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1.
Pediatr Cardiol ; 41(4): 795-800, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32065250

RESUMO

Little data are published about right ventricular (RV) growth and function in infants and neonates after balloon pulmonary valvuloplasty (BPV) for critical valvular pulmonary stenosis (PS). We aimed to assess the RV growth and function during 1 year after BPV for critical valvular PS in neonates and infants. A total of 41 infants and neonates with isolated critical valvular PS who underwent BPV from August 2016 to Sep 2018 were enrolled in the study. Complete Echocardiographic examination was performed to all infants before, 1 week, 1 month, 3 months, 6 months, and 1 year after BPV. The RV systolic pressure and transvalvular pulmonary pressure gradient significantly decreased 1 week after BPV and continue to decrease more slowly during the period of follow-up. During follow-up, RV end-diastolic dimension increased significantly, whereas RV anterior wall thickness significantly decreased. The mean diameters of pulmonary valve annulus and tricuspid valve annulus significantly increased after BPV over the period of follow-up. RV systolic and diastolic dysfunction improved significantly as reported by reduced RV Tei index and tricuspid annular systolic velocity and increased RV E/A ratio. RV growth and function were significantly improved after BPV for critical PS in infants and neonates and catch-up growth of right ventricular structures occurred after 6 months of BPV.


Assuntos
Valvuloplastia com Balão/métodos , Estenose da Valva Pulmonar/cirurgia , Função Ventricular Direita/fisiologia , Ecocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Estenose da Valva Pulmonar/diagnóstico por imagem , Resultado do Tratamento
2.
Ann Thorac Surg ; 109(1): e13-e15, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185205

RESUMO

A 71-year-old woman with pulmonary artery aneurysm had a complication of pulmonary valve stenosis with estimated right ventricular pressure 135 mm Hg and severe aortic valve stenosis with peak pressure gradient 112 mmHg. Coronary angiography revealed stenosis of the left coronary arterial system. Because she presented with narrow pulmonary annulus (16.7 mm) and aortic annulus (19.7 mm), we decided to perform aortic and pulmonary valve reconstruction using autologous pericardium. We performed aneurysmorrhaphy of the pulmonary artery, dual-valve reconstruction, and coronary artery bypass grafting. Postoperative echocardiography showed good opening of dual valves without regurgitation; estimated right ventricular pressure was 23 mm Hg.


Assuntos
Aneurisma/cirurgia , Valva Aórtica/cirurgia , Pericárdio/transplante , Artéria Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Idoso , Aneurisma/complicações , Feminino , Humanos , Estenose da Valva Pulmonar/complicações , Transplante Autólogo , Procedimentos Cirúrgicos Vasculares/métodos
3.
J Thorac Cardiovasc Surg ; 159(3): 1063-1071.e1, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31400815

RESUMO

BACKGROUND: Pulmonary valve replacement is very common among patients with congenital heart disease. The Carpentier Edwards Perimount valve (Edwards Lifesciences, Irvine, Calif), which was originally designed for the aortic position is among the most implanted valves. We aim to describe the follow-up of this valve in the pulmonary position. METHODS: Patients with a Perimount valve implanted between 2003 and 2013 in the University Medical Center Groningen were followed for the primary end point reintervention, defined as surgical or transcatheter valve replacement. Secondary end point was the occurrence of valve failure, defined as significant valvular regurgitation or stenosis. Explanted valves were histologically examined. RESULTS: Forty-five patients (median age at operation 27.8 years, 55.6% women) had a mean follow-up duration of 5.8 ± 3.3 years. There were 7 reinterventions (5 surgical and 2 transcatheter). Freedom from reintervention was respectively 95% ± 4% and 83% ± 8% at 5- and 10- years of follow-up. Freedom from valve failure was 75% ± 4% at 2 years, 65% ± 8% at 5 years of follow-up and 57% ± 10% at 10 years of follow-up. Morphology evaluation (n = 4) showed stiffened valves in the open position, with extensive fibrous tissue overgrowth on the leaflets and a variable proliferation of myofibroblasts. CONCLUSIONS: The Perimount valve has adequate function in the pulmonary valve position at 5 years of follow-up, although after 10 years of follow-up valve failure and reinterventions are common. Explanted valves show retraction and stiffening of the leaflets due to a fibrotic layer on both sides of the leaflet.


Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Pericárdio/transplante , Valva Pulmonar/cirurgia , Stents , Adolescente , Adulto , Cateterismo Cardíaco , Remoção de Dispositivo , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Xenoenxertos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Intervalo Livre de Progressão , Desenho de Prótese , Falha de Prótese , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
5.
World J Pediatr Congenit Heart Surg ; 10(5): 543-551, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496405

RESUMO

BACKGROUND: Following corrective surgery in infancy/childhood for tetralogy of Fallot (TOF) or its variants, patients may eventually require pulmonary valve replacement (PVR). Debate remains over which valve is best. We compared outcomes of the Medtronic Freestyle valve with that of the pulmonary allograft valve following PVR. METHODS: A retrospective study was undertaken from a single surgical practice of adult patients undergoing elective PVR between April 1993 and March 2017. The choice of valve was at the surgeon's discretion. There was a trend toward the almost exclusive use of the more readily available Medtronic Freestyle valve since 2008. RESULTS: One hundred fifty consecutive patients undergoing 152 elective PVRs were reviewed. Their mean age was 33.8 years. Ninety-four patients had a Medtronic Freestyle valve, while 58 had a pulmonary allograft valve. There were no operative or 30-day mortality. The freedom from reintervention at 5 and 10 years was 98% and 98% for the pulmonary allograft and 99% and 89% for the Medtronic Freestyle. There was no significant difference in the rate of reintervention, though this was colored by higher pulmonary gradients across the Medtronic Freestyle despite its shorter follow-up. CONCLUSIONS: Pulmonary valve replacement following previous surgical repair of TOF or its variants was found to be safe with no significant differences in mortality or reintervention between either valve. Although the Medtronic Freestyle valve had a greater tendency toward pulmonary stenosis, additional follow-up is needed to further document its long-term outcomes.


Assuntos
Implante de Prótese de Valva Cardíaca/mortalidade , Próteses Valvulares Cardíacas , Valva Pulmonar/transplante , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Aloenxertos , Procedimentos Cirúrgicos Cardíacos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Reimplante , Estudos Retrospectivos , Transplante Homólogo , Resultado do Tratamento , Adulto Jovem
7.
Methodist Debakey Cardiovasc J ; 15(2): 122-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384375

RESUMO

Right ventricular outflow tract (RVOT) dysfunction is common following surgical repair of tetralogy of Fallot and other forms of complex congenital heart disease. This results in pulmonary stenosis or regurgitation and may ultimately lead to RV failure and dysrhythmias. Transcatheter valve technologies are now available to treat certain patients with RVOT dysfunction. Current devices include the Medtronic Melody valve and the Edwards Lifesciences SAPIEN XT. Although these valves are approved for use in dysfunctional circumferential RVOT conduits, they are increasingly being used off label for nonconduit outflow tracts. Procedural complications include but are not limited to conduit rupture and coronary compression. Longer-term complications include stent fracture and endocarditis. Outcomes with these valves have demonstrated durable relief of stenosis and regurgitation. The Medtronic Harmony valve and the Alterra Prestent from Edwards Lifesciences are investigational devices that are intended to treat the patulous RVOT that is too large to accommodate currently available valves. This review will focus on current indications to treat RVOT dysfunction, existing transcatheter valve technologies, and investigational devices undergoing clinical trials. Hopefully, within the not-too-distant future, transcatheter pulmonary valve implantation will be feasible in the vast majority of patients with RVOT dysfunction following surgical repair of congenital heart disease.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/fisiopatologia , Fatores de Risco , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia
8.
J Vet Intern Med ; 33(5): 2227-2234, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31380593

RESUMO

A 2-year-old American Pit Bull dog was presented for surgical evaluation of imperforate cor triatriatum dexter (CTD) and patent foramen ovale (PFO). Echocardiography identified an imperforate CTD associated with a right-to-left shunting PFO and valvular pulmonary stenosis. A 2-step interventional and surgical approach was used. Initially, a pulmonary balloon valvuloplasty was performed, and subsequently the dog underwent a surgical correction of the atrial anomaly under cardiopulmonary bypass.


Assuntos
Coração Triatriado/veterinária , Doenças do Cão/cirurgia , Forame Oval Patente/veterinária , Estenose da Valva Pulmonar/veterinária , Animais , Valvuloplastia com Balão/veterinária , Ponte Cardiopulmonar/veterinária , Coração Triatriado/diagnóstico por imagem , Coração Triatriado/cirurgia , Doenças do Cão/diagnóstico por imagem , Cães , Ecocardiografia/veterinária , Forame Oval Patente/diagnóstico por imagem , Masculino , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/cirurgia
9.
Ann Thorac Surg ; 108(6): e389-e391, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31152732

RESUMO

This report describes 2 cases of redo cardiac surgery in adult patients with conotruncal anomalies (double-outlet right ventricle and transposition of the great arteries) with pulmonary stenosis who underwent the Rastelli procedure in childhood. Although the Rastelli operation is one of the best options for the patients, conduit stenosis has occasionally developed secondary to compression by the anterior chest wall. To prevent compression by the sternum, partial sternectomy with Rastelli conduit change was performed in these 2 patients.


Assuntos
Transposição das Grandes Artérias/efeitos adversos , Transposição das Grandes Artérias/métodos , Dupla Via de Saída do Ventrículo Direito/cirurgia , Estenose da Valva Pulmonar/cirurgia , Esterno/cirurgia , Transposição dos Grandes Vasos/cirurgia , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Dupla Via de Saída do Ventrículo Direito/diagnóstico por imagem , Seguimentos , Tomografia Computadorizada Quadridimensional/métodos , Humanos , Masculino , Estenose da Valva Pulmonar/etiologia , Reoperação/métodos , Medição de Risco , Amostragem , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Transposição dos Grandes Vasos/diagnóstico por imagem , Resultado do Tratamento
10.
Cardiol Young ; 29(5): 720-724, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31094305

RESUMO

BACKGROUND: Transposition of the great arteries is the most common cyanotic cardiac lesion in newborns. Transposition of the great arteries without surgical correction is fatal during the first year of life. Contemporary outcome studies have shown that survival rates after surgery are excellent and most patients live to adulthood. CASE SUMMARY: Woman with complex transposition of the great arteries with atrial and ventricular septal defects and subvalvular and valvular pulmonary stenosis, who has survived until the age of 31 years without surgery. The diagnosis was made by echocardiography and cardiac magnetic resonance. She underwent successful corrective surgical treatment after this age, by means of a Jatene operation. CONCLUSION: In transposition of the great arteries patients, a high index of cases dies in the first month of life. Our case represents a natural history of the complex transposition of the great arteries. Non-invasive imaging studies are very useful for the diagnosis and follow-up of patients with transposition of the great arteries, especially echocardiography and cardiac magnetic resonance. In our case, the multimodality approach and the corrective surgery allowed her to survive.


Assuntos
Transposição das Grandes Artérias , Comunicação Interventricular/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Transposição dos Grandes Vasos/diagnóstico por imagem , Adulto , Idade de Início , Ecocardiografia , Feminino , Comunicação Interventricular/cirurgia , Humanos , Imagem por Ressonância Magnética , Estenose da Valva Pulmonar/cirurgia , Transposição dos Grandes Vasos/cirurgia
11.
Medicine (Baltimore) ; 98(20): e15754, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096540

RESUMO

RATIONALE: Patients of critical pulmonary artery stenosis would face severe hypoxemia, cardiac failure as well as massive hemorrhage during percutaneous balloon dilation and pulmonary arterial stent implantation. Here, we present a case in which the elective use of extracorporeal membrane oxygenation (ECMO) support successfully facilitated safe percutaneous balloon dilation of pulmonary artery and stent implantation on a patient with severe pulmonary artery stenosis caused by aorto-arteritis. PATIENT CONCERNS: A 47-year-old man was hospitalized due to 10 years of post-exercise exhaustion and shortness of breath. Half a month ago the symptoms deteriorated. He also manifested systemic edema and could only sit upright to breath during night time. Computed tomographic angiography (CTA) indicated severe pulmonary stenosis caused by aorto-arteritis. DIAGNOSES: Right pulmonary artery stenosis, left pulmonary artery occlusion, severe tricuspid regurgitation, right atrium, and ventricle enlargement, atrial fibrillation with rapid ventricular rates, NYHA class IV, pulmonary infection. INTERVENTIONS: V-A ECMO support was considered during percutaneous balloon dilation of pulmonary artery and stent implantation. OUTCOMES: The patient remained hemodynamically stable throughout the procedure with no inotropic support. ECMO was successfully weaned off after the intervention, with no procedural complications. Postoperative echocardiography indicated much better heart function, and he was discharged uneventfully 5 days later. CONCLUSION: V-A ECMO is capable of preventing hypoxemia and providing effective circulation support during cardiac intervention in patients of severe pulmonary stenosis.


Assuntos
Angioplastia Coronária com Balão/instrumentação , Oxigenação por Membrana Extracorpórea/métodos , Cardiopatias/cirurgia , Estenose da Valva Pulmonar/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Hipóxia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estenose da Valva Pulmonar/diagnóstico por imagem , Stents , Procedimentos Cirúrgicos Torácicos
12.
Am Heart J ; 213: 8-17, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31071505

RESUMO

BACKGROUND: Right ventricular (RV) dilation from pulmonary valve regurgitation (PR) is common after intervention(s) for pulmonary stenosis (PS) or atresia and intact ventricular septum (PA/IVS). It is not well established whether PR and RV dilation have similar effects on RV function and exercise capacity in these patients compared to patients after repair of tetralogy of Fallot (rToF). The aims of this study were to compare exercise tolerance, RV function and myocardial mechanics in non-ToF versus rToF children with significantly increased and comparable RV volumes. METHODS: Thirty PS or PA/IVS children after intervention(s) with significant PR and RV dilation (non-ToF group) were retrospectively matched for RV end-diastolic volume index (RVEDVi) and age with 30 rToF patients. Clinical characteristics, RV function by echocardiography and CMR, ECG and exercise capacity were compared between groups. RESULTS: The groups were well matched for RVEDVi and age. Global RV function (RVEF: 48.7 ±â€¯6.4% vs. 48.5 ±â€¯7.2%, P = .81) and exercise capacity (% predicted peak VO2:82.5 ±â€¯17.7% vs. 75.6 ±â€¯20.4%, P = .27) were similarly reduced between groups. RVEDVi correlated inversely with RVEF in both groups (non-ToF:r = -0.39, P = .04, rToF:r = -0.40, P = .03). QRS duration was wider in rToF patients, and in both groups inversely correlated with RVEF (non-ToF:r = -0.77, P < .001, rToF:r = -0.69, P < .001). In contrast to global function, longitudinal RV strain was lower in rTOF vs non-TOF (-20.1 ±â€¯3.9 vs.-25.7 ±â€¯4.4, P < .001). CONCLUSIONS: Global RV function and exercise capacity are similarly reduced in non-ToF and rToF patients with severely dilated RV, after matching by RVEDVi, suggesting a comparable impact of RV dilation on RV global function. The significance of reduced RV longitudinal function and worse dyssynchrony in rToF patients require further exploration.


Assuntos
Tolerância ao Exercício/fisiologia , Hipertrofia Ventricular Direita/fisiopatologia , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/fisiopatologia , Tetralogia de Fallot/fisiopatologia , Função Ventricular Direita/fisiologia , Criança , Pré-Escolar , Estudos Transversais , Ecocardiografia , Teste de Esforço , Feminino , Humanos , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/patologia , Imagem por Ressonância Magnética , Masculino , Análise por Pareamento , Consumo de Oxigênio , Complicações Pós-Operatórias/fisiopatologia , Atresia Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/complicações , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Estudos Retrospectivos , Volume Sistólico , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia
13.
Int J Cardiovasc Imaging ; 35(8): 1453-1463, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30937683

RESUMO

To compare contrast-enhanced magnetic resonance angiography (ceMRA) and 3D steady-state free precession (SSFP) during systole and diastole for assessment of the right ventricle outflow tract (RVOT) in patients considered for percutaneous pulmonary valve implantation (PPVI) after tetralogy of Fallot (TOF) repair. We retrospectively evaluated 89 patients (male: 45, mean age 19 ± 8 years), who underwent cardiac-MRI after surgical TOF-repair. Datasets covering the whole heart in systole and diastole were acquired using ECG-gated 3D SSFP and non-gated ceMRA. Measurements were performed in SSFP-sequences and in ceMRA in the narrowest region of the RVOT to obtain the minimum, maximum and effective diameter. Invasive balloon sizing as the gold standard was available in 12 patients. The minimum diameter in diastolic SSFP, systolic SSFP and ceMRA were 21.4 mm (± 6.1 mm), 22.6 mm (± 6.2 mm) and 22.6 mm (± 6.0 mm), respectively. Maximum diameter was 29.9 mm (± 9.5 mm), 30.0 mm (± 7.0 mm) and 28.8 mm (± 8.1 mm) respectively. The effective diameter was 23.2 mm (± 5.7 mm), 27.4 mm (± 6.7 mm) and 24.4 mm (± 6.2 mm), differing significantly between diastole and systole (p < 0.0001). Measurements in ECG-gated SSFP showed a better inter- and intraobserver variability compared to measurements in non-ECG-gated ceMRA. Comparing invasive balloon sizing with our analysis, we found the highest correlation coefficients for the maximum and effective diameter measured in systolic SSFP (R = 0.99 respectively). ECG-gated 3D SSFP enables the identification and characterization of a potential landing zone for PPVI. The maximum and effective systolic diameter allow precise sizing for PPVI. Patients with TOF-repair could benefit from cardiac MRI before PPVI.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca/métodos , Ventrículos do Coração/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/métodos , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Valvuloplastia com Balão , Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Técnicas de Imagem de Sincronização Cardíaca , Criança , Meios de Contraste/administração & dosagem , Eletrocardiografia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Ventrículos do Coração/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Desenho de Prótese , Valva Pulmonar/fisiopatologia , Valva Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Função Ventricular Direita , Adulto Jovem
14.
Congenit Heart Dis ; 14(5): 691-699, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30989806

RESUMO

BACKGROUND: Little is known about the early time course of biventricular function and mechanics after tetralogy of Fallot (TOF) repair. We sought to evaluate and describe the evolution of the right ventricle (RV) after TOF repair in young infants and children using conventional echocardiographic parameters and global longitudinal strain (GLS). METHODS: A retrospective review was performed of all patients with TOF and pulmonary stenosis who underwent repair from January 2002 to September 2015 and had at least 3 serial postsurgical echocardiograms spanning from infancy to early childhood (<8 years). Student's t test was performed to compare patients who underwent valve sparing (VS) versus transannular patch (TAP) repair. ANOVA was used to track measures of ventricular systolic function over time. RESULTS: We analyzed 151 echocardiograms performed on 42 patients. Pulmonary regurgitation (PR, moderate or severe) and the RV to left ventricular (LV) basal dimension ratio were higher in TAP patients (P < .04 at all-time points). Along with a significant increase in RV basal diameter Z-score in the TAP group (P < .001), there was an improvement in RV and LV GLS over time in both groups (P < .001). The LV GLS at last follow-up was lower in patients who underwent reoperation than those who did not (P = .050). LV GLS at the last follow-up echocardiogram was lower in patients with significant PR than those without (P < .001). CONCLUSIONS: Ventricular function appeared improve over time from the initial postoperative period in TOF patients. TAP repair was associated with a progressively higher RV/LV ratio in young children. GLS and RV/LV basal diameter ratio may be useful when following young children after TOF repair. Further research is necessary to understand the trajectory of ventricular functional and volumetric changes in young children in order to provide the most effective lifetime management of patients with TOF.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ventrículos do Coração/fisiopatologia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Função Ventricular Direita/fisiologia , Criança , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Lactente , Masculino , Período Pós-Operatório , Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/fisiopatologia , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/fisiopatologia
15.
An Pediatr (Barc) ; 91(5): 336-343, 2019 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-30952598

RESUMO

INTRODUCTION: Pulmonary atresia with intact ventricular septum and critical pulmonary stenosis in newborns encompasses a wide spectrum of disease, including cases with significant right ventricular hypoplasia and coronary artery to right ventricle fistulae, which may be considered a contraindication for decompression of the right ventricle. The aim of this study was to review the middle- and long-term outcomes of these patients over 20 years and identify differential factors between both groups, including patients with coronary artery fistulae. PATIENTS AND METHODS: We performed a descriptive retrospective study by identifying all patients that received a diagnosis of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis between January 1996 and January 2018. We collected and analysed data regarding right ventricular morphology, surgical management, percutaneous intervention and medium- and long-term outcomes. RESULTS: 51 patients were admitted. A total of 9 patients (17.6%) died during the followup. None of the deceased patients had coronary artery to right ventricle fistulae. The median length of follow up in the 42 survivors was 8.9 years (1-16). The functional class based on the latest revision of the New York Heart Association classification was 1.2 for the overall sample. Survivors of critical pulmonary stenosis had a functional class of 1.1, and survivors of pulmonary atresia with intact ventricular septum a functional class of 1.6. There were no differences based on the presence or absence of coronary artery to right ventricle fistulae. CONCLUSIONS: Coronary artery to right ventricle fistulae may not be a contraindication for biventricular strategy. Patients with critical pulmonary stenosis had better outcomes compared to patients with pulmonary atresia with intact ventricular septum. The aggressive strategy of opening the pulmonary valve early on was associated with a good overall survival and correlated to a good functional class.


Assuntos
Cardiopatias Congênitas/cirurgia , Intervenção Coronária Percutânea/métodos , Atresia Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
16.
J Card Surg ; 34(5): 236-238, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30924563

RESUMO

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


Assuntos
Técnica de Fontan/métodos , Adolescente , Ponte Cardiopulmonar/métodos , Cateterismo/métodos , Criança , Dupla Via de Saída do Ventrículo Direito/cirurgia , Feminino , Comunicação Interventricular/cirurgia , Humanos , Masculino , Estenose da Valva Pulmonar/cirurgia , Transposição dos Grandes Vasos/cirurgia , Resultado do Tratamento , Atresia Tricúspide/cirurgia , Veia Cava Superior , Adulto Jovem
17.
World J Pediatr Congenit Heart Surg ; 10(2): 151-156, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30841837

RESUMO

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


Assuntos
Transposição das Grandes Artérias/métodos , Transposição dos Grandes Vasos/cirurgia , Anormalidades Múltiplas/cirurgia , Angiografia Coronária , Dupla Via de Saída do Ventrículo Direito/cirurgia , Feminino , Seguimentos , Comunicação Interventricular/cirurgia , Humanos , Imageamento Tridimensional , Lactente , Recém-Nascido , Masculino , Imagem de Perfusão do Miocárdio , Estenose da Valva Pulmonar/cirurgia , Reoperação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Transposição dos Grandes Vasos/diagnóstico por imagem
18.
World J Pediatr Congenit Heart Surg ; 10(2): 157-163, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30841838

RESUMO

OBJECTIVES: Our preferred approach for the surgical treatment of patients with D-transposition of the great arteries, ventricular septal defect, and pulmonary stenosis has been the Rastelli operation. We herein evaluate our 30-year experience with this procedure. METHODS: Clinical records for patients who underwent the Rastelli operation between 1988 and 2017 at our institution were retrospectively reviewed. Primary outcomes included freedom from death or cardiac transplantation and freedom from conduit reintervention. RESULTS: Forty-seven patients met inclusion criteria. Mean follow-up was 11.7 ± 6.8 years. Forty-three (91.5%) patients received a palliative systemic-to-pulmonary artery shunt and/or atrial septostomy prior to the Rastelli procedure. Five (10.6%) patients required ventricular septal defect enlargement at the time of the Rastelli procedure. The overall mean right ventricle-to-pulmonary artery conduit size was 17.0 mm. Mortalities included one early and three late deaths. Freedom from death or cardiac transplantation was 93% and 84% at 5 and 25 years, respectively. Seven patients required pacemaker placement, two immediately postoperatively and five late. Freedom from conduit replacement was 85% and 25% at 5 and 15 years, respectively. Seven (14.9%) patients required a second conduit intervention. Forty-one (87.2%) patients were New York Heart Association class I or II at the most recent follow-up. CONCLUSIONS: The Rastelli operation for D-transposition of the great arteries, ventricular septal defect, and pulmonary stenosis offers excellent mid- to long-term survival. The need for conduit replacement remains the most common indication for reintervention, and further study of the optimal choice of conduit will be useful.


Assuntos
Anormalidades Múltiplas/cirurgia , Transposição das Grandes Artérias/métodos , Comunicação Interventricular/cirurgia , Estenose da Valva Pulmonar/congênito , Transposição dos Grandes Vasos/cirurgia , Anormalidades Múltiplas/mortalidade , Adolescente , Adulto , Prótese Vascular , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Estimativa de Kaplan-Meier , Masculino , Artéria Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
19.
Kyobu Geka ; 72(2): 156-159, 2019 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-30772885

RESUMO

Ross procedure has been found to have a lower incidence of infective endocarditis compared to other aortic replacement procedure using prosthetic valves. We report a case of 25-year-old man who underwent Ross procedure for congenital aortic stenosis and regurgitation when he was 7 years old. He presented with fever and was highly suspected of infective endocarditis. All sets of blood cultures were positive for Heamophilus parainfluenzae. Autologous pericardial pulmonary valve was severely stenotic and computed tomography (CT) scan and radio isotope (RI) scan revealed infection at the stenotic valve. We performed right ventricle (RV)-pulmonary artery (PA) conduit replacement and he was discharged after completion of intravenous antibiotic treatment. We experienced a rare case of infective endocarditis in a patient late after Ross procedure. Prophylaxis against infective endocarditis is mandatory even in patients with infection resistant Ross procedure.


Assuntos
Endocardite Bacteriana/diagnóstico , Infecções por Haemophilus/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar , Adulto , Insuficiência da Valva Aórtica/congênito , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/cirurgia , Endocardite Bacteriana/microbiologia , Haemophilus parainfluenzae/isolamento & purificação , Ventrículos do Coração/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/microbiologia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/microbiologia , Estenose da Valva Pulmonar/diagnóstico por imagem , Resultado do Tratamento
20.
Int J Cardiol ; 281: 113-118, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30732866

RESUMO

OBJECTIVES: Bioprosthetic pulmonary valve conduits have been reported with an increased risk of endocarditis. Thrombus formation is considered as source of these serious and life-threatening infections. We reviewed a series of explanted valved pulmonary conduits for histological evidence for thrombus formation. MATERIALS AND METHODS: Explanted bioprosthetic pulmonary valves were fixed in formalin and embedded in paraffin or in methylmethacrylate. Standard staining as well as immunohistochemical staining techniques were applied. Native pulmonary valves of German domestic pigs served as controls. RESULTS: 47 valved pulmonary conduits (Hancock n = 23, Homograft n = 7, Contegra n = 7, Melody n = 7, other n = 3) were analyzed histologically. Average time of implantation had been 63 months (6 to 342 months). Indications for explantation included significant obstruction (n = 45), regurgitation (n = 7), and/or endocarditis (n = 6). In 44/47 (93%) specimen, we found accumulation of thrombotic material at the basis of the semilunar valve sinus to a variable degree. 11 patients had been treated with antiplatelet agents, 2 had received anticoagulants at the time of explantation. There was no suspicion of thrombus formation clinically or echocardiographically prior to explantation in any of the patients. Control porcine pulmonary valves (n = 5) did not show any evidence of accumulation of thrombotic material. CONCLUSIONS: In a large series of explanted valved pulmonary conduits, formation of subclinical, mostly non-infectious thrombotic material was an almost ubiquitous finding. We speculate that high incidence of endocarditis in bioprosthetic valves may in part be explained by thrombus apposition at the basis of conduit valve sinus.


Assuntos
Bioprótese/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Trombose/patologia , Adolescente , Adulto , Animais , Bioprótese/normas , Criança , Pré-Escolar , Feminino , Próteses Valvulares Cardíacas/normas , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/patologia , Estenose da Valva Pulmonar/patologia , Suínos , Trombose/etiologia , Adulto Jovem
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