Adulto , Bloqueio Atrioventricular/etiologia , Cateterismo Cardíaco , Criança , Pré-Escolar , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Resultado do Tratamento , Adulto Jovem
11.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036736

RESUMO

PHACES syndrome is an uncommon neurocutaneous disorder first identified in 1996. Patients with PHACES syndrome often require surgical treatment for their anomalies, including intracranial vasculopathy, coarctation/interruption of the aorta, intracardiac defects, glaucoma/cataract and sternal defects. Risk factors associated with the symptoms of intraoperative/perioperative management include ischaemic stroke due to the cerebral vasculopathy, airway obstruction due to the subglottic/tracheal haemangiomas and massive bleeding due to the large haemangiomas. Recently, propranolol is considered as first-line therapy for patients with infantile haemangiomas (IHs). However, until now, there have been no reported cases of PHACES syndrome treated by propranolol to reduce the surgical risks associated with IH. In this report, we describe a case of a 14-month-old Japanese girl with PHACES syndrome treated by propranolol for IH before surgical closure of the ventricular septum defect. Oral administration of propranolol was effective in decreasing the size of IH, leading to the uneventful perioperative course.


Assuntos
Anormalidades Múltiplas/cirurgia , Coartação Aórtica/cirurgia , Anormalidades do Olho/cirurgia , Hemangioma/tratamento farmacológico , Síndromes Neurocutâneas/cirurgia , Propranolol/administração & dosagem , Anormalidades Múltiplas/tratamento farmacológico , Anormalidades Múltiplas/patologia , Administração Oral , Antagonistas Adrenérgicos beta , Obstrução das Vias Respiratórias/complicações , Obstrução das Vias Respiratórias/prevenção & controle , Coartação Aórtica/tratamento farmacológico , Coartação Aórtica/patologia , Ecocardiografia/métodos , Anormalidades do Olho/tratamento farmacológico , Anormalidades do Olho/patologia , Feminino , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Hemangioma/diagnóstico por imagem , Humanos , Lactente , Imagem por Ressonância Magnética , Síndromes Neurocutâneas/tratamento farmacológico , Síndromes Neurocutâneas/patologia , Cuidados Pré-Operatórios/normas , Propranolol/efeitos adversos , Doenças Raras , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
12.
World J Pediatr Congenit Heart Surg ; 10(3): 278-285, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31084308

RESUMO

BACKGROUND: Transcatheter device closure of ventricular septal defect (VSD) is an alternative to conventional surgical closure. Device closure of moderate to large perimembranous VSD (pmVSD) is considered technically challenging in smaller children weighing ≤10 kg. Very few studies are published on the outcomes of the same. METHODS: Descriptive single-center retrospective study. Data of 49 children ≤10 kg with moderate to large pmVSDs taken up for transcatheter device closure in our institute were analyzed and their follow-up details were reviewed. RESULTS: Of the 87 patients referred for VSD closure, 49 patients qualified for the inclusion criteria. Median age was 18 months (interquartile range: 13-22). Successful device deployment was achieved in 42 (85.7%) patients. Mean VSD size by transthoracic echocardiography was 5.98 mm (range: 4-12 mm). Mean waist size of the device used was 8.26 mm (range: 4-14 mm). There was one device embolization, requiring catheter-directed retrieval from the left ventricle and subsequent surgical referral for VSD closure. Minor complications such as device-related persistent new aortic regurgitation was noted in one patient and mild tricuspid regurgitation and transient heart block occurred in two patients each. There was no mortality or complete heart block requiring permanent pacemaker implantation immediately or during midterm follow-up (mean follow-up: 20 months; range: 6-72.5 months). CONCLUSION: Device closure of moderate to large pmVSDs in children weighing ≤10 kg is feasible and safe with a success rate of 85.7%. Careful selection of patients and avoidance of oversizing the defect makes the immediate and midterm results acceptable.


Assuntos
Peso Corporal , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Ecocardiografia , Feminino , Comunicação Interventricular/diagnóstico , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
13.
Rev Port Cir Cardiotorac Vasc ; 26(1): 55-58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31104378

RESUMO

Ventricular septal defects are the most common congenital abnormality diagnosed in children but account for only 10 percent of congenital heart defects in adults. Although many defects close spontaneously before adulthood, many others persist, predisposing to endocarditis, and other complications. Herein, we report a case of a known, asymptomatic, perimembranous ventricular septal defects that has complicated at 53 years of age with the need for surgery due to native aortic valve endocarditis and concomitant severe aortic regurgitation. We opted to surgically repair the ventricular septal defects with a pericardial patch through the necessary aortotomy used for aortic valve replacement (Figure 1 and 2). The surgery was straightforward. Postoperative course was only marked by the need of a permanent pacemaker implantation due to a sick sinus syndrome, which was diagnosed before the surgery. Thus, we emphasize the role of surgery in repairing ventricular septal defects and the importance of choosing the appropriate approach, especially when concomitant heart lesions are present.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Endocardite/cirurgia , Comunicação Interventricular/cirurgia , Aorta/cirurgia , Insuficiência da Valva Aórtica/etiologia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Endocardite/etiologia , Comunicação Interventricular/complicações , Humanos , Pessoa de Meia-Idade
14.
Mymensingh Med J ; 28(2): 474-478, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086170

RESUMO

Ventricular septal rupture (VSR) is an uncommon but lethal complication of acute myocardial infarction (MI). Although early surgical closure is the treatment of choice, hospital mortality after emergency surgery remains high. Transcatheter closure of post myocardial infarction ventricular septal defect (PIVSD) has emerged as a potential treatment option in selected cases. Herein, we report a case present in AFC Health FORTIS Heart Institute, Khulna, Bangladesh on 10 February 2017 of sub acute post-MI VSR that was successfully closed using an Amplatzerseptal occlude (ASD) device. The patient had undergone primary percutaneous coronary intervention (PCI) 15 days earlier in the setting of acute MI.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Ruptura Cardíaca Pós-Infarto/etiologia , Comunicação Interventricular/etiologia , Comunicação Interventricular/cirurgia , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/cirurgia , Humanos , Intervenção Coronária Percutânea , Próteses e Implantes , Dispositivo para Oclusão Septal , Resultado do Tratamento , Ruptura do Septo Ventricular/complicações , Ruptura do Septo Ventricular/etiologia
15.
Pediatr Cardiol ; 40(5): 1097-1100, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31073802

RESUMO

Left ventricular pseudoaneurysm (LV-PSA) is a rare complication following cardiac surgery, let alone in the pediatric population. Other known causes of LV-PSA are trauma, percutaneous cardiac intervention, and infections. This report describes the development of LV-PSA following surgical repair of ventricular septal defect (VSD) and coarctation of aorta (CoA) in an infant.


Assuntos
Falso Aneurisma/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Coartação Aórtica/cirurgia , Ecocardiografia , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Recém-Nascido , Masculino
17.
J Cardiothorac Surg ; 14(1): 70, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961628

RESUMO

BACKGROUND: Transthoracic device closure of ventricular septal defect (VSD) is widely used in the clinic, especially in China. Changes in inflammatory marker levels after transthoracic device closure of VSD in pediatric patients have not been reported. METHODS: We retrospectively collected clinical data for 85 pediatric patients in our hospital from September 2017 to January 2018. The patients were divided into two groups according to treatment (device group vs. surgical group). The clinical and experimental data from the two groups were statistically analyzed. RESULTS: Clinical outcomes were good in all patients without any fatal complications. Similar increasing trends in inflammatory markers (white blood cell (WBC) count, procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6)) were found in the two groups, both of which showed noticeable systemic inflammatory responses. In addition, no significant difference in the postoperative levels of inflammatory markers was observed between these two groups. CONCLUSIONS: Although transthoracic device closure of VSD seems to be less traumatic and involves a quicker recovery, it also induces a systemic inflammatory response as measured by WBC count and PCT, CRP and IL-6 levels, and the altered trends in inflammatory markers were similar to those of conventional surgery under CPB.


Assuntos
Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Proteína C-Reativa/análise , Pré-Escolar , China , Feminino , Comunicação Interventricular/sangue , Humanos , Lactente , Interleucina-6/sangue , Contagem de Leucócitos/métodos , Masculino , Período Pós-Operatório , Pró-Calcitonina/sangue , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Resultado do Tratamento
18.
J Card Surg ; 34(5): 236-238, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30924563

RESUMO

BACKGROUND: Total Cavopulmonary connection (Fontan) is the final palliation for patients with a functionally univentricular heart. This is commonly accomplished after a prior bidirectional Glenn on cardiopulmonary bypass (CPB) with separate cannulation of the aorta, superior vena cava (SVC), and inferior vena cava. We describe an alternative technique of Fontan completion that eliminates the need for cannulation and dissection of the SVC, and pulmonary artery dissection. METHODS: Between January and October 2018, 17 patients underwent completion Fontan using an alternate technique at our institute. All operations were conducted on CPB at normothermia without cannulating the SVC RESULTS: Mean CPB time was 60 ± 16.8 minutes (range, 39-102 minutes). There were no early deaths. Mean postoperative Fontan pressures were 15.6 ± 1.2 mm Hg with no gradient between the SVC and IVC pressures. Mean duration of hospital stay was 15.6 ± 3.6 days (range, 10-22 days). No patient developed phrenic nerve paresis or palsy. CONCLUSIONS: Completion without cannulating the SVC is simple, reproducible, and easy to teach. It avoids the disadvantages associated with routine techniques.


Assuntos
Técnica de Fontan/métodos , Adolescente , Ponte Cardiopulmonar/métodos , Cateterismo/métodos , Criança , Dupla Via de Saída do Ventrículo Direito/cirurgia , Feminino , Comunicação Interventricular/cirurgia , Humanos , Masculino , Estenose da Valva Pulmonar/cirurgia , Transposição dos Grandes Vasos/cirurgia , Resultado do Tratamento , Atresia Tricúspide/cirurgia , Veia Cava Superior , Adulto Jovem
19.
Tex Heart Inst J ; 46(1): 44-47, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30833838

RESUMO

Ventricular septal defect (VSD) is a rare, potentially fatal complication of acute myocardial infarction. When surgical closure is contraindicated, transcatheter closure may be an alternative. Residual shunting after transcatheter closure of postinfarction VSDs has been reported; however, we found few cases of this in patients who also had severe heart failure or hemolysis. We report 2 closures of postinfarction VSDs with use of the Amplatzer Septal Occluder. Both elderly patients-one with severe heart failure, one with persistent hemolysis, and neither a surgical candidate-had high-velocity residual shunting through the occluders. We intensively managed the patients' conditions and used angiography and transthoracic echocardiography to record the gradual disappearance of each shunt over 4 months-the first such serial monitoring of which we are aware. We think that even substantial shunting in the presence of severe heart failure or hemolysis can eventually resolve spontaneously, assuming effective management of the concomitant medical conditions.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interventricular/cirurgia , Infarto do Miocárdio/complicações , Dispositivo para Oclusão Septal , Idoso , Ecocardiografia , Feminino , Comunicação Interventricular/etiologia , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Remissão Espontânea , Resultado do Tratamento
20.
World J Pediatr Congenit Heart Surg ; 10(2): 151-156, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30841837

RESUMO

BACKGROUND: Accurate coronary translocation is very important for a successful arterial switch operation (ASO) for transposition of the great arteries (TGA) and to provide good long-term outcomes. We have previously reported the "bay window" technique as a useful option for coronary translocation with excellent midterm results. However, the long-term results of this technique and the morphological changes in the coronary channel have not yet been reported. PATIENTS AND METHODS: Between September 2001 and December 2012, 33 patients with TGA underwent coronary translocation using the bay window technique concomitantly with ASO. The diagnoses were TGA with intact ventricular septum in 21, TGA with ventricular septal defect in 7, and Taussig-Bing anomaly in 5. The median age of the patients at operation was 12 days, and their median body weight was 2.93 kg. Coronary artery patterns were as follows: Shaher and Puddu's type 1 in 23, single coronary artery in 4, intramural type in 1, and others in 5. RESULTS: The median follow-up period was 4.5 years. There were no operative deaths, but there was one late death because of sepsis 13 months after ASO. Coronary artery evaluation with angiography, computed tomography, or myocardial scintigraphy was performed in 22 patients. There was no abnormal coronary morphology or perfusion. Coronary channel dilatation was not observed. Three patients underwent reoperation for pulmonary stenosis. CONCLUSIONS: The bay window technique provides excellent long-term results in ASO for TGA. Three-dimensional computed tomography revealed no aneurysmal changes in the bay window channel at nine-year follow-up examination.


Assuntos
Transposição das Grandes Artérias/métodos , Transposição dos Grandes Vasos/cirurgia , Anormalidades Múltiplas/cirurgia , Angiografia Coronária , Dupla Via de Saída do Ventrículo Direito/cirurgia , Feminino , Seguimentos , Comunicação Interventricular/cirurgia , Humanos , Imagem Tridimensional , Lactente , Recém-Nascido , Masculino , Imagem de Perfusão do Miocárdio , Estenose da Valva Pulmonar/cirurgia , Reoperação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Transposição dos Grandes Vasos/diagnóstico por imagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA