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1.
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
2.
Vet Radiol Ultrasound ; 60(1): 38-46, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30318654

RESUMO

Coronary artery anomalies have been reported in Bulldogs and present an increased risk when performing balloon valvuloplasty. Identification of coronary anomalies has been reported using multidetector-row computed tomographic (MDCT) angiography with electrocardiographic gating. However, the utility of non-electrocardiographic-gated 16-row computed tomographic for MDCT for the identification of coronary artery anatomy or anomalies to the authors' knowledge has not been fully investigated. The purpose of this study was to evaluate the feasibility of non-electrocardiographic-gated computed tomographic (CT) angiography to identify coronary anomalies in Bulldogs with pulmonary valve stenosis. In this prospective, observational study, Bulldogs with echocardiographically diagnosed pulmonary valve stenosis, an echocardiographically derived transpulmonic pressure gradient >70 mm Hg, and a clinician recommendation for balloon valvuloplasty were included. Anesthetized dogs underwent a 16-row MDCT non-electrocardiographic-gated CT angiography. A board-certified veterinary radiologist and board-certified veterinary cardiologist reviewed the CT angiography studies and identified the coronary artery anatomy. When normal coronary artery anatomy was detected on CT angiography, a right ventricular outflow tract fluoroscopic angiogram was performed and evaluated during levophase to confirm normal coronary anatomy prior to balloon valvuloplasty. Dogs with coronary anomalies noted on CT angiography were recovered from anesthesia and balloon valvuloplasty was not performed. All dogs (10/10; 100%) had interpretable images from the non-electrocardiographic-gated CT angiography. Coronary anomalies were identified in six dogs based on non-electrocardiographic-gated CT angiography, five with type R2A anomaly and one had a single left coronary ostium. Four dogs had normal coronary anatomy based on non-electrocardiographic-gated CT angiography. Balloon valvuloplasty was performed without incident in these four dogs. We conclude that non-electrocardiographic-gated CT angiography represents a noninvasive method for diagnosing coronary anomalies in Bulldogs with pulmonary valve stenosis.


Assuntos
Angiografia por Tomografia Computadorizada/veterinária , Anomalias dos Vasos Coronários/veterinária , Doenças do Cão/diagnóstico por imagem , Estenose da Valva Pulmonar/veterinária , Animais , Angiografia por Tomografia Computadorizada/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/patologia , Doenças do Cão/patologia , Cães , Ecocardiografia/veterinária , Eletrocardiografia/veterinária , Feminino , Masculino , Estudos Prospectivos , Estenose da Valva Pulmonar/diagnóstico
3.
Vet Radiol Ultrasound ; 60(2): 145-158, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30475441

RESUMO

Pulmonary valve stenosis (PS) is one of the most commonly diagnosed congenital heart defects in dogs. Currently, transthoracic echocardiography (TTE) is the standard modality used to evaluate PS. Image acquisition by TTE can be challenging in some brachycephalic breeds of dogs. The use of echocardiographic-gated CT angiography (ECG-gated CTA) in veterinary medicine is limited. This retrospective method comparison study investigated right and left ventricular outflow diameters by sedated ECG-gated CTA and unsedated TTE in 14 brachycephalic dogs with PS and 12 brachycephalic dogs without PS. Measurements of ventricular outflow structures were made in early systole and end diastole for both modalities and then compared for significance between systolic and diastolic phases, as well as between the two modalities. Ratios of the pulmonary trunk diameter to the aorta at different locations (aortic valve, aortic annulus, and ascending aorta) and in different planes (transverse, sagittal) were compared between dogs with PS and without PS, as well as within dogs, by both TTE and ECG-gated CTA. Transthoracic echocardiography and ECG-gated CTA both detected significantly greater pulmonary trunk to aorta ratios in dogs with PS at all aortic locations (P < 0.05). Pulmonary valve to aortic valve ratios were significantly smaller in dogs with PS (P < 0.05). Pulmonary trunk to aorta and pulmonary valve to aorta ratios were achieved with good anatomic detail using ECG-gated CTA. Ratios of the pulmonary trunk and pulmonary valve relative to the aorta may be useful to evaluate for PS using a modality that is underutilized for cardiac assessment.


Assuntos
Craniossinostoses/veterinária , Doenças do Cão/diagnóstico , Estenose da Valva Pulmonar/veterinária , Angiocardiografia/veterinária , Animais , Angiografia por Tomografia Computadorizada/veterinária , Craniossinostoses/diagnóstico , Craniossinostoses/diagnóstico por imagem , Doenças do Cão/diagnóstico por imagem , Cães , Ecocardiografia/veterinária , Eletrocardiografia/veterinária , Feminino , Masculino , Estenose da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/diagnóstico por imagem
4.
Congenit Heart Dis ; 14(2): 264-273, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30556322

RESUMO

OBJECTIVE: To evaluate the prevalence of Noonan spectrum disorders (NSD) in a pediatric population with valvar pulmonary stenosis (vPS) and identify the clinical characteristics that differentiate those with NSD from those without NSD. DESIGN: A retrospective chart review of 204 patients diagnosed with vPS between 9/1/2012 and 12/1/2016 at a pediatric medical center was performed. The quantitative features of vPS, genetic diagnosis information, and phenotypic characteristics of Noonan syndrome were collected. Chi-square test, Fisher's exact test, t test, Wilcoxon rank-sum test, and ANOVA were used for comparisons among the groups. Logistic regression was used to test for the association between the clinical characteristics and the presence of NSD. RESULTS: Syndromic diagnoses were made in 10% of the children with vPS, with NSD accounting for 6%. Hypertrophic cardiomyopathy (P < .0001), short stature (P < .0001), developmental delay (P < .0001), ophthalmological abnormalities (P < .0001), pectus carinatum/excavatum (P = .01), neurological abnormalities (P = .022), and aortic stenosis (P = .031) were present more often in individuals with NSD compared to nonsyndromic vPS. A logistic regression analysis showed a 4.8-fold increase in odds for NSD for each additional characteristic (P < .0001). CONCLUSIONS: At least 6% of the children with vPS have an underlying NSD. Individuals with vPS and NSD were significantly more likely to have additional features known to be associated with NSD than those with vPS without NSD. We conclude that vPS in the presence of one or more significant characteristics should prompt referral for genetic evaluation as a guide to ascertain patients at risk for NSD while optimizing the use of clinical genetics evaluation and potential genetic testing.


Assuntos
Anormalidades Múltiplas , Testes Genéticos/métodos , Síndrome de Noonan/epidemiologia , Estenose da Valva Pulmonar/epidemiologia , Ecocardiografia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Noonan/diagnóstico , Ohio/epidemiologia , Prevalência , Estenose da Valva Pulmonar/diagnóstico , Estudos Retrospectivos
6.
Echocardiography ; 35(8): 1227-1229, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29975433

RESUMO

Congenital inferior sinus venosus defect (SVD) is a rare congenital heart disease. Proper diagnosis of this disease is challenging and requires understanding of cardiac hemodynamics. Here, we discuss a patient with a late presentation of combined congenital inferior SVD associated with congenital pulmonary stenosis.


Assuntos
Anormalidades Múltiplas , Diagnóstico Tardio , Ecocardiografia Doppler em Cores/métodos , Eletrocardiografia , Comunicação Interatrial/diagnóstico , Estenose da Valva Pulmonar/diagnóstico , Radiografia Torácica/métodos , Humanos , Masculino , Estenose da Valva Pulmonar/congênito , Doenças Raras , Fatores de Tempo , Adulto Jovem
7.
Cardiol Young ; 28(10): 1162-1164, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29991370

RESUMO

Only few reports have described successful simultaneous transcatheter intervention for CHD in infants. We present an infant with secundum atrial septal defect complicated by valvular pulmonary stenosis. Percutaneous transcatheter pulmonary valvuloplasty was performed first, followed by transcatheter closure of the secundum atrial septal defect uneventfully. Simultaneous transcatheter correction is an effective therapeutic option even in infants.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interatrial/cirurgia , Estenose da Valva Pulmonar/cirurgia , Dispositivo para Oclusão Septal , Ecocardiografia , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico , Humanos , Lactente , Masculino , Estenose da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/etiologia
8.
Tex Heart Inst J ; 45(2): 76-83, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29844739

RESUMO

Percutaneous balloon pulmonary valvuloplasty is the preferred therapy for pulmonary valve stenosis. However, the designs of the cylindrical balloons historically used for valvuloplasty have limitations, especially in patients who have large pulmonary annular diameters. The hourglass-shaped V8 Aortic Valvuloplasty Balloon may prove to be an effective alternative. The balloon has 2 large bulbous segments that are separated by a narrowed waist. The geometric shape is maintained throughout inflation, improving fixation and enabling broader leaflet opening. We present our first experience with the V8 balloon in 3 adults who had severe, symptomatic pulmonary valve stenosis. In addition to describing their cases, we detail our sizing technique for pulmonary valvuloplasty with the V8 balloon. Our successful results suggest that the V8 balloon is efficient and safe for balloon pulmonary valvuloplasty in adults with severe pulmonary valve stenosis.


Assuntos
Valvuloplastia com Balão/instrumentação , Cateterismo Cardíaco/métodos , Estenose da Valva Pulmonar/cirurgia , Angiografia por Tomografia Computadorizada , Ecocardiografia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Pulmonar/diagnóstico , Adulto Jovem
9.
J Med Case Rep ; 12(1): 125, 2018 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-29739439

RESUMO

BACKGROUND: Immature teratoma in a mediastinal location is a rare disease that might present as a valve pathology. Germ cell tumors with mediastinal locations account for up to 6% of immature teratoma cases. We present a case of an immature teratoma located primarily in the anterior mediastinum that manifested solely through symptoms of pulmonary stenosis. CASE PRESENTATION: We report a case of a 20-year-old white man with an immature teratoma who presented with progressive exertional dyspnea. During a cardiac examination, an ejection systolic murmur was observed, and echocardiography findings at an Emergency Centre revealed high velocity flow at the level of the pulmonary artery, indicating pulmonary stenosis. He was hospitalized in our Cardiology Department for further investigation. A chest X-ray revealed a mediastinal mass, and repeated echocardiography indicated the presence of a large mediastinal mass compressing his main pulmonary artery. Magnetic resonance imaging confirmed the tumor in the mediastinum, and a histopathological diagnosis of immature teratoma was established following biopsy. CONCLUSION: Immature teratoma causing cardiac-related complaints might shift the diagnosis toward cardiovascular diseases, thus requiring prompt examination by standard and sophisticated methods to clarify the diagnosis.


Assuntos
Sopros Cardíacos/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Terapia Combinada , Diagnóstico Diferencial , Tratamento Farmacológico , Dispneia/etiologia , Ecocardiografia , Sopros Cardíacos/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias do Mediastino/terapia , Artéria Pulmonar/patologia , Estenose da Valva Pulmonar/diagnóstico , Teratoma/terapia , Resultado do Tratamento , Adulto Jovem
10.
Anesth Analg ; 127(1): 39-45, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29543640

RESUMO

BACKGROUND: Twenty percent of patients born with congenital heart disease present with right ventricular outflow tract abnormalities. These patients require multiple surgical procedures in their lifetime. Transcatheter pulmonary valve replacement (TPVR) has become a viable alternative to conventional pulmonary valve and right ventricular outflow tract surgery in pediatric and adult populations. In this retrospective review, we analyze the perioperative management of adult patients who underwent TPVR in our center. METHODS: The study consisted of a chart review of patients who underwent TPVR at Toronto General Hospital between 2006 and 2015. Information about preoperative assessment, intraoperative anesthetic management, and intra- and postprocedural complications was collected. Two types of percutaneous valves have been used for a conduit or valve size between 16 and 28 mm. These procedures are done via the femoral, jugular, or subclavian vein under general anesthesia. RESULTS: Seventy-nine adults (17-68 years of age) who underwent elective TPVR procedures were included. General anesthesia was used in all cases. Defibrillation was necessary in 1 case, and bradycardia was spontaneously resolved in another 1. Eighty-five percent were successfully extubated at the end of the procedure. Five patients required intraoperative inotropic support. Three patients presented self-resolved hemoptysis. Mechanical ventilation for >24 hours was necessary in 3 cases, 2 of which also required concomitant inotropic support. Four failed deployments and 1 case of persistent conduit stenosis were reported. Three patients required reintubation. All patients were discharged home. CONCLUSIONS: Patients undergoing TPVR represent a complex and heterogeneous population. General anesthesia with endotracheal intubation is preferred. Setup for urgent lung isolation and cardiac defibrillation should be considered. Postoperative monitoring and intensive care setting are required. Anesthesiologists with cardiac anesthesia training are probably better suited to manage these patients.


Assuntos
Anestesia Geral/métodos , Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Adolescente , Adulto , Idoso , Extubação , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cuidados Críticos , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Ontário , Alta do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Desenho de Prótese , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/diagnóstico , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
JACC Cardiovasc Interv ; 11(6): 529-538, 2018 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-29566797

RESUMO

OBJECTIVES: The authors sought to study variation in the practice of balloon aortic (BAV) and pulmonary valvuloplasty (BPV). BACKGROUND: The IMPACT (IMProving Adult and Congenital Treatment) registry provides an opportunity to study practice variation in transcatheter interventions for congenital heart disease. METHODS: The authors studied BAV and BPV in the IMPACT registry from January 1, 2011, to September 30, 2015, using hierarchical multivariable models to measure hospital-level variation in: 1) the distribution of indications for intervention; and 2) in cases with "high resting gradient" as the indication, consistency with published guidelines. RESULTS: A total of 1,071 BAV cases at 60 hospitals and 2,207 BPV cases at 75 hospitals were included. The indication for BAV was high resting gradient in 82%, abnormal stress test or electrocardiogram (2%), left ventricular dysfunction (11%), and symptoms (5%). Indications for BPV were high resting gradient in 82%, right-left shunt (6%), right ventricular dysfunction (7%), and symptoms (5%). No association between hospital characteristics and distribution of indications was demonstrated. Among interventions performed for "high resting gradient," there was significant adjusted hospital-level variation in the rates of cases performed consistently with guidelines. For BAV, significant differences were seen across census regions, with hospitals in the East and South more likely to practice consistently than those in the Midwest and West (p = 0.005). For BPV, no association was found between hospital factors and rates of consistent practice, but there was significant interhospital variation (median rate ratio: 1.4; 95% confidence interval: 1.2 to 1.6; p < 0.001). CONCLUSIONS: There is measurable hospital-level variation in the practice of BAV and BPV. Further research is necessary to determine whether this affects outcomes or resource use.


Assuntos
Estenose da Valva Aórtica/terapia , Valvuloplastia com Balão/tendências , Fidelidade a Diretrizes/tendências , Disparidades em Assistência à Saúde/tendências , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/tendências , Estenose da Valva Pulmonar/terapia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/fisiopatologia , Valvuloplastia com Balão/efeitos adversos , Valvuloplastia com Balão/normas , Fidelidade a Diretrizes/normas , Disparidades em Assistência à Saúde/normas , Hemodinâmica , Humanos , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/epidemiologia , Estenose da Valva Pulmonar/fisiopatologia , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Função Ventricular Esquerda
12.
Cardiol Young ; 28(5): 753-755, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29409567

RESUMO

We report on successful endovascular retrieval of an accidentally flared Melody valve in an adult patient with an indication for percutaneous pulmonary valve implantation. The Melody valve was removed through a 24 F sheath, introduced via the right jugular vein, and the urgent open-heart surgery was avoided.


Assuntos
Bioprótese/efeitos adversos , Remoção de Dispositivo/métodos , Próteses Valvulares Cardíacas/efeitos adversos , Estenose da Valva Pulmonar/cirurgia , Adulto , Cateterismo Cardíaco , Feminino , Humanos , Desenho de Prótese , Falha de Prótese , Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/diagnóstico , Reoperação , Tomografia Computadorizada por Raios X
13.
Cardiol Young ; 28(5): 647-652, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29316997

RESUMO

Pulmonary valve stenosis is common in patients with Noonan's syndrome. The response to balloon valvoplasty varies.We assessed the correlation between re-intervention rate, immediate response, and the progress of the valve gradient over time after intervention. METHODS: This is a retrospective study conducted from 1995 to 2014. RESULTS: Of 14 patients identified, seven had re-intervention 28±54 months (range 3-149, median 3.3) after valvoplasty. These patients did not have a significant decrease in gradient after intervention. Their gradient subsequently decreased during follow-up and then became static before increasing years after intervention. In contrast, the gradient of patients not requiring further intervention continually reduced over time. Demographics did not differ between these groups. CONCLUSION: We could not identify predisposing factors for long-term success of pulmonary valvoplasty in Noonan's patients, but the trajectory of gradients differs significantly between patients needing re-intervention from those who remain free from re-intervention.


Assuntos
Valvuloplastia com Balão/métodos , Cateterismo Cardíaco/métodos , Síndrome de Noonan/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estenose da Valva Pulmonar/cirurgia , Pré-Escolar , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Síndrome de Noonan/complicações , Síndrome de Noonan/diagnóstico , Estenose da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/etiologia , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Reino Unido/epidemiologia
15.
Can J Cardiol ; 33(12): 1737.e5-1737.e7, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29173614

RESUMO

Transcatheter pulmonary valve implantation (TPVI) is a relatively new method of treating patients with significant pulmonary regurgitation or pulmonary stenosis, or both, after reconstruction of the right ventricular outflow tract. It is an attractive alternative to conduit replacement in this group of patients, who are typically young and active. This report includes 4 young women who after successful TPVI became pregnant and gave birth. Transthoracic echocardiography, cardiopulmonary exercise testing, and cardiac magnetic resonance imaging were performed in all patients. The results suggest that pregnancy and delivery after successful TPVI is safe when the appropriate precautions have been taken.


Assuntos
Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Adulto , Cateterismo Cardíaco/métodos , Ecocardiografia , Teste de Esforço , Feminino , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética , Período Pós-Operatório , Gravidez , Resultado da Gravidez , Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/diagnóstico , Resultado do Tratamento
16.
J Cardiothorac Surg ; 12(1): 93, 2017 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-29084562

RESUMO

BACKGROUND: Pulmonary artery intimal spindle cell sarcomas are rare and carry with them a poor prognosis and high rate of recurrence. In extremely rare cases, this tumor can infiltrate the pulmonic valve and manifest as adult-onset pulmonic stenosis. CASE PRESENTATION: We report an unusual case of a patient with symptomatic, adult-onset severe pulmonic stenosis who was referred for possible balloon valvuloplasty but was subsequently found to have pulmonary artery intimal sarcoma infiltrating the pulmonary valve leading to progressive exertional dyspnea. CONCLUSION: The presence of adult-onset pulmonic stenosis should prompt the clinician to investigate further as most cases of pulmonic stenosis are congenital in nature and present early in life. Careful diagnostic evaluation in concert with multimodal imaging should take place to arrive at the correct and challenging diagnosis of sarcoma-induced adult-onset severe pulmonic stenosis. Given the poor prognosis and rapid progression of disease, early diagnosis is crucial.


Assuntos
Neoplasias Cardíacas/diagnóstico , Estenose da Valva Pulmonar/diagnóstico , Sarcoma/diagnóstico , Idoso , Angiografia , Cateterismo Cardíaco , Diagnóstico Diferencial , Ecocardiografia Doppler em Cores , Neoplasias Cardíacas/cirurgia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia/patologia , Valva Pulmonar , Estenose da Valva Pulmonar/cirurgia , Sarcoma/cirurgia , Tomografia Computadorizada por Raios X
17.
BMJ Case Rep ; 20172017 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-28978603

RESUMO

Transcatheter therapy of valvular pulmonary stenosis is one of first catheter interventions facilitating its application in field of structural heart disease and now treatment of choice for significant pulmonary stenosis. Myriads of balloon catheter have been used for this purpose starting from Diamond (Boston Scientific,Natick, MA USA), Marshal (Medi-Tech,Watertown MAUSA), Innoue balloon, Tyshak I and currently Tyshak II. Diameter and length of balloon depend on size of annulus and age group, respectively. Problem with shorter balloon is difficulty in keeping it across the annulus while inflation as it tends to slip distally whereas with longer balloon, potential of tricuspid leak or conduction block as it may impinge on adjacent structures. Potential advantage of Accura balloon over Tyshak balloon lies in its peculiar shape while inflation and variable diameter, making stepwise dilatation possible. Here, we report a case of successful balloon pulmonary valvuloplasty using Accura balloon (Vascular Concept, UK) with little modification of conventional technique.


Assuntos
Valvuloplastia com Balão/instrumentação , Estenose da Valva Pulmonar/diagnóstico , Adolescente , Diagnóstico Diferencial , Dispneia/epidemiologia , Eletrocardiografia , Fadiga/etiologia , Humanos , Masculino , Estenose da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/cirurgia
18.
Am J Cardiol ; 120(10): 1903-1904, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-28912039

RESUMO

A 50-year-old man with a murmur since birth developed systemic arterial hypertension as an adult. He came to the hospital because of dyspnea. He had a pulmonic valve ejection click and a murmur of pulmonic stenosis. His echocardiogram showed biventricular hypertrophy, a flat ventricular septum, a D-shaped left ventricle, systolic doming of the pulmonic valve, and Doppler evidence of a 70 mm Hg peak systolic pressure gradient across the pulmonic valve and a peak right ventricular systolic pressure of 100 mm Hg. His electrocardiograms showed no evidence of the right ventricular and right atrial enlargement so evident on echocardiogram, presumably because it was obscured by the marked changes of left ventricular hypertrophy. Three years later, when he was admitted for sepsis and worsening heart failure with anasarca, the voltage changes of left ventricular hypertrophy had virtually disappeared, likely due to the large amount of fluid between the heart and the electrodes.


Assuntos
Cardiopatias Congênitas/complicações , Hipertrofia Ventricular Esquerda/complicações , Estenose da Valva Pulmonar/complicações , Ecocardiografia Doppler , Eletrocardiografia , Evolução Fatal , Cardiopatias Congênitas/diagnóstico , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Masculino , Pessoa de Meia-Idade , Estenose da Valva Pulmonar/diagnóstico
19.
Heart ; 103(22): 1779-1829, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28954831

RESUMO

CLINICAL INTRODUCTION: A 28-year-old woman with a history of critical pulmonic stenosis, status postsurgical valvotomy and subsequent pulmonary valve replacement, presented to the cardiology clinic with 1 year of progressive exertional dyspnoea. She has a heart rate of 75 bpm and blood pressure of 110/55 mm Hg. Cardiac auscultation reveals a 1/6 systolic ejection murmur along the left sternum and an early 3/6 diastolic decrescendo murmur. A transthoracic echocardiogram is obtained (figure 1). QUESTIONS: Which of the following would be most likely found during right heart catheterisation?Ratio of pulmonary to systemic blood flow (Qp:Qs) >1.5Pulmonary vascular resistance >3 Wood unitsRight atrial pressure >10mm HgPulmonary artery systolic pressure >45mm Hg E. Pulmonary artery diastolic pressure <10mm Hg.


Assuntos
Dispneia/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Esforço Físico , Insuficiência da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Adulto , Função do Átrio Direito , Pressão Atrial , Pressão Sanguínea , Cateterismo Cardíaco , Ecocardiografia Doppler de Pulso , Feminino , Frequência Cardíaca , Humanos , Valor Preditivo dos Testes , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/fisiopatologia
20.
J Pak Med Assoc ; 67(8): 1220-1223, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28839307

RESUMO

OBJECTIVE: To evaluate the effectiveness of pulse oximetry as a screening tool for critical congenital heart defects in newborns. METHODS: This cross-sectional study was conducted at the neonatology department of the Children's Hospital and the Institute of Child Health, Lahore, Pakistan, from January to June 2016, and comprised neonates aged up to 07 days. Babies with a prenatal diagnosis of heart defects and those whose parents refused to give consent were excluded. Oxygen saturation of enrolled patients was measured in right index finger (pre-ductal) and in the left big toe (post-ductal) subsequently. Echocardiography was done on all the enrolled babies to confirm the diagnosis. SPSS 19 was used for data analysis. RESULTS: Of the 145 babies initially enrolled, 138(95.2%) were included. The overall mean age of the babies was 2.17±1.62 days (range: <24 hours-07 days) whereas the mean birth weight was 2.95±0.47kg (range: <2.5->4kg). Babies with pre- and post-ductal oxygen saturation measurement difference of >3% showed a detection rate of 16(45.7%) for critical congenital heart defects. Sensitivity and specificity of this screening test was calculated to be 76.19% and 83.76%, respectively, while positive and negative predictive values were 45.71% and 95.15%, respectively. CONCLUSIONS: The measurement of pre- and post-ductal oxygen saturation by pulse oximetry was an effective screening tool for the detection of critical congenital heart defects in newborns.


Assuntos
Cardiopatias Congênitas/diagnóstico , Oximetria/métodos , Coartação Aórtica/diagnóstico , Estudos Transversais , Ecocardiografia , Feminino , Dedos/irrigação sanguínea , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Recém-Nascido , Masculino , Programas de Rastreamento , Paquistão , Estenose da Valva Pulmonar/diagnóstico , Sensibilidade e Especificidade , Tetralogia de Fallot/diagnóstico , Dedos do Pé/irrigação sanguínea , Transposição dos Grandes Vasos/diagnóstico
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