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1.
Am J Forensic Med Pathol ; 41(1): 40-41, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31929320

RESUMO

The deceased was a 44-year-old male who was treated for a suspected Ebstein's anomaly observed using transthoracic echocardiogram. He was found dead in his bed at home. Autopsy revealed that the septal tricuspid leaflet was intact; however, a large anterior tricuspid leaflet cleft and right atrioventricular cavity dilation were observed. Pathological examination revealed a normal tricuspid valve, except for the presence of a cleft with local fibrosis of the left ventricle papillary muscle and hemosiderin-containing macrophages at both lungs. There were no other abnormalities that may have led to death. It was concluded that he died a cardiac death based on the right heart overload associated with the anterior tricuspid leaflet cleft. This case indicates the possibility that the anterior tricuspid leaflet cleft can cause death and also highlights the necessity of a detailed autopsy to accurately diagnose the cause of death.


Assuntos
Valva Tricúspide/anormalidades , Valva Tricúspide/patologia , Adulto , Proteína C-Reativa/análise , Diagnóstico Diferencial , Anomalia de Ebstein/diagnóstico , Fibrose , Patologia Legal , Insuficiência Cardíaca/etiologia , Ventrículos do Coração/patologia , Hemossiderina/metabolismo , Humanos , Pulmão/metabolismo , Macrófagos/metabolismo , Masculino , Peptídeo Natriurético Encefálico/sangue , Músculos Papilares/patologia , Fragmentos de Peptídeos/sangue , Insuficiência da Valva Tricúspide/complicações
2.
Rev Med Liege ; 75(1): 43-48, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31920043

RESUMO

Ebstein's anomaly is a rare and complex congenital heart disease involving abnormal embryological development of the tricuspid valve. Its exact prevalence remains unknown given the under-diagnosis of minor forms and the broad clinical spectrum of this pathology resulting from the highly variable tricuspid morphology. Echocardiography plays an important role in diagnosis, assessment and prognostic evaluation of this condition. We present the case of a 6-year-old boy born from a twin pregnancy with a severe neonatal EA diagnosed by ultrasound at 29 weeks of gestation and we discuss the management on the light of the recent literature.


Assuntos
Anomalia de Ebstein , Criança , Anomalia de Ebstein/diagnóstico , Anomalia de Ebstein/cirurgia , Ecocardiografia , Feminino , Humanos , Masculino , Gravidez , Diagnóstico Pré-Natal , Valva Tricúspide
3.
Zhonghua Wai Ke Za Zhi ; 57(12): 881-884, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826589

RESUMO

Severe isolated tricuspid regurgitation following left-sided heart valve surgery appears a growing clinical concern. Due to elevated operational risk of redo-sternotomy operation, it brings upon poor prognosis and decreased quality of life for these patients, and technical challenges for cardiac surgeons as well. With the advancing of minimally invasive surgical theory and skills, Chinese cardiac surgeons are building up their own surgical experience with this patient population. However, there remains controversy about the optimal surgical timing and strategy for these high-risk patients. With the lack of recommendation from evidence-based medicine, it is necessary to learn from the pioneers' experience and contemplate on gains and losses in clinical practice, which would help to improve the safety and outcome of the procedure and to benefit these patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Humanos , Prognóstico , Qualidade de Vida , Reoperação , Esternotomia/efeitos adversos , Resultado do Tratamento , Insuficiência da Valva Tricúspide/etiologia
4.
Zhonghua Wai Ke Za Zhi ; 57(12): 893-897, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826591

RESUMO

Tricuspid insufficiency late after left-sided heart valve surgery is not uncommon. These patients usually suffer from severe right heart insufficiency and poor general condition due to untimely surgical intervention, and are often complicated with hepatic and renal insufficiency and hemopoietic dysfunction. The choice of strategy for reoperation and perioperative management are still the major challenges for contemporary cardiac surgeons. This article introduces the clinical characteristics and operation timing of patients with severe tricuspid insufficiency after previous left-sided heart valve surgery, and focuses on the selection of operation approach and operation methods.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Reoperação , Insuficiência da Valva Tricúspide/etiologia
5.
Zhonghua Wai Ke Za Zhi ; 57(12): 898-901, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826592

RESUMO

Objective: To examine the short-term outcomes of minimally invasive reoperation for severe tricuspid regurgitation after left-sided valve surgery. Methods: From January 2015 to December 2018, a total of 89 patients with severe tricuspid regurgitation after left-sided valve surgery received reoperation in Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study. There were 21 males and 68 females, aging of (56.4±7.9) years (range: 41 to 74 years). The interval between previous left-sided valve surgery and tricuspid reoperation was (14.1±6.1) years (range: 4 to 33 years). A combination of multiple minimally invasive techniques were adopted, including endoscopy-assist right minithoracotomy approach, peripheral cannulation strategy with the vacuum-assist single venous drainage technique, heart beating technique, and temporary percutaneous pacemaker implantation, with a concomitant enhancement in preoperative right cardiac function optimization. Results: All patients received minimally invasive isolated tricuspid valve replacement (n=81) or tricuspid valve repair (n=8). After the application of multiple minimally invasive techniques, the operative mortality rate was only 3.4% (3/89). The causes of death were progressive right heart failure with multiorgan failure (n=1) and low cardiac output associated with postoperative bleeding (n=2). Regarding to the perioperative complications, renal replacement therapy rate was 5.6% (5/89), permanent pacemaker implantation rate was 1.1% (1/89), and the incidence of stroke was 0. Mechanical ventilation time was 24(24) hours, ICU stay time was 2.5 (3.0) days (M(Q(R))). During the short-term follow-up, there were no case of severe tricuspid regurgitation, 2 cases of moderate regurgitation, 4 cases of mild-to-moderate regurgitation. Conclusions: For severe tricuspid regurgitation after left-sided valve surgery, the advanced minimally invasive techniques can significantly reduce the operative mortality and morbidity. Minimally invasive bioprosthetic tricuspid valve replacement is a reliable alternative for severe tricuspid regurgitation after left-sided valve surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Idoso , Feminino , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Reoperação , Resultado do Tratamento , Insuficiência da Valva Tricúspide/etiologia
6.
Zhonghua Wai Ke Za Zhi ; 57(12): 902-907, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826593

RESUMO

Objectives: To evaluate the efficacy of minimally invasive surgery in patients with late severe tricuspid regurgitation after cardiac surgery, and to evaluate the role of leaflets augmentation technique in tricuspid valvuloplasty. Methods: From January 2015 to June 2019, 85 patients undergoing tricuspid valve repair procedure with minimally invasive approach at Department of Cardiovascular Surgery, Guangdong provincial People's Hospital were enrolled. There were 22 males and 63 females, aging of (53.6±12.4) years (range: 15 to 75 years). The interval between the prior and current operations was (16.0±7.3) years (range: 0.2 to 35.0 years). The diameter of right atrium and right ventricle was (77.3±17.2) mm and (61.0±8.4) mm, respectively. Tricuspid regurgitation was severe or extremely severe, the tricuspid regurgitation area was (19.0±10.3) cm(2). All patients underwent minimally invasive tricuspid valvuloplasty or tricuspid valve replacement on beating-heart with totally endoscopic technique and port-access approach through right chest wall. The operations included tricuspid valve replacement and tricuspid valvuloplasty, the technique of tricuspid valvuloplasty including leaflets augmentation with patch, ring implantation, chordae tendineaes reconstruction, release of papillary muscle, edge to edge method, etc. Postoperative hospitalization days, the time of ICU stay, blood transfusion rate, ventilator time and the results of echocardiography were recorded. Follow-up was completed regularly by WeChat, telephone and outpatient visit. Results: Sixty-five patients underwent tricuspid valve repair, and 20 patients underwent tricuspid valve replacement because of prosthetic failure and plasty failure. Five patients died during hospitalization, with mortality rate 5.9%. One patient was transferred to local hospital for anti-infection treatment, the other 79 patients were discharged from hospital in well condition and followed-up. The postoperative hospitalization time was 7.0 (5.5) days (M(Q(R))) days, the mean ventilator time was 18.0 (16.2) hours, and the mean ICU stay time was 68.0 (75.5) hours. There were 35 patients without blood conduction transfusion, the transfusion rate was only 58.9% (50/85). Four cases of severe, 9 cases of moderate and 67 cases of mild to zero tricuspid regurgitation were examined before being discharged, with tricuspid regurgitation area of (2.8±3.5) cm(2) (range: 0 to 19.1 cm(2)). The follow-up time was 1 to 38 months. Two patients died during follow-up, one patient died from infective endocarditis and mitral perivalvular leakage, the other one died of intractable right heart failure. One patient was implanted with permanent pacemaker due to Ⅲ atrioventricular block. Valvular re-replacement was performed in 2 patients who were re-admitted for the artificial valve infection and mechanical valve obstruction. No re-operation of tricuspid valve. Conclusions: Totally endoscopic minimally invasive technique provided satisfactory surgical outcomes for critically sick patients with severe tricuspid regurgitation following cardiac surgery. The application of leaflets augmentation technique achieved ideal repair effect for previously unrepairable lesions.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Reoperação , Resultado do Tratamento , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/etiologia , Adulto Jovem
7.
Zhonghua Wai Ke Za Zhi ; 57(12): 908-911, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826594

RESUMO

Objective: To examine minimally invasive tricuspid valve operations applied in tricuspid valve insufficiency patients with previous left-sided valve surgery. Methods: Between September 2017 and June 2019, thirty-six consecutive patients received minimally invasive totally thoracoscopic tricuspid surgery through right thoracotomy at Department of Cardiovascular Surgery, Fisrt Medical Center, People's Liberation Army General Hospital. There were 13 males and 23 females, aging (56±11) years (range: 43 to 79 years). All the patients had isolated significant tricuspid regurgitation after previous left-sided cardiac surgeries. A right anterolateral thoracotomy incision about 4 cm was made from the fourth intercostal space as main operating port. The arterial cannula was placed in femoral artery. The venous cannula was placed in femoral vein using Seldingger technique. Tricuspid valve operation was performed on beating heart by assist of vena vacuum. Results: Tricuspid valve repair was performed in 7 patients. Tricuspid valve replacement with bioprosthesis was performed in 29 patients. The operation time was (2.9±0.3) hours (range:2.5 to 3.6 hours). There was no conversion to sternotomy during operation. There was no severe complications during operation period. There were no complications related to this cannulation technique. The time of cardiopulmonary bypass establishment was (22±5) minutes (range: 12 to 24 minutes) and pump time was (82±16) minutes (range: 62 to 93 minutes). The length of hospital stay was (9±3) days after operation (range: 5 to 13 days). There was no early death in hospital. All patients were followed up for 3 to 22 months. No patient died. Conclusions: One single port-based minimally invasive approach seems to be safe, feasible, and reproducible in case of redo tricuspid valve operations. Only cannulation of inferior vena cava significantly simplified the complexity of isolated redo tricuspid surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Toracoscopia/métodos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Toracoscopia/instrumentação , Toracotomia , Resultado do Tratamento , Insuficiência da Valva Tricúspide/etiologia
8.
Zhonghua Wai Ke Za Zhi ; 57(12): 947-950, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826601

RESUMO

Late tricuspid regurgitation after left-sided valve surgery can negatively affect long-term prognosis. The surgical timing and strategy of tricuspid valve reoperation will have important impact on the surgical outcomes. However, there is no clear recommendations of the surgical timing for this condition in the current guidelines. Generally, tricuspid valve reoperation should be performed before irreversible right heart failure occurs. Although tricuspid valve repair is the first choice for tricuspid regurgitation, bioprosthetic tricuspid valve replacement might be a reliable alternative when tricuspid leaflets have severe rheumatic damage or right ventricle and tricuspid annulus significantly dilate. Combined minimally invasive surgical techniques, including right minithoracotomy approach, accessing the right atrium directly through the pericardium with limited dissection, peripheral cannulation strategy with the vacuum-assist single venous drainage technique and heart beating technique, can significantly decrease the operative mortality and postoperative bleeding. With development of interventional therapy, transcatheter tricuspid valve repair or replacement may become alternatives for tricuspid regurgitation after left-sided valve surgery in the future.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Bioprótese , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Reoperação , Resultado do Tratamento , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/etiologia
11.
J Cardiothorac Surg ; 14(1): 195, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718687

RESUMO

OBJECTIVE: To evaluate the effectiveness of autologous pericardium ring in tricuspid annuloplasty surgery for the treatment of tricuspid regurgitation (TR). METHODS: From December 2010 to December 2012, a total of 107 patients with secondary TR underwent tricuspid annuloplasty. The patients were divided into three groups: autologous pericardium ring group (n = 38), Edwards-MC3 ring group (n = 35), and DeVega group (n = 34). The patients were followed-up for two years. The survival rates and free from hospital readmission rates were measured and analyzed. The patients also received transthoracic echocardiography (TTE) in order to obtain TR regurgitant jet area to right atrial area (STR/STA), diastolic tricuspid annuloplasty diameter (DTAD), right atrial diameter (RAD), and right ventricular diameter (RVD). RESULTS: One patient from DeVega group and one patient from autologous pericardium ring died from low cardiac output syndrome during the perioperative period. In the two-year follow-up period, each group has one instance of death for unclear reasons. One month after operation, the STR/STA, DTAD, RAD, and RVD values in all groups were significantly lower than the pre-operation values (P < 0.05). During the two year follow-up period, DTAD values of patients from DeVega group increased significantly as compared to the values at one month post operation (P<0.05), which is different from the other two groups in which DTAD values remained stable (P>0.05). In both pericardium ring group and Edwards-MC3 group, STR/SRA, remained stable (P>0.05) during the follow-up period, whereas STR/SRA of the DeVega group had showed a tendency of increase (although statistically insignificant, P>0.05). There was no significant difference in the survival rates among three study groups (P > 0.05), but the rate of free from hospital readmission in the DeVega group was significantly lower than those in the other two groups (P < 0.05) during the two-year follow-up period. CONCLUSIONS: Autologous pericardium tissue based ring annuloplasty demonstrated remarkable clinical utility for treating tricuspid regurgitation. It shows similar beneficial results to Edwards-MC3 annuloplasty within a short-term follow-up period, and outperforms the widely used DeVega annuloplasty. Autologous pericardium tissue annuloplasty represents a promising technique for tricuspid annuloplasty and holds great potential for treating tricuspid valve dysfunctions.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Pericárdio/transplante , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Estudos Retrospectivos , Taxa de Sobrevida , Transplante Autólogo , Resultado do Tratamento
12.
EuroIntervention ; 15(10)2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31746757

RESUMO

AIMS: This study sought to analyse multislice computed tomography (MSCT) data of patients with tricuspid regurgitation and to report the variability of fluoroscopic viewing angles for several right-sided heart structures, as well as chamber views of the right heart in order to determine the optimal fluoroscopic viewing angles of six right-sided heart structures and right-heart chamber views. METHODS AND RESULTS: The MSCT data of 44 patients with mild to severe tricuspid regurgitation (TR) were retrospectively analysed. For each patient, we determined the optimal fluoroscopic viewing angles of the annulus/orifice en face view of the tricuspid valve, atrial septum, superior vena cava (SVC), inferior vena cava (IVC), coronary sinus (CS) and pulmonary valve. In this TR patient cohort, the average fluoroscopic viewing angle for the en face view of the tricuspid valve annulus was LAO 54-CAUD 15; RAO 10-CAUD 66 for the SVC orifice; LAO 27-CRA 59 for the IVC orifice; RAO 28-CRA 19 for the CS orifice; RAO 33-CAUD 33 for the atrial septum and LAO 13-CAUD 52 for the pulmonary valve annulus. The average viewing angle for right-heart chamber views was LAO 55-CAUD 15 for the one-chamber view; RAO 59-CAUD 54 for the two-chamber view; RAO 27-CRA 19 for the three-chamber view and LAO 5-CRA 60 for the four-chamber view. CONCLUSIONS: MSCT can provide patient-specific fluoroscopic viewing angles of right-sided heart structures. This information may facilitate transcatheter right-heart interventions.


Assuntos
Tomografia Computadorizada Multidetectores , Insuficiência da Valva Tricúspide , Fluoroscopia , Humanos , Estudos Retrospectivos , Valva Tricúspide , Insuficiência da Valva Tricúspide/diagnóstico
14.
Heart Surg Forum ; 22(5): E343-E351, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31596709

RESUMO

BACKGROUND: To comprehensively investigate early and late outcomes for all valve replacement surgery patients in a non-referral regional hospital database and to compare these results with the literature. METHODS: This was a retrospective study and made up of patients undergoing heart valve replacement in the cardiovascular department of a non-referral regional hospital between May 2008 and February 2018. Inclusion criteria were aortic, mitral and double valve replacement with or without CABG. RESULTS: 212 patients were included in the study. Of the 212 patients, 65 were aortic valve replacement, 119 were mitral valve replacement, 28 were double valve replacement patients. Mean follow-up of all patients was 3.4 ± 2.9 years. There was no significant difference among the groups regarding hospital mortality. The occurrence of acute renal failure and neurological event was the main factors of morbidity-associated mortality. Concomitant CABG procedure was found to be an independent predictor of early mortality after MVR. In the AVR group, there was no significant difference between AVR with CABG and without CABG regarding the 5-year survival rates; whereas in MVR and DVR group, there was a statistically significant difference between the groups. According to Cox proportional hazards model for determining factors related to late mortality, preoperative chronic renal failure and concomitant CABG were factors independently related to late mortality after MVR. CONCLUSION: We believe that our study will contribute to the development of the outcomes of heart valve replacement surgery in these centers by supporting other non-heart center clinics in working toward acceptable morality rates for complex valve surgeries.


Assuntos
Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Lesão Renal Aguda/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bioprótese , Ponte de Artéria Coronária/mortalidade , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Valva Tricúspide/cirurgia , Adulto Jovem
15.
Heart Surg Forum ; 22(5): E411-E415, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31596722

RESUMO

BACKGROUND: In this study, we evaluate different annuloplasty modalities to repair functional tricuspid regurgitation. PATIENTS AND METHODS: Between January 2011 and January 2017, 200 patients with moderate or greater functional tricuspid regurgitation received tricuspid valve repair as part of primary surgeries on the left side of their cardiac valves. Of these, 39 patients received rings (Group A), 84 patients received bands (Group B), and 77 patients received suture annuloplasty (Group C). RESULTS: Two patients from Group C were operated on again, during the primary hospital stay due to severe symptomatic tricuspid regurgitation. The degrees of early postoperative tricuspid regurgitation - mean vena contracta and mean jet area - significantly were higher in Group C. During a mean follow-up period of 26 ± 12.6 months, 5 patients within Group C (6.85%) and one patient in Group B (1.3%) were operated on again with tricuspid valve replacement due to severe symptomatic tricuspid incompetence. Also during follow up, mean degrees of tricuspid regurgitation, mean vena contracta, and mean jet areas significantly were higher in Group C. CONCLUSION: Patients who received rings followed by band annuloplasty had better early and late results with lower recurrence rates than those who received suture annuloplasty.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Complicações Pós-Operatórias/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Anuloplastia da Valva Cardíaca/instrumentação , Feminino , Humanos , Masculino , Reoperação , Suturas , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(42): e17347, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626092

RESUMO

RATIONALE: Non-significant residual shunt is a relatively common complication after device closure of perimembranous ventricular septal defects (Pm-VSD). Lifelong antibiotic prophylaxis has been recommended in guidelines to avoid infectious endocarditis (IE) if residual shunt remains. Clinicians, however, rarely follow it in their practice and regular follow-up was the most common option since post-procedure IE after transcatheter closure of PmVSD is rarely reported. We firstly described a case of IE after transcatheter closure of PmVSD with modified symmetrical double-disk device with a residual shunt, highlighting the need for reassessing the prognostic implications of post-procedure non-significant residual shunt and the most appropriate treatment strategy. PATIENT CONCERNS: A 3-year old female received transcatheter closure of PmVSD sized 5.0 mm on left ventricular angiography with an 8-mm modified symmetric double-disk occluder (SHAMA) owing to a history of recurrent lower respiratory tract infections. Post-procedure echocardiography documented a non-significant residual shunt, but no additional interventions were performed. Two months post procedure, the child was re-admitted into our department with a complaint of persistent fever up to 41°C for 11 days and nonresponse to 1-week course of amoxicillin. DIAGNOSES: The diagnosis of post procedure IE was established since a vegetation (13 × 9 mm) was found to be attached to the tricuspid valve and the occluder, and Staphylococcus aureus was isolated from all three-blood cultures. INTERVENTIONS: After 6 weeks of vancomycin treatment, the vegetation disappeared with no sign of valvular dysfunction. Three weeks after discharge, a second device was implanted to abolish persistent residual flow. OUTCOMES: Unfortunately, the child was ultimately transferred to surgical department due to severe hemolysis after the second device implantation. The occluders were removed and the VSD was closed with a pericardial patch. Tricuspid valvuloplasty was also performed and the following course was uneventful. LESSONS: For non-significant residual shunt after device closure of PmVSD, implantation of a second device or surgical repair may be a better and more satisfactory alternative compared with lifelong antibiotic prophylaxis or no interventions, since associated IE can indeed occur despite its rarity and the risk of antibiotic-associated adverse events may outweigh the benefits.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Endocardite Bacteriana/etiologia , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Pré-Escolar , Endocardite Bacteriana/terapia , Feminino , Humanos , Reoperação/métodos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/isolamento & purificação , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/patologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-31593379

RESUMO

Right-sided infective endocarditis is common in patients who use intravenous drugs. However, even when leaflets are heavily damaged as a result of the endocarditis, an attempt of valve repair is worth a try. Tricuspid valve repair is superior to valve replacement because it is associated with  a lower rate of recurrence and reoperation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Endocardite/cirurgia , Transtornos Relacionados ao Uso de Substâncias/complicações , Valva Tricúspide/cirurgia , Doença Aguda , Adulto , Endocardite/etiologia , Humanos , Recidiva , Reoperação
18.
ABC., imagem cardiovasc ; 32(4): 318-30, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1024061

RESUMO

A doença pulmonar hipertensiva pode ser definida como um conjunto de alterações fisiopatológicas pulmonares que resultam em uma patologia grave, progressiva e com alta morbimortalidade. O ecocardiograma transtorácico é um método de imagem de fácil acesso e essencial para avaliação desta doença, principalmente na faixa pediátrica, na qual há limitações para realização frequente e de rotina do cateterismo direito. Nesta revisão, abordaremos as principais técnicas ecocardiográficas para o diagnóstico e a avaliação hemodinâmica da hipertensão pulmonar na população pediátrica. O diagnóstico precoce e o adequado estadiamento no acompanhamento das intervenções clínicas são fundamentais para escolha assertiva da abordagem terapêutica e, consequentemente, melhora do desfecho clínico


Assuntos
Humanos , Masculino , Feminino , Pediatria , Ecocardiografia/métodos , Criança , Hipertensão Pulmonar/mortalidade , Artéria Pulmonar , Valva Tricúspide , Veia Cava Inferior , Cateterismo Cardíaco , Ecocardiografia Doppler/métodos , Disfunção Ventricular Direita , Disfunção Ventricular Esquerda , Átrios do Coração , Ventrículos do Coração
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