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We aimed to assess the frequency of criss-cross pulmonary arteries and associated intracardiac and vascular anomalies in patients who underwent CT angiography due to suspected congenital heart disease or vascular anomaly at our hospital. We retrospectively evaluated the CT angiography images of 355 patients aged 0-18 years between April 2018 and December 2022. The presence of the criss-cross pulmonary artery anomaly was assessed. Additionally, in patients with a criss-cross pulmonary artery anomaly, accompanying branch pulmonary artery anomalies, aortic arch anomalies, and other vascular-cardiac anomalies were also evaluated. A total of 331 patients' images were evaluated. Criss-cross pulmonary artery anomaly was present in 57 patients (17.2%). Pulmonary artery branch anomaly was present in 16, aortic arch anomaly in 40 patients (70%) with criss-cross pulmonary artery anomaly, while associated intracardiac pathology (by echocardiography) was detected in 43 patients (75.4%). The frequency of criss-cross pulmonary artery was found to be significantly higher in patients with any aortic arch anomaly (p = 0.01). This study represents one of the largest series of patients with criss-cross pulmonary artery anomalies. Our results suggests that it may be more common than previously recognized and potentially overlooked. It is crucial to consider the presence of this anomaly in patients with complex aortic arch anomalies or cardiac pathologies, as it may have implications for surgical approaches and potential complications. Increased awareness of this anomaly among cardiologists and radiologists is necessary for accurate diagnosis and appropriate management.
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OBJECTIVE: Surgical site infection is an important concern due to its association with morbidity and mortality after paediatric cardiac surgery. The aim of this study was to present our approach and experience in the utilisation of a modified care bundle in a recently established paediatric cardiac surgical unit in the low-income region of Turkey. METHODS: Between 2019 and 2021, we identified children who underwent cardiac surgical procedures and retrospectively collected relevant demographic data, disease characteristics, operational data, Risk Adjustment For Congenital Heart Surgery (RACHS-1) scores, and post-operative factors such as morbidities, mortality, critical care, and in-hospital stay lengths. Surgical site infections and late infections were scanned. RESULTS: Ninety-six patients (49 males, 47 females) underwent a total of 127 surgical procedures during the study period. Overall adherence to the protocol was 94%, 100%, and 96% in the pre-operative, intra-operative, and post-operative periods, respectively. There was no reported surgical site infection, and no late infection was encountered throughout the follow-up period. CONCLUSIONS: We conclude that a low rate of surgical site infection, or even a rate of nil, is attainable through the utilisation of locally standardised guidelines for its prevention.
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Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Pacotes de Assistência ao Paciente , Masculino , Feminino , Humanos , Criança , Infecção da Ferida Cirúrgica/prevenção & controle , Estudos Retrospectivos , Região de Recursos Limitados , Cardiopatias Congênitas/cirurgiaRESUMO
OBJECTIVE: We aimed to discuss our unit's experience performing left ventriculotomies on children. METHODS: Between 2000 and 2022, we identified paediatric patients who required left ventriculotomy. Relevant information was gathered retrospectively. RESULTS: There were eight patients who underwent surgical procedure including left ventriculotomy. The range of weight and age was between 4.5 and 50 kg and 5 months to 17 years, respectively. Left ventriculotomy was primarily performed for the excision of cardiac masses in all but one who had pseudoaneurysm repair. There were no deaths that occurred early or late. Pre-operative and post-operative ejection fractions and fractional shortening values were comparable. There was no arrhythmia detected post-operatively. CONCLUSIONS: We conclude that an apical left ventriculotomy does not compromise the function of the left ventricle, even in young infants. In selected patients, it may be used safely for surgical access to the left ventricle.
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Ventrículos do Coração , Lactente , Humanos , Criança , Pré-Escolar , Estudos Retrospectivos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgiaRESUMO
BACKGROUND: This study was performed to investigate the pre-existing histologic alterations at the time of complete repair in patients with tetralogy of Fallot (TOF) and evaluate their effects on the early postoperative outcomes. METHODS: Fourteen patients, seven with acyanotic TOF (SO2 > 90, group I) and seven with cyanotic TOF (SO2 < 90, group II), undergoing complete repair, were enrolled. Right ventricular biopsies were examined for cardiomyocyte injury and fibrosis by light microscopy and mitochondrial injury by electron microscopy. The association of the severity of histologic alterations and postoperative inotrope use, intensive care unit, and in-hospital stays were evaluated. RESULTS: Compared with group I, patients in group II had a higher inotrope score (p = 0.03) and longer intensive care unit (p = 0.01) and in-hospital stays (p = 0.04). Cardiomyocyte injury and mitochondrial damage scores were higher in group II (p = 0.01 and p = 0.02, respectively). Fibrosis was detected in all specimens but was more severe in group II (p < 0.001). However, we could not demonstrate any correlation between histologic alterations and early surgical outcomes. The history of spell was significantly associated with worse early surgical outcomes (p < 0.05). CONCLUSIONS: Pre-existing cardiomyocyte injury accompanied by mitochondrial damage and fibrosis were more pronounced in cyanotic TOF patients. Early repair may prevent the development of histopathologic alterations in these patients.
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Ventrículos do Coração/patologia , Miocárdio/ultraestrutura , Tetralogia de Fallot/patologia , Procedimentos Cirúrgicos Cardíacos , Feminino , Fibrose/patologia , Ventrículos do Coração/cirurgia , Humanos , Lactente , Masculino , Microscopia Eletrônica de Transmissão , Tetralogia de Fallot/cirurgiaRESUMO
Aortico-left ventricular tunnel is a rare congenital anomaly requiring surgical repair early in childhood. After corrective surgery, such patients are at risk of developing aortic insufficiency and aortic root dilatation. Herein, we describe a valve-sparing aortic root replacement 3 decades after the repair of aortico-left ventricular tunnel.
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Anormalidades Múltiplas/cirurgia , Aorta/anormalidades , Aorta/cirurgia , Valva Aórtica/cirurgia , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/anormalidades , Ventrículos do Coração/cirurgia , Complicações Pós-Operatórias/cirurgia , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , Masculino , Tratamentos com Preservação do Órgão/métodos , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
The presence of bilaterally persistent arterial ducts is an uncommon abnormality. Here, we describe the anatomy and successful management of an unusual patient with bilateral ducts in the setting of double inlet left ventricle, discordant ventriculoarterial connections, aortic atresia, and a severely hypoplastic and serpentine aortic arch.
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Anormalidades Múltiplas , Aorta Torácica/anormalidades , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/diagnóstico , Ventrículos do Coração/anormalidades , Transposição dos Grandes Vasos/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Baías , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Recém-Nascido , Masculino , Cuidados Paliativos/métodos , Tomografia Computadorizada por Raios X , Transposição dos Grandes Vasos/cirurgiaRESUMO
An unoperated 45-year-old man with double-inlet single left ventricle, transposed great arteries, ventricular septal defect, and pulmonary stenosis presented with mitral and pulmonary valvular vegetations unresponsive to antibiotic therapy. The initial diagnosis was made with echocardiography, and the morphology was delineated with computed tomography and magnetic resonance imaging. The patient underwent mitral valve replacement with a mechanical valve and pulmonary valve vegetectomy. He recovered well and he is currently well two years after the operation.
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Cardiopatias Congênitas/fisiopatologia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Pulmonar/fisiopatologia , Função Ventricular Esquerda , Antibacterianos/uso terapêutico , Angiografia por Tomografia Computadorizada , Endocardite/diagnóstico por imagem , Endocardite/fisiopatologia , Endocardite/cirurgia , Cardiopatias Congênitas/diagnóstico por imagem , Ventrículos do Coração/anormalidades , Ventrículos do Coração/diagnóstico por imagem , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico por imagem , Transposição dos Grandes Vasos/diagnóstico por imagem , Transposição dos Grandes Vasos/fisiopatologia , Resultado do TratamentoRESUMO
Complications of percutaneous pericardial catheter insertion for pericardial effusion are rare. We describe a rare complication of percutaneous pericardial catheter insertion that penetrated the stomach and diaphragm before getting into the pericardial sac in a patient with lymphoma. The misplaced catheter was extracted surgically and subxiphoid pericardial tube insertion with pleural pericardial window was performed.