RESUMO
OBJECTIVES: The 18- and 16-mm conduits in extracardiac total cavopulmonary connection (eTCPC) were reported to be optimal based on energy loss and flow stagnation at the relatively early phase. However, because the artificial conduit lacks growth potential, we have recently encountered some cases in which the conduit needs to be changed several years after eTCPC. These cases prompted us to reconsider the surgical strategy for eTCPC. METHODS: We reviewed our 20-year single-centre experience with eTCPC patients (n = 256) to compare the 18-mm conduit (n = 195) and 16-mm conduit (n = 61) in terms of mortality and morbidity. RESULTS: The 16-mm conduit was used significantly more frequently in patients whose main chamber was right ventricle (P < 0.001). There was also a significant difference in preoperative inferior vena cava pressure (P = 0.008). There was a significant difference in the actuarial rate of freedom from late-occurring complications, including mortality, between the 2 groups (P = 0.003). There was a significant difference in the actuarial rate of reoperation-free survival (P = 0.042); however, there was no significant difference in resurgical intervention for the conduit (P = 0.333). In multivariate analysis, preoperative inferior vena cava pressure was an independent predictor for late-occurring complications (hazard ratio 1.19; P = 0.026). Conduit size (18 or 16 mm) itself was not an independent predictive factor for late-occurring complications (P = 0.690). CONCLUSIONS: The mid-term clinical outcomes in patients who underwent eTCPC were excellent with low mortality. Preoperative inferior vena cava pressure was the only predictive risk factor for postoperative morbidity, and the 16 mm conduit was not predictive thereof.
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OBJECTIVES: In children, it is difficult to control mitral valve (MV) or tricuspid valve (TV) regurgitation with conventional procedures alone because complex factors hamper easy improvement of valve coaptation. We investigated interannular bridging in children with MV/TV regurgitation. METHODS: The subjects were 9 patients who underwent interannular bridging to control TV or MV regurgitation between January 2014 and December 2021. We analysed reintervention for the valve, progression of stenosis/regurgitation and valve growth. RESULTS: The TV and MV groups included 4 and 5 patients, respectively. At operation, the median age was 5.8 (1.4-14) years in TV and 3.6 (0.3-7.0) years in MV. The median weight was 13.0 (8.4-41.2) kg in TV and 11.0 (4.8-18.3) kg in MV. The median follow-up periods were 78 (11-94) months for TV and 30 (4-34) months for MV. None of the patients in either group underwent reintervention. Moderate or greater regurgitation recurred in 1 TV patient but subsequently improved to mild regurgitation. Valve stenosis (mean diastolic pressure gradient >10 mmHg) was not detected. The median valve diameter (Z-score) ranged from -1.17 (-3.7 to 0.85) at discharge to -0.59 (-1.2 to 2.01) at the latest follow-up in TV patients. In MV patients, valve diameter changed from 1.14 (-1.68 to 1.46) to 0.72 (-0.23 to 1.36). After bridging, the coaptation height was maintained at the same value over time. CONCLUSIONS: Interannular bridging could be a useful approach for complicated TV/MV regurgitation in children.
RESUMO
The primum atrial septal defect suture line adjacent to the crux is performed carefully with various techniques to avoid atrioventricular block in repair of complete atrioventricular septal defect. We describe our technical modification to simplify the shallow suture line only into the endocardium above the atrioventricular node without conduction disturbance.
Assuntos
Comunicação Interatrial , Comunicação Interventricular , Defeitos dos Septos Cardíacos , Humanos , Nó Atrioventricular , Comunicação Interventricular/cirurgia , Técnicas de Fechamento de Ferimentos , Suturas , Comunicação Interatrial/cirurgiaRESUMO
OBJECTIVES: Cardiac malformations are a major component of heterotaxy syndrome that results in significant mortality and morbidity, especially in patients with a single ventricle and right isomerism (RI). The goal of this study was to evaluate the mortality after cardiovascular surgery in patients with a functional single ventricle and RI over a long follow-up period (â¼40 years) and to determine the predicted risk factors for mortality. METHODS: We performed a retrospective review of the medical records of 129 consecutive patients with functional single ventricle and RI who underwent pulmonary flow control operations at Mt. Fuji Shizuoka Children's Hospital between 1979 and 2020. To evaluate mortality rates, the patients were divided into 2 groups (era 1: 1979-1999 and era 2: 2000-2020) based on the date of the first-stage palliation. RESULTS: The estimated survival rate at 10 years was 36.4% in era 1 and 57.8% in era 2. The estimated survival rate improved significantly (P = 0.0268) between the 2 eras. The rate of Fontan procedure completion was also significantly better in the current era (P = 0.0392; 22/59 in era 1 and 38/66 in era 2). In the multivariable analysis, the date of the first-stage palliation was the only predictor of mortality. CONCLUSIONS: The mortality rate after cardiovascular surgery in patients with a functional single ventricle and RI has improved over the past 20 years; however, it still remains high. This improvement may be attributed to our current surgical strategy and clinical management; however, further investigations are needed to prove this observation.
Assuntos
Técnica de Fontan , Cardiopatias Congênitas , Síndrome de Heterotaxia , Coração Univentricular , Criança , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/anormalidades , Ventrículos do Coração/cirurgia , Síndrome de Heterotaxia/cirurgia , Humanos , Lactente , Isomerismo , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
A boy was diagnosed with a unicuspid aortic valve with severe stenosis at birth. Percutaneous balloon aortic valvuloplasty was performed four times; however, he had severe heart and growth failure. Thus, aortic valve repair was performed at age 2 years and 6 months. He weighed 6.6 kg. The aortic valve annulus diameter was 9.8 mm (z value = 0.43). We report on a small toddler with congenital aortic stenosis who was successfully treated with autologous pericardial aortic valve leaflet reconstruction using the open-sleeve technique.
Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Procedimentos Cirúrgicos Cardíacos , Doenças das Valvas Cardíacas , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Pré-Escolar , Doenças das Valvas Cardíacas/cirurgia , Humanos , Recém-Nascido , Masculino , Resultado do TratamentoRESUMO
OBJECTIVE: Patients with unbalanced pulmonary artery growth resulting from pulmonary coarctation are considered unsuitable candidates for the Fontan procedure. Particularly, patients with right isomerism pose a challenge. We aimed to investigate the use of primary central pulmonary artery plasty at initial palliation in patients with right isomerism. METHODS: We recruited 34 right isomerism patients with pulmonary atresia and pulmonary coarctation who underwent modified Blalock-Taussig shunt with or without primary central pulmonary artery plasty between 1998 and 2014. We classified them into the primary central pulmonary artery plasty (group P) and no primary central pulmonary artery plasty (group N) groups. We retrospectively analyzed reintervention for pulmonary artery after initial palliation, difference in size between the left and right pulmonary arteries, overall survival, success of the Fontan procedure. RESULTS: The group P and group N included 25 and 9 patients, respectively. Five (20%) and six (67%) patients in group P and group N, respectively, required reintervention for pulmonary artery after initial palliation (p = 0.017). No patient underwent reintervention for the pulmonary artery before bidirectional cavopulmonary shunt in group P. There was a significant difference in the bilateral pulmonary artery size balance between the groups before bidirectional cavopulmonary shunt (p = 0.041). The two-lung Fontan procedure was successful in 14 (56%) and 1 (11%) patient in group P and group N. CONCLUSION: Primary central pulmonary artery plasty may contribute toward improving the balance in the size of the PA and preclude the need for reintervention for PA.
Assuntos
Coartação Aórtica , Técnica de Fontan , Síndrome de Heterotaxia , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Técnica de Fontan/efeitos adversos , Técnica de Fontan/métodos , Síndrome de Heterotaxia/cirurgia , Humanos , Lactente , Pulmão/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: To reveal the mid-term outcomes of Contegra implantation for the reconstruction of the right ventricular outflow tract to proximal branch pulmonary arteries in a multicentre study. METHODS: Between April 2013 and December 2019, 178 Contegra conduits were implanted at 5 Japanese institutes. The median age and body weight at operation were 16 months (25th-75th percentile: 8-32) and 8.3 kg (6.4-10.6). Sixteen patients were neonates (9.0%). Selected conduit sizes were 12 mm in 28 patients (15.7%), 14 mm in 67 patients (37.6%), 16 mm in 66 patients (37.1%), 18 mm in 5 patients (2.8%) and <12 mm in 12 patients (6.7%). Fifty-six grafts (31.4%) were ring supported. Proximal branch pulmonary arteries were concomitantly augmented in 85 patients (47.5%). Follow-up was completed in all patients and the median follow-up period was 3.1 years (1.3-5.1). RESULTS: The overall, conduit explantation-free and conduit infection-free survival rates at 5 years were 91.3%, 71.0% and 83.7%, respectively. Infection (P = 0.009) and common arterial trunk (P = 0.024) were risk factors for explantation. Conduit durability was shorter in smaller one (P < 0.001). Catheter interventions (for conduit to proximal branch pulmonary artery)-free survival rates at 5 years was 52.9%; however, need for catheter interventions was not a risk factor for conduit explantation. CONCLUSIONS: Mid-term outcomes of reconstruction of the right ventricular outflow tract to the proximal branch pulmonary arteries with Contegra were acceptable. The need for explantation over time was higher in smaller conduits. Conduit infection was a strong risk factor for conduit explantation. Frequently and repeated catheter interventions effectively extended the conduit durability.
Assuntos
Bioprótese , Cardiopatias Congênitas , Obstrução do Fluxo Ventricular Externo , Humanos , Lactente , Recém-Nascido , Japão , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/cirurgiaRESUMO
Staphylococcus lugdunensis infective endocarditis (IE) is very rare in children. A female neonote presented with fever on the 29th postoperative day after undergoing a modified Norwood procedure (right ventricular-pulmonary artery [RV-PA] conduit). Blood cultures were positive for S. lugdunensis. Echocardiography did not demonstrate vegetation. Therefore, we made a diagnosis of catheter-related bacteremia instead of IE. Cultures were negative 3 days after treatment initiation with intravenous vancomycin. One month after discharge, she developed acute hypoxia and could not be revived because of obstruction of RV-PA conduit with large vegetation. Even in S. lugdunensis bacteremia without IE, surgical treatment should be considered early.
Assuntos
Bacteriemia , Embolia , Endocardite Bacteriana , Infecções Estafilocócicas , Staphylococcus lugdunensis , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Criança , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológicoRESUMO
BACKGROUND: Currently, the extracardiac conduit total cavopulmonary connection (eTCPC) is the most widely used for Fontan modification worldwide. Nevertheless, there have been some cases that are difficult for performing eTCPC because of their anatomical complexity, such as apicocaval juxtaposition. For such cases, in 2002, we introduced the intra-extracardiac TCPC (ieTCPC). METHODS: We reviewed our 20-year single-center experience with 316 TCPC patients to compare eTCPC (n = 277) and ieTCPC (n = 39) in terms of mortality and morbidity. ieTCPC was indicated for the cases in which there was concern that the TCPC conduit would be too curved for ordinary eTCPC. RESULTS: Early death occurred in 1 patient and late death occurred in 15 patients. The actuarial survival rate in the eTCPC and the ieTCPC groups at 10 years were 95.1% and 100.0%, respectively. There was no significant difference in actuarial survival between eTCPC and ieTCPC patients. In the multivariate analysis, preoperative superior vena cava pressure and preoperative oxygen saturation were found to be the independent predictor for postoperative mortality. There was also no significant difference in actuarial rate of freedom from late-occurring complications between eTCPC and ieTCPC groups. In the multivariate analysis, dominant right ventricle and preoperative SVC pressure were independent predictors for late-occurring complications. CONCLUSIONS: The clinical outcomes in patients who undergo eTCPC and ieTCPC appear to be excellent, with low mortality and morbidity rates in the midterm. ieTCPC may be a good option for TCPC cases with anatomical complexity such as apicocaval juxtaposition and separated hepatic vein drainage.
Assuntos
Técnica de Fontan/métodos , Cardiopatias Congênitas/cirurgia , Artéria Pulmonar/cirurgia , Veia Cava Inferior/cirurgia , Veia Cava Superior/cirurgia , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A male infant with Kabuki syndrome had trivial congenital mitral regurgitation diagnosed at birth. At the age of 2 years and 9 months, the regurgitation worsened from mild to severe; thus, expedited surgical treatment was pursued. The primary operative finding was severe dysplastic two-leaflet disease. After completing chordal replacement as a conventional repair procedure, more-than-moderate central regurgitation caused by establishing a shallow coaptation between the anterior and posterior leaflets persisted. We report a successful case of mitral valve repair involving the novel option of interannular bridge for valvuloplasty to address congenital mitral regurgitation.
Assuntos
Face/anormalidades , Doenças Hematológicas/complicações , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/congênito , Insuficiência da Valva Mitral/cirurgia , Doenças Vestibulares/complicações , Anormalidades Múltiplas , Pré-Escolar , Humanos , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagemAssuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Anuloplastia da Valva Cardíaca/métodos , Cardiopatias Congênitas/cirurgia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/etiologia , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Recém-Nascido , MasculinoRESUMO
OBJECTIVES: Patients with unbalanced pulmonary artery (PA) growth and decreased unilateral pulmonary circulation are considered unsuitable candidates for the Fontan procedure. Following our previous study on the utility of intrapulmonary-artery septation for patients with PA hypoplasia, we investigated its use in patients with pulmonary venous obstruction (PVO). METHODS: We recruited 42 patients who underwent intrapulmonary-artery septation for unilateral PA hypoplasia and/or PVO between 1998 and 2018 and classified them into no PVO or PVO group. We analysed overall survival, success of the Fontan procedure and data from catheterization and echocardiography. In PVO, we evaluated the functional lung area before the Fontan procedure and the relevance of this parameter to operative outcomes. RESULTS: The PVO and no-PVO group included 24 and 18 patients, respectively. One patient in the no-PVO and 6 patients in the PVO group died during follow-up; this difference was statistically significant (log-rank P = 0.040). In the no-PVO group, 15 (83%) patients achieved two-lung Fontan circulation. In the PVO group, 12 (50%) patients achieved two-lung Fontan circulation. Multivariate analysis revealed that functional lung area and shunt size [significantly larger in patients with functional lung area ≥50% in affected lung (P = 0.040)] were significant factors for successful two-lung Fontan procedure (P = 0.030). CONCLUSIONS: Intrapulmonary-artery septation may contribute to increase functional lung area after PVO release to establish two-lung Fontan circulation in patients with PVO who have unbalanced PA growth and/or decreased unilateral pulmonary circulation.
Assuntos
Técnica de Fontan , Cardiopatias Congênitas , Veias Pulmonares , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Pulmão , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Circulação Pulmonar , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgiaRESUMO
A boy with 22q11.2 deletion was diagnosed with pulmonary atresia with ventricular septal defect (PAVSD) and major aortopulmonary collateral arteries (MAPCAs). At 8 months, unifocalization of left MAPCAs and BT shunt was performed at another hospital. However, they occluded directly after surgery. An angiography revealed 2 MAPCAs supplying all segments of the right lung. Qp:Qs was 2.24. At 1 year 6 months, we performed VSD closure with unifocalization of the only right lung vascularity, using intraoperative PA flow study. We report a successful case of complete repair with unilateral lung in PAVSD and MAPCAs.
Assuntos
Aorta/cirurgia , Defeitos dos Septos Cardíacos/cirurgia , Pulmão/irrigação sanguínea , Artéria Pulmonar/cirurgia , Atresia Pulmonar/cirurgia , Aorta/anormalidades , Procedimento de Blalock-Taussig , Circulação Colateral , Síndrome de DiGeorge/complicações , Defeitos dos Septos Cardíacos/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Artéria Pulmonar/anormalidades , Atresia Pulmonar/complicaçõesRESUMO
BACKGROUND: As for the medical management including surgery for the patients with adult congenital heart disease(ACHD), it may be difficult for most hospitals other than that have both adult/congenital cardiologists/cardiovascular surgeons. Between Shizuoka Prefectural General Hospital and Mt. Fuji Shizuoka Children's Hospital, medical stuff and information have been shared for these 4 years. And joint cardiovascular surgeries have started since 2015 autumn at Shizuoka Prefectural General Hospital. PURPOSE: The contents and the results of these joint operations were evaluated. PATIENTS AND METHODS: Thirteen joint operations were performed and median age at operation was 55 years old( male 3, female 10). The original diagnosis was tetralogy of Fallot/pulmonary atresia with ventricular septal defect 6, ventricular septal defect( VSD)±pulmonary stenosis 4, atrioventicular septal defect/two chamber right ventricle/Ebstein's anomaly 1 ( each). The procedures were pulmonary valve replacement/right ventricle out flow tract reconstruction 7, mitral valve plasty/tricuspid annuloplasty 4, Bentall 2, VSD closure 2 etc.(included multiple choices). RESULTS: There was no early mortality. One late mortality was occurred 17 months after the surgery due to acute myeloid leukemia. General conditions in other patients have been feasible and most of them were followed in Shizuoka Prefectural General Hospital. CONCLUSIONS: The results of the joint operations were feasible in the present study. Our joint project may become more important in the future.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Anomalia de Ebstein , Cardiopatias Congênitas , Comunicação Interventricular , Feminino , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 2-year-old boy underwent repeat right ventricular outflow tract reconstruction (re-RVOTR) with a bovine jugular vein (BJV) graft. He presented with high fever on postoperative day 6. Blood and drainage effusion cultures were all positive for Staphylococcus lugdunensis and vancomycin was prescribed. Echocardiography showed vegetation at the BJV. Re-re-RVOTR was performed 51 days after re-RVOTR. In the operation, vegetation was adhered to the right-sided leaflet and three leaflets were degenerated. After complete BJV graft resection, an expanded polytetrafluoroethylene conduit with trileaflets was implanted. There was no sign of recurrent infection 8 months after the surgery.
Assuntos
Endocardite Bacteriana/cirurgia , Veias Jugulares/transplante , Procedimentos de Cirurgia Plástica/efeitos adversos , Staphylococcus lugdunensis/isolamento & purificação , Obstrução do Fluxo Ventricular Externo/cirurgia , Animais , Bioprótese , Procedimentos Cirúrgicos Cardíacos/métodos , Bovinos , Pré-Escolar , Ecocardiografia/métodos , Endocardite Bacteriana/diagnóstico por imagem , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Prognóstico , Procedimentos de Cirurgia Plástica/métodos , Reoperação/métodos , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/cirurgia , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagemRESUMO
An infant boy with 21 trisomy was diagnosed with complete atrioventricular septal defect-Rastelli type A with parachute left atrioventricular valve and absent left mural leaflet. Biventricular repair was difficult in infancy because the left ventricular volume and left atrioventricular valve annulus were too small. After 2 pulmonary artery bandings, the left atrioventricular valve annulus increased to 85% of normal mitral valve, and the left ventricular end-diastolic volume increased to 98% of normal. We report a successful instance of complete atrioventricular septal defect that achieved biventricular repair via novel left atrioventricular valvuloplasty for parachute left atrioventricular valve and absent left mural leaflet.
Assuntos
Valvuloplastia com Balão/métodos , Síndrome de Down/diagnóstico , Ecocardiografia Transesofagiana/métodos , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Defeitos dos Septos Cardíacos/cirurgia , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Síndrome de Down/complicações , Ecocardiografia/métodos , Seguimentos , Humanos , Recém-Nascido , Masculino , Valva Mitral/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Recuperação de Função Fisiológica/fisiologia , Resultado do TratamentoRESUMO
We describe a patient with reexpanded pulmonary edema after atrial septal defect closure through a right-sided minithoracotomy. After reexpansion of the right lung after weaning from cardiopulmonary bypass, a large amount of serous slight-hemorrhagic bronchial secretions spilled out from the right bronchus. Positive pressure ventilation and differential ventilation were used. We found no bleeding and decreased secretions 24 hours after the onset of reexpanded pulmonary edema. The patient was extubated 42 hours after the operation. To the best of our knowledge, this is the first case report of the development of reexpansion pulmonary edema during a routine minimally invasive operation for atrial septal defect.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Comunicação Interatrial/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Edema Pulmonar/diagnóstico por imagem , Toracotomia/efeitos adversos , Adolescente , Gasometria , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Feminino , Seguimentos , Comunicação Interatrial/diagnóstico por imagem , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Respiração com Pressão Positiva/métodos , Edema Pulmonar/fisiopatologia , Edema Pulmonar/terapia , Radiografia Torácica/métodos , Recidiva , Medição de Risco , Toracotomia/métodos , Resultado do TratamentoRESUMO
We present a case of a 44-year-old woman, with pseudoaneurysm formation at the middle of the prosthetic graft, 60 mm in diameter. She had been diagnosed with atypical coarctation due to aortitis 27 years before, and had undergone a bypass operation with 14 mm-diameter Cooley double velour graft from the ascending aorta to the abdominal aorta. This time, endovascular aortic repair was performed to prevent rupture of the pseudoaneurysm. Though a knitted Dacron graft has a risk of psuedaneurysm formation long patency could be obtained when used in ascending aorta-abdominal aorta bypass.
Assuntos
Falso Aneurisma/cirurgia , Aorta Abdominal/cirurgia , Aorta/cirurgia , Aortite/complicações , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Feminino , Humanos , Imageamento Tridimensional , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The short-term outcome of physiologic repair for congenitally corrected transposition of the great arteries (ccTGA) is generally considered favorable; however, the long-term outcome is the greatest problem, especially with regard to right ventricular (RV) function and tricuspid regurgitation (TR). Although tricuspid valve replacement (TVR) appears to be a realistic choice for treating severe TR, determining the timing of TVR may be difficult. METHODS: We carried out a retrospective analysis of the long-term outcomes of physiologic repair for ccTGA focusing on patients with TVR. The study involved 23 patients after physiologic repair 10 or more years prior. There were 9 TVR cases in 5 pediatric patients (before age 18) and 4 adult patients. RESULTS: There were two late deaths; however, there was no case related with cardiac events. Overall survival at 10 and 20 years were 95.5 and 90.2 %, respectively, and 7 of 8 patients after TVR were NYHA class I or II. No patient has presented postoperative complications in the form of bleeding or embolism after TVR with mechanical valve. CONCLUSIONS: An analysis of the results of physiologic repair for ccTGA showed that the long-term outcome was overall favorable. To maintain RV function, early TVR may be a reasonable option, even in the management of patients during childhood.