RESUMO
PURPOSE: To report on the long-term results after operation for coarctation of the aorta. METHODS: One hundred and four patients were studied, divided in four groups (G1, G2, G3 and G4), according to age at operation. Data analysed: reoperation, persistent hypertension, residual lesions, left ventricular function and ability index. RESULTS: Reoperation was frequent, mainly in G1 (60%) and G4 (29%). Resting hypertension occurred predominantly in cases operated on after the 10th year of life: 28% (G3) and 29% (G4). Exercise hypertension was found in cases operated on after the 20th year. Residual lesions were frequent: 97%, 98%, 83% and 65% (G1 to G4). Individual functional limitation was uncommon. The ability index was normal in the great majority of the patients (94%). CONCLUSION: Reoperation is frequent, particularly for recoarctation and aortic stenosis. Rest and/or exercise hypertension is common and related to delayed surgery. Aortic residual lesions are frequent. Physical limitation is uncommon. Postoperative follow-up is essential in order to detect late complications, which, usually, do not limit the individual patient.
Assuntos
Coartação Aórtica/cirurgia , Qualidade de Vida , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
PURPOSE: To determine the frequency and main features of subsequent cardiovascular surgery in patients operated on for coarctation of the thoracic aorta. METHODS: One hundred and five patients operated on for coarctation of the aorta with a mean follow-up period of 14 years had their notes analysed. The patients were divided in 4 groups according to age at correction of the coarctation. The incidence of recoarctation repair and other cardiovascular operations were noted. RESULTS: Surgical morbidity was important: 33%. Recoarctation occurred in 14% of the cases, mainly in those who had the coarctation resected during the first year of life. Operation for other cardiovascular defects was necessary in 24.5% of the cases. Among these, correction of left-to-right shunts was done in 50% of the patients who had the coarctation resected in the first year of life. Relief of aortic stenosis was the most frequent procedure (73%), tends to be more frequent the other is the patient at coarctation repair and more than one procedure may be necessary in some cases. CONCLUSION: Reoperation is frequent in the long term of patients operated on for coarctation of the aorta. The elective coarctation should be repaired after the first year of life hoping to avoid recoarctation. Routine follow-up is advisable for all patients aiming to detect residual left-to-right shunts and left ventricular outflow tract obstruction. Family counseling regarding prognosis after coarctation resection is recommended.
Assuntos
Coartação Aórtica/cirurgia , Adolescente , Adulto , Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , ReoperaçãoRESUMO
The echocardiographic aspects of the coronary sinus have not received much attention in the literature. In the few published articles about anomalous venous connection to the coronary sinus, the parasternal long axis view has been suggested as ideal for its visualization. More recently, it has been suggested that the coronary sinus in normal hearts is best visualized from the apical transducer position. The purpose of this study was to assess the appearance of the coronary sinus from an apical view in a group of 400 consecutive patients with ages varying from 5 days to 80 years. In ten patients with persistent left superior vena cava, the coronary sinus was markedly dilated throughout its extension. All cases were confirmed either by angiography or surgery. In another three patients with Ebstein's anomaly studied postoperatively, it was observed that the coronary sinus was abnormally draining into the right ventricle below the prosthesis plane. These findings were confirmed by the surgical reports. The routine evaluation of the coronary sinus was better performed by an apical view, which provided detailed information not only of normal, but also abnormal anatomy of this segment of the heart. We speculate that it could be especially useful in diagnosing coronary sinus atresia and thrombosis, and coronary ostium atresia, as well as total anomalous intracardiac pulmonary venous drainage.
RESUMO
Ten patients with duplication of the atrioventricular valves were studied, nine of them with the double orifice located in the mitral valve and the other one in the tricuspid. In two cases the diameter of the secondary valve was the same as that of the normal valve, and in the other 8 cases, it was smaller; each had its own valvular apparatus with chordae tendinae attached to papillary muscles located in different sites. The principal malformation in nine was ostium primum. One of the cases with mitral duplication had pulmonary atresia, an association which has never before been published. In five patients regurgitation of the secondary orifice was present; the diagnosis was made during surgery in nine cases and at necropsy in one. The orifice was sutured in three cases because of regurgitation. Four patients died in the immediate post-operative period, including the one with pulmonary atresia. The other three had pulmonary hypertension. These findings agree with the literature. The etiological hypotheses are discussed and emphasis is given to the importance of the finding of a narrow jet of contrast material directed upward and to the right in the left angiocardiogram in frontal plane. The authors believe that this may be an important sign in diagnosing cases with ostium primum septal defect; taking into account the fact that double mitral orifice is the cause of valvular insufficiency, this can be the site of bacterial endocarditis and usually needs to be surgically closed.