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1.
Oncología (Ecuador) ; 32(1): 87-99, 30-04-2022.
Article in Spanish | LILACS | ID: biblio-1368952

ABSTRACT

Introducción: El síndrome de vena cava superior (SVCS) es una patología poco frecuente, asociado en la mayoría de los casos a neoplasias de origen maligno; la cual en estadios avanzados representa una urgencia médico-oncológica que compromete la vida del paciente. Propósito de la revisión: El objetivo de la revisión es delinear el rol de las diferentes alternativas quirúrgicas y percutáneas para el tratamiento del SVCS. Buscamos reportes en donde se incluye los resultados de mejor supervivencia para los distintos tratamientos actuales. Recientes hallazgos: La literatura médica describe tratamientos como la radioterapia, la quimioterapia, el bypass, la terapia endovascular y la reconstrucción vascular para el manejo del SVCS, sin embargo, no todos responden con la misma eficacia al momento de presentarse una urgencia vital por SVCS; esto producto de los factores intrínsecos y extrínsecos del paciente. Dentro de los factores extrínsecos destaca la condición social la cual, se convierte en un reto al momento de realizar un manejo integral del paciente en ciudades fronterizas, donde los datos que conoce el médico sobre el paciente son limitados o el paciente no tiene un diagnóstico previo que permita orientar el manejo. Conclusiones: El punto de partida del tratamiento del paciente con SVCS consiste en diferenciar la emergencia y la estabilidad mediante la tabla de clasificación de gravedad. En casos emergentes se tiene 2 alternativas: la terapia endovascular y la radioterapia. El abordaje quirúrgico con Baypass está contraindicado y el tratamiento definitivo con reconstrucción vascular con prótesis tiene ventajas y desventajas que deben definirse en forma individual considerando la etiología del cáncer asociado.


Introduction: Superior vena cava syndrome (SVCS) is a rare pathology, associated in most cases with neoplasms of malignant origin; which in advanced stages represents a medical-oncological emergency that compromises the patient's life. Purpose of the review: The objective of the review is to outline the role of the different surgi-cal and percutaneous alternatives for the treatment of SVCS. We look for reports that include the best survival results for the different current treatments. Recent findings: The medical literature describes treatments such as radiotherapy, chemo-therapy, bypass, endovascular therapy and vascular reconstruction for the management of SVCS, however, not all respond with the same efficacy at the time of a vital emergency. by SVCS; this product of the intrinsic and extrinsic factors of the patient. Among the extrinsic fac-tors, the social condition stands out, which becomes a challenge when carrying out an integral management of the patient in border cities, where the data that the doctor knows about the patient is limited or the patient does not have a previous diagnosis. to guide management. Conclusions: The starting point of the treatment of the patient with SVCS consists in differentiating the emergency and the stability by means of the severity classification table. In emergent cases there are 2 alternatives: endovascular therapy and radiotherapy. The surgical approach with Baypass is contraindicated and the definitive treatment with vascular reconstruc-tion with a prosthesis has advantages and disadvantages that must be defined individually considering the etiology of the associated cancer.


Subject(s)
Humans , Adult , Middle Aged , Aged , Therapeutics , Venae Cavae , Superior Vena Cava Syndrome , Vena Cava, Superior , Neoplasms
2.
Arch. argent. pediatr ; 119(5): e526-e530, oct. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1292776

ABSTRACT

La hidrocefalia es una condición clínica que consiste en un cúmulo de líquido cefalorraquídeo a nivel encefálico. Una de las causas, poco frecuente, es el síndrome de Dandy-Walker. Se presenta el caso de un recién nacido con diagnóstico prenatal de hidrocefalia secundaria a una malformación de Dandy-Walker y sospecha de genitales ambiguos. Tras el nacimiento, se confirma el diagnóstico prenatal de malformación de Dandy-Walker asociado a manifestaciones extracraneales poco frecuentes como hipospadias interescrotal y dilatación del seno coronario secundario a persistencia de la vena cava superior izquierda. Con este caso clínico queremos exponer la complejidad del síndrome de Dandy-Walker debido a sus múltiples asociaciones, que marcarán el pronóstico del paciente y la necesidad de tratamiento multidisciplinar.


Hydrocephalus is a clinical condition that consists of an accumulation of cerebrospinal fluid around the brain; Dandy-Walker syndrome is a rare cause of it. We present the case of a newborn with prenatal diagnose of hydrocephalus due to a Dandy-Walker malformation, as well as ambiguous genitalia. After birth, diagnosis of Dandy-Walker malformation associated with uncommon extracranial manifestations is confirmed. Specifically, the baby presents interscrotal hypospadias and coronary sinus dilatation due to the persistence of the left superior vena cava. With the exposition of this case, we bring out the complexity of the Dandy-Walker syndrome due to the malformations associated with it; the ones that will determine the prognosis and the need of a multidisciplinary treatment


Subject(s)
Humans , Male , Pregnancy , Infant, Newborn , Dandy-Walker Syndrome/complications , Dandy-Walker Syndrome/diagnosis , Hydrocephalus/diagnosis , Hydrocephalus/etiology , Prognosis , Vena Cava, Superior , Brain
3.
Rev. bras. cir. cardiovasc ; 35(6): 891-896, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1144012

ABSTRACT

Abstract Objective: To compare the efficacy of blind axillary vein puncture utilizing the new surface landmarks for the subclavian method. Methods: This prospective and randomized study was performed at two cardiology medical centers in East China. Five hundred thirty-eight patients indicated to undergo left-sided pacemaker or implantable cardioverter defibrillator implantation were enrolled, 272 patients under the axillary access and 266 patients under the subclavian approach. A new superficial landmark was used for the axillary venous approach, whereas conventional landmarks were used for the subclavian venous approach. We measured lead placement time and X-ray time from vein puncture until all leads were placed in superior vena cava. Meanwhile, the rate of success of lead placement and the type and incidence of complications were compared between the two groups. Results: There were no significant differences between the two groups in baseline characteristics or number of leads implanted. There were high success rates for both strategies (98.6% [494/501] vs. 98.4% [479/487], P=0.752) and similar complication rates (14% [38/272] vs. 15% [40/266], P=0.702). Six cases in the control group developed subclavian venous crush syndrome and five had pneumothorax, while neither pneumothorax nor subclavian venous crush syndrome was observed in the experimental group. Conclusion: We have developed a new blind approach to cannulate the axillary vein, which is as effective as the subclavian access, safer than that, and also allows to get this vein without the guidance of fluoroscopy, contrast, or echography.


Subject(s)
Humans , Axillary Vein/surgery , Axillary Vein/diagnostic imaging , Vena Cava, Superior , Punctures , China , Prospective Studies , Defibrillators, Implantable
4.
Rev. bras. cir. cardiovasc ; 35(6): 986-989, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143987

ABSTRACT

Abstract Since Barnard's first heterotopic heart transplant in 1974, Copeland's method has been the greatest contribution to heterotopic transplants but has the drawback of donor's right ventricular atrophy. This new method proposes a modification in the anastomosis of the superior vena cava aiming to pre-serve donor's right ventricular function by decompressing the pulmonary territory and reducing the pulmonary arterial pressure, as a biological ventricular assist device. Finally, a second intervention is proposed, where a "twist" is performed to place the donor's heart in an orthotopic position after re-moval of the native heart. A pioneering research on this method received approval from the ethics committee of the Heart Institute of São Paulo. We believe that this method has the potential to im-prove quality of life in a selected group of patients.


Subject(s)
Humans , Heart-Assist Devices , Heart Transplantation , Quality of Life , Vena Cava, Superior , Transplantation, Heterotopic
5.
CorSalud ; 12(4): 383-391, tab, graf
Article in Spanish | LILACS | ID: biblio-1278952

ABSTRACT

RESUMEN Introducción: La persistencia de la vena cava superior izquierda (VCSIP) es la anomalía más común del sistema venoso torácico y puede estar asociadas a otras malformaciones cardiacas. Objetivo: Describir las características ecocardiográficas de la VCSIP y su relación con los factores de riesgo y anomalías asociadas. Método: Se realizó un estudio descriptivo, longitudinal y retrospectivo, con el propósito de contribuir al estudio del diagnóstico prenatal de la VCSIP mediante el análisis de diferentes indicadores. La muestra estuvo conformada por 62 casos con diagnóstico prenatal de VCSIP, en fetos entre 22 y 35 semanas, examinados en el Servicio de Ecocardiografía Fetal del Cardiocentro Pediátrico William Soler, durante el período comprendido desde enero de 2008 hasta mayo de 2012. Resultados: La VCSIP se presentó asociada a cardiopatías congénitas en 33 de los 62 casos. Dentro de estas, las más frecuentes fueron las anomalías troncoconales (38,46%). Conclusiones: La VCSIP es de fácil reconocimiento mediante el ultrasonido de pesquisa y constituye un hallazgo importante para el diagnóstico de las cardiopatías congénitas; por lo cual, ante su sospecha -debido a su frecuente asociación con cardiopatías congénitas- se sugiere ofrecer a la gestante una evaluación detallada del corazón fetal.


ABSTRACT Introduction: The persistence of the left superior vena cava (PLSVC) is the most common anomaly of the thoracic venous system and may be associated with other cardiac malformations. Objective: To describe the echocardiographic characteristics of PLSVC and its relationship with risk factors and associated abnormalities. Method: A descriptive, longitudinal and retrospective study was carried out, in order to contribute to the study of the prenatal diagnosis of PLSVC through the analysis of different indicators. The sample consisted of 62 cases with a prenatal diagnosis of PLSVC, in fetuses between 22 and 35 weeks, examined in the Fetal Echocardiography Department of the Cardiocentro Pediátrico William Soler, during the period from January 2008 to May 2012. Results: The PLSVC was associated with congenital heart disease in 33 of the 62 cases. Among these, the most frequent were conotruncal heart defects (38.46%). Conclusions: The PLSVC is easily recognized by screening ultrasound and represents an important finding for the diagnosis of congenital heart disease; therefore, given its suspicion -due to its frequent association with congenital heart disease- it is suggested to offer the pregnant woman a detailed evaluation of the fetal heart.


Subject(s)
Prenatal Diagnosis , Vena Cava, Superior , Persistent Left Superior Vena Cava
6.
Rev. colomb. cardiol ; 27(5): 469-472, sep.-oct. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289257

ABSTRACT

Resumen La taquicardia por reentrada nodal es la arritmia más frecuente entre las taquicardias supraventriculares paroxísticas; la variedad lenta-rápida es la más común. En muchos casos la ablación de la vía lenta es el tratamiento definitivo y puede llegar a tener alta tasa de éxito y baja frecuencia de complicaciones. La presencia de una vena cava superior izquierda y la ausencia de vena cava superior derecha con drenaje venoso sistémico superior al seno coronario es una malformación congénita poco frecuente, la cual genera alteraciones anatómicas que dificultan el abordaje tradicional para la ablación de esta arritmia. Se presenta el caso de una paciente con esta condición en la que fue exitosa la ablación mediante ecocardiografía intracardiaca y reconstrucción tridimensional.


Abstract Nodal re-entrant tachycardia is the most common arrhythmia among the paroxysmal atrioventricular tachycardias, with the slow-fast variant being the most common. In many cases, the ablation of the slow pathway is the definitive treatment in many cases, often with a high rate of success and low frequency of complications. The presence of a left superior vena cava and the absence of a right superior vena cava with systematic venous drainage above the coronary sinus is a rare congenital malformation that leads to anatomical anomalies. These make it difficult to use the traditional approach for the ablation of this arrhythmia. The case is presented of a patient with this condition in which the ablation was successful using intracardiac echocardiography and three-dimensional reconstruction.


Subject(s)
Humans , Female , Middle Aged , Tachycardia, Paroxysmal , Congenital Abnormalities , Vena Cava, Superior , Tachycardia, Atrioventricular Nodal Reentry
7.
Medicina (B.Aires) ; 80(5): 557-559, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1287210

ABSTRACT

Resumen La persistencia de una vena cava superior izquierda en la población general representa una de las malformaciones del retorno venoso torácico más frecuentes, sin embargo su asociación con agenesia de la vena cava superior derecha e insuficiencia tricuspídea son hallazgos extremadamente infrecuentes.


Abstract The persistence of a left superior vena cava in the general population represents one of the most frequent thoracic venous return malformations, however its association with abscence of the right superior vena cava and tricuspid regurgitation are extremely rare findings.


Subject(s)
Humans , Tricuspid Valve Insufficiency , Vena Cava, Superior/diagnostic imaging
8.
Article in English | WPRIM | ID: wpr-812982

ABSTRACT

Unroofed coronary sinus syndrome (UCSS), also named coronary sinus septal defect, is a rare type of atrial septal defect with the incidence less than 1% of the total number of atrial septal defects. It is caused by incomplete formation of left atrial venous folds during embryonic development. Here we reported a patient with UCSS, who was treated in the Second Xiangya Hospital of Central South University. The patient was 50 years old and the main clinical manifestations were fatigue and shortness of breath after repeated exercise. Color Doppler echocardiography showed coronary sinus dilatation (17 mm×14 mm), indicating the possibility of permanent left superior vena cava. Pulmonary angiography showed that the left ventricle and coronary sinus were developed at the same time while the atrial septum was intact after the development of the left atrium, followed by the right atrium and right ventricle, indicating a partial anomalous pulmonary venous drainage (intracardiac type). Finally, the cardiac computed tomograhic angiography showed that 4 pulmonary veins and permanent left superior vena cava (PLSVC) went into the left atrium and the coronary sinus, respectively, while the coronary sinus septum was absent and the PLSVC was connected with the left atrium. The patient was later treated with the correction of non-parietal sinus syndrome in the Cardiovascular Surgery Department of our hospital.


Subject(s)
Coronary Sinus , Heart Atria , Heart Septal Defects, Atrial , Humans , Middle Aged , Vena Cava, Superior
9.
Rev. costarric. cardiol ; 21(2): 21-28, jul.-dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1042867

ABSTRACT

Resumen La ecocardiografía contrastada con solución salina agitada es una modalidad de imagen establecida. Este método es usualmente utilizado para el diagnóstico de foramen oval permeable, shunts intracardiacos, anomalías del drenaje venoso y shunts intrapulmonares. En este artículo se revisarán aspectos generales de la ecocardiografía contrastada con solución salina, así como métodos diagnósticos enfocados principalmente a la detección de la persistencia de vena cava superior izquierda y sus variantes.


Abstract Echocardiography contrasted with agitated saline solution is an established imaging modality. This method is usually used for the diagnosis of patent foramen ovale, intracardiac shunts and venous drainage abnormalities. In this article, general aspects of the echocardiography contrasted with saline solution will be reviewed, as well as diagnostic methods focused mainly on the detection of the persistence of the left superior vena cava and its variants.


Subject(s)
Humans , Vena Cava, Superior , Echocardiography , Echocardiography, Transesophageal , Costa Rica , Foramen Ovale, Patent , Cardiac Imaging Techniques
10.
Rev. colomb. cardiol ; 26(6): 354-356, nov.-dic. 2019.
Article in Spanish | LILACS, COLNAL | ID: biblio-1115593

ABSTRACT

Resumen La radioterapia mediastínica es uno de los tratamientos fundamentales de las enfermedades malignas torácicas, pero también representa una causa potencial de complicaciones, tanto a corto como a largo plazo. Se presenta una serie de casos de rotura de vena innominada durante esternotomía media en pacientes con fibrosis mediastínica. Los tres casos descritos corresponden a pacientes intervenidos de cirugía cardiaca con antecedentes de radioterapia mediastínica, entre 15-30 años antes de la cirugía, por tres diferentes enfermedades malignas (linfoma de Hodgkin, timoma y cáncer de mama). En los tres casos se reporta rotura de la vena innominada, con desinserción de su origen en la vena cava superior debido a fibrosis mediastínica intensa.


Abstract Although mediastinal radiotherapy is one of the basic treatments of malignant thoracic diseases, it is also a potential cause of short and long-term complications. A series of cases of rupture of the innominate vein during sternotomy are presented in patients with mediastinal fibrosis. The three cases described correspond to patients intervened by cardiac surgery, with a history of mediastinal radiotherapy between 15 to 30 years before the surgery, due to three different malignant diseases (Hodgkin lymphoma, thymoma, and breast cancer). In the three cases, a rupture of the innominate vein is reported; with de-insertion of its origin in the superior vena cava sue to intense mediastinal fibrosis.


Subject(s)
Humans , Female , Middle Aged , Thoracic Surgery , Fibrosis , Vena Cava, Superior , Breast Neoplasms , Hodgkin Disease , Brachiocephalic Veins
12.
Yonsei Medical Journal ; : 56-64, 2019.
Article in English | WPRIM | ID: wpr-719687

ABSTRACT

PURPOSE: Details on the hemodynamic differences among Fontan operations remain unclear according to respiratory and cardiac cycles. This study was undertaken to investigate hemodynamic characteristics in different types of Fontan circulation by quantification of blood flow with the combined influence of cardiac and respiratory cycles. MATERIALS AND METHODS: Thirty-five patients [10 atriopulmonary connections (APC), 13 lateral tunnels (LT), and 12 extracardiac conduits (ECC)] were evaluated, and parameters were measured in the superior vena cava, inferior vena cava (IVC), hepatic vein (HV), baffles, conduits, and left and right pulmonary artery. Pulsatility index (PIx), respiratory variability index (RVI), net antegrade flow integral (NAFI), and inspiratory/expiratory blood flow (IQ/EQ) were measured by intravascular Doppler echocardiography. RESULTS: The PIx between APC and total cavopulmonary connection (TCPC; LT and ECC) showed significant differences at all interrogation points regardless of respiratory cycles. The PIxs of HVs and IVCs in APC significantly increased, compared with that in LT and ECC, and the RVI between APC and TCPC showed significant differences at all interrogation points (p < 0.05). The NAFI and IQ/EQ between APC and TCPC showed significant differences at some interrogation points (p < 0.05). CONCLUSION: Patients with different types of Fontan circulation show different hemodynamic characteristics in various areas of the Fontan tract, which may lead to different risks causing long-term complications. We believe the novel parameters developed in this study may be used to determine flow characteristics and may serve as a clinical basis of management in patients after Fontan operations.


Subject(s)
Circulatory and Respiratory Physiological Phenomena , Echocardiography, Doppler , Fontan Procedure , Hemodynamics , Hepatic Veins , Humans , Pulmonary Artery , Vena Cava, Inferior , Vena Cava, Superior
13.
Article in English | WPRIM | ID: wpr-776963

ABSTRACT

A 68-year-old woman presented with weight loss of 7 kg over two years. Clinical examination revealed no specific abnormality and the patient was otherwise asymptomatic. Chest radiography performed to screen for malignancy revealed a soft tissue opacity projected over the mediastinum. Computed tomography of the thorax showed an enhancing anterior mediastinal mass with heterogeneous enhancement and contrast pooling in the arterial phase, followed by homogeneous enhancement in the venous phase, consistent with an aneurysm arising from the superior vena cava. This case highlights superior vena cava aneurysms as extremely rare causes of anterior mediastinal masses. Other causes of anterior mediastinal masses were also discussed.


Subject(s)
Aged , Aneurysm , Diagnostic Imaging , Female , Humans , Mediastinum , Diagnostic Imaging , Radiography, Thoracic , Tomography, X-Ray Computed , Vena Cava, Superior , Diagnostic Imaging
14.
J. vasc. bras ; 18: e20180062, 2019. tab, ilus
Article in English | LILACS | ID: biblio-1040371

ABSTRACT

The objective of management of superior vena cava syndrome (SVCS) is to promptly alleviate the uncomfortable symptoms. Conventional approaches do not always achieve results as rapidly as endovascular management with stent placement. Objectives To report the experience with endovascular management of SVCS of a Vascular and Endovascular Surgery Service at a Brazilian university hospital. Methods Symptomatic type III SVCS cases were managed with angioplasty and stent placement in 28 patients aged from 37 to 68 years, between 2002 and 2012. The etiology of SVCS was lung or thoracic cancer in 18 patients, while occlusion of the vein for prolonged use of catheters was the cause in the other 10 cases. Results Superior vena cava occlusion repair was not possible in one oligosymptomatic patient with a very severe lesion. Technical success was achieved in 96.4%. There were two deaths, one due to pulmonary embolism, 24 hours after a successful procedure, and the other due to compression of the airways by tumor mass some hours after the procedure. Clinical success was achieved in all cases of technical success, including one patient who died suddenly, after total regression of SVCS symptoms. Symptoms disappeared 24 hours and 48 hours after management in16 and 8 patients respectively; improvement was slower but progressive after 48 hours in the remaining patients. Conclusions Endovascular stent placement was effective for management of SVCS, with good technical and clinical success rates and provided prompt relief from symptoms


O tratamento da síndrome da veia cava superior (SVCS) visa aliviar, rapidamente, os sintomas desconfortáveis. Os resultados das abordagens convencionais nem sempre são tão rápidos quanto os do tratamento endovascular com colocação de stent. Objetivos Relatar a experiência de um Serviço de Cirurgia Vascular e Endovascular de hospital universitário brasileiro com o tratamento endovascular da SVCS. Métodos Vinte e oito pacientes com SVCS sintomática tipo III foram tratados com angioplastia e colocação de stent, entre 2002 e 2012. A idade variou entre 37 e 68 anos. A SVCS resultou de doença neoplásica pulmonar ou torácica em 18 pacientes e de oclusão da veia por uso prolongado de cateteres em 10 pacientes. Resultados Não foi possível reparo da oclusão da veia em um paciente oligossintomático com lesão bastante grave. O sucesso técnico foi de 96,4%. Houve duas mortes, sendo uma por embolia pulmonar 24 horas após procedimento bem-sucedido e outra por compressão das vias aéreas por massa tumoral algumas horas após o procedimento. Houve sucesso clínico em todos os casos de sucesso técnico, incluindo o paciente que faleceu de repente após ter apresentado regressão total dos sintomas. Os sintomas desapareceram em 24 e 48 horas após o tratamento em, respectivamente, 16 e oito pacientes. A melhora foi mais lenta, embora progressiva, após 48 horas nos demais pacientes. Conclusões A colocação de stent endovascular no tratamento da SVCS foi eficaz, com boas taxas de sucesso técnico e clínico e alívio mais rápido dos sintomas


Subject(s)
Vena Cava, Superior , Superior Vena Cava Syndrome , Endovascular Procedures/methods , Vascular Surgical Procedures/methods , Stents , Treatment Outcome
15.
Rev. colomb. cir ; 34(4): 386-393, 20190000. fig
Article in Spanish | LILACS, COLNAL | ID: biblio-1049206

ABSTRACT

El síndrome de Budd-Chiari consiste en la oclusión de la circulación de salida venosa del hígado, desde las sinusoides hepáticas hasta la unión de la vena cava inferior con la aurícula derecha. Esta entidad es muy rara. Las causas son primarias, obstrucción congénita de la vena cava o trombosis espontánea, o secundarias, compresión extrínseca. Si no se trata la obstrucción esta enfermedad, lleva a cirrosis hepática. Se presenta un caso del síndrome de Budd-Chiari de causa primaria por obstrucción membranosa, tratado por vía endovascular de manera exitosa y con resolución de todos los síntomas. Es el primer reporte en Colombia de este tipo de tratamiento (AU)


Budd-Chiari syndrome refers to the occlusion of the venous outflow of the liver, from the hepatic sinusoids to the junction of the inferior vena cava with the right atrium. This entity is very rare. The causes can be divided in primary (congenital vena cava obstruction or spontaneous thrombosis), and secondary (extrinsic compression). If the obstruction is not treated, leads to liver cirrhosis. In this article, we present a case of Budd-Chiari syndrome, primary due to membranous obstruction, successfully managed by the endovascular route with resolution of all symptoms. To our knowledge, this is the first case reported in Colombia utilizing this type of treatment (AU)


Subject(s)
Humans , Budd-Chiari Syndrome , Vena Cava, Superior , Endovascular Procedures , Liver
16.
Article in English | WPRIM | ID: wpr-714576

ABSTRACT

BACKGROUND: This study evaluated echocardiographic changes in full-term healthy neonates during early transitional period from postnatal 0–72 hours at 12-hour intervals by echocardiography. METHODS: This was a prospective, observational, and longitudinal single-center cohort study. Morphometric, functional, systolic, diastolic, and tissue Doppler imaging (TDI) parameters (patent ductus arteriosus [PDA], aorta, superior vena cava [SVC], stroke volume [SV], cardiac output [CO], cardiac index [CI], early diastolic flow velocity [E], late diastolic flow velocity [A], early filling in TDI [E′], peak systolic annular velocity in TDI [S′], late velocity peak in TDI [A′], and myocardial performance index [MPI]) were evaluated in left ventricle (LV) and right ventricle (RV) with 56 newborns. RESULTS: Sizes and peak velocities of PDA before postnatal 24 hours were significantly changed than those after postnatal 24 hours. Aortic velocity time integral (VTI), systolic blood pressure (BP), LV SV/kg, LV CO/kg, LV CI, and SVC flow/LV CO before 24 hours showed significantly changes than those after 24 hours. Also, LV and RV MPI before 24 hours were significantly higher than those after 24 hours. LV E/E′ was significantly higher than RV E/E′. CONCLUSION: Postnatal 24 hours is critical time for hemodynamic closure of PDA because aortic VTI, systolic BP, LV SV, LV CO, LV CI, and SVC flow/LV CO showed simultaneously significant changes after 24 hours at the same time as 24 hours of physiological closure of PDA. Chronological and dramatic changes of systolic, diastolic, and TDI parameters during early postnatal period can be used to compile normal baseline data of healthy full-term neonates.


Subject(s)
Aorta , Blood Pressure , Cardiac Output , Cohort Studies , Ductus Arteriosus , Echocardiography , Heart Ventricles , Hemodynamics , Humans , Infant, Newborn , Prospective Studies , Stroke Volume , Term Birth , Vena Cava, Superior
17.
Article in English | WPRIM | ID: wpr-714025

ABSTRACT

Coronary sinus ostial atresia (CSOA) with persistent left superior vena cava (LSVC) in the absence of an unroofed coronary sinus is a benign and rare anomaly that may be taken lightly in most instances. However, if overlooked in patients undergoing univentricular heart repair such as bidirectional Glenn or Fontan-type surgery, fatal surgical outcomes may occur due to coronary venous drainage failure. We report a case of CSOA with a persistent LSVC that was managed through coronary sinus rerouting during a total cavopulmonary connection, and provide a review of the literature regarding this rare anomaly.


Subject(s)
Coronary Sinus , Drainage , Fontan Procedure , Heart , Heart Bypass, Right , Humans , Vena Cava, Superior
18.
Article in English | WPRIM | ID: wpr-715415

ABSTRACT

BACKGROUND: Heart transplantation (HTx) can be a life-saving procedure for patients in whom single ventricle palliation or one-and-a-half (1½) ventricle repair has failed. However, the presence of a previous bidirectional cavopulmonary shunt (BCS) necessitates extensive pulmonary artery angioplasty, which may lead to worse outcomes. We sought to assess the post-HTx outcomes in patients with a previous BCS, and to assess the technical feasibility of leaving the BCS in place during HTx. METHODS: From 1992 to 2017, 11 HTx were performed in patients failing from Fontan (n=7), BCS (n=3), or 1½ ventricle (n=1) physiology at Asan Medical Center. The median age at HTx was 12.0 years (range, 3–24 years). Three patients (27.3%) underwent HTx without taking down the previous BCS. RESULTS: No early mortality was observed. One patient died of acute rejection 3.5 years after HTx. The overall survival rate was 91% at 2 years. In the 3 patients without BCS take-down, the median anastomosis time was 65 minutes (range, 54–68 minutes), which was shorter than in the patients with BCS take-down (93 minutes; range, 62–128 minutes), while the postoperative central venous pressure (CVP) was comparable to the preoperative CVP. CONCLUSION: Transplantation can be successfully performed in patients with end-stage congenital heart disease after single ventricle palliation or 1½ ventricle repair. Leaving the BCS in place during HTx may simplify the operative procedure without causing significant adverse outcomes.


Subject(s)
Angioplasty , Central Venous Pressure , Fontan Procedure , Heart Defects, Congenital , Heart Transplantation , Heart , Humans , Mortality , Physiology , Pulmonary Artery , Surgical Procedures, Operative , Survival Rate , Vena Cava, Superior
19.
Article in English | WPRIM | ID: wpr-715410

ABSTRACT

We report a case of high-output chylothorax associated with thrombo-occlusion of the superior vena cava (SVC) and left innominate vein (LIV) following an arterial switch operation in a neonate. The chylothorax was resolved by 3 weeks after surgical reconstruction of the SVC and LIV using fresh autologous pericardium. We confirmed the patency of the SVC and LIV with a 1-year follow-up computed tomographic scan at our outpatient clinic.


Subject(s)
Ambulatory Care Facilities , Arterial Switch Operation , Brachiocephalic Veins , Chylothorax , Follow-Up Studies , Humans , Infant, Newborn , Pericardium , Thrombosis , Vena Cava, Superior
20.
Article in English | WPRIM | ID: wpr-764875

ABSTRACT

BACKGROUND: In preterm infants, caffeine citrate is used to stimulate breathing before they are weaned from mechanical ventilation and to reduce the frequency of apnea. In recent studies, effects of caffeine on the cardiovascular system have been emphasized in preterm infants with patent ductus arteriosus (PDA). METHODS: This study aimed to assess the short-term hemodynamic effects on systemic blood flow and ductal shunting flow after loading standard doses of intravenous caffeine in preterm infants. Echocardiographic studies were performed by a single investigator, before and at 1 hour and 4 hours after an intravenous infusion of a loading dose as 20 mg/kg caffeine citrate for 30 minutes. RESULTS: In 25 preterm infants with PDA, left ventricular output decreased progressively during 4 hours after caffeine loading. Superior vena cava (SVC) flow decreased and ductal shunting flow increased at 1 hour and then recovered at 4-hour to baseline values. A diameter of PDA significantly decreased only at 4-hour after caffeine loading. There were no significant changes of these hemodynamic parameters in 29 preterm infants without PDA. CONCLUSION: In preterm infants with PDA, a standard intravenous loading dose of 20 mg/kg caffeine citrate was associated with increasing ductal shunting flow and decreasing SVC flow (as a surrogate for systemic blood flow) 1 hour after caffeine loading, however, these hemodynamic parameters recovered at 4 hours according to partial constriction of the ductus arteriosus. Close monitoring of hemodynamic changes would be needed to observe the risk for pulmonary over-circulation or systemic hypo-perfusion due to transient increasing ductal shunting flow during caffeine loading in preterm infants with PDA.


Subject(s)
Apnea , Caffeine , Cardiovascular System , Citric Acid , Constriction , Ductus Arteriosus , Ductus Arteriosus, Patent , Echocardiography , Hemodynamics , Humans , Infant, Newborn , Infant, Premature , Infusions, Intravenous , Research Personnel , Respiration , Respiration, Artificial , Vena Cava, Superior
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