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ABSTRACT 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.
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ABSTRACT Clinical data: Infant, 11-month-old, male, diagnosis of Tetralogy of Fallot with retrotracheoesophageal course of the brachiocephalic vein. Usual findings of Tetralogy of Fallot on physical examination. Technical description: Chest radiography showed slightly reduced pulmonary vascular markings and no cardiomegaly. Normal preoperative electrocardiogram with postoperative right bundle branch block. Usual findings of Tetralogy of Fallot on echocardiogram. Postoperative computed tomography angiography confirmed left brachiocephalic vein with anomalous retrotracheoesophageal course, configuring a U-shaped garland vein, in addition to postoperative findings of total correction of Tetralogy of Fallot. Operation: Complete surgical repair was performed with pulmonary valve commissurotomy and placement of bovine pericardial patch to solve right ventricular outflow tract obstruction, pulmonary trunk enlargement, and ventricular septal defect closure. Comments: Systemic venous drainage may show variations in patients with Tetralogy of Fallot. These abnormalities are usually of little clinical relevance, as they are asymptomatic. We presented a rare case of retrotracheoesophageal course of an anomalous left brachiocephalic vein with intraoperative diagnosis, confirmed by imaging during postoperative follow-up, without compromising clinical management or surgical approach.
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Abstract Introduction: The objective of this study was to investigate the effect of mivacurium in the application of fast-track anesthesia for transthoracic device closure of ventricular septal defects (VSDs) in children. Methods: The data of 108 children who underwent transthoracic device closure of VSDs from December 2018 to June 2020 were recorded and analyzed. All children were divided into group M (mivacurium group, n=55) and group C (cisatracurium group, n=53) according to the different muscle relaxant drug used. Results: No statistically significant differences in general preoperative data, intraoperative hemodynamic changes, or the incidence of adverse reactions were noted between the two groups (P>0.05). However, the intubation condition rating of children in group M was better than that in group C. The onset time, duration of clinical action and recovery index of the muscle relaxant, postoperative mechanical ventilation duration, and length of intensive care unit stay in group M were significantly lower than those in group C (P<0.05). Conclusion: It is safe and feasible to use mivacurium as a muscle relaxant in children undergoing fast-track cardiac anesthesia during transthoracic device closure of VSDs.
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Abstract Objectives: To compare the advantages and disadvantages of perventricular and percutaneous procedures for treating isolated ventricular septal defect (VSD). Methods: A total of 572 patients with isolated VSD were selected in our hospital between January 2015 and December 2016. The patients' median age and weight were five years (1-26 years) and 29 kg (9-55 kg), respectively. The median diameter of VSD was 6.0 mm (5-10 mm). Patients were divided into two groups. In group A, perventricular device closure was performed in 427 patients; in group B, 145 patients underwent percutaneous device closure. Results: Four hundred twelve patients in group A and 135 patients in group B underwent successful closure. The total occlusion rate was 98.5% (immediately) and 99.5% (3-month follow-up) in group A, which were not significantly different from those in group B (97.7% and 100%, respectively). Patients in group A had longer intensive care unit (ICU) stay than those in group B, but patients in group B experienced significantly longer operative times than those in group A. The follow-up period ranged from 8 months to 1.5 year (median, 1 year). During the follow-up period, late-onset complete atrioventricular block occurred in two patients. No other serious complications were noted in the remaining patients. Conclusion: Both procedures are safe and effective treatments for isolated VSD. The percutaneous procedure has obvious advantages of shorter ICU stay and less trauma than the perventricular procedure. However, the perventricular procedure is simpler to execute, results in a shorter operative time, and avoids X-ray exposure.
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Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Septal Occluder Device/standards , Heart Septal Defects, Ventricular/surgery , Aortic Valve Insufficiency/surgery , Time Factors , Angiography/methods , Echocardiography/methods , Retrospective Studies , Treatment Outcome , Statistics, Nonparametric , Equipment Design , Atrioventricular Block/surgery , Operative Time , Heart Septal Defects, Ventricular/diagnostic imaging , Cardiac Surgical Procedures/instrumentation , Cardiac Surgical Procedures/methods , Length of StayABSTRACT
Resumen Introducción: la endocarditis infecciosa (EI) es una enfermedad poco frecuente pero con elevada morbimortalidad. A pesar del incremento en la incidencia de S. aureus, el grupo HACEK constituye una etiología frecuente. Se comunica un adolescente con cardiopatía congénita que presentó EI a H. parainfluenzae. Caso clínico: 13 años, varón, comunicación interventricular (CIV). Caries. Ingresa 20/6/12 por adelgazamiento, astenia y adinamia de 2 semanas de evolución. Agrega dolor tipo puntada de lado a izquierda, disnea y fiebre. Al examen: regular estado general, frecuencia cardíaca 105 cpm, soplo sistólico 5/6, presión arterial 107/70. Polipnea 28 rpm. Abolición del murmullo alvéolovesicular y matidez en base de hemitórax izquierdo. Leucocitosis 17.700/mL, hemoglobina 8,7 g/dL, Proteína C reactiva 226 mg/dL. Radiografía de tórax: derrame paraneumónico izquierdo. Persiste febril, aumenta dolor torácico, peoría del estado general. Hemocultivo desarrolla H. parainfluenzae. Ecocardiograma transtorácico (ET): CIV sin repercusión hemodinámica, sin vegetaciones. Se reitera ET y se constata vegetación de 12 mm adherida al borde de CIV. En la evolución episodios de probables embolias pulmonares sépticas. A los 12 días cirugía cardíaca con evolución favorable. Discusión: el aislamiento de H. parainfluenzae fue decisivo en la búsqueda de EI. Es importante mantener alto índice de sospecha cuando existen factores de riesgo (CIV, caries). El riesgo embólico aumenta cuando la vegetación es mayor a 10 mm. Es una enfermedad médico-quirúrgica. La indicación y oportunidad de la cirugía es decisiva. Este caso se pudo haber evitado mediante prevención y tratamiento de las caries.
Summary Introduction: infective endocarditis (IE) is a rare disease with high morbidity and mortality rates. The incidence of S. aureus has increased but the agents of the HACEK group are frequent cause of EI. The case reported is an adolescent with congenital heart disease with an IE caused by H. parainfluenzae. Clinical report: 13 years old, male, ventricular septal defect (VSD). Tooth decay. The patient evidenced weight loss and asthenia since June 20, 2012 and in 2 weeks developed adinamia. Later on he presented pleuritic pain, dyspnea and fever. Physical findings: fair general condition; 105 bpm heart rate, 5/6 systolic murmur, blood pressure 107/70 mmHg. Polypnea 28 rpm. Abolition of vesicular murmur and dullness of the left hemithorax. Leukocytosis 17.700 /mL, hemoglobin 8.7 g / dL, C reactive protein (CRP) 226 mg/dL. RxTx: left parapneumonic effusion. Persistent fever, chest pain increases and general condition worsens. H. parainfluenzae was isolated from a single sample of blood culture. Transthoracic echocardiography (TE): VSD without hemodynamic repercussion, no vegetations. TE is reiterated and vegetation of 12 mm attached to the edge of VSD is found. In the evolution the patient develops episodes of probable septic pulmonary emboli. After 12 days of hospitalization, cardiac surgery was performed. After surgery the patient improved. Discussion: the isolation of H parainfluenzae led to IE diagnosis. It is important to maintain a high index of suspicion when there are risk factors (VSD, tooth decay). The embolic risk increases when vegetation is greater than 10 mm. It is a medical-surgical disease. The indication and timing of surgery is crucial. This case could have been avoided through prevention and treatment of tooth decay.
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Introducción: las cardiopatías congénitas constituyen un grupo heterogéneo de defectos morfofuncionales del corazón y los vasos sanguíneos. Objetivo: caracterizar los factores clínicos y epidemiológicos asociados a las cardiopatías congénitas. Material y Método: se realizó un estudio observacional, analítico, tipo caso-control en el servicio de Neonatología del Hospital "Abel Santamaría", años 2010-11. El universo lo constituyeron los 11 138 nacidos vivos en dicho período. La muestra se dividió en Grupo Estudio: 70 niños con diagnóstico de CC en el período neonatal y Grupo Control: 140 recién nacidos a término, nacidos consecutivos a los del estudio, tomando dos controles por cada caso. Se utilizó el test de Ji Cuadrado con nivel de significación p<0.05 y el OR para determinar la fuerza de asociación entre variables. Resultados: la incidencia de cardiopatía en el periodo fue de 6,3 por 1000 nacidos vivos. Predominaron las edades maternas entre 20 y 34 años. La enfermedad materna más frecuente fue la anemia (17,1%) en el grupo estudio, constituyendo un factor de riesgo. Los hábitos tóxicos estuvieron presentes en el 58,6% de las madres del grupo estudio. Predominó el sexo masculino (54,3%) y la comunicación interventricular aislada (45,7%). El 21,4% de las cardiopatías aparecieron en asociación con otras malformaciones, siendo la más frecuente la trisomía 21. La supervivencia fue del 92.9%. Conclusiones: los factores clínicos y epidemiológicos asociados a las cardiopatías congénitas fueron la edad materna de 20 a 34 años, la anemia, los hábitos tóxicos y el sexo masculino.
Introduction: congenital heart diseases constitute a heterogeneous group of heart morpho-functional and blood vessels defects. Objective: to characterize clinical and epidemiological factors associated with congenital heart diseases. Material and method: an observational, analytical, case-control type study was carried out in neonatology service at "Abel Santamaria Cuadrado" University Hospital during 2010-2011. The target group was comprised of 11 138 newborn infants in such period. The sample was divided into: Study Group (70 newborn infants) having the diagnosis of congenital heart disease in the neonatal period and a Control Group: 140 at term newborn infants, born consecutively of those included into the Study Group, taking two controls per each case. Chi-square test with a level of significance p<0.05 and the odd ratio were used to determine the strength of association among the variables. Results: the incidence of heart diseases during the period was 6,3 per 1000 alive newborn infants. Maternal ages between 20 and 34 years old prevailed, where anaemia was the most prevailing disease found in the study group (17,1%), which was a risk factor. Toxic habits were present in 58,6% of mothers included in the study group. Male sex prevailed (54,3%) and isolated interventricular communication (45,7%). Heart disease (21,4%) appeared in association with other malformations, where trisomy-21 was the most frequent. The survival rate was 92.9%. Conclusions: clinical and epidemiological factors associated with congenital heart diseases were maternal age (20 to 34 years old), anemia, toxic habits and male sex.
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BACKGROUND: Surgical repair of post-infarct ventricular septal defect (VSD) is considered one of the most challenging procedures having high surgical mortality. This study aimed to evaluate the outcomes of the surgical repair of post-infarct VSD. METHODS: From May 1991 to July 2012, 34 patients (mean age, 67.1+/-7.9 years) underwent surgical repair of post-infarct VSD. A retrospective review of clinical and surgical data was performed. RESULTS: VSD repair involved the infarct exclusion technique using a patch in all patients. For coronary revascularization, 12 patients (35.3%) underwent concomitant coronary artery bypass graft, 3 patients (8.8%) underwent preoperative percutaneous coronary intervention, and 9 patients (26.5%) underwent both of these procedures. The early mortality rate was 20.6%. Six patients (17.6%) required reoperation due to residual shunt or newly developed VSD. During follow-up (median, 4.8 years; range, 0 to 18.4 years), late death occurred in nine patients. Overall, the 5-year and 10-year survival rates were 54.4%+/-8.8% and 44.3%+/-8.9%, respectively. According to a Cox regression analysis, preoperative cardiogenic shock (p=0.069) and prolonged cardiopulmonary bypass time (p=0.008) were independent predictors of mortality. CONCLUSION: The early surgical outcome of post-infarct VSD was acceptable considering the high-risk nature of the disease. The long-term outcome, however, was still dismal, necessitating comprehensive optimal management through close follow-up.