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1.
Medicina (Kaunas) ; 55(9)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31546957

RESUMO

Background and Objectives: Infective endocarditis in the pulmonary position is a rare disease. Isolated pulmonary valve endocarditis is extremely rare. The aim of our study was to assess patients who were treated surgically for pulmonary endocarditis at our institution from January 2003 to December 2017. Materials and Methods: We analyze eight cases of infectious endocarditis in pulmonary position out of 293 patients who were operated for infective endocarditis (2.7%, 8/293). Only two of these eight patients were not related to congenital heart malformation. They were followed for early and late mortality, long-term survival, postoperative morbidity and reoperations. Results: Among six patients suffering from congenital heart disease, four patients underwent corrections of pulmonary valve malformation previously, and their infected grafts were replaced by two allografts and two xenografts. The two other patients had replaced their infected pulmonary valves with allografts. Two non-congenital patients with pulmonary valve endocarditis underwent valve replacement with biological prosthesis. All patients survived the early postoperative course. The mean follow-up time was 9.1 (interquartile range (IQR), 5.3-12.6) years. The long-term follow-up included seven patients. One patient (12.5%, 1/8) died more than 4 years after the surgery due to sepsis. Pulmonary endocarditis was the rarest endocarditis treated surgically (p < 0.001). Conclusion: Surgery for infective endocarditis in the pulmonary position (IEPP) is an effective method of treatment with excellent early outcome and good late results despite a very uncommon pathology and few operations being performed. Surgery performed earlier may make the procedure less radical.


Assuntos
Endocardite/cirurgia , Complicações Pós-Operatórias/mortalidade , Valva Pulmonar/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Endocardite/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Reoperação/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
3.
Methodist Debakey Cardiovasc J ; 15(2): 122-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384375

RESUMO

Right ventricular outflow tract (RVOT) dysfunction is common following surgical repair of tetralogy of Fallot and other forms of complex congenital heart disease. This results in pulmonary stenosis or regurgitation and may ultimately lead to RV failure and dysrhythmias. Transcatheter valve technologies are now available to treat certain patients with RVOT dysfunction. Current devices include the Medtronic Melody valve and the Edwards Lifesciences SAPIEN XT. Although these valves are approved for use in dysfunctional circumferential RVOT conduits, they are increasingly being used off label for nonconduit outflow tracts. Procedural complications include but are not limited to conduit rupture and coronary compression. Longer-term complications include stent fracture and endocarditis. Outcomes with these valves have demonstrated durable relief of stenosis and regurgitation. The Medtronic Harmony valve and the Alterra Prestent from Edwards Lifesciences are investigational devices that are intended to treat the patulous RVOT that is too large to accommodate currently available valves. This review will focus on current indications to treat RVOT dysfunction, existing transcatheter valve technologies, and investigational devices undergoing clinical trials. Hopefully, within the not-too-distant future, transcatheter pulmonary valve implantation will be feasible in the vast majority of patients with RVOT dysfunction following surgical repair of congenital heart disease.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/fisiopatologia , Fatores de Risco , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia
4.
Expert Rev Med Devices ; 16(9): 829-834, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31432698

RESUMO

Background: After encouraging results with the Edwards Sapien and XT valves, this study aimed to review procedural data and early outcomes for the Sapien 3 valves for transcatheter pulmonary valve replacement (TPVR). Methods: We performed a multicenter, retrospective analysis of cases who underwent a Sapien 3 TPVR between 2015 and 2017 in 7 centers in Germany with a follow-up of up to 2 years. Results: 56 patients could be enrolled (weight 58,5 ± 25,0 kg; 53% Tetralogy of Fallot, 45% native RVOT). Most procedures were two-stage procedures (82,1%) with 100% prestenting. Valve sizes were 20 mm (n = 1), 23 mm (n = 15), 26 mm (n = 27), 29 mm (n = 13). Procedural success rate was 96.4%. Two patients underwent surgical valve implantation after balloon rupture during TPVR. Follow-up data were available up to 24-month post TPVR. The rate of patients with ? moderate and severe pulmonary regurgitation decreased to 0% after TPVR, peak systolic gradient decreased from 24,2 (SD±20,9) mmHg to 7,1 mmHg (SD±5,0). There were no endocarditis, severe tricuspid valve impairment or stent fractures. Conclusions: With the Edwards Sapien 3 valve, the patient pool for TPVR can be substantially extended. Continued data collection is necessary to verify long-term results.


Assuntos
Cateterismo Cardíaco , Implante de Prótese de Valva Cardíaca , Valva Pulmonar/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Seguimentos , Alemanha , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/fisiopatologia , Estudos Retrospectivos , Sístole , Resultado do Tratamento , Adulto Jovem
5.
J Clin Ultrasound ; 47(9): 568-571, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31392732

RESUMO

Primary cardiac tumors are rare, but papillary fibroelastoma (PFE) is reportedly the most common form, which usually occurs on the left-side valves of the heart. However, PFE involving the tricuspid and pulmonary valves has also been documented. Although PFE is benign and seldom associated with valvular dysfunction, the associated embolic complications may lead to serious consequences. Most patients with PFE lack specific clinical symptoms and the diagnosis is incidental. Surgical resection is the mainstay treatment for PFE in order to prevent the occurrence of embolic complications. In this report, we present a case of a rare asymptomatic PFE of the pulmonary valve, which was incidentally noted during a routine examination with transthoracic echocardiography (TEE). There was neither valvular dysfunction nor hemodynamic change. The PFE was surgically removed, and the diagnosis was further confirmed with histopathology.


Assuntos
Ecocardiografia/métodos , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Achados Incidentais , Valva Pulmonar/diagnóstico por imagem , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/cirurgia
6.
World J Pediatr Congenit Heart Surg ; 10(4): 499-501, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307304

RESUMO

BACKGROUND: Several modifications of the Norwood procedure utilizing valved right ventricle to pulmonary artery conduits have recently been reported. Our group has been using aortic or pulmonary valved homografts combined with PTFE tube grafts for now 16 years. METHODS: In this report, we review our technique in detail and describe any changes that have occurred over the years. We provide detailed illustrations of our preferred surgical technique, report outcome data, and compare it to the other conduit options available. RESULTS: Between 2006 and 2015, 130 stage I Norwood procedures were performed at our institution, 100 of them using valved conduits. Our technique is described and illustrated in detail. Early mortality was 15%. Postoperative percutaneous intervention on the conduit was required in 29% of cases. CONCLUSIONS: While a randomized trial comparing different valved conduits is lacking, we believe a composite conduit made from homograft aortic or pulmonary valves and PTFE tube grafts is an excellent choice in stage I Norwood procedure.


Assuntos
Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Procedimentos de Norwood/métodos , Artéria Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Transplante Homólogo , Resultado do Tratamento
7.
Anatol J Cardiol ; 22(1): 21-25, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31264658

RESUMO

OBJECTIVE: The Ross procedure has been cited as the procedure of choice for young patients requiring aortic valve replacement. However, potential for reintervention requirement in both left and right ventricular outflow tracts can be a source of concern. The aim of the present study was to describe our experience with this procedure. METHODS: A retrospective chart review of all the patients who underwent the Ross procedure in a single institution was performed. National death registry records were used for late mortality. RESULTS: Eighteen Ross procedures between May 2003 and May 2018 were performed. The median age of the cohort was 15 [interquartile range (IQR): 12-18] years. The pulmonic conduit was a homograft in 11 patients, Labcor in 5 patients, Contegra in 1 patient, and Medtronic Freestyle Valve in 1 patient. There were three early deaths. The median follow-up of 15 hospital survivors was 11 (IQR: 3-14) years. Any late mortality was not observed. In the two surviving patients with infective endocarditis, there was no recurrent infective endocarditis. Freedom from reintervention was 80% at 8 years and onward. Any risk factors associated with reintervention could not be identified. However, freedom from autograft dilatation at 10 years was 45%. CONCLUSION: Autograft failure is a potential problem in the long-term follow-up of Ross patients. Freedom from reintervention was satisfactory, and the type of pulmonic conduit did not affect the mid-term outcomes. In patients with infective endocarditis, the Ross procedure has a low recurrence rate, but it might have an increased risk of mortality.


Assuntos
Valva Aórtica/cirurgia , Endocardite/cirurgia , Cardiopatias Congênitas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valva Pulmonar/cirurgia , Adolescente , Ponte Cardiopulmonar , Criança , Estudos de Coortes , Morte Súbita Cardíaca/etiologia , Endocardite/mortalidade , Feminino , Cardiopatias Congênitas/mortalidade , Doenças das Valvas Cardíacas/congênito , Doenças das Valvas Cardíacas/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Reoperação , Estudos Retrospectivos , Transplante Autólogo/métodos , Obstrução do Fluxo Ventricular Externo
8.
Int Heart J ; 60(4): 983-985, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257331

RESUMO

Infective endocarditis (IE) is a lethal complication inpatients with congenital heart disease. We report a case of percutaneous implanted pulmonary valve IE in a 49-year-old female. She underwent a previous surgery for tetralogy of Fallot with transannular patching of the right ventricular outflow tractat the age of 18 years. Echocardiography showed chronic moderate to severe pulmonary regurgitation with right heart enlargement. She underwent transcatheter pulmonary valve implantation with a 26 mm Venus-P valve (Venus Medtech, Shanghai, China) in order to release pulmonary insufficiency. Two months after implantation, she presented with recurrent chills and febrile for one week, and percutaneous implanted pulmonary valve IE was diagnosed. According to the antibiotic susceptibility test, she was given penicillin and gentamycin. At 12 months follow-up, TTE showed vegetation completely disappeared and the valve functioned normally. The patient recovered uneventfully without any complications like recurrent IE.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Endocardite/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Antibacterianos/uso terapêutico , Ecocardiografia , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X
9.
Pediatr Cardiol ; 40(6): 1105-1112, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31214731

RESUMO

Tetralogy of Fallot (ToF) is one of the most common cyanotic congenital heart defects. We sought to summarize all available data regarding the epidemiology and perioperative outcomes of syndromic ToF patients. A PRISMA-compliant systematic literature review of PubMed and Cochrane Library was performed. Twelve original studies were included. The incidence of syndromic ToF was 15.3% (n = 549/3597). The most prevalent genetic syndromes were 22q11.2 deletion (47.8%; 95% CI 43.4-52.2) and trisomy 21 (41.9%; 95% CI 37.7-46.3). Complete surgical repair was performed in 75.2% of the patients (n = 161/214; 95% CI 69.0-80.1) and staged repair in 24.8% (n = 53/214; 95 CI 19.4-30.9). Relief of RVOT obstruction was performed with transannular patch in 64.7% (n = 79/122; 95% CI 55.9-72.7) of the patients, pulmonary valve-sparing technique in 17.2% (n = 21/122; 95% CI 11.5-24.9), and RV-PA conduit in 18.0% (n = 22/122; 95% CI 12.1-25.9). Pleural effusions were the most common postoperative complications (n = 28/549; 5.1%; 95% CI 3.5-7.3). Reoperations were performed in 4.4% (n = 24/549; 95% CI 2.9-6.4) of the patients. All-cause mortality rate was 9.8% (n = 51/521; 95% CI 7.5-12.7). Genetic syndromes are seen in approximately 15% of ToF patients. Long-term survival exceeds 90%, suggesting that surgical management should be dictated by anatomy regardless of genetics.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Tetralogia de Fallot/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Síndrome de DiGeorge/epidemiologia , Síndrome de Down/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Valva Pulmonar/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tetralogia de Fallot/epidemiologia , Tetralogia de Fallot/etiologia , Tetralogia de Fallot/genética , Resultado do Tratamento
10.
World J Pediatr Congenit Heart Surg ; 10(4): 513-514, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31117878

RESUMO

Absent pulmonary valve is a rare congenital heart defect where the pulmonary valve is either absent or rudimentary. It is usually associated with tetralogy of Fallot although it has been reported with other lesions. We present a rare case of absent pulmonary valve associated with transposition of great arteries and non-routable ventricular septal defect that was surgically managed by aortic root translocation.


Assuntos
Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Valva Pulmonar/anormalidades , Transposição dos Grandes Vasos/cirurgia , Aorta Torácica/diagnóstico por imagem , Ecocardiografia , Humanos , Lactente , Masculino , Valva Pulmonar/cirurgia , Transposição dos Grandes Vasos/diagnóstico
11.
J Card Surg ; 34(7): 570-576, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31090116

RESUMO

BACKGROUND: Pulmonary artery aneurysms (PAAs) are a rare but potentially lethal cardiovascular pathology. PAAs tend to develop in young patients with no gender discrepancy; they are most often associated with congenital heart disorders but also with systemic infections, vasculitis, pulmonary arterial hypertension, chronic pulmonary embolism, and malignancies. Dissection and rupture carry significant morbidity and mortality, thus patients require careful management, especially those with associated pulmonary hypertension. Given the rarity of this condition, physicians have yet to establish standard treatment guidelines. Most studies published to date are case reports with one or two patients; here, we describe our experience with six cases of large PAAs treated surgically at our institution. METHODS: We identified and retrospectively analyzed clinical data for patients who underwent surgery for PAAs between 2009 and 2017. RESULTS: The average age at surgery was 59.73 years, five patients were females, and 83.3% had baseline hypertension. Systolic murmurs were the most common clinical finding. The average aneurysmal size was 65.0 mm. We repaired the PAA with a woven Dacron graft (22-26 mm) in four patients. We performed concomitant pulmonary valve procedures on five patients: four replacements and one repair. Mean pump and cross-clamp times were 108.5 and 65 minutes. Operative and 30-day mortality was 0%. Average length of stay was 10.5 days. CONCLUSIONS: Postoperative mortality was 0%; all patients showed improvement of symptoms after surgery. These findings confirm that PAA repair has an acceptable risk profile in select patients.


Assuntos
Aneurisma/cirurgia , Artéria Pulmonar/cirurgia , Idoso , Aneurisma/etiologia , Implante de Prótese Vascular/métodos , Feminino , Cardiopatias Congênitas/complicações , Sopros Cardíacos/etiologia , Humanos , Hipertensão Pulmonar/complicações , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos , Valva Pulmonar/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
12.
Int J Cardiovasc Imaging ; 35(8): 1453-1463, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30937683

RESUMO

To compare contrast-enhanced magnetic resonance angiography (ceMRA) and 3D steady-state free precession (SSFP) during systole and diastole for assessment of the right ventricle outflow tract (RVOT) in patients considered for percutaneous pulmonary valve implantation (PPVI) after tetralogy of Fallot (TOF) repair. We retrospectively evaluated 89 patients (male: 45, mean age 19 ± 8 years), who underwent cardiac-MRI after surgical TOF-repair. Datasets covering the whole heart in systole and diastole were acquired using ECG-gated 3D SSFP and non-gated ceMRA. Measurements were performed in SSFP-sequences and in ceMRA in the narrowest region of the RVOT to obtain the minimum, maximum and effective diameter. Invasive balloon sizing as the gold standard was available in 12 patients. The minimum diameter in diastolic SSFP, systolic SSFP and ceMRA were 21.4 mm (± 6.1 mm), 22.6 mm (± 6.2 mm) and 22.6 mm (± 6.0 mm), respectively. Maximum diameter was 29.9 mm (± 9.5 mm), 30.0 mm (± 7.0 mm) and 28.8 mm (± 8.1 mm) respectively. The effective diameter was 23.2 mm (± 5.7 mm), 27.4 mm (± 6.7 mm) and 24.4 mm (± 6.2 mm), differing significantly between diastole and systole (p < 0.0001). Measurements in ECG-gated SSFP showed a better inter- and intraobserver variability compared to measurements in non-ECG-gated ceMRA. Comparing invasive balloon sizing with our analysis, we found the highest correlation coefficients for the maximum and effective diameter measured in systolic SSFP (R = 0.99 respectively). ECG-gated 3D SSFP enables the identification and characterization of a potential landing zone for PPVI. The maximum and effective systolic diameter allow precise sizing for PPVI. Patients with TOF-repair could benefit from cardiac MRI before PPVI.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca/métodos , Ventrículos do Coração/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/métodos , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Valvuloplastia com Balão , Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Técnicas de Imagem de Sincronização Cardíaca , Criança , Meios de Contraste/administração & dosagem , Eletrocardiografia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Ventrículos do Coração/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador , Imagem Tridimensional , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Desenho de Prótese , Valva Pulmonar/fisiopatologia , Valva Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Função Ventricular Direita , Adulto Jovem
13.
J Med Case Rep ; 13(1): 97, 2019 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-30999926

RESUMO

BACKGROUND: Pulmonary valve infective endocarditis is a rare diagnosis that is usually associated with immunocompromised states or structurally abnormal hearts. It is unusual for it to occur in structurally normal hearts or to cause recurrent symptoms after targeted antibiotics. Although guidelines suggest follow-up with repeat echocardiography and inflammatory marker surveillance, this case demonstrates that these are not always useful investigations, and instead imaging of the chest may be more appropriate. CASE PRESENTATION: We describe a case of a 74-year-old man who presented with respiratory symptoms and was originally misdiagnosed with pneumonia but later found to have a large pulmonary valve vegetation caused by Streptococcus mitis. Despite initially responding to antibiotic therapy, the vegetation continued to cause pulmonary emboli and cavitating lung abscesses months later, necessitating pulmonary valve replacement. CONCLUSIONS: This case demonstrates that pulmonary valve endocarditis can present atypically with recurrent respiratory symptoms, and in such cases, echocardiography should be considered to investigate for right-sided infective endocarditis. In addition, despite correct treatment, with normalization of inflammatory markers and improvement in vegetation size, infective endocarditis can continue to cause systemic symptoms. Finally, clinicians should consider chest computed tomography routinely as part of right-sided infective endocarditis follow-up.


Assuntos
Diagnóstico Tardio/efeitos adversos , Endocardite Bacteriana/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Idoso , Antibacterianos/uso terapêutico , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Humanos , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/etiologia , Masculino , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Valva Pulmonar/microbiologia , Valva Pulmonar/cirurgia , Streptococcus mitis/isolamento & purificação , Tomografia Computadorizada por Raios X
14.
J Cardiothorac Surg ; 14(1): 77, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987651

RESUMO

PURPOSE: To evaluate the potential for right ventricular reverse remodelling after pulmonary valve replacement using cardiac magnetic resonance imaging, in adults with corrected tetralogy of Fallot and severe pulmonary insufficiency. MATERIAL AND METHODS: Ten patients with previous correction of tetralogy of Fallot with severe pulmonary insufficiency accepted for pulmonary valve replacement were evaluated prospectively with cardiac magnetic resonance imaging preoperatively and re-evaluated 10 ± 5 months postoperatively. Follow up for survival was 100% complete with mean of 37 ± 12 months. RESULTS: The preoperative mean indexed right ventricular end-diastolic volume was reduced from 161 ± 33 ml/m2 to 120 ± 23 ml/m2 postoperatively, p < 0.001. The preoperative mean indexed right ventricular stroke volume was reduced from 72 ± 20 ml/m2 to 50 ± 6 ml/m2 postoperatively, p = 0.002. After pulmonary valve replacement, the right ventricular ejection fraction did not change significantly (46% versus 42%, p = 0.337). Pulmonary insufficiency fraction decreased from 49% ± 11 to 1% ± 1 postoperatively, p < 0.001. CONCLUSIONS: Pulmonary valve replacement leads to a favourable early reverse remodelling with a reduction in RV volumes and improved function in all patients regardless of their preoperative indexed right ventricular volume.


Assuntos
Implante de Prótese de Valva Cardíaca , Imagem por Ressonância Magnética/métodos , Insuficiência da Valva Pulmonar/fisiopatologia , Tetralogia de Fallot/fisiopatologia , Função Ventricular Direita/fisiologia , Remodelação Ventricular/fisiologia , Adolescente , Adulto , Procedimentos Cirúrgicos Cardíacos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Prospectivos , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Valva Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/cirurgia , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Adulto Jovem
15.
Scand Cardiovasc J ; 53(3): 148-152, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31017007

RESUMO

Objectives: We aimed to investigate the outcome of tricuspid valve repair (TVR) performed concomitantly with pulmonary valve replacement in repaired tetralogy of Fallot (TOF) patients. Design: This retrospective study included all patients who underwent pulmonary vale replacement from 2000 to 2016 after TOF correction. TVR patient data were compared to those of patients who underwent pulmonary vale replacement alone. Results: Thirty-eight patients were enrolled. The degree of tricuspid regurgitation was significantly decreased after operation in the TVR group. Tricuspid valve annulus and annuloectasia before operation did not vary between groups (21.1 ± 6.3 and 41.4% in no TVR vs. 21.3 ± 4.8 and 52.6% in TVR). However pre-operative right ventricular volumes were larger in the TVR group. Normal tricuspid valve coaptation (body to body) was observed less frequently in the TVR group than in the other group (52.6% vs. 93.1%, p < .001). Pre-operative tricuspid regurgitation had a linear correlation with right ventricular volume, but not with tricuspid annulus size. Conclusion: Tricuspid annulus diameter decreased significantly regardless of TVR. Abnormal coaptations were observed more in patients group and the degree of pre-operative tricuspid regurgitation was linearly correlated with right ventricular volume rather than tricuspid annulus size.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adolescente , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Tetralogia de Fallot/complicações , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/fisiopatologia , Adulto Jovem
16.
Ann Thorac Surg ; 108(2): 567-573, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30974093

RESUMO

BACKGROUND: Bovine jugular vein (BJV) conduits are commonly used for pulmonary valve replacement in pediatric patients. They are available in supported (sBJV) and unsupported (uBJV) versions. The purpose of this study was to compare outcomes of sBJV and uBJV conduits. METHODS: In this single-center retrospective review of patients younger than 18 years undergoing BJV placement (2009 to 2017), blinded cardiologists reviewed postoperative 6-, 12-, 24-, 36-month, and the most recent echocardiogram before any valve-related event or death. Outcomes assessed included conduit stenosis (m/s), regurgitation (none to mild vs moderate to severe) and right ventricular function (normal vs abnormal). Cox proportional models and Kaplan-Meier analyses were performed. RESULTS: BJV conduits (N = 109) were placed (39 supported, 70 unsupported) in 101 patients. Patient characteristics and conduit size were not different between cohorts. sBJV had more stenosis at 6 and 12 months (p = 0.02 and p = 0.03), but Vmax in both groups was mild (≤2 m/s). A greater proportion of uBJV had moderate to severe regurgitation at 12 months compared with sBJV (p = 0.03). Right ventricular function did not differ at any time point. On last follow-up echocardiogram, sBJV conduits had higher gradients (p = 0.01). This was not associated with increased intervention or replacement. Freedom from replacement or intervention did not differ between valve types (median follow-up, 3.6 years). There was a 9% incidence of endocarditis at median follow-up 2.4 years. Seventy percent of cases with endocarditis were managed medically. CONCLUSIONS: There were no clinically significant echocardiographic or outcome differences between sBJV and uBJV conduits. We identified a relatively high incidence of endocarditis, which is consistent with prior reports.


Assuntos
Bioprótese , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Veias Jugulares/transplante , Valva Pulmonar/cirurgia , Animais , Bovinos , Criança , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Lactente , Masculino , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
17.
Ann Thorac Surg ; 108(2): 581-589, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30928547

RESUMO

BACKGROUND: Unlike the vast amount of animal data available on the recellularization of allogenic decellularized heart valves (DHVs), there have only been sporadic histologic reports on such grafts in humans. METHODS: Two experienced cardiac pathologists independently evaluated human specimens obtained during reoperation between December 2010 and April 2017 DHVs in seven categories after automated staining (scores: 0 to 6) in comparison with published data. An optimal result of 42 points was classified as 100%. RESULTS: We found that 364 DHVs, 236 decellularized pulmonary homografts (DPHs), and 128 decellularized aortic homografts (DAHs) were implanted, and freedom from explantation was 96.1% (DAH) and 98.7% (DPH). Reoperations were because of (suspected) endocarditis in 5 of 11 patients, stenosis at the subvalvular or valvular or supravalvular level in 3 of 11 patients, planned staged reoperation in 2 of 11 patients, and 1 heart transplantation. Good reader agreement was reflected by an interagreement weighted κ of 0.783 (95% confidence interval: 0.707 to 0.859). The relative histologic score in nonendocarditis specimens was 76% ± 4.3% (maximum 81%). Intracellular procollagen type 1 production was found in recipient mesenchymal cells within the transplanted grafts. In endocarditis specimens the histologic score was significantly lower with 48% ± 7.3% (minimum 41%, p = 0.0004) because of leucocyte infiltration and matrix degradation. One DPH showed immune system-mediated graft failure. Grafts obtained during the first 12 months after implantation were not evenly repopulated with less recellularization in the inner parts; no difference was found between DAH and DPH with respect to extent of recellularization. CONCLUSIONS: Substantial in vivo recellularization with noninflammatory cells was observed in this study. Spontaneous recellularization appears to require multiple months, which correspondingly has an impact on size selection for growing patients.


Assuntos
Valva Aórtica/patologia , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Valva Pulmonar/patologia , Adolescente , Adulto , Valva Aórtica/cirurgia , Criança , Pré-Escolar , Criopreservação , Feminino , Seguimentos , Doenças das Valvas Cardíacas/patologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Valva Pulmonar/cirurgia , Reoperação , Estudos Retrospectivos , Transplante Heterólogo , Transplante Homólogo , Adulto Jovem
18.
Am J Case Rep ; 20: 478-481, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30956275

RESUMO

BACKGROUND One of the most common complications after repair of Fallot's tetralogy is pulmonary valve regurgitation (PR). There are many concepts of treatment, such as surgical, percutaneous, or hybrid pulmonary valve repair. Surgical pulmonary valve replacement is associated with low operative morbidity and mortality and shows very good long-term results. For that reason, it remains the standard of treatment. CASE REPORT We present a case of a 26-year-old male patient who underwent a successful emergent surgical pulmonary valve replacement after a failed percutaneous pulmonary valve intervention, which was performed due to pulmonary regurgitation. CONCLUSIONS Despite the modern (interventional and hybrid) procedures in the treatment of pulmonary valve regurgitation after repair of Fallot's tetralogy, surgical treatment for pulmonary regurgitation still remains the gold standard for young adult patients.


Assuntos
Implante de Prótese de Valva Cardíaca , Complicações Pós-Operatórias/cirurgia , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Adulto , Humanos , Masculino , Insuficiência da Valva Pulmonar/etiologia
19.
World J Pediatr Congenit Heart Surg ; 10(2): 197-205, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30841830

RESUMO

BACKGROUND: Postcongenital heart surgery pulmonary regurgitation requires subsequent pulmonary valve replacement. We sought to compare the outcomes of pulmonary valve replacement after using bioprosthetic valves, porcine versus pericardial bioprosthesis. METHOD: Retrospective single-center study of consecutive pulmonary valve replacement in patients with pulmonary regurgitation following initial congenital cardiac surgery. From 2004 to 2016, 82 adult patients (53 males, 29 females) underwent pulmonary valve replacement at a mean age of 28.7 ± 8 years (range 18-52 years) with a mean time to pulmonary valve replacement of 24 ± 7 years (range 13-43 years). Porcine bioprosthetic valves (group 1, n = 32) and pericardial valves (group 2, n = 50) were used. Cardiac magnetic resonance imaging was performed (n = 54) at a mean of 18 ± 13 months before and 24 ± 21 months after pulmonary valve replacement. RESULTS: No significant difference was seen between the groups except that the mean follow-up was longer for group 1 (5.02 ± 2.06 vs 4.08 ± 3.21 years). In-hospital mortality was 1.1%. Follow-up completeness was 100% with no late death. Mean right ventricular end-systolic and end-diastolic volumes reduced significantly in both the groups ( P < .001), whereas right ventricular ejection fraction remained unchanged (group 1, P = .129; group 2, P = .675) . Only the left ventricular end-diastolic volume increased in both the groups, but the increase was significant for group 2 only (group 1, P = .070; group 2, P = .015), whereas the left ventricular end-systolic and ejection fraction remained unchanged in both the groups. There was no reoperation for pulmonary valve replacement. Freedom from intervention was 93.8% (group 1) and 100% (group 2) at eight years after pulmonary valve replacement ( P = .407). CONCLUSION: Midterm outcomes of pulmonary valve replacement in our adult cohort were satisfactory. Both types of bioprosthetic valves performed comparably for eight years and were a good option in adults.


Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Adolescente , Adulto , Animais , Ecocardiografia , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Desenho de Prótese , Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/mortalidade , Estudos Retrospectivos , Suínos , Resultado do Tratamento , Adulto Jovem
20.
World J Pediatr Congenit Heart Surg ; 10(2): 145-150, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30841840

RESUMO

OBJECTIVE: Hinge washing is a crucial factor in the prevention of mechanical prosthetic valvar thrombosis, especially in the pulmonary valve position. The aim of this laboratory study was to determine the relationship between pressure difference and the amount of hinge washing in the closed position, using the pressures that are normal for the right ventricle and pulmonary artery. METHODS: In an in vitro setting, four different bileaflet mechanical valves were tested for hinge washing in closed position. Based on similarity in inner diameter (range: 20.5-21.4 mm), the following valves were tested: Abbott SJM Regent size 23, Cryolife On-X size 23, LivaNova Carbomedics-R size 25, Medtronic Open Pivot (M-OP)-A size 25. Tests were carried out in a range between 3 and 100 mm Hg pressure difference, using water as a test fluid. The amount of leakage per minute through the closed valve was measured. RESULTS: All four valves showed an increase in leakage with increasing transvalvar gradient, and the relationship between pressure and leakage behaves in logarithmic fashion. Leakage under normal pulmonary diastolic pressure conditions (10 mm Hg) was between 23.3% and 29.3% of the leakage under aortic diastolic pressure conditions (80 mm Hg). The Cryolife On-X valve showed the highest closed leakage volume under pulmonary conditions (10 mm Hg) 0.254 ± 0.01 (L/min), where the Medtronic M-OP showed the lowest leakage volume with 0.125 ± 0.014 (mL/min). CONCLUSION: Hinge washing is related to transvalvar pressure difference in closed position. Valve brands differed significantly from each other in the amount of hinge washing.


Assuntos
Pressão Sanguínea , Próteses Valvulares Cardíacas , Hemodinâmica , Trombose/prevenção & controle , Humanos , Técnicas In Vitro , Desenho de Prótese , Falha de Prótese , Valva Pulmonar/cirurgia
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