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1.
J Cardiothorac Surg ; 19(1): 329, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38867224

RESUMO

Iatrogenic aortic regurgitation secondary to leaflet injury is a rare complication of mitral valve surgery. For the first time, we report a patient who had progressive aortic regurgitation due to non-coronary leaflet perforation after robotic mitral valve repair and required aortic valve repair 18 months after this initial surgery. As in our case, aortic regurgitation after mitral valve surgery may remain undiagnosed on intraoperative transesophageal echocardiography or undetected until the patient's discharge due to gradual enlargement of very small perforations over the postoperative course.


Assuntos
Insuficiência da Valva Aórtica , Ecocardiografia Transesofagiana , Doença Iatrogênica , Insuficiência da Valva Mitral , Valva Mitral , Procedimentos Cirúrgicos Robóticos , Humanos , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Feminino
3.
Chest ; 159(6): e371-e375, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34099152

RESUMO

CASE PRESENTATION: A 19-year-old pregnant woman at week 32 of gestation was referred to our clinic with progressive shortness of breath for the further evaluation and treatment of high-risk pregnancy. Her complaints had been existing since her childhood. Two years prior to her admission, she had been diagnosed with heart failure with preserved ejection fraction due to cardiomyopathy and associated pulmonary hypertension. The patient had no family history of any cardiac disease. She had never smoked or drunk alcohol. Her clinical condition had deteriorated progressively with the pregnancy.


Assuntos
Artéria Coronária Esquerda Anormal , Cardiomiopatias , Procedimentos Cirúrgicos Cardiovasculares/métodos , Insuficiência Cardíaca , Hipertensão Pulmonar , Cuidado Pós-Natal/métodos , Complicações Cardiovasculares na Gravidez , Adulto , Artéria Coronária Esquerda Anormal/complicações , Artéria Coronária Esquerda Anormal/diagnóstico por imagem , Artéria Coronária Esquerda Anormal/fisiopatologia , Artéria Coronária Esquerda Anormal/cirurgia , Cateterismo Cardíaco/métodos , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Cesárea/métodos , Angiografia por Tomografia Computadorizada/métodos , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia/métodos , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/terapia , Gravidez de Alto Risco , Volume Sistólico , Resultado do Tratamento
4.
J Vasc Surg Cases Innov Tech ; 7(2): 335-338, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34041423

RESUMO

Fibrosing mediastinitis can lead to superior vena cava obstruction by generating a fibroinflammatory mass in the mediastinum. Surgical caval reconstruction with conduits could be indicated for cases of unsuccessful or technically unfeasible endovascular stenting and angioplasty. The use of cryopreserved vascular homografts seems to be better than prosthetic conduits for mid- and long-term patency, as was observed in the case we have described in the present report.

5.
Pediatr Transplant ; 24(3): e13698, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32189417

RESUMO

Bradyarrhythmias are a common complication following pediatric OHT and may require permanent pacemaker implantation (PPM). The purpose of this study was to investigate the incidence, predictors, and outcomes of children undergoing PPM implantation following OHT. A PRISMA-compliant systematic literature review was performed using the PubMed database and the Cochrane Library (end-of-search date: January 27, 2019). The Newcastle-Ottawa scale and the Joanna Briggs Institute tool were used to assess the quality of cohort studies and case reports, respectively. We analyzed data from a total of 11 studies recruiting 7198 pediatric patients who underwent heart transplant. PPM implantation was performed in 1.9% (n = 137/7,198; 95% CI: 1.6-2.2) of the patients. Most patients underwent dual-chamber pacing (46%, 95% CI: 32.6-59.7). Male-to-female ratio was 1.3:1. Mean patient age at the time of OHT was 10.1 ± 6.3. Overall, biatrial anastomosis was used in 62.2% (95% CI: 52.8-70.6) of the patients. The bicaval technique was performed in the remaining 37.8% (95% CI: 29.4-47.1). Sinus node dysfunction was the most frequent indication for PPM implantation (54.4%; 95% CI: 42.6-65.7) followed by AV block (45.6%; 95% CI: 34.3-57.3). The median time interval between OHT and PPM implantation ranged from 17 days to 12.5 years. All-cause mortality was 27.9% (95% CI: 18.6-39.6) during a median follow-up of 5 years. PPM implantation is rarely required after pediatric OHT. The most common indication for pacing is sinus node dysfunction, and patients undergoing biatrial anastomosis may be more likely to require PPM.


Assuntos
Bradicardia/terapia , Transplante de Coração , Marca-Passo Artificial , Complicações Pós-Operatórias/terapia , Adolescente , Bradicardia/epidemiologia , Bradicardia/etiologia , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Recém-Nascido , Complicações Pós-Operatórias/epidemiologia
7.
Ann Thorac Surg ; 109(3): e219-e221, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31589855

RESUMO

Repeat cardiac operations are common among patients with complex congenital heart disease. Inadvertent cardiotomy during redo sternotomy can increase intraoperative time and mortality. Establishing extracorporeal circulation before resternotomy may render redo congenital cardiac surgery cases safer and more expeditious. In the present report, we describe the technique of preemptive cannulation of the abdominal aorta (or right common iliac artery) and inferior vena cava. This approach may be a useful when femoral vessels are occluded owing to many catheterizations or prior cannulations. In our practice, no reentry injuries or other complications related to abdominal vessel cannulation have occurred.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/cirurgia , Esternotomia , Aorta Abdominal , Cateterismo , Pré-Escolar , Humanos , Artéria Ilíaca , Masculino , Cuidados Pré-Operatórios , Reoperação , Esternotomia/métodos , Veia Cava Inferior
8.
Pediatr Cardiol ; 40(6): 1105-1112, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31214731

RESUMO

Tetralogy of Fallot (ToF) is one of the most common cyanotic congenital heart defects. We sought to summarize all available data regarding the epidemiology and perioperative outcomes of syndromic ToF patients. A PRISMA-compliant systematic literature review of PubMed and Cochrane Library was performed. Twelve original studies were included. The incidence of syndromic ToF was 15.3% (n = 549/3597). The most prevalent genetic syndromes were 22q11.2 deletion (47.8%; 95% CI 43.4-52.2) and trisomy 21 (41.9%; 95% CI 37.7-46.3). Complete surgical repair was performed in 75.2% of the patients (n = 161/214; 95% CI 69.0-80.1) and staged repair in 24.8% (n = 53/214; 95 CI 19.4-30.9). Relief of RVOT obstruction was performed with transannular patch in 64.7% (n = 79/122; 95% CI 55.9-72.7) of the patients, pulmonary valve-sparing technique in 17.2% (n = 21/122; 95% CI 11.5-24.9), and RV-PA conduit in 18.0% (n = 22/122; 95% CI 12.1-25.9). Pleural effusions were the most common postoperative complications (n = 28/549; 5.1%; 95% CI 3.5-7.3). Reoperations were performed in 4.4% (n = 24/549; 95% CI 2.9-6.4) of the patients. All-cause mortality rate was 9.8% (n = 51/521; 95% CI 7.5-12.7). Genetic syndromes are seen in approximately 15% of ToF patients. Long-term survival exceeds 90%, suggesting that surgical management should be dictated by anatomy regardless of genetics.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Tetralogia de Fallot/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Síndrome de DiGeorge/epidemiologia , Síndrome de Down/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Valva Pulmonar/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tetralogia de Fallot/epidemiologia , Tetralogia de Fallot/etiologia , Tetralogia de Fallot/genética , Resultado do Tratamento
9.
Q J Nucl Med Mol Imaging ; 62(2): 200-208, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25319041

RESUMO

BACKGROUND: We sought to evaluate the potential role of positron emission tomography-computed tomography (PET-CT) for the detection and diagnosis of potential infections of vascular grafts using combining metabolic (i.e., radioactive fluorine-fluoro-D-deoxyglucose [18F-FDG]) PET with morphological (CT) information and investigate long-term capability. METHODS: Seventeen patients with suspected vascular-graft infection underwent thoracic-abdominal-pelvic FDG PET combined with contrast-enhanced CT using a hybrid PET-CT scanner providing co-registered PET and CT images. RESULTS: In this retrospect study, we suspected graft infection in 14 of 17 patients detected using PET-CT and increased the maximal uptake of 18F-FDG around the grafts. Other vascular localizations were not observed. All patients with positive PET-CT results underwent redo-surgery, and the infection was ultimately confirmed using microbiological testing in 12 of 14 patients. Follow-up time was median of 58 months (range 36-73 months) for all 17 patients. In these patients, there was no further evidence of graft infection found on clinical and imaging follow-up. CONCLUSIONS: This is first investigation presenting long-term follow-up, which confirmed that 18F-FDG-PET/CT is an excellent diagnostic modality for suspected vascular graft infection. 18F-FDG PET-CT exhibited a sensitivity of 100% and specificity of 71.4% for the detection of vascular-graft infection.


Assuntos
Prótese Vascular/microbiologia , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
10.
Eur Surg Res ; 58(3-4): 169-179, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28297697

RESUMO

BACKGROUND: Biodegradable atrioventricular annuloplasty rings are theoretically more infection resistant due to their intra-annular implantation technique and nonporous structures (monofilament of poly-1,4-dioxanone). The aim of this study was to investigate the infection resistance of a biodegradable annuloplasty ring (Kalangos-Bioring®) in a rat subcutaneous implantation model and to compare it with a commonly used conventional annuloplasty ring (Edwards Physio II®). METHODS: This study included 32 Wistar albino rats which were divided into 2 groups according to the implantation of sterile or infected annuloplasty rings as control and study groups. Each animal had 2 implantation pockets (made on the right and left side of the dorsal median line) where 1 cm of the biodegradable annuloplasty ring was implanted into one pocket and 1 cm of the conventional annuloplasty ring was implanted into the other pocket. The infection model was created by topical inoculation of 1 mL Staphylococcus aureus strain (2 × 107 colony-forming units/mL) into the implantation pockets before skin closure. Each group was equally divided into 4 subgroups according to different follow-up schedules. The animals were inspected for local as well as systemic infection signs, and the rings were explanted at weeks 2, 4, 9, and 14 following implantation. Implantation pockets were evaluated macroscopically as well as by histopathological examinations. Microbiological analysis of the explanted implants with surrounding tissue was done by using quantitative sonication method. RESULTS: Conventional ring-implanted pockets showed a more prominent inflammation reaction than the biodegradable ring-implanted pockets, and this characteristic was found to be accentuated with bacterial contamination. The sterile rings did not reveal any positive cultures in either group. The number of positive cultures found in conventional rings contaminated with S. aureus was greater than in the biodegradable ring group (11/16 vs. 2/16 positive cultures, respectively; p = 0.0032). The amounts of growing bacteria in the culture environment were also statistically significantly higher in the conventional ring group (7,175 ± 5,936 vs. 181 ± 130 colony-forming units/mL, respectively; p < 0.0005). CONCLUSIONS: This is the first experimental study confirming the theoretical advantage of the infection resistance of the biodegradable annuloplasty ring (Kalangos-Bioring®) when implanted in an active infectious environment. Large animal models mimicking clinical scenarios and clinical comparative studies are needed to verify our results.


Assuntos
Anuloplastia da Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Animais , Anuloplastia da Valva Cardíaca/efeitos adversos , Masculino , Teste de Materiais , Infecções Relacionadas à Prótese/etiologia , Ratos Wistar , Staphylococcus aureus
12.
Ann Vasc Surg ; 33: 230.e15-8, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26968368

RESUMO

BACKGROUND: To report the case of a rapidly growing aortic false aneurysm because of Q fever infection that was managed by embolization. CASE REPORT: An 80-year-old man was admitted to our unit for an aortic false aneurysm from a chronic Q fever infection. During his stay, the aneurysm showed rapid progression necessitating urgent treatment. The patient was unfit for surgical repair; moreover, the location of the aneurysm at the level of the superior mesenteric artery prohibited the use of an endovascular graft. He was managed by coiling of the aneurysmal cavity with multiple detachable coils after positioning of a bare aortic stent to lock the coils and prevent their migration into the aortic lumen. The false aneurysm was successfully thrombosed with no complications. The patient was then put on doxycycline and hydroxychloroquine to target Coxiella burnetii. CONCLUSIONS: Aortic false aneurysm coiling is feasible in cases where an endograft is not possible or an open repair is contraindicated. The use of a bare metal stent may help as a barrier to prevent the coils from migrating into the aneurysm and thus avoiding embolization into the systemic circulation.


Assuntos
Falso Aneurisma/terapia , Aneurisma Infectado/terapia , Aneurisma Aórtico/terapia , Coxiella burnetii/isolamento & purificação , Embolização Terapêutica , Febre Q/microbiologia , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Aneurisma Infectado/diagnóstico por imagem , Angiografia Digital , Antibacterianos/uso terapêutico , Aneurisma Aórtico/diagnóstico por imagem , Aortografia/métodos , Técnicas Bacteriológicas , Angiografia por Tomografia Computadorizada , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Febre Q/diagnóstico , Resultado do Tratamento
13.
Innovations (Phila) ; 11(1): 70-2, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26901750

RESUMO

A 65-year-old patient underwent double coronary artery bypass grafting using the left internal thoracic artery on the left anterior descending coronary artery and nitinol alloy mesh [external Saphenous Vein Support (eSVS)]-covered saphenous vein graft to the right posterior descending coronary artery. Transit-time flow measurements (TTFMs) were obtained on meshed and bare parts of the vein graft. There was no difference in TTFM parameters (flow, pulsatility index, and diastolic fraction values) obtained from the eSVS mesh-covered and the uncovered parts of the venous graft. This observation confirms that eSVS mesh does not interfere with TTFM on venous coronary bypass conduits.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Ponte de Artéria Coronária/métodos , Veia Safena/transplante , Telas Cirúrgicas , Idoso , Circulação Coronária/fisiologia , Humanos , Monitorização Intraoperatória/métodos , Veia Safena/fisiologia
14.
Surg Radiol Anat ; 38(3): 361-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26553051

RESUMO

PURPOSE: Many regions worldwide report difficulties in recruiting applicants to surgery. One strategy proposed to reverse this trend consists of early exposure of medical students to the field. Against this backdrop, the present study presents an innovative approach for anatomy teaching, integrating a surgically relevant trend: 3D printing. METHODS: Whole-body computed tomography (CT) was made of two cadavers. Twelve students performed measurements and 3D reconstructions of selected anatomical structures (Osirix, Mimics). 3D printed (3DP) models were obtained (ZPrinter 310 Plus), and the students completed the analogous measurements on these replicas. Finally, classical anatomical dissection was performed and the same parameters were measured. The differences between the values obtained by the three modalities were submitted to standard statistical analysis (Wilcoxon two-tail paired test). RESULTS: Qualitative comparison of the digital 3D reconstructions based on the students' manual CT segmentation and the anatomical reality showed excellent correlation. Quantitatively, the values measured on the CT images and the physical models created by 3D printing differed from those measured on the cadavers by less than 2 mm. Students were highly appreciative of the approach (CT, 3DP, cadaver). Their average satisfaction score was 5.8 on a 1-6 scale. CONCLUSIONS: This study shows that the approach proposed can be achieved. The results obtained also show that CT-based 3D printed models are close to the authentic anatomic reality. The program allows early and interactive exposure of medical students to a surgically relevant trend-in this case 3D printing.


Assuntos
Anatomia/educação , Impressão Tridimensional , Adulto , Idoso , Dissecação , Estudos de Viabilidade , Feminino , Humanos , Imageamento Tridimensional , Masculino , Projetos Piloto , Tomografia Computadorizada por Raios X , Imagem Corporal Total
15.
Heart Surg Forum ; 18(3): E114-5, 2015 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-26115157

RESUMO

INTRODUCTION: Anomalies of the aortic arch are frequent congenital malformations, which rarely form partial or complete vascular rings. A rare form of vascular ring is the encircling, or circumflex, aortic arch. CASE REPORT: A 19-month-old boy, with no respiratory symptoms, was referred for ventricular septal defect (VSD) repair. Cardiac magnetic resonance imaging and echocardiography confirmed the perimembranous VSD, a bicuspid aortic valve with normal function, and showed a right-sided ascending aorta, bifurcating to the left behind the esophagus and trachea above the tracheal bifurcation, with a left-sided descending aorta, a left ligamentum arteriosum and aberrant left subclavian artery, realizing a circumflex aortic arch. The child underwent successful VSD repair and ligamentum arteriosum division, with an uneventful postoperative course. CONCLUSIONS: Previous reports have described the association of circumflex aortic arch with VSD, but there is no previous report of its association with VSD and bicuspid aortic valve. Patients are usually symptomatic either preoperatively, or after VSD repair. For this reason, division of the ligamentum arteriosum, to open the vascular ring and free the trachea and esophagus from compression, should be performed in patients undergoing cardiac surgery for associated malformations.


Assuntos
Aorta Torácica/anormalidades , Valva Aórtica/anormalidades , Comunicação Interventricular/complicações , Doenças das Valvas Cardíacas/complicações , Aorta Torácica/cirurgia , Valva Aórtica/cirurgia , Doenças Assintomáticas , Doença da Válvula Aórtica Bicúspide , Procedimentos Cirúrgicos Cardíacos , Comunicação Interventricular/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Lactente , Masculino
16.
Int Wound J ; 12(5): 595-7, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24684727

RESUMO

A 56-year-old patient who underwent ascending aorta replacement postoperatively developed mediastinitis with atypical Mycoplasma hominis. We present the first successful treatment of M. hominis mediastinitis after cardiac surgery with vacuum-assisted closure (VAC)-Instill(®) therapy combined with dilute antiseptic irrigation for bacterial eradication.


Assuntos
Mediastinite/microbiologia , Infecções por Mycoplasma/terapia , Mycoplasma hominis , Tratamento de Ferimentos com Pressão Negativa , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/terapia , Doenças da Aorta/cirurgia , Humanos , Mediastinite/terapia , Pessoa de Meia-Idade , Infecções por Mycoplasma/etiologia , Infecção da Ferida Cirúrgica/microbiologia
17.
Ann Emerg Med ; 65(1): 23-6, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24530109

RESUMO

Survival after cardiac arrest depends on prompt and effective cardiopulmonary resuscitation (CPR). Resuscitative teams are more frequently using mechanical chest compression devices, as documented in physiologic and experimental data, suggesting that these devices are more effective than manual CPR. A 41-year-old male patient presented with an ST-elevation myocardial infarction with cardiac arrest. The patient was immediately resuscitated by manual chest compressions; CPR was continued with a mechanical chest compression device (LUCAS 2). The patient had experienced a 15-minute period of "low-flow" without "no-flow" episode. After a discussion with the heart team, we decided that the patient was a candidate for extracorporeal membrane oxygenation (ECMO) therapy. During the ECMO implantation, we noticed that while performing transesophageal echocardiography, chest compressions were ineffective with the machine. After the ECMO implantation, we observed myocardial damage in the right-sided heart cavities. The present case report illustrates the likelihood that the mechanical chest compression device has limitations that might contribute to inadequate CPR. Therefore, rescuers should consider the efficacy of their chest compression through a continuous hemodynamic monitoring during CPR.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Massagem Cardíaca/instrumentação , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Reanimação Cardiopulmonar/métodos , Ecocardiografia , Oxigenação por Membrana Extracorpórea , Massagem Cardíaca/métodos , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/diagnóstico por imagem , Falha de Tratamento
18.
Cardiol Young ; 25(2): 295-300, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24382023

RESUMO

INTRODUCTION: Patients with absent pulmonary valve syndrome often present early with airway compression from aneurysmal pulmonary arteries. This study reviews our experience in managing absent pulmonary valve syndrome in later presenting children, and techniques used for managing airway compression. METHODS: This study is a retrospective chart review of all patients who underwent repair of absent pulmonary valve syndrome from 2000 to 2012 at our institution. The primary endpoints were post-operative bronchoscopic and clinical evidence of persistent airway compression and need for reinterventions on the pulmonary arteries. RESULTS: A total of 19 patients were included during the study period. The mean age at repair was 4.1±3.0 years (range 10 months-11 years). In all, seven patients had pre-operative bronchoscopic evidence of airway compression, which was managed by pulmonary artery reduction plasty in four patients and Lecompte manoeuvre in three patients. There were no peri-operative deaths. In patients with pulmonary artery plasty, two had no post-operative airway compression, one patient had improved compression, and one patient had unchanged compression. In patients managed with a Lecompte manoeuvre, two patients had no or trivial airway compression and one had improved compression. There were six late reinterventions or reoperations on the pulmonary arteries - two out of four in the pulmonary artery plasty group and one out of three in the Lecompte group. CONCLUSIONS: Most late-presenting patients with absent pulmonary valve syndrome do not have airway compression. Either pulmonary artery reduction plasty or the Lecompte manoeuvre can relieve proximal airway compression, without a significantly different risk of pulmonary artery reintervention between techniques.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Aneurisma/cirurgia , Brônquios , Comunicação Interventricular/cirurgia , Doenças das Valvas Cardíacas/congênito , Artéria Pulmonar/cirurgia , Valva Pulmonar/anormalidades , Traqueia , Aneurisma/complicações , Broncoscopia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Comunicação Interventricular/complicações , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Humanos , Lactente , Masculino , Reoperação , Estudos Retrospectivos , Síndrome
20.
BMC Surg ; 14: 48, 2014 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-25087015

RESUMO

BACKGROUND: One third of patients with infective endocarditis will require operative intervention. Given the superiority of valve repair over valve replacement in many indications other than endocarditis, there has been increasing interest and an increasing number of reports of excellent results of valve repair in acute infective endocarditis. The theoretically ideal material for valve repair in this setting is non-permanent, "vanishing" material, not at risk of seeding or colonization. The goal of this contribution is to review currently available data on biodegradable materials for valve repair in infective endocarditis. DISCUSSION: Rigorous electronic and manual literature searches were conducted to identify reports of biodegradable materials for valve repair in infective endocarditis. Articles were identified in electronic database searches of Medline, Embase and the Cochrane Library, using a predetermined search strategy. 49 manuscripts were included in the review. Prosthetic materials needed for valve repair can be summarized into annuloplasty rings to remodel the mitral or tricuspid annulus, and patch materials to replace resected valvar tissue. The commercially available biodegradable annuloplasty ring has shown interesting clinical results in a single-center experience; however further data is required for validation and longer follow-up. Unmodified extra-cellular matrix patches, such as small intestinal submucosa, have had promising initial experimental and clinical results in non-infected valve repair, although in valve repair for endocarditis has been reported in only one patient, and concerns have been raised regarding their mechanical stability in an infected field. SUMMARY: These evolving biodegradable devices offer the potential for valve repair with degradable materials replaced with autologous tissue, which could further improve the results of valve repair for infective endocarditis. This is an evolving field with promising experimental or initial clinical results, however long-term outcomes are lacking and further data is necessary to validate this theoretically interesting approach to infective endocarditis.


Assuntos
Implantes Absorvíveis , Endocardite/cirurgia , Próteses e Implantes , Técnicas de Sutura/instrumentação , Suturas , Humanos , Desenho de Prótese
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