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Amirghofran AA, Salimi M, Kamran H, Bazrafshan H, Navaei MR, Shokrollahi A, Nirooei E, Edraki M, Amoozgar H, Ajami G, Arabi H. Long-term outcomes of the classic Konno-Rastan procedure in paediatric and adult patients: impact of aortic annulus size on patient outcomes. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad151. [PMID: 37665750 DOI: 10.1093/icvts/ivad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/14/2023] [Accepted: 09/02/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES The classic Konno-Rastan procedure may yield different outcomes regarding aortic annulus diameters ≤15 mm and larger. Focusing on the effect of the diameter of the aortic annulus, we described the long-term outcomes of our patients. METHODS The outcomes of paediatric and adult patients who underwent surgery from 2000 to 2021 were studied retrospectively. The patient population was divided into 2 groups with aortic annulus diameters ≤15 mm and >15, and the outcomes were compared between the 2 groups. RESULTS A total of 48 patients, with a mean age of 12.24 ± 9.42 years (2-53 years) and a median follow-up duration of 8 years (7 months to 20 years) with an IQR of 5.5, were enrolled. The mean peak instantaneous pressure gradient was 78.97 ± 25.29 mmHg, which decreased to 21.43 mmHg (P-value = 0.012). The maximum left ventricular outflow tract gradient at the last follow-up was 28.21 mmHg, with the exception of 1 case with a gradient of 68.45 mmHg. The mean diameter of the aortic annulus was 15.34 ± 3.87 mm (8-23 mm), and the mean prosthetic valve size was 20.31 mm, which was 5 mm (33%) larger than the native annulus diameter. The overall mortality rate was 6.3%, with 1 death in the hospital and 2 in the first year after the surgery. The major complication rate, including mortality, heart block and reintervention, was higher in patients with ≤15 mm annulus (P-value = 0.028.) However, there was no difference between the 2 groups in follow-up. Four (8%) late cardiac reoperations were performed, none of which were related to our surgeries. CONCLUSIONS Kono-Rastan surgery for patients with aortic valve diameter of ≤15 mm can be performed with acceptable long-term outcomes.
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Affiliation(s)
| | - Maryam Salimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali Shokrollahi
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Nirooei
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Edraki
- Pediatric Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Amoozgar
- Pediatric Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Ajami
- Pediatric Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Arabi
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Huamán-Benancio G, Peralta-Ponce C, Vinelli-Arzubiaga D, Esquivel-León C, Padilla IP. [Outcomes of percutaneous balloon pulmonary valvuloplasty in pulmonary valve stenosis in the pediatric population in a single center, Lima - Peru]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:60-68. [PMID: 37351308 PMCID: PMC10284577 DOI: 10.47487/apcyccv.v3i2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/26/2022] [Indexed: 06/24/2023]
Abstract
Objective To evaluate the effectiveness of the procedure and outcomes during follow-up. Methods 80 patients with pulmonary valvular stenosis who underwent percutaneous balloon valvuloplasty between January 2014 and December 2019 are described. Demographic, echocardiographic, and hemodynamic characteristics of the procedure were evaluated. Follow-up included clinical, echocardiographic parameters, pulmonary regurgitation severity, and residual pulmonary gradient at each cutoff point. Results The age range was 2 years (interquartile range: 10.5 months - 6 years), and the predominant sex was male with 56.2%. The transvalvular pulmonary gradient decreased from 61.7 mmHg +- 21.2 to 17 mmHg (interquartile range: 11-26 mmHg). The immediate success rate was 90%. Follow-up time showed a median of 21 months (interquartile range: 5-47.5 months). All patients at follow-up showed some degree of pulmonary insufficiency at each cutoff point; 17% of the cases at the end of their follow-up were found to have severe insufficiency. Three cases of long-term restenosis were found (3.8%), and 6 (7.5%) were admitted for valvuloplasty surgery or pulmonary valve replacement. The complications reported reached 10% of cases, two patients were admitted to surgery during the procedure for major complications. A significant association was found with severe pulmonary insufficiency at the end of follow-up and ring/balloon ratio. Conclusions Percutaneous transluminal valvuloplasty with balloon is an effective technique in the treatment of pulmonary valvular stenosis, with reported complications but with good results during follow-up.
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Affiliation(s)
- Gian Huamán-Benancio
- Servicio clínico de Cardiología Pediátrica, Instituto Nacional Cardiovascular - INCOR, EsSalud. Lima, Perú. Servicio clínico de Cardiología Pediátrica Instituto Nacional Cardiovascular - INCOR, EsSalud Lima Perú
| | - Carlos Peralta-Ponce
- Servicio clínico de Cardiología Pediátrica, Instituto Nacional Cardiovascular - INCOR, EsSalud. Lima, Perú. Servicio clínico de Cardiología Pediátrica Instituto Nacional Cardiovascular - INCOR, EsSalud Lima Perú
| | - Daniella Vinelli-Arzubiaga
- . Facultad de Medicina, Universidad Ricardo Palma.. Lima, Perú Universidad Ricardo Palma Facultad de Medicina Universidad Ricardo Palma. Lima Peru
| | - Cesar Esquivel-León
- . Servicio clínico de Cardiología Pediátrica, Hospital Luis Albecht, EsSalud. Trujillo, Perú. Servicio clínico de Cardiología Pediátrica Hospital Luis Albecht, EsSalud Trujillo Perú
| | - Isabel Pinedo Padilla
- . Servicio de Endocrinología Hospital Carrión, MINSA. Lima, Perú. Servicio de Endocrinología Hospital Carrión MINSA Lima Perú
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Santarelli G, Bouvard J, Brethel SF, Gordon S, Lord S, Mavropoulou A, Oliveira P, Sykes KT, Swift S, Culshaw GJ. Non-cardiogenic pulmonary oedema complicating balloon valvuloplasty and stent angioplasty of severe pulmonary valve stenosis in four dogs. J Vet Cardiol 2021; 39:79-88. [PMID: 34999479 DOI: 10.1016/j.jvc.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 11/15/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
In dogs, balloon valvuloplasty is considered the treatment of choice for severe pulmonary valve stenosis, and this technique is currently performed routinely in specialist referral practices with low morbidity and mortality. Stent angioplasty has also been recently proposed as a viable treatment option. The present case series describes the clinical course of four dogs with severe pulmonary valve stenosis, treated with balloon valvuloplasty or stent angioplasty at four different institutions, which developed non-cardiogenic pulmonary oedema perioperatively after apparently successful dilation of the pulmonary valve. In three cases, there was evidence of some degree of pulmonary hypertension before ballooning. Despite intensive care, the complication proved fatal in three cases. Clinicians should therefore be aware of this life-threatening complication, previously undescribed in dogs.
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Affiliation(s)
- G Santarelli
- Cardiopulmonary Service, Hospital for Small Animals, Royal (Dick) School of Veterinary Studies & The Roslin Institute, The University of Edinburgh, Roslin, EH25 9RG, UK.
| | - J Bouvard
- Cardiopulmonary Service, Hospital for Small Animals, Royal (Dick) School of Veterinary Studies & The Roslin Institute, The University of Edinburgh, Roslin, EH25 9RG, UK
| | - S F Brethel
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, 32608, USA
| | - S Gordon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843, USA
| | - S Lord
- Anesthesia Service, Roslin, EH25 9RG, UK
| | - A Mavropoulou
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin, SG5 3HR, UK
| | - P Oliveira
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin, SG5 3HR, UK
| | - K T Sykes
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843, USA
| | - S Swift
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, 32608, USA
| | - G J Culshaw
- Cardiopulmonary Service, Hospital for Small Animals, Royal (Dick) School of Veterinary Studies & The Roslin Institute, The University of Edinburgh, Roslin, EH25 9RG, UK
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Amirghofran A, Edraki F, Edraki M, Ajami G, Amoozgar H, Mohammadi H, Emaminia A, Ghasemzadeh B, Borzuee M, Peiravian F, Kheirandish Z, Mehdizadegan N, Sabri M, Cheriki S, Arabi H. Surgical repair of tetralogy of Fallot using autologous right atrial appendages: short- to mid-term results. Eur J Cardiothorac Surg 2021; 59:697-704. [PMID: 33164039 DOI: 10.1093/ejcts/ezaa374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The prevention of pulmonary insufficiency (PI) is a crucial part of the tetralogy of Fallot repair. Many techniques have been introduced to construct valves from different materials for the right ventricular outflow tract, including the most commonly constructed monocusp valves. We are introducing a new bicuspid valve made intraoperatively using the autologous right atrial appendage (RAA) to prevent PI in these patients. METHODS The RAA valve was constructed and used in 21 patients with tetralogy of Fallot. The effective preservation of the native valve was impossible in all patients because of either a severe valve deformity or a small annulus. The RAA valve was created after ventricular septal defect closure and right ventricular outflow tract myectomy and was covered with a bovine transannular pericardial patch. The perioperative data were evaluated, and the echocardiography results were assessed immediately after operations and in follow-up with a median of 10.5 months. The data were retrospectively compared with 10 other patients with similar demographic data but with only transannular patches. RESULTS The mean age of the patients was 13.3 months. No mortality or related morbidity occurred after repair using the RAA valve. The PI severity early after the operation was trivial or no PI in 18 patients, and mild PI was observed in 3 patients, which progressed to moderate PI in one of them in the mean 12-month follow-up period. Fifteen patients had mild or no pulmonary stenosis, while moderate pulmonary stenosis was observed in 6 others. Compared with the other 10 patients with only transannular patches, the RAA valve patients had prolonged operative and clamping times, but no difference in postoperative course and shorter hospital stays. The degree of PI was, of course, significantly less in the RAA valve patients, but pulmonary stenosis was the same. CONCLUSIONS The RAA valve construction is a safe and effective technique to prevent PI after the tetralogy of Fallot repair, at least in terms of short- and mid-term results. A longer follow-up period is needed to confirm if this new valve can eliminate or significantly delay the need for pulmonary valve replacement in these patients.
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Affiliation(s)
| | | | - Mohammadreza Edraki
- Cardiovascular and Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Ajami
- Cardiovascular and Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Amoozgar
- Cardiovascular and Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Mohammadi
- Cardiovascular and Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Emaminia
- Inova Heart and Vascular Institute, Fall Church, VA, USA
| | - Bahram Ghasemzadeh
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Borzuee
- Cardiovascular and Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farah Peiravian
- Pediatric Department, Faculty of Medicine, Islamic Azad University, Kazerun Branch, Kazerun, Iran
| | - Zahra Kheirandish
- Pediatric Department, Faculty of Medicine, Islamic Azad University, Kazerun Branch, Kazerun, Iran
| | - Nima Mehdizadegan
- Cardiovascular and Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Hamid Arabi
- Shiraz University of Medical Sciences, Shiraz, Iran
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