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1.
Rev. bras. cir. cardiovasc ; 36(5): 717-719, Sept.-Oct. 2021. tab, graf
Article Dans Anglais | LILACS | ID: biblio-1351648

Résumé

Abstract Although many anatomical variations may be encountered in children with double outlet right ventricle, coexistence of levo-malposed great vessels and left juxtaposed atrial appendages is uncommonly observed. This case report underlines the rarity of this anatomical combination and its clinical significance along with the surgical management in an infant.


Sujets)
Humains , Nourrisson , Enfant , Transposition des gros vaisseaux/imagerie diagnostique , Ventricule droit à double issue/chirurgie , Ventricule droit à double issue/imagerie diagnostique , Auricule de l'atrium/chirurgie , Auricule de l'atrium/imagerie diagnostique , Cardiopathies congénitales/chirurgie , Cardiopathies congénitales/imagerie diagnostique , Artères
2.
Rev. bras. cir. cardiovasc ; 35(4): 593-596, July-Aug. 2020. tab, graf
Article Dans Anglais | LILACS, SES-SP | ID: biblio-1137291

Résumé

Abstract The standard treatment of transposition of the great arteries is the arterial switch operation (ASO). Despite successful surgical correction, patients cannot tolerate extubation after the operation. Major aortopulmonary collaterals (MAPCAs) are one of the rare causes of prolonged mechanical ventilation due to significant hemodynamic effects. We report a 28-day-old newborn with transposition of the great arteries and a ventricular septal defect (VSD) who underwent ASO and VSD closure. After postoperative extubation failed twice, four large MAPCAs were revealed during heart catheterization. After transcatheter closure of these four MAPCAs, the patient was extubated and discharged 27 days after the procedure.


Sujets)
Humains , Nouveau-né , Transposition des gros vaisseaux/chirurgie , Détransposition artérielle/effets indésirables , Communications interventriculaires/chirurgie , Études rétrospectives , Résultat thérapeutique , Extubation
3.
Rev. bras. cir. cardiovasc ; 35(4): 445-451, July-Aug. 2020. tab, graf
Article Dans Anglais | LILACS, SES-SP | ID: biblio-1137300

Résumé

Abstract Objective: To evaluate surgical management and results of patients with pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries (PA/VSD/MAPCAs). Methods: We reviewed a consecutive series of patients with PA/VSD/MAPCAs between January 2012 and October 2018. Study patients were separated into Group A, efficient MAPCAs; Group B, hypoplastic MAPCAs; Group C, severe hypoplastic MAPCAs at all divisions; and Group D, distal stenosis at most MAPCAs divisions. Results: Thirty-six patients were included in the study. Median age at operation time was 5.5 months (2-110 months), median weight was 8 kg (2.5-21 kg), and median number of MAPCAs was three (1-6). In Group A, 14 patients underwent single-stage total correction (TC); in Group B, 18 patients underwent unifocalization and central shunting; and in Group C, four patients had aortopulmonary window creation and collateral ligation. No patient was placed in Group D. Seventy percent of patients (n=25) had the TC operation. Early mortality was not seen in Group A, but the other two groups had a 13.6% mortality rate. At the follow-up, three patients had reintervention, two had new conduit replacement, and one had right ventricular outflow tract reconstruction. Conclusion: Evaluating patients with PA/VSD/MAPCAs in detail and subdividing them is quite useful in determining the appropriate surgical approach. With this strategy, TC can be achieved in most patients. Single-stage TC is better than other surgical methods due to its lower mortality and reintervention rates. Care should be taken in terms of early postoperative intensive care complications and reintervention indications during follow-ups.


Sujets)
Humains , Mâle , Femelle , Nourrisson , Enfant d'âge préscolaire , Enfant , Atrésie pulmonaire/chirurgie , Malformations des cloisons cardiaques/chirurgie , Procédures de chirurgie cardiaque , Artère pulmonaire/chirurgie , Artère pulmonaire/imagerie diagnostique , Études rétrospectives , Circulation collatérale
4.
Rev. bras. cir. cardiovasc ; 35(1): 113-116, Jan.-Feb. 2020. tab, graf
Article Dans Anglais | LILACS | ID: biblio-1092459

Résumé

Abstract A 30-month-old male patient with transposition of the great arteries with intact ventricular septum (TGA/IVS) is presented. Arterial switch operation (ASO) was performed in the light of echocardiographic and angiographic findings. The patient remained under extracorporeal membrane oxygenation support for seven days postoperatively, and his cardiac functions returned to normal at the postoperative 10th day. He was discharged at the postoperative 20th day. The present case, which presents one of the most advanced ages at operation for TGA/IVS among previously reported cases, is used to discuss late ASO in this study.


Sujets)
Mâle , Enfant d'âge préscolaire , Transposition des gros vaisseaux , Oxygénation extracorporelle sur oxygénateur à membrane , Septum interventriculaire/chirurgie , Détransposition artérielle , Résultat thérapeutique
5.
Rev. bras. cir. cardiovasc ; 34(3): 335-343, Jun. 2019. tab
Article Dans Anglais | LILACS | ID: biblio-1013465

Résumé

Abstract Objective: To reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure. Methods: We reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as "prolonged". Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE). Results: VSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) (P-value<0.001) and prolonged cardiopulmonary bypass time (P=0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE (P=0.03). Conclusion: Higher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.


Sujets)
Humains , Mâle , Femelle , Grossesse , Nourrisson , Complications postopératoires/étiologie , Techniques de fermeture des plaies/effets indésirables , Communications interventriculaires/chirurgie , Facteurs temps , Poids , Pontage cardiopulmonaire/méthodes , Études rétrospectives , Facteurs de risque , Facteurs âges , Statistique non paramétrique , Unités de soins intensifs , Durée du séjour
6.
Rev. bras. cir. cardiovasc ; 32(6): 468-474, Nov.-Dec. 2017. tab, graf
Article Dans Anglais | LILACS | ID: biblio-897962

Résumé

Abstract Introduction: Extracorporeal membrane oxygenation (ECMO) has become a standard technique over the past few decades in intensive care unit (ICU). Objective: A review of pediatric patients who received ECMO support in the pediatric cardiac ICU was conducted to determine the incidence, risk factors and causal organisms related to acquired infections and assess the survival rates of ECMO patients with nosocomial infections. Methods: Sixty-six patients who received ECMO support in the pediatric cardiac ICU between January 2011 and June 2014 were included in the study. Demographic, echocardiographic, hemodynamic features and surgical procedures were reviewed. Results: Sixty-six patients received a total of 292.5 days of venoarterial ECMO support. Sixty were postoperative patients. Forty-five patients were weaned from ECMO support with an ECMO survival rate of 68.2%. The rate of infection was 116.2/1000 ECMO days. Prolonged ICU stay, duration of ventilation and ECMO were found associated with development of nosocomial infection and only the duration of ECMO was an independent risk factor for nosocomial infections in ECMO patients. Conclusion: The correction of the underlying process leading to ECMO support and shortening the length of ECMO duration together with stricter application of ECMO indications would improve the infection incidence and hospital surveillance of the patient group.


Sujets)
Humains , Mâle , Femelle , Nourrisson , Enfant d'âge préscolaire , Oxygénation extracorporelle sur oxygénateur à membrane/effets indésirables , Infection croisée/étiologie , Oxygénation extracorporelle sur oxygénateur à membrane/mortalité , Oxygénation extracorporelle sur oxygénateur à membrane/statistiques et données numériques , Unités de soins intensifs pédiatriques , Infection croisée/microbiologie , Infection croisée/prévention et contrôle , Infection croisée/épidémiologie , Méthodes épidémiologiques , Infections bactériennes à Gram négatif/classification , Infections bactériennes à Gram négatif/microbiologie , Infections bactériennes à Gram négatif/prévention et contrôle , Infections bactériennes à Gram négatif/épidémiologie , Bactéries à Gram négatif/isolement et purification
7.
Rev. bras. cir. cardiovasc ; 32(1): 29-37, Jan.-Feb. 2017. tab, graf
Article Dans Anglais | LILACS | ID: biblio-843458

Résumé

Abstract Objective: This study evaluated clinical and diagnostic findings, treatment methods, and follow-up of cases of anomalous coronary arteries from the pulmonary artery. Methods: The study included all cases diagnosed with anomalous coronary arteries from the pulmonary artery between January 2012 and January 2016. Data from patients’ demographic characteristics, electrocardiography, echocardiography, angiographic findings, operation, intensive care unit stay, and follow-up were evaluated. Results: The study included 12 patients (8 male, 4 female), 10 with anomalous left coronary artery from the pulmonary artery (ALCAPA) and 2 with anomalous right coronary artery from the pulmonary artery (ARCAPA). Median age at diagnosis was 4 months (range, 1 month - 10 years old) and median weight was 5.5 kg (range, 3-30 kg). The most common complaints were murmur (n=7) and respiratory distress (n=5). In 4 cases, the initial diagnosis was dilated cardiomyopathy. Electrocardiographs were pathologic in all cases. Echocardiographic examination revealed medium to severe mitral valve regurgitation in 4 cases and reduced (< 40%) ejection fraction in 6 patients. Of the 12 patients, 8 underwent direct implantation of the left coronary artery into the aorta, 2 underwent implantation of the right coronary artery into the aorta, and the remaining 2 underwent a Takeuchi procedure. There were no early mortalities. Median hospital stay was 20 days (range, 5-35 days). Median follow-up duration was 18 months (range, 5-36 months), and no cases required further surgery during follow-up. Conclusions: Anomalous coronary arteries from the pulmonary artery can be successfully repaired providing there is early diagnosis and effective, appropriate intensive care unit follow-up. Therefore, coronary artery origins should be evaluated carefully, especially in cases with dilated cardiomyopathies.


Sujets)
Humains , Mâle , Femelle , Nourrisson , Enfant d'âge préscolaire , Enfant , Artère pulmonaire/malformations , Syndrome de Bland-White-Garland/chirurgie , Syndrome de Bland-White-Garland/imagerie diagnostique , Échocardiographie , Oxygénation extracorporelle sur oxygénateur à membrane , Études rétrospectives , Vaisseaux coronaires , Électrocardiographie , Procédures de chirurgie cardiaque , Unités de soins intensifs
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