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1.
World J Pediatr Congenit Heart Surg ; 12(2): 197-203, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33684000

RESUMO

BACKGROUND: The optimal surgical management of patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and left ventricular outflow tract obstruction (LVOTO) is debatable. This is our initial experience with pulmonary root translocation (PRT), a technique that aims to preserve the pulmonary valve function. METHODS: From July 2012 to October 2019, 16 patients underwent anatomical repair for TGA, VSD, and LVOTO. The median age was 12 months (range: 7 months to 13 years), and the median weight was 7.75 kg (range: 5.6-29.5 kg). Thirteen patients had a diagnosis of d-TGA and three had congenitally corrected transposition of the great arteries (cc-TGA). The surgical technique involved PRT from the left ventricle (LV) to the right ventricle and routing the LV to the aorta. The left ventricular outflow tract orifice resulting from the pulmonary root extraction was closed with a pericardial patch. In patients with cc-TGA, an atrial switch operation was added. A bidirectional Glenn was necessary in four patients with a long LV to aorta tunnel. One patient required a transannular patch to reconstruct the right ventricular outflow tract (RVOT). RESULTS: The median follow-up was 27 months. There was one hospital death due to residual mitral regurgitation. One patient died at home four months after hospital discharge. The remaining patients are doing well with adequate RVOT function and no valve regurgitation. CONCLUSIONS: Complete correction of TGA, VSD, and LVOTO using PRT was achieved with acceptable risk in patients with pliable and nondysplastic pulmonary valve. The translocated pulmonary root performed well in this short follow-up.


Assuntos
Anormalidades Múltiplas , Procedimentos Cirúrgicos Cardíacos/métodos , Transposição Congênita Corrigida de Grandes Artérias/cirurgia , Ventrículos do Coração/transplante , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Ventrículos do Coração/cirurgia , Humanos , Lactente , Masculino , Resultado do Tratamento
7.
Cardiovasc Pathol ; 49: 107226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574866

RESUMO

Cardiac rhabdomyoma is the most prevalent cardiac tumors in the pediatric population, in close association with tuberous sclerosis complex. It is usually detected antenatally or postnatally by echocardiography. Clinical presentations depend greatly on the size and position of the tumor mass. Interestingly, rhabdomyoma has a propensity to regress spontaneously and is not usually operated upon, unless the patient becomes hemodynamically compromised. Herein, we report an unusual case of surgically treated cardiac rhabdomyoma in a baby boy presented at birth with a progressive enlarging intraventricular mass, complicated with left ventricular outflow tract obstruction 7 weeks later. Histopathological examination of the intracardiac mass revealed sheets of tumor cells with spider-like morphology (known as "spider cells"), confirmed the diagnosis of rhabdomyoma. Close disease monitoring of patient's hemodynamic status in a newly diagnosed cardiac rhabdomyoma is inevitable as the tumor, although rare, may progress.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Neoplasias Cardíacas/cirurgia , Rabdomioma/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Progressão da Doença , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/fisiopatologia , Humanos , Lactente , Masculino , Recuperação de Função Fisiológica , Rabdomioma/diagnóstico por imagem , Rabdomioma/patologia , Rabdomioma/fisiopatologia , Resultado do Tratamento , Carga Tumoral , Função Ventricular Esquerda , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/patologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia
8.
Circ Cardiovasc Interv ; 13(1): e008320, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32525412

RESUMO

BACKGROUND: The Harmony transcatheter pulmonary valve (TPV) was designed for treatment of postoperative pulmonary valve regurgitation in patients with repaired right ventricular outflow tracts. METHODS: The Native TPV EFS (Early Feasibility Study) is a prospective, multicenter, nonrandomized feasibility study. Three-year outcomes are reported. RESULTS: Of 20 implanted patients, 17 completed 3-year follow-up (maximum: 4.1 years). There were no deaths and 2 early explants. One patient did not complete the 3-year visit. In patients with available 3-year echocardiographic data, 1 had a mild paravalvular leak and the rest had none/trace; 1 patient had mild pulmonary valve regurgitation and the remainder had none/trace. The 3-year mean right ventricular outflow tract echocardiographic gradient was 15.7±5.5 mm Hg. Radiographically, no late frame fractures or erosions were identified. At 2 years, 2 patients presented with an increased echocardiographic outflow gradient (1 mixed lesion with moderate/severe pulmonary valve regurgitation). Computed tomography scans identified neointimal tissue ingrowth within the stent frame in both patients, and they were treated successfully with a transcatheter valve-in-valve procedure (Melody TPV). Additional follow-up computed tomography scans performed at 3.2±0.5 years after implant were obtained in 16 patients and revealed luminal tissue thickening at the inflow and outflow portion of the frame with no significant alteration of the valve housing. CONCLUSIONS: Three-year results from the Native TPV EFS revealed stable Harmony TPV device position, good valve function in most, and the absence of moderate/severe paravalvular leak and significant late frame fractures. Two patients developed significant neointimal proliferation requiring valve-in-valve treatment, while all others had no clinically significant right ventricular outflow tract obstruction. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01762124.


Assuntos
Bioprótese , Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Adulto , Canadá , Cateterismo Cardíaco/efeitos adversos , Estudos de Viabilidade , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Estudos Prospectivos , 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/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
10.
J Cardiothorac Surg ; 15(1): 71, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366268

RESUMO

BACKGROUND: Primary undifferentiated spindle cell sarcoma in the right ventricle is an extremely rare tumor. Radical surgical excision is the optimal treatment for long-term survival due to poor response to chemotherapy or radiotherapy at an advanced stage. CASE PRESENTATION: A 42-year-old man with no previous medical history presented with mild dyspnea on exertion and abdominal distension that lasted a week. Computed tomography (CT) revealed a huge homogeneous mass completely obstructing the right ventricle and extending into the pulmonary trunk. However, he suddenly collapsed the next day while on his way to an echocardiography. An extracorporeal membrane oxygenation (ECMO) device was inserted percutaneously and ECMO support was urgently initiated. Based on consideration of right ventricular outflow tract (RVOT) obstruction in the initial CT scan, we decided to remove the mass from the right ventricle immediately. The main mass was resected to relieve the RVOT obstruction, and after the operation, the ECMO was removed from the operation room. However, the patient failed to regain consciousness and electroencephalography (EEG) and subsequent magnetic resonance imaging (MRI) indicated severe hypoxic brain damage. We assume CPR was unsuccessful because the mass completely blocked the RVOT. Pathology revealed the mass was an undifferentiated spindle cell sarcoma. CONCLUSIONS: We present the case of a 42-year-old male with cardiac arrest due to right ventricular outflow tract obstruction by a tumor of the right ventricle. Surgical resection was performed and in histopathology it was proved to be an undifferentiated spindle cell sarcoma.


Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Sarcoma/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Adulto , Reanimação Cardiopulmonar , Dispneia/etiologia , Ecocardiografia , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Humanos , Hipóxia Encefálica/etiologia , Imagem por Ressonância Magnética , Masculino , Artéria Pulmonar , Sarcoma/complicações , Sarcoma/patologia , Sarcoma/cirurgia , Tomografia Computadorizada por Raios X , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/patologia , Obstrução do Fluxo Ventricular Externo/cirurgia
11.
Pediatr Cardiol ; 41(6): 1153-1159, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32394061

RESUMO

We determined the prevalence and factors associated with tricuspid regurgitation (TR) in adults with repair of right ventricular (RV) outflow obstruction. A total of 256 patients (128 males) were studied at 25.7 ± 7.2 years after surgery, of whom 179 had repaired tetralogy of Fallot (TOF), 31 had pulmonary atresia with intact ventricular septum (PAIVS), and 46 had pulmonary stenosis (PS). The mitral and tricuspid annulus diameters, maximum right atrial (RA) area, RV end-systolic and end-diastolic areas, and tricuspid and pulmonary regurgitation were assessed using echocardiography. The prevalence of moderate-to-severe TR was 20.7%. Subgroup analysis revealed that prevalence was greater in patients with repaired TOF (20.7%) and PAIVS (35.5%) than PS patients (10.9%). As a group, severity of TR was found to be correlated with RA area (r = 0.35, p < 0.001), RV end-diastolic (r = 0.28, p < 0.001) and end-systolic (r = 0.22, p = 0.001) areas, and tricuspid valve annulus diameter (r = 0.15, p = 0.022). Moderate-to-severe TR was associated with development of cardiac arrhythmias with an odds ratio of 2.9 (95% CI 1.1 to 8.1, p = 0.031). Multivariate analysis revealed maximum RA area (ß = 0.36, p = 0.016) as an independent determinant of severity of TR. Moderate-to-severe TR occurs in about one-fifth of adults with repaired TOF, PAVIS, and PS and is associated with RA dilation and risk of development of cardiac arrhythmias.


Assuntos
Insuficiência da Valva Tricúspide/etiologia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Adulto , Arritmias Cardíacas/etiologia , Estudos Transversais , Ecocardiografia , Feminino , Átrios do Coração/patologia , Humanos , Masculino , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/complicações , Adulto Jovem
14.
J Card Surg ; 35(4): 957-960, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115762

RESUMO

BACKGROUND: A complex and rare form of persistent truncus arteriosus needs careful attention when choosing the optimal strategy for repair. AIM OF THE STUDY: We herein describe our surgical strategy of a small infant having this malformation concomitantly with right aortic arch, unusual pulmonary artery branching and a left superior vena cava. METHODS: The patient underwent initially bilateral pulmonary arterial banding followed by the Rastelli type definitive repair. The pulmonary arteries were unified in front of the left superior vena cava, and the right ventricular outflow tract was readily reconstructed. RESULTS: The patient is doing well with an excellent hemodynamic status. CONCLUSIONS: We considered the two-stage approach was sensible in this particular patient.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/métodos , Artéria Pulmonar/cirurgia , Persistência do Tronco Arterial/cirurgia , Anormalidades Múltiplas , Aorta Torácica/anormalidades , Hemodinâmica , Humanos , Recém-Nascido , Masculino , Artéria Pulmonar/anormalidades , Resultado do Tratamento , Persistência do Tronco Arterial/complicações , Persistência do Tronco Arterial/fisiopatologia , Veia Cava Superior/anormalidades , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Obstrução do Fluxo Ventricular Externo/cirurgia
15.
Catheter Cardiovasc Interv ; 95(4): 838-839, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32159290

RESUMO

Evaluation of the severity of aortic stenosis in the presence of dynamic left ventricular outflow (LVOT) obstruction is challenging. Invasive hemodynamic assessment with provocative maneuvers can be useful to differentiate of the relative components of obstruction. In patients with both dynamic LVOT obstruction and aortic stenosis, surgical myectomy and concurrent surgical aortic valve replacement is the optimal treatment strategy; combined alcohol septal ablation and transcatheter aortic valve replacement should only be considered for very high surgical risk patients.


Assuntos
Estenose da Valva Aórtica/cirurgia , Cardiomiopatia Hipertrófica/cirurgia , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Obstrução do Fluxo Ventricular Externo/cirurgia , Valva Aórtica , Constrição Patológica , Humanos , Resultado do Tratamento
16.
Ann Thorac Surg ; 110(2): e147-e149, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32205114

RESUMO

The Yasui operation is indicated in an interrupted aortic arch and a posterior malaligned ventricular septal defect with a narrow subaortic region. We present a modification of the Yasui procedure in which the aortic reconstruction was simplified using a nonvalved cryopreserved femoral vein homograft to connect the pulmonary artery to the descending aorta. A side-to-side anastomosis was performed between the femoral vein homograft and ascending aorta to complete the neoaortic reconstruction. After baffling the left ventricle to the pulmonary artery with a patch, a valved segment from the same femoral vein homograft was used to restore continuity of the right ventricular outflow.


Assuntos
Aorta Torácica/cirurgia , Criopreservação , Veia Femoral/cirurgia , Artéria Pulmonar/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Aloenxertos , Humanos , Recém-Nascido , Procedimentos Cirúrgicos Vasculares/métodos
20.
Pediatr Cardiol ; 41(3): 599-606, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31894397

RESUMO

Surgical pulmonary valve insertion (SPVI) for re-entry right ventricular outflow tract intervention (RVOTI) remains an established and reproducible approach. Fast-track in patients undergoing RVOTI of the comprehensive valve program targets early ICU and hospital discharge (Hd). Feasibility study for outcome and cost analysis was undertaken. Between January 2015 and December 2016, 34 patients underwent re-entry RVOTI. Seventeen had SPVI and 17 transcatheter PVI (TPVI). Surgical perioperative fast-track protocol was used. Echocardiographic evaluation preoperatively (TTE-1), after RVOTI (TTE-2), at hospital discharge (TTE-3), and follow-up (TTE-4) were obtained. Cost Analysis included procedural and hospital costs. Mean follow-up period was 11.3 ± 6.9 months. All patients were extubated prior to ICU arrival. Mean age was 8.5 ± 7.8 for SPVI [vs 28.5 ± 8.6 years for TPVI] (p < 0.05). There was no hospital mortality or 30-day readmission for SPVI (versus 1 for TPVI).Mean hospital length of stay (LOS) was 4.1 ± 1.1 days for SPVI [vs 1.1 ± 0.7 days for TPVI] (p < 0.05). Number of prior sternal re-entry had no influence on outcome. RV systolic pressure referenced to LVSP (rRVSP, %) and diastolic dimension (RVEDDi, z score) showed sustainable improvement (TTE-2, TTE-3, TTE-4) in both groups compared to TTE-1 (p < 0.05). Mean total hospital cost was $5475.86 ± 2503.91 lower after SPVI (p = 0.09), 21.7% procedural cost reduction. Patients undergoing RVOTI can be safely stratified, based on a customized concept, towards SPVI or TPVI. Standardized strategy can advocate a fast-track path. SPVI is associated with comparable mid-term outcomes to TPVI although SPVI is delivered in younger patients. Despite longer LOS SPVI is associated with reduced hospital cost. Multisite studies might help determine suitability for each strategy on cost containment/quality of life basis.


Assuntos
Implante de Prótese de Valva Cardíaca/economia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adulto , Cateterismo Cardíaco , Criança , Pré-Escolar , Análise Custo-Benefício , Ecocardiografia , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Adulto Jovem
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