RESUMEN
Inferior sinus venosus defect (SVD) is less common than a superior one. The lower edge of the defect straddles the orifice of the inferior vena cava, and this makes surgical repair via bicaval cannulation a technical challenge. The orifice of the unroofed right pulmonary vein is caused by the interatrial communication in sinus venosus defects which results in partial anomalous pulmonary vein drainage (PAPVD). Novel transcatheter closure of a superior SVD has recently been described; however, transcatheter closure of an inferior SVD has not yet been reported in the published literature. Here, we report the first successful transcatheter closure of an inferior SVD with bare and covered stents and the rerouting of a PAPVD into the left atrium to avoid occlusion of the hepatic veins. In this single-case report, we carefully describe the planning process, how the procedure was performed, and the steps taken to recapture and reposition a migrated stent. Careful patient selection and intensive assessment of pulmonary and hepatic vein anatomy before and during the procedure were necessary to achieve a successful outcome.
RESUMEN
Background: Transcatheter pulmonary valve replacement (TPVR) has become an alternative to surgical pulmonary valve placement (SPVR) for patients after tetralogy of Fallot repair. This study compared the outcomes of TPVR with those of SPVR. Methods: We reviewed data from patients who underwent pulmonary valve replacement with a median of 2 years of follow-up. Results: Between 2010 and 2021, 215 patients underwent pulmonary valve replacement (72 TPVR and 143 SPVR). The median size of the right ventricular end-diastolic volume index in the TPVR group was 165 mL/m2 (IQR, 136-190) and 184 mL/m2 (IQR, 163-230) in the SPVR group (P = .001). The median value of the maximum landing zone at the right ventricular outflow tract (RVOT) in patients with native RVOT was 26 mm (IQR, 24-28) in the 43 patients in the TPVR group and 31 mm (IQR, 28-34) in the 101 patients in the SPVR group (P < .001). The median size of the pulmonary valve implant for the native RVOT in the TPVR group was 29.0 mm (IQR, 26.0-29.0) and 24.0 mm (IQR, 24.0-24.0) in the SPVR group (P < .001). There were no deaths in the TPVR group and 8 deaths in the SPVR group (P = .041). Major complications and the length of hospitalization were lower in the TPVR group (P = .001). After 2 years, the mean decrease in QRS duration was 5 milliseconds (IQR, 1-14) in the TPVR group and 1 millisecond (IQR, -4 to 10) in the SPVR group (P = .006). Conclusions: TPVR allows for larger implants, resulting in lower mortality, shorter hospital stays, and fewer major cardiac events. SPVR may be preferable in patients with larger (>30 mm) native RVOT and in those who require concomitant surgical procedures.
RESUMEN
OBJECTIVE: Sildenafil, an orally administered phosphodiesterase type 5 (PDE-5) inhibitor, was known for enhancing the downstream effects of NO. It was approved for treatment in patients with pulmonary arterial hypertension (PAH). Recently, a generic sildenafil (Unison Laboratories, Thailand) was proved to have the same bioequivalent as in the original formula. The authors conducted a 12-week case series to study the efficacy and safety of Elonza (generic sildenafil) in PAH patients. MATERIAL AND METHOD: Comparison of both hemodynamic data from cardiac catheterization and clinical outcome such as six minute walk test (6MWT) were performed to assess the efficacy of generic sildenafil at the dosage of 50 mg given orally three times daily in patients with PAH over a 12 weeks period. RESULTS: There were 20 patients whose average age was 31.4 +/- 14.3 years old (13-58) and their average weight was 48.1 +/- 11.9 kg (31-79). There were three idiopathic pulmonary artery hypertensions (IPAH) and 17 congenital left to right shunts. There was a 15.1% decrease in pulmonary vascular resistance index (PVRi) from 20.5 +/- 13.9 to 17.4 +/- 2.9 Wood unit m2 at the end of 12 weeks (p = 0.044). The ratio of pulmonary to systemic vascular resistance (PVR/SVR) was also decreased from 0.71 +/- 0.57 to 0.52 +/- 0.41 (p = 0.014). 6MWT increased significantly from 271 +/- 59 meters (m) at baseline to 297 +/- 48 m, 307 +/- 43 m and 321 +/- 52 m at week 2, 6 and 12, respectively (p = 0.01). There was no significant change in other hemodynamic parameter, Borg dyspnea score, and functional class. CONCLUSION: At the end of the 12-week treatment, a 50 mg three times daily of generic sildenafil given to patients with PAH was shown to have benefit on decreasing PVRi, PVR/SVR ratio. There was also an increase in mean average of 6MWT at the end of 12 weeks.