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2.
J Vet Cardiol ; 28: 11-22, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32163862

RESUMO

INTRODUCTION/OBJECTIVES: Balloon instability is commonly encountered during balloon pulmonary valvuloplasty (BPV) and may result in an unsuccessful procedure. The NuCLEUS-X™ catheter is a recently developed BPV catheter with a unique barbell shape and an ordered pattern of inflation that stabilizes the balloon to span the valve annulus before expansion of the balloon center. ANIMALS: Ten client-owned dogs with severe valvular pulmonic stenosis (PS). MATERIALS AND METHODS: Prospective observational study. The BPV procedure was performed by standard technique with use of NuCLEUS-X™ catheters targeting a balloon-to-annulus ratio between 1.2 and 1.5. Balloon stability, safety, and procedural success were assessed. Procedural success was defined as either a reduction in the Doppler transpulmonic PG by at least 50% of the pre-procedural PG or <80 mmHg one month post procedure. RESULTS: Balloon stability centered at the pulmonic valve on the first inflation was achieved in 10/10 cases. The mean PG before BPV was 141 mmHg ±41 mmHg, and the PG after BPV at one month was 83 mmHg ±41 mmHg. Procedural success was achieved in 56% of patients. All dogs survived the BPV, and no major procedural complications were encountered using the NuCLEUS-X™ catheter. CONCLUSIONS: The use of the NuCLEUS-X™ catheter is feasible for BPV in dogs with severe PS. The unique balloon shape provided catheter stability on the first inflation in all dogs, which may be beneficial when stabilization of a conventional BPV catheter cannot be achieved.


Assuntos
Valvuloplastia com Balão/veterinária , Doenças do Cão/terapia , Estenose da Valva Pulmonar/veterinária , Animais , Valvuloplastia com Balão/instrumentação , Pressão Sanguínea , Cateteres Cardíacos , Doenças do Cão/congênito , Cães , Estudos Prospectivos , Estenose da Valva Pulmonar/congênito , Estenose da Valva Pulmonar/terapia , Resultado do Tratamento
3.
J Vet Cardiol ; 28: 1-10, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32086158

RESUMO

Valve restenosis after percutaneous balloon pulmonary valvuloplasty (BPV) for the treatment of congenital pulmonic stenosis (PS) may occur in up to 17% of canine cases. Outcomes in dogs with PS that are treated with repeat BPV after restenosis have not been described. The present report details the clinical courses of four dogs with congenital PS, previously treated with conventional BPV and atenolol (n = 4) or atenolol alone (n = 1), two with anomalous, circumpulmonary coronary artery anatomy, which underwent BPV followed immediately by external beam radiation therapy (BPV + EBRT) to prevent valve restenosis. External beam radiation therapy involved five daily fractions of 3.6 Gray to the pulmonic valve. Echocardiographic and clinical follow-up information for 2-4 years after BPV + EBRT is presented. Three dogs experienced long-term reduction in transpulmonic pressure gradient. In one dog, which was treated with conservative BPV + EBRT as first-line therapy, return of transpulmonic pressure gradient to pretreatment levels was noted by 7 months after BPV + EBRT. Although clinical benefit remains unproven, the addition of EBRT to conventional BPV may be a treatment option for dogs experiencing restenosis after BPV or those in which restenosis is considered likely. Further study to evaluate the efficacy and safety of this approach is needed.


Assuntos
Valvuloplastia com Balão/veterinária , Doenças do Cão/terapia , Estenose da Valva Pulmonar/terapia , Animais , Doenças do Cão/congênito , Doenças do Cão/radioterapia , Cães , Ecocardiografia/veterinária , Feminino , Seguimentos , Masculino , Estenose da Valva Pulmonar/congênito , Estenose da Valva Pulmonar/radioterapia , Recidiva , Resultado do Tratamento
4.
An. pediatr. (2003. Ed. impr.) ; 91(5): 336-343, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186771

RESUMO

Introducción: Los neonatos afectos de atresia pulmonar con tabique interventricular íntegro y estenosis pulmonar crítica representan un espectro amplio, incluyendo aquellos con hipoplasia significativa del ventrículo derecho. La presencia de fístulas arteriales coronarias a ventrículo derecho puede ser una contraindicación para la descompresión del ventrículo derecho. El principal objetivo del presente trabajo es analizar los resultados a corto y largo plazo durante 20 años de estos pacientes, e identificar los factores diferenciales entre ambos grupos incluyendo aquellos pacientes afectos por fístulas arteriales coronarias. Pacientes y métodos: Estudio retrospectivo donde se identificaron todos los pacientes diagnosticados de atresia pulmonar con septo interventricular íntegro y estenosis pulmonar crítica entre los meses de enero de 1996 y enero de 2018. Se recogieron y analizaron las características morfológicas del ventrículo derecho, el manejo quirúrgico, la intervención percutánea y la evolución a corto y a largo plazo. Resultados: Fueron incluidos cincuenta y un pacientes. Un total de 9 (17,6%) fallecieron durante el seguimiento. Ninguno de ellos presentaba fístulas arteriales coronarias a ventrículo derecho. La mediana de seguimiento de los restantes 42 supervivientes fue de 8,9 años (rango: 1-16). La clase funcional según la New York Heart Association en la revisión más reciente fue de 1,2. Los supervivientes del grupo de estenosis pulmonar crítica presentaban una clase funcional de 1,1 y los del grupo de atresia pulmonar con tabique interventricular íntegro de 1,6. No hubo diferencias entre los pacientes que presentaban fístulas arteriales coronarias a ventrículo derecho y los que no. Conclusiones: La presencia de fístulas arteriales coronarias a ventrículo derecho no es una contraindicación para la vía biventricular. Los pacientes con estenosis pulmonar crítica presentan una mejor evolución que los afectos de atresia pulmonar con tabique interventricular íntegro. La estrategia de apertura agresiva y precoz de la válvula pulmonar tiene una buena supervivencia global correlacionada con una buena clase funcional


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 follow up. 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
Humanos , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Atresia Pulmonar/terapia , Septo Interventricular , Estenose da Valva Pulmonar/terapia , Estudos Retrospectivos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Ondas de Rádio/uso terapêutico , Fluoroscopia/métodos
5.
Turk Kardiyol Dern Ars ; 47(7): 619-621, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31582677

RESUMO

Pulmonary valvular stenosis is a rare valvular disease; it accounts for 7% to 12% of all patients with congenital heart disease. Patients with mild or moderate pulmonary stenosis (PS) are usually asymptomatic and the stenosis is often detected incidentally with echocardiography performed for another reason. Severe PS typically presents with symptoms related to increased right ventricular pressure and right heart failure. Valvular heart diseases are associated with increased morbidity and mortality in pregnancy due to cardiovascular alterations that occur during the gestational period, such as increased extracellular volume, a faster heart rate, and decreased venous return due to compression of the vena cava inferior by the enlarged uterus. While mild or moderate PS can be well tolerated in pregnancy, severe PS can lead to maternal and fetal perinatal complications. Presently described is the case of a pregnant patient with severe PS who successfully underwent balloon valvuloplasty in the third trimester.


Assuntos
Complicações Cardiovasculares na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Estenose da Valva Pulmonar/diagnóstico , Valvuloplastia com Balão , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/terapia , Estenose da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/terapia , Índice de Gravidade de Doença , Gravação em Vídeo , Adulto Jovem
6.
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
7.
J Med Case Rep ; 13(1): 219, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31319891

RESUMO

BACKGROUND: Adults with unoperated congenitally corrected transposition of the great arteries are rare but form a distinct group among adults with congenital heart disease. Patients with congenitally corrected transposition of the great arteries often have one or more associated cardiac anomalies that dictate the need for, and timing of, surgical intervention in childhood. However, in a proportion of patients, the hemodynamics does not require surgical attention during childhood, and, in some patients, a correct diagnosis is not established until adulthood. Here we report an adult case of unoperated congenitally corrected transposition of the great arteries with a large ventricular septal defect and probable pulmonary arterial hypertension. CASE PRESENTATION: Our patient was a 46-year-old Korean man. Transthoracic echocardiography and cardiac catheterization demonstrated hemodynamically balanced ventricles with a non-regurgitant systemic atrioventricular valve, normal pulmonary arterial pressure, and a reasonable difference between the oxygen saturation values of the aorta and pulmonary trunk, even with the presence of a large ventricular septal defect. Further morphological assessments using cardiac computed tomography and three-dimensional modeling/printing of his heart revealed that the mitral valve was straddling over the posteriorly positioned ventricular septal defect, which could explain the functional and anatomical subvalvular pulmonary stenosis and a small amount of shunt flow through the large ventricular septal defect. We interpreted this combination of cardiac defects as able to sustain his stable cardiac function. Thus, we decided to maintain his unoperated status. CONCLUSION: A detailed anatomical understanding based on transthoracic echocardiography, cardiac computed tomography, and three-dimensional printing can justify a decision to not operate in cases of congenitally corrected transposition of the great arteries with hemodynamically balanced pulmonary stenosis and a ventricular septal defect, as observed in the present case.


Assuntos
Transposição Congênita Corrigida de Grandes Artérias/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Transposição Congênita Corrigida de Grandes Artérias/terapia , Tratamento Conservador , Ecocardiografia , Comunicação Interventricular/patologia , Comunicação Interventricular/terapia , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Estenose da Valva Pulmonar/patologia , Estenose da Valva Pulmonar/terapia
8.
Congenit Heart Dis ; 14(6): 1037-1045, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31250555

RESUMO

OBJECTIVE: Evaluate long-term outcomes following balloon pulmonary valvuloplasty (BPV) for pulmonary stenosis (PS). BACKGROUND: Long-term data following BPV is limited to small, single center studies. METHODS: BPV from April 12, 1985 to January 7, 2015 from three centers were included. Outcomes studied were ≥ moderate PI by echocardiogram and residual PS ≥ 40 mm Hg. Risk factors for ≥ moderate PI, residual PS, and repeat intervention were assessed by univariate and multivariate analysis. RESULTS: Among 254 patients, mean age at BPV was 3.8 years (range 1 day-67 years), initial PS catheter gradient was 56 mm Hg (IQR 40-70), 19% had critical PS, and 9% had genetic syndromes. Mean follow-up duration was 7.5 years (maximum 25 years). Sixty-nine (29%) had ≥ moderate PI, 41 patients (17%) had residual PS > 40 mm Hg, and 31 (13%) had re-intervention. In univariate analysis, younger age, lower weight, greater initial PS gradient, greater initial RV/systemic pressure ratio, critical PS, and longer follow-up duration were associated with ≥ moderate PI. Greater initial PS gradient was associated with long-term residual PS or repeat intervention. In multivariate analysis, greater initial gradient and lower weight were independently associated with > moderate PI and greater initial PS gradient and genetic abnormality were independently associated with residual PS and repeat intervention. CONCLUSION: Smaller patients with greater initial PS were more likely to develop significant long-term PI. Patients with greater initial PS and genetic abnormalities were more likely to have residual PS or require repeat intervention following BPV.


Assuntos
Valvuloplastia com Balão/efeitos adversos , Hemodinâmica , Insuficiência da Valva Pulmonar/epidemiologia , Estenose da Valva Pulmonar/terapia , Valva Pulmonar/fisiopatologia , Adolescente , Adulto , Idoso , Peso Corporal , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Cardiol Young ; 29(4): 492-498, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31030705

RESUMO

OBJECTIVE: To assess the feasibility, safety, and efficiency of ductal stenting in pulmonary atresia with intact ventricular septum or critical pulmonary stenosis after balloon pulmonary valvuloplasty. BACKGROUND: Ductal stenting in pulmonary atresia with intact ventricular septum is a re-emerging and promising technique. There is little data available on its outcomes after establishing prograde pulmonary blood flow. METHODS: We retrospectively reviewed all neonates with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis who underwent ductal stenting after balloon valvuloplasty. Ductal stenting was performed either in the same setting (group A) or a few days later after balloon valvuloplasty (group B). We compared the two groups. RESULTS: Eighteen coronary stents were transvenously delivered and successfully deployed in 18 newborns. There was no procedure-related mortality. The median hospital stay post-intervention was 6 days with a mean discharge oxygen saturation of 94%. Group A had a shorter overall hospital stay with a shorter overall time of irradiation but with a longer overall procedural time. On a follow-up of 18 months, no re-intervention for stent failure or overflow was undertaken. The median stent patency based on echocardiography was 12 months. CONCLUSION: Stenting the arterial duct in pulmonary atresia with intact ventricular septum or critical pulmonary stenosis is a feasible, safe, and efficient technique. It avoids surgery or long hospital stay with prostaglandin infusion. The minimal 6 months stent longevity provides a period of time long enough to decide whether the right ventricular diastolic function is normalised or Glenn surgery is still needed.


Assuntos
Cardiopatias Congênitas/terapia , Atresia Pulmonar/terapia , Circulação Pulmonar , Estenose da Valva Pulmonar/terapia , Stents , Angiografia , Valvuloplastia com Balão , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Recém-Nascido , Líbano , Masculino , Atresia Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Função Ventricular Direita
10.
J Vet Cardiol ; 21: 41-48, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30797444

RESUMO

Four dogs presented for evaluation and treatment of severe pulmonic valve stenosis and underwent stenting of the pulmonic valve annulus using bare-metal balloon-expandable stents. All dogs survived the procedure with immediate reduction of the transpulmonary valve pressure gradient and increase in activity levels. One dog had a stent fracture and migration 1 month after the intervention. This dog underwent a second procedure, in which multiple stents were used to alleviate the obstruction. The stents that were placed at the level of the right ventricular outflow tract fractured within 1 month of the procedure, and the patient died when a third (surgical) approach was attempted. The other three dogs remain alive 54, 42, and 29 months after the procedure. Stent angioplasty may be a viable option for dogs with valvular pulmonic stenosis in which routine balloon valvuloplasty does not provide a successful outcome. Aggressive attempts to diminish RVOT dynamic obstruction with high-dose beta blockade and avoiding deployment of the stent within the RVOT are recommended to prevent stent fracture and migration.


Assuntos
Valvuloplastia com Balão/veterinária , Doenças do Cão/terapia , Estenose da Valva Pulmonar/veterinária , Stents/veterinária , Animais , Valvuloplastia com Balão/métodos , Doenças do Cão/diagnóstico por imagem , Cães , Ecocardiografia/veterinária , Feminino , Masculino , Falha de Prótese , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/terapia , Radiografia Torácica , Stents/efeitos adversos
11.
Am J Cardiol ; 123(3): 454-459, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30503800

RESUMO

Transient left ventricular (LV) dysfunction occurs in some infants born with critical pulmonary stenosis (PS) or membranous pulmonary atresia with intact ventricular septum (PAIVS) after pulmonary valve (PV) balloon dilation (BD). The cause for this is not well understood. We sought to characterize this LV dysfunction by investigating regional differences in this cohort using myocardial strain imaging. Patients who underwent neonatal (<2 weeks age) PV BD for critical PS or PAIVS from Jan, 2007 to March, 2014 with echocardiographic images suitable for strain analysis were identified; infants with ≥moderate post-BD LV dysfunction (ejection fraction <40%, n = 8) were matched 1:1 with controls who underwent PV BD but did not develop LV dysfunction. Longitudinal and circumferential global and segmental strain were analyzed before and after PV BD. For the 8 LV dysfunction cases, LV global longitudinal strain worsened after PV BD (-16% pre- vs -8% post-PV BD, p = 0.008) with similar impairment in global LV circumferential strain (-17% vs -8%, p = 0.008); there was no significant change in RV global or segmental longitudinal strain pre- vs post-PVBD. No significant pre/post-BD differences in global or circumferential strain were found in control pts. Segmental analysis of longitudinal and circumferential LV strain before and after balloon dilation in cases demonstrated decreased strain in all segments, but more pronounced and statistically significant in septal segments as compared with the free wall. In conclusion, transient LV dysfunction post-PV BD for critical PS/PAIVS is characterized by impaired global longitudinal and circumferential LV strain, with the most significant reductions in strain at the interventricular septum; longitudinal RV strain remains unchanged. These findings suggest that the mechanism of LV dysfunction post-PV BD is adverse ventricular-ventricular interactions specifically involving the interventricular septum.


Assuntos
Valvuloplastia com Balão , Cardiopatias Congênitas/terapia , Atresia Pulmonar/terapia , Estenose da Valva Pulmonar/terapia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Estudos de Casos e Controles , Ecocardiografia , Feminino , Cardiopatias Congênitas/fisiopatologia , Humanos , Recém-Nascido , Masculino , Atresia Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/fisiopatologia , Estudos Retrospectivos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Septo Interventricular/diagnóstico por imagem , Septo Interventricular/fisiopatologia
13.
J Vet Intern Med ; 32(5): 1570-1578, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30079482

RESUMO

BACKGROUND: Velocity ratio, velocity time integral (VTI) ratio, and pulmonary valve area indexed to body surface area (iPVA) are methods of assessment of pulmonary valve stenosis (PS) severity that are less dependent on blood flow. Studies evaluating these methods are limited. OBJECTIVES: To determine the effects of butorphanol, atenolol, and balloon valvuloplasty (BV) on velocity ratio, VTI ratio, iPVA, mean PG, and max PG. ANIMALS: Twenty-seven dogs with PS (max PG >50 mm Hg). METHODS: Prospective study. All dogs underwent an echocardiogram at baseline, 5-minutes after administration of butorphanol (0.2-0.25 mg/kg IV), and 2-to-4 weeks after atenolol (1-1.5 mg/kg q12h). Twenty-one of these were evaluated 24-hours after BV. RESULTS: There were no significant differences (P > .05) amongst any of the methods of assessment of PS severity after butorphanol. After atenolol, mean (SD) of mean (57.0 [21.0] mm Hg) and max PG (93.1 [33.8] mm Hg) were significantly decreased (P ≤ .047) compared with baseline (65.2 [26.2] mm Hg and 108 [44.4] mm Hg, respectively). After atenolol, there were no significant (P ≥ .12) differences in velocity ratio (0.29 [0.09]), VTI ratio (0.18 [0.05]), or iPVA (0.43 [0.16] cm2 /m2 ) compared with baseline (0.30 [0.09], 0.19 [0.09], 0.44 [0.17] cm2 /m2 , respectively). CONCLUSIONS AND CLINICAL IMPORTANCE: Atenolol might reduce mean and max PG but does not alter less flow-dependent methods of assessment of PS severity (velocity ratio, VTI ratio, and iPVA) in dogs with PS. Results support an integrative approach to assessment of PS severity that includes less flow-dependent methods, particularly in states of altered flow or right ventricular function.


Assuntos
Doenças do Cão/diagnóstico por imagem , Ecocardiografia Doppler , Estenose da Valva Pulmonar/veterinária , Valva Pulmonar/diagnóstico por imagem , Animais , Valvuloplastia com Balão/veterinária , Cães , Feminino , Masculino , Estudos Prospectivos , Valva Pulmonar/patologia , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/patologia , Estenose da Valva Pulmonar/terapia
14.
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 , Avaliação de Processos e Resultados em Cuidados de 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 , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , 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
15.
J Vet Cardiol ; 20(2): 115-122, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29459123

RESUMO

OBJECTIVES: We aimed to evaluate safety and efficacy of high-pressure balloon valvuloplasty (HPBVP) for treatment of canine severe pulmonary valve stenosis (PS). A secondary aim was to provide pre-procedure predictors of success. ANIMALS: Twenty-five dogs. METHODS: Prospective observational study. Dogs with severe PS (echocardiographically derived trans-pulmonary peak/maximum pressure gradient (EDPG) ≥80 mmHg) were recruited. All dogs underwent echocardiography before and 20-24hrs after HPBVP using a high-pressure balloon with rated burst pressures ranging from 12 to 18 ATM. Procedural success was defined as a post-HPBVP EDPG reduction of ≥50% or reduction into at least the moderate category of PS (50-79 mmHg). Optimal result was defined as a post-procedural EDPG ≤30 mmHg. RESULTS: Initial median (IQR) EDPG for all dogs was 96 (88, 127) mmHg with a post-operative median of 48 (36, 65) mmHg. The median EDPG reduction provided by HPBVP was 63% (39, 68); procedural success rate was 92% (23 dogs). Optimal results were achieved in 56% (14 dogs). There were no significant correlations between EDPG reduction and valve morphology (Type A and Type B) or severity of right ventricular hypertrophy. Pulmonary valve annulus diameter was the only echocardiographic variable that was significantly correlated to EDPG reduction (p = 0.02; r = -0.46). No dog experienced any anesthetic or surgical complications, and all patients survived the procedure. CONCLUSIONS: In this cohort of 25 dogs with severe PS, HPBVP was safe and effective. The procedural success rate and high number of optimal results achieved with HPBVP suggest future randomized controlled trials comparing HPBVP to conventional valvuloplasty are warranted.


Assuntos
Valvuloplastia com Balão/veterinária , Doenças do Cão/terapia , Estenose da Valva Pulmonar/veterinária , Animais , Valvuloplastia com Balão/métodos , Pressão Sanguínea , Doenças do Cão/congênito , Cães , Ecocardiografia/veterinária , Projetos Piloto , Estudos Prospectivos , Estenose da Valva Pulmonar/congênito , Estenose da Valva Pulmonar/terapia , Resultado do Tratamento
16.
Catheter Cardiovasc Interv ; 91(7): E68-E71, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28029208

RESUMO

A 26-year-old female with carcinoid heart disease consisting of severe pulmonary and tricuspid valve stenosis was admitted with line associated sepsis. She recovered from sepsis with antibiotics and aggressive fluid resuscitation but became grossly volume overloaded with evidence of tense ascites and lower extremity edema. She developed worsening renal and hepatic function due to congestive nephropathy and hepatopathy, which did not respond to intravenous diuretics, and she was deemed too sick for surgical pulmonary and tricuspid valve replacement. Pulmonary and tricuspid valvuloplasty was performed as a rescue measure to alleviate her congestive symptoms and improve her candidacy for valve replacement. © 2016 Wiley Periodicals, Inc.


Assuntos
Valvuloplastia com Balão , Doença Cardíaca Carcinoide/terapia , Estenose da Valva Pulmonar/terapia , Estenose da Valva Tricúspide/terapia , Adulto , Doença Cardíaca Carcinoide/diagnóstico por imagem , Doença Cardíaca Carcinoide/fisiopatologia , Ecocardiografia Doppler em Cores , Feminino , Humanos , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/fisiopatologia
17.
Pan Afr Med J ; 30: 245, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30627306

RESUMO

Interauricular communication (IAC) is the second most important congenital heart disease in children. It accounts for 6-8% of congenital cardiac malformations in children. However, many questions are still open about this pathology. Thus, this study aims to report the prevalence rate of IAC in hospital but especially to describe its clinical, paraclinical and therapeutic aspects. For this purpose, we conducted a retrospective descriptive study. Data were collected by means of a questionnaire and then entered and analyzed in Sphinx (V5). The prevalence in Hospital was 2x1000. The average age of patients was 37 months, the sex-ratio was 0,75. No prenatal diagnosis was made. Parental consanguinity was detected in 30% of cases. Respiratory infections were found in 24% of cases. Cardiomegaly was found in 35 cases with hypervascularization in 63% of cases. Ultrasound showed a predominance of ostium secundum; wide IAC was found in 63% of cases. Pulmonary stenosis was the most important associated heart attack. Pulmonary arterial hypertension was found in 63% of the cases. Treatment was based on diuretics, which were largely used and only 7 children underwent surgery. Evolution was favorable in 39 patients reflecting a rate of 79%. Early diagnosis of IAC should be improved as well as surgical treatment of IAC affecting infants.


Assuntos
Cardiomegalia/epidemiologia , Cardiopatias Congênitas/epidemiologia , Hipertensão Pulmonar/epidemiologia , Estenose da Valva Pulmonar/epidemiologia , Adolescente , Cardiomegalia/terapia , Criança , Pré-Escolar , Diuréticos/uso terapêutico , Feminino , Cardiopatias Congênitas/fisiopatologia , Hospitais Pediátricos , Hospitais Universitários , Humanos , Hipertensão Pulmonar/terapia , Lactente , Masculino , Prevalência , Estenose da Valva Pulmonar/terapia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Senegal/epidemiologia , Inquéritos e Questionários
18.
JACC Cardiovasc Interv ; 10(17): 1788-1798, 2017 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-28823777

RESUMO

OBJECTIVES: The aim of this study was to evaluate survival following catheter intervention in pediatric patients with pulmonary vein stenosis (PVS). BACKGROUND: Despite aggressive surgical and catheter intervention on PVS in children, recurrence and progression of stenosis can lead to right heart failure and death. Clinicians continue to seek effective treatment options for PVS. METHODS: A single-center, retrospective study was performed including all patients <18 years of age who underwent catheter intervention (balloon angioplasty and bare-metal stent and drug-eluting stent insertion) on PVS. Endpoints included death, vein loss, and rate of reintervention. RESULTS: Thirty patients underwent intervention (balloon angioplasty, n = 9; bare-metal stent, n = 5; drug-eluting stent, n = 16) at a median age of 6.4 months (4.3 to 9.9 months). Median follow-up duration was 30.6 months (77 days to 10.5 years). Fourteen patients (47%) died at a median of 2.0 months (0.4 to 3.2 months) following intervention. There was no association between DES placement and survival (p = 0.067). Reintervention (catheter or surgical) was associated with improved survival (p = 0.001), with a 1-year survival rate of 84% compared with 25% for no reintervention. Vein loss occurred in 34 of 58 (59%) veins at a median of 3.3 months (1.0 to 5.0 months). One-year vein survival was higher with DES implantation (p = 0.031) and with reintervention (p < 0.001). CONCLUSIONS: DES implantation at first catheter intervention appears to be associated with improved vein survival but may not result in improved patient survival. However, reintervention appears to be associated with improved patient survival and vein patency, suggesting that despite mode of treatment, frequent surveillance is important in the care of these patients.


Assuntos
Estenose da Valva Pulmonar/terapia , Fatores Etários , Angiografia , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Angioplastia com Balão/mortalidade , Stents Farmacológicos , Georgia , Humanos , Lactente , Estimativa de Kaplan-Meier , Metais , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/mortalidade , Estenose da Valva Pulmonar/fisiopatologia , Retratamento , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
19.
BMJ Case Rep ; 20172017 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-28705851

RESUMO

Femoral vein is the usual approach to balloon pulmonary valvuloplasty (BPV). However, alternative access may be mandated in some peculiar situations. We hereby report a 10-year-old patient with symptomatic severe valvular pulmonary stenosis with interrupted inferior vena cava which was successfully treated with transjugular BPV. Technical considerations for this approach as well as other possible options for such patients are discussed.


Assuntos
Valvuloplastia com Balão/métodos , Estenose da Valva Pulmonar/terapia , Criança , Feminino , Humanos , Veias Jugulares/cirurgia , Veia Cava Inferior/anormalidades
20.
Cardiol Young ; 27(7): 1314-1322, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28619122

RESUMO

Introduction Percutaneous balloon valvuloplasty is the primary treatment for critical pulmonary valve stenosis in neonates. Thus far, a few studies have reported long-term results of this technique in neonatal critical pulmonary valve stenosis. METHODS: We carried out a retrospective study of all consecutive newborns with critical pulmonary valve stenosis subjected to percutaneous balloon valvuloplasty at a single centre, between 1994 and 2014, to assess its immediate and long-term safety and efficacy. RESULTS: A total of 24 neonates presented with critical pulmonary valve stenosis. The mean diameter of the pulmonary annulus was 7 mm (±1.19); 33.3% had a dysplastic pulmonary valve, and 92% were started on prostaglandin E1 treatment. Percutaneous balloon valvuloplasty was performed at a mean age of 4.0±4.3 days using, on average, a balloon-to-pulmonary annulus ratio of 1.18 mm (with a range from 0.9 to 1.43). Immediate success was achieved in 22/24 patients (92%) with a reduction in the pulmonary transvalvular peak gradient (p<0.05) and in the right ventricle/systemic pressure ratio (p<0.05). There was one death (4%) 6 days after the procedure, and 29.2% of them had transient rhythm complications. For a mean follow-up time of 8.4 years, the re-intervention rate was 42.9%. In total, 14 re-interventions were performed in nine neonates, including surgery in six. Freedom from re-intervention was 50% at 8 years and 43% at 10 and 15 years. CONCLUSION: This series, to the best of our knowledge, has had the longest follow-up of neonates with critical pulmonary valve stenosis. Percutaneous balloon valvuloplasty is a safe and effective treatment, and in our study 75% of the patients were exclusively treated using this technique.


Assuntos
Valvuloplastia com Balão , Atresia Pulmonar/terapia , Estenose da Valva Pulmonar/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Portugal , Estenose da Valva Pulmonar/congênito , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
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