Interventional techniques in congenital heart disease (original) (raw)
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Combined Surgical and Interventional Approaches for Treating Patients with Congenital Heart Disease
Journal of Cardiac Surgery, 2015
During the last decade the cooperation between surgeons and cardiologists has further expanded by combining surgical and interventional techniques (CCBSI) performed in the operating room, without the use of fluoroscopy. We sought to evaluate the results of our experience with CCBSI. Methods: All children with congenital heart disease (CHD) who underwent a CCBSI in the operating room between June 2007 and January 2014 were enrolled. Results: Sixty-eight patients were included. Median age at CCBSI was five months (range 1-48 months). The three main diagnoses leading to surgery included: (1) tetralogy of Fallot (TOF) (n = 40), (2) muscular ventricular septal defects (VSD) (n = 12), (3) single ventricle with pulmonary artery branch stenosis (n = 4). There were 72 catheter-based procedures associated with surgical maneuvres, including: (1) transatrial balloon dilation (BD) of the pulmonary valve (n = 45), (2) transinfundibular BD of the main pulmonary artery trunk (n = 12), (3) perventricular VSD closure with septal occluder (n = 8), (4) BD of pulmonary artery branches (n = 5), and other less common procedures (n = 2). There were no procedurerelated complications and no hospital deaths. Median follow-up time was four years (range 0.95-7.9 years). There was one late death for respiratory distress after transapical balloon dilation of the aortic valve. One patient required BD and stenting of the left pulmonary artery branch 3.6 years after intraoperative BD for residual stenosis. Conclusions: The CCBSI represents a safe and effective treatment for selected patients with complex CHD. It will be helpful in minimizing patients' surgical trauma and in shortening or avoiding the use of cardiopulmonary bypass.
Balloon valvuloplasty for treating pulmonic, mitral and aortic valve stenosis
The American Journal of Cardiology, 1988
Percutaneous balloon valvuloplasty is a technique that has been developed in the cardiac catheterization laboratory over the last 5 years for the treatment of pulmonic, mitral and aortic valve stenosis in children and adults. This review will attempt to summarize recent advances in this new field of invasive cardiology over the last several years. (Am J Cardiol 1988;61:102G-108G) Over the last 5 years, percutaneous balloon valvuloplasty has emerged as a new treatment for pulmonic, mitra] and aortic valve stenosis in both children and adults. Preliminary reports have described highly successful procedures with a low complication rate as well as significant short-term hemodynamic and symptomatic improvement. Whereas the Food and Drug Administration has recently approved pulmonary valvuloplasty for clinical use, balloon valvuloplasty of other valves is still an experimental technique whose overall safety and long-term efficacy are currently under investigation. This review summarizes the advances in valvuloplasty equipment and technique over the last several years, as well as current indications, results and complications. Lessons Learned from Surgery Pulmonic stenosis: Recognition of the potential use of balloon dilatation to treat valvular stenosis was a natural consequence of the early surgical experience with mechanical dilatation of stenotic pulmonary, mitral and aortic valves. The earliest reports on the surgical treatment of congenital pulmonic stenosis involved the Brock procedure, 1 in which a valvulotome was introduced through a small incision in the right ventricle and advanced through the pulmonic valve to incise congenitally fused valvular commissures. The commissural incisions were subsequently enlarged using a graded series of bougies, and then completed with a hinged dilating instrument. Although the eventual development of cardiopulmonary bypass allowed open
Arquivos brasileiros de cardiologia, 2016
Good clinical evolution was observed after correction of marked critical pulmonary valve stenosis, with central orifice with one (01) mm of diameter of valve opening, in a case of right heart failure and cyanosis by right to left shunt through foramen ovale, on an emergency basis, with circulatory arrest without cardiopulmonary bypass, at 4 months of age. On that occasion, a commissurotomy of the trivalvular pulmonary valve through the pulmonary trunk was performed. Mild systolic murmur in the pulmonary area, though less intense than before surgery, which remained audible until adolescence. Currently, the patient is able to carry out routine activities and does not refer any symptoms. The patient has led a normal life, having graduated in law at a traditional university with normal and well tolerated physical performance.
Nonsurgical pulmonary valve replacement: Why, when, and how?
Catheterization and Cardiovascular Interventions, 2004
Patients with surgery on the right ventricular outflow tract for congenital heart disease constitute the most common group for reoperations during late follow-up. Surgical pulmonary valve replacement can be performed with low mortality; however, it sets up a substrate for future operations. Also, the risk of cardiopulmonary bypass, infection, bleeding, and ventricular dysfunction remains. A transcatheter technique is likely to have more acceptance and may expand the indications for early intervention for right ventricular outflow tract dysfunction. Catheter Cardiovasc Interv 2004;62:401-408.
THORACIC AND CARDIOVASCULAR SURGERY SURGERY FOR CONGENITAL HEART DISEASE
2000
82 conduits were placed in the outflow of the venous ventricle. Patients who received homografts (n = 2 patients), heterografts (n = 3 patients), and valveless conduits (n = 19 patients) and those patients who died within 90 days after the operation were excluded. Fifty-four survivors of pulmonary outflow reconstruction with fresh autologous pericardial valved conduits were followed up from 5 to 15 years (mean, 7.47 ± 2.8 years). Diagnosis include D-transposition of great arteries (n = 16 patients), L-transposition of great arteries (n = 14 patients), tetralogy of Fallot, pulmonary atresia with ventricular septal defect (n = 11 patients), truncus arteriosus (n = 10 patients), and double-outlet ventricle (n = 3 patients). Implantation age ranged from 0.25 to 24 years (mean, 5.2 ± 4.2 years). Median conduit diameter was 16 mm. Two-dimensional echocardiographic Doppler evaluations were made yearly; 9 patients underwent cardiac catheterization. Reintervention for stenosis was indicated when the pressure gradient exceeded 50 mm Hg.
A sutureless technique for the relief of pulmonary vein stenosis with the use of in situ pericardium
The Journal of Thoracic and Cardiovascular Surgery, 1998
Pulmonary vein (PV) stenosis develops as a progressive and usually lethal complication after surgical repair of total anomalous PV connection. Conventional surgical repair for the management of recurrent PV stenosis has been generally unsuccessful because of proliferative neointimal hyperplasia resulting in recurrent PV obstruction. The factors that result in recurrent stenosis after the usual types of patch venoplasty are unknown. We speculated that direct suturing of PVs and patch material may be the substrate for turbulent blood flow triggering intimal hyperplasia and eventual narrowing of the vein. On the basis of these considerations, we developed a sutureless technique for repairing PV stenosis with in situ pericardium. We present here its early but promising results.
Hybrid Procedures for Complex Congenital Cardiac Lesions
The Heart Surgery Forum, 2009
Background: We present an alternative treatment employing a hybrid approach used in 3 patients with congenital heart disease. The goal was to provide optimal therapy by minimizing the potentially harmful effects of methods that accompany conventional surgical procedures. Methods: Two patients aged 4 and 6 months underwent beating-heart closure of a muscular ventricular septal defect (VSD) with an occluding device. In addition, an 8-year-old patient with supraaortic, main, and branch pulmonary artery (PA) stenosis underwent conventional surgical patch augmentation of the ascending aorta and the main PA and intraoperative stenting of the branch PA stenoses. Results: No patient deaths occurred. One patient developed a postoperative pneumothorax. Median intensive care unit and hospital stays for the VSD patients were 1 and 5 days and for the other patients 2 and 20 days, respectively. At median follow-up of 25 months, all patients were well and had required no further interventions. Conclusions: Patients with muscular VSD can currently be treated with the hybrid approach. Intraoperative PA stenting in addition to conventional surgical repair can be performed safely and may be complementary in patients with complex lesions.
Pulmonary Artery Branch Stenosis in Patients with Congenital Heart Disease
OBJECTIVE: We sought to evaluate our recent experience with surgical treatment of branch pulmonary artery (PA) stenosis both for native and acquired lesions. MATERIALS AND METHODS: The postoperative course of patients who underwent surgical PA plasty augmentation between January 2004 and January 2012 were reviewed. Primary outcomes included the need for further surgical procedures or interventional maneuvers on the branch PAs for residual stenosis. RESULTS: Thirty-four patients were included. Median age at PA plasty was eight months (range 8 days to 3.4 years). There were 12 native and 22 acquired PA stenoses, which were mainly located at the PA branch origin (n = 25, 73%). The PA plasty was defined as simple (n = 16, 47%) and as complex (n = 18, 53%), which included multiple maneuvers on the PA branches. Median follow-up time after surgical treatment was 4.7 years (range 0.9 to 8.7 years). One patient died 3 days after complex PA plasty for low output syndrome and another died 22 months later for congestive heart failure. Twenty-one (63.6%) underwent 40 catheter intervention procedures on the PA branches for residual stenosis. The majority of them (n = 10, 57.1%) were operated before the age of six months and the majority had an acquired PA stenosis (14, 66.7%). Three patients underwent additional surgical maneuvers on the PA branches. CONCLUSIONS: PA branch stenosis represents a life-threatening condition often necessitating further surgical or interventional treatment. A combined collaborative surgical followed by transcatheter approach is important, particularly in cases with an acquired PA stenosis who require complex surgical repair.