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Boutsikou M, Uebing A, Kilner P, Li W, Kempny A, Gatzoulis MA. Brock procedure: 52 years of effective palliation for Tetralogy of Fallot. Int J Cardiol 2015. [PMID: 26197408 DOI: 10.1016/j.ijcard.2015.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- M Boutsikou
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.
| | - A Uebing
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College School of Medicine, London, UK
| | - P Kilner
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College School of Medicine, London, UK
| | - W Li
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - A Kempny
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College School of Medicine, London, UK
| | - M A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK; National Heart and Lung Institute, Imperial College School of Medicine, London, UK
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Manchikalapudi RB, Klugherz BD. Tetralogy of Fallot: the oldest reported survivor of Brock's procedure. Clin Cardiol 2008; 31:556-8. [PMID: 19006112 PMCID: PMC6653242 DOI: 10.1002/clc.20299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 09/15/2007] [Indexed: 11/08/2022] Open
Abstract
We report the case of a 79-y-old male with Tetralogy of Fallot (TOF) who underwent Brock's procedure in his twenties and has survived event-free. Brock's procedure, which entailed infundibular resection and pulmonary valvotomy, has been associated with complications including the need for re-operation, pulmonary regurgitation, and biventricular failure.
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Affiliation(s)
- Rama Bindu Manchikalapudi
- Department of Internal Medicine, Abington Memorial Hospital 1200 Old York Rd. Abington, PA 19001, USA.
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Abstract
It is accepted medical practice to prevent bacterial endocarditis in patients with susceptible congenital or acquired cardiac malformations who are likely to experience predictable procedure-related bacteremia. Patients in general, those with congenital heart disease specifically, are insufficiently aware of the need for such prophylaxis. It is responsibility of the physician to determine which patients are susceptible to endocarditis and the need for endocarditis prophylaxis for each patient for any given instance and to educate the patient as to this need. The American Heart Association provides wallet-sized cards that may be given to each patient. Those patients not previously known to have heart disease are, of course, not eligible for chemoprophylaxis. Because these represent many of the patients with endocarditis each year, it can be argued that only a minority of patients have preventable cases. Regarding the clinical application of anti-infective endocarditis prophylaxis, the American Heart Association gives this perspective: This statement represents recommended guidelines to supplement practitioners in the exercise of their clinical judgement and is not intended as a standard of care for all cases.... Because no adequate, controlled clinical trials of antibiotic regimens for the prevention of bacteria endocarditis in humans have been done, recommendations are based on vitro studies, clinical experience, data from experimental animal models, and assessment of both the bacteria most likely to produce bacteremia from a given site and those most likely to result in endocarditis. Bacterial endocarditis is one of the few infectious disease that almost always result in death unless treated. The dramatic nature of the morbidity and mortality of infective endocarditis in those so afflicted makes the prevention of even a few cases worth the effort.
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Affiliation(s)
- J S Child
- Department of Medicine, University of California Los Angeles School of Medicine, USA
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Abstract
The average life expectancy of patients with congenital heart disease has dramatically improved over the past four decades because of advances in medical and surgical therapy, with patients with complex lesions surviving to adolescence and adulthood. Tetralogy of Fallot, transposition of the great arteries, ventricular septal defects, patent ductus, and bicuspid aortic valves in particular are susceptible to infective endocarditis. Most operated patients are left with some form of residua or sequelae, many of which predispose to infective endocarditis. Surgical palliation, such as systemic-to-pulmonary shunts, and reparative surgery, often requiring prosthetic valve or conduit replacement, are major predisposing conditions. Accordingly, recognition, prevention, and treatment strategies for infective endocarditis assume increasing importance in adolescents and adults with congenital heart disease, operated or not.
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Affiliation(s)
- H Dodo
- Division of Cardiology, National Children's Hospital, Tokyo, Japan
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Hughes CF, Lim YC, Cartmill TB, Grant AF, Leckie BD, Baird DK. Total intracardiac repair for tetralogy of Fallot in adults. Ann Thorac Surg 1987; 43:634-8. [PMID: 3592833 DOI: 10.1016/s0003-4975(10)60237-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The anatomic and clinical features of 47 patients who were 18 years of age or older at the time of total intracardiac repair for tetralogy of Fallot are reviewed. Twenty (43%) patients had had previous palliative surgery. Of 14 pulmonary-systemic shunts, 9 (64%) remained patent. The location of the ventricular septal defect was infracristal in 90% of patients. The predominant right ventricular outflow tract obstruction was at the infundibulum in 30%; another 64% of patients had combined valvular and infundibular obstruction. Total intracardiac repair was achieved; hospital mortality was 8.5%. Morbidity was minor, and hemorrhage was a significant problem in only 2 patients. Thirty-five patients have been followed from 11 months to 15 years after surgery. There were 4 late deaths; the actuarial 10-year survival rate was 82%.
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Perloff JK, Friedman WF, Laks H, Child JS. From cyanotic infant to acyanotic adult - the odyssey of blue babies. West J Med 1983; 139:673-87. [PMID: 6197818 PMCID: PMC1010966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
An edited summary of an Interdepartmental Conference arranged by the Department of Medicine of the UCLA School of Medicine, Los Angeles. Director of Conferences: William M. Pardridge, MD, Associate Professor of Medicine.In the past two decades we have witnessed the maturing of diagnostic and surgical skills in the management of congenital heart disease. Although longevity and quality of life have improved, cures are few; varying degrees of postoperative medical supervision are therefore needed. This new patient population of adults requiring long-term medical care continues to increase. Proper management of such patients can be taxing, requiring knowledge not only of the preoperative disease but also of the nature and effects of surgical intervention and of the presence, type and extent of late postoperative residua and sequelae. The tetralogy of Fallot is taken as a model because it is well known in both pediatric and adult medicine, because intracardiac repair includes a wide range of techniques and because postoperative residua and sequelae comprise a broad spectrum of patient care concerns.
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Nandi PL, Wong PHC, Mok CK. Corrective surgery for tetralogy of fallot in adolescents and adults. Indian J Thorac Cardiovasc Surg 1983. [DOI: 10.1007/bf02664868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kaplan EL, Rich H, Gersony W, Manning J. A collaborative study of infective endocarditis in the 1970s. Emphasis on infections in patients who have undergone cardiovascular surgery. Circulation 1979; 59:327-35. [PMID: 759000 DOI: 10.1161/01.cir.59.2.327] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Twenty-six major cardiovascular centers participated in a cooperative study of all cases of infective endocarditis occurring during a single calendar year to obtain an overview of infective endocarditis. The study was designed to learn which patients appear to be at highest risk to develop this infection after palliative or reparative cardiovascular surgery. Of 278 patients developing infective endocarditis during the year at these medical centers, 63 (23%) had had previous cardiovascular surgery and 215 had not. Seventy percent of the 278 patients had recognized congenital or acquired heart disease before developing the infection. Rheumatic heart disease accounted for over half of the patients with underlying structural heart disease. A majority (55%) of the 63 patients who had been operated on before developing endocarditis had prosthetic valves inserted. Of those who did not require prosthetic valves, the majority had congenital heart disease with systemic artery-to-pulmonary artery shunts. Although these data were obtained from a selected group of patients, they confirm a significant risk of endocarditis in patients with prosthetic valves and suggest that in postoperative patients with non-valvular congenital heart disease, the highest risk appears to be in cyanotic patients with palliative pulmonary artery-to-systemic artery shunts.
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Jones M, Ferrans VJ. Myocardial degeneration in congenital heart disease. Comparison of morphologic findings in young and old patients with congenital heart disease associated with muscular obstruction to right ventricular outflow. Am J Cardiol 1977; 39:1051-63. [PMID: 141201 DOI: 10.1016/s0002-9149(77)80221-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
A retrospective review of 149 episodes of bacterial endocarditis (BE) in 141 patients under 25 years of age, at The Children's Hospital Medical Center from 1933 through June of 1972, demonstrates increasing survival and a distinct change in the frequency of underlying congenital heart disease and rheumatic heart disease (RHD). Certain forms of congenital heart disease such as tetralogy of Fallot, small ventricular septal defect, and aortic stenosis are at particular risk for BE. Following BE, patients with ventricular septal defect and tetralogy of Fallot have less morbidity and higher survival rates than children with aortic outflow lesions. over the entire time period, alpha Streptococcus is the most common pathogen and Staphylococcus aureus, second most frequent organism. Surgical correction in patients with congenital heart disease may offer the best form of prevention.
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Gersony WM, Batthany S, Bowman FO, Malm JR. Late follow-up of patients evaluated hemodynamically after total correction of tetralogy of Fallot. J Thorac Cardiovasc Surg 1973. [DOI: 10.1016/s0022-5223(19)40620-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Reid JM, Coleman EN, Barclay RS, Stevenson JG. Blalock-Taussig anastomosis in 126 patients with Fallot's tetralogy. Thorax 1973; 28:269-72. [PMID: 4724493 PMCID: PMC470029 DOI: 10.1136/thx.28.3.269] [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: 01/12/2023]
Abstract
The long-term results of Blalock anastomosis in 126 patients (1954-71) for Fallot's tetralogy are presented. The operative mortality was 10% and the overall mortality 38%. The 78 survivors were reviewed after periods of surveillance ranging from six months to 17 years. Complications were few. It is concluded that although total correction as a primary procedure has become the treatment of choice in most, it may in some instances never be technically feasible because of extreme underdevelopment of the right ventricular outflow tract. In the very young with urgent symptoms and rapid deterioration total correction would be considered hazardous. In the infant a high operative mortality reflected the inadequate calibre of the vessels used in the shunt operation.
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