RESUMEN
Left atrioventricular valve aneurysm is a rare condition. Here we present a rare case of partial atrioventricular septal defect with an extremely thin left atrioventricular valve aneurysm mimicking valve perforation. Preoperative echocardiography demonstrated severe left sided atrioventricular valve regurgitation on the "cleft" and leaflet perforation. But we discovered a left sided atrioventricular valve aneurysm instead of a valve perforation. The "cleft" edge and the aneurysm were closed.
Asunto(s)
Defectos del Tabique Interventricular , Insuficiencia de la Válvula Mitral , Humanos , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/cirugía , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , EcocardiografíaRESUMEN
Postinfarction interventricular septum defect is a rare, but very serious and sometimes fatal, complication of acute myocardial infarction. This article describes a clinical case of online diagnosis of a late-stage myocardial infarction and the subsequent successful endovascular repair of a postinfarction ventricular septum defect with a Myval™ occluder.
Asunto(s)
COVID-19 , Defectos del Tabique Interventricular , Infarto del Miocardio , Tabique Interventricular , Humanos , Pandemias , COVID-19/complicaciones , Infarto del Miocardio/complicaciones , Infarto del Miocardio/cirugía , Defectos del Tabique Interventricular/complicacionesRESUMEN
We describe a 60-year-old woman with post-myocardial infarction (MI) ventricular septal defect (VSD) and cardiogenic shock who was successfully stabilized with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge therapy for the surgical closure of her VSD. This case highlights the role of VA-ECMO in the management of post-MI VSD to improve the results of surgical repair and patient survival.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Defectos del Tabique Interventricular , Humanos , Femenino , Persona de Mediana Edad , Choque Cardiogénico/etiología , Choque Cardiogénico/cirugía , Oxigenación por Membrana Extracorpórea/métodos , Defectos del Tabique Interventricular/cirugía , Defectos del Tabique Interventricular/complicaciones , Miocardio , Estudios RetrospectivosRESUMEN
Abstract Introduction: The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge. Methods: This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR). Results: A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse. Conclusion: We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.
Asunto(s)
Humanos , Anciano , Insuficiencia de la Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/complicaciones , Prolapso de la Válvula Aórtica/cirugía , Prolapso de la Válvula Aórtica/complicaciones , Prolapso de la Válvula Aórtica/diagnóstico por imagen , Defectos del Tabique Interventricular/cirugía , Defectos del Tabique Interventricular/complicaciones , Prolapso , Síndrome , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge. METHODS: This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR). RESULTS: A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse. CONCLUSION: We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.
Asunto(s)
Insuficiencia de la Válvula Aórtica , Prolapso de la Válvula Aórtica , Defectos del Tabique Interventricular , Anciano , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/cirugía , Prolapso de la Válvula Aórtica/complicaciones , Prolapso de la Válvula Aórtica/diagnóstico por imagen , Prolapso de la Válvula Aórtica/cirugía , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/cirugía , Humanos , Prolapso , Estudios Retrospectivos , Síndrome , Resultado del TratamientoRESUMEN
A brown howler monkey (Alouatta guariba clamitans) was presented with lethargy, hyporexia, cough and heart murmur. The complementary tests and necropsy revealed pleuropneumonia, bacterial endocarditis and interventricular septal defect. To the best of our knowledge, this is the first report of increased cardiac troponin I levels in this species.
Asunto(s)
Endocarditis Bacteriana/veterinaria , Defectos del Tabique Interventricular/veterinaria , Enfermedades de los Monos/diagnóstico , Troponina I/sangre , Alouatta , Animales , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Resultado Fatal , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/patología , Masculino , Enfermedades de los Monos/patología , Choque Séptico/veterinariaRESUMEN
Myocardial bridges are a congenital anomaly in which a segment of the coronary artery takes a "tunneled" intramuscular course. Few reports have associated myocardial bridges with left-ventricular dysfunction in patients with ischemia. Intermittent left bundle branch block is a conduction disturbance that has been described to be associated with myocardial bridges and cardiac memory. This study reports unusual associations of multiple myocardial bridges, angina, left-ventricular dysfunction, intermittent left bundle branch block, and cardiac memory.
Asunto(s)
Angina Estable/diagnóstico , Angina Estable/tratamiento farmacológico , Bloqueo de Rama/diagnóstico por imagen , Electrocardiografía , Disfunción Ventricular Izquierda/diagnóstico por imagen , Antagonistas Adrenérgicos beta/uso terapéutico , Angina Estable/etiología , Aspirina/administración & dosificación , Bloqueo de Rama/complicaciones , Bloqueo de Rama/fisiopatología , Cardiotónicos , Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Ecocardiografía , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/diagnóstico por imagen , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Imagen por Resonancia Cinemagnética/métodos , Masculino , Persona de Mediana Edad , Multimorbilidad , Puente Miocárdico/complicaciones , Puente Miocárdico/diagnóstico por imagen , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
OBJECTIVE: The aim of this study is to compare the continuous and combined suturing techniques in regards to the needing epicardial pacing at the time of weaning from cardiopulmonary bypass (EP-CPB) and to evaluate permanent epicardial pacemaker (PEP) implantation in patients who had undergone surgical ventricular septal defect (VSD) closure. METHODS: This single-centre retrospective survey includes 365 patients who had consecutively undergone VSD closure between January 2006 and October 2015. RESULTS: The median age and weight of the patients were 15 months (range 27 days - 56.9 years) and 10 kg (range 3.5 - 100 kg), respectively. Continuous and combined suturing techniques were utilised in 302 (82.7%) and 63 (17.3%) patients, respectively. While 25 (6.8%) patients required EP-CPB, PEP was implanted in eight (2.2%) patients. Comparison of the continuous and combined suturing techniques regarding the need for EP-CPB (72% vs. 28%, P=0.231) and PEP implantation (87.5% vs. 12.5%, P=1.0) were not statistically significant. The rate of PEP implantation in patients with perimembraneous VSD without extension and perimembraneous VSD with inlet extension did not reveal significant difference between the suture techniques (P=1.0 and P=0.16, respectively). In both univariate and multivariate analyses, large VSD (P=0.001; OR 8.63; P=0.011) and perimembraneous VSD with inlet extension (P<0.001; OR 9.02; P=0.005) had a significant influence on PEP implantation. CONCLUSION: Both suturing techniques were comparable regarding the need for EP-CPB or PEP implantation. Caution should be exercised when closing a large perimembraneous VSD with inlet extension.
Asunto(s)
Estimulación Cardíaca Artificial/métodos , Defectos del Tabique Interventricular/cirugía , Marcapaso Artificial , Técnicas de Sutura , Adolescente , Adulto , Distribución por Edad , Estimulación Cardíaca Artificial/estadística & datos numéricos , Niño , Preescolar , Femenino , Bloqueo Cardíaco/etiología , Bloqueo Cardíaco/terapia , Defectos del Tabique Interventricular/complicaciones , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana Edad , Marcapaso Artificial/estadística & datos numéricos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Técnicas de Sutura/estadística & datos numéricos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Abstract Objective: The aim of this study is to compare the continuous and combined suturing techniques in regards to the needing epicardial pacing at the time of weaning from cardiopulmonary bypass (EP-CPB) and to evaluate permanent epicardial pacemaker (PEP) implantation in patients who had undergone surgical ventricular septal defect (VSD) closure. Methods: This single-centre retrospective survey includes 365 patients who had consecutively undergone VSD closure between January 2006 and October 2015. Results: The median age and weight of the patients were 15 months (range 27 days - 56.9 years) and 10 kg (range 3.5 - 100 kg), respectively. Continuous and combined suturing techniques were utilised in 302 (82.7%) and 63 (17.3%) patients, respectively. While 25 (6.8%) patients required EP-CPB, PEP was implanted in eight (2.2%) patients. Comparison of the continuous and combined suturing techniques regarding the need for EP-CPB (72% vs. 28%, P=0.231) and PEP implantation (87.5% vs. 12.5%, P=1.0) were not statistically significant. The rate of PEP implantation in patients with perimembraneous VSD without extension and perimembraneous VSD with inlet extension did not reveal significant difference between the suture techniques (P=1.0 and P=0.16, respectively). In both univariate and multivariate analyses, large VSD (P=0.001; OR 8.63; P=0.011) and perimembraneous VSD with inlet extension (P<0.001; OR 9.02; P=0.005) had a significant influence on PEP implantation. Conclusion: Both suturing techniques were comparable regarding the need for EP-CPB or PEP implantation. Caution should be exercised when closing a large perimembraneous VSD with inlet extension.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Marcapaso Artificial/estadística & datos numéricos , Estimulación Cardíaca Artificial/métodos , Técnicas de Sutura/estadística & datos numéricos , Defectos del Tabique Interventricular/cirugía , Factores de Tiempo , Estimulación Cardíaca Artificial/estadística & datos numéricos , Modelos Logísticos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Distribución por Edad , Estadísticas no Paramétricas , Bloqueo Cardíaco/etiología , Bloqueo Cardíaco/terapia , Defectos del Tabique Interventricular/complicacionesRESUMEN
OBJECTIVES: The present study aims to describe the clinical, electrocardiographic, and echocardiographic cardiological findings in a group of patients with oral clefts. METHODS: This is a prospective cross-sectional study on 70 children (age range from 13 days to 19 years) with oral clefts who attended the multidisciplinary program of a university hospital from March 2013 to September 2014. The patients were evaluated by a pediatric cardiologist and underwent detailed anamnesis, physical examination, electrocardiogram, and echocardiogram. RESULTS: Sixty percent of the patients were male; 55.7% presented with cleft lip and palate, and 40.0% presented with health complaints. Comorbidities were found in 44.3%. Relevant pregnancy, neonatal, family and personal antecedents were present in 55.7%, 27.1%, 67.2%, and 24.3% of the patients, respectively. Regarding the antecedents, 15.2% of the patients presented with a cardiac murmur, 49.0% with a familial risk of developing plurimetabolic syndrome, and 6% with family antecedents of rheumatic fever. Electrocardiographic evaluation showed one case of atrioventricular block. Echocardiograms were abnormal in 35.7% of the exams, including 5 cases of mitral valve prolapse - one of which was diagnosed with rheumatic heart disease. CONCLUSION: The finding of a family risk of developing plurimetabolic syndrome and a diagnosis of rheumatic heart disease indicates that patients with oral clefts may be more prone to developing acquired heart disease. Thus, our findings highlight the importance of anamnesis and methodological triangulation (clinical-electrocardiographic-echocardiographic) in the investigation of patients with oral clefts and emphasize that cardiological follow-up to evaluate acquired and/or rhythm heart diseases is necessary. This strategy permits comorbidity prevention and individualized planned treatment.
Asunto(s)
Anomalías Cardiovasculares/complicaciones , Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Adolescente , Adulto , Anomalías Cardiovasculares/diagnóstico por imagen , Niño , Preescolar , Estudios Transversales , Ecocardiografía , Electrocardiografía , Salud de la Familia , Femenino , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/diagnóstico por imagen , Humanos , Lactante , Recién Nacido , Masculino , Síndrome Metabólico/complicaciones , Estudios Prospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
OBJECTIVES: The present study aims to describe the clinical, electrocardiographic, and echocardiographic cardiological findings in a group of patients with oral clefts. METHODS: This is a prospective cross-sectional study on 70 children (age range from 13 days to 19 years) with oral clefts who attended the multidisciplinary program of a university hospital from March 2013 to September 2014. The patients were evaluated by a pediatric cardiologist and underwent detailed anamnesis, physical examination, electrocardiogram, and echocardiogram. RESULTS: Sixty percent of the patients were male; 55.7% presented with cleft lip and palate, and 40.0% presented with health complaints. Comorbidities were found in 44.3%. Relevant pregnancy, neonatal, family and personal antecedents were present in 55.7%, 27.1%, 67.2%, and 24.3% of the patients, respectively. Regarding the antecedents, 15.2% of the patients presented with a cardiac murmur, 49.0% with a familial risk of developing plurimetabolic syndrome, and 6% with family antecedents of rheumatic fever. Electrocardiographic evaluation showed one case of atrioventricular block. Echocardiograms were abnormal in 35.7% of the exams, including 5 cases of mitral valve prolapse — one of which was diagnosed with rheumatic heart disease. CONCLUSION: The finding of a family risk of developing plurimetabolic syndrome and a diagnosis of rheumatic heart disease indicates that patients with oral clefts may be more prone to developing acquired heart disease. Thus, our findings highlight the importance of anamnesis and methodological triangulation (clinical-electrocardiographic-echocardiographic) in the investigation of patients with oral clefts and emphasize that cardiological follow-up to evaluate acquired and/or rhythm heart diseases is necessary. This strategy permits comorbidity prevention and individualized planned treatment.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Adulto Joven , Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Anomalías Cardiovasculares/complicaciones , Índice de Severidad de la Enfermedad , Ecocardiografía , Salud de la Familia , Estudios Transversales , Estudios Prospectivos , Medición de Riesgo , Anomalías Cardiovasculares/diagnóstico por imagen , Síndrome Metabólico/complicaciones , Electrocardiografía , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/diagnóstico por imagenRESUMEN
OBJECTIVE: The objective of our study was to determine the feasibility of early extubation and to identify the risk factors for delayed extubation in pediatric patients operated for ventricular septal defect closure. METHODS: A prospective, observational study was carried out at our Institute. This study involved consecutive 135 patients undergoing ventricular septal defect closure. Patients were extubated if feasible within six hours after surgery. Based on duration of extubation, patients were divided two groups: Group 1= extubation time ≤ 6 hours, Group 2= extubation time >6 hours. RESULTS: A total of 99 patients were in Group 1 and 36 patients in Group 2. Duration of ventilation was 4.4±0.9 hours in Group 1 and 25.9±24.9 hours in Group 2 (P<0.001). Univariate analysis showed that young age, low weight, low partial pressure of oxygen, trisomy 21, multiple ventricular septal defect, high vasoactive inotropic score, transient heart block and low cardiac output syndrome were associated with delayed extubation. However, regression analysis revealed that only trisomy 21 (OR: 0.248; 95%CI: 0.176-0.701; P=0.001), low cardiac output syndrome (OR: 0.291; 95%CI: 0.267-0.979; P=0.001), multiple ventricular septal defect (OR: 0.243; 95%CI: 0.147-0.606; P=0.002) and vasoactive inotropic score (OR: 0.174 95%CI: 0.002-0.062; P=0.039) are strongest predictors for delayed extubation. CONCLUSION: Trisomy 21, low cardiac output syndrome, multiple ventricular septal defect and high vasoactive inotropic score are significant risk factors for delay in extubation. Age, weight, pulmonary artery hypertension, size of ventricular septal defect, aortic cross-clamp and cardiopulmonary bypass time did not affect early extubation.
Asunto(s)
Extubación Traqueal/normas , Defectos del Tabique Interventricular/cirugía , Atención Perioperativa/normas , Gasto Cardíaco Bajo/complicaciones , Niño , Preescolar , Síndrome de Down/complicaciones , Estudios de Factibilidad , Femenino , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/rehabilitación , Humanos , Lactante , Masculino , Contracción Miocárdica/fisiología , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
Objective: The objective of our study was to determine the feasibility of early extubation and to identify the risk factors for delayed extubation in pediatric patients operated for ventricular septal defect closure. Methods: A prospective, observational study was carried out at our Institute. This study involved consecutive 135 patients undergoing ventricular septal defect closure. Patients were extubated if feasible within six hours after surgery. Based on duration of extubation, patients were divided two groups: Group 1= extubation time ≤ 6 hours, Group 2= extubation time >6 hours. Results: A total of 99 patients were in Group 1 and 36 patients in Group 2. Duration of ventilation was 4.4±0.9 hours in Group 1 and 25.9±24.9 hours in Group 2 (P<0.001). Univariate analysis showed that young age, low weight, low partial pressure of oxygen, trisomy 21, multiple ventricular septal defect, high vasoactive inotropic score, transient heart block and low cardiac output syndrome were associated with delayed extubation. However, regression analysis revealed that only trisomy 21 (OR: 0.248; 95%CI: 0.176-0.701; P=0.001), low cardiac output syndrome (OR: 0.291; 95%CI: 0.267-0.979; P=0.001), multiple ventricular septal defect (OR: 0.243; 95%CI: 0.147-0.606; P=0.002) and vasoactive inotropic score (OR: 0.174 95%CI: 0.002-0.062; P=0.039) are strongest predictors for delayed extubation. Conclusion: Trisomy 21, low cardiac output syndrome, multiple ventricular septal defect and high vasoactive inotropic score are significant risk factors for delay in extubation. Age, weight, pulmonary artery hypertension, size of ventricular septal defect, aortic cross-clamp and cardiopulmonary bypass time did not affect early extubation.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Atención Perioperativa/normas , Extubación Traqueal/normas , Defectos del Tabique Interventricular/cirugía , Factores de Tiempo , Gasto Cardíaco Bajo/complicaciones , Estudios de Factibilidad , Estudios Prospectivos , Factores de Riesgo , Síndrome de Down/complicaciones , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/rehabilitación , Contracción Miocárdica/fisiologíaRESUMEN
The morphological findings in the lung vessels of children with pulmonary arterial hypertension associated with uncorrected congenital cardiac shunts may be qualitatively and quantitatively assessed by lung biopsy in selected cases. Among 297 lung biopsies collected over a period of 11 years two cases were detected presenting the typical findings of pulmonary capillary hemangiomatosis, a rare disorder usually associated with pulmonary veno-occlusive disease. We report the clinical and histological findings and discuss about the impact of this unexpected and not-previously described associated lesion on the prognosis and on the therapeutic strategy in patients with pulmonary hypertension associated with congenital heart disease.
Asunto(s)
Hemangioma Capilar/diagnóstico por imagen , Hipertensión Pulmonar/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Preescolar , Hipertensión Pulmonar Primaria Familiar , Femenino , Defectos del Tabique Interatrial/complicaciones , Defectos del Tabique Interventricular/complicaciones , Hemangioma Capilar/complicaciones , Hemangioma Capilar/patología , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/patología , Pulmón/patología , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/patología , CintigrafíaRESUMEN
OBJETIVO: Conocer las complicaciones médico quirúrgicas, post tratamiento quirúrgico de la comunicación interventricular (CIV) de pacientes menores de 17 años, tratados en el INSN. MATERIAL Y MÉTODOS: Estudio descriptivo, retrospectivo. Se incluyeron todos los pacientes menores de 17 años atendidos por CIV en el INSN, de Enero del 2007 a Julio del 2011. RESULTADOS: Se revisaron 61 historias clínicas de pacientes con diagnóstico de CIV. 22 eran de sexo femenino (36.1%), y 39 masculino (63.9%). El tipo de CIV más frecuente fue el perimembranoso (78.7%) seguidos por los CIV de entrada de salida y muscular (7.1%). Según la técnica operatoria: 75.4% fueron transatriales y 11.5% transpulmonares. Las complicaciones médicas post quirúrgicas más frecuentes, fueron el bloqueo aurículo ventricular e insuficiencia cardiaca congestiva ambas con el 8.2% de frecuencia. La complicación quirúrgica más frecuente fue el CIV residual (29.5%), seguida de dehiscencia esternal (9.8%) e infección de herida operatoria (8.2%). 47.5% no presentó ninguna complicación quirúrgica. CONCLUSIONES: El tratamiento quirúrgico de la comunicación interventricular es una alternativa segura para la corrección de esta patología.
OBJETIVE: The purpose of this study was to know the surgical and medical complications in ventricular septal defects (VSD) surgical treatment in pediatrics patients in INSN. MATERIALS AND METHODS: A descriptive and retrospective study in pediatrics patients that underwent VSD surgical closure in the cardiac service of ôINSNõ in Lima, Perú, between January 2007 to July 2011. RESULTS: We reviewed 61 medical records, there were 22 (36.1%) females and 39 (63.9%) males. The perimembranous VSDs was the more frequent (78.7%) followed the enter and way muscle VSDs (7.1%). The closure of the ventricular septal defects with the transatrial approach was the predominant surgical treatment (29.5%). The residual shunts were the complication in the surgical management of VSDs with more incidence. The auricular-ventricular block and congestive heart failure were the medical complications with more incidence (both with 8.2%). 47.5% of patients had no surgical complications. CONCLUSIONS: The ventricular septal defects surgical closure is the safe alternative for correction this anomaly in the INSN.
Asunto(s)
Humanos , Defectos del Tabique Interventricular/cirugía , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/terapiaRESUMEN
OBJECTIVE: Optimal surgical treatment of patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary stenosis (PS) remains a matter of debate. This study evaluated the clinical outcome and right ventricle outflow tract performance in the long-term follow-up of patients subjected to pulmonary root translocation (PRT) as part of their surgical repair. METHODS: From April 1994 to December 2010, we operated on 44 consecutive patients (median age, 11 months). All had malposition of the great arteries as follows: TGA with VSD and PS (n = 33); double-outlet right ventricle with subpulmonary VSD (n = 7); double-outlet right ventricle with atrioventricular septal defect (n = 1); and congenitally corrected TGA with VSD and PS (n = 3). The surgical technique consisted of PRT from the left ventricle to the right ventricle after construction of an intraventricular tunnel that diverted blood flow from the left ventricle to the aorta. RESULTS: The mean follow-up time was 72 ± 52.1 months. There were 3 (6.8%) early deaths and 1 (2.3%) late death. Kaplan-Meier survival was 92.8% and reintervention-free survival was 82.9% at 12 years. Repeat echocardiographic data showed nonlinear growth of the pulmonary root and good performance of the valve at 10 years. Only 4 patients required reinterventions owing to right ventricular outflow tract problems. CONCLUSIONS: PRT is a good surgical alternative for treatment of patients with TGA complexes, VSD, and PS, with acceptable operative risk, high long-term survivals, and few reinterventions. Most patients had adequate pulmonary root growth and performance.
Asunto(s)
Anomalías Múltiples , Procedimientos Quirúrgicos Cardíacos , Ventrículo Derecho con Doble Salida/cirugía , Defectos del Tabique Interventricular/cirugía , Estenosis de la Válvula Pulmonar/cirugía , Válvula Pulmonar/cirugía , Transposición de los Grandes Vasos/cirugía , Función Ventricular Derecha , Brasil , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Distribución de Chi-Cuadrado , Niño , Preescolar , Supervivencia sin Enfermedad , Ventrículo Derecho con Doble Salida/complicaciones , Ventrículo Derecho con Doble Salida/diagnóstico por imagen , Ventrículo Derecho con Doble Salida/mortalidad , Ventrículo Derecho con Doble Salida/fisiopatología , Femenino , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/mortalidad , Defectos del Tabique Interventricular/fisiopatología , Mortalidad Hospitalaria , Humanos , Lactante , Estimación de Kaplan-Meier , Masculino , Válvula Pulmonar/anomalías , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/crecimiento & desarrollo , Estenosis de la Válvula Pulmonar/complicaciones , Estenosis de la Válvula Pulmonar/diagnóstico por imagen , Estenosis de la Válvula Pulmonar/mortalidad , Estenosis de la Válvula Pulmonar/fisiopatología , Reoperación , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Transposición de los Grandes Vasos/complicaciones , Transposición de los Grandes Vasos/diagnóstico por imagen , Transposición de los Grandes Vasos/mortalidad , Transposición de los Grandes Vasos/fisiopatología , Resultado del Tratamiento , UltrasonografíaRESUMEN
Se reporta el caso de una gestante que en ultrasonido realizado en el segundo trimestre de la gestación se sospecha un defecto de septación ventricular, se confirmó la presencia de una comunicación interventricular tipo perimembranosa con extensión muscular y mal alineamiento del tabique interventricular, que trajo como consecuencia disminución del tamaño del tracto de salida del ventrículo izquierdo, sin causar obstrucción. En el estudio posnatal se evidenció la patología señalada así como la presencia de una comunicación interauricular y persistencia del conducto arterioso. Las ilustraciones empleadas se corresponden con imágenes grabadas en el Cardiocentro Pediátrico William Soler y en su servicio de anatomía patológica. Se trata del primer caso reportado en nuestro país(AU)
The case of a pregnant with suspicion of a ventricular septate defect according to ultrasound carried out during the second trimester of pregnancy is reported confirming the presence of a peri-membranous intraventricular communication with muscular lengthening and a malalignment of interventricular septum leading to a decrease in the size of outlet tract from the left ventricle without obstruction. In the postnatal study it was evidenced the marked pathology, as well as the presence of a interauricular communication and persistence of arterial conduct. Illustrations used are in correspondence with the images taped in the William Soler Children Heart Center and in its pathological anatomy service(AU)