RESUMEN
Background Intensive monitoring has been associated with a lower death rate between the Norwood operation and superior cavopulmonary connection, possibly due to early identification and effective treatment of residual anatomic lesions like recoarctation before lasting harm occurs. Methods and Results Neonates undergoing a Norwood operation and receiving interstage care at a single center between January 1, 2005, and September 18, 2020, were studied. In those with recoarctation, we evaluated association of era ([1] preinterstage monitoring, [2] a transitional phase, [3] current era) and likelihood of hemodynamic compromise (progression to moderate or greater ventricular dysfunction/atrioventricular valve regurgitation, initiation/escalation of vasoactive/respiratory support, cardiac arrest preceding catheterization, or interstage death with recoarctation on autopsy). We also analyzed whether era was associated with technical success of transcatheter recoarctation interventions, major adverse events, and transplant-free survival. A total of 483 subjects were studied, with 22% (n=106) treated for recoarctation during the interstage period. Number of catheterizations per Norwood increased (P=0.005) over the interstage eras, with no significant change in the proportion of subjects with recoarctation (P=0.36). In parallel, there was a lower likelihood of hemodynamic compromise in subjects with recoarctation that was not statistically significant (P=0.06), with a significant difference in the proportion with ventricular dysfunction at intervention (P=0.002). Rates of technical success, procedural major adverse events, and transplant-free survival did not differ (P>0.05). Conclusions Periods with interstage monitoring were associated with increased referral for catheterization but also reduced likelihood of ventricular dysfunction (and a suggestion of lower likelihood of hemodynamic compromise) in subjects with recoarctation. Further study is needed to guide optimal interstage care of this vulnerable population.
Asunto(s)
Síndrome del Corazón Izquierdo Hipoplásico , Procedimientos de Norwood , Disfunción Ventricular , Recién Nacido , Humanos , Lactante , Resultado del Tratamiento , Disfunción Ventricular/etiología , Hemodinámica , Estudios Retrospectivos , Factores de RiesgoRESUMEN
La Coartación Aórtica representa del 5% - 10% de las malformaciones congénitas cardiovasculares. Lamayoría se localizan, en la pared posterior de la aorta (yuxtaductales) Objetivo: Establecer evolución clínicapost tratamiento de coartación aórtica, en el Hospital General de Enfermedad del Instituto Guatemalteco deSeguridad Social. Metodología: Estudio descriptivo, retrospectivo, en pacientes <15 años de edad, condiagnóstico de coartación aórtica que ya hubieran recibido tratamiento. Resultados: Se encontraron 39pacientes. 21 de sexo masculino y 18 de sexo femenino; 18 pacientes (9 masculino / 9 femenino) fuerontratados por intervencionismo; 12 pacientes con tratamiento medico. Las complicaciones fueron 10pacientes con recoartación y 7 pacientes con hipertensión arterial, el 100% en clase funcional NYHA tipo I y0% de mortalidad. Conclusiones: Los pacientes post tratamiento de coartación de aorta, cursaron conevolución clínica adecuada, 43% de ellos tuvo algún tipo de complicación, la mortalidad fue 0%.(
Aortic Coarctation represent 5 % - 10 % of congenital cardiovascular malformations. Most are located in theposterior wall of the aorta (yuxtaductal) Objective: To establish clinical outcome after treatment of aorticcoarctation in the General Hospital of Disease in Guatemalan Institute of Social Security. Methodology: Descriptive, retrospective study, in patients <15 years of age, diagnosed with aortic coarctation who hadalready received treatment. Results: 39 patients were found. 21 male and 18 female, 18 patients (9 male / 9female) were treated for interventional cardiology, 12 patients with medical treatment. Complications werepresent in 10 patients with Re coarctation and 7 patients with hypertension, 100% in NYHA functional class Itype and 0% mortality. Conclusions: The post treatment of aortic coarctation patients, presented with goodclinical course, 43 % of them had some type complication, and mortality was 0 %.
Asunto(s)
Humanos , Niño , Coartación Aórtica , Aorta Torácica/anomalías , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnósticoRESUMEN
We present the case of a 62-year-old woman who presented with recoarctation and then experienced rupture of the aorta and severe clinical deterioration after a stent was deployed. She was treated immediately by intrastent deployment of a stent-graft, which resolved the extremely serious situation.