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Aboulhosn JA. The Role of Catheter-Based and Surgical Treatments in Patients With Congenital Heart Disease and Pulmonary Hypertension. ACTA ACUST UNITED AC 2013. [DOI: 10.21693/1933-088x-11.4.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This manuscript is intended to provide a brief overview of the indications for and outcomes of surgical and transcatheter interventions for congenital heart disease and pulmonary hypertension (PH). Pulmonary hypertension is frequently encountered in children and adults with congenital heart disease and is most commonly related to large “central” shunts, ie, those occurring at the ventricular or great arterial level (Figure 1). If uncorrected early in infancy or childhood, large central shunts result in increased pulmonary blood flow, left heart volume overload, PH, and heart failure. If the child survives this initial period of volume overload and heart failure, they will very likely develop effacement of the normal pulmonary arterial architecture and severe elevations in pulmonary arterial resistance, eventually resulting in cyanosis and Eisenmenger syndrome.1
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Affiliation(s)
- Jamil A. Aboulhosn
- Director, Ahmanson/UCLA Adult Congenital, Heart Disease Center, Los Angeles, CA
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Driscoll DJ. Dan Goodrich McNamara. Clin Cardiol 2009; 32:E78-9. [PMID: 19816968 PMCID: PMC6653396 DOI: 10.1002/clc.20385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 01/11/2008] [Indexed: 11/11/2022] Open
Affiliation(s)
- David J Driscoll
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine Rochester, 200 First Street SW, Rochester, Michigan 55905, USA.
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Cheung DT, Choo SJ, Grobe AC, Marchion DC, Luo HH, Pang DC, Favara BE, Oury JH, Duran CM. Behavior of vital and killed autologous pericardium in the descending aorta of sheep. J Thorac Cardiovasc Surg 1999; 118:998-1005. [PMID: 10595970 DOI: 10.1016/s0022-5223(99)70093-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Cardiovascular implants of fresh autologous pericardium produced mixed results including fibrosis with retraction or thinning and dilatation. The reasons for these differences are unknown but may involve activation of cells intrinsic to the tissue implant. To better understand the behavior of autologous pericardial implants, we studied the outcomes of vital pericardium (fresh) versus ethanol-killed pericardium. METHODS Fresh and ethanol-killed autologous pericardium was transplanted as a patch, a conduit, or a rectangular flap bisecting the lumen in the descending aorta of sheep. The implants, recovered at 1, 5, 10, 15, and 30 days, were evaluated macroscopically and microscopically and by immunohistologic studies. RESULTS Fresh implants showed good preservation with fibrin deposition on day 15. Microscopically, cells positive for alpha-actin and von Willebrand-related antigen appeared in the fibrin by day 10. By day 30 the flap was fibrotic and retracted whereas the patch and conduit retained their original appearance on the luminal aspect. An endothelium-like layer expressing von Willebrand-related antigen was present in the patch and conduit but absent in the flap. In contrast, the ethanol-killed implants were free of fibrin by day 10. By day 30, there were no signs of fibrosis or retraction, and a surface layer of cells expressing von Willebrand-related antigen, characteristic of endothelial cells, was present on all implants. All ethanol-killed implants were repopulated by host cells. CONCLUSION The transluminal flap is an interesting model for studying the behavior of intraluminal autologous pericardial cardiovascular implants. Killing of the pericardial implants alleviated the fibrosis and tissue retraction observed with fresh flap implants.
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Affiliation(s)
- D T Cheung
- International Heart Institute of Montana Foundation, St Patrick Hospital, 554 West Broadway, Missoula, MT 59801, USA
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Leão LE, Buffolo E, Coto AE, Maluf MA, Andrade JC. Transaortic approach has a role in the surgical treatment of ventricular septal defects. CARDIOVASCULAR SURGERY (LONDON, ENGLAND) 1996; 4:250-4. [PMID: 8861448 DOI: 10.1016/0967-2109(96)82326-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A transaortic approach was used for surgical closure of ventricular septal defects (VSDs), sometimes as first choice and otherwise as an alternative approach. This paper presents the experience in a group of 124 patients who underwent VSD closure by a transaortic approach in an 18-year-period, between 1974 and 1992. Patients were divided in three groups: (I) Isolated VSD, 89 patients (mean age 7.6 years); (II) VSD associated with other malformations, 27 patients (mean age 10.8 years); and (III) recurrent VSD, eight patients (mean age 15.6 years). Two deaths occurred in the postoperative period (2/124), one after closure of VSD in a patient with severe pulmonary hypertension; another death was observed after transaortic closure of the VSD as part of the repair of a complex heart malformation. There were no instances of new right bundle branch block (RBBB) in the group operated on for isolated VSDs. Three cases of left bundle branch block (LBBB) (3.4%) occurred in the isolated VSD group. There were no cases of complete aortic valve (AV) block in the whole series and no instances of AV dysfunction. The transaortic approach is an alternative for the surgical treatment of ventricular septal defects. The ease of exposure and closure of defects suggest this technique to be a particularly attractive approach in the treatment of small to moderate-sized VSDs and also in recurrent VSDs.
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Affiliation(s)
- L E Leão
- Escola Paulista de Medicina, São Paulo, Brazil
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Shaddy RE, Boucek MM, Sturtevant JE, Ruttenberg HD, Jaffe RB, Tani LY, Judd VE, Veasy LG, McGough EC, Orsmond GS. Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation 1993; 87:793-9. [PMID: 8443900 DOI: 10.1161/01.cir.87.3.793] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The use of balloon coarctation angioplasty instead of surgery as treatment for unoperated coarctation of the aorta is controversial. The efficacy and complications of the two procedures have not been studied before in a prospective fashion. METHODS AND RESULTS Thirty-six patients were prospectively randomized to either angioplasty (20 patients) or surgery (16 patients). Immediate results and patient follow-up, including physical examination, angiograms, and magnetic resonance imaging, were compared between groups. Reduction in peak systolic pressure gradient across the coarctation was similar (86%) immediately after both balloon coarctation angioplasty and surgery. On follow-up, aneurysms were seen only in the angioplasty group (20%) and not in the surgery group (0%). No aneurysms have shown progression or required surgery. The incidence of other complications was similar in both groups, although two patients experienced neurological complications after surgery. Although not statistically different, the incidence of restenosis (peak systolic pressure gradient > or = 20 mm Hg) tended to be greater in the angioplasty group (25%) than in the surgery group (6%). Restenosis after angioplasty occurred more frequently in patients with an aortic isthmus/descending aorta diameter ratio < 0.65 and was associated with an immediate catheterization residual peak systolic pressure gradient across the coarctation > or = 12 mm Hg. CONCLUSIONS Immediate gradient reduction is similar after balloon coarctation angioplasty and surgical treatment of unoperated coarctation of the aorta. The risks of aneurysm formation and possibly restenosis after angioplasty are higher than after surgery, although the risks of other complications are similar. Balloon coarctation angioplasty may provide an effective initial alternative to surgical repair of unoperated coarctation of the aorta in children beyond infancy, particularly in patients with a well-developed isthmus. Further follow-up is necessary to determine the long-term risks of postangioplasty aneurysms.
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Affiliation(s)
- R E Shaddy
- Department of Pediatrics, University of Utah Medical Center, Salt Lake City
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Humes RA, Porter CJ, Puga FJ, Schaff HV, Danielson GK. Utility of temporary atrial epicardial electrodes in postoperative pediatric cardiac patients. Mayo Clin Proc 1989; 64:516-21. [PMID: 2725064 DOI: 10.1016/s0025-6196(12)65555-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The utility of atrial electrograms recorded from temporary bipolar atrial epicardial electrodes in postoperative pediatric cardiac patients was assessed by (1) examining the accuracy of the surface electrocardiographic tracings and (2) analyzing the treatment modalities used for the arrhythmias diagnosed on the basis of the atrial electrograms. Atrial electrograms were obtained simultaneously with single-lead surface electrocardiographic recordings from 20 pediatric patients (ages 7 months to 11 years) after intracardiac repair of congenital heart defects. Interpretations of 25 surface recordings by five pediatric cardiologists were compared with analyses of the electrograms. Sinus rhythm was interpreted correctly by most reviewers 100% of the time, whereas atrioventricular conduction disturbances and narrow QRS tachycardias were identified correctly 77% and 14% of the time, respectively. Of those rhythms incorrectly interpreted, 89% had some type of active therapeutic intervention. Single-lead surface electrocardiographic recordings are imprecise for evaluating postoperative rhythms in pediatric cardiac patients, and our experience suggests that rhythms for which active intervention is necessary may be more difficult to interpret correctly by surface monitoring alone.
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Affiliation(s)
- R A Humes
- Section of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905
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Flanagan MF, Leatherman GF, Carls A, Keane JF, Selwyn AP, Lock JE. Changing trends of congenital heart disease in adults: a catheterization laboratory perspective. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1986; 12:215-8. [PMID: 3757022 DOI: 10.1002/ccd.1810120403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Advances in cardiac surgery now enable many children with congenital heart disease (CHD) to survive to adulthood. The influence of such advances on the frequency of various lesions among adult patients undergoing cardiac catheterization (CC) has not previously been addressed. This retrospective analysis of 329 adults with CHD undergoing CC at an adult and at a pediatric referral center demonstrates that when compared to 20 years ago, adults with CHD who now undergo CC are more likely to have complex cardiac disease, and more have had prior surgery. In addition, despite more aggressive surgical management, ventricular dysfunction and dysrhythmias are now commonly encountered residua of CHD in adults who require diagnostic CC. Premature coronary artery disease appears uncommon. These changing characteristics of adults with CHD require consideration in the planning of future health care for these patients.
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Abstract
A transpulmonary arterial approach to the closure of a high ventricular septal defect (VSD) has been used, between 1978 and 1982, in eight patients. The reasons were ease of access and the wish to overcome the problems associated with right ventriculotomy. The patients' ages ranged from three weeks to 15 months, their weight from 2.9 kg to 9 kg. The approach was used both when the VSD was an isolated anomaly and when there were major associated defects. It is in this latter group, four with aortic arch anomalies, two with additional double outlet right ventricle (DORV), that avoidance of ventriculotomy was most helpful. It was especially important in the two patients with DORV and a perimembranous, outlet subpulmonary VSD, where it was possible to close off the left ventricular outflow tract and pulmonary valve using a patch, without opening the right ventricle, which was subsequently to become the systemic ventricle. This technique obviates the need for ventriculotomy in the closure of some perimembranous outlet and doubly committed subarterial VSDs, and is the approach of choice for the closure of a perimembranous, outlet, subpulmonary VSD in DORV.
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Piehler JM, Danielson GK, Pluth JR, Orszulak TA, Puga FJ, Schaff HV, Edwards WD, Shub C. Enlargement of the aortic root or anulus with autogenous pericardial patch during aortic valve replacement. J Thorac Cardiovasc Surg 1983. [DOI: 10.1016/s0022-5223(19)39146-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McNamara DG, Latson LA. Long-term follow-up of patients with malformations for which definitive surgical repair has been available for 25 years or more. Am J Cardiol 1982; 50:560-8. [PMID: 7051799 DOI: 10.1016/0002-9149(82)90325-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The results of long-term follow-up studies of patients with five common congenital heart defects are reviewed. The lesions included are ventricular septal defect, atrial septal defect, patent ductus arteriosus, pulmonary stenosis and coarctation of the aorta. A definitive, rather than palliative, operation has been available for each of these lesions for more than 25 years. Therefore many patients who have undergone operation for one of these lesions are now reaching adulthood. Although most of these postoperative patients live a normal life, many have residuae or sequelae that require close observation or treatment. Other persistent abnormalities of the physical examination, electrocardiogram and chest radiogram are obvious but call for no precaution or treatment. We have drawn on our own experience and the published experience of others to identify those findings and historical factors that best reflect the long-term prognosis of these patients. In addition, recommendations concerning the need for continued prophylaxis against infective endocarditis, and the problems of insurability and employability of these postoperative patients are discussed.
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Goor DA, Massini C, Shem-Tov A, Neufeld HN. Transatrial repair of double-outlet right ventricle in infants. Thorax 1982; 37:371-5. [PMID: 7112474 PMCID: PMC459319 DOI: 10.1136/thx.37.5.371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In three infant cases of double outlet right ventricle (DORV), two with normally related great arteries (NGA) and one with side-by-side great arteries, a transatrial repair was carried out. In all three cases, the results were excellent. It is concluded that in the small baby with DORV with NGA and in DORV with side-by-side great arteries with a hypoplastic crista, a transatrial repair should be successful. This is dependent on the VSD being in the perimembranous (and, therefore, subaortic) location and on the absence of infundibular pulmonary stenosis. In all other varieties of DORV the repair should probably be done through the ventricle.
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Hjelms E, Pohlner P, Barratt-Boyes B, Gavin J. Study of autologous pericardial patch-grafts in the right ventricular outflow tracts in growing and adult dogs. J Thorac Cardiovasc Surg 1981. [DOI: 10.1016/s0022-5223(19)37669-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Norberg WJ, Tadavarthy M, Knight L, Nicoloff DM, Moller JH. Late hemodynamic and angiographic findings after ascending aorta-pulmonary artery anastomosis. J Thorac Cardiovasc Surg 1978. [DOI: 10.1016/s0022-5223(19)39575-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kawashima Y, Fujita T, Mori T, Ihara K, Manabe H. Trans—pulmonary arterial closure of ventricular septal defect. J Thorac Cardiovasc Surg 1977. [DOI: 10.1016/s0022-5223(19)41373-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Forfang K, Simonsen S, Andersen A, Efskind L. Atrial septal defect of secundum type in the middle-aged. Clinical results of surgery and correlations between symptoms and hemodynamics. Am Heart J 1977; 94:44-54. [PMID: 868742 DOI: 10.1016/s0002-8703(77)80342-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Adams FH. Overview of pediatric cardiology with a critique of congenital heart disease in the 1970's. Am J Cardiol 1977; 39:754-6. [PMID: 855799 DOI: 10.1016/s0002-9149(77)80141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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