RESUMEN
A total of 124 stents were implanted to 91 patients with various forms of congenital heart failure for the resolution of obstruction of 111 segments in pulmonary arteries. All these patients were treated in A. N. Bakulev Research Centre of Cardiovascular Surgery in the period from 1994 to 2007. Analysis of observations in early and late postoperative periods indicates that the efficiency of stenting of obstructed pulmonary arteries was 96.4% and the restenosis rate in the follow-up period 3.9%. It is concluded that stenting of pulmonary arteries is an effective and safe method for the management of obstruction problems. In the majority of patients it allows to avoid surgical intervention on pulmonary arteries.
Asunto(s)
Angioplastia , Arteriopatías Oclusivas/terapia , Cardiopatías Congénitas/cirugía , Arteria Pulmonar , Stents , Adolescente , Adulto , Angiografía , Arteriopatías Oclusivas/diagnóstico por imagen , Niño , Preescolar , Femenino , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/terapia , Defectos del Tabique Interventricular/cirugía , Humanos , Masculino , Arteria Pulmonar/anomalías , Arteria Pulmonar/diagnóstico por imagen , Tetralogía de Fallot/cirugíaRESUMEN
Results of radical correction of the Fallot tetrade after reconstruction of outflow tracts from the right ventricle (RV) without plastic surgery on the interventricular septum defect were evaluated in 25 patients aged 5-30 (mean 12.3 +/- 3.8) years in the late postoperative period (1-10, mean 6.5 years). Clinical condition of the patients on the moment of examination was satisfactory, they had no complaints. 14 (56%) patients needed second operation within 2.9 +/- 1.9 (mean) years after primary surgery. It significantly increased the number of patients referred to 1-2 functional classes NYHA (from 56 to 60% and from 28 to 32% respectively). The number of patients of functional class 3 decreased from 12 to 8%). The were no FC-4 patients. Survival rate estimated by the actuarial method was 92% by year 9 postoperatively. 84, 76, 72, 60, and 56% of the patients did not need second operation 1, 2-3, 4, 7, and 9 years respectively after primary surgery due to adequate care in the early postoperative period, timely diagnosis of complications, and their rapid management. It is concluded that radical correction of Fallot's tetrade after reconstruction of outflow tracts has good or satisfactory outcome in 92% of the patients.
Asunto(s)
Calidad de Vida , Tetralogía de Fallot/cirugía , Adolescente , Adulto , Niño , Preescolar , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Reoperación , Factores de Tiempo , Resultado del TratamientoRESUMEN
The paper analyzes the first experience with intravascular ultrasound study (IUSS) in 9 patients at the Cardiosurgery Center. It presents the potentialities of IUSS during interventional radiological procedures. It is concluded that there are benefits and trends of the technique in the exploration of various vascular beds.
Asunto(s)
Angioplastia de Balón , Vasos Sanguíneos/diagnóstico por imagen , Radiografía Intervencional , Ultrasonografía Intervencional , Adulto , Anciano , Angiografía Coronaria , Humanos , Masculino , Persona de Mediana Edad , StentsRESUMEN
The authors analyze the experience gained in catheter operations performed at their Department over the recent 28 years. A total of 500 balloon (Rashkind) and 35 knife (Park) atrioseptostomies were performed in critical patients with different "blue" congenital diseases over this period. An immediate hemodynamic effect at the operation table was attained in 95% of patients. Transluminal balloon valvuloplasty (TLBVP) was performed in 372 patients with valvular stenosis of the pulmonary artery. The results of this operation depend on the patient's age, anatomy of the defect, and correct choice of the diameter of balloon catheter. This intervention is particularly effective in patients aged under 1. In patients with combined valvular and infundibular stenosis the results of TLBVP depend on the severity of stenosis and age of patient. An attempt at TLBVP of congenital aortal stenosis was undertaken in 67 patients. Valvuloplasty was carried out in 57 patients. The operation was effective in 13 (62%) out of 21 patients aged under 1. The mortality in this group was 5.5%. Balloon valvuloplasty of the pulmonary artery was carried out in 71 patients with cyanotic congenital heart diseases. The intervention helped eliminate the critical state, rise the systolic pressure in the pulmonary artery, improve blood saturation with oxygen, and evade the operation for creation of a systemic-pulmonary anastomosis. Isolated and postoperative stenoses of pulmonary arteries were removed in 65 patients. Six Johnson and Johnson stents were effectively implanted to 3 patients with rigid postoperative stenoses; in 32 patients transluminal balloon angioplasty (TLBAP) for coarctation and recoarctation of the aorta brought about a satisfactory immediate hemodynamic effect. TLBAP of Blalock-Taussig's stenosed anastomosis were performed in 60 patients with various cyanotic congenital heart diseases. Its results were good in 39 (65%) patients, satisfactory in 19 (31.7%), and unsatisfactory in only 2 (3%) cases. Of the novel endocardial interventions, dilatation of the conduit following Rastrelli's operation, creation of a defect of the atrial septum after Fontain's operation, and embolization of the coronary-cardiac fistulas and of patent ductus arteriosus were carried out. This review demonstrates wide use of endocardial surgery methods in the treatment of some congenital heart diseases; in many cases such treatment may be an alternative to surgical interventions.
Asunto(s)
Cateterismo , Cardiopatías Congénitas/terapia , Adolescente , Adulto , Angiografía , Coartación Aórtica/diagnóstico por imagen , Coartación Aórtica/terapia , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/terapia , Aortografía , Niño , Preescolar , Conducto Arterioso Permeable/diagnóstico por imagen , Conducto Arterioso Permeable/terapia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estenosis de la Válvula Pulmonar/diagnóstico por imagen , Estenosis de la Válvula Pulmonar/terapia , Transposición de los Grandes Vasos/diagnóstico por imagen , Transposición de los Grandes Vasos/terapiaRESUMEN
Transluminal balloon angioplasty of Blalock-Taussig's stenotic anastomosis was performed in 37 patients with various congenital heart diseases in 1989 to April 1993. The patients' age ranged from 3 to 16 years (mean 8.4 +/- 0.5 years). Arterial blood oxygen saturation varied from 38 to 74% (mean 62.4 +/- 1.5%). Hemoglobin amounted to 14 to 28.4 g% (mean 19.0 +/- 8.4 g%). Phonocardiography recorded no or low-amplitude systolic-diastolic anastomosis murmur in points IV-V in all patients. After balloon anastomosis dilatation, arterial blood oxygen saturation increased, on an average, from 62.4 +/- 1.5% to 81.2 +/- 1.2%. Anastomosis angiometry performed prior to and following balloon dilatation showed its significant dilatation (on an average, from 3.39 +/- 0.19 to 5.26 +/- 0.24 mm). There was a distinct systolic-diastolic murmur of anastomosis on the PhCG. Post-balloon-dilatation complications occurred only in 3 cases: femoral thrombosis in 2 patients and pulmonary edema in 1. The late results were studied in 18 patients at months 2 to 40. None of them showed deterioration of clinical results after balloon dilatation. Eight patients were radically operated on. The best results were achieved in patients with discrete anastomosis stenoses and when balloons whose diameter corresponded to that of the subclavian artery and equal to 0.92-1.2 mm were used. A good effect following balloon angioplasty was observed in 24 (64.9%), satisfactory and poor results were found in 12 (32.4%) and 1 (2.7%), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Cardiopatías Congénitas/cirugía , Adolescente , Anastomosis Quirúrgica , Angioplastia Coronaria con Balón , Niño , Preescolar , Cianosis/etiología , Cardiopatías Congénitas/complicaciones , Humanos , Estudios RetrospectivosRESUMEN
Dilatation of a stenosed Blalock-Taussig anastomosis was performed in 15 patients with blue-type congenital heart diseases at the Bakulev Institute of Cardiovascular Surgery, AMS USSR, from March, 1989 to May, 1991. Seven of these patients had a severe form of Fallot's tetralogy, 4--double origin of the great vessels from the right ventricle with stenosis of the pulmonary artery, 2--atresia of the right atrioventricular orifice with stenosis of the pulmonary artery, 1--atresia of the right atrioventricular orifice with atresia of the pulmonary artery, and 1 patient had corrected transposition of the great vessels with stenosis of the pulmonary artery. The patients' ages ranged from 4 to 13 years (9.45 +/- 8.1 years on the average). Saturation of arterial blood with oxygen varied from 38 to 77% (64.2 +/- 2.9% on the average). A low-amplitude to-and-fro sound of the anastomosis was either recorded or absent on the phonocardiogram. The diameter of the balloons used ranged from 4 to 13 mm. Inflation of the balloon lasted from 5 to 60 sec. Dilatation was conducted 3 to 9 times. After dilatation saturation of arterial blood with oxygen increased to 81 +/- 2.7% on the average. A clearly defined to-and-fro murmur of the anastomosis was recorded on the phonocardiogram. Angiometry of the anastomosis performed before and after dilatation showed it to be widened considerably from 3.5 +/- 0.2 mm to 5.7 +/- 0.4 mm on the average. One patient underwent a radical operation 8 months after balloon dilatation.