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2.
World J Pediatr Congenit Heart Surg ; 12(1): 116-123, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33407030

RESUMO

Several techniques designed to improve long-term results after repair of tetralogy of Fallot are described. We have recently embarked on a program focused on preserving the native pulmonary valve. Here, combined techniques are described in detail, including intraoperative pulmonary valve balloon dilatation, pulmonary valve reconstruction by delamination and resuspension of the leaflets, and pulmonary valve annulus augmentation. As with any other complex congenital heart disease, senior surgeons should select teaching cases, starting from the less severe side of the spectrum.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Seguimentos , Humanos , Lactente , Fatores de Tempo , Resultado do Tratamento
3.
J Card Surg ; 35(10): 2640-2648, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33043664

RESUMO

INTRODUCTION: Various valve repair techniques have been described for prevention of pulmonary insufficiency (PI) during right ventricular outflow tract (RVOT) reconstruction with transannular patch. Herein, we present the early results of an alternative technique of neopulmonary valve reconstruction using right atrial appendage (RAA) tissue. METHODS: Between October 2019 and December 2019, 12 patients with tetralogy of fallot (TOF) (n = 10), TOF-absent pulmonary valve (n = 1) and intact ventricular septum-pulmonary atresia (n = 1) underwent RVOT reconstruction with neopulmonary valve that was created using RAA tissue. Median age and weight of patients were 9.9 months (5 months-14 years) and 9.8 kg (6.2-47), respectively. RESULTS: No mortality or major events developed. Postoperative echocardiography revealed none/trace PI in 11 patients and mild PI in 1 patient. Median right ventricle/left ventricle ratio was 0.46 (0.35-0.65) and RVOT gradient was 20 mm Hg (0-30). Median cardiopulmonary bypass and aortic clamping times were 121 minutes (81-178) and 94 minutes (59-138), respectively. Operative times revealed statistically significant learning curve pattern in terms of cardiopulmonary bypass (r2 = .568; P = .005) and aortic clamping times (r2 = .635; P = .002). Median ventilation time, intensive care unit stay, and the length of hospital stay were 6 hours (2-48), 1 days (1-5), and 7 days (4-10), respectively. Longer perfusion time was not correlated with postoperative times. At median 6 months, echocardiography showed none/trivial PI in 11 patients and mild PI in one patient. CONCLUSION: Early results showed that neopulmonary valve reconstruction using the RAA tissue may provide a reasonable alternative for RVOT reconstruction with transannular patch. But long-term results are needed.


Assuntos
Apêndice Atrial/transplante , Implante de Prótese de Valva Cardíaca/métodos , Ventrículos do Coração/cirurgia , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tetralogia de Fallot/cirurgia , Adolescente , Ponte Cardiopulmonar , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Duração da Cirurgia , Atresia Pulmonar/cirurgia , Resultado do Tratamento
4.
Zhonghua Wai Ke Za Zhi ; 58(10): 793-797, 2020 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-32993268

RESUMO

Objective: To evaluate the early results of pulmonary autograft mitral valve replacement (Ross Ⅱ procedure) in infants with intractable congenital mitral valve lesions. Methods: Between August 2018 and September 2019, 6 infants underwent mitral valve replacement with a pulmonary autograft in Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center. There were 2 males and 4 females.The age at surgery ranged from 50 days to 1 year old.Preoperative diagnoses included severe to critic mitral valve insuffiency in all patients, moderate mitral valve stenosis in 3 patients, and mitral valve prolapse in one. When the pulmonary autograft was harvested, a cuff of bovine or autologous pericardium was sewn onto the proximal (infundibular) end of the autograft ( "top-hat" configuration). The distal (pulmonary) end of the autograft was secured to the mitral annulus.At the level of the left atrial free wall, the pericardial cuff was progressively tailored and sewn onto the atrial wall to remain away from the ostia of the pulmonary veins and to maintain normal morphology of the autograft. The bovine jugular valved conduit was used to reconstruct the right ventricular outflow tract. Results: There was one early death due to sudden cardiac arrest at the night of surgery day. The remaining 5 patients were successfully recovered and discharged. Follow-up of survivors ranged from 3 to 13 months. Echocardiographic follow-up demonstrated the flow velocity across the mitral valve position was 1.5 to 2.3 m/s, with a means gradient of 4 to 6 mmHg (1 mmHg=0.133 kPa). Four patients showed mild mitral insuffiency, normal left atrium and ventricle size and left ventricle ejection fraction.One patient had moderate mitral insuffiency, pulmonary valve endocarditis, and reduced left ventricle ejection fraction. The clinical symptoms of all survivals improved significantly and the weight gain were satisfactory. Conclusion: Pulmonary autograft mitral valve replacement may be a feasible and effective remedial surgical strategy for young infants with intractable congenital mitral valve lesions.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Valva Pulmonar , Autoenxertos , Feminino , Humanos , Lactente , Masculino , Valva Pulmonar/cirurgia , Valva Pulmonar/transplante , Transplante Autólogo
5.
J Vis Exp ; (161)2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32804160

RESUMO

Heart conditions in which the tricuspid valve (TV) faces either increased volume or pressure stressors are associated with premature valve failure. Mechanistic studies to improve our understanding of the underlying pathophysiology responsible for the development of premature TV failure are lacking. Due to the inability to conduct these studies in humans, an animal model is required. In this manuscript, we describe the protocols for a novel chronic recovery infant piglet heart model for the study of changes in the TV when placed under combined volume and pressure stress. In this model, volume loading of the right ventricle and the TV is achieved through the disruption of the pulmonary valve. Then pressure loading is accomplished through the placement of a pulmonary artery band. The success of this model is assessed at four weeks post intervention surgery through echocardiography, intracardiac pressure measurement, and pathologic examination of the heart specimens.


Assuntos
Ventrículos do Coração/fisiopatologia , Valva Tricúspide/fisiopatologia , Anestesia , Animais , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Hemodinâmica , Imageamento Tridimensional , Masculino , Modelos Animais , Tamanho do Órgão , Pressão , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Valva Pulmonar/fisiopatologia , Valva Pulmonar/cirurgia , Suínos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia
7.
J Card Surg ; 35(7): 1725-1728, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32579761

RESUMO

Infective endocarditis (IE) is a serious condition leading to heart failure, persistent sepsis. The management of IE involving valve is mainly excision of the infected valve and replacement with a heart valve; which are also at the risk of prosthetic valve endocarditis. Hence repair of the valve with autologous pericardium is much more physiological. We had a 20-year-old male presented with features of heart failure and high-grade fever not responding to optimum medical management. Two-dimensional echocardiogram revealed vegetation on pulmonary valve cusps with the erosion of the left and right cusps. Neo cusps with autologous pericardium offered good hemodynamics with trivial regurgitation. The patient is doing well with normal pulmonary valve function 3 months after surgery. This technique is reliable, economic, and easily reproducible.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Endocardite/cirurgia , Glutaral/uso terapêutico , Pericárdio/transplante , Valva Pulmonar/cirurgia , Ecocardiografia , Endocardite/complicações , Endocardite/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Valva Pulmonar/diagnóstico por imagem , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
8.
Circ Cardiovasc Interv ; 13(1): e008320, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32525412

RESUMO

BACKGROUND: The Harmony transcatheter pulmonary valve (TPV) was designed for treatment of postoperative pulmonary valve regurgitation in patients with repaired right ventricular outflow tracts. METHODS: The Native TPV EFS (Early Feasibility Study) is a prospective, multicenter, nonrandomized feasibility study. Three-year outcomes are reported. RESULTS: Of 20 implanted patients, 17 completed 3-year follow-up (maximum: 4.1 years). There were no deaths and 2 early explants. One patient did not complete the 3-year visit. In patients with available 3-year echocardiographic data, 1 had a mild paravalvular leak and the rest had none/trace; 1 patient had mild pulmonary valve regurgitation and the remainder had none/trace. The 3-year mean right ventricular outflow tract echocardiographic gradient was 15.7±5.5 mm Hg. Radiographically, no late frame fractures or erosions were identified. At 2 years, 2 patients presented with an increased echocardiographic outflow gradient (1 mixed lesion with moderate/severe pulmonary valve regurgitation). Computed tomography scans identified neointimal tissue ingrowth within the stent frame in both patients, and they were treated successfully with a transcatheter valve-in-valve procedure (Melody TPV). Additional follow-up computed tomography scans performed at 3.2±0.5 years after implant were obtained in 16 patients and revealed luminal tissue thickening at the inflow and outflow portion of the frame with no significant alteration of the valve housing. CONCLUSIONS: Three-year results from the Native TPV EFS revealed stable Harmony TPV device position, good valve function in most, and the absence of moderate/severe paravalvular leak and significant late frame fractures. Two patients developed significant neointimal proliferation requiring valve-in-valve treatment, while all others had no clinically significant right ventricular outflow tract obstruction. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01762124.


Assuntos
Bioprótese , Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Adulto , Canadá , Cateterismo Cardíaco/efeitos adversos , Estudos de Viabilidade , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
9.
Pediatr Cardiol ; 41(6): 1190-1198, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32474738

RESUMO

Patients with congenital heart disease (CHD) who undergo cardiac procedures may become hemodynamically unstable. Predictive algorithms that utilize dense physiologic data may be useful. The compensatory reserve index (CRI) trends beat-to-beat progression from normovolemia (CRI = 1) to decompensation (CRI = 0) in hemorrhagic shock by continuously analyzing unique sets of features in the changing pulse photoplethysmogram (PPG) waveform. We sought to understand if the CRI accurately reflects changing hemodynamics during and after a cardiac procedure for patients with CHD. A transcatheter pulmonary valve replacement (TcPVR) model was used because left ventricular stroke volume decreases upon sizing balloon occlusion of the right ventricular outflow tract (RVOT) and increases after successful valve placement. A single-center, prospective cohort study was performed. The CRI was continuously measured to determine the change in CRI before and after RVOT occlusion and successful TcPVR. Twenty-six subjects were enrolled with a median age of 19 (interquartile range (IQR) 13-29) years. The mean (± standard deviation) CRI decreased from 0.66 ± 0.15 1-min before balloon inflation to 0.53 ± 0.16 (p = 0.03) 1-min after balloon deflation. The mean CRI increased from a pre-valve mean CRI of 0.63 [95% confidence interval (CI) 0.56-0.70] to 0.77 (95% CI 0.71-0.83) after successful TcPVR. In this study, the CRI accurately reflected acute hemodynamic changes associated with TcPVR. Further research is justified to determine if the CRI can be useful as an early warning tool in patients with CHD at risk for decompensation during and after cardiac procedures.


Assuntos
Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Hemodinâmica , Adolescente , Adulto , Algoritmos , Cateterismo Cardíaco , Feminino , Humanos , Masculino , Fotopletismografia , Estudo de Prova de Conceito , Estudos Prospectivos , Valva Pulmonar/cirurgia , Volume Sistólico , Resultado do Tratamento , Sinais Vitais/fisiologia , Adulto Jovem
10.
J Card Surg ; 35(7): 1711-1713, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32445258

RESUMO

Marked thrombocytopenia causes significant bleeding in cardiovascular surgery. Herein, we describe the case of a 47-year-old woman with immune thrombocytopenia who underwent successful pulmonary valve replacement for pulmonary valve regurgitation and stenosis after complete repair of tetralogy of Fallot. Her platelet count decreased significantly to less than 5 × 109 /L on postoperative day 3, thus multiple platelet transfusions were given. Pulse steroid therapy with dexamethasone was subsequently administered systemically for 4 days. After the treatment, her platelet count started to recover. There were no significant postoperative bleeding events, and red blood cell transfusion was not required. Other than the platelet event, the postoperative course was uneventful and the patient was discharged on postoperative day 15.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Transfusão de Plaquetas , Cuidados Pós-Operatórios , Hemorragia Pós-Operatória/prevenção & controle , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Trombocitopenia/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Resultado do Tratamento
11.
Surg Technol Int ; 36: 217-223, 2020 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-32379893

RESUMO

Severe tricuspid regurgitation (TR) is associated with significant mortality and morbidities. Currently, surgical tricuspid repair with annuloplasty is the gold standard treatment. However, the prohibitive risks of open surgery and increasing evidence that severe TR should be intervened on early has led to an outburst in the development and evolution of transcatheter tricuspid valve interventions (TTVI). These technologies are broadly categorized into direct suture annuloplasty devices, minimally invasive annuloplasty, direct ring annuloplasty devices, coaptation-based strategies, edge-to-edge repair devices, and transcatheter valve replacement. Each has its own set of advantages and limitations and have been tried, to varying degrees of success, in a myriad of pathoanatomic scenarios. Challenges faced in TTVI device and trial designs include heterogeneous patient populations, the need for quality imaging, variations of imaging requirements and anatomic criteria by device, hard-to-define clinical endpoints, and the poor prognosis carried by significant residual TR. Similar to tricuspid valve disease, pulmonic valve (PV) disease can occur on its own or secondary to a congenital heart defect, most commonly tetralogy of Fallot. Many patients with pulmonic stenosis or insufficiency often require repeat surgical interventions for other cardiac problems, highlighting the importance of developing transcatheter approaches to reduce the number of repeat open-heart surgeries required. Transcatheter PV replacement (TPVR) is growing in use and is the procedure of choice in patients with failed bioprostheses via valve-in-valve implantation. The Melody (Medtronic Inc., Minneapolis, Minnesota) and SAPIEN XT (Edwards Lifesciences Inc., Irvine, California) devices are the currently available TPVR technologies. Current limitations here include device kinking, the risk of stent fracture, anatomic difficulties, such as asymmetric right ventricular outflow tracts leading to poor landing zones and procedural risks of coronary artery and aortic root compression.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Pulmonar , Cateterismo Cardíaco , Humanos , Valva Pulmonar/cirurgia , Resultado do Tratamento
12.
Expert Rev Med Devices ; 17(6): 541-554, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32459512

RESUMO

INTRODUCTION: Right ventricular outflow tract (RVOT) dysfunction is common among individuals with congenital heart disease (CHD). Surgical intervention often carries prohibitive risks due to the need for sequential pulmonary valve (PV) replacements throughout their life in the majority of cases. Transcatheter pulmonary valve replacement (tPVR) is one of the most exciting recent developments in the treatment of CHD and has evolved to become an attractive alternative to surgery in patients with RVOT dysfunction. AREAS COVERED: In this review, we examine the pathophysiology of RVOT dysfunction, indications for tPVR, and the procedural aspect. Advancements in clinical application and valve technology will also be covered. EXPERT OPINION: tPVR is widely accepted as an alternative to surgery to address RVOT dysfunction, but still significant numbers of patients with complex RVOT morphology deemed not suitable for tPVR. As the technology continues to evolve, new percutaneous valves will allow such complex RVOT patient to benefit from tPVR.


Assuntos
Cateterismo Cardíaco , Implante de Prótese de Valva Cardíaca , Valva Pulmonar/cirurgia , Criança , Próteses Valvulares Cardíacas , Humanos , Seleção de Pacientes , Valva Pulmonar/fisiopatologia , Resultado do Tratamento
13.
Int J Cardiovasc Imaging ; 36(10): 1973-1982, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32462447

RESUMO

The hemodynamic impact of residual pulmonary regurgitation (PR) in repaired Tetralogy of Fallot (rTOF) has been well demonstrated. However, markers driving the decision making process to indicate the ideal timing of pulmonary valve replacement (PVR) are still uncertain. Furthermore, very few studies have included the right atrium (RA) dilatation as a preoperative risk factor for post-PVR clinical adverse outcome. The aim of this study was to investigate the impact of pre-PVR right atrial dilation on adverse outcomes in rTOF. We retrospectively reviewed from our CMR database all rTOF patients who underwent CMR study before and after PVR. Detailed clinical and surgical history were collected, in addition to imaging data. The composite primary and secondary post-PVR end points were also recorded. The study cohort consisted of 41 patients (mean age at PVR repair 27.4 ± 10 years). As expected, end-diastolic and end-systolic right ventricle (RV) volumes significantly decreased after PVR (p < 0.001). The RV reverse remodeling, defined by ΔRVEDVi and ΔRVESVi, was associated with both pre-PVR RVEDVi and RVESVi. The higher the pre-PVR RV volumes, more the RV reverse remodeling will be obtained post-surgery. Patients who experienced an adverse outcome were older at pre-PVR, they had a higher Nt-ProBNP, worse VO2/kg/min, more significant tricuspid regurgitation and more dilated RA. The association with the RA dilatation persists and becomes even more significant if we exclude patients who had tricuspid repair beside RVOT surgical reconstruction. Besides RV volumes and function, RA dimensions may play a pivotal role in the decision making of TOF patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Átrios do Coração/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/efeitos adversos , Imagem por Ressonância Magnética , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Função do Átrio Direito , Remodelamento Atrial , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tomada de Decisão Clínica , Bases de Dados Factuais , Feminino , Átrios do Coração/fisiopatologia , Implante de Prótese de Valva Cardíaca/mortalidade , Hemodinâmica , Humanos , Masculino , Valor Preditivo dos Testes , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/mortalidade , Insuficiência da Valva Pulmonar/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tetralogia de Fallot/mortalidade , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Função Ventricular Direita , Remodelação Ventricular , Adulto Jovem
15.
J Card Surg ; 35(5): 1152-1155, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32302027
16.
Interact Cardiovasc Thorac Surg ; 30(5): 780-782, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32298427

RESUMO

Ventricular tachyarrhythmia (VT) is a major cause of late morbidity and mortality in patients who underwent surgical repair of tetralogy of Fallot. The majority of VTs are monomorphic macro-reentrant VT (MVT) and depend on slow conducting areas of diseased myocardium bordered by unexcitable tissue (anatomical isthmuses). Myocardial fibrosis due to surgical incisions, patch material and valve annuli are typical boundaries of anatomical isthmuses (AI). The conducting myocardium between the pulmonary valve and ventricular septum defect patch is called isthmus 3, and the majority of MVTs originate from this area. During pulmonary valve replacement, there is excellent exposure of isthmus 3. Importantly, after pulmonary valve replacement, the homograft may cover important parts of isthmus 3, which makes percutaneous catheter ablation at a later stage impossible. In all patients who need pulmonary valve replacement late after tetralogy of Fallot repair, preoperative electrophysiology study and electroanatomical mapping can identify patients with inducible MVT or slow conduction carrying high risk of MVT. In these patients, intraoperative cryoablation of isthmus 3 should be performed and bidirectional conduction block across the cryoablation line should be demonstrated by intraoperative differential pacing.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criocirurgia , Valva Pulmonar/cirurgia , Taquicardia Ventricular/prevenção & controle , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Arritmias Cardíacas/etiologia , Ablação por Cateter/efeitos adversos , Criança , Pré-Escolar , Feminino , Comunicação Interventricular/complicações , Comunicação Interventricular/cirurgia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/etiologia , Tetralogia de Fallot/complicações , Adulto Jovem
17.
Ann Thorac Surg ; 110(4): e323-e325, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32145193

RESUMO

Approximately 5% of percutaneous pulmonary valve implantations (PPVIs) are at risk for coronary compression. Therefore, PPVI is contraindicated if coronary anomalies and tested coronary flow impairment are observed. Simultaneous right ventricular outflow tract ballooning and coronary angiography are mandatory elucidating contraindications for PPVI. We present the case of a 22-year-old woman who had Rastelli repair with chronic right heart failure. Weighing the risk of several offered surgical options, she underwent successful PPVI after minimally invasive direct coronary artery bypass procedure.


Assuntos
Ponte de Artéria Coronária/métodos , Implante de Prótese de Valva Cardíaca/métodos , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Contraindicações de Procedimentos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Adulto Jovem
19.
J Card Surg ; 35(5): 1122-1124, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32176359

RESUMO

BACKGROUND AND AIMS: Pulmonary artery aneurysm is a rare disease. A 59-year-old Chinese female was diagnosed with idiopathic pulmonary aneurysm with pulmonary regurgitation. She had a past medical history of hemoptysis and systemic lupus erythematosus. METHODS: She underwent a successful total pulmonary artery and valve replacement with an Avalus-Gelweave conduit. RESULTS: The postoperative echocardiogram showed a 7 mm Hg peak gradient across the prosthetic valve. The patient's postoperative recovery was uncomplicated. CONCLUSIONS: A bioprosthetic aortic valve can be used in a pulmonary position to achieve a good gradient and avoid long term anticoagulation therapy.


Assuntos
Aneurisma/cirurgia , Bioprótese , Implante de Prótese Vascular/métodos , Prótese Vascular , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Artéria Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Aneurisma/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Pulmonar/complicações , Doenças Raras , Resultado do Tratamento
20.
BMC Infect Dis ; 20(1): 212, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164584

RESUMO

BACKGROUND: Pulmonary endarteritis is a rare clinical phenomenon with congenital heart that can potentially lead to major complications. CASE PRESENTATION: We report a 47-year-old man with pulmonary endarteritis. This patient presented with hypertension, chest pain and a previous history of pulmonary valve disease during childhood. Also, eight-months prior, he was hospitalized with dyspnea (Functional Class III), cough, phlegm, and night sweats without fever. Echocardiographic diagnosis in the first transtransthoracic echocardiography (TTE) was intense pulmonary valve stenosis (PVS) an, thus, the pulmonary valve vegetation and PVS, established by transesophageal echocardiography (TEE). He was referred for surgery after 1 weeks of intravenous antibiotic therapy for removal of the vegetation. CONCLUSIONS: Finally he was asymptomatic at 3-months of follow-up and was clinically in good condition. Therefore, the detection of infective endocarditis of the lung valve must not lengthy be prolonged.


Assuntos
Endarterite/diagnóstico , Endocardite Bacteriana/diagnóstico , Embolia Pulmonar/diagnóstico , Sepse/diagnóstico , Antibacterianos/uso terapêutico , Ecocardiografia Transesofagiana , Endarterite/diagnóstico por imagem , Endarterite/terapia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/terapia , Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/diagnóstico por imagem , Sepse/terapia , Tomografia Computadorizada por Raios X
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