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3.
Methodist Debakey Cardiovasc J ; 15(2): 133-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384376

RESUMO

Dextro-transposition of the great arteries (d-TGA) is a lethal congenital heart defect in which the great arteries-the pulmonary artery and aorta-are transposed to create ventriculoarterial discordance. Corrective surgical interventions have resulted in significant improvements in morbidity and mortality for this once-fatal congenital heart defect. The initial palliative surgery for d-TGA was the atrial switch operation, which provided physiological correction. The Mustard and Senning "atrial switch" procedures, in which an atrial baffle is created to produce a discordant atrioventricular connection on the existing discordant ventriculoarterial connection, showed preliminary success for the correction of d-TGA. However, follow-up evaluations demonstrated increasing complications from the right ventricle utilized as a systemic ventricle, resulting in progressive right ventricular dysfunction. Thus, the search continued for an anatomical correction of d-TGA to return the great arteries to their normal ventricular connections. The arterial switch operation (ASO), though attempted and theorized by many, was first successfully performed by Dr. Jatene and colleagues in 1975. For ASO, the distal main pulmonary artery and the distal ascending aorta are transected and then anastomosed to their respective ventricles with relocation of the coronary arteries to the neoaorta. The ASO has replaced the atrial switch operation since the 1980s and is now the standard surgical correction for d-TGA. As more patients who have undergone ASO are living into adulthood, late complications of this procedure have become more evident. The most common late postoperative complications include coronary artery stenosis, neoaortic root dilation, neoaortic insufficiency, and neopulmonic stenosis. Adults who have undergone ASO in childhood will need follow-up with surveillance imaging and evaluation of new symptoms or declining function to prevent and manage late postoperative complications. This review describes the management strategies for common late complications in patients who have undergone ASO.


Assuntos
Transposição das Grandes Artérias/efeitos adversos , Cuidados Paliativos , Complicações Pós-Operatórias/cirurgia , Transposição dos Grandes Vasos/cirurgia , Adulto , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Fatores de Risco , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição dos Grandes Vasos/fisiopatologia , Resultado do Tratamento
4.
Cardiol Young ; 29(8): 1104-1106, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347481

RESUMO

We present a case of pulmonary venous baffle obstruction in a child with a history of congenitally corrected transposition status post double switch repair. We highlight two forms of volume rendering three-dimensional reconstructions from computed tomographic data which allowed for detailed pre-surgical planning. These reconstructions emphasise the concept of maximizing previously obtained two-dimensional data in a time-efficient and cost-effective manner. The benefits of these reconstructions are reviewed, highlighting the relatively novel virtual dissection reconstruction technique that appeared identical to what the surgeon encountered in the operating theatre. This technique allowed the surgeon to quickly advance a preconceived detailed surgical repair.


Assuntos
Processamento de Imagem Assistida por Computador , Veias Pulmonares/cirurgia , Transposição dos Grandes Vasos/cirurgia , Dissecação , Feminino , Humanos , Imageamento Tridimensional , Lactente , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tomografia Computadorizada por Raios X , Transposição dos Grandes Vasos/diagnóstico por imagem
5.
Cardiol Young ; 29(7): 983-985, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31230600

RESUMO

A percutaneous transcatheter balloon dilation of a pulmonary venous pathway obstruction was successfully performed in a 40-year-old patient after a Mustard procedure. During the procedure, real-time three-dimensional trans-oesophageal echocardiography demonstrated the morphology of the obstruction. Our case highlights the usefulness of real-time three-dimensional trans-oesophageal echocardiography as a guide for transcatheter intervention in the increasing number of adults with CHD.


Assuntos
Angioplastia Coronária com Balão , Transposição das Grandes Artérias , Pneumopatia Veno-Oclusiva/diagnóstico por imagem , Pneumopatia Veno-Oclusiva/terapia , Transposição dos Grandes Vasos/complicações , Ultrassonografia de Intervenção , Adulto , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Humanos , Masculino , Pneumopatia Veno-Oclusiva/complicações , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição dos Grandes Vasos/cirurgia
7.
Radiología (Madr., Ed. impr.) ; 61(3): 262-265, mayo-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185299

RESUMO

La transposición congénitamente corregida de grandes arterias (TGAcc) implica una doble discordancia: atrio-ventricular y ventriculo-arterial. Presentamos las imágenes de resonancia magnética cardíaca de una paciente de 9 años con TGAcc, comunicación interventricular y coartación de aorta, a quien se le realizó cerclaje pulmonar, corrección de la coartación y posterior "doble switch". Se realiza una revisión de la patología y de las complicaciones a evaluar tras la intervención quirúrgica


Congenitally corrected transposition of the great vessels implies double discordance: atrioventricular and ventriculoarterial. We present cardiac magnetic resonance images from a 9-year-old girl with congenitally corrected transposition of the great vessels, interventricular communication, and coarctation of the aorta who was treated with pulmonary artery banding, correction of coarctation, and posterior double switch. We also review the disease and the complications that should be evaluated after the surgical intervention


Assuntos
Humanos , Feminino , Criança , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição das Grandes Artérias/métodos , Coartação Aórtica/diagnóstico por imagem , Transposição dos Grandes Vasos/cirurgia , Coartação Aórtica/cirurgia , Resultado do Tratamento
8.
Cardiol Young ; 29(5): 720-724, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31094305

RESUMO

BACKGROUND: Transposition of the great arteries is the most common cyanotic cardiac lesion in newborns. Transposition of the great arteries without surgical correction is fatal during the first year of life. Contemporary outcome studies have shown that survival rates after surgery are excellent and most patients live to adulthood. CASE SUMMARY: Woman with complex transposition of the great arteries with atrial and ventricular septal defects and subvalvular and valvular pulmonary stenosis, who has survived until the age of 31 years without surgery. The diagnosis was made by echocardiography and cardiac magnetic resonance. She underwent successful corrective surgical treatment after this age, by means of a Jatene operation. CONCLUSION: In transposition of the great arteries patients, a high index of cases dies in the first month of life. Our case represents a natural history of the complex transposition of the great arteries. Non-invasive imaging studies are very useful for the diagnosis and follow-up of patients with transposition of the great arteries, especially echocardiography and cardiac magnetic resonance. In our case, the multimodality approach and the corrective surgery allowed her to survive.


Assuntos
Transposição das Grandes Artérias , Comunicação Interventricular/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Transposição dos Grandes Vasos/diagnóstico por imagem , Adulto , Idade de Início , Ecocardiografia , Feminino , Comunicação Interventricular/cirurgia , Humanos , Imagem por Ressonância Magnética , Estenose da Valva Pulmonar/cirurgia , Transposição dos Grandes Vasos/cirurgia
9.
Ann Thorac Surg ; 108(3): 813-819, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30998905

RESUMO

BACKGROUND: Ductal stenting is performed to retrain involuted left ventricles (LVs) in patients with d-transposition of the great arteries and intact ventricular septum (TGA-IVS). However, its efficacy is largely unknown. This study aimed to determine the safety and efficacy of ductal stenting in retraining of the involuted LV in patients with TGA-IVS. METHODS: This was a single-center, retrospective study. Echocardiographic assessment of the LV geometry, mass, and free wall thickness was performed before stenting and before the arterial switch operation. Patients then underwent the arterial switch operation, and the postoperative outcomes were reviewed. RESULTS: There were 11 consecutive patients (male, 81.8%; mean age at stenting, 43.11 ± 18.19 days) with TGA-IVS with involuted LV who underwent LV retraining by ductal stenting from July 2013 to December 2017. Retraining by ductus stenting failed in 4 patients (36.3%). Two patients required pulmonary artery banding, and another 2 had an LV mass index of less than 35 g/m2. Patients in the successful group had improved LV mass index from 45.14 ± 17.91 to 81.86 ± 33.11g/m2 (p = 0.023) compared with 34.50 ± 10.47 to 20.50 ± 9.88 g/m2 (p = 0.169) and improved LV geometry after ductal stenting. The failed group was associated with an increased need for extracorporeal support (14.5% vs 50%, p = 0.012). An atrial septal defect-to-interatrial septum length ratio of more than 0.38 was associated with failed LV retraining. CONCLUSIONS: Ductal stenting is an effective method to retrain the involuted LV in TGA-IVS. A large atrial septal defect (atrial septal defect-to-interatrial septum length ratio >0.38) was associated with poor response to LV retraining.


Assuntos
Transposição das Grandes Artérias/métodos , Comunicação Interatrial/cirurgia , Stents , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição dos Grandes Vasos/cirurgia , Função Ventricular Esquerda/fisiologia , Centros Médicos Acadêmicos , Estudos de Coortes , Canal Arterial/diagnóstico por imagem , Canal Arterial/cirurgia , Ecocardiografia/métodos , Feminino , Seguimentos , Comunicação Interatrial/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Recém-Nascido , Malásia , Masculino , Segurança do Paciente , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Transposição dos Grandes Vasos/mortalidade
11.
World J Pediatr Congenit Heart Surg ; 10(2): 151-156, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30841837

RESUMO

BACKGROUND: Accurate coronary translocation is very important for a successful arterial switch operation (ASO) for transposition of the great arteries (TGA) and to provide good long-term outcomes. We have previously reported the "bay window" technique as a useful option for coronary translocation with excellent midterm results. However, the long-term results of this technique and the morphological changes in the coronary channel have not yet been reported. PATIENTS AND METHODS: Between September 2001 and December 2012, 33 patients with TGA underwent coronary translocation using the bay window technique concomitantly with ASO. The diagnoses were TGA with intact ventricular septum in 21, TGA with ventricular septal defect in 7, and Taussig-Bing anomaly in 5. The median age of the patients at operation was 12 days, and their median body weight was 2.93 kg. Coronary artery patterns were as follows: Shaher and Puddu's type 1 in 23, single coronary artery in 4, intramural type in 1, and others in 5. RESULTS: The median follow-up period was 4.5 years. There were no operative deaths, but there was one late death because of sepsis 13 months after ASO. Coronary artery evaluation with angiography, computed tomography, or myocardial scintigraphy was performed in 22 patients. There was no abnormal coronary morphology or perfusion. Coronary channel dilatation was not observed. Three patients underwent reoperation for pulmonary stenosis. CONCLUSIONS: The bay window technique provides excellent long-term results in ASO for TGA. Three-dimensional computed tomography revealed no aneurysmal changes in the bay window channel at nine-year follow-up examination.


Assuntos
Transposição das Grandes Artérias/métodos , Transposição dos Grandes Vasos/cirurgia , Anormalidades Múltiplas/cirurgia , Angiografia Coronária , Dupla Via de Saída do Ventrículo Direito/cirurgia , Feminino , Seguimentos , Comunicação Interventricular/cirurgia , Humanos , Imageamento Tridimensional , Lactente , Recém-Nascido , Masculino , Imagem de Perfusão do Miocárdio , Estenose da Valva Pulmonar/cirurgia , Reoperação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Transposição dos Grandes Vasos/diagnóstico por imagem
12.
Echocardiography ; 36(5): 1005-1008, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30801777

RESUMO

Transposition of the great arteries (TGA) with a posterior aorta is an uncommon but historically important variant of TGA. In this arrangement, the aorta is posterior to the pulmonary valve, maintains fibrous continuity with the mitral valve, and arises from the right ventricle. We present a case of fetal echocardiography demonstrating TGA with a posterior aorta. Postnatal transthoracic echocardiography and intra-operative assessment confirm the anatomy. To the best of our knowledge, this is the first published case of this anatomic lesion by fetal echocardiography.


Assuntos
Valva Aórtica/anormalidades , Ecocardiografia/métodos , Valva Pulmonar/anormalidades , Transposição dos Grandes Vasos/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Valva Aórtica/diagnóstico por imagem , Feminino , Coração Fetal/diagnóstico por imagem , Coração Fetal/cirurgia , Humanos , Recém-Nascido , Gravidez , Valva Pulmonar/diagnóstico por imagem , Transposição dos Grandes Vasos/embriologia , Transposição dos Grandes Vasos/cirurgia
14.
Int J Cardiol ; 280: 53-56, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30660585

RESUMO

INTRODUCTION: Neo-aortic root dilatation and regurgitation are common progressive long-term complications of the arterial switch operation (ASO) for transposition of the great arteries (TGA) with increasing clinical burden. While several risk factors have been identified, most are constitutional. The acute aortic angle commonly seen after ASO might alter aortic dynamics and facilitate progression of the neo-aortic root dilatation and aortic regurgitation, but insufficient data is available. We intend to assess the effect of the aortic angle in the extent of neo-aortic root dilatation and presence of regurgitation. METHODS: Retrospective analysis of TGA patients undergoing CMR after ASO at a single tertiary centre from November 2010 to July 2017. RESULTS: 180 patients were analysed, 157 of which having adequate imaging of the aortic arch and root. Neo-aortic root Z score was normally distributed with 73% of patients having a Z score > 2. The aortic angle had a significant (p < 0,001) inverse relationship with the neo-aortic root Z score both in univariate and multivariate linear regression. Other significant associations were male gender and the concomitant presence of a VSD or a dysplastic neo-aortic valve. The presence of neo-aortic regurgitation was also inversely correlated with the aortic angle. The presence of a bicuspid neo-aortic valve was another significant association, further correlating with the more severe forms. CONCLUSIONS: Acute aortic angles associate more extensive neo-aortic root dilatation and higher incidence of regurgitation. We believe a surgical technique promoting less acute aortic angles has potential for ameliorating the long-term outcomes of TGA.


Assuntos
Coartação Aórtica/diagnóstico por imagem , Transposição das Grandes Artérias/tendências , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição dos Grandes Vasos/cirurgia , Coartação Aórtica/etiologia , Transposição das Grandes Artérias/efeitos adversos , Feminino , Humanos , Recém-Nascido , Imagem Cinética por Ressonância Magnética/tendências , Masculino , Estudos Retrospectivos
15.
Congenit Heart Dis ; 14(3): 464-469, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30681770

RESUMO

OBJECTIVE: Management of the patients with transposition of the great arteries and intact ventricular septum may be challenging beyond the newborn period. Herein, we would like to present our alternative strategy for training the left ventricle in these patients. METHODS: Six patients with transposition of the great arteries and intact ventricular septum were evaluated in our clinic. Two of them were palliated with Glenn procedure and pulmonary banding as a definitive treatment strategy at other centers. Four patients were operated on and a bidirectional cavopulmonary anastomosis in combination with pulmonary artery banding was performed (stage-1: palliation and ventricular training) in our center. In four out of these six patients, arterial switch operation was performed with takedown and direct re-anastomosis of the superior vena cava to right atrium after an interstage period of 21-30 months (stage-2: anatomical repair). RESULTS: Any mortality was not encountered. The left ventricular mass indices increased from 18-32 to 44-74 g/m2 in patients undergoing the anatomical repair. All of the patients were uneventfully discharged following the second stage. The mean follow-up period was 20 months (9-32 months) following stage 2. All of the patients are doing well with trivial neoaortic regurgitation and normal biventricular function. CONCLUSIONS: Bidirectional cavopulmonary anastomosis with pulmonary artery banding may be a promising left ventricle training approach in ventriculoarterial discordance when compared to the traditional pulmonary artery banding with concomitant systemic-to-pulmonary artery shunt procedures which still carry a significant interstage morbidity and mortality.


Assuntos
Transposição das Grandes Artérias/métodos , Técnica de Fontan/métodos , Cuidados Paliativos/métodos , Artéria Pulmonar/cirurgia , Transposição dos Grandes Vasos/cirurgia , Função Ventricular Esquerda , Remodelação Ventricular , Transposição das Grandes Artérias/efeitos adversos , Pré-Escolar , Feminino , Técnica de Fontan/efeitos adversos , Humanos , Lactente , Masculino , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Tempo , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição dos Grandes Vasos/fisiopatologia , Resultado do Tratamento
16.
Jpn J Radiol ; 37(4): 308-314, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30603834

RESUMO

OBJECTIVE: The purpose of this study was to investigate whether the origins and courses of the coronary arteries could be better assessed using ECG-gated dual-source computed tomography (CT) than with echocardiography in neonates with transposition of the great arteries (TGA). METHODS: A total of 17 neonates within 14 days old who underwent both echocardiography and retrospective ECG-gated coronary CT angiography were retrospectively reviewed. The patients were sedated and intubated during CT examinations, and CT images were obtained with a breath-hold. CT images were reconstructed by multiple cardiac phases, and the coronary artery assessment was performed in the most static phase. Coronary anomalies were classified by Shaher's classification and validated by surgical findings. RESULTS: CT correctly classified 16 of 17 cases (Shaher type 1: 7, type 2: 4, type 9: 3, type 3: 1, type 4: 2), whereas echocardiography classified only 8 of 17 cases correctly. Dual-source CT had a significantly higher diagnostic ability than echocardiography (p = 0.0078). CONCLUSION: Dual-source coronary CT angiography has a higher diagnostic ability than echocardiography in the assessment of the origins and courses of the coronary arteries in neonates with TGA.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia/métodos , Transposição dos Grandes Vasos/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Transposição dos Grandes Vasos/complicações
17.
Ann Thorac Surg ; 107(4): 1226-1231, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30529669

RESUMO

BACKGROUND: The Rastelli procedure has been criticized for a high rate of left ventricular outflow tract obstruction (LVOTO) and translocation procedures have been proposed as an alternative. Infundibular resection can be performed during Rastelli to optimize the outflow tract. This study examines whether a selective policy to enlarge the outflow tract improves Rastelli outcomes across all morphological variants. METHODS: Single institution 29-year experience in 105 patients. Patients were classified into transposition of the great arteries with ventricular septal defect, congenitally corrected transposition of the great arteries with ventricular septal defect, and double outlet right ventricle morphology groups. The infundibular muscle was routinely resected if prominent, in 28 cases. RESULTS: Early mortality was 1.9% (2 of 105) and actuarial survival was 95.4% (95% confidence interval [CI], 89% to 99%) at 1 year, 92.9% (95% CI, 85% to 97%) at 5 years, and 84.5% (95% CI, 74% to 92%) at 10 years. The cumulative freedom from LVOTO was 99% (95% CI, 96% to 100%), 97% (95% CI, 92% to 99%), and 90% (95% CI, 88% to 96%) at 1, 5, and 10 years, respectively. The incidence was similar in all morphological groups and those undergoing infundibular resection were not at higher risk of late LVOTO. Eleven patients required surgical reoperation on the left ventricular outflow tract over a median follow-up period of 8.5 years, with no mortality, although 2 of these patients developed complete heart block. Left ventricular function was well preserved in 98.1% of all cases, including all of those requiring left ventricular outflow tract reoperation. CONCLUSIONS: The Rastelli is a safe procedure that can be applied in a variety of morphological variants. LVOTO remains a late complication of Rastelli, but can be minimized by concomitant infundibular muscle resection. Late reoperation is safe and ventricular function is well preserved in greater than 95% of cases at late follow-up. The operation has stood the test of time and avoids many of the risks of translocation procedures.


Assuntos
Transposição das Grandes Artérias/efeitos adversos , Comunicação Interventricular/cirurgia , Segurança do Paciente , Transposição dos Grandes Vasos/cirurgia , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/cirurgia , Transposição das Grandes Artérias/métodos , Pré-Escolar , Estudos de Coortes , Feminino , Comunicação Interventricular/diagnóstico por imagem , Humanos , Lactente , Masculino , Miocárdio , Prognóstico , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Fatores de Tempo , Transposição dos Grandes Vasos/diagnóstico por imagem , Resultado do Tratamento , Reino Unido , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem
19.
Ann Thorac Surg ; 107(4): 1203-1211, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30391244

RESUMO

BACKGROUND: The growth of the neoaortic root after the arterial switch operation for the transposition of the great arteries remains unclear. This study aimed to investigate the growth of the neoaortic root and identify risk factors for neoaortic root dilatation. METHODS: Serial angiographic measurements of the neoaortic root for at least 10 years were evaluated in 145 patients. A total of 1,876 measurements of the sinuses of the Valsalva and the neoaortic annuli were obtained. A linear mixed effects model was used for z-score analysis, including evaluation of risk factors for neoaortic root dilatation. To assess changes in the time course of neoaortic root absolute diameters, a nonlinear mixed effects model with a growth curve model was used. RESULTS: The growth curve revealed progressive growth of the neoaortic root during somatic growth and stabilization in adulthood without normalization. The growth rates of the sinus and annulus were 0.0046 and 0.029 z-score per year, respectively. The sinus and annulus were estimated to grow up to 47 ± 1 mm and 31 ± 1 mm, respectively. Major risk factors for neoaortic root dilatation were double-outlet right ventricle (parameter estimate [PE] = 2.1, 95% confidence interval [CI] = 1.5 to 2.7, p < 0.0001 for sinus; PE = 1.2; 95% CI = 0.7 to 1.6, p < 0.0001 for annulus) and presence of neoaortic valve insufficiency (PE = 0.9; 95% CI = 0.4 to 1.5; p < 0.001 for sinus; PE = 1.6, 95% CI = 1.2 to 2.0, p < 0.0001 for annulus). CONCLUSIONS: The risk for neoaortic root dilatation was common. Long-term surveillance is mandatory, particularly in patients with double-outlet right ventricle and neoaortic valve insufficiency.


Assuntos
Transposição das Grandes Artérias/métodos , Angiografia por Tomografia Computadorizada/métodos , Dupla Via de Saída do Ventrículo Direito/cirurgia , Seio Aórtico/diagnóstico por imagem , Transposição dos Grandes Vasos/cirurgia , Fatores Etários , Transposição das Grandes Artérias/mortalidade , Pré-Escolar , Intervalos de Confiança , Dupla Via de Saída do Ventrículo Direito/diagnóstico por imagem , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Monitorização Fisiológica/métodos , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição dos Grandes Vasos/mortalidade , Resultado do Tratamento , Adulto Jovem
20.
Semin Thorac Cardiovasc Surg ; 31(3): 488-493, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29621622

RESUMO

Although low birth weight is a known risk factor for mortality in congenital heart lesions and may consequently delay surgical repair, outcomes in low-weight neonates undergoing the arterial switch operation (ASO) have not been well described. Our objective was to assess the safety of this procedure in infants weighing ≤2.5 kg at the time of surgery. We retrospectively analyzed outcomes for all neonates undergoing the ASO at our institution from 2005 to 2015. Our primary outcome of interest was major morbidity or operative mortality, assessed as a composite outcome. From 2005 to 2015, 217 neonates underwent the ASO, with 31 (14%) weighing ≤2.5 kg at the date of surgery, and 8 weighing <2.0 kg. Neonates weighing ≤2.5 kg were more likely to be premature than those weighing >2.5 kg, but there was no difference in the age at operation between these groups. Overall, 32 infants experienced a major morbidity or mortality, including 37.5% (n = 3) weighing <2.0 kg, 8.7% (n = 2) weighing 2.0-2.5 kg, and 14.5% (n = 7) weighing >2.5 kg (P = 0.141). One infant weighing <2.0 kg (1.1 kg) and 4 infants weighing >2.5 kg died. In multivariable models, odds of major morbidity or mortality were significantly higher for infants weighing <2 kg compared with infants weighing >2.5 kg (odds ratio 3.93, 95% confidence interval 1.04-14.85, P = 0.044), but there was no difference between infants weighing 2.0-2.5 kg and those weighing >2.5 kg (P = 0.225). The ASO can be performed safely in 2.0- to 2.5-kg neonates and yields results comparable with higher weight infants. Imposed delays for corrective surgery may not be necessary for these low-weight infants with transposition of the great arteries.


Assuntos
Transposição das Grandes Artérias , Recém-Nascido de Baixo Peso , Transposição dos Grandes Vasos/cirurgia , Transposição das Grandes Artérias/efeitos adversos , Transposição das Grandes Artérias/mortalidade , Peso ao Nascer , Idade Gestacional , Mortalidade Hospitalar , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Estudos Retrospectivos , Fatores de Risco , Tempo para o Tratamento , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição dos Grandes Vasos/mortalidade , Resultado do Tratamento
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