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[PMID]:28453807
[Au] Autor:Polimenakos AC; Subramanian S; ElZein C; Ilbawi MN
[Ad] Endereço:Division of Pediatric Cardiovascular Surgery, Advocate Children's Hospital, Oak Lawn, IL, USA.
[Ti] Título:Attrition in patients with single ventricle and trisomy 21: outcomes after a total cavopulmonary connection.
[So] Source:Interact Cardiovasc Thorac Surg;24(5):747-754, 2017 05 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Data are limited regarding the management of children with trisomy 21 (T21) syndrome and a functional single ventricle (FSV). We evaluated patients with T21 and a FSV who had a total cavopulmonary connection (TCPC). METHODS: From September 1999 to August 2012, 139 patients with a FSV underwent a TCPC. Sixty-five had unbalanced atrioventricular septal defect. Thirteen had T21. Three (of 13) had heterotaxy syndrome. The mean age at the Fontan operation was 27.6 ± 12.1 months. RESULTS: The initial procedure was pulmonary artery banding in 9 patients, systemic-to-pulmonary shunt in 2 and Damus-Kaye-Stansel/Norwood procedure in 2. Median follow-up was 69 months (interquartile range 25-75, 21-99). There was 1 death after a Damus-Kaye-Stansel/Norwood procedure and one interstage death after a bidirectional Glenn procedure. Nine (of 11) survivors underwent a Fontan operation. A fenestrated Fontan procedure was the predominate operation in 78%. One patient was deemed unsuitable for a Fontan operation. There was 1 takedown and 1 late death after the Fontan operation. Heterotaxy syndrome did not affect outcome ( P > 0.05). There was no statistical difference in the pre-Fontan McGoon ratio, hospital length of stay, duration of pleural drainage and Fontan-related adverse events between patients with a dominant right ventricle and those with a left ( P > 0.05). CONCLUSIONS: A TCPC in patients with T21 and an FSV is associated with reproducible, satisfactory outcomes. An assisted-Glenn procedure with pulsatile pulmonary blood flow and a fenestrated Fontan may be associated with attenuated perioperative morbidity and late attrition.
[Mh] Termos MeSH primário: Anormalidades Múltiplas
Síndrome de Down/diagnóstico
Derivação Cardíaca Direita/métodos
Cardiopatias Congênitas/cirurgia
Ventrículos do Coração/anormalidades
Complicações Pós-Operatórias/epidemiologia
[Mh] Termos MeSH secundário: Feminino
Seguimentos
Cardiopatias Congênitas/diagnóstico
Ventrículos do Coração/cirurgia
Seres Humanos
Lactente
Recém-Nascido
Masculino
Estudos Retrospectivos
Taxa de Sobrevida/tendências
Fatores de Tempo
Resultado do Tratamento
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivw413


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[PMID]:28935329
[Au] Autor:Raees MA; Mazhar D; Christensen JT; Parra DA; Killen S; Bichell DP
[Ad] Endereço:Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
[Ti] Título:Bidirectional Inferior Cavopulmonary Anastomosis: Pre-Fontan Interim Palliation.
[So] Source:Ann Thorac Surg;104(4):e329-e331, 2017 Oct.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:We report a novel method of constructing an extracardiac bidirectional inferior cavopulmonary anastomosis. Our patient was a 4-month-old girl with complex single-ventricle anatomy and a small-caliber superior vena cava. A direct anastomosis from the inferior vena cava to the main pulmonary artery was constructed by using all autologous tissue. The resulting pathway remained patent and exhibited growth with age. Furthermore, a pulmonary arteriovenous malformation did not develop. This case demonstrates how a bidirectional inferior cavopulmonary anastomosis is feasible in the human and can provide similar hemodynamic results as the bidirectional superior cavopulmonary anastomosis.
[Mh] Termos MeSH primário: Dupla Via de Saída do Ventrículo Direito/cirurgia
Técnica de Fontan/métodos
Derivação Cardíaca Direita/métodos
Artéria Pulmonar/cirurgia
Transposição dos Grandes Vasos/cirurgia
Veia Cava Superior/cirurgia
[Mh] Termos MeSH secundário: Cateterismo Cardíaco/métodos
Dupla Via de Saída do Ventrículo Direito/diagnóstico por imagem
Feminino
Seguimentos
Seres Humanos
Imagem Tridimensional/métodos
Lactente
Cuidados Paliativos/métodos
Segurança do Paciente
Artéria Pulmonar/anormalidades
Medição de Risco
Transposição dos Grandes Vasos/diagnóstico por imagem
Resultado do Tratamento
Veia Cava Superior/anormalidades
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE


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[PMID]:28774381
[Au] Autor:Ratnayaka K; Moore JW; Rios R; Lederman RJ; Hegde SR; El-Said HG
[Ad] Endereço:Division of Cardiology, Rady Children's Hospital, Department of Pediatrics, University of California San Diego, San Diego, California; Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland. Electronic address: kratnayaka@r
[Ti] Título:First-in-Human Closed-Chest Transcatheter Superior Cavopulmonary Anastomosis.
[So] Source:J Am Coll Cardiol;70(6):745-752, 2017 Aug 08.
[Is] ISSN:1558-3597
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In the care of patients with congenital heart disease, percutaneous interventional treatments have supplanted many surgical approaches for simple lesions, such as atrial septal defect. By contrast, complex congenital heart defects continue to require open-heart surgery. In single-ventricle patients, a staged approach is employed, which requires multiple open-heart surgeries and significant attendant morbidity and mortality. A nonsurgical transcatheter alternative would be attractive. OBJECTIVES: The authors sought to show the feasibility of catheter-only, closed-chest, large-vessel anastomosis (superior vena cava and pulmonary artery [PA] or bidirectional Glenn operation equivalent) in a patient. METHODS: In preclinical testing over a decade, the authors developed the techniques and technology needed for nonsurgical crossing from a donor (superior vena cava) to a recipient (PA) vessel and endovascular stent-based anastomosis of those blood vessels. The authors undertook this transcatheter approach for an adult with untreated congenital heart disease with severe cyanosis and significant surgical risk. They rehearsed the procedure step by step using contrast-enhanced cardiac computed tomography and a patient-specific 3-dimensional printed heart model. RESULTS: The authors describe a first-in-human, fully percutaneous superior cavopulmonary anastomosis (bidirectional Glenn operation equivalent). The patient, a 35-year-old woman, was homebound due to dyspnea and worsening cyanosis. She was diagnosed with functional single ventricle and very limited pulmonary blood flow. The heart team believed surgical palliation conferred high operative risk due to the patient's complete condition. With the percutaneous procedure, the patient recovered uneventfully and remained improved clinically after 6 months. CONCLUSIONS: This procedure may provide a viable alternative to one of the foundational open-heart surgeries currently performed to treat single-ventricle congenital heart disease.
[Mh] Termos MeSH primário: Cateterismo Cardíaco/métodos
Procedimentos Cirúrgicos Cardíacos/métodos
Derivação Cardíaca Direita/métodos
Cardiopatias Congênitas/cirurgia
Ventrículos do Coração/cirurgia
Artéria Pulmonar/cirurgia
Veia Cava Superior/cirurgia
[Mh] Termos MeSH secundário: Adulto
Estudos de Viabilidade
Feminino
Cardiopatias Congênitas/diagnóstico
Seres Humanos
Imagem Tridimensional
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170805
[St] Status:MEDLINE


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[PMID]:28589407
[Au] Autor:Yagi Y; Yamamoto M; Saito H; Mori T; Morimoto Y; Oyasu T; Tachibana T; Ito YM
[Ad] Endereço:Department of Anesthesiology, Hokkaido University Hospital, N15 W7 Kita-ku, Sapporo, 0608638, Japan.
[Ti] Título:Changes of Cerebral Oxygenation in Sequential Glenn and Fontan Procedures in the Same Children.
[So] Source:Pediatr Cardiol;38(6):1215-1219, 2017 Aug.
[Is] ISSN:1432-1971
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Recently, it is common to perform the Fontan procedure after the Glenn procedure as surgical repair for the univentricular heart. How the brain oxygen saturation (rSO ) values change with the cardiac restoration and the process of growth during these procedures in individual children remains unknown. In this study, we retrospectively studied rSO data as well as the perioperative clinical records of 30 children who underwent both Glenn and Fontan procedures by the same surgeon in the same institute. The rSO was measured at the beginning and end of each procedure with an INVOS 5100C. Cerebral perfusion pressure was calculated by subtracting central venous pressure from mean arterial pressure. Arterial oxygen saturation (SaO ) and the hemoglobin concentration were obtained as candidates affecting rSO changes at the start and the end of both procedures. The rSO increased during the Glenn procedure, but this increase was slight and insignificant. On the other hand, the rSO significantly increased during the Fontan procedure. Significant increases in SaO were observed only between the beginning and end of the Fontan procedure. Correlation coefficients determined by linear regression analysis were more than 0.5 between rSO and SaO in both procedures. Multiple linear regression analysis showed that SaO was the key determinant of the rSO . The rSO increases step by step from the Glenn to the Fontan procedure in the same patient. Within each procedure, SaO is the key determinant of the rSO . The significance of rSO monitoring in these procedures should be further evaluated.
[Mh] Termos MeSH primário: Encéfalo/irrigação sanguínea
Circulação Cerebrovascular
Derivação Cardíaca Direita
Cardiopatias Congênitas/sangue
Cardiopatias Congênitas/cirurgia
Oxigênio/sangue
[Mh] Termos MeSH secundário: Pré-Escolar
Feminino
Técnica de Fontan
Seres Humanos
Lactente
Masculino
Oximetria
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
S88TT14065 (Oxygen)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1007/s00246-017-1647-0


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[PMID]:28393444
[Au] Autor:Talwar S; Kumar MV; Nehra A; Malhotra Kapoor P; Makhija N; Sreenivas V; Choudhary SK; Airan B
[Ad] Endereço:Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
[Ti] Título:Bidirectional Glenn on cardiopulmonary bypass: A comparison of three techniques.
[So] Source:J Card Surg;32(5):303-309, 2017 May.
[Is] ISSN:1540-8191
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To analyze the intraoperative and early results of the bidirectional Glenn (BDG) procedure performed on cardiopulmonary bypass (CPB) using three different techniques. METHODS: Between September 2013 and June 2015, 75 consecutive patients (mean age 42 ± 34.4 months) undergoing BDG were randomly assigned to either technique I: open anastomosis or technique II: superior vena cava (SVC) cannulation or technique III: intermittent SVC clamping. We monitored the cerebral near infrared spectrophotometry (NIRS), SVC pressure, CPB time, intensive care unit (ICU) stay, and neurocognitive function. RESULTS: Patients in technique III had abnormal lower NIRS values during the procedure (57 ± 7.4) compared to techniques I and II (64 ± 7.5 and 61 ± 8.0, P = 0.01). Postoperative SVC pressure in technique III was higher than other two groups (17.6 ± 3.7 mmHg vs. 14.2 ± 3.5 mmHg and 15.3 ± 2.0 mmHg in techniques I and II, respectively = 0.0008). CPB time was highest in technique II (44 ± 18 min) compared to techniques I and III (29 ± 14 min and 38 ± 16 min, P = 0.006), respectively. ICU stay was longer in technique III (30 ± 15 h) compared to the other two techniques (22 ± 8.5 h and 27 ± 8.3 h in techniques I and II, respectively = 0.04). No patient experienced significant neurocognitive dysfunction. CONCLUSION: All techniques of BDG provided acceptable results. The open technique was faster and its use in smaller children merits consideration. The technique of intermittent clamping should be used as a last resort.
[Mh] Termos MeSH primário: Ponte Cardiopulmonar
Derivação Cardíaca Direita/métodos
Cardiopatias Congênitas/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Unidades de Terapia Intensiva
Tempo de Internação
Masculino
Transtornos Neurocognitivos
Complicações Pós-Operatórias
Período Pós-Operatório
Pressão
Artéria Pulmonar/cirurgia
Fatores de Tempo
Resultado do Tratamento
Veia Cava Superior/cirurgia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170411
[St] Status:MEDLINE
[do] DOI:10.1111/jocs.13123


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[PMID]:28274521
[Au] Autor:Tadphale SD; Tang X; ElHassan NO; Beam B; Prodhan P
[Ad] Endereço:Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee; Pediatric Critical Care, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee. Ele
[Ti] Título:Cavopulmonary Anastomosis During Same Hospitalization as Stage 1 Norwood/Hybrid Palliative Surgery.
[So] Source:Ann Thorac Surg;103(4):1285-1291, 2017 Apr.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Limited literature has examined characteristics of infants with hypoplastic left heart syndrome (HLHS) who remain hospitalized during the interstage period. We described their epidemiologic characteristics, in-hospital outcomes, and identified risk factors that predict the need for superior cavopulmonary anastomosis (SCPA) during the same hospitalization. METHODS: This retrospective multicenter database analysis included infants with HLHS who underwent stage 1 palliation from 2004 through 2013. RESULTS: Among 5374 infants with HLHS, 314 (5.8%) underwent SCPA during the same hospitalization as stage 1 palliation. They had a higher incidence of baseline comorbidities, complications, and interventions than infants who were discharged. Despite an overall increase in need for SCPA in the same hospitalization across different eras, there was no significant statistical difference in mortality in the two groups in the same era. Septicemia, necrotizing enterocolitis, modified Blalock-Taussig shunt, cardiac catheterization, cardiopulmonary resuscitation, extracorporeal membrane oxygenation, gastrostomy tube, and antiarrhythmic agents were independently associated with increased odds of undergoing SCPA during the same hospitalization. Patients undergoing right ventricle to pulmonary artery shunt were less likely to remain hospitalized until stage 2 palliation. Nonsurvivors in the SCPA group had greater need for interventions and worse intensive care unit outcomes. CONCLUSIONS: Infants with HLHS who remain hospitalized after stage 1 until their stage 2 palliation differ significantly from infants who were discharged. Several clinical characteristics, comorbidities, and need for interventions are associated with the likelihood for undergoing stage 2 palliation during the same hospitalization. Timely identification and intervention of adjustable causes of heart failure may improve outcomes.
[Mh] Termos MeSH primário: Derivação Cardíaca Direita
Síndrome do Coração Esquerdo Hipoplásico/cirurgia
Procedimentos de Norwood
Cuidados Paliativos
[Mh] Termos MeSH secundário: Feminino
Hospitalização
Seres Humanos
Lactente
Recém-Nascido
Masculino
Estudos Retrospectivos
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171115
[Lr] Data última revisão:
171115
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE


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[PMID]:27587501
[Au] Autor:Steele MM; Zahr RA; Kirshbom PM; Kopf GS; Karimi M
[Ad] Endereço:Department of Surgery, Section of Cardiac Surgery, Pediatric Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT, USA margaret.steele@yale.edu.
[Ti] Título:Quality of Life for Historic Cavopulmonary Shunt Survivors.
[So] Source:World J Pediatr Congenit Heart Surg;7(5):630-4, 2016 Sep.
[Is] ISSN:2150-136X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Beginning with Dr William Glenn in 1958, 90 patients with congenital heart lesions underwent cavopulmonary (Glenn) shunts over a 30-year period. In 2015, the follow-up data on this original cohort were reported. The study focuses on the current quality of life of this cohort. METHODS: Of the original 91 cavopulmonary shunt survivors, 14 (ages: 26-59; average length of postsurgical follow-up: 38.4 years) completed the Rand 36-Item Short-Form Health Survey, volume 2 (SF-36v2) quality-of-life survey at clinical office visits, over the phone or via regular mail. Diagnoses included tricuspid atresia (n = 9), double inlet left ventricle (n = 1), d-transposition of great arteries (n = 1), Ebstein's anomaly (n = 1), tetralogy of Fallot (n = 1), and pulmonary atresia with hypoplastic right ventricle (n = 1). Norm-based comparison of cavopulmonary shunt survivors to the general population was performed using a one-sample t test. RESULTS: The 36-question health survey, SF-36v2, provided physical and mental health summary measures standardized to achieve a mean of 50. The 14 survivors' physical composite score was 47.18 (standard deviation [SD]: 8.24; P = .22) and mental composite score was 52.71 (SD: 5.64; P = .095). CONCLUSION: The cavopulmonary shunt is now a widely used surgical palliation for single-ventricle patients and can be associated with physical and mental health outcomes similar to the general US population. Cavopulmonary shunt survivors' SF-36v2 survey results do not demonstrate a statistically significant difference from the general US population in physical or mental health measures. The results of this study contribute to the discussion of quality of life for patients with congenital heart disease by following up with the oldest known survivors.
[Mh] Termos MeSH primário: Derivação Cardíaca Direita
Cardiopatias Congênitas
Qualidade de Vida
[Mh] Termos MeSH secundário: Adulto
Feminino
Seguimentos
Derivação Cardíaca Direita/história
Derivação Cardíaca Direita/métodos
Cardiopatias Congênitas/fisiopatologia
Cardiopatias Congênitas/cirurgia
História do Século XX
História do Século XXI
Seres Humanos
Masculino
Meia-Idade
Fatores de Tempo
Estados Unidos
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170605
[Lr] Data última revisão:
170605
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160903
[St] Status:MEDLINE
[do] DOI:10.1177/2150135116658009


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[PMID]:27390988
[Au] Autor:Egbe AC; Connolly HM; Dearani JA; Bonnichsen CR; Niaz T; Allison TG; Johnson JN; Poterucha JT; Said SM; Ammash NM
[Ad] Endereço:Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address: egbe.alexander@mayo.edu.
[Ti] Título:When is the right time for Fontan conversion? The role of cardiopulmonary exercise test.
[So] Source:Int J Cardiol;220:564-8, 2016 Oct 01.
[Is] ISSN:1874-1754
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To determine if Fontan conversion (FC) resulted in improvement in exercise capacity (EC), and to determine the role of cardiopulmonary exercise test (CPET) in risk stratification of patients undergoing FC. METHODS: A retrospective review of patients who underwent CPET prior to FC at Mayo Clinic from 1994 to 2014. The patients who also underwent post-operative CPET were selected for the analysis of improvement in EC defined as 10% increase in baseline peak oxygen consumption (VO2). RESULTS: 75 patients CPET prior to FC; mean age 24±6years; 44 males (59%); and 51 (68%) were in NYHA III/IV prior to FC. Pre-operative peak VO2 was 15.5±3.4ml/kg/min. A comparison of pre- and post-FC CPET data was performed using 42 patients (56%) that underwent CPET after FC. Improvement in EC occurred in 18 of 42 patients (43%). Baseline peak VO2 >14ml/kg/min was associated with improved EC (hazard ratio [HR] 1.85; P=.02). Improvement in New York Heart Association (NYHA) class occurred in 12 (67%) patients with improved EC vs 2 (8%) without improved EC. Improvement in NYHA class was more likely to occur in patients with improved EC compared to those without improvement EC (odds ratio 4.11, P=.01). There were 10 (13%) perioperative deaths, and baseline peak VO2 ≤14ml/kg/min was predictive of perioperative mortality (HR 3.74; P<.001). CONCLUSIONS: Baseline peak VO2 was predictive of perioperative survival, and improvement in EC. Performance on CPET in failing Fontan patients might be a useful clinical parameter in determining appropriate timing of FC.
[Mh] Termos MeSH primário: Teste de Esforço/métodos
Técnica de Fontan/métodos
Assistência Perioperatória/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Coortes
Teste de Esforço/mortalidade
Teste de Esforço/tendências
Feminino
Técnica de Fontan/mortalidade
Técnica de Fontan/tendências
Derivação Cardíaca Direita/mortalidade
Derivação Cardíaca Direita/tendências
Seres Humanos
Masculino
Consumo de Oxigênio/fisiologia
Assistência Perioperatória/mortalidade
Assistência Perioperatória/tendências
Estudos Retrospectivos
Taxa de Sobrevida/tendências
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170829
[Lr] Data última revisão:
170829
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160709
[St] Status:MEDLINE


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[PMID]:27085581
[Au] Autor:Ratnayaka K; Rogers T; Schenke WH; Mazal JR; Chen MY; Sonmez M; Hansen MS; Kocaturk O; Faranesh AZ; Lederman RJ
[Ad] Endereço:Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland; Division of Cardiology, Children's National Medical Center, Washington, District of Columbia.
[Ti] Título:Magnetic Resonance Imaging-Guided Transcatheter Cavopulmonary Shunt.
[So] Source:JACC Cardiovasc Interv;9(9):959-70, 2016 May 09.
[Is] ISSN:1876-7605
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The aim of this study was to test the hypothesis that real-time magnetic resonance imaging (MRI) would enable closed-chest percutaneous cavopulmonary anastomosis and shunt by facilitating needle guidance along a curvilinear trajectory, around critical structures, and between a superior vena cava "donor" vessel and a pulmonary artery "target." BACKGROUND: Children with single-ventricle physiology require multiple open heart operations for palliation, including sternotomies and cardiopulmonary bypass. The reduced morbidity of a catheter-based approach would be attractive. METHODS: Fifteen naive swine underwent transcatheter cavopulmonary anastomosis and shunt creation under 1.5-T MRI guidance. An MRI antenna-needle was advanced from the superior vena cava into the target pulmonary artery bifurcation using real-time MRI guidance. In 10 animals, balloon-expanded off-the-shelf endografts secured a proximal end-to-end caval anastomosis and a distal end-to-side pulmonary anastomosis that preserved blood flow to both branch pulmonary arteries. In 5 animals, this was achieved with a novel, purpose-built, self-expanding device. RESULTS: Real-time MRI needle access of target vessels (pulmonary artery), endograft delivery, and superior vena cava shunt to pulmonary arteries were successful in all animals. All survived the procedure without complications. Intraprocedural real-time MRI, post-procedural MRI, x-ray angiography, computed tomography, and necropsy showed patent shunts with bidirectional pulmonary artery blood flow. CONCLUSIONS: MRI guidance enabled a complex, closed-chest, beating-heart, pediatric, transcatheter structural heart procedure. In this study, MRI guided trajectory planning and reproducible, reliable bidirectional cavopulmonary shunt creation.
[Mh] Termos MeSH primário: Cateterismo Cardíaco
Derivação Cardíaca Direita/métodos
Imagem por Ressonância Magnética Intervencionista
Artéria Pulmonar/diagnóstico por imagem
Veia Cava Superior/diagnóstico por imagem
[Mh] Termos MeSH secundário: Animais
Cateterismo Cardíaco/instrumentação
Cateteres Cardíacos
Estudos de Viabilidade
Derivação Cardíaca Direita/instrumentação
Imagem por Ressonância Magnética Intervencionista/instrumentação
Modelos Animais
Desenho de Prótese
Stents
Sus scrofa
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160418
[St] Status:MEDLINE


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[PMID]:27053697
[Au] Autor:Kozlik-Feldmann R; Hansmann G; Bonnet D; Schranz D; Apitz C; Michel-Behnke I
[Ad] Endereço:Department of Paediatric Cardiology, University Heart Center, Medical University Hamburg, Hamburg, Germany.
[Ti] Título:Pulmonary hypertension in children with congenital heart disease (PAH-CHD, PPHVD-CHD). Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK.
[So] Source:Heart;102 Suppl 2:ii42-8, 2016 May.
[Is] ISSN:1468-201X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is a complex disease that presents with a broad spectrum of morphological and haemodynamic findings of varying severity. Recently, the aspect of paediatric pulmonary hypertensive vascular disease (PPHVD) has been introduced to expand the understanding of the full spectrum of pulmonary hypertension and increased pulmonary vascular resistance. Evaluation and treatment of PAH-CHD/PPHVD-CHD can be divided into in different topics. First, defining criteria for operability and initiation of advanced therapies preoperatively and postoperatively is an unresolved issue. Second, management of Eisenmenger syndrome is still an important question, with recent evidence on the severity of the disease and a more rapidly progressive course than previously described. Third, the Fontan circulation with no subpulmonary ventricle requires a distinct discussion, definition and classification since even a mild rise in pulmonary vascular resistance may lead to the so-called failing Fontan situation. Patients with CHD and single-ventricle physiology (Fontan/total cavopulmonary anastomosis) require a particularly stepwise and individualised approach. This consensus statement is on the current evidence for the most accurate evaluation and treatment of increased pulmonary artery pressure and resistance, as well as ventricular dysfunction, in children with congenital heart defects, and provides according practical recommendations. To optimise preoperative and postoperative management in patients with PAH-CHD, diagnostic and treatment algorithms are provided.
[Mh] Termos MeSH primário: Anti-Hipertensivos/uso terapêutico
Técnica de Fontan
Cardiopatias Congênitas/terapia
Hipertensão Pulmonar/terapia
Disfunção Ventricular/terapia
[Mh] Termos MeSH secundário: Adolescente
Algoritmos
Cateterismo Cardíaco
Procedimentos Cirúrgicos Cardíacos
Criança
Consenso
Gerenciamento Clínico
Permeabilidade do Canal Arterial/complicações
Permeabilidade do Canal Arterial/diagnóstico
Permeabilidade do Canal Arterial/terapia
Complexo de Eisenmenger/complicações
Complexo de Eisenmenger/diagnóstico
Complexo de Eisenmenger/terapia
Derivação Cardíaca Direita
Cardiopatias Congênitas/complicações
Cardiopatias Congênitas/diagnóstico
Hemodinâmica
Seres Humanos
Hipertensão Pulmonar/complicações
Hipertensão Pulmonar/diagnóstico
Artéria Pulmonar
Circulação Pulmonar
Resistência Vascular
Vasodilatação
Vasodilatadores
Disfunção Ventricular/complicações
Disfunção Ventricular/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antihypertensive Agents); 0 (Vasodilator Agents)
[Em] Mês de entrada:1608
[Cu] Atualização por classe:161124
[Lr] Data última revisão:
161124
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160408
[St] Status:MEDLINE
[do] DOI:10.1136/heartjnl-2015-308378



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