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1.
J Thorac Cardiovasc Surg ; 159(4): 1466-1476.e2, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31926718

RESUMO

OBJECTIVES: Optimal management of tetralogy of Fallot in symptomatic neonates and young infants remains controversial. METHODS: A retrospective review of 53 patients (26 male) with symptomatic tetralogy of Fallot who underwent primary repair (group 1, n = 22) or initial palliation (group 2, n = 31) within 2 months (60 days) after birth between 2005 and 2018 was performed. Subsequent repairs were performed in 29 patients at postpalliation 7.1 months in group 2 except for 2 interstage mortalities. Optimal early outcome was defined as no significant pulmonary stenosis or significant pulmonary regurgitation, and no reintervention within 12 months after repair. RESULTS: In group 2, median Z-score of the pulmonary valve annulus and McGoon ratio increased after palliation from -3.52 to -2.95 (P = .074) and from 1.31 to 1.93 (P < .001), respectively. Pulmonary annulus preservation at repair and optimal early outcome were achieved in 38 patients (17/22, 77%, group 1; 21/29, 72%, group 2) and 26 patients (12/22, 55%, group 1; 14/29, 48%, group 2), respectively. On logistic regression analysis, initial Z-score of the pulmonary valve annulus was the only predictor of annulus preservation at repair (odds ratio, 1.715, P = .0204) and optimal early outcome (odds ratio, 1.583, P = .0259). The annulus preservation probability curve according to the initial postnatal Z-score of the pulmonary valve annulus of all patients with repair (n = 51) showed an annulus preservation probability less than 70% in 3 patients (3/22) in group 1 and greater than 85% in 8 patients (8/29) in group 2, signifying that the alternative strategy might have been beneficial for each subset. CONCLUSIONS: The surgical strategy for symptomatic tetralogy of Fallot should be individualized according to the initial size of the pulmonary valve annulus.


Assuntos
Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Modelos Logísticos , Masculino , Cuidados Paliativos , Reoperação , Estudos Retrospectivos , Taxa de Sobrevida , Tetralogia de Fallot/mortalidade , Resultado do Tratamento
2.
Int J Cardiovasc Imaging ; 36(4): 691-700, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31907684

RESUMO

Aortopathy is a recognized comorbidity of Tetralogy of Fallot (TOF). Aortic flow in children with repaired TOF is abnormal despite normal aortic valve anatomy and early surgical repair that results in aortic size normalization. The purpose of this study was to investigate the flow hemodynamics inside the left ventricle (LV) of children with repaired TOF using 4D-Flow MRI derived vorticity. Vorticity is the spatial derivative of flow velocity and is sensitive to anatomic and geometric variations. Vorticity was calculated inside the LV of children with repaired TOF having normal aortic size (n = 14) and normal controls (n = 10) during systolic ejection phase. All subjects underwent comprehensive biventricular analysis including the MRI based feature-tracking based LV strain analysis and mechanical dyssynchrony. Right ventricular (RV) volumetric indices along with LV mechanical indices were correlated with LV vorticity. All TOF patients had supraphysiologic helical flow in the ascending aorta. The generated peak systolic vorticity integrated over the LV volume was elevated in TOF group compared to control (median: 1344 vs. 858 s-1, P < 0.001). TOF patients had increased LV mechanical dyssynchrony (47 ± 11 vs. 32 ± 7 ms, P < 0.001) and reduced LV global circumferential strain (19 ± 2 vs. 21 ± 2%, P = 0.020). In the TOF group, LV systolic vorticity was independent of RV size and LV mechanical indices. Pathologic aortic flow in children with repaired TOF is associated with abnormal ejection flow patterns inside the LV. Increased systolic vorticity was not associated with LV mechanical dyssynchrony and RV dilation, suggesting that systolic flow inside the LV is independent of impaired LV contractile mechanics and inter-ventricular interactions.


Assuntos
Aorta/fisiopatologia , Doenças da Aorta/fisiopatologia , Procedimentos Cirúrgicos Cardíacos , Hemodinâmica , Tetralogia de Fallot/cirurgia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda , Adolescente , Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Velocidade do Fluxo Sanguíneo , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Feminino , Humanos , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/fisiopatologia , Imagem Cinética por Ressonância Magnética , Masculino , Imagem de Perfusão do Miocárdio/métodos , Estudos Retrospectivos , Fatores de Risco , Sístole , Tetralogia de Fallot/complicações , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Direita , Remodelação Ventricular
3.
BMC Pregnancy Childbirth ; 19(1): 486, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823779

RESUMO

BACKGROUND: Tetralogy of Fallot (TOF) is a severe type of congenital heart disease (CHD) and it confers substantial risk to mother and fetus for pregnant women. However, the outcome of pregnancy in women with TOF has not been well studied. METHODS: Women with TOF who have been seen and/or delivered at our tertiary-care hospital between April 2008 and January 2018 were retrospective reviewed. RESULTS: A total of 31 pregnant women with TOF were identified during ten-year period. Among these patients, cardiac defects remained uncorrected in 12 women and were surgically repaired in 19 women. The frequency of miscarriages, premature birth, and the percentage of neonates of small for gestational age (SGA) were greater in the uncorrected group than the surgically repaired group (16.67% vs 0, 50% vs 5.26, 41.67% vs 10.53% respectively). The neonatal mortality and fetal mortality were not observed in the surgically repaired group, but were observed in the uncorrected group [3.23% (1/31) and 6.45(2/31) respectively]. Furthermore, the obstetric and cardiac complications in the two groups were stratified and analyzed. CONCLUSIONS: Surgical correction of TOF is associated with improved maternal and perinatal outcome. However, pregnancy in women with uncorrected TOF was still seen and it was observed at a rate of 1.4/10,000 in our medical center during ten year period. The high degree of ventricular dilatation heart, high functional classifications, serious cardiac arrhythmias and pulmonary hypertension appeared to be associated with maternal and neonatal risks.


Assuntos
Complicações na Gravidez/etiologia , Resultado da Gravidez , Tetralogia de Fallot , Adulto , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia
4.
Am J Cardiol ; 124(11): 1780-1784, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586531

RESUMO

Patients with tetralogy of Fallot (TOF) have abnormal right ventricular (RV) afterload because of residual or recurrent outflow tract obstruction, often with abnormal pulmonary artery (PA) vascular function. The purpose of this study was to determine if RV afterload was independently associated with death and/or heart transplant in patients with TOF. This is a retrospective study of TOF patients that underwent cardiac catheterization for clinical indications at Mayo clinic between 1990 and 2015. Invasively measured RV systolic pressure (RVSP) was used to define RV afterload. To explore clinical utility for echocardiographic estimates of invasive data, correlations between invasive and Doppler-derived indices of RV afterload were examined. Among 266 patients with TOF (age 35 ± 14 years, TOF-pulmonary atresia 117 [44%]), RVSP was 72 ± 28 mm Hg, PA systolic pressure 45 ± 19 mm Hg, mean PA pressure 27 ± 10 mm Hg, pulmonary vascular resistance 4.2 ± 3.1 WU, and PA wedge pressure 14 ± 5 mm Hg. Over a mean follow up of 12.9 years, there were 35 deaths and 4 heart transplants. Invasively measured RVSP (hazard ratio 1.25, 95% confidence interval 1.12 to 1.37; p <0.001) and TOF-pulmonary atresia (hazard ratio 1.18, 95% confidence interval 1.08 to 1.41; p = 0.023) were independent risk factors for death and/or transplant. Doppler-derived RVSP was well-correlated with invasive RVSP (r = 0.92, p <0.001), and was also independently associated with the combined end point. RVSP, a composite measure of RV afterload, is independently prognostic in patients with TOF, and can be reliably assessed using Doppler echocardiography. Further study is required to test whether interventions to reduce RVSP can improve outcomes in patients with TOF.


Assuntos
Previsões , Ventrículos do Coração/fisiopatologia , Tetralogia de Fallot/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita/fisiologia , Cateterismo Cardíaco , Pré-Escolar , Ecocardiografia Doppler , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Volume Sistólico , Tetralogia de Fallot/complicações , Tetralogia de Fallot/diagnóstico , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/etiologia
6.
Anesth Prog ; 66(3): 159-161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31545670

RESUMO

This is a case report of a 21-year-old male patient with Cornelia de Lange syndrome (CdL) and unrepaired tetralogy of Fallot scheduled for dental treatment under general anesthesia. Anticipated dental care consisted of restorative treatment and extractions. Surgical correction of the patient's congenital cardiac abnormalities had not occurred by the time of dental treatment. As such, the developed anesthetic plan included the following goals: prevention of any anoxic episodes or spell and preparation for difficult airway management due to micrognathia secondary to CdL. To help ensure adequacy of oxygenation during induction, the normal anesthetic face mask was specially modified with a hole to permit use of the fiberoptic scope during induction and intubation. With preoperative consultation involving a cardiologist as well as the use of the modified mask, general anesthesia was safely administered without any complications.


Assuntos
Síndrome de Cornélia de Lange , Cárie Dentária , Tetralogia de Fallot , Anestesia Geral , Síndrome de Cornélia de Lange/complicações , Cárie Dentária/terapia , Humanos , Intubação Intratraqueal , Masculino , Tetralogia de Fallot/complicações , Adulto Jovem
8.
J Pak Med Assoc ; 69(9): 1383-1384, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511731

RESUMO

Aggregatibacter aphrophilus and Beta haemolytic Streptococci Lancefield group F are part of the normal oral flora and are known to cause endocarditis, sinusitis, empyema, meningitis and septic arthritis. They are now emerging as a cause of brain abscess particularly in patients with congenital heart diseases. We report a case of a 10-year-old boy with Tetralogy of Fallot (TOF), who presented with fever, headache and drowsiness. Culture yielded the growth of Aggregatibacter aphrophilus and Beta hemolytic streptococci Lancefield group F. He became clinically stable after treatment with ceftriaxone.


Assuntos
Abscesso Encefálico/complicações , Coinfecção/complicações , Infecções por Pasteurellaceae/complicações , Infecções Estreptocócicas/complicações , Tetralogia de Fallot/complicações , Aggregatibacter aphrophilus , Antibacterianos/uso terapêutico , Abscesso Encefálico/microbiologia , Abscesso Encefálico/terapia , Ceftriaxona/uso terapêutico , Criança , Coinfecção/microbiologia , Coinfecção/terapia , Craniotomia , Técnicas de Cultura , Humanos , Masculino , Infecções por Pasteurellaceae/microbiologia , Infecções por Pasteurellaceae/terapia , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia , Streptococcus milleri (Grupo) , Tomografia Computadorizada por Raios X
9.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352379

RESUMO

We report the case of a patient diagnosed with extreme tetralogy of Fallot who received subclavian-pulmonary artery shunt at the age of 3 years and underwent corrective surgery at the age of 16 years. The patient developed progressive effort dyspnea and left ventricular dysfunction from the age of 40 years. The exploratory finding of a continuous jugular and left subclavian murmur prompted an echocardiographic study that evidenced a continuous flow in the suprasternal view. CT study confirmed the patency of the surgical subclavian-pulmonary artery shunt, which was percutaneously embolised with the implantation of an Amplatzer plug, with a good final outcome and no residual flow. The patient showed a satisfactory development with clinical improvement, decreased left ventricular volume and enhanced left ventricular function.


Assuntos
Procedimento de Blalock-Taussig , Dispneia/etiologia , Embolização Terapêutica , Tetralogia de Fallot/complicações , Grau de Desobstrução Vascular/fisiologia , Disfunção Ventricular Esquerda/etiologia , Adulto , Eletrocardiografia , Humanos , Masculino , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Artéria Subclávia/fisiopatologia , Artéria Subclávia/cirurgia , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/cirurgia
10.
J Cardiothorac Surg ; 14(1): 99, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159878

RESUMO

BACKGROUND: There is great discussion about non-confluent pulmonary artery (PA) reconstruction, and several materials have been used. Autologous pericardium is considered feasible for infectious resistance, autoimmune response, extensibility, and growth potential. CASE PRESENTATION: The patient was born at 39 weeks (body mass = 2550 g). He was diagnosed with tetralogy of Fallot, pulmonary atresia, non-confluent PA, and bilateral patent ductus arteriosus. Right and left Blalock-Taussig shunts with patent ductus arteriosus ligations were placed on day 27 and 3 months, respectively. At 19 months (8.8 kg), definitive repair was performed with tricuspid valved conduit concurrent with PA reconstruction using an autologous pericardium roll conduit. The autologous pericardium was treated with glutaraldehyde (autologous pericardium fixed with 0.4% glutaraldehyde for 7 min and rolled as conduit - 12 mm in diameter and 30 mm in length). Following an incision on the visceral side of the PAs before the 1st branch, the autologous pericardial roll conduit was anastomosed. Follow-up angiographies on postoperative months 9 and 57 demonstrated that the PA, including the autologous pericardium roll conduit, had spontaneously enlarged. CONCLUSION: Particularly for non-confluent PA, the patients require increased pulmonary beds at an early age because of hypoplastic PA. While size mismatch between the graft and native PA develops as the child grows, size-adjustable extensibility of the PA graft should be noted.


Assuntos
Pericárdio/transplante , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Anormalidades Múltiplas/cirurgia , Pré-Escolar , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/cirurgia , Humanos , Lactente , Masculino , Artéria Pulmonar/anormalidades , Atresia Pulmonar/complicações , Atresia Pulmonar/cirurgia , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia , Transplante Autólogo
11.
Cardiol Young ; 29(6): 845-846, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159910

RESUMO

Correction of tetralogy of Fallot during infancy usually eliminates the risks associated with general anaesthesia. In rare cases of uncorrected defects persisting into adulthood, anaesthetic management during non-cardiac surgery may therefore be challenging. We describe the use of continuous spinal anaesthesia to successfully circumvent the operative risk of major abdominal surgery in an adult patient with uncorrected tetralogy of Fallot.


Assuntos
Raquianestesia/métodos , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Tetralogia de Fallot/complicações , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Gástricas/complicações , Tetralogia de Fallot/diagnóstico
13.
Can J Cardiol ; 35(6): 721-726, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31151707

RESUMO

BACKGROUND: Lesion complexity and prosthetic valves are known risk factors for infective endocarditis in patients with congenital heart disease. Tetralogy of Fallot (TOF) is the most common complex/cyanotic congenital heart disease and often requires prosthetic valve implantation. Population-based risk of endocarditis in TOF patients is unknown. METHODS: We reviewed the National Inpatient Sample (NIS) and identified admissions in TOF patients (>18 years), 2000 to 2014. The primary outcome was to describe incidence of endocarditis-related admissions. To assess trends, we divided the study period into tertiles: early (2000 to 2004), mid (2005 to 2009) and late (2010 to 2014) eras. The secondary outcome was to compare in-hospital mortality, complications, and health care resource utilization between admissions with and without endocarditis. RESULTS: There were 393 (2.1%) endocarditis-related admissions among 18,353 admissions, and the incidence of endocarditis-related admissions increased over time: 1.9% (early era) vs 2.2% (mid-era) vs 2.4% (late era), P < 0.001. Overall in-hospital mortality was 6%. In addition to previously described risk factors for endocarditis, such as previous pacemaker/defibrillator or prosthetic valve implantation, we observed an association between endocarditis-related admissions and male gender, black race, and lower socioeconomic class. In comparison with admissions without endocarditis, the endocarditis-related admissions had higher in-hospital mortality, complications, and health care resource utilization measured by length of stay, inflation-adjusted hospitalization cost, and type of hospital discharge. CONCLUSIONS: Incidence of endocarditis-related admissions increased over time and was associated with higher mortality, complications, and health care resource utilization. Further studies are required to investigate the observed temporal increase in incidence of endocarditis and explore new strategies to improve outcomes.


Assuntos
Endocardite/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Tetralogia de Fallot/complicações , Adulto , Bases de Dados Factuais , Endocardite/economia , Endocardite/etiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Hospitalização/economia , Hospitalização/tendências , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Tetralogia de Fallot/epidemiologia , Estados Unidos/epidemiologia
14.
Interact Cardiovasc Thorac Surg ; 29(4): 625-631, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31177278

RESUMO

OBJECTIVES: The timing for pulmonary valve replacement (PVR) after tetralogy of Fallot repair is controversial, due to limitations in estimating right ventricular dysfunction and recovery. Intraoperative imaging could add prognostic information, but transoesophageal echocardiography is unsuitable for exploring right heart function. Right ventricular function after PVR was investigated in real time using a novel video-based contactless kinematic evaluation technology (Vi.Ki.E.), which calculates cardiac fatigue and energy consumption. METHODS: Six consecutive patients undergoing PVR at 13.8 ± 2.6 years (range 6.9-19.8) after the repair of tetralogy of Fallot were enrolled. Mean right ventricular end-diastolic and end-systolic volume at magnetic resonance imaging were 115.6 ± 16.2 ml/m2 and 61.5 ± 14.6 ml/m2, respectively. Vi.Ki.E. uses a fast-resolution camera placed 45 cm above the open chest, recording cardiac kinematics before and after PVR. An algorithm defines cardiac parameters, such as energy, fatigue, maximum contraction velocity and tissue displacement. RESULTS: There were no perioperative complications, with patients discharged in satisfactory clinical conditions after 7 ± 2 days (range 5-9). Vi.Ki.E. parameters describing right ventricular dysfunction decreased significantly after surgery: energy consumption by 45% [271 125 ± 9422 (mm/s)2 vs 149 202 ± 11 980 (mm/s)2, P = 0.0001], cardiac fatigue by 12% (292 671 ± 29 369 mm/s2 vs 258 755 ± 42 750 mm/s2, P = 0.01), contraction velocity by 54% (3412 ± 749 mm/s vs 1579 ± 400 mm/s, P = 0.0007) and displacement by 23% (27 ± 4 mm vs 21 ± 4 mm, P = 0.01). Patients undergoing PVR at lower end-diastolic volumes, had greater functional recovery of Vi.Ki.E. parameters. CONCLUSIONS: Intraoperative Vi.Ki.E shows immediate recovery of right ventricular mechanics after PVR with less cardiac fatigue and energy consumption, providing novel insights that may have a prognostic relevance for functional recovery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/cirurgia , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Disfunção Ventricular Direita/diagnóstico por imagem , Adolescente , Fenômenos Biomecânicos , Criança , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Projetos Piloto , Prognóstico , Insuficiência da Valva Pulmonar/complicações , Tetralogia de Fallot/complicações , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia , Adulto Jovem
15.
Echocardiography ; 36(7): 1434-1436, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31215683

RESUMO

An 8-year-old boy with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals status post complete repair including a fenestrated ventricular septal defect patch presented to the catheterization laboratory for fenestration closure. During the procedure, the catheterization wire was found to have an unusual intracardiac loop and was unable to be straightened within the heart. Three-dimensional transesophageal echocardiography revealed the wire was looped around a right ventricular papillary muscle. The wire was readjusted, and the fenestration was successfully closed. Three-dimensional imaging was essential in unambiguously defining the catheter course and assisting in fenestration closure.


Assuntos
Procedimentos Cirúrgicos Cardíacos/instrumentação , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Músculos Papilares/diagnóstico por imagem , Criança , Humanos , Masculino , Músculos Papilares/cirurgia , Atresia Pulmonar/complicações , Tetralogia de Fallot/complicações
17.
Cardiol Young ; 29(8): 1020-1024, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31208473

RESUMO

Elevated left ventricular end diastolic pressure is a risk factor for ventricular arrhythmias in patients with tetralogy of Fallot. The objective of this retrospective study was to identify echocardiographic measures associated with left ventricular end diastolic pressure >12 mmHg in this population. Repaired tetralogy of Fallot patients age ≥13 years, who underwent a left heart catheterisation within 7 days of having an echocardiogram were evaluated. Univariate comparison was made in echocardiographic and clinical variables between patients with left ventricular end diastolic pressure >12 versus ≤12 mmHg. Ninety-four patients (54% male) with a median age of 24.6 years were included. Thirty-four (36%) had left ventricular end diastolic pressure >12 mmHg. Patients with left ventricular end diastolic pressure >12mmHg were older (median 32.9 versus 24.0 years, p = 0.02), more likely to have a history of an aortopulmonary shunt (62% versus 38%, p = 0.03), and have a diagnosis of hypertension (24% versus 7%, p = 0.03) compared to those with left ventricular end diastolic pressure ≤12 mmHg. There were no significant differences in mitral valve E/A ratio, annular e' velocity, or E/e' ratio between patients with left ventricular end diastolic pressure >12 versus ≤12 mmHg. Patients with left ventricular end diastolic pressure >12mmHg had larger left atrial area (mean 17.7 versus 14.0 cm2, p = 0.03) and larger left atrium anterior-posterior diameter (mean 36.0 versus 30.6 mm, p = 0.004). In conclusion, typical echocardiographic measures of left ventricular diastolic dysfunction may not be reliable in tetralogy of Fallot patients. Prospective studies with the use of novel echocardiographic measures are needed.


Assuntos
Diástole , Ecocardiografia Doppler , Tetralogia de Fallot/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adolescente , Adulto , Cateterismo Cardíaco/efeitos adversos , Feminino , Humanos , Masculino , Curva ROC , Estudos Retrospectivos , Tetralogia de Fallot/cirurgia , Disfunção Ventricular Esquerda/etiologia , Adulto Jovem
18.
Cardiol Young ; 29(5): 684-688, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31118113

RESUMO

BACKGROUND: Residual right ventricular outflow obstruction during Tetralogy of Fallot repair necessitates peri-operative revision often requiring trans-annular patch with its negative sequels. Bidirectional Glenn shunt in this setting reduces trans-pulmonary gradient to avoid revision. METHODS: Bidirectional Glenn shunt was added during Tetralogy repair in patients with significant residual obstruction. A total of 53 patients between January, 2011 and June, 2018 were included. Final follow-up was conducted in July, 2018. RESULTS: Mean age at operation was 5.63±3.1 years. Right to left ventricular pressure ratio reduced significantly (0.91±0.09 versus 0.68±0.05; p<0.001) after bidirectional Glenn, avoiding revision in all cases. Glenn pressures at ICU admission decreased significantly by the time of ICU discharge (16.7±3.02 versus 13.5±2.19; p<0.001). Pleural drainage ≥ 7 days was seen in 14 (26.4%) patients. No side effects related to bidirectional Glenn-like facial swelling or veno-venous collaterals were noted. Mortality was 3.7%. Discharge echocardiography showed a mean trans-pulmonary gradient of 32.11±5.62 mmHg that decreased significantly to 25.64±5 (p<0.001) at the time of follow-up. Pulmonary insufficiency was none to mild in 45 (88.2%) and moderate in 6 (11.8%). Mean follow-up was 36.12±25.15 months (range 0.5-90). There was no interim intervention or death. At follow-up, all the patients were in NYHA functional class 1 with no increase in severity of pulmonary insufficiency. CONCLUSION: Supplementary bidirectional Glenn shunt significantly reduced residual right ventricular outflow obstruction during Tetralogy of Fallot repair avoiding revision with satisfactory early and mid-term results.


Assuntos
Técnica de Fontan , Tetralogia de Fallot/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Criança , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Valva Pulmonar/anormalidades , Insuficiência da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/congênito , Reoperação , Tetralogia de Fallot/complicações , Fatores de Tempo , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/complicações
20.
Pediatr Cardiol ; 40(5): 1009-1016, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31062060

RESUMO

Atrial flutter/fibrillation (AFL/AF) is a late complication in adults with repaired tetralogy of Fallot (TOF). Its effects on long-term prognosis are not fully understood. We evaluate the impact of AFL/AF in adults with repaired TOF on global mortality and unplanned hospitalizations during follow-up, and the predictors for AFL/AF occurrence. The presence of AFL/FA was analysed in all exams performed during the last 10 years of outpatients follow up in a unicentric cohort of repaired TOF between 1980 and 2003. Two-hundred and six patients were included; at a mean follow-up of 21 ± 8.2 years, there were 5 deaths (19.2%) in the AFL/AF group and 2 (1.1%) in those without arrhythmia (p < 0.001). Patients with AFL/AF where older at the time of the surgical repair (p < 0.001) and had a higher rate of reinterventions (p = 0.003). No differences were observed between the groups regarding the use of a transannular patch, ventriculotomy and previous palliative shunt. QRS duration was longer in patients with AFL/AF (174 ± 33.4) when compared to those without arrhythmia (147 ± 39.6; p < 0.0001). Age at surgery, QRS duration, and tricuspid regurgitation ≥ moderate were independent risk predictors for AFL/AF. In the multivariate analysis, atrial flutter/fibrillation and QRS duration were predictors of death and hospitalization. AFL/AF is associated with an increased risk of death and hospitalization during the follow-up of patients with repaired TOF. Early detection of AFL/AF and their predictors is an essential step in the evaluation of such population.


Assuntos
Fibrilação Atrial/etiologia , Flutter Atrial/etiologia , Ablação por Cateter/efeitos adversos , Tetralogia de Fallot/mortalidade , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Flutter Atrial/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia
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