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1.
World J Pediatr Congenit Heart Surg ; 10(4): 426-432, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307296

RESUMO

BACKGROUND: Single-stage biventricular repair remains a challenging and difficult decision in high-risk newborns and early infants with the presence of left ventricular outflow tract obstruction (LVOTO) or borderline hypoplasia of the left ventricle (LV). METHODS: Six high-risk patients underwent the initial hybrid procedure (bilateral pulmonary banding + ductal stenting) for staged biventricular repair. Their median age was 17 days (range: 7-55 days). The diagnosis was interrupted aortic arch (IAA), ventricular septal defect (VSD), and LVOTO (n = 3); IAA and VSD (n = 1); and aortic annular hypoplasia, aortic arch hypoplasia, VSD, and LVOTO (n = 1). The last patient had borderline LV with large atrial septal defect (ASD) and aortic arch hypoplasia. The patient with borderline LV had also ASD closure with small fenestration. RESULTS: One patient died of sepsis after the hybrid procedure. Other patients underwent biventricular repair 8 to 13 months later. Three patients had conventional repair with conal septum resection. The other patient with IAA, in whom LVOTO was considered nonresectable, underwent Yasui operation. The last patient with borderline LV had enough development of left heart structures during follow-up and underwent aortic arch repair. One patient who had conal septum resection died after biventricular repair. One patient needed a tracheostomy; four patients were discharged uneventfully and their clinical conditions were good on postoperative year 1. CONCLUSION: Staged biventricular repair with the initial hybrid procedure may be a feasible and safe alternative in high-risk neonates and early infants. Hybrid intervention may provide the development of cardiac structures in time and a better evaluation for the possibility of biventricular repair in borderline patients.


Assuntos
Coartação Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Ventrículos do Coração/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico , Ecocardiografia , Feminino , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico , Ventrículos do Coração/anormalidades , Humanos , Lactente , Recém-Nascido , Masculino , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/etiologia
2.
World J Pediatr Congenit Heart Surg ; 10(4): 502-503, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307300

RESUMO

Cardiovascular computed tomographic angiography (CCTA) 3-D thoracic reconstruction can serve as a "virtual patient avatar" providing surgical views for approach to complex anomalous coronary artery anatomy. Images demonstrated a single coronary artery ostium arising from the right aortic sinus with trifurcation into a prepulmonic left anterior descending coronary artery (LAD), an interarterial circumflex with a subsequent intraseptal course, and normal course of the right coronary artery. Virtual 3-D CCTA reconstructions were important to planning an incisional plane for surgical correction.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Imagem Tridimensional , Realidade Virtual , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Humanos , Valor Preditivo dos Testes , Seio Aórtico/anormalidades
3.
World J Pediatr Congenit Heart Surg ; 10(4): 433-439, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307309

RESUMO

OBJECTIVE: To assess the efficacy and safety of the Nit-Occlud ASD-R (PFM S.R.L, La Paz, Bolivia) in the percutaneous closure of secundum atrial septal defects (ASD). PATIENTS AND METHODS: Fifty-three consecutive patients with median age of 11 years (range 3-67) and mean weight 27.1 kg (range 13-75 kg), treated in two cardiology centers between May 2007 and March 2011. RESULTS: Mean fluoroscopy time was 14 minutes (5-53), mean procedure time was 70 minutes (45-150), mean defect size, as measured by the stop-flow technique, was 17.8 mm (5.6-31), and mean stent size of the implanted device was 18 mm (6-28), which is 0.98 times the defect size. Successful closure of the ASD without major complications was achieved in 49 of 53 patients. In 71.4% of patients in whom device implantation was accomplished, there was no evidence of a persistent shunt at the completion of the procedure. This closure rate increased to 91.7% after 24 hours, with 95.8% closure after three months and 100% closure after six months. Device embolization occurred in one patient within 24 hours of implantation and required surgical device removal and ASD closure. There were no other major complications and no deaths during the period of follow-up (average 72 months; range 59-105 months). CONCLUSION: The Nit-Occlud ASD-R device is safe and effective with very good closure rates.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Países em Desenvolvimento , Feminino , Fluoroscopia , Seguimentos , Comunicação Interatrial/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Cirurgia Assistida por Computador , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
Braz J Cardiovasc Surg ; 34(3): 344-351, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310474

RESUMO

OBJECTIVES: To compare the advantages and disadvantages of perventricular and percutaneous procedures for treating isolated ventricular septal defect (VSD). METHODS: A total of 572 patients with isolated VSD were selected in our hospital between January 2015 and December 2016. The patients' median age and weight were five years (1-26 years) and 29 kg (9-55 kg), respectively. The median diameter of VSD was 6.0 mm (5-10 mm). Patients were divided into two groups. In group A, perventricular device closure was performed in 427 patients; in group B, 145 patients underwent percutaneous device closure. RESULTS: Four hundred twelve patients in group A and 135 patients in group B underwent successful closure. The total occlusion rate was 98.5% (immediately) and 99.5% (3-month follow-up) in group A, which were not significantly different from those in group B (97.7% and 100%, respectively). Patients in group A had longer intensive care unit (ICU) stay than those in group B, but patients in group B experienced significantly longer operative times than those in group A. The follow-up period ranged from 8 months to 1.5 year (median, 1 year). During the follow-up period, late-onset complete atrioventricular block occurred in two patients. No other serious complications were noted in the remaining patients. CONCLUSION: Both procedures are safe and effective treatments for isolated VSD. The percutaneous procedure has obvious advantages of shorter ICU stay and less trauma than the perventricular procedure. However, the perventricular procedure is simpler to execute, results in a shorter operative time, and avoids X-ray exposure.


Assuntos
Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal/normas , Adolescente , Adulto , Angiografia/métodos , Insuficiência da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/cirurgia , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Ecocardiografia/métodos , Desenho de Equipamento , Feminino , Comunicação Interventricular/diagnóstico por imagem , Humanos , Lactente , Tempo de Internação , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Int Heart J ; 60(4): 998-1002, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257334

RESUMO

Ventricular pseudoaneurysm (PSA) is a rare, yet life-threatening complication of myocardial infarction, cardiac surgery, and transcatheter valve replacement. Although conventional surgery is the preferred treatment strategy, transcatheter closure has emerged as an effective alternative in selected candidates. In this report, we describe successful transcatheter closure of two unique cases of ventricular pseudoaneurysm (PSA): first, a complex post-myocardial infarction left ventricular PSA (LVPSA) with multi-communications, and second, a case of post-traumatic right ventricular PSA (RVPSA) following blunt chest injury caused by domestic violence.


Assuntos
Falso Aneurisma/cirurgia , Cateterismo Cardíaco/métodos , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração , Infarto do Miocárdio/complicações , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Violência Doméstica , Ecocardiografia , Feminino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiologia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnóstico
6.
Int Heart J ; 60(4): 938-943, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308320

RESUMO

The literature on malignant cardiac tumors is relatively limited because they are rare, especially among the Chinese population. We analyzed 14 patients diagnosed with malignant cardiac tumors in Fuwai Hospital and present the results of surgical treatments on the tumors. The mean age at tumor diagnosis was 47 years in a male-dominated cohort. There was a high frequency of pericardial effusion and coronary artery involvement in our group. We compared the survival times of patients who received different treatments and found that surgery improved prognosis of tumors, especially for patients who underwent orthotopic heart transplantation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia/métodos , Neoplasias Cardíacas/diagnóstico , Imagem Cinética por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Biomarcadores Tumorais/análise , China/epidemiologia , Feminino , Neoplasias Cardíacas/mortalidade , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências
7.
World J Pediatr Congenit Heart Surg ; 10(4): 446-453, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307305

RESUMO

BACKGROUND: Very little is known about clinical and biomarker predictors of readmissions following pediatric congenital heart surgery. The cardiac biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) can help predict readmission in adult populations, but the estimated utility in predicting risk of readmission or mortality after pediatric congenital heart surgery has not previously been studied. Our objective was to evaluate the association between pre- and postoperative serum biomarker levels and 30-day readmission or mortality for pediatric patients undergoing congenital heart surgery. METHODS: We measured pre- and postoperative NT-proBNP levels in two prospective cohorts of 522 pediatric patients <18 years of age who underwent at least one congenital heart operation from 2010 to 2014. Blood samples were collected before and after surgery. We evaluated the association between pre- and postoperative NT-proBNP with readmission or mortality within 30 days of discharge, using multivariate logistic regression, adjusting for covariates based on the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Mortality Risk Model. RESULTS: The Johns Hopkins Children's Center cohort and the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) cohort demonstrate event rates of 12.9% and 9.4%, respectively, for the composite end point. After adjustment for covariates in the STS congenital risk model, we did not find an association between elevated levels of NT-proBNP and increased risk of readmission or mortality following congenital heart surgery for either cohort. CONCLUSIONS: In our two cohorts, preoperative and postoperative values of NT-proBNP were not significantly associated with readmission or mortality following pediatric congenital heart surgery. These findings will inform future studies evaluating multimarker risk assessment models in the pediatric population.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/sangue , Peptídeo Natriurético Encefálico/sangue , Readmissão do Paciente/tendências , Fragmentos de Peptídeos/sangue , Medição de Risco/métodos , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Seguimentos , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Mortalidade Hospitalar/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Maryland/epidemiologia , Alta do Paciente/tendências , Período Pós-Operatório , Prognóstico , Precursores de Proteínas , Estudos Retrospectivos , Taxa de Sobrevida/tendências
8.
Br J Anaesth ; 123(4): 408-420, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31320115

RESUMO

Preoperative cardiac function is an important predictor of postoperative outcomes. Patients with heart failure are at higher risk of perioperative morbidity and mortality. Left ventricular ejection fraction, derived by standard echocardiography, is most frequently used to assess cardiac function in the intraoperative and postoperative periods. Myocardial strain analysis, a measurement of myocardial deformation, can provide additional information to left venricular eject fraction estimation. Here, we provide an overview of myocardial strain and different methods used to evaluate strain, including speckle tracking echocardiography. Speckle tracking echocardiography is an imaging modality that can analyse and track small segments of the myocardium, which provides greater detail for assessing global and regional cardiac motion and function. We further review the literature to illustrate the value of speckle tracking echocardiography-derived myocardial strain in describing cardiac function and its association with adverse surgical outcomes in the perioperative period, including low cardiac output states, need for inotropic support, postoperative arrhythmias, subclinical myocardial ischaemia, and length of hospital stay.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Coração/diagnóstico por imagem , Assistência Perioperatória/métodos , Ecocardiografia , Testes de Função Cardíaca , Humanos , Interpretação de Imagem Assistida por Computador , Miocárdio , Volume Sistólico
9.
Expert Rev Cardiovasc Ther ; 17(6): 395-412, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31179756

RESUMO

Introduction: Surgery is a major stressor especially for older patients that are prone for postoperative complications and mortality. Hospitalization due to surgery and illness can be major life events, and the age-related impairments in physiological function and the decreased ability to respond to metabolic and hormonal perturbations in response to surgery often lead to a longer convalescence. Areas covered: This article gives an overview of the effects of PET in various surgical fields and also what to account for and expect of PET after various types of surgery. A comprehensive literature search was performed in Pubmed, Embase, Medline, Cochrane Library, and PEDro database (from the earliest date of each database to March 2019) using search words 'Preoperative Exercise Therapy', 'Physical Therapy' and 'surgery'. Secondly, the literature searches were modified depending on the surgical specialty. Expert opinion: Evidence is growing that preoperative exercise therapy in various surgical specialties is well tolerated and effective, with by far the most evidence in the cardiac surgical field. Future improvements in standards of care and optimal pre-operative preparation should not only focus on the surgical team and the hospital organization but also on incorporating the active role of the patient.


Assuntos
Terapia por Exercício/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Exercício/fisiologia , Humanos
11.
Br J Radiol ; 92(1101): 20170980, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31199672

RESUMO

Resternotomy (RS) is a common occurrence in cardiac surgical practice. It is associated with an increased risk of injury to old conduits, cardiac structures, catastrophic hemorrhage and subsequent high morbidity and mortality rate in the operating room or during the recovery period. To mitigate this risk, we evaluated the role of multidetector CT (MDCT) in planning repeat cardiac surgery. We evaluated sternal compartment abnormalities, sternal/ascending aorta distance, pre-reoperative assessment of the aorta (wall, diameters, lumen, valve), sternal/right ventricle distance, diaphragm insertion, pericardium and cardiac chambers, sternal/innominate vein distance, connection of the grafts to the predicted median sternotomy cut, graft patency and anatomic course, possible aortic cannulation and cross-clamping sites and additional non-cardiovascular significant findings. Based on the MDCT findings, surgeons employed tailored operative strategies, including no-touch technique, clamping strategy and cardiopulmonary bypass (CPB) via peripheral cannulation assisted resternotomy. Our experience suggests that MDCT provides information which contributes to the safety of re-operative heart surgery reducing operative mortality and adverse outcomes. The radiologist must be aware of potential surgical options, including in the report any findings relevant to possible resternotomy complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Tomografia Computadorizada Multidetectores/métodos , Cuidados Pré-Operatórios/métodos , Reoperação/métodos , Esternotomia/métodos , Humanos , Esterno/diagnóstico por imagem , Esterno/cirurgia
12.
Medicine (Baltimore) ; 98(24): e15897, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192923

RESUMO

RATIONALE: Hemophilia A (HA) is an X-linked recessive disorder caused by clotting factor VIII (FVIII) deficiency. There is limited data on the use of replacement therapy in cardiac surgery. Since no international guideline for anticoagulation in such patient exists, careful thought should be taken to design an individualized anticoagulation strategy. PATIENT CONCERNS: We report a 54-year-old male with severe HA with FVIII activity of 0.8% when he was first diagnosed, who underwent successful mitral valve repair and coronary artery bypass graft with FVIII replacement perioperatively. DIAGNOSES: Transthoracic echocardiography and coronary angiography confirmed the HA patient with the diagnosis of severe mitral valve regurgitation and left anterior descending artery stenosis. INTERVENTIONS: Before surgery, a bolus of 1000 IU FVIII was injected, which obtained an FVIII of 80%. After induction, a 3750 IU bolus of FVIII was injected and subsequent FVIII level reached 135%. Mitral valve repair and coronary artery bypass graft with FVIII replacement were performed. After the surgery, a repeat FVIII activity level was 50.6%. The 400 mL of autologous blood and 700 mL of cardiopulmonary bypass (CPB) machine blood was returned to the patient as well as 4 units of fresh frozen plasma with an additional bolus of 1000 IU FVIII. 100 mg aspirin per day alone was given after surgery. OUTCOMES: The patient recovered uneventfully and 1-year follow-up showed no complications. LESSONS: The anticoagulant or antiplatelet regimen of HA patient following surgery should be individualized based on the evaluation of the risk factors for bleeding and thrombosis and the lowest FVIII activity ever recorded after FVIII replacement therapy.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Fator VIII/administração & dosagem , Hemofilia A/tratamento farmacológico , Insuficiência da Valva Mitral/cirurgia , Ponte de Artéria Coronária , Fator VIII/uso terapêutico , Implante de Prótese de Valva Cardíaca , Hemofilia A/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Resultado do Tratamento
13.
Ann R Coll Surg Engl ; 101(7): 522-528, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155918

RESUMO

INTRODUCTION: Longer durations of cardiopulmonary bypass and aortic cross clamp are associated with increased morbidity and mortality. Little is known about the effect of automated knot fasteners (Cor-Knot®) in minimally invasive mitral valve repair on operative times and outcomes. The aim of this study was to evaluate whether these devices shortened cardiopulmonary bypass and aortic cross clamp times and whether this impacted on postoperative outcomes. MATERIALS AND METHODS: All patients undergoing isolated minimally invasive mitral valve repair by a single surgeon between March 2011 and March 2016 were included (n = 108). Two cohorts were created based on the use (n = 52) or non-use (n = 56) of an automated knot fastener. Data concerning intraoperative variables and postoperative outcomes were collected and compared. RESULTS: Preoperative demographics were well matched between groups with no significant difference in logistic Euroscore (manual vs automated: median 3.1, interquartile range, IQR, 2.1-5.5, vs 5.4, IQR 2.2-8.3; P = 0.07, respectively). Comparing manually tied knots to an automated fastener, cardiopulmonary bypass and aortic cross clamp times were significantly shorter in the automated group (cardiopulmonary bypass: median 200 minutes, IQR 180-227, vs 165 minutes (IQR 145-189 minutes), P < 0.001; aortic cross clamp 134 minutes (IQR 121-150 minutes) vs 111 minutes (IQR 91-137 minutes), P < 0.001, respectively). There was no mortality and no strokes, nor were there any differences in postoperative outcomes including reoperation for bleeding, renal failure, intensive care or hospital stay. CONCLUSIONS: The use of an automated knot fastener significantly reduces cardiopulmonary bypass and aortic cross clamp times in minimally invasive mitral valve repair but this does not translate into an improved clinical outcome.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Técnicas de Sutura/instrumentação , Idoso , Procedimentos Cirúrgicos Cardíacos/instrumentação , Ponte Cardiopulmonar/efeitos adversos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Reoperação/estatística & dados numéricos , Resultado do Tratamento
16.
Semin Pediatr Surg ; 28(2): 111-114, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31072458

RESUMO

Omphaloceles are ventral abdominal wall defects that are associated with significant other anomalies in up to 80% of cases in some descriptions. Of these abnormalities, Cardiac defects are some of the more common ones, and have the most substantial impact on outcomes and survival. In cases with a severe congenital heart defect (CHD), the omphalocele management changes significantly. This article addresses the common defects seen, and their management issues.


Assuntos
Anormalidades Múltiplas , Cardiopatias Congênitas , Hérnia Umbilical , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/embriologia , Anormalidades Múltiplas/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/embriologia , Cardiopatias Congênitas/cirurgia , Hérnia Umbilical/diagnóstico , Hérnia Umbilical/embriologia , Hérnia Umbilical/cirurgia , Herniorrafia/métodos , Humanos , Recém-Nascido
17.
Mymensingh Med J ; 28(2): 474-478, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086170

RESUMO

Ventricular septal rupture (VSR) is an uncommon but lethal complication of acute myocardial infarction (MI). Although early surgical closure is the treatment of choice, hospital mortality after emergency surgery remains high. Transcatheter closure of post myocardial infarction ventricular septal defect (PIVSD) has emerged as a potential treatment option in selected cases. Herein, we report a case present in AFC Health FORTIS Heart Institute, Khulna, Bangladesh on 10 February 2017 of sub acute post-MI VSR that was successfully closed using an Amplatzerseptal occlude (ASD) device. The patient had undergone primary percutaneous coronary intervention (PCI) 15 days earlier in the setting of acute MI.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Ruptura Cardíaca Pós-Infarto/etiologia , Comunicação Interventricular/etiologia , Comunicação Interventricular/cirurgia , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/cirurgia , Humanos , Intervenção Coronária Percutânea , Próteses e Implantes , Dispositivo para Oclusão Septal , Resultado do Tratamento , Ruptura do Septo Ventricular/complicações , Ruptura do Septo Ventricular/etiologia
18.
Pan Afr Med J ; 32: 55, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31143360

RESUMO

In recent years, low-dose, short-acting anesthetic agents, which replaced the former high-dose opioid regimens, offer a faster postoperative recovery and decrease the need for mechanical ventilatory support. In this study, the aim was to determine the success rate of fast-track approach in surgical procedures for congenital heart disease. There is some evidence, mostly from retrospective analyses, that fast tracking can be beneficial. Ninety-one cases with moderate complex cardiac malformations were operated with fast-track protocol during cardiothoracic charitable missions. The essential aspects of early extubation in our cohort included: selected patients with good preoperative status, good surgical result with hemodynamic stability in low dose of inotropic drugs at the end of bypass, no active bleeding. In this setting a carefull choice and dosing of anesthetic agents, alongside a good postoperative analgesia are mandatory. The authors found that an early extubation (< 4 hours) can be both effective and safe as it reduces intubation and ventilator times without increasing post-operative complications in pediatric congenital heart disease. This study supports a wider use of fast-track extubation protocols in paediatric patients submitted for congenital cardiac surgery in developing countries.


Assuntos
Extubação/métodos , Anestésicos/administração & dosagem , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/cirurgia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Países em Desenvolvimento , Feminino , Humanos , Lactente , Intubação Intratraqueal/métodos , Masculino , Missões Médicas , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo
19.
World J Pediatr Congenit Heart Surg ; 10(3): 313-320, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31084304

RESUMO

BACKGROUND: Pulmonary vascular supply in tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCAs) is highly variable. Our approach to surgical management of this condition emphasizes early repair including unifocalization and reconstruction of the pulmonary circulation, incorporating all lung segments and addressing stenoses both proximal to and within the lung, in addition to ventricular septal defect closure. At our institution, we have over 15 years of experience using lung perfusion scintigraphy (LPS) to assess the distribution of pulmonary blood flow after complete unifocalization and repair. METHODS: We reviewed clinical and quantitative LPS data in 310 patients who underwent complete unifocalization and repair of TOF/MAPCAs from 2003 to 2018 at our institution. Postrepair relative lung perfusion distributions were determined from LPS initially obtained at our institution within 60 days after repair and thereafter. RESULTS: Total lung perfusion to the right and left lungs was 58.0% ± 14.2% and 42.0% ± 14.2%, respectively. Perfusion was balanced in 75% of patients and unbalanced in 25%, including 11% in whom it was extremely unbalanced. On multivariable analysis, older age at repair, surgery other than a single-stage complete unifocalization, and native anatomy consisting of unilateral pulmonary blood supply through a ductus arteriosus were associated with unbalanced perfusion. CONCLUSION: We present our experience using LPS as an outcome measure after surgical repair of TOF/MAPCAs. Balanced lung perfusion was present in the majority of patients who had complete repair of TOF/MAPCAs performed at our center.


Assuntos
Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Circulação Colateral/fisiologia , Artéria Pulmonar/cirurgia , Circulação Pulmonar/fisiologia , Tetralogia de Fallot/cirurgia , Cintilografia de Ventilação/Perfusão/métodos , Idoso , Aorta Torácica/diagnóstico por imagem , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Artéria Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/fisiopatologia
20.
World J Pediatr Congenit Heart Surg ; 10(3): 360-363, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31084306

RESUMO

Anomalous origin of a coronary artery from the opposite aortic sinus of Valsalva can present in various ways, ranging from a benign and incidental finding to sudden cardiac death. The variant with an intraseptal subpulmonary course (sometimes referred to as intraconal), is widely perceived to carry a low risk of ischemia and has been considered to be a benign variant, not requiring surgical treatment. In one of our recent patients, however, nuclear scintigraphy highlighted a myocardial perfusion deficit in the territory supplied by the allegedly benign anomalous coronary artery, prompting the need for a more aggressive surgical approach.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Circulação Coronária/fisiologia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Criança , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/cirurgia , Ecocardiografia , Humanos , Masculino , Tomografia Computadorizada por Raios X
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