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1.
J Cardiothorac Surg ; 15(1): 297, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008444

RESUMO

BACKGROUND: While the aneurysms of the membranous septum (AVS) are rare, the possibility that they lead to obstruction is even rarer. To the best of our knowledge, 11 similar cases have been reported since 1982. CASE PRESENTATION: Initially, the five-year-old boy was evaluated for dyspnoea that had been present since birth. He did not receive any medical treatment until the previous year. At the age of four, the transthoracic echocardiography showed a large aneurysm extending to the right ventricular outflow tract (RVOT) and causing RVOT stenosis. Complete surgical resection of the aneurysmal tissue was performed, and the boy was discharged home in satisfactory condition. CONCLUSIONS: As the occurrence of RVOT obstruction by a membranous ventricular septal aneurysm is very rare, we are reporting the second case in which an aneurysm of the membranous septum dynamically obstructed the RVOT in a child. We are also reviewing all the previously reported similar cases in the literature. Further studies are needed to obtain a more comprehensive understanding of aneurysms of the membranous septum (AVS).


Assuntos
Aneurisma Cardíaco/cirurgia , Cardiopatias Congênitas/cirurgia , Comunicação Interventricular/cirurgia , Septo Interventricular/cirurgia , Pré-Escolar , Dispneia/etiologia , Ecocardiografia , Aneurisma Cardíaco/complicações , Cardiopatias Congênitas/complicações , Comunicação Interventricular/complicações , Ventrículos do Coração , Humanos , Masculino
2.
Medicine (Baltimore) ; 99(35): e21758, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871896

RESUMO

INTRODUCTION: Gastroesophageal reflux disease is a common and troublesome condition. This paper reports a rare case of gastroesophageal reflux disease caused by ectopic biliary drainage accompanying the absence of a pyloric channel and duodenal bulb in a female patient with multiple underlying malformations. PATIENT CONCERNS: A 24-year-old female presented with acid regurgitation and abdominal pain for one month. She was born two weeks premature and with blindness of the right eye. Cardiac murmur was detected in the physical examination. DIAGNOSIS: Gastroendoscopy was performed, and a class D reflux esophagitis and ectopic papilla complicated with the absence of a pyloric channel and duodenal bulb were found. Doppler echocardiography further confirmed the defects of atrial and ventricular septa. Trio-based whole exome sequencing was performed on the proband and her family to find the potential association of multiple variations. However, no putative pathogenic mutations were found. INTERVENTIONS: The patient received proton pump inhibitors and prokinetic treatment and underwent surgical repair of septal defects. OUTCOMES: The symptoms were quickly relieved, and the patient was kept stable upon follow-up. CONCLUSION: The combination of an absent pylorus and ectopic papilla is a rare cause of reflux esophagitis. Unusual gastrointestinal anatomical variations may be accompanied by other malformations. Though no remarkable mutation were detected in this case, sequencing is an efficient technique worth full consideration.


Assuntos
Ampola Hepatopancreática/anormalidades , Esofagite Péptica/etiologia , Anormalidades Múltiplas , Cegueira/congênito , Esofagite Péptica/tratamento farmacológico , Feminino , Gastroscopia , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Inibidores da Bomba de Prótons/uso terapêutico , Sequenciamento Completo do Exoma , Adulto Jovem
3.
Asian Cardiovasc Thorac Ann ; 28(6): 336-338, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32539424

RESUMO

Rapidly progressive epicardial hemorrhagic blebs during weaning from cardiopulmonary bypass after perimembranous ventricular septal defect closure has not been reported previously. Here, we describe the case of a 3-month-old baby with life-threatening epicardial hemorrhagic blebs and an interventricular septal hematoma after perimembranous ventricular septal defect patch closure.


Assuntos
Vesícula/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Comunicação Interventricular/cirurgia , Hematoma/etiologia , Pericárdio/transplante , Vesícula/diagnóstico por imagem , Evolução Fatal , Comunicação Interventricular/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Humanos , Lactente , Masculino
4.
Asian Cardiovasc Thorac Ann ; 28(6): 333-335, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32551840

RESUMO

The introduction of the arterial switch operation has improved the surgical outcome of transposition of the great arteries. However, coronary anomalies such as intramural coronary arteries, single coronary artery, or coronary arteries originating from a single arterial sinus have been reported as independent risk factors for early mortality and late morbidity after an arterial switch operation. We performed an arterial switch operation using a unique technique for translocation of the coronary arteries originating from a single left-side arterial sinus, to prevent coronary artery distortion and subsequent coronary malperfusion.


Assuntos
Transposição das Grandes Artérias , Seio Coronário/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Transposição dos Grandes Vasos/cirurgia , Seio Coronário/anormalidades , Seio Coronário/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Lactente , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/diagnóstico por imagem , Resultado do Tratamento
5.
West Afr J Med ; 37(3): 281-283, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32476123

RESUMO

BACKGROUND: Ventricular Septal Defect (VSD) is the commonest congenital heart disease. Without appropriate treatment, it is associated with significant morbidity and mortality. Surgical repair under cardiopulmonary bypass has been the standard treatment. Results of such treatment is not readily available from the West African sub region. We analysed the outcome of surgical repair of VSDs carried out in this Centre over a 20-year period. PATIENTS AND METHODS: A retrospective study was done for all patients who had surgical repair of VSD from January 1993 to December 2012. RESULTS: There were a total of 207 patients, with 6 and 23 of them operated on in the first and last years of the study respectively. There were 121 (58.5%) males and 86 (41.5%) females. The mean age was 10.0 ± 10.5 (11 months - 55 years), with a median of 7 years. The modal class interval was 0 - 5 years (46.4%). Most of the VSDs were perimembranous 168 (81.1%), followed by outlet VSDs 19 (9.2%), muscular VSDs 11 (5.3%) and inlet VSDs 9 (4.4%). Fifty-four cases (26%) had associated congenital cardiac anomalies that needed concomitant surgical intervention, with the commonest being Pulmonary Stenosis (PS) 21 (10.1%), followed by Patent Ductus Ateriosus (PDA) 10 (4.8%). The complication rate was 6.4% (13 cases), comprising a morbidity of 4.4 % (9 cases) and early mortality of 2.0% (4 cases). The morbidity was due to bleeding requiring re-exploration 2 (1.0%), residual VSD requiring re-do 3 (1.4%), complete heart block requiring permanent pacemaker implantation 2 (1.0%), acute renal failure requiring dialysis 1 (0.5%), sternal wound infection requiring debridement 1 (0.5%). The mortality was due to pulmonary hypertension. CONCLUSION: With a morbidity of 4.4% and early mortality of 2.0%, the outcome of surgical repair of VSDs from this study is good. Children with VSDs must be offered repair as soon as possible to avoid the numerous complications that usually follow untreated VSDs.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Septos Cardíacos/cirurgia , Hipertensão Pulmonar/complicações , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Gana/epidemiologia , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
J Card Surg ; 35(6): 1345-1347, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-276419

RESUMO

During the COVID-19 pandemic, emergency room visits have drastically decreased for non-COVID conditions such as appendicitis, heart attack, and stroke. Patients may be avoiding seeking medical attention for fear of catching the deadly condition or as an unintended consequence of stay-at-home orders. This delay in seeking care can lead to increased morbidity and mortality, which has not been figured in the assessment of the extent of damage caused by this pandemic. This case illustrates an example of "collateral damage" caused by the COVID-19 pandemic. What would have been a standard ST-elevation myocardial infarction treated with timely and successful stenting of a dominant right coronary artery occlusion, became a much more dangerous postinfarction ventricular septal defect; all because of a 2-day delay in seeking medical attention by an unsuspecting patient.


Assuntos
Infecções por Coronavirus/epidemiologia , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Comunicação Interventricular/etiologia , Pneumonia Viral/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento , Diagnóstico Tardio , Ecocardiografia/métodos , Serviço Hospitalar de Emergência , Ruptura Cardíaca Pós-Infarto/cirurgia , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Segurança do Paciente , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Fatores de Tempo , Resultado do Tratamento
7.
J Cardiothorac Surg ; 15(1): 75, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32381035

RESUMO

OBJECTIVES: This study aimed to identify Chinese parents' knowledge and attitudes toward transthoracic device closure of ventricular septal defect (VSD). METHODS: This cross-sectional study collected data on a total of 203 Chinese parents of patients with VSD were included, and an author-designed three-page questionnaire was used. RESULTS: A total of 73.9% of the parents had heard of transthoracic device closure of VSD; however, they lacked detailed knowledge. 88.2% parents expressed their willingness to undergo this procedure. Although there was no significant correlation between knowledge about the occluder material and acceptance of the method, knowledge of other information was significantly related to willingness to undergo the procedure. Some parents expressed some concerns and high expectations, but the postoperative risk reduced their desire for accepting the procedure. This study also found that most parents did not have a detailed understanding of such procedure. CONCLUSION: Parents of patients with VSD in China need continued education regarding transthoracic device closure of VSD, especially in terms of its benefits and limited postoperative complications. In addition, it is essential to reduce the cost of this procedure to promote its development and application.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Conhecimentos, Atitudes e Prática em Saúde , Comunicação Interventricular/cirurgia , Pais , Complicações Pós-Operatórias , Dispositivo para Oclusão Septal , Adulto , China , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Cirurgia Assistida por Computador , Resultado do Tratamento , Adulto Jovem
8.
BMC Surg ; 20(1): 115, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32456641

RESUMO

BACKGROUND: Treatments for perimembranous ventricular septal defects (pmVSD) mainly include conventional surgical repair (CSR), transcatheter device closure (TDC), and perventricular device closure (PDC). We aimed to perform a network meta-analysis to compare the three approaches in patients with pmVSD. METHODS: We searched for comparative studies on device closure and conventional repair for pmVSD to April 2020. A network meta-analysis was performed under the frequentist frame with risk ratio and 95% confidence interval. The main outcome was the procedural success rate. Additional outcomes were postoperative complications, including residual shunt, intra-cardiac conduction block, valvular insufficiency, incision infection, and pericardial effusion. RESULTS: Twenty-four studies of 8113 patients were included in the comparisons. The pooled estimates of success rate favored the CSR compared with the PDC. No significant differences of success rate were found in the TDC versus CSR and the PDC versus TDC. The pooled estimates of incidences of the residual shunt, new tricuspid regurgitation, incision infection, and pericardial effusion favored the PDC compared with the CSR. There were no significant differences between the PDC and TDC approaches in all outcomes except new aortic regurgitation. CONCLUSION: The PDC technique not only reduces the risk of significant complications compared with the CSR, but also produces not inferior results compared with the TDC in selected pmVSD patients. PROSPERO REGISTRATION NUMBER: CRD42019125257.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal , Humanos , Metanálise em Rede , Derrame Pericárdico/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos
9.
J Card Surg ; 35(6): 1345-1347, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32419177

RESUMO

During the COVID-19 pandemic, emergency room visits have drastically decreased for non-COVID conditions such as appendicitis, heart attack, and stroke. Patients may be avoiding seeking medical attention for fear of catching the deadly condition or as an unintended consequence of stay-at-home orders. This delay in seeking care can lead to increased morbidity and mortality, which has not been figured in the assessment of the extent of damage caused by this pandemic. This case illustrates an example of "collateral damage" caused by the COVID-19 pandemic. What would have been a standard ST-elevation myocardial infarction treated with timely and successful stenting of a dominant right coronary artery occlusion, became a much more dangerous postinfarction ventricular septal defect; all because of a 2-day delay in seeking medical attention by an unsuspecting patient.


Assuntos
Infecções por Coronavirus/epidemiologia , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Comunicação Interventricular/etiologia , Pneumonia Viral/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento , Diagnóstico Tardio , Ecocardiografia/métodos , Serviço Hospitalar de Emergência , Ruptura Cardíaca Pós-Infarto/cirurgia , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Segurança do Paciente , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Fatores de Tempo , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(19): e20120, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384490

RESUMO

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


Assuntos
Insuficiência da Valva Aórtica/complicações , Endocardite/complicações , Infecções Estafilocócicas/complicações , Adolescente , Cateterismo Cardíaco/métodos , Endocardite/tratamento farmacológico , Endocardite/cirurgia , Comunicação Interventricular/cirurgia , Humanos , Masculino , Dispositivo para Oclusão Septal , Valva Tricúspide/patologia
11.
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
13.
Am J Cardiol ; 125(11): 1710-1717, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32291090

RESUMO

To better understand the evolvement of the pulmonary dysfunction in the aging ventricular septal defect (VSD) patient, we invited adult patients with a congenital VSD and healthy age- and gender-matched controls for static and dynamic spirometry, impulse oscillometry, multiple breath washout, and diffusion capacity for carbon monoxide testing. Primary outcome was forced expiratory volume in 1 second. In total, 30 patients with a surgically corrected VSD (mean age 51 ± 8 years), 30 patients with a small, unrepaired VSD (mean age 55 ± 1 years), and 2 groups of 30 age- and gender-matched, healthy controls (mean age 52 ± 9 years and 55 ± 10 years, respectively) were included. Median age of radical surgery was 6.3 (total range: 1.4 to 54) years and median follow-up after surgery was 40 years (total range: 3.4 to 54). Compared with healthy matched controls, surgically corrected VSD patients had lower forced expiratory volume in 1 second, 87 ± 19% versus 105 ± 14% of predicted, p <0.01, lower forced vital capacity, 92 ± 16% versus 107 ± 13% of predicted, p <0.01, and lower peak expiratory flow, 100 ± 21% versus 122 ± 16% of predicted, p <0.01. Furthermore, corrected VSD patients revealed increased airway resistance in the small airways, 30 ± 22% versus 15 ± 14% of total resistance, p <0.01, and reduced diffusion capacity, 84 ± 12% versus 101 ± 11%, p <0.01. Patients with a small, unrepaired VSD had comparable pulmonary function to their matched controls. In conclusion, VSD patients 40 years of age or older demonstrated significant impaired pulmonary function in terms of reduced dynamic pulmonary function, increased airway resistance in the small airways, and reduced diffusion capacity up to 54 years after defect closure compared with healthy age- and gender-matched controls.


Assuntos
Comunicação Interventricular/fisiopatologia , Pulmão/fisiopatologia , Adulto , Idoso , Resistência das Vias Respiratórias , Testes Respiratórios , Monóxido de Carbono , Procedimentos Cirúrgicos Cardíacos , Estudos de Casos e Controles , Feminino , Volume Expiratório Forçado , Comunicação Interventricular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Oscilometria , Pico do Fluxo Expiratório , Capacidade de Difusão Pulmonar , Índice de Gravidade de Doença , Espirometria , Capacidade Vital
14.
Cir. pediátr ; 33(2): 91-94, abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-190848

RESUMO

Introducción: La hernia diafragmática intrapericárdica consiste en un prolapso de las estructuras abdominales dentro del pericardio, representando una de las entidades menos frecuentes dentro del conjunto de las hernias diafragmáticas. Caso clínico: Se presenta el caso de un lactante de 4 meses intervenido de comunicación interventricular (CIV) que, en el postoperatorio, la auscultación cardiopulmonar detecta ruidos hidroaéreos y el control radiológico de tórax muestra un neumopericardio atípico. Ante los hallazgos clínico-radiológicos, y sin sintomatología abdominal sobreañadida objetivable, se solicita un tránsito gastrointestinal (TGI) donde se pone de manifiesto la herniación intrapericárdica de asas intestinales. Tras la intervención quirúrgica abdominal reparadora, el paciente fue dado de alta, sin otras complicaciones. Comentarios: Se realiza un breve recordatorio de las hernias diafragmáticas intrapericárdicas como una entidad de escasa incidencia dentro del conjunto de hernias diafragmáticas, siendo la cirugía cardiaca un posible factor iatrogénico poco frecuente. La sospecha clínica, junto con los hallazgos de imagen, son fundamentales para llegar a un diagnóstico y tratamiento quirúrgico precoz


Introduction: Intrapericardial diaphragmatic hernia is an abdomi-nal organ prolapse inside the pericardium. It is one of the less frequent instances within the diaphragmatic hernia group. Clinical Case: This is the case of a 4-month-old infant undergo-ing surgery for interventricular communication (IVC). Postoperatively, pulmonary auscultation detected air-fluid sounds, and thoracic radiologi-cal control showed an atypical pneumopericardium. Given clinical and radiological findings, and in the absence of additional abdominal symptoms, gastrointestinal transit (GIT) was performed, demonstrating intra-pericardial herniation of the intestinal loops. The patient was discharged following abdominal surgical repair, with no further complications. Discussion: Intrapericardial diaphragmatic hernia is an infrequent instance within the diaphragmatic hernia group, with cardiac surgery being a rare potential iatrogenic factor. Clinical suspicion and imag-ing findings are key to perform early diagnosis and surgical treatment


Assuntos
Humanos , Masculino , Lactente , Hérnia Diafragmática/etiologia , Pericárdio , Comunicação Interventricular/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hérnia Diafragmática/cirurgia , Pericárdio/cirurgia
15.
J Card Surg ; 35(5): 1062-1071, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32237166

RESUMO

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


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte de Artéria Coronária , Comunicação Interventricular/cirurgia , Ponte Cardiopulmonar/efeitos adversos , Feminino , Comunicação Interventricular/etiologia , Comunicação Interventricular/mortalidade , Humanos , Masculino , Infarto do Miocárdio/complicações , Taxa de Sobrevida , Resultado do Tratamento
16.
J Card Surg ; 35(5): 1085-1089, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32207192

RESUMO

Hypoplastic ascending aorta and interrupted aortic arch (IAA) are rarely associated with dextro-transposition of the great arteries (D-TGA). Severe hypoplastic ascending aorta may preclude coronary artery transfer making arterial switch operation problematic. We report a case of D-TGA with a large subpulmonic ventricular septal defect, IAA, and hypoplastic ascending aorta that underwent successful biventricular surgical repair without coronary artery transfer.


Assuntos
Aorta/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Transposição dos Grandes Vasos/cirurgia , Anormalidades Múltiplas , Aorta/patologia , Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Transposição das Grandes Artérias , Vasos Coronários/cirurgia , Feminino , Comunicação Interventricular/cirurgia , Humanos , Recém-Nascido
17.
J Interv Cardiol ; 2020: 8948249, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32161516

RESUMO

Objectives: To demonstrate safety and efficacy of using different generations of softer Amplatzer™ devices for ventricular septal defect (VSD) closure to avoid serious complications at follow-up. Background: Transcatheter closure of perimembranous ventricular septal defects (PmVSD) is a well-established procedure; however, it is associated with unacceptable incidence of complete heart block. Great advantages have been achieved by using softer devices for VSD transcatheter closure. The first and second generation of Amplatzer™ occluders (AVP II, ADO, and ADO II) seem to offer a safe and attractive alternative for this procedure. These devices can be delivered using either an arterial (retrograde) or venous (prograde) approach. Methods and Results: Patients with congenital PmVSD who underwent transcatheter closure using ADO, ADO II, and AVP II devices were included. Primary end point was to determine efficacy and safety of these generations of devices and to determine the incidence of complications at follow-up (complete AV block and aortic/tricuspid/mitral regurgitation). One hundred and nineteen patients underwent VSD closure at a median age of 5 years (8 months-54 years). During the catheterization, there were only minor complications and at follow-up of 36 ± 25.7 months (up to 99 months), the closure rate was high of 98.3% and freedom from AV block was 100%. Conclusions: The use of softer Amplatzer™ devices is a good alternative to achieve PmVSD closure safely with no risk of AVB during the procedure or at midterm follow-up.


Assuntos
Cateterismo Cardíaco , Bloqueio Cardíaco , Comunicação Interventricular , Implantação de Prótese , Dispositivo para Oclusão Septal , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Pré-Escolar , Segurança de Equipamentos , Feminino , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/prevenção & controle , Comunicação Interventricular/fisiopatologia , Comunicação Interventricular/cirurgia , Humanos , Masculino , México/epidemiologia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Estudos Retrospectivos , Risco Ajustado , Resultado do Tratamento
18.
Medicine (Baltimore) ; 99(11): e19147, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176041

RESUMO

INTRODUCTION: Trans-catheter closure of peri-membranous ventricular septal defects (VSDs) using Amplatzer-Type devices, has been widely reported in the past decade. We hereby report a rare complication of frequent premature ventricular contractions (PVCs) and paroxysmal ventricular tachycardia (PVT) sustained 48 days after the closure of VSD.More importantly, the arrhythmias were successfully treated with radiofrequency catheter ablation (RFCA) after medical therapy failed to restore and maintain sinus rhythm. PATIENT CONCERNS: We reported an 8-year-old boy with frequent PVCs and PVT sustained 48 days after the closure of VSD. The boy has no palpitation, chest distress and other uncomfortable symptoms. DIAGNOSIS: This patient was diagnosed as frequent PVCs and PVT by Holter monitoring for 24 hours. INTERVENTIONS: RFCA was administered. OUTCOMES: The patient was discharged 48 hours with no complication and remained asymptomatic 12 months after the ablation. CONCLUSION: Radiofrequency ablation helps treat PVCs and PVT in children and has a higher efficacy in restoring and maintaining sinus rhythm.


Assuntos
Ablação por Cateter/efeitos adversos , Comunicação Interventricular/cirurgia , Taquicardia Paroxística/etiologia , Taquicardia Ventricular/etiologia , Ablação por Cateter/métodos , Criança , Eletrocardiografia , Humanos , Masculino , Taquicardia Paroxística/diagnóstico , Taquicardia Ventricular/diagnóstico
19.
J Thorac Cardiovasc Surg ; 160(2): 490-496, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32192723

RESUMO

OBJECTIVE: To visualize and quantify the atrioventricular conduction axis in the setting of ventricular septal defect using phase contrast computed tomography. METHODS: We used the SPring-8 synchrotron radiation facility in Hyogo prefecture in Japan, processing and reconstructing the data with 3-dimensional software. RESULTS: We studied 8 hearts obtained from patients known to have had ventricular septal defects, aged from 6 to 150 days, with a median of 24.5 days. None of the individuals, however, had undergone corrective surgery. The penetrating bundle was found at a median of 1.43 mm from the septal crest, with a range of 0.99 to 1.54 mm. The distance to the nonbranching bundle to the right ventricular endocardium was 1.10 mm, with a range from 0.49 to 2.49 mm, to the origin of the left bundle branch was 2.46 mm, with a range from 1.7 to 3.18 mm, and to the origin of the right bundle branch was 2.34 mm, with a range from 0.50 to 2.59 mm. The median distance from the edge of the caudal limb of the septomarginal trabeculation to the right bundle branch was 1.04 mm, with a range from 0.81 to 1.16 mm. CONCLUSIONS: We were able to show the precise location of the axis, with our findings suggesting that longitudinal sutures placed along the posteroinferior rim should be effective in avoiding iatrogenic injury, but sutures should not be placed in the valley between the limbs of the septomarginal trabeculation.


Assuntos
Sistema de Condução Cardíaco/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tomada de Decisão Clínica , Feminino , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/fisiopatologia , Bloqueio Cardíaco/prevenção & controle , Sistema de Condução Cardíaco/fisiopatologia , Comunicação Interventricular/fisiopatologia , Comunicação Interventricular/cirurgia , Humanos , Doença Iatrogênica , Imageamento Tridimensional , Lactente , Recém-Nascido , Japão , Masculino , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Técnicas de Sutura/efeitos adversos
20.
Ann Thorac Surg ; 109(6): e457-e459, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32035048

RESUMO

A redo surgical approach to residual ventricular septal defect (VSD) is technically demanding. Sternum reentry has to be performed very carefully to avoid any uncontrolled bleeding, and preparation of the adhesions must be made to expose the most important structures (ascending aorta, caval veins). However, percutaneous transcatheter device closure of the residual VSD with radiation exposure can cause arrhythmia, valve injury, and vascular complications. This report presents a less invasive technique to treat residual VSD, without arterial access, radiation exposure, or cardiopulmonary bypass.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Punções/métodos , Dispositivo para Oclusão Septal , Criança , Feminino , Comunicação Interventricular/diagnóstico , Humanos , Masculino , Reoperação
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