ABSTRACT
Serum galactomannan antigen detection was used for the diagnosis and follow-up of cardiac aspergillosis after surgery in 2 nonneutropenic patients. The galactomannan index, developed in response to surgical and antifungal therapies, could prove to be a valuable method for the diagnosis and follow-up of fungal infections in such patients.
Subject(s)
Antigens, Fungal/blood , Aspergillosis/diagnosis , Heart Diseases/diagnosis , Mannans/blood , Adolescent , Biomarkers , Child , Follow-Up Studies , Galactose/analogs & derivatives , Humans , MaleABSTRACT
INTRODUCTION AND OBJECTIVES: To carry out a retrospective analysis of the indications for, and the results and complications of interventional catheterization after the Norwood procedure. METHODS: Between February 1993 and December 2006, 25 interventional catheterizations were performed in 14 patients who had undergone the Norwood procedure, prior to the Glenn or Fontan procedure. RESULTS: Nine angioplasties were carried out for recoarctation in seven of the 14 patients (2 patients developed restenosis after their first angioplasty). Detachment of the left pulmonary artery occurred either immediately or during follow-up in 3 patients who underwent the classical Norwood procedure. Overall, 10 pulmonary artery angioplasties were required in 7 patients. Three patients needed embolization: one of venous collaterals (using coils), one of the left superior vena cava (using an Amplatzer duct occluder), and one of a left Blalock-Taussig shunt (using an Amplatzer duct occluder). Two patients required a cavopulmonary (Glenn) anastomosis, and another underwent fibrinolysis for thrombosis of the superior vena cava and pulmonary artery. Other findings, which were not treated percutaneously, included: stenosis of the supra-aortic trunk (n=6), femoral artery stenosis (n=2), femoral vein thrombosis (n=5), and subclavian vein thrombosis (n=1). The following complications were recorded: arterial ischemia (n=2), cardiac arrest or bradycardia (n=4), and transient atrioventricular block (n=1). CONCLUSIONS: Following stage I of the Norwood procedure, the angiographic and hemodynamic assessments needed for the diagnosis and treatment of pulmonary artery or aortic arch stenosis must be carried out promptly. Although treating recoarctation by angioplasty can be effective, restenosis frequently occurs. With the Sano procedure, detachment of the left pulmonary artery, but not pulmonary artery stenosis, can be avoided. After stage II, the presence of venovenous collaterals must be ruled out, because they frequently require embolization. In these patients, interventional catheterization is associated with a higher incidence of complications than in other groups.
Subject(s)
Angioplasty , Aortic Coarctation/therapy , Cardiac Surgical Procedures/methods , Catheterization , Hypoplastic Left Heart Syndrome/surgery , Postoperative Complications/therapy , Pulmonary Artery/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Retrospective StudiesABSTRACT
Introducción y objetivos. Análisis retrospectivo de las indicaciones, los resultados y las complicaciones del cateterismo terapéutico en pacientes tras cirugía tipo Norwood. Métodos. Entre febrero de 1993 y diciembre de 2006 se realizaron 25 procedimientos intervencionistas en 14 pacientes con cirugía tipo Norwood, previo al Glenn o Fontan. Resultados. En 7 de los 14 pacientes se realizaron 9 angioplastias de recoartación (2 presentaron nuevamente reestenosis tras la primera angioplastia). En 3 pacientes con Norwood clásico se encontró inicialmente o evolutivamente desconexión de arteria pulmonar izquierda; 7 pacientes precisaron 10 angioplastias de arterias pulmonares; 3 pacientes precisaron embolizaciones: de colaterales venosas (n = 1, con coils), de vena cava superior izquierda (n = 1, con oclusor Amplatzer para ductus) y de fístula Blalock-Taussig izquierdo (n = 1, con oclusor Amplatzer para ductus). En 2 casos se realizó angioplastia del Glenn y en otro, fibrinolisis de trombosis de vena cava superior y arteria pulmonar. Otros hallazgos, sobre los que no se realizaron técnicas intervencionistas, fueron: estenosis de troncos supraaórticos (n = 6), estenosis en las arterias femorales (n = 2), trombosis venosa femoral (n = 5) o de vena subclavia (n = 1). Como complicaciones se registraron: isquemia arterial (n = 2), parada cardiaca o bradicardia (n = 4) y bloqueo auriculoventricular transitorio (n = 1). Conclusiones. Tras la cirugía tipo Norwood debe realizarse una valoración angiohemodinámica precoz para detectar y tratar estenosis de arterias pulmonares y/o del arco aórtico. Aunque la angioplastia de la recoartación puede ser efectiva, la reestenosis es frecuente. La técnica de Sano evita la desconexión de la arteria pulmonar izquierda, pero no el desarrollo de estenosis de arterias pulmonares. Tras el estadio II, debe estudiarse si hay colaterales venovenosas, pues éstas con frecuencia precisan embolización. El cateterismo terapéutico en estos pacientes comporta una incidencia de complicaciones mayor que en otros grupos de pacientes (AU)
Introduction and objectives. To carry out a retrospective analysis of the indications for, and the results and complications of interventional catheterization after the Norwood procedure. Methods. Between February 1993 and December 2006, 25 interventional catheterizations were performed in 14 patients who had undergone the Norwood procedure, prior to the Glenn or Fontan procedure. Results. Nine angioplasties were carried out for recoarctation in seven of the 14 patients (2 patients developed restenosis after their first angioplasty). Detachment of the left pulmonary artery occurred either immediately or during follow-up in 3 patients who underwent the classical Norwood procedure. Overall, 10 pulmonary artery angioplasties were required in 7 patients. Three patients needed embolization: one of venous collaterals (using coils), one of the left superior vena cava (using an Amplatzer duct occluder), and one of a left Blalock-Taussig shunt (using an Amplatzer duct occluder). Two patients required a cavopulmonary (Glenn) anastomosis, and another underwent fibrinolysis for thrombosis of the superior vena cava and pulmonary artery. Other findings, which were not treated percutaneously, included: stenosis of the supra-aortic trunk (n=6), femoral artery stenosis (n=2), femoral vein thrombosis (n=5), and subclavian vein thrombosis (n=1). The following complications were recorded: arterial ischemia (n=2), cardiac arrest or bradycardia (n=4), and transient atrioventricular block (n=1). Conclusions. Following stage I of the Norwood procedure, the angiographic and hemodynamic assessments needed for the diagnosis and treatment of pulmonary artery or aortic arch stenosis must be carried out promptly. Although treating recoarctation by angioplasty can be effective, restenosis frequently occurs. With the Sano procedure, detachment of the left pulmonary artery, but not pulmonary artery stenosis, can be avoided. After stage II, the presence of venovenous collaterals must be ruled out, because they frequently require embolization. In these patients, interventional catheterization is associated with a higher incidence of complications than in other groups (AU)
Subject(s)
Humans , Cardiac Catheterization/methods , Heart Defects, Congenital/diagnosis , Hypoplastic Left Heart Syndrome/diagnosis , Ultrasonography, Interventional/methods , Heart Defects, Congenital/surgery , Postoperative Care/methods , Retrospective Studies , Pulmonary Valve Stenosis/diagnosis , Aortic Valve Stenosis/diagnosis , Angioplasty/methods , FibrinolysisABSTRACT
A case of giant remnant of the right sinus venosus valve simulating first a pulmonary stenosis and afterward a left atrial tumor is described. We believe that this is the first reported case in which a correct diagnosis was performed before surgery.
Subject(s)
Heart Atria/surgery , Heart Neoplasms/diagnosis , Heart Valve Diseases/surgery , Pulmonary Valve Stenosis/diagnosis , Blood Flow Velocity , Cardiac Surgical Procedures , Coronary Circulation , Cyanosis/etiology , Diagnosis, Differential , Female , Heart Valve Diseases/diagnosis , Humans , Infant, Newborn , Pulmonary Valve/abnormalities , Treatment OutcomeABSTRACT
We describe a patient with a diagnosis of heterotaxia and independent drainage of the suprahepatic veins into the venous atrium who underwent total extracardiac cavopulmonary connection in which hepatic vein drainage remained directly into the atrium. In the immediate postoperative period she showed increasing cyanosis that suggested substantial right-to-left shunt. Surgical ligation of the suprahepatic veins resolved the complication effectively without signs of hepatic congestion or portal hypertension.
