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1.
Rev. argent. cardiol ; 90(1): 25-30, mar. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1407106

ABSTRACT

RESUMEN Introducción: El manejo inicial de neonatos con tetralogía de Fallot (TF), con síntomas asociados a una anatomía desfavorable y un flujo vascular pulmonar significativamente reducido es controversial, y un desafío clínico. Objetivo: Describir la evolución clínica y comparar el crecimiento de ramas pulmonares en neonatos con TF sintomáticos ingresados al Departamento de Cardiología del Hospital de Niños de Córdoba, desde marzo de 2011 hasta marzo de 2021, que recibieron anastomosis de Blalock-Taussig modificada (aBTm) versus colocación de stent en tracto de salida de ventrículo derecho (sTSVD). Material y métodos: Estudio retrospectivo, observacional. Se identificaron 113 pacientes con TF; 20 de ellos (18%) fueron neonatos sintomáticos y requirieron paliación inicial. Las variables categóricas se expresan como porcentaje; las continuas como mediana y rango intercuartilo (RIC). Un valor de p <0,05 se consideró significativo. Resultados: De los 20 pacientes incluidos en el estudio, 11 (55%) constituyen el grupo aBTm y 9 (45%) el grupo sTSVD. En el grupo aBTm la rama pulmonar derecha (RPD) pre paliación tenía un score Z -3 (RIC 4,20), que aumentó a -1,6 (RIC 1,56) (p = 0,11) post intervención; y la rama pulmonar izquierda (RPI) un score Z -2,5 (RIC 4,8) que se incrementó a -1,80 (RIC 2,36) (p = 0,44). En el grupo sTSVD la RPD pre paliación tuvo un score Z -3,45 (RIC 3,83) que aumentó a - 2,5 (RIC 3,58) (p = 0,021) y la RPI un score Z -4,10 (RIC 2,51) que se incrementó a -2,00 (RIC 3,75) (p = 0,011). La saturación de O2 (SO2) pre intervención fue 75% (RIC 6), y aumentó a 87% (RIC 9) en el grupo aBTm (p = 0,005); e inicialmente fue 75% (RIC 16) y aumentó a 91% (RIC 13) en el grupo sTSVD (p = 0,008). La mediana de estadía hospitalaria post procedimiento fue 10 días (RIC 11) en el grupo aBTm, y 6 (RIC 2) en el grupo sTSVD (p= 0,095). Conclusiones: En neonatos con TF sintomáticos, ambas estrategias paliativas mejoran la condición clínica. En los que recibieron sTSVD, se objetivó un crecimiento mayor de las ramas pulmonares. Mayor número de casos y seguimiento más largo serán necesarios para confirmar estos hallazgos.


ABSTRACT Background: The initial management of neonate patients with tetralogy of Fallot (TOF) associated with an unfavorable anatomy and significantly reduced pulmonary vascular flow is controversial and continues to be a clinical challenge. Objective: The aim of this study was to describe the clinical evolution and to compare pulmonary artery branch development in symptomatic neonatal TOF patients who received a modified Blalock Taussig shunt (mBT) versus right ventricular outflow tract stent placement (RVOTs) at the Department of Cardiology, Hospital de Niños de Córdoba, between March 2011 and March 2021. Methods: A retrospective, observational study identified 113 patients with TOF, 20 of which (18%) were symptomatic neonates requqiring initial palliative intervention. Categorical variables are expressed as percentage and continuous variables as median and interquartile range (IQR). A p value <0.05 was considered significant. Results: Among the 20 patients included in the study, 11 (55%) formed the mBT group and 9 (45%) the RVOTs group. In the mBT group, pre-palliative procedure right pulmonary artery (RPA) Z score was -3 (IQR 4.20) and increased to -1.6 (IQR 1.56) (p = 0.11) and left pulmonary artery (LPA) Z score of -2.5 (IQR 4.8) increased to -1.80 (IQR 2.36) (p = 0.44). In the RVOTs group, RPA Z score prior to palliative intervention was -3.45 (IQR 3.83) and increased to -2.5 (IQR 3.58) (p = 0.021) and LPA Z score of -4.10 (IQR 2.51) to -2.00 (IQR 3.75) (p = 0.011). Pre-intervention peripheral O2 saturation of 75% (IQR 6) increased to 87% (IQR 9) in the mBT group (p= 0.005) and from initially 75% (IQR 16) to 91% (IQR 13) in the RVOTs group (p= 0.008). Mean hospital stay after the procedure was 10 days (IQR 11) in the mBT group and 6 days (IQR 2) in the RVOTs group (p= 0.095). Conclusions: In symptomatic neonates with TOF, both palliative strategies improved the clinical condition. In patients who received RVOTs, there was greater development of pulmonary artery branches. A larger number of cases and longer-term follow-up will be necessary to confirm these findings.

2.
Arq. bras. cardiol ; 117(4): 657-663, Oct. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1345229

ABSTRACT

Resumo Fundamento Tendo em vista os casos de lactentes sintomáticos com Tetralogia de Fallot (TF), baixo peso ao nascimento e anatomia complexa, o implante de stent na via de saída do ventrículo direito (VSVD) tem sido indicado alternativamente à cirurgia de Blalock-Taussig (BT). Objetivo Avaliar o implante endovascular de stent na VSVD como abordagem primária no lactente com TF e não candidato à cirurgia de BT, bem como relatar seus resultados a médio prazo e até a retirada do stent na cirurgia corretiva. Métodos Entre outubro de 2015 e abril de 2018, uma série de seis lactentes portadores de TF receberam stents para desobstrução da VSVD. Os parâmetros hemodinâmicos foram comparados em períodos pré e pós-implante. Resultados As medianas de idade e peso no momento do procedimento foram de 146,5 dias e 4,9 kg, respectivamente. O gradiente sistólico máximo diminuiu de 63,5 mmHg para 50,5 mmHg, enquanto o diâmetro dos ramos pulmonares direito e esquerdo aumentou de 3,5 mm para 4,9 mm e 4,3 mm, respectivamente. O índice de Nakata aumentou de 96,5 mm para 108,3 mm; assim como o peso, de 4,9 kg para 5,5 kg. A saturação de oxigênio aumentou de 83,5% para 93%. Houve um caso de migração do stent e dois óbitos, um deles devido à embolização do stent e o outro não teve relação com o procedimento. Conclusões O implante de stent na VSVD como procedimento paliativo na TF se mostra uma alternativa promissora para o tratamento de lactentes com má anatomia e baixo peso ao nascimento.


Abstract Background Endovascular stent placement in the right ventricular outflow tract (RVOT) has been an alternative to Blalock-Taussig (BT) surgery in the treatment of Tetralogy of Fallot (TOF) in symptomatic infants with low birth weight and complex anatomy. Objective To evaluate endovascular stent placement in the RVOT as a primary treatment for infants with TOF who are not candidates for BT surgery, and evaluate medium-term outcomes until the stent is removed during corrective surgery. Methods Six infants with TOF were treated with RVOT stenting from October 2015 to April 2018. Hemodynamic parameters were compared between the pre- and post-stenting periods. Results At the time of stenting, participants had a median age and weight of 146.5 days and 4.9 kg, respectively. Peak systolic gradient decreased from 63.5 mm Hg to 50.5 mm Hg, while the diameter of the left and right pulmonary arteries increased from 3.5 mm to 4.9 mm and 4.3 mm, respectively. The Nakata index increased from 96.5 mm to 108.3 mm; weight increased from 4.9 kg to 5.5 kg; and oxygen saturation, from 83.5% to 93%. There was one case of stent migration and two deaths, one caused by stent embolization and the other unrelated to study procedures. Conclusions RVOT stenting is a promising alternative for the palliative treatment of TOF in infants with low birth weight and complex anatomy.


Subject(s)
Humans , Infant , Tetralogy of Fallot/surgery , Blalock-Taussig Procedure , Palliative Care , Pulmonary Artery/surgery , Retrospective Studies , Treatment Outcome
3.
Chinese Journal of Thoracic and Cardiovascular Surgery ; (12): 577-580, 2018.
Article in Chinese | WPRIM | ID: wpr-711843

ABSTRACT

Objective To analyze the influencing factors of surgical management for Blalock-Taussig shunt during neonatal period,and to summarize the clinical experience,therefore,to improve the surgical outcome.Methods The clinical data between Jan 2011 and Dec 2016 were reviewed,42 neonates(26 males,16 females)with the mean age from 1 to 29 days,and weight from 2.3 to 4.1 kg,underwent a Blalock-Taussig shunt.The additional operation included PDA retention in 3 patients,right ventricular outflow tract retention in 12 patients,B-T conduit banding in 2 patients and PDA banding in 1 patient.Results The early mortality was 28.6% (12/42).Univariate analysis revealed low birth weight,waiting time for surgery,preoperative acidosis or cardiac shock,dual pulmonary blood supply,conduit/weight,high IS (inotropic drugs score),unplanned intervention as risk factors for early death.In the multivariate analysis,preoperative acidosis or cardiac shock,conduit/weight,high IS were independent risk factors of early death.Conclusion The mortality rate after the neonatal modified Blalock-Taussig shunt remains high.It can be improved by proper perioperative treatment,immediate surgical treatment and choose suitable conduit size,maintain the stable circulation.

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