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1.
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
2.
J Vet Cardiol ; 24: 20-27, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405551

RESUMO

A 9-month-old kitten with increased resting respiratory rate and exercise intolerance was diagnosed with a congenital partial atrioventricular septal defect causing pulmonary over circulation and presumed pulmonary hypertension based on echocardiogram. Invasive pressure measurements and contrast angiography confirmed this diagnosis. The cat underwent pulmonary artery banding under general anesthesia. Findings of echocardiogram 10 days postoperatively suggested reduced left-to-right shunt volume. Echocardiographic findings were static 4 months postoperatively.


Assuntos
Doenças do Gato/diagnóstico , Comunicação Interventricular/veterinária , Artéria Pulmonar/anormalidades , Animais , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/cirurgia , Gatos , Diagnóstico Diferencial , Ecocardiografia/veterinária , Comunicação Interventricular/diagnóstico , Masculino , Artéria Pulmonar/cirurgia
3.
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
4.
Cardiol Young ; 29(7): 986-988, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31331408

RESUMO

Patients with a significant left-to-right shunt at ventricular level may become inoperable at an early age due to irreversible pulmonary vascular disease. On the other hand, even suprasystemic pulmonary hypertension due to mitral stenosis remains treatable. We report a 24-year-old patient with large ventricular septal defect, severe mitral stenosis and cyanosis who improved after surgical correction of both the lesions. This emphasises the importance of additional post-capillary pulmonary hypertension in Eisenmenger syndrome.


Assuntos
Cianose/complicações , Complexo de Eisenmenger/cirurgia , Comunicação Interventricular/complicações , Comunicação Interventricular/cirurgia , Hipertensão Pulmonar/complicações , Estenose da Valva Mitral/complicações , Complexo de Eisenmenger/complicações , Complexo de Eisenmenger/diagnóstico , Feminino , Comunicação Interventricular/diagnóstico , Humanos , Adulto Jovem
5.
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
6.
J Invasive Cardiol ; 31(9): 247-252, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31199350

RESUMO

BACKGROUND: Surgical transapical (TA) access is an established technique for structural heart (SH) procedures, but is associated with considerable morbidity. Percutaneous TA puncture provides direct access for SH procedures and may overcome the disadvantages of surgical access. This study sought to evaluate the safety of percutaneous TA left ventricular access for SH interventions. METHODS: We performed a retrospective analysis at a university hospital. Thirteen percutaneous TA procedures were performed on consecutive patients between January 2013 and July 2017 to provide LV access for transcatheter therapies. All procedures were performed under general anesthesia with three-dimensional transesophageal echocardiography guidance. RESULTS: All TA punctures were successful. Delivery sheath sizes ranged from 5 Fr to 7 Fr. Eleven of the 13 TA sites were closed with a device. Total median procedural and fluoroscopy times were 106 minutes (interquartile range, 39-117 minutes) and 26.5 minutes (interquartile range, 8.3-43.8 minutes), respectively. The planned procedure was completed successfully in all cases. One access-site complication occurred, involving embolism of a duct occluder into the pleural space and extravasation from the apical puncture site. Hemostasis of the apex site was achieved immediately with placement of three vascular plugs from a femoral approach. Two patients died prior to discharge and neither death was related to a procedural complication. There were no significant pericardial effusions. CONCLUSION: Percutaneous TA access can be achieved safely in most cases to provide access for transcatheter procedures with short procedure times. Device closure of the TA access site is reliable, with a low complication rate and no procedure-related mortality.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Ventrículos do Coração/cirurgia , Dispositivo para Oclusão Septal , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Feminino , Fluoroscopia , Seguimentos , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/mortalidade , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
8.
Curr Cardiol Rep ; 21(7): 59, 2019 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-31111245

RESUMO

PURPOSE OF REVIEW: This review aims to delineate the actual role of percutaneous intervention in the closure of post-myocardial infarction ventricular septal defect (post-MI VSD) and to briefly summarize the main steps of this procedure. RECENT FINDINGS: Most of the published studies report experiences using Amplatzer devices for post-MI VSD closure. In the acute phase, morbidity and mortality are quite high up to 70%, with a mean success rate of 90%, with 95% confidence intervals from 60 to 100%, and a 30-day mortality of 40%, with 95% confidence intervals from 0 to 55%. In the chronic phase, that is 14 days after myocardial infarction, results are very encouraging, with lower morbidity and mortality (23% at 30 days) and a higher rate of complete closure. A multimodality imaging approach has been proposed in order to increase the success rate of this procedure. Percutaneous closure is a safe and effective procedure in highly specialized centers and an appropriate patient selection is of paramount importance to the success of the procedure. Device closure of post-MI VSD can be considered a true alternative to the standard surgical approach. However, many problems still exist for percutaneous post-MI VSD treatment.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interventricular/cirurgia , Infarto do Miocárdio/complicações , Dispositivo para Oclusão Septal , Cateterismo Cardíaco/efeitos adversos , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/etiologia , Humanos , Infarto do Miocárdio/cirurgia , Complicações Pós-Operatórias , Prognóstico , Fatores de Tempo , Resultado do Tratamento
10.
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
11.
Orphanet J Rare Dis ; 14(1): 76, 2019 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-30944003

RESUMO

BACKGROUND: Discussions continue as to whether ventricular septal defects are best categorized according to their right ventricular geography or their borders. This is especially true when considering the perimembranous defect. Our aim, therefore, was to establish the phenotypic feature of the perimembranous defect, and to establish the ease of distinguishing its geographical variants. METHODS AND RESULTS: We assessed unrepaired isolated perimembranous ventricular defects from six historic archives, subcategorizing them using the ICD-11 coding system. We identified 365 defects, of which 94 (26%) were deemed to open centrally, 168 (46%) to open to the outlet, and 84 (23%) to the inlet of the right ventricle, with 19 (5%) being confluent. In all hearts, the unifying phenotypic feature was fibrous continuity between the leaflets of the mitral and tricuspid valves. This was often directly between the valves, but in all instances incorporated continuity through the atrioventricular portion of the membranous septum. In contrast, we observed fibrous continuity between the leaflets of the tricuspid and aortic valves in only 298 (82%) of the specimens. When found, discontinuity most commonly was seen in the outlet and central defects. There were no discrepancies between evaluators in distinguishing the borders, but there was occasional disagreement in determining the right ventricular geography of the defect. CONCLUSIONS: The unifying feature of perimembranous defects, rather than being aortic-to-tricuspid valvar fibrous continuity, is fibrous continuity between the leaflets of the atrioventricular valves. While right ventricular geography is important in classification, it is the borders which are more objectively defined.


Assuntos
Comunicação Interventricular/patologia , Consenso , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/patologia , Comunicação Interventricular/diagnóstico , Humanos
12.
J Invasive Cardiol ; 31(4): E64-E65, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30927537
13.
Heart Vessels ; 34(9): 1491-1498, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30859378

RESUMO

Proximal aortic enlargement is associated with an increased risk of heart failure and all-cause mortality. Recently, aortic root dilatation (ARD) was reported in postoperative patients with ventricular septal defects (VSDs). However, the impact of ARD on left ventricular (LV) function in postoperative VSD patients remains unclear. Thus, the aim of this study was to investigate the effect of ARD on LV function in patients with postoperative VSD. One hundred and thirty-five patients (> 15 years of age) with surgically repaired isolated ventricular defects and who underwent transthoracic echocardiography in our institution between 2009 and 2013 were identified. ARD was defined as an observed aortic root diameter/body surface area > 2.1 cm/m2. The propensity score estimating the probability of having ARD adjusted for anatomical and clinical characteristics was calculated. Forty-four patients (32.6%) had ARD. In unadjusted analyses, right ventricular systolic pressure, Tei index, and E/e' were significantly (p < 0.05) higher in patients with ARD than in those without ARD (31.3 ± 7.5 vs. 35.4 ± 13.7 mmHg, 0.32 ± 0.10 vs. 0.44 ± 0.15, and 7.1 ± 1.7 vs. 9.5 ± 2.9, respectively). In the propensity score-adjusted analysis, significant differences in the Tei index and E/e' were confirmed between the two groups (Tei index difference: 0.11, 95% confidence interval 0.05-0.17; E/e' difference: 2.4, 95% confidence interval 1.3-3.5). However, there were no differences in the other echocardiographic measurements. The presence of ARD in patients with postoperative VSD was significantly associated with LV diastolic dysfunction. Thus, surgically repaired VSD patients require careful screening for aortic enlargement and LV function.


Assuntos
Doenças da Aorta/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Comunicação Interventricular/cirurgia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Doenças da Aorta/etiologia , Estudos Transversais , Dilatação , Ecocardiografia , Feminino , Comunicação Interventricular/diagnóstico , Humanos , Japão , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Medição de Risco , Fatores de Risco , Disfunção Ventricular Esquerda/etiologia
14.
Cardiol Young ; 29(3): 375-379, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30724146

RESUMO

IntroductionPulmonary atresia, ventricular septal defect, major aorto-pulmonary collateral arteries, and pulmonary arteries hypoplasia are rare and complex congenital defects that require early interventions to relieve cyanosis and enhance the growth of native pulmonary arteries. The treatment of these patients is still controversial. Surgical techniques require cardiopulmonary bypass which is poorly tolerated by small infants. Percutaneous techniques such as radiofrequency perforation can be challenging. The hybrid technique consists of perventricular stenting of the right ventricle outflow tract through medial sternotomy, to restore native pulmonary flow. METHODS: We retrospectively reviewed the cardiovascular database of our centre in order to analyse our experience in hybrid procedure. We detected six patients who underwent hybrid first approach between November 2007 and December 2015. We report our early results and mid-term outcomes. RESULTS: Median age at the procedure was 26 days, median weight was 3150 g, and median Nakata index was 52 mm2/m2. All procedures were successful except for one: this patient underwent a surgical shunt. No immediate and early deaths or major complications occurred and oxygen saturation levels increased in all the patients. Patients were followed up for a period of 12-103 months, and four of them underwent a procedure of unifocalisation at the mean age of 12.5 months. CONCLUSIONS: We reported data from the largest series of patients who underwent this hybrid procedure. Our experience demonstrated encouraging results to expand the use of this approach to bridge high-risk patients with diminutive pulmonary arteries to a second step of surgical repair.


Assuntos
Anormalidades Múltiplas , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Ventrículos do Coração/cirurgia , Artéria Pulmonar/cirurgia , Atresia Pulmonar/cirurgia , Stents , Angiografia , Cateterismo Cardíaco/métodos , Feminino , Seguimentos , Comunicação Interventricular/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Atresia Pulmonar/diagnóstico , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
J Matern Fetal Neonatal Med ; 32(17): 2837-2841, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29510647

RESUMO

Introduction: Our objective was to evaluate the incidence of chromosomal aberration (both microscopic and submicroscopic) and the clinical outcome of fetuses with isolated muscular ventricular septal defect (VSD). Material and methods: The study included 40 pregnant women whose fetuses were diagnosed with isolated muscular ventricular septal defect (mVSD). Of these, 30 patients underwent amniocentesis and 10 declined. All samples were tested by chromosomal microarray analysis (CMA). Of the 40 women in the study, 32 gave birth and the clinical outcome of the children was retrieved from the patients' medical records. Results: Of the 30 patients who underwent amniocentesis, one was detected with mosaic Klinefelter syndrome and one was detected with a pathogenic copy number variant unrelated to the VSD. Clinical follow-up was performed on 26 children after birth. The first postnatal echocardiography did not detect a VSD in 13 (50%) of the followed-up children. Spontaneous closure occurred in another eight (30.8%) children during the postnatal follow-up period. In only five children (19.2%) VSD was still detected by echocardiography after the first year of life. Discussion: Isolated muscular VSD diagnosed prenatally does not appear to be a significant risk factor for chromosomal abnormalities and has a favorable clinical outcome.


Assuntos
Aberrações Cromossômicas , Comunicação Interventricular/diagnóstico , Amniocentese , Pré-Escolar , Ecocardiografia , Feminino , Idade Gestacional , Comunicação Interventricular/embriologia , Comunicação Interventricular/genética , Humanos , Lactente , Recém-Nascido , Masculino , Análise em Microsséries , Gravidez , Resultado da Gravidez , Remissão Espontânea , Ultrassonografia Pré-Natal
16.
Heart ; 105(6): 464-469, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30181200

RESUMO

CLINICAL INTRODUCTION: A 23-year-old woman followed at another medical centre for congenital heart disease (CHD) presented to our emergency clinic with 3 weeks of bilateral pleuritic chest pain. She returned from holiday in Greece 6 weeks earlier where a tattoo and nasal piercing had been performed. There was no history of night sweats or fever.Her temperature was 37.5°C, heart rate 120 beats/min, oxygen saturations 94% on room air and blood pressure 110/74. Her chest was clear and there was systolic murmur on auscultation. The chest radiograph showed peripheral bilateral lower zone atelectasis. The ECG demonstrated sinus tachycardia. The haemoglobin was 11.2 g/dL, white cell count 10.18×109/L, C-reactive protein 67 mg/L (normal <5 mg/L) and D dimer=430 ng/mL (normal <230 ng/mL).A pulmonary embolus was suspected and a CT pulmonary angiogram was performed (figure 1). QUESTION: Based on the CT findings, what is the most likely underlying congenital heart lesion in this patient?Bicuspid aortic valveCoarctation of the aortaFontan circulationParachute mitral valveVentricular septal defect heartjnl;105/6/464/F1F1F1Figure 1CT pulmonary angiogram (coronal views).


Assuntos
Piercing Corporal/efeitos adversos , Dor no Peito/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Endocardite , Comunicação Interventricular , Embolia Pulmonar , Tatuagem/efeitos adversos , Diagnóstico Diferencial , Eletrocardiografia/métodos , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/fisiopatologia , Feminino , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/fisiopatologia , Humanos , Exame Físico/métodos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Embolia Pulmonar/fisiopatologia , Radiografia Torácica/métodos , Adulto Jovem
17.
Ann Thorac Surg ; 107(2): e147-e149, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30359595

RESUMO

Ventricular septal defect (VSD) is a life-threatening complication of myocardial infarction. Surgical repair is generally performed through a left/right ventriculotomy. To avoid complications associated with ventriculotomy, a right transatrial approach has been proposed. We describe a modified transatrial approach through the left atrium for basal-inferior VSD. After left atriotomy, mitral valve is detached from the annulus to expose the defect, which is closed with a pericardial patch. Two patients were operated by this method. In both cases venoarterial extracorporeal membrane oxygenation with a ventricular vent was utilized to unload the left ventricle. Echocardiography revealed no residual shunt in both cases.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/etiologia , Ventrículos do Coração/cirurgia , Infarto do Miocárdio/complicações , Ecocardiografia , Seguimentos , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos
18.
Ann Thorac Surg ; 107(3): 817-822, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30312613

RESUMO

BACKGROUND: This study compared the safety and effectiveness of intraoperative device closure of a perimembranous ventricular septal defect (pmVSD) using the right thoracic minimal incision to right ventricle and lower midline sternotomy to right ventricle approaches. METHODS: We retrospectively analyzed the clinical data of 46 patients who underwent intraoperative device closure of a pmVSD through the right thoracic minimal incision to right ventricle route (group 1) and 52 patients who underwent intraoperative device closure of a pmVSD through a minimal incision in the lower sternum (group 2) at our hospital from March 2016 to March 2017. In group 1, a right thoracic minimal incision to the fourth intercostal space was used to establish a delivery system through the right ventricle to complete pmVSD closure. RESULTS: In group 1, intraoperative device closure of the pmVSD was successful in 44 patients and was converted to open surgery in 2 patients (a delivery system could not be established in the one, and a significant residual shunt was present in the other). In group 2, the corresponding numbers of patients were 50 and 2, respectively. Neither group exhibited serious adverse effects, including dislocation of the occluder, third-degree atrioventricular block, or new onset of aortic valve regurgitation during the perioperative period or during a median follow-up period of 1 to 2 years. CONCLUSIONS: Intraoperative device closure of a pmVSD through the right thoracic minimal incision to right ventricle approach is safe and effective. This procedure can avoid some of the shortcomings caused by sternotomy, uses an incision with an improved cosmetic appearance, and is worth recommendation.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interventricular/cirurgia , Ventrículos do Coração/cirurgia , Esternotomia/métodos , Técnicas de Fechamento de Ferimentos/instrumentação , Pré-Escolar , Ecocardiografia , Desenho de Equipamento , Feminino , Seguimentos , Comunicação Interventricular/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Estudos Retrospectivos , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do Tratamento
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