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1.
Arch Cardiovasc Dis ; 113(2): 113-120, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32081640

RESUMO

BACKGROUND: The indications for percutaneous pulmonary valve implantation (PPVI) have been extended to include large dysfunctional right ventricular outflow tracts (RVOTs). Prestenting of the RVOT is commonly performed before PPVI in order to ensure a stable landing zone. The AndraStent XXL (AndraMed GmbH, Reutlingen, Germany), a cobalt-chromium stent with semi-open cell design, has unique mechanical properties in this indication but is no longer available in France. AIMS: To assess the efficiency of AndraStent XXL before PPVI. METHODS: In this retrospective multicentre cohort study, 86 AndraStents XXL were implanted in 77 patients in 6 centres. RESULTS: PPVI was indicated mainly for pulmonary regurgitation (75.3%) in native or patched RVOT (88.3%). The stents were manually mounted on balloon catheters and delivered through sheaths using a conventional femoral approach. PPVI was performed successfully in 97.4% of patients after successful prestenting, generally during the same procedure (77.9%). There were no deaths associated with stent implantation, and four patients experienced five complications, mainly stent embolization, including one requiring surgery. Neither stent fracture nor dysfunction were observed in any patient during a mean follow-up of 19.2±8.7months. Stent analysis showed an excellent maximal stent expansion (97.1%) regardless of balloon size. A 22.3%±3.4 stent shortening with a 30mm balloon was observed. CONCLUSIONS: Implantation of large cobalt-chromium AndraStent XXL stents is efficient for prestenting before PPVI.


Assuntos
Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Stents , Obstrução do Fluxo Ventricular Externo/terapia , Adolescente , Adulto , Cateterismo Cardíaco/efeitos adversos , Criança , Feminino , França , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Adulto Jovem
3.
J Thorac Cardiovasc Surg ; 159(3): 844-852.e1, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053434

RESUMO

OBJECTIVE: There has been debate on the importance and pathophysiologic effects of the dynamic subaortic pressure gradient in hypertrophic obstructive cardiomyopathy. The study was conducted to elucidate the hemodynamic abnormalities associated with the dynamic pressure gradient in hypertrophic obstructive cardiomyopathy. METHODS: Eight patients with hypertrophic obstructive cardiomyopathy and 7 patients with valvular aortic stenosis underwent a detailed hemodynamic study of pressure flow relationships before and after myectomy or aortic valve replacement during operation. RESULTS: In aortic stenosis, the increased gradient after premature ventricular contraction was associated with an increase in peak flow (325 ± 122 mL/s to 428 ± 147 mL/s, P = .002) and stroke volume (75.0 ± 27.3 mL to 88.0 ± 24.0 mL, P = .004), but in hypertrophic obstructive cardiomyopathy peak flow remained unchanged (289 ± 79 mL/s to 299 ± 85 mL/s, P = .334) and stroke volume decreased (45.9 ± 18.7 mL to 38.4 ± 14.4 mL, P = .04) on the postpremature ventricular contraction beat. After myectomy, the capacity to augment stroke volume on the postpremature ventricular contraction beats was restored in patients with hypertrophic obstructive cardiomyopathy (45.6 ± 14.4 mL to 54.4 ± 11.8 mL, P = .002). CONCLUSIONS: The pressure flow relationship in hypertrophic obstructive cardiomyopathy supports the concept of true obstruction to outflow, with a low but continued flow during late systole, when the ventricular-aortic pressure gradient is the highest. Septal myectomy can abolish obstruction and restore the ability to augment stroke volume, which may explain the mechanism of symptomatic improvement after operation.


Assuntos
Estenose da Valva Aórtica/cirurgia , Cardiomiopatia Hipertrófica/cirurgia , Implante de Prótese de Valva Cardíaca , Volume Sistólico , Função Ventricular Esquerda , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Idoso , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Pressão Arterial , Função do Átrio Esquerdo , Pressão Atrial , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/complicações , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/etiologia , Pressão Ventricular
4.
J Thorac Cardiovasc Surg ; 159(3): 1014-1025.e8, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31590953

RESUMO

OBJECTIVES: To evaluate whether the long-term outcomes of modified-single-patch (MSP) repair of complete atrioventricular septal defect are equivalent to double-patch (DP) repair with respect to survival and risk of reoperation for left atrioventricular valve regurgitation or left ventricular outflow tract obstruction. METHODS: All patients who underwent biventricular repair of complete atrioventricular septal defect in Australia from 1990 to 2015 using either a MSP or DP technique were identified. Demographic characteristic details, operative data, and outcomes were analyzed. A propensity score analysis was performed to balance the 2 treatment groups according to several baseline covariates. Survival and freedom from reintervention between the 2 groups were compared using Kaplan-Meier curves and log-rank tests. RESULTS: A total of 819 patients underwent repair of complete atrioventricular septal defect (252 MSP and 567 DP) during the study period. There was no significant difference in unmatched survival (P = .85) and event-free survival (P = .49) between MSP and DP repair. Propensity score matching resulted in a total of 223 matched pairs. Matched analysis found no difference in overall survival (P = .59) or event-free survival (P = .90) between repair techniques, with an estimated event-free survival at 5, 10, and 15 years of 83%, 83%, and 74% for DP and 83%, 80%, and 77% for the MSP group, respectively. There was no significant difference between repair techniques in reoperation for left atrioventricular valve regurgitation or left ventricular outflow tract obstruction or need for permanent pacemaker. CONCLUSIONS: Overall and event free survival are similar following either MSP or DP repair of complete atrioventricular septal defect. There is no increased risk of reoperation for left ventricular outflow tract obstruction with the MSP technique.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Defeitos dos Septos Cardíacos/cirurgia , Austrália/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Bases de Dados Factuais , Feminino , Defeitos dos Septos Cardíacos/diagnóstico , Defeitos dos Septos Cardíacos/mortalidade , Defeitos dos Septos Cardíacos/fisiopatologia , Humanos , Lactente , Masculino , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Intervalo Livre de Progressão , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Obstrução do Fluxo Ventricular Externo/mortalidade , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Obstrução do Fluxo Ventricular Externo/cirurgia
5.
Curr Cardiol Rep ; 21(11): 136, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31673812

RESUMO

PURPOSE OF REVIEW: To discuss the critical role of the mitral valve (MV) in the pathophysiology of obstruction in hypertrophic cardiomyopathy (HCM), evaluation of the MV in HCM, the impact of MV characteristics on treatment in HCM, and management of the MV at the time of septal myectomy. RECENT FINDINGS: Multimodality imaging helps describe mitral abnormalities in HCM, though significant controversy persists on what to do with these abnormalities. In certain cases, intervention on the MV may be necessary, although outcomes may be worse in those who undergo mitral interventions. Thorough assessment of MV anatomy and function is paramount in evaluating a patient with HCM. Emphasis should be placed on thorough evaluation and description of mitral abnormalities in HCM. Given significant practice variation, future studies could compare MV practice differences across institutions and how these impact long-term outcomes.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica/cirurgia , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Imagem Multimodal , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Obstrução do Fluxo Ventricular Externo/cirurgia
7.
J Interv Card Electrophysiol ; 56(1): 37-43, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31478158

RESUMO

PURPOSE: The aim of this study was to develop a new electrocardiographic criterion for differentiating the origin of outflow tract ventricular arrhythmias (OT-VAs) with precordial transition in lead V3. METHODS: A total of 147 consecutive patients with OT-VAs displaying precordial transition in lead V3 who underwent successful catheter ablation in the right ventricular outflow tract (RVOT) (n = 118) or left ventricular outflow tract (LVOT) (n = 29) were included in this study. The V1-V3 transition index was defined as the sum of S-wave amplitude in lead V1 and V2 during premature ventricular contractions (PVCs) divided by the S-wave amplitude during sinus rhythm (SR), respectively, minus the sum of R-wave amplitude in lead V1, V2, and V3 during PVCs divided by the R-wave amplitude during SR, respectively, i.e., [(SPVC/SSR)V1 + (SPVC/SSR)V2] - [(RPVC/RSR) V1 + (RPVC/RSR)V2 + (RPVC/RSR)V3]. RESULTS: The V1-V3 transition index was significantly higher for RVOT origins than for LVOT origins (1.25 ± 2.48 vs. - 3.94 ± 3.11; P < 0.001). Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.931 for the V1-V3 transition index, and a cutoff value of > - 1.60 predicted a RVOT origin with a 93% sensitivity and 86% specificity. With respect to AUC and accuracy, the V1-V3 transition index was superior to any previously proposed ECG indices for differentiating left from right OT-VAs. In 37 prospective cases, the new index was able to predict the site of a RVOT origin with 95% accuracy (35 of 37 cases). CONCLUSIONS: The V1-V3 transition index is a useful novel ECG criterion for distinguishing left from right OT-VAs with precordial transition in lead V3.


Assuntos
Eletrocardiografia/métodos , Taquicardia Ventricular/diagnóstico , Obstrução do Fluxo Ventricular Externo/diagnóstico , Complexos Ventriculares Prematuros/diagnóstico , Adolescente , Adulto , Idoso , Ablação por Cateter , Diagnóstico Diferencial , Mapeamento Epicárdico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/cirurgia , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Obstrução do Fluxo Ventricular Externo/cirurgia , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/cirurgia
8.
Methodist Debakey Cardiovasc J ; 15(2): 122-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384375

RESUMO

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


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/fisiopatologia , Fatores de Risco , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia
9.
J Thorac Cardiovasc Surg ; 158(4): 1158-1167.e1, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31301903

RESUMO

OBJECTIVES: D-transposition of the great arteries and l-transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction are complex biventricular congenital heart diseases for which decision-making regarding surgical strategy remains challenging. We investigated the intermediate-term outcomes of Fontan versus biventricular procedures in these patients. METHODS: We analyzed 129 patients with d-transposition of the great arteries/ventricular septal defect/left ventricular outflow tract obstruction (n = 85) or l-transposition of the great arteries/ventricular septal defect/left ventricular outflow tract obstruction (n = 44) and 2 functional ventricles from Australia who had primary surgical management (29 Fontan, 100 biventricular repair) undertaken between 1990 and 2015. RESULTS: Median operative age of patients was 2.9 years (range, 0.2-26.8 years). During a median follow-up of 6.2 years (range, 2 days to 25.8 years), 9 patients died after biventricular repair (3 early and 6 late deaths). One patient received a transplant 1.2 years after Fontan completion. Overall transplant-free survivals at 1, 5, 10, and 15 years were 95%, 93%, 92%, and 90%, respectively. Overall reintervention-free survivals at 1, 5, 10, and 15 years were 79%, 64%, 45%, and 29% respectively. Biventricular repair tended to be associated with a higher rate of death, transplantation, or reintervention than the Fontan pathway (hazard ratio, 1.83; 95% confidence interval, 0.90-3.71; P = .10). Some 73% of transplant-free survivors had New York Heart Association class I. Functional status was similar between the Fontan and biventricular groups. CONCLUSIONS: Intermediate-term outcomes were comparable between patients with d-transposition of the great arteries/ventricular septal defect/left ventricular outflow tract obstruction and patients with l-transposition of the great arteries/ventricular septal defect/left ventricular outflow tract obstruction. Both Fontan and biventricular pathways are associated with excellent mortality and functional outcomes. Biventricular patients have a greater risk of reintervention. The Fontan procedure is a viable option when anatomic risk factors preclude biventricular repair.


Assuntos
Técnica de Fontan , Comunicação Interventricular/complicações , Ventrículos do Coração/cirurgia , Transposição dos Grandes Vasos/cirurgia , Obstrução do Fluxo Ventricular Externo/etiologia , Adolescente , Adulto , Austrália , Criança , Pré-Escolar , Feminino , Técnica de Fontan/efeitos adversos , Técnica de Fontan/mortalidade , Comunicação Interventricular/mortalidade , Comunicação Interventricular/fisiopatologia , Transplante de Coração , Ventrículos do Coração/anormalidades , Ventrículos do Coração/fisiopatologia , Humanos , Lactente , Masculino , Cuidados Paliativos , Intervalo Livre de Progressão , Recuperação de Função Fisiológica , Sistema de Registros , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/mortalidade , Transposição dos Grandes Vasos/fisiopatologia , Obstrução do Fluxo Ventricular Externo/mortalidade , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Adulto Jovem
12.
Echocardiography ; 36(6): 1165-1172, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31148272

RESUMO

Left ventricular outflow tract obstruction is a serious complication of mitral valve surgery (repair and replacement) and transcatheter mitral valve replacement. An appreciation of the various mechanisms which cause outflow obstruction in these settings is critical to avoiding this complication and to initiating appropriate treatment. This article discusses the mechanisms, pathophysiology, and imaging of left ventricular outflow tract obstruction which can arise following insertion of a variety of mitral valve prosthetics.


Assuntos
Ecocardiografia/métodos , Implante de Prótese de Valva Cardíaca , Valva Mitral/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Complicações Pós-Operatórias/fisiopatologia
13.
J Med Case Rep ; 13(1): 184, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31203815

RESUMO

BACKGROUND: Accessory mitral valve tissue is a rare congenital anomaly that is commonly diagnosed in early childhood and rarely in adulthood. It is usually asymptomatic. However, it may cause left ventricular outflow tract obstruction in a way that mimics various other causes of obstruction. A 72-year-old Caucasian man complained of chest discomfort and exertional dyspnea for 3 months. There were no specific findings from a physical examination except systolic murmur. Transthoracic echocardiography demonstrated a mass on the mitral valve extending to the intraventricular septal, raising the pressure gradient flow across the aortic valve. Transesophageal echocardiography showed parachute-like tissue connected to the anterior leaflet of the mitral valve causing left ventricular outflow tract obstruction. During the surgery preparation period, he underwent coronary angiography and computed tomography to study the anatomy surrounding the mass. After surgery, biopsy showed non-specific findings. CONCLUSION: When facing a case of aortic valve stenosis, accessory mitral valve tissue should be kept in mind as one of the possible underlying causes despite its rarity. Although it is simple and noninvasive, echocardiography remains the best diagnostic procedure to make the correct decision about management and to define the golden time for surgical intervention.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas , Valva Mitral , Obstrução do Fluxo Ventricular Externo , Idoso , Angiografia Coronária/métodos , Ecocardiografia Transesofagiana/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/patologia , Cardiopatias Congênitas/fisiopatologia , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Valva Mitral/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Obstrução do Fluxo Ventricular Externo/cirurgia
14.
J Cardiovasc Med (Hagerstown) ; 20(6): 389-396, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30994509

RESUMO

AIMS: Left ventricular outflow tract (LVOT) obstruction is a key feature of hypertrophic cardiomyopathy (HCM) that identifies patients at increased risk of adverse outcomes. Previous studies have hypothesized that LVOT obstruction enhances myocardial fibrosis and increases left ventricular (LV) filling pressures, producing greater clinical deterioration. However, this hypothesis has not been demonstrated in a clinical cohort comparing obstructive and nonobstructive patients. METHODS: Patients with HCM in whom Doppler echocardiography was performed within 30 days of cardiac MRI were enrolled, using the E/e' ratio to assess LV diastolic function and late gadolinium enhancement to evaluate the extent of fibrosis. Data were assorted according to LVOT obstruction status at rest. RESULTS: The current study enrolled 67 patients who were mostly middle-aged (56.8 ±â€Š13.2 years old) men (75%) with preserved ejection fraction. Obstructive HCM presented a significant association with a high fibrosis extent [odds ratio (OR) 3.33; P = 0.034] which was maintained after adjusting for sex and age (OR 4.37; P = 0.016) but not for maximum LV wall thickness (OR 2.13; P = 0.225). Obstructive HCM was also associated with a clinically significant E/e' ratio more than 14 (OR 7.8; P = 0.001) which decreased slightly after adjusting for age, sex and maximum LV thickness (OR 6.54; P = 0.014). There was a significant association between an E/e' ratio more than 14 and the extent of fibrosis (OR 1.29; P < 0.001) which was maintained after adjusting for age, sex and maximum LV wall thickness (OR 1.36; P = 0.001). CONCLUSION: LVOT obstruction may play a role in the extent of fibrosis in HCM, possibly conditioning greater diastolic dysfunction.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia Doppler , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Remodelação Ventricular , Adulto , Idoso , Cardiomiopatia Hipertrófica/patologia , Cardiomiopatia Hipertrófica/fisiopatologia , Estudos Transversais , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Volume Sistólico , Fatores de Tempo , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/fisiopatologia , Obstrução do Fluxo Ventricular Externo/patologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Pressão Ventricular
15.
Cardiol Young ; 29(4): 505-510, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30942148

RESUMO

OBJECTIVES: Pulmonary homografts are standard alternatives to right ventricular outflow tract reconstruction in congenital heart surgery. Unfortunately, shortage and conduit failure by early calcifications and shrinking are observed for small-sized homografts in younger patients. In neonates, Contegra® 12 mm (Medtronic Inc., Minneapolis, Minnesota, United States of America) could be a valuable alternative, but conflicting evidence exists. There is no published study considering only newborns with heterogeneous pathologies. We retrospectively compared the outcomes of these two conduits in this challenging population. METHODS: Patients who underwent a right ventricular outflow tract reconstruction between January 1992 and December 2014 at the Hôpital Universitaire des Enfants Reine Fabiola were included. We retrospectively collected and analysed demographic, echocardiographic, surgical, and follow-up data. RESULTS: Of the 53 newborns who benefited from a right ventricular outflow tract reconstruction during the considered period, 30 received a Contegra 12 mm (mean age 15 ± 8 days), and 23 a small (9-14 mm) pulmonary homograft (mean age 10 ± 7 days). Overall mortality was 16.6% with Contegra versus 17.4% in the pulmonary homograft group (p = 0.98 log-rank). Operative morbidity and early re-operation for conduit failure were not significantly different between the two groups. Mean follow-up in this study is 121 ± 74 months. Survival free from re-operation was not different between the two groups (p = 0.15). Multivariable analysis showed that weight and significant early gradient were factors associated with anticipated conduit failure. CONCLUSIONS: Contegra 12 mm is a valid alternative to small pulmonary homografts in a newborn patient population. TRIAL REGISTRATION: NCT03348397.


Assuntos
Veias Jugulares/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Obstrução do Fluxo Ventricular Externo/cirurgia , Bélgica , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Análise Multivariada , Reoperação , Estudos Retrospectivos , Transplante Homólogo , Resultado do Tratamento
16.
Congenit Heart Dis ; 14(4): 651-656, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30861318

RESUMO

OBJECTIVE: Various options exist for right ventricular outflow tract (RVOT) reconstruction in congenital heart disease. The Freestyle porcine aortic root may be used but its longevity is not well defined. DESIGN: We performed a retrospective review of all non-Ross RVOT reconstructions using the Freestyle root in our institution. Survival and reintervention, either by surgery, transcatheter valve implantation, balloon valvuloplasty, or bare metal stent placement, were recorded. Factors associated with reintervention were assessed using Cox regression. RESULTS: Between January 2002 and December 2015, there were 182 patients identified. Sixteen patients were lost to follow-up and 3 patients died, unrelated to cardiac surgery. Of the remaining 163 patients, the median age was 12.2 years (interquartile range 6.4-16.4), median weight was 39.0 kg (interquartile range 19.9-59.3), and the median body surface area was 1.23 m2 (interquartile range 0.79-1.64). Ninety-three (57%) patients had tetralogy of Fallot. The median follow-up was 5.4 years (interquartile range 2.9-8 years). There were no operative or cardiac-related deaths. Thirty-eight patients (23%) required reintervention. The rate of freedom from reintervention was 93.2% (95% CI 86.7%-96.6%) at 5 years and 48.4% (95% CI 34.9%-60.6%) at 10 years. Age < 10 years, weight < 39 kg, and body surface area <1.2 m2 at the time of valve placement, as well as valve size ≤25 mm were significantly associated with need for earlier reintervention. CONCLUSIONS: The Freestyle root in the RVOT is associated with excellent survival and low midterm need for reintervention. Its longevity is comparable to published data on homografts and other bioprosthetic valves.


Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Ventrículos do Coração/cirurgia , Valva Pulmonar/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Animais , Cateterismo Cardíaco , Criança , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Xenoenxertos , Humanos , Masculino , Desenho de Prótese , Valva Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Suínos , Fatores de Tempo , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/fisiopatologia
18.
G Ital Cardiol (Rome) ; 20(2): 109-116, 2019 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-30747926

RESUMO

Hypertrophic obstructive cardiomyopathy (HOCM) is the most frequently inherited cardiovascular disease (prevalence in the general population of 1/500) and is characterized by significant left ventricular hypertrophy, especially in the interventricular septum, combined with small-volume cardiac cavities. Transaortic surgical septal myectomy is the most commonly used technique to treat HOCM, and is associated with low operative morbidity and mortality and a reduction of the outflow gradients. The composite operative mortality of only 0.4% (17/3695 patients) from 5 major high-volume centers in North America highlights the role of dedicated HOCM units. The involvement of the mitral valve in the pathophysiology of HOCM has been addressed as systolic anterior motion (SAM)-related left ventricular outflow tract obstruction. Hypertrophic cardiomyopathy mitral malformations include leaflet elongation and a wide array of malformations of the papillary muscles and chordae that can be detected by transthoracic and transesophageal echocardiography and by cardiac magnetic resonance. Because they participate fundamentally in the predisposition to SAM, they have increasingly been repaired surgically.


Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Valva Mitral/fisiopatologia , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/fisiopatologia , Ecocardiografia/métodos , Ecocardiografia Transesofagiana/métodos , Humanos , Imagem por Ressonância Magnética/métodos , Obstrução do Fluxo Ventricular Externo/fisiopatologia
19.
JACC Cardiovasc Interv ; 12(2): 182-193, 2019 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-30678797

RESUMO

OBJECTIVES: The aim of this study was to evaluate the predictors of left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR). BACKGROUND: LVOT obstruction is a major concern with TMVR, but limited data exist regarding its predictors and impact on outcomes. METHODS: Patients with pre-procedural multidetector row computed tomography (MDCT) undergoing TMVR for failed mitral bioprosthetic valves (valve-in-valve), annuloplasty rings (valve-in-ring), and mitral annular calcification (valve-in-MAC) were included in this study. Echocardiographic and procedural characteristics were recorded, and comprehensive assessment with MDCT was performed to identify the predictors of LVOT obstruction (defined as an increment of mean LVOT gradient ≥10 mm Hg from baseline). The new LVOT (neo-LVOT) area left after TMVR was estimated by embedding a virtual valve into the mitral annulus on MDCT, simulating the procedure. RESULTS: Among 194 patients with pre-procedural MDCT undergoing TMVR (valve-in-valve, 107 patients; valve-in-ring, 50 patients; valve-in-MAC, 37 patients), LVOT obstruction was observed in 26 patients (13.4%), with a higher rate after valve-in-MAC than valve-in-ring and valve-in-valve (54.1% vs. 8.0% vs. 1.9%; p < 0.001). Patients with LVOT obstruction had significantly higher procedural mortality compared with those without LVOT obstruction (34.6% vs. 2.4%; p < 0.001). Receiver-operating characteristic curve analysis showed that an estimated neo-LVOT area ≤1.7 cm2 predicted LVOT obstruction with sensitivity of 96.2% and specificity of 92.3%. CONCLUSIONS: LVOT obstruction after TMVR was associated with higher procedural mortality. A small estimated neo-LVOT area was significantly associated with LVOT obstruction after TMVR and may help identify patients at high risk for LVOT obstruction.


Assuntos
Calcinose/cirurgia , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Obstrução do Fluxo Ventricular Externo/etiologia , Idoso , Idoso de 80 Anos ou mais , Calcinose/diagnóstico por imagem , Calcinose/mortalidade , Calcinose/fisiopatologia , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Ecocardiografia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/mortalidade , Estenose da Valva Mitral/fisiopatologia , Tomografia Computadorizada Multidetectores , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/mortalidade , Obstrução do Fluxo Ventricular Externo/fisiopatologia
20.
Semin Thorac Cardiovasc Surg ; 31(3): 424-431, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641129

RESUMO

Surgical septal myectomy is a standard treatment option for patients with hypertrophic obstructive cardiomyopathy. Subvalvular abnormalities of the mitral valve might play an important role in residual left ventricular outflow tract obstruction. This randomized study aimed to compare the surgical outcomes of septal myectomy with vs without subvalvular interventions. Between July 2015 and December 2016, 80 eligible patients were randomly assigned to undergo septal myectomy with vs without subvalvular intervention. The peak gradient was 92.3 ± 16.9 and 88.1 ± 15.4 mm Hg, respectively (P = 0.281). The mean septum thickness was 26.8 ± 4.5 and 26.1 ± 4.2 mm, respectively (P = 0.504). Moderate or severe systolic anterior motion syndrome-mediated mitral regurgitation was observed in all patients. There was no residual mitral regurgitation in the group with subvalvular intervention, while 15% of patients in the control group had regurgitation (P = 0.013). Residual systolic anterior motion syndrome was observed in 5% and 27.5% of patients, respectively (P = 0.007). The median postoperative gradient was 13 (interquartile range 9-16) mm Hg and 8 (interquartile range 4-12) mm Hg, respectively (P = 0. 0.019). At the 12-month follow-up, all patients were alive. There were 87.5% vs 77.5%, and 12.5% vs 22.5% of patients categorized as having New York Heart Association functional classes I and II, respectively (P = 0.378). The prevalence rate of residual mitral regurgitation was 10% and 32.5%, respectively (P = 0.010). Concomitant subvalvular intervention during septal myectomy more effectively eliminates left ventricular outflow tract obstruction, providing better freedom from residual mitral regurgitation without clinical benefit 1 year after surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Feminino , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Federação Russa , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/fisiopatologia
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