Hand-sewn expanded polytetrafluoroethylene valved conduit for right ventricular outflow tract reconstruction / 中南大学学报(医学版)

OBJECTIVES@#Due to the lack of large-sized pulmonary valved conduit products in clinical practice, hand-sewn expanded polytetrafluoroethylene (ePTFE) valved conduit has been used for right ventricular outflow tract (RVOT) reconstruction in many heart centers around the world. This study aims to summarize the early results of the ePTFE valved conduit and the sewing technology of the conduit in combination with the latest progress, and to provide a reference for the application of ePTFE valved conduit.@*METHODS@#A total of 21 patients using ePTFE valved conduit for RVOT reconstruction in the Second Xiangya Hospital, Central South University from October 2018 to October 2020 were prospectively enrolled in this study. The age at the implantation of the conduit was 4.3 to 43.8 (median 15.1) years old, with weight of (38.9±4.1) kg. In this cohort, 14 patients underwent re-reconstruction of RVOT, including 12 patients with pulmonary regurgitation at 6.3 to 31.0 (median 13.8) years after tetralogy of Fallot (TOF) repair, and 2 patients with failed bovine jugular vein conduit (BJVC). Seven patients underwent Ross operations. Among them, 3 were for aortic valve stenosis, 2 were for aortic regurgitation, and 2 were for both stenosis and regurgitation. The ePTFE valved conduits were standard hand-sewn during the surgery. The 3 leaflets were equal in size with arc-shaped lower edge of the valve sinus. The free edge of the valve leaflets was straight with the length of about 1 mm longer than the diameter. The height of the valve sinus was 4/5 of the diameter. The junction of the valve leaflet was 3/4 of the height of the sinus. The designed leaflets were then continuous non-penetrating sutured into the inner surface of Gore-Tex vessel to make a valved conduit. Valved conduits with diameter of 18, 20, and 22 mm were used in 2, 9, and 10 cases, respectively. The surgical results, postoperative recovery time, and serious complications were summarized, and the changes of postoperative cardiac function status and hemodynamic status of the conduits were investigated.@*RESULTS@#During the implantation of ePTFE valved conduit for RVOT reconstruction, 2 patients underwent mechanical mitral valve replacement with Ross operation, 2 patients with pulmonary regurgitation with repaired TOF underwent left and right pulmonary artery angioplasty, and 1 patient with failed BJVC underwent tricuspid valvuloplasty. The cardiopulmonary bypassing time for patients underwent re-reconstruction of RVOT was (130.9±16.9) min, with aorta clamping for 1 patient to repair the residual defect of the ventricular septum. The cardiopulmonary bypassing and aorta clamping time for Ross operation were (242.7±20.6) min and (145.6±10.5) min, respectively. The duration of postoperative ventilator assistance, intensive care unit stay, and hospital stay were 3.5 h to 7.7 d (median 17.1 h),11.2 h to 29.5 d (median 1.9 d), and 6.0 to 56.0 (median 13.0) d, respectively. All patients survived after discharge from hospital. The follow-up rate after discharge was 100% with median time at 15.0 (13.0 to 39.0) months. No death happened during the follow-up. One patient underwent stent implantation due to right coronary stenosis 2 months after Ross operation. One patient underwent balloon dilation due to right pulmonary artery ostium stenosis 1 year after re-reconstruction of RVOT. The cardiac function of all patients recovered to NYHA class I 6 months after operation. The peak pressure gradient across the valve measured by transthoracic echocardiography before discharge was (9.4±2.6) mmHg (1 mmHg=0.133 kPa), and (18.3±6.1) mmHg at the last follow-up. There was no significant increase in the gradient during the follow-up (P=0.134). No patient suffered from mild or more pulmonary regurgitation.@*CONCLUSIONS@#Hand-sewn ePTFE valved conduit is feasible for RVOT reconstruction. It is a promising material for RVOT reconstruction which can effectively meet clinical need. In our experience, the ePTFE valved conduit is simple to manufacture with satisfactory early outcomes.In the application of ePTFE valved conduit, attention should be paid to implantation indications and postoperative anticoagulation management, especially to the preparation details of the valved conduit, to obtain better function and durability of the conduit after implantation.

A mass causing right ventricular outflow obstruction - a dreadful complication

Abstract The most common cardiac tumour in the pediatric age group is rhabdomyoma. These are usually located in the ventricles, either in the ventricular septum or free wall. Cardiac tumours in early infancy may lead to severely compromised blood flow due to inflow or outflow tract obstruction. The diagnosis of cardiac rhabdomyoma can be established by transthoracic echocardiography (TTE). Rhabdomyomas have a natural history of spontaneous regression; surgical intervention is reserved for patients with symptoms of severe obstruction or hemodynamic instability. In this study, a case of two-year old child who presented with failure to thrive and underwent excision of pedunculated mass from the right ventricular outflow tract was reported.

Correction of left ventricular outflow tract obstruction caused by anomalous papillary muscle and subaortic membrane

Abstract This paper presents a case study of a 30-year-old male patient with dyspnea on exertion had echocardiographic diagnosis of aortic subvalvar stenosis. Discrete mitral regurgitation and aortic valve dysplasia with mild to moderate insufficiency and hypertrophic cardiomyopathy were also noted. During surgery, a rare condition was identified: presence of papillary muscle anomaly associated with the subaortic membrane as a cause of obstruction of the left ventricular outflow tract. With the resection of these structures and a mitral valve annuloplasty, the patient evolved with a significant improvement of clinical condition and heart failure, with no residual mitral insufficiency.

Ecocardiografia transesofágico intraoperatório na avaliação de gradientes residuais após correção cirúrgica das obstruções das vias de saída ventriculares direita e esquerda / Intraoperative transesophageal echocardiography in the evaluation of residual gradients after surgical correction of right and left ventricular outflow tract obstructions

Fundamento: O Ecocardiograma Transesofágico (ETE) intraoperatório tem sido muito utilizado durante as correções das cardiopatias congênitas; entretanto, em obstruções de vias de saída dos ventrículos, as informações são limitadas. Objetivo: Avaliar a confiabilidade do ETE em detectar gradientes residuais em pacientes com obstruções de vias de saída dos ventrículos. Pacientes e Método: Os gradientes sistólicos após circulação extracorpórea ao ETE de 127 pacientes (idade média de 7 anos), sendo 79 com obstrução direita e 48 com obstrução esquerda, foram comparados ao Ecocardiograma Transtorácico (ETT) após cirurgia. Gradientes maiores que 40 mmHg foram considerados de significância hemodinâmica.Resultados: Nas obstruções esquerdas o ETE mostrou gradientes médios maiores que o ETT (30 mmHg vs 24mmHg; p = 0,014). Os gradientes ao ETE foram menores que 40 mmHg em 75% dos pacientes e houve concordância com o ETT em 97%. Nos demais, o gradiente ao ETE foi maior que 40 mmHg e houve concordância com o ETT em 33%. Nas obstruções direitas o ETE mostrou gradientes médios semelhantes ao ETT (28 mmHg vs 25 mmHg; p = 0,21). Os gradientes ao ETE foram menores que 40 mmHg em 88% dos pacientes e houve concordância com o ETT em 91,5%. Nos demais, o gradiente ao ETE foi maior que 40 mmHg e houve concordância com o ETT em 60%. Conclusão: O ETE mostrou-se útil na detecção de gradientes residuais nas vias de saída dos ventrículos nos pacientes estudados. Entretanto, em gradientes maiores que 40 mmHg, o ETE sugere maior severidade das obstruções, particularmente no lado esquerdo.

Background: Despite the large use of intraoperative Transesophageal Echocardiography (TEE) in congenital heart surgery, limited information is available regarding ventricular outflow tract obstruction. Objective: The aim of this study was to assess the reliability of the post-bypass TEE to detect residual gradients in patients with ventricular outflow obstruction. Patients and Methods: Post-bypass TEE peak systolic gradients of 127 patients (mean age of 7 years), being 79 with right ventricular outflow tract obstruction and 48 with left ventricular outflow tract obstruction, were compared with the postoperative TTE. Postoperative lesions were considered of hemodynamic significance when peak systolic gradient was higher than 40 mmHg. Results: In patients with left ventricular outflow tract obstruction TEE showed mean peak systolic gradients higher than TTE (30 mmHg versus 24 mmHg; p= 0,014). In 75%, TEE gradients were lower than 40 mmHg and agreed with TTE in 97%. In the remaining patients, TEE gradients were higher than 40 mmHg and agree with TTE in 33%. In patients with right ventricular outflow tract obstruction TEE mean gradients agreed with TTE (28 mmHg versus 25 mmHg; p= 0.21). In 88%, TEE gradients were lower than 40 mmHg and agreed with TTE in 91.5%. In the remaining patients, TEE gradients were higher than 40 mmHg and agreed with TTE in 60%.Conclusion: TEE showed to be a reliable technique to detect residual ventricular outflow tract obstructions in the majority of patients. However, when considered gradients higher than 40 mmHg, TEE suggested a greater severity of obstructions, particularly on the left side.

Implante de conducto apicoaórtico en paciente con estenosis aórtica severa post reemplazo valvular protésico / Apicoaortic valved conduit implanted in a patient with severe aortic stenosis due to mismatched aortic valve prosthesis

Introducción: La estenosis aórtica fibrocálcica es el tipo de valvulopatía más frecuente, especialmente en los adultos mayores, siendo el reemplazo valvular aórtico el tratamiento definitivo. Un mal resultado post operatorio puede deberse a un mal funcionamiento de la válvula protésica. Caso clínico: Paciente de 42 años de edad sometido a reemplazo valvular aórtico por presentar estenosis aórtica severa fibrocálcica en una válvula bicúspide y aorta de pared muy fina. Evoluciona asintomático durante 4 años, al cabo de los cuales y luego de abandonar su tratamiento anticoagulante consulta por disnea y dolor anginoso. Un ecocardiograma muestra estenosis severa de la válvula protésica. Dado los antecedentes de su cirugía previa se decide implantar un conducto de dacrón valvulado ápico-aórtico a través de toracotomía posterolateral izquierda. Evolución post operatoria muy satisfactoria permaneciendo asintomático, con un seguimiento de 15 meses. La recidiva de la estenosis aórtica severa post reemplazo valvular protésico tiene en el bypass ápico-aórtico una excelente alternativa de tratamiento efectivo, especialmente cuando el recambio valvular tradicional implica un alto riesgo quirúrgico.

Introduction: The most frequent surgical procedure of severe left ventricular outflow tract obstruction due to severe aortic stenosis is aortic valve replacement, but there is an alternative and less conventional method described by Cooley used in patients with previous aortic valve replacement and severe aortic wall calcification that bypasses the left ventricular outflow tract through the implant of an apicoaortic valved conduit. Clinical case: We describe the case of 42 years old patient with severe aortic stenosis due to mismatched valve prosthesis previously installed treated by of apicoaortic conduit implanted through left posterolateral thoracotomy.

Idiopathic left ventricular outflow tract pseudoaneurysm.

Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare occurrence and may produce clinically unpredictable symptoms. A very few cases of LVOT pseudoaneurysm are reported and there has always been a predisposing factor in these reported cases such as history of infective endocarditis, myocardial infarction, prosthetic aortic valve replacement or chest trauma. Our patient did not have the above predisposing conditions. Intra operative transesophageal echocardiography helped patient management and guided the surgical team in securing and isolation of the aneurysmal sac from the LVOT.

Giant ventricular myxoma obstructing right ventricular outflow tract / Mixoma ventricular direito gigante obstruindo via de saída do ventrículo direito

Intracardiac myxoma is predominantly located in the left atrium but their location in the right ventricle is quite unusual. We present a case in which successful excision of the tumor was done through bicameral approach.

Mixoma intracardíaco localiza-se predominantemente no átrio esquerdo, e sua localização no ventrículo direito é bastante incomum. Apresentamos um caso no qual excisão bem sucedida do tumor foi feita por meio de abordagem bicameral.

Disfunção do homoenxerto pulmonar utilizado na reconstrução do trato de saída do ventrículo direito / Dysfunction of the pulmonary homograft used in the reconstruction of the right ventricle exit tract / Disfunción del homoinjerto pulmonar utilizado en la reconstrucción del tracto de salida del ventrículo derecho

FUNDAMENTO: O homoenxerto pulmonar tem sido utilizado como uma opção na correção de cardiopatia congênita com obstrução da via de saída do ventrículo direito. Os resultados em longo prazo, no entanto, mostram-se pouco satisfatórios. OBJETIVO: Identificar os fatores de risco associados à disfunção e à falência do homoenxerto pulmonar. MÉTODOS: Estudo em crianças submetidas à ampliação da via de saída do ventrículo direito com homoenxerto pulmonar. As variáveis clínicas, cirúrgicas, evolutivas e de aspectos morfológicos da prótese foram analisadas como fatores de risco. RESULTADOS: A amostra final de 75 pacientes com idade mediana na cirurgia de 22 meses, variando de 1-157 meses, apresentou 13 pacientes (17,0 por cento) que desenvolveram disfunção do homoenxerto, caracterizado por estenose ou insuficiência pulmonar grave. O tempo de ocorrência entre o implante do homoenxerto e a detecção da disfunção foi de 45 ± 20 meses. Quando o tamanho do homoenxerto foi menor de 21 mm e o escore Z da valva pulmonar foi menor do que zero, ou maior do que três, foram considerados fatores de risco para a ocorrência de disfunção. CONCLUSÃO: O homoenxerto pulmonar de tamanho menor do que 21 mm e a valva pulmonar inadequada para idade e peso do paciente são fatores determinantes para disfunção da prótese.

BACKGROUND: The pulmonary homograft has been used as an option in the correction of congenital cardiopathy with obstruction of the right ventricle exit tract. The long term results, however, are little satisfactory. OBJECTIVE: Identify the risk factors associated to the dysfunction and the pulmonary homograft failure. METHODS: Study with children submitted to the enlargement of the exit tract of the right ventricle with pulmonary homograft. The clinical, surgical, evolutional and morphological aspects of the prosthesis variables were analyzed as risk factors. RESULTS: The final sample of 75 patients with median age at the surgery of 22 months, varying from 1-157 months, presented 13 patients (17.0 percent) who developed dysfunction of the homograft, characterized by stenosis or severe pulmonary insufficiency. The occurrence time between the homograft implant and the detection of the dysfunction was of 45 ± 20 months. When the size of the homograft was smaller than 21 mm and the Z score of the pulmonary valva is lower than zero, or higher than three, the risk factors were considered for the dysfunction occurrence. CONCLUSION: The pulmonary homograft smaller than 21 mm and the inadequate pulmonary valva for the age and weight of the patient are determining factors for the prosthesis dysfunction.

FUNDAMENTO: El homoinjerto pulmonar ha sido utilizado como una opción en la corrección de cardiopatía congénita con obstrucción de la vía de salida del ventrículo derecho. Los resultados a largo plazo, mientras tanto, se muestran poco satisfactorios. OBJETIVO: Identificar los factores de riesgo asociados a la disfunción y a la falla del homoinjerto pulmonar. MÉTODOS: Estudio en niños sometidos a la ampliación de la vía de salida del ventrículo derecho con homoinjerto pulmonar. Las variables clínicas, quirúrgicas, evolutivas y de aspectos morfológicos de la prótesis fueron analizadas como factores de riesgo. RESULTADOS: La muestra final de 75 pacientes con edad mediana en la cirugía de 22 meses, variando de 1-157 meses, presentó 13 pacientes (17,0 por ciento) que desarrollaron disfunción del homoinjerto, caracterizado por estenosis o insuficiencia pulmonar grave. El tiempo de ocurrencia entre el implante del homoinjerto y la detección de la disfunción fue de 45 ± 20 meses. Cuando el tamaño del homoinjerto fue menor de 21 mm y el escore Z de la válvula pulmonar fue menor que cero, o mayor que tres, fueron considerados factores de riesgo para la ocurrencia de disfunción. CONCLUSIÓN: El homoinjerto pulmonar de tamaño menor que 21 mm y la válvula pulmonar inadecuada para edad y peso del paciente son factores determinantes para disfunción de la prótesis.

Mortalidade hospitalar na cirurgia de reconstrução da via de saída do ventrículo direito com homeonxerto pulmonar / Hospital mortality in surgery for reconstruction outflow right ventricle with pulmonary homograft

FUNDAMENTO: Mortalidade hospitalar na cirurgia de reconstrução da via de saída do ventrículo direito com homoenxerto pulmonar é variável. OBJETIVOS: Identificar os fatores de risco associados à mortalidade hospitalar e ao perfil clínico dos pacientes. MÉTODOS: Estudo de crianças submetidas à reconstrução da via de saída do ventrículo direito com homoenxerto pulmonar. Analisados como fatores de risco as variáveis clínicas, cirúrgicas e de aspectos morfológicos da prótese. RESULTADOS: Noventa e dois pacientes foram operados entre 1998 e 2005, apresentando principalmente atresia pulmonar com comunicação interventricular e a tetralogia de Fallot. Quarenta pacientes foram atendidos no primeiro mês de vida. Necessitaram de 38 cirurgias de Blalock Taussig devido à gravidade clínica. A idade mediana na cirurgia de correção total foi de 22 meses, variando de 1 mês a 157 meses. O tamanho homoenxerto pulmonar variou de 12 a 26 mm e o tempo de extracorpórea foi 132 ± 37 minutos. Após a cirurgia houve 17 óbitos (18 por cento casos), em média 10,5 ± 7,5 dias após. A causa predominante foi falência de múltiplos órgãos. Na análise univariada entre os tipos de cardiopatia, estas deferiram na idade, momento da cirurgia, tamanho do homoenxerto, valor Z da valva pulmonar, tempo de circulação extracorpórea, manutenção da integridade do homoenxerto e alteração da árvore pulmonar. Não houve diferença estatística com relação à mortalidade hospitalar entre as variáveis e o tipo de cardiopatia. CONCLUSÃO: As cardiopatias obstrutivas do lado direito necessitam de atendimento cirúrgico nos primeiros dias de vida. A cirurgia de correção total apresenta risco de mortalidade de 18 por cento, mas não houve associação com nenhuma variável estudada.

BACKGROUND: Hospital mortality for surgical reconstruction of the outflow of the right ventricle with pulmonary homograft is variable. OBJECTIVES: To identify risk factors associated with hospital mortality and clinical profile of patients. METHODS: Children underwent reconstruction of the outflow tract of right ventricle with pulmonary homograft. Analyzed as risk factors for the clinical, surgical and morphological aspects of the prosthesis. RESULTS: Ninety-two patients operated on between 1998 and 2005 presented mainly pulmonary atresia with ventricular septal defect and tetralogy of Fallot. Forty patients were treated in the first month of life. He needed 38 surgeries to Blalock Taussig due to clinical severity. The median age at surgery for total correction was 22 months, ranging from 1 to 157 months. Size pulmonary homograft ranging from 12 to 26 mm and length of bypass was 132 ± 37 minutes. After surgery there were seventeen deaths (18 percent cases) on average 10.5 ± 7.5 days. The predominant cause was multiple organ failure. In the univariate analysis between the types of heart disease, they found in favor of age at surgery, size of homograft, pulmonary valve Z value, CPB time, maintaining the integrity of the homograft and pulmonary tree change. There was no statistical differencein hospital mortality between the variables and the type of heart disease. CONCLUSION: The congenital obstructive right requires surgical care in the first days of life. The total correction surgery has a risk rate of 18 percent but there was no association with any variable studied.

Nova técnica: translocação aórtica e pulmonar com preservação da valva pulmonar / New technique: aortic and pulmonary translocation with preservation of pulmonary valve

Realizamos com sucesso novo procedimento cirúrgico, em duas crianças portadoras de transposição das grandes artérias associada a comunicação interventricular e obstrução da via de saída do ventrículo esquerdo. A cirurgia consiste na realização de translocação aórtica com a valva aórtica e as artérias coronárias para o ventrículo esquerdo, após a ampliação da via de saída desse ventrículo e da comunicação interventricular com pericárdio autólogo fixado em glutaraldeído, associada à translocação do tronco pulmonar para o ventrículo direito, conservando integralmente a valva pulmonar.

We applied successfully, a new surgical technique, in two children with transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction, that utilized aortic translocation with the aortic valve and the coronary arteries to the left ventricle, after correction of left outflow tract obstruction and correction of the ventricular septal defect, associated to pulmonary root translocation to the right ventricle, conserving integrally the pulmonary valve.

Late outcome of right ventricular outflow tract repair using bicuspid pulmonary prosthesis in tetralogy of Fallot surgery repair: case report / Resultado tardio da reconstrução da via de saída do ventrículo direito com prótese pulmonar bicúspide na correção da tetralogia de Fallot: relato de caso

We present a case of a 19 year-old female patient, with tetralogy of Fallot and hypoplastic pulmonary ring. Diagnosis was performed by echocardiography and cardiac catheterization. The surgical repair was performed at the age of 2 years old. A right ventricular outflow tract remodeling was performed using a porcine pulmonary bicuspid prosthesis. The patient presented a uneventful follow-up during 17 years. Postoperative assessment has shown: mild pulmonary insufficiency and mild pulmonary ventricle gradient, satisfactory right ventricular performance and prosthesis not presenting calcification. This is an option to correct the tetralogy of Fallot adopted by our Institution in the last two decades.

É apresentado o caso de uma paciente de 19 anos de idade, sexo feminino, portadora de tetralogia de Fallot com anel pulmonar hipoplásico. O diagnóstico foi feito com ecoDopplercardiograma e cateterismo cardíaco. A correção cirúrgica foi realizada com 2 anos de idade. Para a reconstrução da valva pulmonar e via de saída do ventrículo foi utilizada prótese bivalvular pulmonar porcina. A paciente teve boa evolução clínica durante 17 anos. A avaliação pós-operatória demonstrou: discreta insuficiência pulmonar, discreto gradiente transvalvar pulmonar, desempenho do ventrículo direito preservado e prótese pulmonar sem calcificação. Esse é o procedimento adotado pela nossa Instituição para a correção da tetralogia de Fallot, nos últimos 20 anos.

Tunnel type left ventricular outflow tract obstruction: an unusual complex congenital cardiac anomaly in adult

A 24-year-old man, referred to our center with generalized body edema and hypotension. He had a complex congenital heart disease that finally discharged after konno operation

Emprego e avaliação em médio prazo da cúspide de homoenxerto decelularizado na correção da tetralogia de Fallot / The use and midium-term evaluation of decellularized allograft cusp in the surgical treatment of the tetralogy of Fallot

OBJETIVO: Descrever a técnica de preparo e a evolução ecocardiográfica das cúspides de homoenxerto decelularizado utilizadas em pacientes com tetralogia de Fallot. MÉTODOS: No período de março de 2005 a agosto de 2007, 15 pacientes foram submetidos ao implante deste tipo de enxerto e foram acompanhados clinicamente e com ecocardiograma para avaliar o resultado morfofuncional dos enxertos. RESULTADOS: O acompanhamento médio foi de 12,7 meses (1-25 meses). A análise ecocardiográfica em médio prazo revelou: insuficiência pulmonar leve em nove (60 por cento) pacientes, moderada em três (20 por cento) e importante em três (20 por cento); a função sistólica do ventrículo direito esteve preservada em 13 (86,7 por cento) pacientes e com disfunção leve em dois (13,3 por cento); 11 (73,4 por cento) pacientes não apresentaram gradientes na via de saída do ventrículo direito (VD), e em quatro (26,6 por cento) pacientes evidenciou-se a presença de estenose leve; a mobilidade da cúspide foi normal em todos os pacientes; não houve espessamento maior de 1,5mm nas cúspides analisadas; não se detectou nenhuma calcificação nas cúspides. Catorze (93,3 por cento) pacientes apresentaram Z score entre -1 e 0,7 e um (6,7 por cento) paciente apresentou anel pulmonar com Z score de + 2,5. CONCLUSÃO: O retalho de homoenxerto decelularizado parece ser uma boa opção para a ampliação da via de saída do VD nos pacientes submetidos à correção total da tetralogia de Fallot em médio prazo.

OBJECTIVE: To describe the technique of implantation and to show the echocardiographic follow-up of the decellularized cusps allografts used in patients with tetralogy of Fallot. METHODS: Fifteen patients underwent this implantation between March 2005 and August 2007 and they were clinically followed-up. An echocardiogram was performed to evaluate the morphofunctional result of the allografts. RESULTS: The mean follow-up was 12.7 months (1-25 months). The echocardiography results showed that pulmonary insufficiency was mild in nine (60 percent) patients, moderate in three (20 percent) patients, and severe in three (20 percent) patients. The results also showed that the systolic right ventricle function was normal in 13 (86.7 percent) and that there was mild dysfunction in two (13.3 percent). Eleven (73.4 percent) patients did not present any gradient in the right ventricular outflow tract and four (26.6 percent) presented mild stenosis. The mobility of the cusps were normal in all cases and there was no thickness larger than 1,5mm. There was no calcification; 14 patients (93,3 percent) presented Z score between -1 and 0,7 and one patient presented dilated pulmonary annulus with a Z score of + 2.5. CONCLUSION: In midium-term follow-up, the decellularized allograft seemed to be a good option for right ventricle outflow tract enlargement in patients underwent tetralogy of Fallot.

Ablação com radiofreqüência de extra-sístoles da via de saída do ventrículo direito / Radiofrequency catheter ablation of premature ventricular contractions originating in the right ventricular outflow tract

OBJETIVOS: Avaliar se a ablação com radiofreqüência é um procedimento eficiente para o tratamento das extra-sístoles da via de saída do ventrículo direito (EVSVD), e se resulta em melhora dos sintomas. MÉTODOS: Estudo prospectivo, com 30 pacientes consecutivos (idade média de 40±13 anos, 25 do sexo feminino), sem cardiopatia estrutural aparente, com EVSVD, muito freqüentes (densidade média de 1.263±593/h), sintomáticos por mais de 1 ano (média =74 meses) e refratários aos fármacos antiarrítmicos (3±1,7, incluindo os beta-bloqueadores), que foram submetidos à ablação com radiofreqüência. RESULTADOS: Após o primeiro procedimento, houve 23 sucessos iniciais (76,6 por cento) e 7 iniciais insucessos (23,4 por cento). Quatro pacientes tiveram recorrências, sendo que dois desses não se submeteram ao segundo procedimento. O segundo procedimento foi realizado em 9 pacientes (7 insucessos iniciais e 2 recorrências), e o sucesso ocorreu em 5 pacientes adicionais, sendo 1 caso por acesso epicárdico. A taxa de sucesso final foi de 80 por cento (24/30), e nenhuma complicação maior ocorreu. Após um seguimento médio de 14±6 meses, no grupo de sucesso final houve uma redução de mais de 90 por cento na densidade das extra-sístoles(24/24; p<0,0001) e resultante ausência de sintomas na maioria dos pacientes (23/24; p<0,001). CONCLUSÃO: A ablação com radiofreqüência é um tratamento seguro e eficaz para os pacientes com extra-sístoles persistentes e sintomáticas com morfologia do trato de saída do ventrículo direito.

OBJECTIVES: To evaluate if radiofrequency catheter ablation is an effective procedure for the treatment of right ventricular outflow tract premature ventricular contractions (RVOT-PVC) and ascertain if it results in an improvement of symptoms. METHODS: A prospective study with 30 consecutive patients (mean age 40 ± 13 years, 25 females), with no apparent structural cardiopathy, with very frequent (mean density of 1,263 ± 593/h) RVOT-PVC, symptomatic for more than one year (mean = 74 months) and resistant to antiarrhythmic drugs (3 ± 1.7, including beta-blockers), who underwent radiofrequency catheter ablation. RESULTS: After the first procedure, there were 23 initial successful cases (76.6 percent) and 7 initial failures (23.4 percent). Four patients experienced relapses, two of whom did not undergo the second procedure. The second procedure was carried out in 9 patients (7 initial failures and 2 relapses), and there was success in 5 additional patients, one of them by epicardial access. The final success rate was 80 percent (24/30), and there were no major complications. After a mean follow-up of 14 ± 6 months, in the successful group there was a reduction greater than 90 percent in density of premature ventricular contractions (PVC) (24/24; p<0.0001) and a resulting absence of symptoms in the majority of patients (23/24; p<0.001). CONCLUSION: Radiofrequency catheter ablation is a safe and effective treatment for patients with persistent and symptomatic PVC with RVOT morphology.

Ventrículo derecho doble cámara: experiencia con 42 pacientes pediátricos / Double chamber of right ventricle: experience in 42 pediatric patients

Se estudiaron en forma retrospectiva 42 pacientes con diagnóstico de Ventrículo Derecho de Doble Cámara (VDDC) con el objeto de analizar y conocer los aspectos clínicos, métodos y diagnósticos, tratamiento y evolución de esta patología. La mayoría de los pacientes tenían una malformación cardíaca asociada, siendo la comunicación interventricular la de más alta frecuencia (88 por ciento). La historia clínica, el examen físico, el electrocardiograma y la radiografía de tórax no fueron de ayuda en el diagnóstico. Los hallazgos auscultatorios más frecuentes estaban relacionados a la anomalía asociada (comunicación interventricular). El diagnóstico clínico de VDDC se planteó en sólo 4 pacientes. El ecocardiograma bidimensional doppler color constituyó un excelente métodos diagnóstico en 90 por ciento de los casos. La angiocardiografía confirmó los hallazgos ecocardiográficos y resultó de ayuda diagnóstica en dos pacientes, permitiendo la diferenciación con otros tipos de estenosis subpulmonar. La cirugía y el pronóstico a largo plazo de los pacientes fue bueno, asimilándose a las series publicadas.

Divertículos de la valva anterior mitral como causa de obstrucción del tracto de salida del ventrículo izquierdo

Hombre de 35 años quien consultó por disnea progresiva de 6 meses de evolución. El ecocardiograma transesofágico mostró obstrucción del tracto de salida del ventrículo izquierdo por probable membrana subaórtica. En cirugía se encontraron dos formaciones saculares (divertículos) en la válvula mitral; el mayor de ellos protruía por el tracto de salida del ventrículo izquierdo causando obstrucción. Se practicó extirpación de la válvula con sus divertículos y se colocó prótesis mecánica