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1.
J Cardiothorac Surg ; 15(1): 297, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008444

RESUMO

BACKGROUND: While the aneurysms of the membranous septum (AVS) are rare, the possibility that they lead to obstruction is even rarer. To the best of our knowledge, 11 similar cases have been reported since 1982. CASE PRESENTATION: Initially, the five-year-old boy was evaluated for dyspnoea that had been present since birth. He did not receive any medical treatment until the previous year. At the age of four, the transthoracic echocardiography showed a large aneurysm extending to the right ventricular outflow tract (RVOT) and causing RVOT stenosis. Complete surgical resection of the aneurysmal tissue was performed, and the boy was discharged home in satisfactory condition. CONCLUSIONS: As the occurrence of RVOT obstruction by a membranous ventricular septal aneurysm is very rare, we are reporting the second case in which an aneurysm of the membranous septum dynamically obstructed the RVOT in a child. We are also reviewing all the previously reported similar cases in the literature. Further studies are needed to obtain a more comprehensive understanding of aneurysms of the membranous septum (AVS).


Assuntos
Aneurisma Cardíaco/cirurgia , Cardiopatias Congênitas/cirurgia , Comunicação Interventricular/cirurgia , Septo Interventricular/cirurgia , Pré-Escolar , Dispneia/etiologia , Ecocardiografia , Aneurisma Cardíaco/complicações , Cardiopatias Congênitas/complicações , Comunicação Interventricular/complicações , Ventrículos do Coração , Humanos , Masculino
3.
J Card Surg ; 35(7): 1740-1742, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32484973

RESUMO

BACKGROUND AND AIMS: Lipomatous hypertrophy of the interatrial septum is an uncommon type of cardiac adipose tumor. It is extremely rare for these lesions to be located in the interventricular septum. METHODS: We report this case of incidentally diagnosed lipomatous hypertrophy of the interventricular septum with right ventricular outflow obstruction which caused minimal symptoms and Wolff-Parkinson-White pattern on EKG. CONCLUSION: We also discuss the diagnosis and management of this condition.


Assuntos
Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Lipoma/diagnóstico , Lipoma/cirurgia , Neoplasias Lipomatosas/diagnóstico , Neoplasias Lipomatosas/cirurgia , Septo Interventricular/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana , Eletrocardiografia , Feminino , Neoplasias Cardíacas/patologia , Humanos , Hipertrofia , Lipoma/patologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Lipomatosas/patologia , Resultado do Tratamento , Septo Interventricular/patologia , Síndrome de Wolff-Parkinson-White
4.
Braz J Cardiovasc Surg ; 35(1): 113-116, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32270968

RESUMO

A 30-month-old male patient with transposition of the great arteries with intact ventricular septum (TGA/IVS) is presented. Arterial switch operation (ASO) was performed in the light of echocardiographic and angiographic findings. The patient remained under extracorporeal membrane oxygenation support for seven days postoperatively, and his cardiac functions returned to normal at the postoperative 10th day. He was discharged at the postoperative 20th day. The present case, which presents one of the most advanced ages at operation for TGA/IVS among previously reported cases, is used to discuss late ASO in this study.


Assuntos
Transposição das Grandes Artérias , Oxigenação por Membrana Extracorpórea , Transposição dos Grandes Vasos , Septo Interventricular , Pré-Escolar , Humanos , Masculino , Resultado do Tratamento , Septo Interventricular/cirurgia
5.
Ann Thorac Surg ; 110(4): e327-e329, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32224240

RESUMO

Conjoined twins are rare congenital malformations known to be associated with cardiac abnormalities. Management of transposition of the great arteries with an intact ventricular septum in this subgroup of patients is challenging, especially in the presence of multiple comorbidities. Prevention of left ventricular involution until the patient is stable for an arterial switch operation is a real challenge. We report a case of early ductal stenting to keep the left ventricle well trained in a separated conjoined twin who eventually underwent an arterial switch operation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças em Gêmeos , Stents , Transposição dos Grandes Vasos/cirurgia , Gêmeos Unidos , Função Ventricular Esquerda/fisiologia , Septo Interventricular/cirurgia , Pré-Escolar , Humanos , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Transposição dos Grandes Vasos/diagnóstico , Septo Interventricular/diagnóstico por imagem
8.
Am Heart J ; 221: 159-164, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31937404

RESUMO

BACKGROUND: Septal myectomy remains the criterion standard for treatment of symptomatic, medically refractory hypertrophic cardiomyopathy (HCM). There is no specific surgical risk calculator for septal myectomy. METHODS: This study compares the outcomes of septal myectomy at a tertiary referral center with predicted outcomes of mitral valve (MV) repair and aortic valve replacement (AVR) using the Society of Thoracic Surgeons Adult Cardiac Surgery Risk Calculator (STS Calculator). A total of 298 consecutive patients with HCM underwent isolated septal myectomy from 2011 to 2014. Observed outcomes of septal myectomy were compared with the STS Calculator predicted risk of isolated MV repair and AVR predicted within this population using 1-sample tests of proportions. RESULTS: Thirty-day mortality for myectomy in this cohort was zero. STS Calculator predicted risk of mortality for MV repair was 0.7% (P = .14) and for AVR = 1.1% (P = .06). Follow-up for vital status was 6.0 ±â€¯0.7 years, at which 294 (98.7%) patients were alive. Hospital stay length was 4.9 ±â€¯1.9 days. One (0.3%) patient experienced a postoperative deep sternal wound infection, and 1 (0.3%) patient experienced a prolonged ventilated state. Postoperative atrial fibrillation occurred in 64 (21.5%) patients. During 30 days of follow-up, no patients experienced stroke, renal failure, or needed dialysis. CONCLUSIONS: Septal myectomy, performed in a tertiary referral center, had a 30-day mortality rate of 0% and low morbidity rate. There was no difference between observed myectomy mortality and STS Calculator predicted risk for AVR and MV repair. It is possible that a larger sample could reveal lower mortality than STS prediction.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica/cirurgia , Mortalidade Hospitalar , Complicações Pós-Operatórias/epidemiologia , Insuficiência Renal/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Septo Interventricular/cirurgia , Adulto , Idoso , Valva Aórtica/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Anuloplastia da Valva Mitral , Prognóstico , Respiração Artificial , Medição de Risco , Infecção da Ferida Cirúrgica/epidemiologia
9.
J Thorac Cardiovasc Surg ; 159(5): 1936-1940, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31810644

RESUMO

OBJECTIVES: Interventricular septal hematoma (IVSH) is a rare complication, which may result from ventricular septal defect (VSD) repair. IVSH can result in conduction and/or hemodynamic abnormalities related to impaired ventricular filling or outflow tract obstruction. We report the novel use of extracorporeal membrane oxygenation (ECMO) for management. METHODS: Echocardiography reports (January 1980 to December 2016) were searched for the term "hematoma" in our institutional database and reviewed to determine appropriate cases. Charts and imaging (reports) data were abstracted. All intraoperative and select postoperative echocardiograms were reread by a pediatric cardiologist. RESULTS: N = 12 patients with IVSH. Mean age and weight at surgery were 59 ± 41 days and 3.4 (2.9-5.1) kg, respectively, while the most frequent diagnosis was tetralogy of Fallot. Although all patients had intraoperative transesophageal echocardiography (TEE), only 55% (6 of 11, missing [m] = 1) of IVSH were discovered intraoperatively. Of the 5 patients not discovered intraoperatively (m = 1), IVSH was postoperatively detected secondary to arrhythmia/decompensation by echocardiogram 10.1 ± 7.9 hours postoperatively. Five patients (42%) were managed with ECMO (1 unable to separate from bypass). Overall mortality was 33%. For patients in whom ECMO was used, 2 of 5 (40%) survived. Mean time to IVSH resolution in all survivors was 20 ± 185 days. CONCLUSIONS: IVSH from VSD repair can result in clinical decompensation and mortality. This may relate to the high proportion missed intraoperatively. ECMO should be considered an important modality, which can allow for IVSH resolution. However, considerations must be made to allow for appropriate anticoagulation to avoid hematoma expansion and repeat imaging during ECMO to continually assess the interventricular septum.


Assuntos
Oxigenação por Membrana Extracorpórea , Comunicação Interventricular/cirurgia , Hematoma/terapia , Complicações Pós-Operatórias/terapia , Ecocardiografia Transesofagiana , Oxigenação por Membrana Extracorpórea/mortalidade , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Hematoma/mortalidade , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Septo Interventricular/cirurgia
10.
Am J Cardiol ; 125(1): 120-126, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31727261

RESUMO

Atrial fibrillation (AF) has important clinical consequences in hypertrophic cardiomyopathy (HC). Safety and efficacy of the Cox-Maze IV procedure (when combined with ventricular septal myectomy) in patients with obstructive HC and paroxysmal AF is largely unresolved. Records of 395 consecutive HC patients (age 55 ± 13 years) who underwent septal myectomy for heart failure symptoms between 2004 and 2015 were reviewed. Sixty-two patients also had concomitant complete biatrial Cox-Maze IV for a history of symptomatic paroxysmal AF (3.0 ± 3.6 episodes) combined with myectomy comprise the study cohort. Freedom from symptomatic AF recurrences after operation was assessed. Left ventricular outflow gradients were reduced from 81 ± 28 mm Hg preoperatively to 1.2 ± 6.8 mm Hg after operation. At most recent follow-up, 53 patients (85%) were asymptomatic or mildly symptomatic. Freedom from recurrent symptomatic AF after myectomy/Cox-Maze IV was: 85% (95% confidence interval [CI] 73, 92) at 1 year, 69% (95% CI 55, 79) at 3 years, and 64% (95% CI 48, 75) at 5 years, including 34 patients (54%) who have experienced no symptomatic AF episodes for up to 8.2 years following surgery. The only clinical predictor of recurrent AF over follow-up was preoperative transverse left atrial dimension ≥45 mm (p <0.01). In conclusion, biatrial Cox-Maze IV combined with septal myectomy is associated with favorable long-term freedom from symptomatic paroxysmal AF recurrence, as well as from obstructive heart failure symptoms. These data support myectomy/Cox-Maze as an effective management option for the subgroup of HC patients with symptomatic outflow obstruction and paroxysmal AF.


Assuntos
Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Septo Interventricular/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia , Septo Interventricular/diagnóstico por imagem , Adulto Jovem
11.
Cardiology ; 145(1): 53-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31747665

RESUMO

BACKGROUND: Percutaneous intramyocardial (PIM) septal radiofrequency ablation (SRA) is a novel treatment approach for hypertrophic obstructive cardiomyopathy patients, but there has been lack of a large animal model to study PIM-SRA. We aimed to validate the long-term safety and efficacy of PIM-SRA and to observe pathological changes of the ablated interventricular septum (IVS) in a healthy sheep model. METHODS AND RESULTS: Twelve sheep were randomized to the PIM-SRA group (n = 6) and the sham group (n = 6). In the PIM-SRA group, a radiofrequency (RF) electrode was inserted into the IVS with a maximum power of 80 W for 5 min. In the sham group, the RF electrode tip was positioned in the IVS segment but without RF power delivery. Septal hypokinesis was seen in all PIM-SRA group animals immediately after the procedure; the systolic wall thickening rate and motion amplitude of the ablated region decreased (p < 0.01), and the diastolic IVS thickness also decreased significantly over time (p < 0.01). ECG showed that all the sheep had normal sinus rhythm during the follow-up. Pathological examinations revealed scar tissue in the ablated region as expected. CONCLUSIONS: PIM-SRA produced precisely ablated myocardial tissue, reduced the IVS thickness significantly, preserved the global LV function, and avoided the incidence of conduction system damage in the long term. PIM-SRA was found to be a safe and effective minimally invasive septal reduction therapy.


Assuntos
Ablação por Cateter/métodos , Modelos Animais de Doenças , Ecocardiografia/métodos , Septo Interventricular/diagnóstico por imagem , Septo Interventricular/cirurgia , Animais , Eletrocardiografia/métodos , Distribuição Aleatória , Ovinos , Fatores de Tempo
13.
J Coll Physicians Surg Pak ; 29(11): 1087-1091, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31659968

RESUMO

Double-chambered left ventricle is a rare congenital heart defect. The clinical features, diagnosis, treatment and patient prognosis of this lesion have not been sufficiently elaborated. The present systematic review found that the accessory ventricular septum was often an abnormal muscle band, and sometimes a membranous structure, a fibromuscular ridge, or prominent trabeculations. Less than one-third of the patients are associated with other congenital heart defects. Diagnosis of double-chambered left ventricle can usually be made by transthoracic echocardiography; however, it might be misdiagnosed as atrial or ventricular septal defect. The accessory chamber was often smaller than the main chamber, and often has wall thinning. The accessory chamber wall dysfunction/hypokinesis was seen in half of the cases. One-third patients had left ventricular outflow tract obstruction. The adult patients showed abnormal electrocardiographic findings more than in pediatrics. Nevertheless, no differences were found between adult and pediatric patients in terms of left ventricular function and structure, treatment of choice, and patient outcomes. Most patients are asymptomatic with no left ventricular obstruction, and thus do not need surgical treatment. Surgical resection of the accessory ventricular septum is warranted when the patients become symptomatic as a result of left ventricular obstruction, or associated with other congenital heart defects. The patients' outcomes are promising. Differential diagnosis should be made from other types of left ventricular outpouching, other congenital heart defects, and left ventricular non-compaction.


Assuntos
Dupla Via de Saída do Ventrículo Direito/diagnóstico , Dupla Via de Saída do Ventrículo Direito/cirurgia , Adulto , Criança , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Humanos , Prognóstico , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/cirurgia , Septo Interventricular/cirurgia
14.
Rev Port Cardiol ; 38(7): 473-480, 2019 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31495717

RESUMO

INTRODUCTION: In obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA) can lead to gradient reduction and symptom improvement. We aimed to assess the efficacy and safety of ASA in a long-term outcome study. METHODS: We analyzed patients who underwent ASA over a seven-year period in a tertiary center. The primary echocardiographic endpoint was >50% reduction in left ventricular outflow tract (LVOT) gradient within a year of the procedure. The primary clinical endpoints were improvement in functional capacity and a combined endpoint of cardiac death and rehospitalization for cardiac cause. The follow-up period was 4.17±2.13 years. RESULTS: A total of 80 patients, mean age 63.9±12.3 years, 30.0% male, were analyzed. Baseline LVOT gradient was 96.3±34.6 mmHg and interventricular septal thickness was 21.6±3.1 mm. Minor complications were observed in 6.3% and major complications in 2.5%, and 8.8% received a permanent pacemaker. The primary echocardiographic endpoint was achieved by 85.7%. At three-month follow-up, LVOT gradient was 25.8±26.0 mmHg in the successful procedure group, compared to 69.2±35.6 mmHg in the other patients (p=0.001). At six months, LVOT gradient was 27.1±27.4 vs. 58.2±16.6 mmHg (p=0.024). Among 74 patients in NYHA class III/IV before the procedure, 57 (77%) improved to NHYA class I/II. The combined primary clinical endpoint (cardiac death and rehospitalization for cardiac cause) was observed in 27.5% (n=22). In the unsuccessful group, the combined endpoint was observed in 54.5%, compared to only 22.7% in the successful group. Only two patients died of cardiac causes. CONCLUSION: ASA is a safe procedure with a high success rate. Patients who achieved significant reductions in LVOT gradient suffered less cardiac death and rehospitalization for cardiac cause.


Assuntos
Técnicas de Ablação/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Etanol/farmacologia , Obstrução do Fluxo Ventricular Externo/cirurgia , Septo Interventricular/cirurgia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/etiologia , Septo Interventricular/diagnóstico por imagem
15.
Am J Cardiol ; 124(8): 1272-1278, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31447010

RESUMO

Alcohol septal ablation (ASA) and ventricular septal myectomy (VSM) are 2 options of ventricular septal reduction therapy (VSRT) for obstructive hypertrophic cardiomyopathy (HC). We hypothesized that patients with HC who underwent ASA have a higher risk of acute care use (i.e., emergency department [ED] visit or unplanned hospitalization) for cardiovascular disease (CVD) than VSM. We performed a comparative effectiveness study of ASA versus VSM (reference group) among patients with HC who underwent VSRT, using population-based ED and inpatient databases in 3 states, 2005 to 2014. The outcome was acute care use for CVD during a 2-year post-VSRT period. We constructed univariable and multivariable logistic regression models to compare the risk during sequential 6-month periods. We also performed sensitivity analysis with propensity score-matching at 1:1 ratio. We identified 850 patients with HC who underwent VSRT, including 393 with ASA and 457 with VSM. During 13 to 18 months after VSRT, there was a nonsignificantly higher risk with ASA than VSM (adjusted odds ratio [OR] 1.73; 95% confidence interval [CI] 0.83 to 3.60; p = 0.14). Patients who had ASA had a significantly higher risk in the 19 to 24 months post-VSRT period (adjusted OR 2.12; 95% CI 1.06 to 4.23; p = 0.03). Similarly, the propensity score-matched analysis demonstrated a higher risk with ASA than VSM during 13 to 18 months (OR 2.97; 95% CI 1.04 to 8.46; p = 0.04) and 19 to 24 months (OR 7.06; 95% CI 2.04 to 24.36; p = 0.002) after VSRT. In conclusion, among 850 patients with HC who underwent VSRT, the risk of acute care use for CVD was higher after ASA than VSM during the second post-VSRT year.


Assuntos
Técnicas de Ablação/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Etanol/farmacologia , Septo Interventricular/cirurgia , Adolescente , Adulto , Cardiomiopatia Hipertrófica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Heart Rhythm ; 16(9): 1421-1428, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31226487

RESUMO

BACKGROUND: The slow pathway region (SPR) is commonly targeted during ablation of atrioventricular nodal reentrant tachycardia. However, its role in idiopathic ventricular arrhythmias (IVAs) remains unknown. OBJECTIVE: The purpose of this study was to describe the electrocardiographic and electrophysiological characteristics of IVAs that were successfully ablated from the SPR. METHODS: Medical records of consecutive patients undergoing ablation of IVAs in the para-Hisian region between 2010 and 2018 were reviewed to identify subjects whose ventricular arrhythmias were targeted from the SPR. RESULTS: Among 63 patients with para-Hisian IVAs undergoing ablation, the SPR was targeted in 12 (20%; mean age 64 ± 7 years; 9 men). All patients presented with ventricular premature depolarizations manifesting left bundle branch block morphology with variable precordial transition (leads V2-V5) and a mean QRS duration of 131 ± 11 ms. In all cases, leads I and aVL had positive forces (R or Rs) and lead aVR had negative forces (QS or Qr). In the majority of cases, lead II had positive forces (R or Rs; n = 9 [75%]) and lead III had negative forces (rS or QS; n = 9 [75%]). Mean activation at the SPR was 31 ± 5 ms pre-QRS. All patients had initial ablation with radiofrequency, resulting in junctional rhythm in 9 (75%); 3 (25%) patients required additional cryoablation. Ablation was successful in 11 patients (92%). One patient required a permanent pacemaker for heart block but subsequently recovered intrinsic conduction. CONCLUSION: The SPR can be a source of IVAs, which can be safely and successfully ablated in most cases using radiofrequency energy. IVAs arising from this location manifest unique electrocardiographic features.


Assuntos
Fascículo Atrioventricular , Ventrículos do Coração/fisiopatologia , Taquicardia Ventricular , Fascículo Atrioventricular/fisiopatologia , Fascículo Atrioventricular/cirurgia , Eletrofisiologia Cardíaca , Ablação por Cateter/métodos , Eletrocardiografia/métodos , Fenômenos Eletrofisiológicos , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/cirurgia , Resultado do Tratamento , Septo Interventricular/fisiopatologia , Septo Interventricular/cirurgia
18.
Innovations (Phila) ; 14(3): 281-285, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31050323

RESUMO

Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During "minimally invasive endoscopic" and "robotic" mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.


Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Obstrução do Fluxo Ventricular Externo/prevenção & controle , Septo Interventricular/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Septo Interventricular/diagnóstico por imagem
20.
Eur J Cardiothorac Surg ; 56(5): 898-903, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30932159

RESUMO

OBJECTIVES: To review the long-term surgical outcomes of ventricular septation for double-inlet left ventricle and reconsider the possibility of ventricular septation as an option of surgical treatments. METHODS: Between 1978 and 1994, 22 patients with double-inlet left ventricle underwent ventricular septation. The mean age at operation was 5.3 years (range 0-22 years). Follow-up was carried out in 20 of 22 patients (91%) and the mean follow-up period was 14.7 years (range 0-39 years). RESULTS: Actuarial survival and reoperation-free survival rates at 30 years were 49% and 21%, respectively. To date, 8 patients have been followed up. Among them, atrioventricular valve replacement and permanent pacemaker were required in 4 and 7 patients, respectively. Late cardiac catheter examination at 25.5 years after surgery showed that the median cardiac index was 2.6 l/min/m2 (range 2.1-3.4 l/min/m2), left ventricular end-diastolic pressure was 7 mmHg (range 4-11 mmHg), left ventricular ejection fraction was 50% (range 27-63%), right ventricular ejection fraction was 53% (range 31-66%) and central venous pressure was 6 mmHg (range 4-11 mmHg). At the latest follow-up, the New York Heart Association Functional Classification was I for 5 patients, II for 2 patients and III for 1 patient. The median peak oxygen uptake was 52.9% (range 44.1-93.5%). CONCLUSIONS: Some patients with double-inlet left ventricle were able to maintain low central venous pressure and a sufficient cardiac index long after ventricular septation. Although the single ventricle strategy remains a first-line treatment, ventricular septation can be a surgical treatment option.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ventrículos do Coração/cirurgia , Septo Interventricular/cirurgia , Adolescente , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Coração Univentricular/cirurgia , Função Ventricular Esquerda/fisiologia , Adulto Jovem
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