RESUMEN

Pulmonary stenosis is one of the most common complications in patients with transposition of the great arteries after the arterial switch operation. The reason for this is multifactorial and related to the anterior shift of the pulmonary trunk during the LeCompte manoeuvre, the complex suture line required to fill the gaps after harvesting the coronary arteries, and the need for patch implantation to maintain a tensionless anastomosis.We reviewed all patients with transposition of the great arteries operated on at our institute between 1991 and 2020 to establish the frequency of pulmonary stenosis during post-operative follow-up, reinterventions, and reoperations related to pulmonary stenosis and its potential risk factors.During the analysed period, we performed 848 arterial switch operations for simple and complex cases of transposition of the great arteries. The overall early mortality was 6.96%, and the late mortality was 2.53%. Among all study groups, 243 (28.66%) patients developed mild pulmonary stenosis, 43 patients (5.07%) developed moderate, and 45 patients (5.31%) developed severe pulmonary stenosis. During follow-up, 21 patients required interventions related to pulmonary stenosis. Pulmonary reconstruction with patches, aortic arch anomalies, and ventricular septal defects associated with transposition of the great arteries were significant risk factors. Nine patients required reoperation because of pulmonary artery stenosis with patch reconstruction of the pulmonary artery, aortic arch anomalies, and aortic cross-clamping time, increasing the risk of reoperation.Pulmonary stenosis in patients with transposition of the great arteries after the arterial switch operation is a common complication. If significant, it occurs early after surgery and is the most frequent reason for post-operative interventions and reoperations.

Asunto(s)

Operación de Switch Arterial , Estenosis de la Válvula Pulmonar , Transposición de los Grandes Vasos , Humanos , Operación de Switch Arterial/efectos adversos , Transposición de los Grandes Vasos/complicaciones , Estenosis de la Válvula Pulmonar/etiología , Arteria Pulmonar/cirugía , Pronóstico , Reoperación , Complicaciones Posoperatorias/etiología , Estudios de Seguimiento , Resultado del Tratamiento

RESUMEN

OBJECTIVES: Coronary complications are still the main reason for early mortality after an arterial switch operation. The high incidence of coronary anomalies in patients with transposition of the great arteries may increase the difficulty of coronary transfer, and among them, an intramural pattern was shown to be an independent risk factor of early mortality. However, recently published studies have reported that this rare coronary variant has no impact on the survival rate. The aim of this study was to assess the frequency of intramural coronary patterns in patients with transposition and the impact on overall mortality after an arterial switch operation. Additionally, we presented all coronary arrangements associated with intramural patterns in our cohort and the surgical techniques used to manage them successfully. METHODS: All arterial switch operations were retrospectively reviewed. In each case, the surgical reports contained detailed graphical representations and coronary anatomy patterns. All operatively confirmed intramural patterns were included in the analysis. RESULTS: Among 806 patients, 271 patients had coronary anomalies (33.62%), and 28 patients had an intramural pattern (3.47%), which was frequently associated with other complex coronary anomalies (P < 0.001). Overall survival was significantly higher in patients with intramural coronary artery patterns than in those with other coronary variants (21.34% vs 8.74%, P = 0.024, log-rank test). CONCLUSIONS: Intramural patterns associated with transposition remain a surgical challenge and increase overall mortality in our cohort. To reliably confirm or reject the significance of the observed impact of this rare coronary variant, a multicentre data analysis is required.

Asunto(s)

Anomalías de los Vasos Coronarios , Transposición de los Grandes Vasos , Anomalías de los Vasos Coronarios/epidemiología , Anomalías de los Vasos Coronarios/cirugía , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Estudios de Seguimiento , Humanos , Incidencia , Estudios Retrospectivos , Transposición de los Grandes Vasos/cirugía

RESUMEN

Neoaortic regurgitation and root dilatation are common findings in patients with transposition after an arterial switch operation. The aim of this study was to describe the relation between neoaortic regurgitation long term after an arterial switch procedure, aortic root diameters, and surgical technique used. We also assessed the agreement of the neoaortic regurgitation grade and root diameters in different imaging modalities. For this retrospective study, we qualified 56 consecutive patients who, according to our institutional protocol, had a routine postoperative evaluation of more than 16 years with multimodality imaging studies. Neoaortic regurgitation was assessed by both transthoracic echocardiography and magnetic resonance imaging, and the root diameters obtained by echocardiography and tomography were compared to the reference values and associated with the presence of neoaortic insufficiency. Neoaortic insufficiency was present in 75% of examined patients; the vast majority of them had trace or mild regurgitation, and its qualitative evaluation was significantly different between echocardiography and magnetic resonance imaging. In our study group, the neoaortic valve and aortic sinus were larger in relation to the normal values, and they were significantly correlated with the presence of neoaortic insufficiency, but not with the surgical technique used. Values obtained by echocardiography and tomography correlated well but were significantly different. Transthoracic echocardiography has a tendency to overestimate the severity of regurgitation compared to magnetic resonance imaging. Neoaortic valve and sinus dilatation are significantly correlated with valve insufficiency, but in most cases of root dilatation, the valve remains competent.

Asunto(s)

Insuficiencia de la Válvula Aórtica/etiología , Operación de Switch Arterial/efectos adversos , Transposición de los Grandes Vasos/cirugía , Adolescente , Adulto , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Periodo Posoperatorio , Valores de Referencia , Estudios Retrospectivos , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/patología , Adulto Joven

RESUMEN

INTRODUCTION: Coronary artery complications are the main reason for early mortality after an arterial switch operation. Late complications are relatively rare, and there is no consensus regarding the need or indications for routine follow-up coronary artery evaluations or the best first-line assessment modality. The aim of this study was to present the long-term post-operative frequency of coronary abnormalities in asymptomatic patients with transposition of the great arteries discovered by coronary CT angiography and potential "red flags" revealed by other examinations. PATIENTS AND METHODS: A group of 50 consecutive asymptomatic patients who underwent routine long-term coronary artery evaluation after an arterial switch operation according to our institutional protocol were qualified for this study. This routine in-hospital visit included a detailed medical interview, electrocardiography, echocardiography, Holter electrocardiography examinations, and laboratory and cardiopulmonary exercise tests. Patients who showed significant abnormalities were qualified for perfusion scintigraphy. RESULTS: Unfavourable coronary abnormalities were detected in 30 patients (60%) and included ostial stenosis, muscular bridge, coronary fistula, interarterial course, proximal kinking, high ellipticity index, proximal acute angulation (<30 degree) of the left coronary artery, and proximal acute angulation of the right coronary artery. These features could not be predicted based on the medical interviews, surgical reports, or non-invasive screening test results. CONCLUSION: Complex coronary configurations with potentially dangerous coronary features are common in patients with transposition after an arterial switch operation. Such high-risk patients cannot be identified indirectly, and coronary CT angiography provides accurate information that is useful for post-operative management.

Asunto(s)

Operación de Switch Arterial/efectos adversos , Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico , Transposición de los Grandes Vasos/cirugía , Adolescente , Adulto , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/etiología , Vasos Coronarios/cirugía , Ecocardiografía , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Imagenología Tridimensional , Incidencia , Masculino , Polonia/epidemiología , Tomografía de Emisión de Positrones , Complicaciones Posoperatorias/epidemiología , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Transposición de los Grandes Vasos/diagnóstico , Adulto Joven

RESUMEN

Coronary complications in patients with transposition of the great arteries (TGA) after an arterial switch operation (ASO) are relatively rare, but of all the possible postoperative adverse events, they are potentially the most dangerous. The fate of the coronary arteries, which are transplanted during the neonatal ASO, remains uncertain. There is also no consensus regarding their postoperative evaluation, especially in asymptomatic patients. The aim of this study was to present the early results of routinely performed coronary computed tomography angiography (CCTA) in asymptomatic adolescents and young adults with TGA after an ASO. An initial series of 50 CCTAs performed in asymptomatic patients with TGA after an ASO were evaluated. In each case, a detailed examination of the coronary anatomy, its relationship to the surrounding structures, its exact position in the neoaortic sinus, and the presence of significant coronary abnormalities was performed. The CT scans revealed significant coronary abnormalities in 12 asymptomatic patients: three had acute proximal angulation and stenosis, four had an intra-arterial course, seven had a muscular bridge, one had a left anterior descending artery with an intramuscular course, and one had coronary fistulas to the pulmonary arteries. Additionally, in 25 patients, proximal acute angulation of at least one coronary artery was detected, and four of them had a high ellipticity index. Most of the potentially severe anatomical features were related to the left coronary artery or the left anterior descending artery. CCTA routinely performed on asymptomatic patients with TGA after an ASO provides accurate and useful information for postoperative management. The frequency of coronary anomalies and potentially dangerous anatomical features in this group of patients is high, and their impact on postoperative follow-up remains unknown.

Asunto(s)

Operación de Switch Arterial/efectos adversos , Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Transposición de los Grandes Vasos/diagnóstico por imagen , Adolescente , Adulto , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/etiología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiología , Vasos Coronarios/cirugía , Humanos , Recién Nacido , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Transposición de los Grandes Vasos/cirugía , Adulto Joven

RESUMEN

BACKGROUND: Coronary anomalies are frequently present in children with transposition of the great arteries (TGA). Such anomalies significantly increase the complexity of arterial switch operations and may have an effect on postoperative outcomes. In this study, we aimed to assess the frequency of coronary anomalies in children with TGA and describe their effect on postoperative outcomes. METHODS: All patients with TGA who underwent an arterial switch operation between 1991 and 2015 were consecutively enrolled in this study. Patient coronary patterns were obtained from corresponding operative reports and analyzed to determine their associations with adverse postoperative outcomes. RESULTS: The study included 715 patients with isolated and complex TGA. Coronary anomalies were present in 33.7% of patients and were significantly correlated with the side-by-side configuration of the great arteries. Coronary sinuses with more than 1 ostium were associated with a significantly increased risk of postoperative death (hazard ratio [HR], 2.58), and coronary arteries with a single ostium were associated with an increased risk of postoperative reinterventions (HR, 2.49). In contrast, the trap-door technique of coronary artery transplantation was associated with a reduced risk of reinterventions during postoperative follow-up (HR, 0.40). Complex coronary anomalies were significantly associated with postoperative coronary events (HR, 2.12). CONCLUSIONS: With the exception of patients whose circumflex artery branches off of the right coronary artery, an anomaly that clearly has no effect on postoperative follow-up, patients with unusual coronary patterns are at higher risk for adverse postoperative outcomes than patients with normal coronary anatomy and must be monitored carefully.

Asunto(s)

Operación de Switch Arterial/efectos adversos , Anomalías de los Vasos Coronarios/epidemiología , Anomalías de los Vasos Coronarios/cirugía , Mortalidad Hospitalaria , Transposición de los Grandes Vasos/epidemiología , Transposición de los Grandes Vasos/cirugía , Operación de Switch Arterial/métodos , Operación de Switch Arterial/mortalidad , Niño , Preescolar , Estudios de Cohortes , Comorbilidad , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Pronóstico , Modelos de Riesgos Proporcionales , Reoperación/métodos , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Análisis de Supervivencia , Transposición de los Grandes Vasos/diagnóstico por imagen , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodos

RESUMEN

INTRODUCTION: Creation of a fenestration during completion of a total cavopulmonary connection (TCPC) has been associated with a reduction in early mortality and morbidity. However, the long-term benefits are negated by an associated limitation in exercise tolerance and the potential risks of thrombo-embolic complications. We sought to describe the safety and efficacy of an Amplatzer Duct Occluder II (ADO II) for transcatheter fenestration closure following TCPC. MATERIAL AND METHODS: Between January 2000 and July 2014, 102 patients underwent percutaneous closure of extra-cardiac TCPC fenestrations with a range of devices. Patients in whom fenestration closure was performed with an ADO II and who had at least 6 months of follow-up were included in this study. RESULTS: Forty-seven patients had successful fenestration occlusion with an ADO II. The mean oxygen saturation and mean systemic venous pressures increased from 84.8 ±6.1% before to 97.6 ±2.9% (p < 0.001) after and from 14.2 ±2.15 mm Hg before to 15.6 ±2.2 mm Hg after closure (p < 0.001). Eight patients developed heart failure symptoms, managed by optimization of medical therapy, with 1 patient requiring device removal to reopen the fenestration. Color Doppler transthoracic echocardiography demonstrated residual flow across the device in 18 (38%), 10 (22%), 5 (11%) and 4 (9%) patients before discharge, at 1 and 6 months, and at the latest outpatient visit, respectively. CONCLUSIONS: The ADO II can be safely and effectively used to close fenestrations in extra-cardiac type Fontan completions. Many of the design features of this device confer potential benefit in this population.

RESUMEN

OBJECTIVES: Reoperations and catheter interventions after the arterial switch operation (ASO) are relatively rare, but their frequency varies among different centres. They significantly impact the postoperative course of children with transposition of the great arteries (TGA). The aim of this study was to assess the frequency of reoperations and catheter interventions in patients with TGA after the ASO and to identify the potential risk factors. METHODS: For this retrospective case review study we included all consecutive 715 patients with TGA who underwent the ASO in the Department of Cardiac Surgery between the years 1991 and 2015. All of the surgical procedures were performed by one cardiac surgery team led by J.J.M., using the same surgical technique with his own specific modifications. RESULTS: The overall early mortality after the ASO was 7.4%; late mortality occurred in 15 cases (2.3%) and the mean clinical follow-up of our cohort was 10.5 years. Early reoperations (<30 days after surgery) were performed in 37 patients (5.1%). Reoperations were performed in 31 patients (4.7% of survivors), and their risk factors were previous early reoperation and left ventricle outflow tract obstruction, while isolated TGA reduced the risk of reoperations. Catheter interventions were performed in 25 patients (3.8% of survivors). In the majority of the cases, the indications for percutaneous procedures were pulmonary stenosis and recoarctation of the aorta. The statistically significant risk factors were aortic arch anomalies associated with TGA and neopulmonary artery anastomosis with a patch, while isolated TGA decreased the risk of reintervention. Freedom from cumulative reinterventions after the ASO was 90.4% at 5 years; 88.0% at 10 years; 86.5% at 15 years and 86.5% from 20 to 25 years. CONCLUSION: The frequency of reoperations and percutaneous interventions in patients with TGA after the ASO remains low. The majority of the procedures are performed because of pulmonary stenosis and recoarctation of aorta. Cardiac anomalies associated with TGA have a significant impact on the incidence of reoperation and reintervention.

Asunto(s)

Operación de Switch Arterial/efectos adversos , Cateterismo Cardíaco/métodos , Complicaciones Posoperatorias/epidemiología , Transposición de los Grandes Vasos/cirugía , Adolescente , Operación de Switch Arterial/métodos , Cateterismo Cardíaco/estadística & datos numéricos , Niño , Femenino , Humanos , Masculino , Polonia/epidemiología , Complicaciones Posoperatorias/cirugía , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Transposición de los Grandes Vasos/mortalidad

Asunto(s)

Estenosis Coronaria/complicaciones , Estenosis Coronaria/cirugía , Transposición de los Grandes Vasos/complicaciones , Transposición de los Grandes Vasos/cirugía , Operación de Switch Arterial , Autoinjertos , Niño , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Humanos , Masculino , Pericardio/trasplante

RESUMEN

OBJECTIVES: The purpose of this paper is to report our 10 years of experience of interventional treatment of patients with hypoplastic left heart syndrome and to focus on the frequency, type, and results of percutaneous interventions during all the stages of palliation, considering the different techniques, devices, and complications. BACKGROUND: Constant progress in surgical treatment of congenital heart defects in the last decade has significantly improved the prognosis for children with hypoplastic left heart syndrome. However, morbidity and mortality remain relatively high. Modern interventional procedures complement or occasionally replace surgical treatment. METHODS: Between January, 2001 and December, 2010, 161 percutaneous interventions were performed in 88 patients with hypoplastic left heart syndrome. Patients were divided into four groups: (a) before the first surgical treatment including hybrid approach, (b) after first-stage Norwood operation, (c) after second-stage bidirectional Glenn operation, and (d) after third-stage Fontan operation. RESULTS: Percutaneous interventions resulted in statistically significant changes in pulmonary artery pressures, vessel diameters, and O2 saturation. Complications occurred in 4.3% of interventions and were related mainly to stent implantation in stenosed pulmonary arteries. CONCLUSIONS: Percutaneous interventions may result in haemodynamic stability and reduction in the number of operations. They may result in significant changes in pulmonary artery pressures, vessel diameters, O2 saturation, with a low rate of complications, which are mainly related to stent implantation in the pulmonary arteries.

Asunto(s)

Angioplastia de Balón/métodos , Estenosis de la Válvula Aórtica/terapia , Cateterismo Cardíaco/métodos , Defectos del Tabique Interatrial/terapia , Síndrome del Corazón Izquierdo Hipoplásico/terapia , Estenosis de la Válvula Aórtica/complicaciones , Procedimiento de Blalock-Taussing/métodos , Niño , Preescolar , Estudios de Cohortes , Procedimientos Endovasculares/métodos , Procedimiento de Fontan/métodos , Defectos del Tabique Interatrial/complicaciones , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/complicaciones , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Lactante , Recién Nacido , Procedimientos de Norwood/métodos , Estudios Retrospectivos , Stents , Resultado del Tratamiento

RESUMEN

OBJECTIVES: Anatomical repair seems an ideal method for the surgical treatment of the anomalous left coronary artery arising from the pulmonary artery (ALCAPA) in infancy. The medium-term outcome has been investigated for infants with ALCAPA following the restoration of a dual-coronary arterial circulation. METHODS: Between April 1995 and July 2012, 23 infants with a median age of 4 months underwent surgical repair of ALCAPA in our department. Direct implantation of the anomalous coronary artery into the ascending aorta was feasible in 16 patients. A trap door flap method was used in 5 cases and a tubular extension technique in 2. No infant underwent mitral valve repair at the time of ALCAPA surgery. Left ventricular function and the degree of mitral valve regurgitation were assessed during a 10-year follow-up. RESULTS: Four patients died in the early postoperative period, without independent predictors associated with this mortality. During follow-up, improvement in myocardial function occurred in all patients both early and late. There was only one improvement in severe mitral valve regurgitation. Subsequently, 2 children needed mitral valve replacement. There were no early or late reoperations of the reimplanted coronary arteries. CONCLUSIONS: Aortic reimplantation is an effective surgical treatment for ALCAPA in infants burdened with a low risk of reoperation due to coronary artery stenosis. There was good potential for myocardial recovery within the first year after surgery. Restoration of the anatomical coronary circulation did not improve mitral valve function in infants with severe preoperative mitral incompetence.

Asunto(s)

Procedimientos Quirúrgicos Cardíacos , Anomalías de los Vasos Coronarios/cirugía , Arteria Pulmonar/cirugía , Análisis de Varianza , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Circulación Coronaria , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/mortalidad , Anomalías de los Vasos Coronarios/fisiopatología , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Mortalidad Hospitalaria , Humanos , Lactante , Modelos Logísticos , Masculino , Válvula Mitral/fisiopatología , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/cirugía , Arteria Pulmonar/anomalías , Arteria Pulmonar/fisiopatología , Circulación Pulmonar , Recuperación de la Función , Reoperación , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular Izquierda

RESUMEN

OBJECTIVES: Neoaortic root changes in children with transposition of the great arteries (TGA) are reportedly risk factors for the development of neoaortic regurgitation (NeoAR). The aims of this study were to assess the neoaortic root diameter and relative proportion in children with TGA after surgical correction and to identify possible correlations with the development of neoaortic insufficiency. METHODS: Of the 611 children who had the arterial switch operation performed in the Cardiology Department of the Polish Mother's Memorial Hospital, 172 consecutive patients were qualified for this study. The inclusion criteria were: anatomical correction performed during the neonatal period, more than 10 years of postoperative observation and at least two full echocardiographic examinations. RESULTS: NeoAR increased during postoperative follow-up and at the end of the observation period, 76% of the patients had NeoAR (27%-trace, 42%-mild, 7%-moderate and 0.6%-severe). Among the analysed risk factors for NeoAR development, the significant ones were arterial valve discrepancy (OR = 2.05; 95% CI: 1.04-4.02; P = 0.031) and the non-facing commissures (OR = 4.05; 95% CI: 1.34-11.9; P = 0.01). The neoaortic root diameter was not statistically significantly correlated with the presence of NeoAR or with the heart defects associated with transposition. The neoaortic root was initially, on average, 37% (z-score = 1.58) bigger than the aortic root in healthy children. This disproportion increased during the follow-up evaluations to 57% (z-score = 2.09). CONCLUSIONS: The neoaortic root in children after the arterial switch procedure develops differently from that in healthy children, but this is not evidently related to NeoAR development or associated heart defects.

Asunto(s)

Aorta/fisiopatología , Aorta/cirugía , Transposición de los Grandes Vasos/cirugía , Adolescente , Análisis de Varianza , Aorta/diagnóstico por imagen , Aorta/patología , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/patología , Insuficiencia de la Válvula Aórtica/fisiopatología , Procedimientos Quirúrgicos Cardiovasculares/métodos , Niño , Preescolar , Ecocardiografía , Femenino , Humanos , Lactante , Recién Nacido , Estimación de Kaplan-Meier , Masculino , Factores de Riesgo , Transposición de los Grandes Vasos/diagnóstico por imagen , Transposición de los Grandes Vasos/fisiopatología

RESUMEN

BACKGROUND: Neopulmonary stenosis at anastomosis site is one of the most frequent complications after the arterial switch procedure for transposition of the great arteries. The surgical technique is a crucial factor associated with the frequency of stenotic complications. We present the outcomes of direct neopulmonary anastomosis during the arterial switch procedure in patients with simple transposition. This research was to assess the efficacy of this surgical technique based on the incidence of postprocedural supravalvular neopulmonary stenosis (SVPS). METHODS: Among 545 patients operated on in our department between 1992 and 2009, the 346 consecutive survivors who had undergone simple transposition in the first month of life were included in this analysis. Switch procedures were performed with direct neopulmonary artery anastomosis in 318 patients (92%); in the remaining 28 (8%), the risk of coronary artery compression required the use of a pericardial patch for pulmonary reconstruction. RESULTS: Neopulmonary stenosis occurred in 9 patients (2.6%): 5 had undergone direct neopulmonary reconstruction, and 4 had been treated with a patch. Balloon angioplasty of SVPS was performed twice in 1 patient. No patients required reoperation to treat neopulmonary stenosis. In multivariate analysis (logistic regression), patch reconstruction (odds ratio, 27.5; p=0.001) and nonfacing commissures (odds ratio, 11.1; p=0.004) were correlated significantly with the incidence of SVPS. CONCLUSIONS: Direct neopulmonary artery anastomosis during arterial switch is an interesting alternative to patch reconstructions and ensures a good postoperative result with low rates of complications and SVPS.

Asunto(s)

Procedimientos Quirúrgicos Cardíacos/efectos adversos , Arteria Pulmonar/cirugía , Estenosis de la Válvula Pulmonar/cirugía , Transposición de los Grandes Vasos/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Adolescente , Niño , Preescolar , Ecocardiografía Doppler , Femenino , Estudios de Seguimiento , Humanos , Lactante , Periodo Intraoperatorio , Masculino , Estenosis de la Válvula Pulmonar/diagnóstico , Estenosis de la Válvula Pulmonar/etiología , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

Right coronary artery dissection related to medical procedures is a very rare life-threatening complication caused by a combination of vessel occlusion and myocardial ischaemia. This paper presents a case of dissection which occurred during a Ross cardiac surgery procedure. The complication was observed after proximal right coronary constriction on the cannula used to administer cardioplegia. The damaged part of the internal membrane was resected during the operation. We present a five-year follow-up of this patient.

Asunto(s)

Procedimientos Quirúrgicos Cardíacos/efectos adversos , Catéteres/efectos adversos , Vasos Coronarios/lesiones , Disección/efectos adversos , Soplos Cardíacos/cirugía , Complicaciones Intraoperatorias , Adolescente , Angiografía Coronaria/métodos , Vasos Coronarios/cirugía , Estudios de Seguimiento , Humanos , Masculino , Resultado del Tratamiento

RESUMEN

OBJECTIVE: Prolonged length of stay in intensive care units after congenital heart disease surgery is associated with poor outcome, places a considerable burden on the financial resources of hospitals, and is an organizational challenge as well. This research discusses the impact of perioperative factors on prolonged stay in intensive care units. METHODS: This is a retrospective study examining the determinants of prolonged intensive care length of stay in 693 children after cardiac surgery. Univariate and multivariate analyses were performed for an intensive care unit stay over 3 and over 14 days. RESULTS: Neonatal age, preoperative mechanical ventilation and preoperative myocardial dysfunction, complexity and duration of procedures, as well as postoperative complications (low cardiac output syndrome, bleeding, re-operation, acute kidney injury, sepsis, respiratory insufficiency, pulmonary hypertension, pneumothorax, postoperative cardiac arrest, pneumonia, and delayed sternum closure) prolong intensive care unit hospitalization over 3 days. Patients with acute kidney injury requiring renal replacement therapy, pneumothorax, pulmonary hypertension, need for re-operation during the same admission, and myocardial dysfunction prior to surgery are at high risk of intensive care unit stay over 14 days. CONCLUSIONS: Some patients with a risk of prolonged hospitalization may be identified preoperatively, the others just after the operation. Optimizing preoperative status and aggressive treatment of complications may have significant influence on the duration of hospitalization in intensive care units. The knowledge of risk factors may facilitate organizational procedures and rational bed management.

Asunto(s)

Cardiopatías Congénitas/cirugía , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Factores de Edad , Puente Cardiopulmonar , Niño , Preescolar , Métodos Epidemiológicos , Femenino , Predicción , Humanos , Lactante , Recién Nacido , Periodo Intraoperatorio , Masculino , Polonia , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/estadística & datos numéricos , Cuidados Preoperatorios/métodos , Pronóstico , Respiración Artificial , Estudios Retrospectivos

RESUMEN

Modified Blalock-Taussig (B-T) shunt occlusion results in a sudden reduction of pulmonary vascular perfusion, causing dramatic saturation drop and cyanosis which pose a direct hazard to a child's life. The results of percutaneous local r-tpa infusion, balloon angioplasty and additionally stent implantation in obstructed modified B-T shunts were studied to assess their role as an alternative to a re-do surgery. We outline two pediatric centers' experience (period 2004-2008) regarding the effectiveness of various emergency treatment methods for occlusion or critical stenosis of systemic-to-pulmonary arterial shunts in 23 children. Local r-tpa infusion via catheter was performed in 12/23 patients, balloon angioplasty in 22/23 and additionally stent implantation in 3/23 children. Procedures were successful in 22/23 patients (96%), with an increase in arterial saturation [average: 30%; standard deviation (S.D.) 15%; Shapiro-Wilk test; dependent t-test-P<0.01]. Unrestricted contrast flow was achieved in 18 patients, reduced central flow in three and minimal flow in one child. Neither local nor systemic complications occurred. Our experience demonstrates the possibility of successful early shunt recanalization with the use of local thrombolytic therapy combined with the balloon angioplasty. The presence of old fixed thrombus with neointimal hypertrophy in the shunt constitutes an indication for endovascular stent implantation.

Asunto(s)

Cateterismo Cardíaco/métodos , Cateterismo/métodos , Oclusión de Injerto Vascular/terapia , Puente Cardíaco Derecho/efectos adversos , Cardiopatías Congénitas/cirugía , Angiografía/métodos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Preescolar , Estudios de Cohortes , Tratamiento de Urgencia , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/diagnóstico por imagen , Puente Cardíaco Derecho/métodos , Cardiopatías Congénitas/diagnóstico , Humanos , Lactante , Recién Nacido , Masculino , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento

RESUMEN

Anatomical correction is a procedure of choice for transposition of the great arteries (TGA) in neonates. During surgery, the aorta and pulmonary artery are switched-the native pulmonary valve becomes the neoaortic valve. The fate of this valve remains uncertain. Many reports suggest that its ability to function worsens with time after surgery. Of 519 patients with TGA operated on between 1991 and 2008, 161 met inclusion criteria for this retrospective study and were followed 10 years or more to assess neoaortic valve regurgitation (NeoAR) occurrence and development and to estimate potential risk factors. The subjects were divided into 2 groups: group 1 (simple TGA) and group 2 (TGA + ventricle septal defect). Within the analyzed group, the frequency of significant regurgitation increased from 9% 1 year after the operation to 47% at the most recent follow-up. No severe regurgitation necessitating reoperation was observed. Analysis of potential risk factors revealed that pulmonary/aortic valve diameter discrepancy and nonfacing commissures were associated with increased risk of development of neoaortic insufficiency. NeoAR arises and develops over time after correction of the defect. No hemodynamic repercussions necessitating cardiac surgical interventions were observed. The majority of insufficiencies are detected between 2 and 6 years after surgery. The degree of incompetence is usually mild and increases during follow-up by about 0.5 or 1 degree. The risk factors for NeoAR appearance are pulmonary artery/aortic annulus discrepancy and nonfacing commissures.

RESUMEN

This paper presents a case of a rare combination of right lung agenesis and atrial septal defect type II (ASD II). Successful surgical repair of ASD II was performed at the age of six years with total circulatory arrest (TCA) and deep hypothermia, because of difficult approach. Computed tomography and intraoperative findings are described. From patho-embryological consideration, defects in the primitive respiratory apparatus in embryo stages were presumably responsible for agenesis of the lung. The patient was found to have a very short stump of the right pulmonary artery, but this malformation seems to be secondary.

Asunto(s)

Defectos del Tabique Interatrial/cirugía , Pulmón/anomalías , Niño , Dextrocardia/diagnóstico por imagen , Ecocardiografía , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Masculino , Tomografía Computarizada por Rayos X

RESUMEN

OBJECTIVE: To evaluate the outcome after early, primary repair of Tetralogy of Fallot (TOF) in children under 6 months of age. METHODS: 74 infants, who underwent repair of TOF between 1992 and 2003, aged from 1.5 to 6 months, were investigated. 32 (43%) patients were cyanotic, 14 (18%) had anoxemic spells. Most of them were qualified for surgical procedure by echocardiographic study only, 26 patients required cardiac catheterisation. Two had balloon angioplasty prior to primary repair. None of them underwent initial palliation. Mean follow-up was 4.9 years (1 -9.5 years). RESULTS: 71 children survived and they were in good condition. 3 patients died (mortality 3.6%). One child required reoperation. Transannular patch (TAP) was inserted in 66% of patients. Right ventricular outflow tract obstruction (RVOTO) more than 40 mmHg occurred in 2 infants. Moderate pulmonary insufficiency was present in 38 infants (25%). None of the patients had QRS complex longer than 140 msec. CONCLUSIONS: Early one-stage repair of TOF was achieved with low mortality rate and low risk for reoperation (1.5%). It eliminates initial palliation and drug therapy.

Asunto(s)

Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Tetralogía de Fallot/epidemiología , Tetralogía de Fallot/cirugía , Edad de Inicio , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Lactante , Bienestar del Lactante/estadística & datos numéricos , Masculino , Polonia , Estudios Retrospectivos , Análisis de Supervivencia , Tetralogía de Fallot/complicaciones , Resultado del Tratamiento