Trasiranje žičare

Trasiranje žičare

Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association

Objective: This study aims to analyse the collective experience of participating European Congenital Heart Surgeons Association centres in the surgical management of complications resulting from trans-catheter closure of atrial septal defects (ASDs). Methods: The records of all (n=56) patients, aged 3-70 years (median 18 years), who underwent surgery for complications of trans-catheter ASD closure in 19 participating institutions over a 10-year period (1997-2007) were retrospectively reviewed. Risk factors for surgical complications were sought. Surgical outcomes were compared with those reported for primary surgical ASD closure in the European Association of Cardio-thoracic Surgery Congenital Database. Results: A wide range of ASD sizes (5-34mm) and devices of various types and sizes (range 12-60mm) were involved, including 13 devices less than 20mm. Complications leading to surgery included embolisation (n=29), thrombosis/thrombo-embolism/cerebral ischaemia or stroke (n=12), significant residual shunt (n=12), aortic or atrial perforation or erosion (n=9), haemopericardium with tamponade (n=5), aortic or mitral valve injury (n=2) and endocarditis (n=1). Surgery (39 early emergent and 17 late operations) involved device removal, repair of damaged structures and ASD closure. Late operations were needed 12 days to 8 years (median 3 years) after device implantation. There were three hospital deaths (mortality 5.4%). During the same time period, mortality for all 4453 surgical ASD closures reported in the European Association of Cardio-Thoracic Surgery Congenital Database was 0.36% (p=0.001). Conclusions: Trans-catheter device closure of ASDs, even in cases when small devices are used, can lead to significant complications requiring surgical intervention. Once a complication leading to surgery occurs, mortality is significantly greater than that of primary surgical ASD closure. Major complications can occur late after device placement. Therefore, lifelong follow-up of patients in whom ASDs have been closed by devices is mandator

Rare case of a mixed type total anomalous pulmonary venous return – benefits of a patient specific 3D model in the preoperative preparation

Изобразяването на точна морфологична диагноза при дете с рядка и комплексна вродена сърдечна малформация (ВСМ) е от изключително значение при планирането на хирургичната корекция и по възможност за редуциране на оперативния риск. Представяме случай на 3-месечно кърмаче с рядък вариант на тотално аномално вливане на белодробни вени (ТАВБВ) от разпръснат (смесен) тип, който илюстрира ползата от употребата на допълнителни образни методи и техники при оперативното планиране. Аномалният дренаж на белодробните вени (БВ) на пациента е както следва: лява и дясна долни БВ – дренирани в коронарния венозен синус, дренаж на горната лява БВ чрез вертикален съд към вена иномината и дренаж на горна дясна БВ към горна празна вена. Клиничната картина се изразява в развитие на сърдечна недостатъчност, белодробен венозен застой и лекостепенна хипоксемия в рамките на първите дни след раждането. Трансторакалната ехокардиография (ТТЕ) демонстрира критериите на ТАВБВ, но чрез метода е трудно определянето на всички от изброените анатомични особености. Точната морфологична диагноза е поставена чрез контрастна компютърна аксиална томография (КАТ). Допълнителните техники на 3D моделиране и 3D принтиране на пациент-специфичен модел на база на проведената КАТ допринесоха за планиране на хирургичната стратегия. Пациентът е опериран на 3- месечна възраст, като уникалното за случая е, че при операцията са използвани всички оперативни техники за корекция на ТАВБВ – деруфинг на коронарен венозен синус, анастомоза на дрениращ съд към ляво предсърдие и Warden техника за тунелиране на горнолобарните десни белодробни вени от устието на горна празна вена към ляво предсърдие. Обратната връзка от оперативния екип показва, че допълнителните образни методи и принтираният 3D модел представят патологичните особености в степен, напълно отговаряща на интраоперативната находка. Accurate imaging of the morphology in a child with a rare and complex congenital heart disease (CHD) is crucial for the surgical planning and, if possible – the minimization of operative risk. We present a case of a 3-month-old child with a rare variant of Total Anomalous Pulmonary Venous Return (TAPVR) – mixed type – which illustrates the benefi t of additional imaging modalities and techniques for the operative planning. The patient’s anomalous drainage of the pulmonary veins (PV) is as follows: left and right lower PVs drained in the coronary venous sinus, left upper PV drained via a vertical vein into the innominate vein and the right upper PV drained into the superior vena cava (SVC). Clinical fi ndings consist of heart failure (HF), pulmonary venous congestion and mild hypoxemia developing within the fi rst days after birth. Transthoracic echocardiography (TTE) demonstrates the features of TAPVR, but the modality is unable to differentiate all of the described anatomic details. Accurate morphological diagnosis is obtained via contrast Computed Tomography (CT). The. additional techniques of 3D modelling and 3D printing of a patient-specifi c model, based on the acquired CT, contributed to the planning of the surgical strategy. The patient underwent a radical operation at age of 3 months. The unique aspect of the case is the application of all possible operative techniques for correction of TAPVR – coronary sinus deroofi ng, anastomosis of a draining vessel into the left atrial appendage and Warden procedure which involves tunnelling of the right upper PVs from the SVC into the left atrium. Feedback from the surgical team shows that the additional imaging methods and the printed 3D model represent the pathology in detail that completely corresponds to the intra-operative fi nding

Rare case of a mixed type total anomalous pulmonary venous return – benefits of a patient specific 3D model in the preoperative preparation

Изобразяването на точна морфологична диагноза при дете с рядка и комплексна вродена сърдечна малформация (ВСМ) е от изключително значение при планирането на хирургичната корекция и по възможност за редуциране на оперативния риск. Представяме случай на 3-месечно кърмаче с рядък вариант на тотално аномално вливане на белодробни вени (ТАВБВ) от разпръснат (смесен) тип, който илюстрира ползата от употребата на допълнителни образни методи и техники при оперативното планиране. Аномалният дренаж на белодробните вени (БВ) на пациента е както следва: лява и дясна долни БВ – дренирани в коронарния венозен синус, дренаж на горната лява БВ чрез вертикален съд към вена иномината и дренаж на горна дясна БВ към горна празна вена. Клиничната картина се изразява в развитие на сърдечна недостатъчност, белодробен венозен застой и лекостепенна хипоксемия в рамките на първите дни след раждането. Трансторакалната ехокардиография (ТТЕ) демонстрира критериите на ТАВБВ, но чрез метода е трудно определянето на всички от изброените анатомични особености. Точната морфологична диагноза е поставена чрез контрастна компютърна аксиална томография (КАТ). Допълнителните техники на 3D моделиране и 3D принтиране на пациент-специфичен модел на база на проведената КАТ допринесоха за планиране на хирургичната стратегия. Пациентът е опериран на 3- месечна възраст, като уникалното за случая е, че при операцията са използвани всички оперативни техники за корекция на ТАВБВ – деруфинг на коронарен венозен синус, анастомоза на дрениращ съд към ляво предсърдие и Warden техника за тунелиране на горнолобарните десни белодробни вени от устието на горна празна вена към ляво предсърдие. Обратната връзка от оперативния екип показва, че допълнителните образни методи и принтираният 3D модел представят патологичните особености в степен, напълно отговаряща на интраоперативната находка. Accurate imaging of the morphology in a child with a rare and complex congenital heart disease (CHD) is crucial for the surgical planning and, if possible – the minimization of operative risk. We present a case of a 3-month-old child with a rare variant of Total Anomalous Pulmonary Venous Return (TAPVR) – mixed type – which illustrates the benefi t of additional imaging modalities and techniques for the operative planning. The patient’s anomalous drainage of the pulmonary veins (PV) is as follows: left and right lower PVs drained in the coronary venous sinus, left upper PV drained via a vertical vein into the innominate vein and the right upper PV drained into the superior vena cava (SVC). Clinical fi ndings consist of heart failure (HF), pulmonary venous congestion and mild hypoxemia developing within the fi rst days after birth. Transthoracic echocardiography (TTE) demonstrates the features of TAPVR, but the modality is unable to differentiate all of the described anatomic details. Accurate morphological diagnosis is obtained via contrast Computed Tomography (CT). The. additional techniques of 3D modelling and 3D printing of a patient-specifi c model, based on the acquired CT, contributed to the planning of the surgical strategy. The patient underwent a radical operation at age of 3 months. The unique aspect of the case is the application of all possible operative techniques for correction of TAPVR – coronary sinus deroofi ng, anastomosis of a draining vessel into the left atrial appendage and Warden procedure which involves tunnelling of the right upper PVs from the SVC into the left atrium. Feedback from the surgical team shows that the additional imaging methods and the printed 3D model represent the pathology in detail that completely corresponds to the intra-operative fi nding

Catheter ablation of macroreentrant atrial tachycardias following transconduit puncture access in a patient after total cavopulmonary connection with an extracardiac conduit

Представяме случай на 23-годишен мъж с комплексна вродена сърдечна малформация с еднокамерна физиология, наложила многократни оперативни интервенции, включително и извършване на тотална кавопулмонална анастомоза. Пациентът се представя с често (почти ежедневно) рецидивираща предсърдна тахикардия с висока камерна честота и лоша субективна и хемодинамична поносимост. Поради неуспех от лечението с антиаритмични медикаменти пациентът беше насочен за извършване на катетърна аблация. За достъп до предсърдието беше използвана пункция на кондуита със стандартен комплект за транссептална пункция. Преминаването на транссепталния интродюсер в предсърдието беше неуспешно поради значителна резистентност от стената на кондуита и предсърдната стена. Затова се наложи балонна дилатация на пункционното отверстие с режещ балон, което даде възможност за безпрепятствено въвеждане на управляем транссептален интродюсер в предсърдието. Индуцираха се няколко предсърдни тахиаритмии, две от които позволиха изграждане на активационна карта. Диагностицираха се макрориентри тахикардия, вероятно зависима от кавоануларния истмус, и макрориентри тахикардия със сложен кръг тип осморка, ангажираща десните белодробни вени и деснопредсърдното ухо. След създаване на линейни лезии през критичните истмуси на двата кръга се постигна неиндуцируемост. Пациентът е проследен за период от 9 месеца, през които не са регистрирани ритъмни нарушения.  We present the case of a 23-year-old male diagnosed with a complex congenital heart disease (with single ventricle physiology) which necessitated many surgical interventions including total cavopulmonary connection. The patient presents with recurrent (almost daily) highly symptomatic atrial tachycardia with rapid ventricular rate and poor haemodynamic tolerance. Due to failure of antiarrhythmic drug therapy the patient was referred for catheter ablation. Atrial access was provided following transconduit puncture with a standard transseptal set. Crossing to the atrium with the transseptal introducer was not successful due to resistance from the conduit and the atrial wall. Therefore, balloon dilation of the puncture using a cutting balloon was carried out which resulted in easy crossing to the atrium with a steerable transseptal introducer. Several atrial tachyarrhythmias were induced two of which allowed mapping demonstrating a macroreentrant tachycardia dependent on the cavoannular isthmus as well as a complex figure-of-eight circuit involving right pulmonary veins and the right atrial appendage. Linear lesions transecting the critical isthmuses of the two circuits were delivered which rendered the patient noninducible. During a 9-month follow-up period the patient remained arrhythmia free

Right Ventricular Outflow Tract Reconstruction in Truncus Arteriosus: A 30-Year Two-Center Comparison between Homografts and Bovine Jugular Vein

ABSTRACT Introduction: Homografts and bovine jugular vein are the most commonly used conduits for right ventricular outflow tract reconstruction at the time of primary repair of truncus arteriosus. Methods: We reviewed all truncus patients from 1990 to 2020 in two mid-volume centers. Inclusion criteria were primary repair, age under one year, and implantation of either homograft or bovine jugular vein. Kaplan-Meier analysis was used to estimate survival, freedom from reoperation on right ventricular outflow tract, and freedom from right ventricular outflow tract reoperation or catheter intervention. Results: Seventy-three patients met the inclusion criteria, homografts were implanted in 31, and bovine jugular vein in 42. There was no difference in preoperative characteristics between the two groups. There were 25/73 (34%) early postoperative deaths and no late deaths. Follow-up for survivals was 17.5 (interquartile range 13.5) years for homograft group, and 11.5 (interquartile range 8.5) years for bovine jugular vein group (P=0.002). Freedom from reoperation on right ventricular outflow tract at one, five, and 10 years in the homograft group were 100%, 83%, and 53%; and in bovine jugular vein group, it was 100%, 85%, and 50% (P=0.79). There was no difference in freedom from reoperation or catheter intervention (P=0.32). Conclusion: Bovine jugular vein was equivalent to homografts up to 10 years in terms of survival and freedom from right ventricular outflow tract reoperation or catheter intervention. The choice of either valved conduit did not influence the durability of the right ventricle-pulmonary artery conduit in truncus arteriosus

Surgical options after Fontan failure

Objective The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-) HTX. Methods A retrospective international study was conducted by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). Results The most prevalent indication for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p Conclusions Takedown surgery for failing Fontan is mostly performed in the early postoperative phase, with a high risk of mortality. There is no difference in survival after Fontan conversion or HTX.Peer reviewe

Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association

Objective: This study aims to analyse the collective experience of participating European Congenital Heart Surgeons Association centres in the surgical management of complications resulting from trans-catheter closure of atrial septal defects (ASDs). Methods: The records of all (n = 56) patients, aged 3-70 years (median 18 years), who underwent surgery for complications of trans-catheter ASD closure in 19 participating institutions over a 10-year period (1997-2007) were retrospectively reviewed. Risk factors for surgical complications were sought. Surgical outcomes were compared with those reported for primary surgical ASD closure in the European Association of Cardio-thoracic Surgery Congenital Database. Results: A wide range of ASD sizes (5-34 mm) and devices of various types and sizes (range 12-60 mm) were involved, including 13 devices less than 20 mm. Complications leading to surgery included embolisation (n = 29), thrombosis/thrombo-embolism/cerebral ischaemia or stroke (n = 12), significant residual shunt (n = 12), aortic or atrial perforation or erosion (n = 9), haemopericardium with tamponade (n = 5), aortic or mitral valve injury (n = 2) and endocarditis (n = 1). Surgery (39 early emergent and 17 late operations) involved device removal, repair of damaged structures and ASD closure. Late operations were needed 12 days to 8 years (median 3 years) after device implantation. There were three hospital deaths (mortality 5.4%). During the same time period, mortality for all 4453 surgical ASD closures reported in the European Association of Cardio-Thoracic Surgery Congenital Database was 0.36% ( p = 0.001). Conclusions: Trans-catheter device closure of ASDs, even in cases when small devices are used, can lead to significant complications requiring surgical intervention. Once a complication leading to surgery occurs, mortality is significantly greater than that of primary surgical ASD closure. Major complications can occur late after device placement. Therefore, lifelong follow-up of patients in whom ASDs have been closed by devices is mandatory. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Surgical options after Fontan failure

OBJECTIVE: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. METHODS: A retrospective international study was conducted by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). RESULTS: The most prevalent indication for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p<0.001). Fontan takedown was mostly performed in the early postoperative phase after Fontan completion, while Fontan conversion and HTX were mainly treatment options for late failure. Early (30 days) mortality was high for Fontan takedown (ie, 26%). Median follow-up was 5.9 years (range 0-23.7 years). The combined end point mortality/HTX was reached in 44.7% of the Fontan takedown patients, in 26.3% of the Fontan conversion patients and in 34.0% of the HTX patients, respectively (log rank p=0.08). Survival analysis showed no difference between Fontan conversion and HTX (p=0.13), but their ventricular function differed significantly. In patients who underwent Fontan conversion or HTX ventricular systolic dysfunction appeared to be the strongest predictor of mortality or (re-)HTX. Patients with valveless atriopulmonary connection (APC) take more advantage of Fontan conversion than patients with a valve-containing APC (p=0.04). CONCLUSIONS: Takedown surgery for failing Fontan is mostly performed in the early postoperative phase, with a high risk of mortality. There is no difference in survival after Fontan conversion or HTX.status: publishe