Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.833
Filtrar
2.
Medicine (Baltimore) ; 99(47): e22576, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33217792

RESUMO

RATIONALE: Left ventricle-right atrium (LV-RA) shunt is a rare case and surgical repair has been the routine procedure to correct this defect. With the rapid development of transcatheter technology, some of the cases can be closed with transcatheter technique. Here, we would like to report a congenital LV-RA case who received transcatheter closure using the Amplazter duct occluder II (ADO II) and the short-term outcomes of this procedure. PATIENT CONCERNS: A 2-year-old female presented a systolic murmur between the 2 to 3 sternal rib during the routine examination before kindergarten administration. DIAGNOSIS: The patient denied any cardiac surgery, endocarditis, trauma or cardiomyopathy. The echocardiography confirmed an abnormal shunt between left ventricle and right atrium located in the superior part of ventricular septum which is closed to septal tricuspid valve and anterior mitral valve, and the diameter of this shunt is 2 mm. Besides, the dilation of right atrium (40 mm) has been identified which was not a common clinical manifestation of typical ventricular septal defect. Angiography demonstrated the shunt driven from left ventricle to right atrium. INTERVENTION: An AGA ADO II device had been delivered to close the defect. OUTCOME: Follow-up kept for 3 months. Echocardiography revealed completed closure of the shunt with normal movement and function valves. And no complication of arrhythmia has been recorded. LESSONS: This case report highlighted the administration of ADO II in some ventricular septal defect with superior location, and provided an essential experience of using ADO II to close long tunnel type LV-RA shunt.


Assuntos
Átrios do Coração/anormalidades , Cardiopatias Congênitas/cirurgia , Comunicação Interventricular/cirurgia , Ventrículos do Coração/anormalidades , Dispositivo para Oclusão Septal , Cateterismo Cardíaco/métodos , Angiografia Coronária , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Lactente
3.
Int Heart J ; 61(6): 1212-1219, 2020 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-33191342

RESUMO

This study aims to compare and analyze the health-related quality of life (HRQoL) of adult patients with ventricular septal defects (VSDs) who underwent transthoracic or transcatheter device closure.The HRQoL data of 30 patients who underwent transthoracic device closure for VSDs and 30 who underwent transcatheter device closure for VSDs were retrospectively evaluated before and one year after the procedure. The Medical Outcomes Study 36-Item Short-Form (SF-36), the Hospital Anxiety and Depression Scale (HADS), and a self-designed questionnaire were used as evaluation tools.After treatment, both groups showed significant improvements in SF-36 and HADS scores. After comparing the two groups regarding the SF-36, there was a significant difference in the two dimensions of vitality and mental health. There were no statistically significant differences in the HADS-A and HADS-D scores between these two groups. The results of the self-designed questionnaire also showed that the subjective feedback of the two groups was roughly the same. In the process of exploring the influential factors, we found that the scores of patients on most dimensions of the SF-36 in the two groups showed a significantly negative trend with increasing age. In terms of HADS scores, patients in both groups showed a tendency toward increasing scores with age.The HRQoL of adult patients undergoing transthoracic and transcatheter device closure for VSDs was similar, and the HRQoL was affected by the patient's own condition, so it is necessary to pay more attention to patients after device closure.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interventricular/cirurgia , Saúde Mental , Desempenho Físico Funcional , Qualidade de Vida , Dispositivo para Oclusão Septal , Esternotomia/métodos , Adolescente , Adulto , Ansiedade/psicologia , Depressão/psicologia , Feminino , Comunicação Interventricular/fisiopatologia , Comunicação Interventricular/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Estudos Retrospectivos , Papel (figurativo) , Resultado do Tratamento , Adulto Jovem
4.
Int Heart J ; 61(6): 1220-1228, 2020 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-33191343

RESUMO

Transcatheter closure (TCC) has emerged as the first-line treatment for coronary artery fistulas. However, limited data exist regarding the long-term outcomes and technical aspects of this procedure. We aimed to report the long-term outcomes and technical aspects of TCC of large coronary-cameral fistulas (CCFs).All patients with large CCFs who underwent attempted TCC using the patent ductus arteriosus (PDA) occluder or Amplatzer vascular plug (AVP), from June 2002 to December 2017, were retrospectively reviewed. A total of 23 patients with large CCFs underwent attempted TCC using the PDA occluder or AVP. Most CCFs originated from the right coronary artery and drained predominantly into the right heart chamber. Procedural success was achieved in 21 (91.3%) patients. Devices were deployed using the arteriovenous loop in 15, transarterial approach in 4, and arterio-artery loop approach in 2 patients. Procedural complications included coronary spasm in one and side branch occlusion in one patient. Among these 21 patients with successful device implantation, follow-up angiograms or computed tomography angiograms were obtained in 14 (66.7%) patients at a median of 11.0 (range, 9.8-16.3) months. Late complications included thrombosis of residual fistula segment without myocardial infarction (MI) in one, coronary thrombosis resulting in MI in one, and recanalization necessitating re-intervention in one patient. No death and device embolization occurred.TCC of large CCFs using the PDA occluder or AVP is an effective therapy in anatomically suitable candidates, with favorable long-term outcomes. Given that potentially hazardous complications may occur late after the procedure, long-term periodic evaluation is mandatory.


Assuntos
Cateterismo Cardíaco , Anomalias dos Vasos Coronários/cirurgia , Cardiopatias/cirurgia , Dispositivo para Oclusão Septal , Fístula Vascular/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Átrios do Coração/anormalidades , Cardiopatias/congênito , Cardiopatias/diagnóstico por imagem , Ventrículos do Coração/anormalidades , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Vascular/congênito , Fístula Vascular/diagnóstico por imagem , Adulto Jovem
5.
Herzschrittmacherther Elektrophysiol ; 31(4): 430-433, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-33034760

RESUMO

Dislodgement of a left atrial appendage occluder after liberation represents a nightmare in cardiac interventions. We present a case with this complication and an easy step-by-step protocol that can help to retrieve and venously extract this foreign body with less stress. Particularly the do-it-yourself construction of a "home-made snare" facilitates trapping of large implants which are too large for conventional snares.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Migração de Corpo Estranho , Dispositivo para Oclusão Septal , Acidente Vascular Cerebral , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Cateterismo Cardíaco , Remoção de Dispositivo , Humanos , Resultado do Tratamento
6.
J Cardiothorac Surg ; 15(1): 256, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933575

RESUMO

OBJECTIVE: To explore the effects of using the WeChat platform on the perioperative health education of parents of children who underwent transthoracic device closure of ventricular septal defects (VSDs). METHODS: Participants were divided into a WeChat group and a leaflet group. Responses to relevant questionnaires and clinical data were recorded and analyzed. RESULTS: Before the operation, the scores of the Caretaker Knowledge Questionnaire in the WeChat group were significantly higher than those in the leaflet group. The scores of PSQ-18 in the WeChat group were significantly higher than those in the leaflet group. All the children in the WeChat group were followed up 1 month after discharge, while four children in the leaflet group were lost to follow-up. The rate of attrition in the leaflet group was significantly higher than that in the WeChat group. For the postoperative complications, there was no significant difference between the two groups. CONCLUSION: Perioperative health education for parents of children who undergo transthoracic device closure of VSDs through the WeChat platform can effectively enhance parents' knowledge of care, improve parent satisfaction, which is an effective method to ensure convenient operation and reduce loss to follow-up.


Assuntos
Comunicação Interventricular/cirurgia , Pais , Educação de Pacientes como Assunto , Mídias Sociais , Adulto , Pré-Escolar , Feminino , Humanos , Masculino , Período Perioperatório , Dispositivo para Oclusão Septal , Inquéritos e Questionários
9.
Am J Cardiol ; 135: 99-104, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-32866447

RESUMO

Left atrial appendage occlusion is utilized as a second line therapy to long-term oral anticoagulation in appropriately selected patients with atrial fibrillation (AF). We examined the feasibility of cryoballoon (CB) pulmonary vein isolation (PVI) subsequent to Watchman device implantation. The study prospectively identified patients with Watchman devices (>90 days old) who underwent CB-PVI ablation between 2018 and 2019. Twelve consecutive patients (male 50%; mean age 71 ± 9 years; CHA2DS2-VASc score 3.4 ± 1.1) underwent CB-PVI procedures after Watchman device implantation (mean 182 ± 82 days). Acute PVI was achieved in 100% of patients. All patients had evidence of complete (n = 9) or partial (n = 3) endothelialization of the surface of the Watchman device with conductive tissue properties demonstrated during electrophysiologic testing. There were no major procedure-related complications including death, stroke, pericardial effusion, device dislodgment, device thrombus, or new or increasing peri-device leak. Mean peri-device leak size (45-day postimplant: 0.06 ± 0.09 mm vs Post-PVI: 0.04 ± 0.06 mm; p = 0.61) remained unchanged. Two patients had recurrence of AF after the 90-day blanking period (13.2 ± 6.6 months). One patient underwent a redo ablation procedure for recurrent AF. This pilot study suggests the potential feasibility of CB-PVI ablation in patients with chronic Watchman left atrial appendage occlusion devices. Larger prospective studies are needed to confirm the clinical efficacy and safety of this approach.


Assuntos
Apêndice Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Criocirurgia , Veias Pulmonares/cirurgia , Dispositivo para Oclusão Septal , Idoso , Idoso de 80 Anos ou mais , Criocirurgia/instrumentação , Fenômenos Eletrofisiológicos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
10.
Am J Cardiol ; 134: 83-90, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892987

RESUMO

The optimal antiplatelet strategy after left atrial appendage (LAA) occlusion able to protect from device-related thrombosis, paying the lowest price in terms of bleeding increase, is unclear. In a real-world, observational study we performed a head-to-head comparison of single versus dual antiplatelet therapy (SAPT vs DAPT) in patients who underwent LAA occlusion. We included 610 consecutive patients, stratified according to the type of post-procedural antiplatelet therapy (280 on SAPT and 330 on DAPT). Primary outcome measure was the incidence of the net composite end point including Bleeding Academic Research Consortium classification 3-5 bleeding, major adverse cardiovascular events or device-related thrombosis at 1-year follow-up. The use of SAPT compared with DAPT was associated with similar incidence of the primary net composite end point (9.3% vs 12.7% p = 0.22), with an adjusted hazard ratio (HR) of 0.69, 95% confidence interval 0.41 to 1.15; p = 0.15) at multivariate analysis. However, SAPT significantly reduced Bleeding Academic Research Consortium classification 3-5 bleeding (2.9% vs 6.7%, p = 0.038; adjusted HR 0.37, 0.16 to 0.88; p = 0.024). The occurrence of ischemic events (major adverse cardiovascular events or device-related thrombosis) was not significantly different between the 2treatment strategies (7.8% vs 7.4%; adjusted HR 1.34, 0.70 to 2.55; p = 0.38). In patients who underwent LAA occlusion, post-procedural use of SAPT instead of DAPT was associated with reduction of bleeding complications, with no significant increase in the risk of thrombotic events. These hypothesis-generating findings should be confirmed in a specific, randomized study.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Terapia Antiplaquetária Dupla/estatística & dados numéricos , Hemorragia/epidemiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Implantação de Prótese , Acidente Vascular Cerebral/prevenção & controle , Trombose/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Aspirina/uso terapêutico , Fibrilação Atrial/complicações , Doenças Cardiovasculares/mortalidade , Clopidogrel/uso terapêutico , Embolia/etiologia , Embolia/prevenção & controle , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Dispositivo para Oclusão Septal , Acidente Vascular Cerebral/etiologia
11.
Am J Cardiol ; 136: 81-86, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32946860

RESUMO

Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation therapy in patients with non-valvular atrial fibrillation for the prevention of embolic stroke and systemic embolism. Although elderly patients (>75 years) have both higher ischemic and bleeding risk as compared with younger patients, they benefit from optimal anticoagulation. The subanalysis aimed to assess the indications, the safety, efficacy, and 1-year outcomes of interventional LAAC in elderly patients (≥ 75 years) compared with younger (< 75 years) patients in clinical practice. We analyzed data from the prospective Left-Atrium-Appendage Occluder Registry Germany. A total of 638 patients were included in the registry, 402 (63%) were aged ≥ 75 years. Compared with younger subjects, patients aged ≥75 were more likely to have higher CHA2DS2-VASC and HAS-BLED scores. Procedural success rate was high und similar in both groups (97.6%). Periprocedural adverse events were not statistically significant in groups (11.9% in <75 years vs 12.9% in ≥75 years; p = 0.80). At 1 year follow-up, all-cause mortality was higher in patients aged ≥75 compared withwith younger group (13.0% vs 7.8 %,p = 0.04), mainly due to non-cardiovascular causes (10.6% vs 6.0%). No significant differences in major bleeding, stroke, systemic embolism were observed. In conclusion, LAAC is feasible and safe in patients with AF at high stroke risk and with contraindications for OAC and should be considered as candidates for LAA closure. Elderly patients often present these characteristics and could benefit from this novel therapy.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Dispositivo para Oclusão Septal , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Fatores de Tempo , Resultado do Tratamento
12.
BMC Surg ; 20(1): 208, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32948172

RESUMO

BACKGROUND: This report presents updated data and mid-term follow-up information to a former study introducing the novel technique of percutaneous-perventricular device closure of doubly committed subarterial ventricular septal defect. METHODS: Thirty-eight patients were added to the former series. There were 54 patients in total who had isolated doubly committed subarterial ventricular septal defects and underwent percutaneous-perventricular device closure. Closure outcomes and possible complications were measured in the hospital and during the 2.5-year follow-up. RESULTS: Surgery was successful in 53 patients (98.1%). There was no death, residual shunt, new valve regurgitation or arrhythmia either perioperatively or during the entire follow-up period. Only one patient developed pericardial effusion and tamponade in the former series. The mean hospital stay was 3.2 ± 0.6 days (range, 3.0 to 6.0 days), and only one unsuccessful case needed blood transfusion (1.9%). CONCLUSIONS: The percutaneous-perventricular device closure of isolated doubly committed subarterial ventricular septal defects appeared to be safe. Close monitoring for bleeding is essential postoperatively, especially in younger patients. This technique is generally safe with acceptable mid-term follow-up.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Comunicação Interventricular , Dispositivo para Oclusão Septal , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Comunicação Interventricular/cirurgia , Humanos , Lactente , Masculino , Resultado do Tratamento
13.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(6): 495-499, 2020 Jun 24.
Artigo em Chinês | MEDLINE | ID: mdl-32842260

RESUMO

Objective: To explore whether the atrial septal defect(ASD) size, the type of occlusion umbrella selected, and the morphological changes after release of occlusion umbrella affect the headache symptoms of ASD patients after operation. Methods: A total of 567 ASD ptients, who underwent successful implantion with a single occlude from January 2014 to December 2017 in General Hospital of Northern Theater Command were enrolled. The patients were divided into symptomatic group and asymptomatic group according to the presence or absence of headache symptoms after occlusion. X-ray catheter calibration method was used to measure the diameter(d), thickness(L), maximum diameter of the left umbrella surface after release(D2) and the value of i (i = D2/L). Risk factors related to headache were analyzed by multivariate logistic regression analysis. linear regression analysis was used to detect the relationship between the type of occluder umbrella and ASD diameter in asymptomatic group. Results: A total of 567 patients with one occluder umbrella were included, and 148(26.1%) cases were male. The age was (34.4±19.4) years old. The follow-up time was (12.7±2.8) months. There were 51 cases in the symptomatic group and 516 cases in the asymptomatic group. In 29 patients who were treated by extending the course or increasing the dose of aspirin, the symptoms disappeared or improved. There was no significant difference in the maximum ASD diameter (TTE measured) and the size of occluder between the symptomatic group and asymptomatic group(both P>0.05). The value of d ((19.80±6.67)mm vs.(17.40±7.28) mm, P=0.041) D2 ((43.29±7.41)mm vs. (39.20±9.59)mm, P=0.013)and L((13.06±3.72)mm vs. (10.19±2.90) mm,P=0.025) of the symptomatic group were all higher than that of the asymptomatic group,while the i value was smaller((3.54±0.88)vs.(3.99±0.93),P=0.010). The results of multivariate logistic regression analysis showed that the value of L(OR=1.286,95%CI 1.176-1.406, P=0.002) and the value of i(OR=0.916,95%CI 0.867-0.968, P<0.001) were independent factors of headache symptoms in patients after ASD occlusion, while the value of d and the value of D2 were not independent factors (both P>0.05). Linear equations obtained from asymptomatic patients showed the size of occluder =1.121×the maximum ASD diameter of TTE measured +6.414. Conclusions: There is no correlation between the symptoms with the expanded diameter and the maximum diameter of left umbrella's surface after released. The Postoperative discomfort symptoms is significantly correlated to the thickness of the occluder and the value of i. It is suggested that headache could be induced by the oversized occlude, thus choosing the appropriate size of the occluder is essential to reduce the occurrence of postoperative headache symptoms. Increasing the size of occluder because of worrying about the abscission and removal of the occlude is unreasonable. The antiplatelet therapy should also be strengthened to reduce the occurrence of symptoms and improve the symptoms of the patients if the occluder's size is too large. This regression equation (The size of occluder =1.121 × the maximum ASD diameter of TTE measured +6.414) could be used as a reference for the suitable selection of ASD occluder.


Assuntos
Comunicação Interatrial , Dispositivo para Oclusão Septal , Adolescente , Adulto , Cateterismo Cardíaco , Ecocardiografia Transesofagiana , Cefaleia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Resultado do Tratamento , Adulto Jovem
14.
Medicine (Baltimore) ; 99(34): e21356, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846756

RESUMO

RATIONALE: To discuss suitable criteria for the application of asymmetric Amplatzer occluders for perimembranous ventricular septal defects (pmVSDs). PATIENTS CONCERNS AND DIAGNOSES: We retrospectively studied 18 children with perimembranous VSDs who underwent attempted asymmetric occluder closure between January 2015 and December 2018 in our center. INTERVENTIONS: Asymmetric Amplatzer occluders were attempted to be placed to all the enrolled patients. We analyzed the diameter of the defects with the receiver operating characteristic curve (ROC) values, the size of the occluders attempted, the presence of aneurysm and the presence of aortic valve prolapse for each patient. Then, for patients who experienced successful device implantation, the therapeutic efficiency was evaluated by follow-up. OUTCOMES: Only 5 out of a total of 18 patients completed successful device implantation. Compared with failed cases, successful cases demonstrated a significantly smaller VSD size (5.46 ±â€Š1.03 mm vs. 8.73 ±â€Š2.33 mm, P = 0.012) and had a low ratio of aortic valvar prolapse (20% vs. 76.92%, P = 0.026). Four out of 5 successful cases involved arrhythmia complications, but the rhythm of the heart recovered after drug treatment. According to the ROC and Youden analyses, the cut-off value of the defect size for successful asymmetric Amplatzer occluder implantation was no larger than 5.7 mm. LESSONS: The application of an asymmetric Amplatzer occluder expands the range of indications for patients with superior localized VSD but is largely limited in cases with aortic valvar prolapse and large VSD sizes. All successful cases recovered from arrhythmia postprocedure.


Assuntos
Comunicação Interventricular/terapia , Dispositivo para Oclusão Septal/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
15.
BMC Cardiovasc Disord ; 20(1): 376, 2020 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-32807103

RESUMO

BACKGROUND: A subclavian-superior vena cava arteriovenous fistula is usually acquired and secondary to trauma or operations, while congenital causes are very rare. A congenital arteriovenous fistula leads to congestive heart failure soon after birth and is typically diagnosed in early infancy. CASE PRESENTATION: We present an unusual case of a 21-year-old female suffering from new-onset heart failure at 20 years old who was diagnosed with a congenital arteriovenous fistula from the right subclavian artery to the superior vena cava (RSA-to-SVC) with stenosis at the proximal initial site of the fistula. The patient successfully underwent transcatheter occlusion for the fistula and had a significant improvement in symptoms at the 3-month follow-up. CONCLUSIONS: An RSA-to-SVC fistula is a very rare congenital disorder that can lead to shunt-related heart failure. If there is an indication for closure, as with the patient presented, percutaneous device closure can be considered a reasonable option.


Assuntos
Fístula Arteriovenosa/complicações , Insuficiência Cardíaca/etiologia , Artéria Subclávia/anormalidades , Veia Cava Superior/anormalidades , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/terapia , Cateterismo Cardíaco/instrumentação , Constrição Patológica , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Recuperação de Função Fisiológica , Dispositivo para Oclusão Septal , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Resultado do Tratamento , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/fisiopatologia , Adulto Jovem
16.
Am J Cardiol ; 132: 133-139, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32753269

RESUMO

We aimed to evaluate the feasibility of interventional treatment of atrial septal defect (ASD) in low weight infants under 2-year-old. Seven hundred and ninety-three secundum ASD patients were divided into 2 groups: 665 were above 2-year-old and 128 were under 2-year-old. The basic conditions before the operation, postoperative complications within 24 hours, and adverse outcomes during a three-year follow-up were compared between the 2 groups using multivariate analysis. There were significant differences in age, weight, and the diameter of the ASD between the 2 groups (p <0.001). The immediate success rate of the procedure was 96.7%. There were no significant differences in the success rate of the procedure, the incidence of residual shunt, arrhythmia, procedure-related arrhythmia, and occluder shedding between 2 groups (p >0.05). Similarly, we found no association between age ≤2-year-old and any adverse outcomes postprocedure within 24 hours, including procedure failure (OR = 0.35; 95%CI: 0.04 to 2.93), residual shunt (OR = 1.07; 95%CI: 0.54 to 2.14), arrhythmia (OR = 0.68; 95%CI: 0.32 to 1.43), or procedure-related arrhythmia (OR = 0.34; 95%CI: 0.04 to 2.87). In the follow-up data, we found no association between age ≤2-year-old and arrhythmia (HR = 0.95; 95%CI: 0.50 to 1.80) and procedure-related arrhythmia (HR = 0.96;95%CI:0.25 to 3.64). Kaplan-Meier survival curves indicated no significant difference in the occurrence of arrhythmia between the 2 groups (log-rank test: p = 0.776). In conclusion, percutaneous ASD closure in young and low weight infants has a high success and low complication rate, along with reliable effects.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interatrial/cirurgia , Recém-Nascido de Baixo Peso , Complicações Pós-Operatórias/epidemiologia , Dispositivo para Oclusão Septal , Criança , Pré-Escolar , China/epidemiologia , Estudos de Viabilidade , Feminino , Seguimentos , Comunicação Interatrial/diagnóstico , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Fatores de Tempo
17.
J Cardiothorac Surg ; 15(1): 212, 2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762705

RESUMO

BACKGROUND: To study the clinical manifestations and advantages of open-heart surgery and echocardiographic transthoracic or percutaneous closure with secundum atrial septal defect (ASD). The surgeon's learning curve was also analyzed. METHODS: In all, 115 consecutive patients with ASD from May 2013 to May 2019 were enrolled. According to the operative procedure, patients were divided into three groups: group one (open repair group) (n = 24), where patients underwent ASD repair (ASDR) under cardiopulmonary bypass (CPB); group two (closed surgical device closure group) (n = 69), where patients (six patients ≤1 y and sixteen ≤10 kg) underwent transthoracic ASD occlusion under transesophageal echocardiographic (TEE) guidance; and group three (transcatheter occlusion group) (n = 22), where patients underwent percutaneous ASD occlusion under echocardiography. The clinical features and results of each group were analyzed. All patients were telephonically followed-up after 3 months. RESULTS: All the three methods treating ASD were successfully performed in our hospital. It was also a typical developing history of congenital heart disease (CHD) surgery in China. One patient in the group two was transferred to emergency surgery for occluder retrieval and CPB-ASDR. Eight patients experienced failed transthoracic or percutaneous occlusion, two of whom underwent unsuccessful percutaneous closure at another hospital. Two patients each in the groups two and three were intraoperatively converted to CPB-ASDR. Two patient in the group three was converted to transthoracic occlusion surgery. All patients were discharged without any residual shunt. The three-month follow-up also did not show any residual shunt and occluder displacement. CONCLUSION: In low-weight, infants, or huge ASDs with suitable rim for device occlusion, transthoracic ASD closure was successfully performed. Based on knowledge of ASD anatomy and skilled transthoracic occlusion of ASD, surgeons can perform percutaneous occlusion of ASD under echocardiographic guidance.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana , Ecocardiografia , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Adolescente , Adulto , Peso Corporal , Ponte Cardiopulmonar , Criança , Pré-Escolar , China , Feminino , Humanos , Lactente , Curva de Aprendizado , Masculino , Dispositivo para Oclusão Septal , Resultado do Tratamento , Adulto Jovem
18.
Int Heart J ; 61(4): 848-850, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32728003

RESUMO

Right ventricular (RV) dysfunction may occur after cardiac surgery and it is not rare after corrective repair of tetralogy of Fallot (TOF). If traditional treatments with volume management, infusion of inotropic agents, and use of pulmonary vasodilators cannot stabilize the patient, extracorporeal membrane oxygenation (ECMO) or a ventricular assist device (VAD) will be considered as the last resort. Here, we report a young infant patient with RV failure after corrective repair of TOF and without closure of an atrial septal defect (ASD), who was rescued by veno-venous (VV) -ECMO.


Assuntos
Septo Interatrial/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Tetralogia de Fallot/cirurgia , Disfunção Ventricular Direita/terapia , Assistência ao Convalescente , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ecocardiografia/métodos , Insuficiência Cardíaca/fisiopatologia , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Comunicação Interatrial/cirurgia , Coração Auxiliar , Humanos , Lactente , Masculino , Dispositivo para Oclusão Septal/normas , Tetralogia de Fallot/diagnóstico por imagem , Resultado do Tratamento
20.
Arch Cardiovasc Dis ; 113(8-9): 513-524, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32680737

RESUMO

BACKGROUND: Closure of patent foramen ovale is well-managed in adults, but is performed less frequently in children. AIM: To analyse all patent foramen ovale closures performed in the past 20 years in French paediatric centres. METHODS: Retrospective study of patent foramen ovale closures in children without cardiopathy in nine centres between 2000 and 2019. RESULTS: Forty-one procedures were carried out in children (median age: 14.9 years). Thirty-one patent foramen ovales were closed after a transient ischaemic attack or stroke, six for a left-to-right shunt and four for other reasons. Transthoracic echocardiography was used for 72.2% of the diagnoses and transoesophageal echocardiography for 27.8%. A substantial degree of shunting was found in 42.9% of patients and an atrial septal aneurysm in 56.2%. General anaesthesia with transoesophageal echocardiography guidance was performed in 68.3% of the procedures; local anaesthesia and transthoracic echocardiography or intracardiac echocardiography was performed in 31.7%. The success rate was 100%. The median fluoroscopy time was 4.14minutes: 3.55minutes with transoesophageal echocardiography; and 4.38minutes with transthoracic echocardiography (P=0.67). There was only one periprocedural complication (2.4%). Postoperatively, 80,5% of patients were treated with aspirin and 12,2% with an anticoagulant. The rate of complete occlusion was 56.8% immediately after the procedure, 68.6% at 1 year and 92.3% at the last follow-up. There were no delayed complications or cases of recurrent stroke during follow-up (median follow-up: 568 days). CONCLUSION: Closure of patent foramen ovale in children appears to be safe and effective, as we noted a low rate of immediate complications, no delayed complications and no stroke recurrence in this indication.


Assuntos
Cateterismo Cardíaco/instrumentação , Forame Oval Patente/terapia , Dispositivo para Oclusão Septal , Adolescente , Fatores Etários , Cateterismo Cardíaco/efeitos adversos , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , França , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA