Comparison of transcatheter atrial septal defect closure in children, adolescents and adults: Differences, challenges and short-, mid- and long-term results

WOS: 000387737700017PubMed ID: 27826346Background and Objectives: This study aims to compare the characteristics, effectiveness and results of transcatheter closure of atrial septal defect between children, adolescents, and adults. Subjects and Methods: In this study, 683 patients who underwent atrial septal defect closure in the last 10 years were divided into three groups: children (age 16) as group 1, group 2 and group 3, respectively. Results: The average defect size and incidence of complex atrial septal defect were higher in group 3 (p=0.0001 and 0.03 respectively). While the average size of the devic was higher in adults (22.6 +/- 6.4 mm vs. 18.5 +/- 4.9 mm; p=0.0001), the ratio of the device size/total septum was higher in both children and adolescents (Group 1 and 2). In the child and adolescent groups and patients with only complex atrial septal defect, the use of techniques, other than standard deployment, was similar in all three groups (p=0.86 and 0.41, respectively). The ratio of the residual shunt was similar in all three groups. Major complications were seen in 5 cases (4 cases with migration, and 1 case with dislocation) in group 3 and 1 case (migration) in group 1. Conclusion: Depending on the complexity of the defect and age of the patient, transcatheter closure of atrial septal defect might have certain difficulties and complications. Patients must be evaluated in detail to avoid major complications and possible problems during the procedure

Use of covered stents in simultaneous management of coarctation of the aorta and patent ductus arteriosus

WOS: 000429628000003PubMed ID: 29578201Objective: To report clinical and procedural characteristics of twelve patients who received a covered stent for the treatment of aortic coarctation and concurrent patent ductus arteriosus (PDA). Methods: A single center database was retrospectively evaluated to obtain data of patients with combined aortic coarctation and PDA. We selected patients in whom a covered stent was used for the treatment of both pathologies. The stent length was chosen so as to cover the entire length of the lesion from healthy to healthy tissue and also cover the ampulla of PDA. Results: The median age of the patients was 15 (range, 6.5-35) years. The diameter of the coarctated segment increased from a median of 8.4 (range, 2.6-10.8) mm to 16 (range, 9-24) mm (p<0.005), whereas the pressure gradient decreased from a median of 43 (range, 10-71) mm Hg to 0 (range, 0-8) mm Hg (p<0.005). Fourteen covered stents were used for 12 patients. Following deployment, seven stents were flared with larger and low-pressure balloons because of the gap between the distal end of the stent and the poststenotic dilated segment of the aorta, which caused residual PDA shunts and/or instability of the stent. After the procedure, no residual PDA shunt was present in any patient. Conclusion: To the best of our knowledge, this study includes the largest series of patients reported in literature in whom covered CP stents were used for simultaneous percutaneous treatment of coarctation and PDA. The procedure was successful and stable results were obtained during follow-up in all cases

Bezoara Bağlı İleus: Endoskopik Parçalamaya İkincil

Bezoar, gıda veya yabancı cisimlerin gastrointestinal sistemde taş benze-ri kitle şeklinde sertledir ve nadiren obstrüksiyona ve ileusa neden olur. Midede olan bezoar, genellikle konservatif yöntemlerle tedavi edilebilir. Bezoarlar endoskopik tedavisi sırasında genellikle parçalanarak gastroin-testinal sistemden çıkartılır. Obstrüksiyonu endoskopik tedavinin nadir bir komplikasyonudur ve genellikle gastrointestinal sistemden çıkartılamayan bezoar parçalarına bağlı gelişir. Bu yazıda endoskopik bezoar tedavisi son-rası ileus gelişen 78 yaşında kadın hasta sunulmuştur.Bezoar is a hardened mass of food or foreign objects found in the gastro- intestinal system, which occasionally causes obstruction and ileus. Bezoar, if present in the stomach, should generally be treated with conservative methods. During endoscopic treatment, bezoar is usually fragmented and removed. An uncommon complication of endoscopic treatment is gas- trointestinal obstruction because of unremoved fragments. We report a 78-year-old female with ileus after endoscopic fragmentation of bezoar

Scimitar syndrome: different clinical presentations and results

Amaç: Bu çalışmada Scimitar sendromu tanısı konulmuş hastalar değerlendirildi.Ça­lış­ma­pla­nı:­Çalışmaya Ocak 2003 - Aralık 2011 tarihleri arasında kliniğimizde Scimitar sendromu tanısı konulmuş ortalama ağırlıkları 16.7±21.8 kg olan, 12 hasta (8 kız, 4 erkek; ort. yaş 4.0±4.8 yıl; dağılım 1 ay - 16 yıl), alındı. Hastaların klinik bulguları, fizik muayene, telekardiyografi, ekokardiyografi, kalp kateterizasyonu ve cerahi bulguları ve izlem verileri geriye dönük olarak gözden geçirildi.Bul gu lar: On iki hastadan beşi (%42) infantil tip ve yedisi (%58) çocuk/erişkin tip Scimitar sendromu olarak değerlendirildi. İnfantil tipteki hastaların tümünde taşipne ve kalp yetersizliği bulguları varken, çocuk/erişkin tipteki hastaların birinde tekrarlayan alt solunum yolu enfeksiyonu öyküsü vardı. Ek kardiyak defektler hastaların yedisinde atriyal septal defekt, birinde aort koarktasyonu, ikisinde patent duktus arteriyozus ve birinde ventriküler septal defekt ile pulmoner atrezi idi. Bir hastada iki taraflı Scimitar sendromu vardı. İnfantil Scimitar sendromlu hastaların tümü şiddetli pulmoner hipertansiyonlu iken, çocuk/erişkin tipteki hastalardan biri hafif pulmoner hipertansiyonlu idi. Aortopulmoner kollateral arter saptanan dokuz hastadan altısında arter transkateter yolla kapatıldı. On hastaya (%83) cerrahi girişim uygulandı. İnfantil Scimitar sendromlu bir hasta ameliyat sonrası erken dönemde, ameliyat edilmeyen iki taraflı Scimitar sendromlu diğer bir hasta ise takipte akciğer enfeksiyonu nedeniyle kaybedildi.So nuç: Scimitar sendromu farklı klinik tablolarla seyredebilen nadir bir sendromdur. Çocuk/erişkin tip hastalığı olan hastalar sıklıkla asemptomatiktir; ancak tekrarlayan akciğer enfeksiyonları da izlenebilir. Aortopulmoner kollateral oklüzyon semptomatik iyileşme sağlayabilse de özellikle Scimitar veni tıkanmış ve ilave kardiyak anomalisi bulunan hastalarda cerrahi gerekir.Background: This study aims to evaluate patients diagnosed with Scimitar syndrome. Methods: Twelve patients (8 girls, 4 boys; mean age: 4.0&plusmn;4.8 years; range 1 month to 16 years) with a mean weight of 16.7&plusmn;21.8 kg who were diagnosed with Scimitar syndrome in our clinic between January 2003 and December 2011 were included. Clinical findings of the patients, physical examination, telecardiography, echocardiography, cardiac catheterization, and surgical findings and follow-up data were retrospectively reviewed. Results: Of 12 patients, five (42%) were considered with infantile type and seven (58%) with child/adult type Scimitar syndrome. All patients of infantile type presented with tachypnea and cardiac failure findings, while one patient with child/adult type had a history of recurrent lower respiratory tract infection. Additional cardiac defects were atrial septal defect in seven, coarctation in one, patent ductus arteriosus in two, and ventricular septal defect with pulmonary atresia in one patient. Bilateral Scimitary syndrome was present in one patient. All infantile type patients had severe pulmonary hypertension, while only one of the child/adult type patients had mild pulmonary hypertension. Six of nine patients with aortopulmonary collateral artery underwent transcatheter closure of the artery. Surgery was performed in 10 patients (83%). One patient with infantile type in the early postoperative period and another patient with bilateral Scimitar syndrome who was not operated during follow-up died due to pulmonary infection. Conclusion: Scimitar syndrome is a rare syndrome which may present with different clinical presentations. Patients with child/ adult type disease are often asymptomatic, however, may present with recurrent pulmonary infections. Although aortopulmonary collateral occlusion may provide symptomatic relief, surgery is indicated in patients with obstructed Scimitar vein and additional cardiac anomalies, in particular

A retrospective analysis of cases with left atrial isomerism

Amaç: Bu çalışmada sol atriyal izomerik hastalarında eşlik eden kardiyak patolojiler değerlendirildi ve takip sonuçları sunuldu. Çalış­ma­ planı:­ Temmuz 2002 - Aralık 2016 tarihleri arasında iki doğumsal kalp hastalıkları merkezinde sol atriyal izomerizmli toplam 72 hasta (25 erkek, 47 kız; ort. yaş 44.6±65.8 ay; dağılım 0 gün - 255 ay) retrospektif olarak incelendi. Olguların klinik, radyolojik, elektrokardiyografik, ekokardiyografik ve anjiyokardiyografik bulguları, cerrahi ve transkateter işlemler ve ameliyat sonrası takip verileri kaydedildi. Bulgu­lar:­ Ortalama takip süresi 108±49.5 (dağılım 12-173) ay idi. Yetmiş iki hastanın dördüne cerrahi gerekmez iken, iki hastaya kalıcı kalp pili takıldı. Cerrahi gereken 68 hastanın 17’si iki ventrikül tamiri adayı iken, geriye kalan 51 hasta tek ventrikül tamiri adayıydı. Yirmi dokuz hastaya Kawashima işlemi uygulandı. Bu hastaların yedisinde pulmoner antegrad akım açık bırakıldı. Dört hastada hepatik venler aynı seansta Fontan dolaşımına dahil edildi. Altı hastada takip sırasında ilerleyici siyanoz nedeniyle hepatik venler, ekstrakardiyak kondüit yardımıyla, pulmoner artere yönlendirildi. Cerrahi sonrasında üç hasta kaybedildi. Hepatik venlerin aynı seansta ya da ikinci bir seansta Fontan dolaşımına dahil edildiği hastalar veya antegrad pulmoner akımın açık bırakıldığı hastalarda mortalite veya ilerleyici siyanoz gözlenmedi. Sonuç:­ İki ventrikül fizyolojisine sahip hastaların genel prognozu mükemmeldir. Ancak, Kawashima işlemi yapılan hastalarda doku oksijenizasyonu düşme eğilimindedir. Bu nedenle, Kawashima işlemi yapılan hastalarda, aynı seansta hepatik venlerin dolaşıma dahil edilmesi veya uygun olgularda antegrad akımın açık bırakılması güvenli bir yaklaşım olarak görünmektedir.Background: In this study, we aimed to evaluate accompanying cardiac pathologies in patients with left atrial isomerism and report the follow-up results. Methods: A total of 72 patients (25 males, 47 females; mean age 44.6±65.8 months; range 0 day to 255 months) with left atrial isomerism in two congenital heart diseases centers were retrospectively analyzed between July 2002 and December 2016. Clinical, radiological, electrocardiographic, echocardiographic, and angiocardiographic findings of the patients, surgical and transcatheter procedures, and postoperative follow-up data were recorded. Results: The mean follow- up was 108±49.5 (range 12 to 173) months. Of 72 patients, four did not require surgery, while a permanent pacemaker was implanted in two patients. Of 68 patients who needed surgery, 17 were the candidates of biventricular correction, while the remaining 51 patients were the candidates of univentricular correction. The Kawashima procedure was performed in 29 patients. The pulmonary antegrade flow was left open in seven of these patients. In four patients, hepatic veins were incorporated into the Fontan circulation at the same session. In six patients, hepatic veins were directed to the pulmonary artery due to progressive cyanosis during follow-up using extracardiac conduit. Three patients died after surgery. Mortality or progressive cyanosis was not observed in any patients in whom the hepatic veins were incorporated into the Fontan circulation at the same or in another session, or in the patients in whom the antegrade flow was left open. Conclusion: The overall prognosis is excellent in patients with biventricular physiology. However, tissue oxygenation tends to fall in patients undergoing Kawashima procedure. Therefore, incorporation of the hepatic veins into the pulmonary circulation at the same session, or leaving the antegrade flow open in suitable cases seems to be a safe approach in patients undergoing Kawashima procedure

Diagnosis, Treatment and Outcomes of Patients with Aortopulmonary Window

Background: Aortopulmonary window (APW) is a communication between the ascending aorta and the pulmonary artery in the presence of two separate semilunar valves and is the rarest of septal defects. Aims: To present our experience with the diagnosis and outcome of APW cases. Study Design: Retrospective cohort study. Methods: Between June 2003 and October 2011, thirteen patients were diagnosed with APW. Clinical features of patients, findings of echocardiographic and angiographic examination, results of surgical intervention and follow-up were reviewed retrospectively. Results: Eleven children (10 days to 16 years), underwent surgical correction of APW. In a 12-month-old boy, the defect was repaired by the transcatheter approach. In addition to APW repair, closure of VSD was performed in 2 patients. APW were associated with interruption in two patients; one also had a complex pathology. None of the patients died due to complications of surgical or transcatheter procedures. After a median follow-up period of 40 months, the patients were asymptomatic and none of them required additional medication, except for the patient with complex pathology including an interrupted aortic arch, who underwent balloon angioplasty for recoarctation. Conclusion: In any infant with the findings of congestive heart failure and failure to thrive, APW must be kept in mind as a differential diagnosis. In isolated APW cases before 6 months of age, echocardiography is often sufficient for diagnosis. In complex cases, cardiac catheterisation is performed for the comprehensive evaluation of associated defects. After 6 months, cardiac catheterisation could be utilised to perform vasoreactivity testing and, if possible, to close the defect

Early Outcomes of Sutureless Aortic Valves

Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results: The mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time

Yenidoğan ve infant döneminde sağ ventrikül çıkım yoluna stent yerleştirilmesi: Çok merkezli, retrospektif çalışma

Background: The aim of this study was to evaluate the outcomes of right ventricular outflow tract stenting for palliation during the newborn and infancy periods. Methods: Between January 2013 and January 2018, a total of 38 patients (20 males, 18 females; median age 51 days; range, 3 days to 9 months) who underwent transcatheter right ventricular outflow tract stenting in three centers were retrospectively analyzed. Demographic characteristics, cardiac pathologies, angiographic procedural, and clinical follow-up data of the patients were recorded. Results: The diagnoses of the cases were tetralogy of Fallot (n=27), double outlet right ventricle (n=8), complex congenital heart disease (n=2), and Ebstein's anomaly (n=1). The median weight at the time of stent implantation was 3.5 (range, 2 to 10) kg. Five cases had genetic abnormalities. The median pre-procedural oxygen saturation was 63% (range, 44 to 80%), and the median procedural time was 60 (range, 25 to 120) min. Acute procedural success ratio was 87%. Reintervention was needed in seven of patients due to stent narrowing during follow-up. During follow-up period, seven cases died. Total correction surgery was performed in 26 patients without any mortality. While a transannular patch was used in 22 patients, valve protective surgery was implemented in two patients, and the bidirectional Glenn procedure was performed in two patients. Conclusion: Based on our study results, right ventricular outflow tract stenting is a form of palliation which should be considered particularly in cases in whom total correction surgery is unable to be performed due to morbidity.Amaç: Bu çalışmada yenidoğan ve infant döneminde palyasyon amaçlı sağ ventrikül çıkım yoluna stent uygulanan olguların değerlendirilmesi amaçlandı. Ça­lış­ma pla­nı: Ocak 2013 ve Ocak 2018 tarihleri arasında, üç merkezde, sağ ventrikül çıkım yoluna transkateter yoldan stent yerleştirilen toplam 38 hasta (20 erkek, 18 kadın; medyan yaş 51 gün; dağılım 3 gün-9 ay) retrospektif olarak incelendi. Hastaların demografik özellikleri, kardiyak patolojileri, anjiyografi işlem ve klinik izlem verileri kaydedildi. Bulgular: Tanılar Fallot tetralojisi (n=27), çift çıkışlı sağ ventrikül (n=8), kompleks doğumsal kalp hastalığı (n=2) ve Ebstein anomalisi (n=1) idi. Stent yerleştirme sırasında medyan ağırlık 3.5 (dağılım, 2-10) kg idi. Beş olguda genetik anormallikler mevcuttu. İşlem öncesi medyan oksijen satürasyonu %63 (dağılım, %44-80) ve medyan işlem süresi 60 (dağılım, 25-120) dk. idi. Akut işlem başarısı %87 idi. Takip döneminde stent daralması nedeniyle yedi hastaya tekrar girişim uygulandı. Takip döneminde, yedi olgu kaybedildi. Hastaların 26’sına mortalite olmaksızın tam düzeltme ameliyatı yapıldı. Yirmi iki hastada transanüler yama kullanılırken, iki hastada kapak koruyucu tam düzeltme ve iki hastada çift yönlü Glenn operasyonu gerçekleştirildi. So­nuç: Çalışma sonuçlarımıza göre, sağ ventrikül çıkım yoluna stent yerleştirilmesi, özellikle morbidite nedeni ile tam düzeltme ameliyatı yapılamayan olgularda akla gelmesi gereken bir palyasyon çeşididir