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1.
Clin Nucl Med ; 46(1): e61-e62, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32956125

RESUMO

Acquired pulmonary stenosis in adults is rare and is usually caused by extrinsic compression from a mediastinal tumor. We present a case of anterior mediastinal Hodgkin lymphoma, who presented with cough and hemoptysis. Compression of the bilateral pulmonary arteries by the mediastinal mass was demonstrated by transthoracic echocardiography and CT pulmonary angiography. FDG PET/CT showed diffusely increased FDG uptake in right ventricular myocardium in addition to lymphomatous involvement of the lymph nodes and spleen.


Assuntos
Glucose/metabolismo , Ventrículos do Coração/patologia , Neoplasias do Mediastino/complicações , Miocárdio/metabolismo , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/metabolismo , Adulto , Angiografia , Ecocardiografia , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estenose da Valva Pulmonar/diagnóstico por imagem
2.
J Card Surg ; 35(11): 2927-2933, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33111442

RESUMO

OBJECTIVE: The arterial switch operation (ASO) is the standard treatment for the transposition of the great arteries. The timely variation in the residual pressure gradient across the pulmonary arteries is ill-defined. This study is aimed to study the progressive changes in the pressure gradient across the pulmonary valve and pulmonary arteries after ASO. METHODS: All eligible patients for this study who underwent ASO between 2000 and 2019 were reviewed. Transthoracic echocardiography was used to estimate the peak pressure gradient across the pulmonary artery and its branches. The primary outcome was the total peak pressure gradient (TPG) which is the sum of peak pressure gradients across the main pulmonary artery and pulmonary artery branches. Furthermore, longitudinal data analyses with mixed-effect modeling were used to determine the independent predictors for the changes in the pressure gradient. RESULTS: Three hundred and nine patients were included in the study. Over a 17-year follow-up, the freedom from pulmonary stenosis reintervention was 95% (16 out of the 309 patients underwent reintervention = 5%). The longitudinal data analyses of serial 1844 echocardiographic studies for the included patients revealed that the TPG recorded in the first postoperative echocardiogram across pulmonary valve, right and left pulmonary artery branches was the most significant predictor for reintervention. CONCLUSION: The total peak gradient measured in the first postoperative echocardiogram is the most important predictor for reintervention. We propose that a total peak gradient in the first postoperative echocardiography of 55 mm Hg or more is a predictor for reintervention.


Assuntos
Pressão Arterial , Transposição das Grandes Artérias/métodos , Artéria Pulmonar/fisiopatologia , Valva Pulmonar/fisiopatologia , Transposição dos Grandes Vasos/fisiopatologia , Transposição dos Grandes Vasos/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Artéria Pulmonar/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/fisiopatologia , Reoperação , Transposição dos Grandes Vasos/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
3.
J Card Surg ; 35(11): 2979-2986, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33111443

RESUMO

AIM: To evaluate the imaging characteristics and associations in patients with twisted atrioventricular connections on multidetector computed tomography (CT) angiography. MATERIAL AND METHODS: We retrospectively reviewed 2605 CT angiography studies performed for suspected congenital heart diseases in our institution from January 2014 to December 2018. Twisted atrioventricular connections were diagnosed in 12 patients. Segmental sequential approach developed by Anderson et al was employed to characterize the complex congenital heart disease. Ventricular topology was also determined. CTA was also assessed to look for any associated intra- and extracardiac anomalies. RESULTS: Out of 12 patients with twisted atrioventricular connections, usual viscero-atrial arrangement was seen in nine patients, two patients had mirror-imaged viscero-atrial arrangement and one patient had mirror-imaged atrial arrangement. Right-sided heart was seen in four patients. Two patients had discordant atrioventricular connections, seven had concordant atrioventricular connections while three showed double-inlet right ventricle. Ventriculoarterial connections were concordant in two patients, discordant in one patient while nine patients had double-outlet right ventricle. Superior-inferior ventricular morphology with near-horizontal interventricular septum was seen in four patients. Left-sided aortic arch with normal branching pattern was observed in nine patients. No coronary anomaly was seen in any patient. Other associations included ventricular and atrial septal defects, pulmonic stenosis, hypoplasia/atresia of tricuspid valve, straddling of mitral valve, and duplicated superior caval veins. CONCLUSION: CT angiography is useful in diagnosis of twisted atrioventricular connections with accurate identification of viscero-atrial arrangement, atrioventricular and ventriculoarterial connections, and orientation and presence or absence of associated anomalies.


Assuntos
Coração Entrecruzado/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Anormalidades Múltiplas , Adolescente , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Dupla Via de Saída do Ventrículo Direito/diagnóstico por imagem , Feminino , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Humanos , Lactente , Masculino , Estenose da Valva Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Atresia Tricúspide/diagnóstico por imagem
4.
Int Heart J ; 61(5): 1075-1078, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921664

RESUMO

Pulmonary valve stenosis (PVS) accounts for approximately 10% of all congenital heart defects. Echocardiography and right heart catheterization are the gold standards for diagnosis of PVS and for assessing disease severity and responsiveness to treatment.Recently, cardiac magnetic resonance imaging (cMRI) has been established as an important tool to comprehensively evaluate cardiac structure and function; however, research into the usefulness of cMRI for PVS management is limited. Here, we describe a case of a 59-year-old female with isolated, severe PVS who was successfully treated with balloon pulmonary valvuloplasty (BPV) followed by sequential cMRI at 1 and 12 months. Exertional dyspnea and elevated plasma BNP concentration were observed 1 month after BPV; however, echocardiographic findings did not indicate recurrent stenosis or increased pulmonary valve regurgitation but an increase in mitral E/e'. cMRI demonstrated improved systolic forward flow and RV function with enlargement of LV volume, and the rapid increase in LV preload might be associated with the transient deterioration in symptoms and BNP level, which both gradually improved within 3 months after BPV. cMRI further depicted that a reduced RV mass index and increased RV cardiac output were achieved gradually during the follow-up period.In conclusion, cMRI in combination with echocardiography was sufficiently informative to follow-up this PVS patient both before and after BPV. cMRI is easily reproducible in adult patients; therefore, cMRI should be recommended for long-term follow-up in adult PVS patients.


Assuntos
Valvuloplastia com Balão/métodos , Ecocardiografia , Imagem por Ressonância Magnética , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/cirurgia , Recuperação de Função Fisiológica , Técnicas de Imagem Cardíaca , Débito Cardíaco , Dispneia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Período Pós-Operatório , Estenose da Valva Pulmonar/congênito , Estenose da Valva Pulmonar/fisiopatologia , Índice de Gravidade de Doença , Função Ventricular Direita
5.
PLoS One ; 15(8): e0237193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780780

RESUMO

BACKGROUND: The myocardial adaptive mechanism in patients with repaired tetralogy of Fallot (rTOF) is less understood. We aimed to investigate biventricular myocardial adaptive remodeling in rTOF patients. METHODS: We recruited 32 rTOF patients and 38 age- and sex-matched normal controls. The pulmonary stenosis of rTOF patients was measured using catheterized pressure gradient between right ventricle (RV) and pulmonary artery (PGRVPA). rTOF patients with PGRVPA < 15 mmHg and ≥15 mmHg were classified as low pulmonary stenosis (rTOFlow, n = 19) and high pulmonary stenosis (rTOFhigh, n = 13) subgroups, respectively. Magnetic resonance imaging tissue phase mapping was employed to evaluate the voxelwise biventricular myocardial motion in longitudinal (Vz), radial (Vr), and circumferential (Vφ) directions. RESULTS: The rTOFlow subgroup presented higher pulmonary regurgitation fraction than rTOFhigh subgroup (p < 0.001). Compared with the normal group, only rTOFlow subgroup presented a decreased RV ejection fraction (RVEF) (p < 0.05). The rTOFlow subgroup showed decreased systolic and diastolic Vz in RV and LV, whereas rTOFhigh subgroup showed such change only in RV. In rTOFlow subgroup, RVEF significantly correlated with RV systolic Vr (r = 0.56, p < 0.05), whereas LVEF correlated with LV systolic Vz (r = 0.51, p = 0.02). Prolonged QRS correlated with RV systolic Vr (r = -0.58, p < 0.01) and LV diastolic Vr (r = 0.81, p < 0.001). No such correlations occurred in rTOFhigh subgroup. CONCLUSIONS: The avoidance of unfavorable functional interaction in RV and LV in rTOFhigh subgroup suggested that adequate pulmonary stenosis (PGRVPA ≥ 15 mmHg in this sereis) has a protective effect against pulmonary regurgitation.


Assuntos
Imagem por Ressonância Magnética/métodos , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/reabilitação , Adulto , Pressão Sanguínea , Estudos de Casos e Controles , Teste de Esforço , Feminino , Frequência Cardíaca , Humanos , Masculino , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/fisiopatologia , Volume Sistólico , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/cirurgia , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Esquerda , Função Ventricular Direita , Adulto Jovem
6.
J Card Surg ; 35(10): 2798-2799, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32652587

RESUMO

We present a case of a 12-year-old boy with discordance between the atrial arrangement and the thoracoabdominal arrangement in the setting of twisted atrioventricular connections. This case highlights the importance of a separate description of all visceral organs and venous drainage for an accurate description of visceroatrial arrangement in cases of congenital heart defects.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Ventrículos do Coração/anormalidades , Levocardia/diagnóstico , Estenose da Valva Pulmonar/diagnóstico por imagem , Criança , Angiografia por Tomografia Computadorizada , Átrios do Coração/anormalidades , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino
7.
J Card Surg ; 35(5): 1152-1155, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32302027
8.
Am J Case Rep ; 21: e920822, 2020 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-32111814

RESUMO

BACKGROUND Congenitally corrected transposition of great arteries (ccTGA) represents a distinct rare group of congenital heart diseases. Survival of unoperated ccTGA in the presence of large ventricular septal defect (VSD) is exceptional. Furthermore, late presentation of such patients in the absence of severe pulmonary hypertension or severe systemic right ventricle dysfunction is unusual. CASE REPORT We report a rare late presentation of ccTGA associated with large VSD in the absence of severe pulmonary hypertension or systemic ventricle dysfunction. An associated severe pulmonary valve stenosis maintained a balanced and stable condition up to the fourth decade of life. The patient has also dextrocardia, which is an unusual association. The diagnosis was reached using multimodality imaging including transthoracic echocardiogram (TTE), transesophageal echography (TEE), cardiac magnetic resonance imaging (CMR), and cardiac computed tomography (cardiac CT). CONCLUSIONS The presence of pulmonary stenosis can provide a physiological protection that avoids unnecessary surgical correction of large VSD in ccTGA patients. However, such a decision should be made on an individual basis and following a careful anatomical and functional evaluation.


Assuntos
Transposição Congênita Corrigida de Grandes Artérias/diagnóstico por imagem , Dextrocardia/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Adulto , Humanos , Masculino
9.
BMC Infect Dis ; 20(1): 212, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164584

RESUMO

BACKGROUND: Pulmonary endarteritis is a rare clinical phenomenon with congenital heart that can potentially lead to major complications. CASE PRESENTATION: We report a 47-year-old man with pulmonary endarteritis. This patient presented with hypertension, chest pain and a previous history of pulmonary valve disease during childhood. Also, eight-months prior, he was hospitalized with dyspnea (Functional Class III), cough, phlegm, and night sweats without fever. Echocardiographic diagnosis in the first transtransthoracic echocardiography (TTE) was intense pulmonary valve stenosis (PVS) an, thus, the pulmonary valve vegetation and PVS, established by transesophageal echocardiography (TEE). He was referred for surgery after 1 weeks of intravenous antibiotic therapy for removal of the vegetation. CONCLUSIONS: Finally he was asymptomatic at 3-months of follow-up and was clinically in good condition. Therefore, the detection of infective endocarditis of the lung valve must not lengthy be prolonged.


Assuntos
Endarterite/diagnóstico , Endocardite Bacteriana/diagnóstico , Embolia Pulmonar/diagnóstico , Sepse/diagnóstico , Antibacterianos/uso terapêutico , Ecocardiografia Transesofagiana , Endarterite/diagnóstico por imagem , Endarterite/terapia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/terapia , Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/diagnóstico por imagem , Sepse/terapia , Tomografia Computadorizada por Raios X
10.
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
11.
J Thorac Cardiovasc Surg ; 160(2): 476-484, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32014323

RESUMO

OBJECTIVES: The long-term durability of the 2 most commonly used types of bioprosthetic valves in the pulmonic position, the porcine and pericardial valves, is unclear. We compared the long-term durability of the pericardial (Carpentier-Edwards PERIMOUNT [CE]) and porcine (Hancock II) valves in the pulmonic position in patients with congenital cardiac anomalies. METHODS: We retrospectively reviewed the medical records of 258 cases (248 patients) of pulmonary valve implantation or replacement using CE (129 cases, group CE) or porcine (129 cases, group H) valves from 2 institutions between 2001 and 2009. RESULTS: The patients' age at pulmonary valve implantation was 14.9 ± 8.7 years. No significant differences in perioperative characteristics were observed between groups CE and H. Follow-up data were complete in 219 cases (84.9%) and the median follow-up duration was 10.5 (interquartile range, 8.4∼13.0) years. Ten mortalities (3.9%) occurred. Sixty-four patients underwent reoperation for pulmonary valve replacement due to prosthetic valve failure; 10 of these 64 patients underwent reoperation during the study period. Patients in group CE were significantly more likely to undergo reoperation (hazard ratio, 2.17; confidence interval, 1.26-3.72; P = .005) than patients in group H. Patients in group CE showed had a greater prosthetic valve dysfunction (moderate-to-severe pulmonary regurgitation or pulmonary stenosis with ≥3.5 m/s peak velocity through the prosthetic pulmonary valve) rate (hazard ratio, 1.83; confidence interval, 1.07-3.14; P = .027) than patients in group H. CONCLUSIONS: Compared with the pericardial valve, the porcine valve had long-term advantages in terms of reduced reoperation rate and prosthetic valve dysfunction in the pulmonic position in patients with congenital cardiac anomalies.


Assuntos
Bioprótese , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Adolescente , Animais , Bovinos , Criança , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Hemodinâmica , Xenoenxertos , Humanos , Masculino , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Falha de Prótese , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/mortalidade , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/mortalidade , Estenose da Valva Pulmonar/fisiopatologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Seul , Sus scrofa , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
J Vet Cardiol ; 26: 19-28, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31794914

RESUMO

INTRODUCTION/OBJECTIVES: We sought to determine the prevalence and clinical significance of right heart remodeling and right ventricular (RV) dysfunction in dogs with pulmonary valve stenosis (PS). We also sought to evaluate repeatability of several measurements of severity of PS, right heart size, and RV function in dogs with PS. ANIMALS, MATERIALS AND METHODS: Several indices of right atrial (RA) size and RV size and function were prospectively evaluated in 48 dogs with PS. Regression analysis was used to determine if indices of right heart size and function were independently associated with maximum transpulmonary pressure gradient (max PG) and adverse clinical findings (exercise intolerance, syncope, or right heart failure). Eight dogs underwent a second echocardiogram performed by the same operator to assess repeatability of the echocardiographic indices, which was quantified by coefficient of variation (CV) and repeatability coefficient. RESULTS: Increased RA size (81%), increased RV wall thickness (83%), and decreased tricuspid annular plane systolic excursion (TAPSE [81%]) were common. Right atrial size, end-diastolic RV area, and RV wall thickness were independently associated with max PG. Decreased TAPSE was independently associated with adverse clinical findings. All indices except RA area (18.6%) and RV systolic velocity (20.7%) had CVs <15%. Repeatability coefficients are available to help distinguish a true change versus measurement variability during serially obtained exams. CONCLUSIONS: Right heart remodeling and RV dysfunction are common in dogs with PS and are associated with echocardiographic and clinical severity. Results support the quantitative assessment of right heart size and function in dogs with PS.


Assuntos
Doenças do Cão/diagnóstico por imagem , Ecocardiografia/veterinária , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Estenose da Valva Pulmonar/veterinária , Disfunção Ventricular Direita/veterinária , Animais , Cães , Feminino , Átrios do Coração/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Masculino , Estenose da Valva Pulmonar/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Disfunção Ventricular Direita/diagnóstico por imagem
16.
J Vet Cardiol ; 26: 39-50, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31794916

RESUMO

INTRODUCTION/OBJECTIVES: Coronary artery abnormalities are described sporadically in dogs, most commonly with pulmonic stenosis. Computed tomographic angiography (CTA) allows non-invasive assessment of coronary anatomy. Three-dimensional (3D) models improve the understanding and visualization of spatially complex anatomy. The study objective was to evaluate coronary artery anomalies using CTA imaging and using rapid prototyping technology to create life-sized coronary artery models of these studies. ANIMALS, MATERIAL AND METHODS: Combined retrospective case and prospective pilot study. Inclusion criteria were dogs with reported coronary artery anomalies. The CTA data sets were imported into a medical imaging framework for the analysis of the coronary arteries and into a 3D-planning and printing software for creating printable 3D models. The 3D models were printed using fusion deposition modeling technology. RESULTS: Six male dogs with an R2A coronary artery anomaly and pulmonic stenosis diagnosed by CTA were included. Electrocardiogram (ECG)-gated CTA allowed better identification of anomalous coronary arteries than non-gated CTA. In all dogs, the right coronary artery had a smaller diameter than the left and the left coronary artery or its branch had a prepulmonic course. All ECG-gated studies were 3D printed while non-gated studies were not printable due to CTA artifacts. CONCLUSION: In dogs, CTA is effective for diagnosis of coronary artery anomalies. Printed 3D models of ECG-gated CTA studies were of excellent quality and allowed direct visualization of abnormal coronary artery anatomy. The usefulness of these models to improve the understanding of anomalous coronary artery anatomy could be evaluated in future studies.


Assuntos
Angiografia por Tomografia Computadorizada/veterinária , Vasos Coronários/patologia , Doenças do Cão/patologia , Impressão Tridimensional , Estenose da Valva Pulmonar/veterinária , Animais , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/veterinária , Cães , Eletrocardiografia/veterinária , Masculino , Projetos Piloto , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/patologia
18.
Catheter Cardiovasc Interv ; 94(4): 625-635, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31471941

RESUMO

OBJECTIVES: We sought to delineate the risk factors for infective endocarditis (IE) in patients undergoing transcatheter pulmonary valve replacement (TCPVR). BACKGROUND: Despite the therapeutic benefits of TCPVR for treatment of dysfunctional right ventricular outflow tracts, IE is a major complication of the approach. Specific hemodynamic gradients and patient immune status as predisposing factors for IE are largely unexplored. METHODS: We performed a retrospective review of patients who had undergone TCPVR at UCLA between October 2010 and October 2017. Cases of IE were diagnosed based on the modified Duke criteria. RESULTS: Two hundred and thirty-five cases of TCPVR were performed with a mean follow-up of 2.6 years (range 0.0-8.0 years). Sixteen distinct IE events developed in 13 patients (Melody™ n = 12, SAPIEN n = 1), with a median time from implant to IE of 3.3 years (range 2.0-7.2 years). Univariate Cox regression showed that immunocompromised status was significantly associated with the development of IE hazard ratios (HR 5.43 [1.80-16.4], p = .003). Kaplan-Meier curves show that the 5-year freedom from IE among immunocompetent patients was 87% (95% CI 78-96%) versus 64% (95% CI 39-89%) among immunocompromised patients (log-rank p = .02). Postimplant right ventricular systolic pressure was higher among immunocompromised patients (p = .03). The risk of IE post-TCPVR in immunocompromised patients with residual pulmonary stenosis was 43%. CONCLUSIONS: Among the risk factors examined in this study, immunocompromised status was the most significant predictor of IE development post-TCPVR. Patients with the lowest risk of IE are those with competent immune systems, without a history of IE, and with minimal residual pulmonary valve gradients post-TCPVR.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Endocardite/etiologia , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Adolescente , Adulto , Cateterismo Cardíaco/instrumentação , Tomada de Decisão Clínica , Endocardite/diagnóstico , Endocardite/imunologia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/imunologia , Cardiopatias Congênitas/fisiopatologia , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Hospedeiro Imunocomprometido , Masculino , Intervalo Livre de Progressão , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/imunologia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/imunologia , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/imunologia , Estenose da Valva Pulmonar/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
19.
J Med Case Rep ; 13(1): 291, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31521201

RESUMO

BACKGROUND: Subpulmonic membrane as a cause of right ventricular outflow tract obstruction in patients with concordant ventriculoarterial connection and intact ventricular septum is considered to be rare. Association with cor triatriatum dexter and success of subpulmonic balloon valvuloplasty have never been reported, at least to the best of our knowledge. CASE PRESENTATION: A 3-year-old Moroccan boy was referred to our tertiary care hospital with complaints of dyspnea on moderate exertion. A physical examination revealed parasternal lift, systolic thrill, and a 4/6 ejection systolic murmur, best heard over the left second intercostal space. His oxygen saturation was 99% on room air. Two-dimensional echocardiography showed a discrete circumferential membrane just below the pulmonic valve and a right atrial membrane. Continuous wave Doppler interrogation showed peak systolic pressure gradient of 85 mmHg across the subpulmonic membrane and no significant gradient across the right atrial membrane. Balloon dilation of the subpulmonic membrane was performed and the pressure gradient came down to 50 mmHg. During follow-up, he reported marked improvement in terms of exercise tolerance. Transthoracic echocardiography showed residual pressure gradient of approximately 40 mmHg across the membrane. Surgery resection of the two membranes was programmed, but he died after an extracardiac disease (appendicular peritonitis). CONCLUSIONS: Subpulmonic membrane as an isolated cause of right ventricular outflow tract obstruction is rare. Its association with cor triatriatum dexter is even less common. The result of percutaneous balloon valvuloplasty of subpulmonic membrane is an interesting alternative while waiting for surgery. Surgery is currently the preferred modality of treatment with the resection of both right atrial and subpulmonic membranes.


Assuntos
Valvuloplastia com Balão , Coração Triatriado , Estenose da Valva Pulmonar/terapia , Obstrução do Fluxo Ventricular Externo/terapia , Pré-Escolar , Ecocardiografia , Humanos , Masculino , Estenose da Valva Pulmonar/diagnóstico por imagem , Radiografia , Obstrução do Fluxo Ventricular Externo/etiologia
20.
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
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