ABSTRACT
BACKGROUND: Preoperative risk analysis for Fontan candidates is still less than optimal in that patients with apparently low risks may have poor surgical outcome; prolonged pleural drainage, protein losing enteropathy, pulmonary thromboembolism and death. We hypothesized that low pulmonary vascular compliance (PVC) is a risk factor for prolonged pleural effusion drainage after the Fontan operation. MATERIAL AND METHOD: A retrospective review of 96 consecutive patients who underwent the Extracardiac Fontan procedures (median age: 3.9 years) was performed. Fontan risk score (FRS) was calculated from 12 categorized preoperative anatomic and physiologic variables. PVC (mm(2)/m(2) . mmHg) was defined as pulmonary artery index (mm(2)/m(2)) divided by total pulmonary resistance (W.U . m(2)) and pulmonary blood flow (L/min/m(2)), based on the electrical circuit analogue of the pulmonary circulation. Chest tube indwelling time was log-transformed (log indwelling time, LIT) to fit normal distribution, and the relationship between preoperative predictors and LIT was analyzed by multiple linear regression. RESULT: Preoperative PVC, chest tube indwelling time and LIT ranged from 6 to 94.8 mm(2)/mmHg/m(2) (median: 24.8), 3 to 268 days (median: 20 days), and 1.1 to 5.6 (mean: 2.9, standard deviation: 0.8), respectively. FRS, PVC, cardiopulmonary bypass time (CPB) and central venous pressure at postoperative 12 hours were correlated with LIT by univariable analyses. By multiple linear regression, PVC (p=0.0018) and CPB (p=0.0024) independently predicted LIT, explaining 21.7% of the variation. The regression equation was LIT=2.74-0.0158 . PVC+0.00658 . CPB. CONCLUSION: Low pulmonary vascular compliance is an important risk factor for prolonged pleural effusion drainage after the extracardiac Fontan procedure.
Subject(s)
Humans , Cardiopulmonary Bypass , Central Venous Pressure , Chest Tubes , Compliance , Drainage , Fontan Procedure , Linear Models , Pleural Effusion , Protein-Losing Enteropathies , Pulmonary Artery , Pulmonary Circulation , Pulmonary Embolism , Retrospective Studies , Risk FactorsABSTRACT
Hybrid procedure was performed for a thirteen-day-old girl with a functionally single ventricle, who weighed 2.2 kg and had been prematurely born at 32(+5) weeks of gestation. She underwent bilateral pulmonary artery banding using 3.5 mm Gore-Tex graft, ductal stenting using balloon expandable stent, and reverse Blalock-Taussig shunt with 3.5 mm Gore-Tex vascular graft. After discharge, she was followed up for 4 months, and underwent 2nd stage operation (extensive arch reconstruction with Damus-Kaye-Stansel anastomosis, atrial septectomy, bilateral pulmonary artery angioplasty, bidirectional cavopulmonary shunt). She has been followed up for 4 months after the 2nd operation with an excellent clinical condition.
Subject(s)
Female , Humans , Pregnancy , Angioplasty , Polytetrafluoroethylene , Pulmonary Artery , Stents , TransplantsABSTRACT
Cardiac myxoma is the most common primary tumor of the heart, but right ventricular myxoma causing outflow obstruction is relatively rare. A 15 years old girl developed dyspnea on exertion and intermittent syncope caused by a right ventricular mass obstructing the right ventricle outflow tract. Transthoracic echocardiography revealed 3.6 x 3.0 cm sized pedunculated subpumonic mass originating from the right ventricular anterior free wall. The patient underwent an emergency operation, consisting of the removal of the mass by wide excision of the tumor base and PTFE (polytetrafluoroethylene) patching of the right ventricular anterior free wall defect. Pathological findings of the mass were compatible with myxoma, and the patient was discharged uneventfully 7 days after the operation.
Subject(s)
Adolescent , Female , Humans , Dyspnea , Echocardiography , Emergencies , Heart , Heart Neoplasms , Heart Ventricles , Myxoma , Polytetrafluoroethylene , Syncope , Ventricular Outflow ObstructionABSTRACT
Cardiac myxoma is the most common primary tumor of the heart, but right ventricular myxoma causing outflow obstruction is relatively rare. A 15 years old girl developed dyspnea on exertion and intermittent syncope caused by a right ventricular mass obstructing the right ventricle outflow tract. Transthoracic echocardiography revealed 3.6 x 3.0 cm sized pedunculated subpumonic mass originating from the right ventricular anterior free wall. The patient underwent an emergency operation, consisting of the removal of the mass by wide excision of the tumor base and PTFE (polytetrafluoroethylene) patching of the right ventricular anterior free wall defect. Pathological findings of the mass were compatible with myxoma, and the patient was discharged uneventfully 7 days after the operation.
Subject(s)
Adolescent , Female , Humans , Dyspnea , Echocardiography , Emergencies , Heart , Heart Neoplasms , Heart Ventricles , Myxoma , Polytetrafluoroethylene , Syncope , Ventricular Outflow ObstructionABSTRACT
Abdominal tumors that can grow through vascular lumen and spread to the right heart are rare. Intravenous leiomyomatosis is a rare tumor that originates from the uterus and spreads through the vessels. Although histologically benign, tumor extension with mechanical obstruction of the inferior vena cava, right cardiac cavities, or even the pulmonary artery, may occasionally result in fatal outcome. The best treatment is complete surgical resection of the entire tumor using cardiopulmonary bypass and total circulation arrest. We report a case of intravenous leiomyomatosis of the uterus that showed intravascular growth up to the right atrium. The patient underwent successful resection of the tumor by one-stage cardiotomy with laparotomy.
