ABSTRACT
Ventricular septal defect (VSD) is the most common congenital cardiac anomaly with a prevalence of 1.17 per 1000 live births. Haemodynamically significant VSDs require closure either surgical or transcatheter. We report a case of transcatheter device closure of a moderate-sized perimembranous ventricular septal defect (PmVSD), the first of its kind in Nigeria. The procedure was performed on a 23-month-old female weighing 10 kg who had presented with a history of frequent pneumonia and poor weight gain and signs of heart failure. The procedure was uncomplicated, and she was discharged 24 hours after the intervention. She had been followed-up two years post-procedure without complications and she had achieved appreciable weight gain. This non-surgical option was effective in this patient and provided the advantage of limited hospitalization, accelerated recovery, and intervention without the need for blood products. Such interventions should be scaled up in Nigeria and other sub-Saharan African countries.
Subject(s)
Cardiac Catheterization , Heart Septal Defects, Ventricular , Humans , Female , Infant , Child, Preschool , Nigeria , Cardiac Catheterization/methods , Heart Septal Defects, Ventricular/surgery , Hospitalization , Treatment Outcome , Weight GainABSTRACT
OBJECTIVE: Reconstruction of branch pulmonary arteries (PAs) can be challenging in redo congenital heart surgeries. Treatment options like percutaneous stent implantation and surgical patch angioplasty may yield suboptimal results. We present our experience with hybrid intraoperative stenting which may be an effective alternative option. METHODS: We retrospectively analyzed data of all patients with PA stenosis who underwent intraoperative PA branch stenting in our institution between January 2011 and December 2012. RESULTS: Ten patients [6 females, median age 10 (1.4 to 37) years], underwent hybrid stenting of the PA. Primary cardiac diagnoses were pulmonary atresia with ventricular septal defect (VSD) in three patients, pulmonary atresia with intact ventricular septum in two, Tetralogy of Fallot (TOF) in one, Double outlet right ventricle (DORV) with pulmonary stenosis (PS) in one, complex single ventricle in two and VSD with bilateral branch PA stenosis in one patient. Concomitant surgeries were revision/reconstruction of RV-PA conduit in 4, Fontan completion in 4, repair of TOF with conduit placement in 1 and VSD closure in 1 patient. The left PA was stented in 7, the right in 2 and both in 1, with a total of 11 stents. There were no complications related to stent implantation. Two early postoperative deaths were unrelated to stent implantation. At mean follow-up period of 14.8 (12-26) months, stent position and patency were satisfactory in all survivors. None of them needed repeat dilatation or surgical reintervention. CONCLUSION: Hybrid stenting of branch PA is a safe and effective option for PA reconstruction in redo cardiac surgeries. With meticulous planning, it can be safely performed without fluoroscopy.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Intraoperative Care/methods , Pulmonary Artery/surgery , Pulmonary Valve Stenosis/surgery , Stents , Adolescent , Adult , Cardiac Surgical Procedures/methods , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/surgery , Heart Septal Defects, Atrial/diagnostic imaging , Heart Septal Defects, Atrial/surgery , Hospital Mortality , Humans , India , Infant , Male , Patient Safety , Pulmonary Valve Stenosis/diagnostic imaging , Reoperation/methods , Retrospective Studies , Risk Assessment , Survival Rate , Tetralogy of Fallot/diagnostic imaging , Tetralogy of Fallot/surgery , Treatment Outcome , Ultrasonography , Young AdultABSTRACT
BACKGROUND: Decisions to operate on patients with shunt lesions presenting late with severe pulmonary arterial hypertension (PAH) and borderline operability are often not based on precise cut off values of haemodynamic data owing to paucity of studies. OBJECTIVE: To assess the reliability of the preoperative haemodynamic data and reactivity test in predicting the postoperative reversibility of PAH in patients with isolated large ventricular septal defects (VSDs) and borderline operability. PATIENTS AND METHOD: Between 2004 and 2010, 30 patients underwent VSD closure surgically; no early deaths occurred. Twenty-six patients were followed up regularly (mean 39.6±16â months) and one late postoperative death occurred. Fourteen patients who had been followed up for at least 1â year postoperatively underwent cardiac catheterisation. RESULTS: There were 3 responders (asymptomatic patients with pulmonary vascular resistance (PVR) index <3â WU.m(2)) and 12 non-responders. The following were lower among responders: mean age at surgery (3.2±0.42 vs 11.55±3.29â years, p=0.227), mean baseline PVR index (3.69±0.8 vs 10.57±9.1, p=0.204), average resistance ratio (RR=0.25±0.01 vs 0.59±0.25, p=0.049) and ratio of pulmonary and systemic mean pressures (PAm:SAm ratio) (0.70±0.009 vs 0.87±0.118, p=0.003). CONCLUSIONS: Preoperative 'base line' PAm:SAm and RR appear to be better predictors of postoperative outcome than other baseline parameters. Preoperative reactivity test had no significant role in predicting postoperative reversibility of PAH at mid-term.
