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The Journal of Thoracic and... Dec 2023To review outcomes after a uniform strategy of transventricular repair of tetralogy of Fallot.
OBJECTIVES
To review outcomes after a uniform strategy of transventricular repair of tetralogy of Fallot.
METHODS
A total of 244 consecutive patients underwent transventricular primary repair of tetralogy of Fallot from 2004 to 2019. Median age at operation was 71 days; 57 (23%) patients were premature; 57 (23%) patients had low birth weight (<2.5 kg), and 40 (16%) had genetic syndromes. The diameter of pulmonary valve annulus, right pulmonary artery (PA), and left PA were 6.0 ± 1.8 mm (z score, -1.7 ± 1.3), 4.3 ± 1.4 mm (z score, -0.9 ± 1.2) and 4.1 ± 1.5 mm (z score, -0.5 ± 1.3).
RESULTS
Three (1.2%) operative deaths were recorded. Ninety patients (37%) underwent transannular patching. Postoperative echocardiographic peak right ventricular outflow tract gradient decreased from 72 ± 27 mm Hg to 21 ± 16 mm Hg. Median intensive care unit and hospital stay were 3 and 7 days. The survival rate at 10 years was 94.6% ± 1.8%. Reintervention was required 86 times (55 catheter interventions) in 56 patients following tetralogy of Fallot repair. The freedom from all-cause reintervention rate at 10 years was 70.5% ± 3.6%. Cyanotic spells (hazard ratio, 2.14; 95% CI, 1.22-3.90; P < .01) and smaller pulmonary valve annulus z score (hazard ratio, 1.26; 95% CI, 1.01-1.59; P = .04) were associated with increasing risk of all reinterventions. Freedom from redo surgery for right ventricular outflow tract obstruction and right ventricular dilatation at 10 years were, respectively, 85.0% ± 3.1% and 98.7% ± 0.9%. Freedom from valve implantation was 96.7% ± 1.5% at 10 years.
CONCLUSIONS
A uniform strategy of primary repair of tetralogy of Fallot through a transventricular approach resulted in low reoperation rate in the first decade. The need of pulmonary valve implantation was limited to <4% at 10 years.
Topics: Humans; Infant; Tetralogy of Fallot; Reoperation; Treatment Outcome; Retrospective Studies; Pulmonary Valve
PubMed: 37301251
DOI: 10.1016/j.jtcvs.2023.05.036 -
Chinese Medical Journal Jun 2024Intrauterine valvuloplasty is an innovative therapy, which promotes ventricular growth and function in some congenital heart diseases (CHDs). The technique remains...
BACKGROUND
Intrauterine valvuloplasty is an innovative therapy, which promotes ventricular growth and function in some congenital heart diseases (CHDs). The technique remains challenging and can only be performed in a few centers. This study aimed to assess the feasibility and mid-term outcomes of fetal cardiac intervention (FCI) in fetuses with critical CHD in an experienced tertiary center.
METHODS
Five fetal aortic valvuloplasty (FAV) or fetal pulmonary valvuloplasty (FPV) procedures were performed in our fetal heart center between August 2018 and May 2022. Technical success was defined as crossing the aortic or pulmonary valve and balloon inflation, followed by evidence of increased blood flow across the valve and/or new regurgitation. Follow-up clinical records and echocardiography were obtained during the prenatal and postnatal periods.
RESULTS
Five fetuses received FAV or FPV, including critical aortic stenosis ( n = 2) and pulmonary atresia with intact ventricular septum ( n = 3). The mean maternal age was 33.0 ± 2.6 years. The median gestational age (GA) at diagnosis was 24 weeks (range, 22-26 weeks). The median GA at intervention was 29 weeks (range, 28-32 weeks). All five cases underwent successful or partially successful procedures. One patient had pulmonary valve perforation without balloon dilation. No procedure-related deaths or significant complications occurred. However, one neonatal death occurred due to heart and renal failure. The median follow-up period was 29.5 months (range, 8.0-48.0 months). The four surviving patients had achieved biventricular circulation, exhibited improved valve, and ventricular development at the last follow-up visit.
CONCLUSION
Intrauterine FCI could be performed safely with good prognosis in critical CHD.
Topics: Humans; Female; Heart Defects, Congenital; Pregnancy; Prognosis; Adult; Gestational Age; Echocardiography; Pulmonary Atresia; Balloon Valvuloplasty; Ultrasonography, Prenatal; Fetus; Aortic Valve Stenosis
PubMed: 37488672
DOI: 10.1097/CM9.0000000000002796 -
Advances in Experimental Medicine and... 2024Tetralogy of Fallot (TOF) is the most common cyanotic heart defect. TOF consists of the combination of four anomalies (Fig. 35.1): (1) a large malalignment ventricular... (Review)
Review
Tetralogy of Fallot (TOF) is the most common cyanotic heart defect. TOF consists of the combination of four anomalies (Fig. 35.1): (1) a large malalignment ventricular septal defect, (2) an obstruction of the right ventricular outflow tract (usually infundibular and valvular pulmonary stenosis with a small pulmonary valve annulus and supravalvular stenosis, (3) an aorta that "overrides" the ventricular septal defect, and (4) right ventricular hypertrophy. TOF represents 4-8% of congenital heart defects. Specific variations of TOF include all forms of pulmonary atresia with VSD and absent pulmonary valve syndrome. In addition, the left and right main pulmonary arteries may be stenotic or hypoplastic. In these cases, there may be major aortopulmonary collateral arteries (MAPCAs) which are vessels arising from the aorta or the subclavian arteries that supply segments of the pulmonary arterial tree. Additional variations include an ASD (Pentalogy of Fallot), a right aortic arch, and coronary abnormalities.
Topics: Tetralogy of Fallot; Humans; Double Outlet Right Ventricle
PubMed: 38884737
DOI: 10.1007/978-3-031-44087-8_35 -
Cardiovascular Revascularization... Aug 2023
Review
Topics: Humans; Aortic Valve Stenosis; Transcatheter Aortic Valve Replacement; Treatment Outcome; Aortic Valve; Percutaneous Coronary Intervention
PubMed: 37221118
DOI: 10.1016/j.carrev.2023.04.017 -
Cardiology in the Young Nov 2023Neurocognitive impairment and quality of life are two important long-term challenges for patients with complex CHD. The impact of re-interventions during adolescence and...
BACKGROUND
Neurocognitive impairment and quality of life are two important long-term challenges for patients with complex CHD. The impact of re-interventions during adolescence and young adulthood on neurocognition and quality of life is not well understood.
METHODS
In this prospective longitudinal multi-institutional study, patients 13-30 years old with severe CHD referred for surgical or transcatheter pulmonary valve replacement were enrolled. Clinical characteristics were collected, and executive function and quality of life were assessed prior to the planned pulmonary re-intervention. These results were compared to normative data and were compared between treatment strategies.
RESULTS
Among 68 patients enrolled from 2016 to 2020, a nearly equal proportion were referred for surgical and transcatheter pulmonary valve replacement (53% versus 47%). Tetralogy of Fallot was the most common diagnosis (59%) and pulmonary re-intervention indications included stenosis (25%), insufficiency (40%), and mixed disease (35%). There were no substantial differences between patients referred for surgical and transcatheter therapy. Executive functioning deficits were evident in 19-31% of patients and quality of life was universally lower compared to normative sample data. However, measures of executive function and quality of life did not differ between the surgical and transcatheter patients.
CONCLUSION
In this patient group, impairments in neurocognitive function and quality of life are common and can be significant. Given similar baseline characteristics, comparing changes in neurocognitive outcomes and quality of life surgical versus transcatheter pulmonary valve replacement will offer unique insights into how treatment approaches impact these important long-term patient outcomes.
PubMed: 38031461
DOI: 10.1017/S1047951123003979 -
Computer Methods and Programs in... Dec 2023Aimed at the shortcomings of using time interval ( [Formula: see text] ) between the sounds produced by the aortic valve closure (A) and the pulmonary valve closure (P)... (Review)
Review
BACKGROUND AND OBJECTIVE
Aimed at the shortcomings of using time interval ( [Formula: see text] ) between the sounds produced by the aortic valve closure (A) and the pulmonary valve closure (P) to detect the wide splitting of the second heart sound (S), which are the [Formula: see text] easily influenced by the heartbeat and not easily distinguished from the fixed splitting of S without considering the entire respiratory phase, and from the third heart sound (S), this study proposes a novel methodology to detect the wide splitting of S using an estimated split coefficient of S ( [Formula: see text] ) combined with an adaptive number (N) of S.
METHODOLOGY
The methodology is orderly summarized as follows: Stage 1 describes the segmentation-based S automatic location and extraction. A Gaussian mixture model (GMM)-based regression model for S is proposed to estimate the positions of A and P, then an overlapping rate (OLR)-based [Formula: see text] and the [Formula: see text] are estimated, and finally, a N-S is automatically determined to calculate the statistics of [Formula: see text] and [Formula: see text] . In stage 3, based on the combination of estimated features, the detection of wide splitting of S is determined.
RESULTS
The performance is evaluated using a total of 3350-period heart sounds from 72 patients, with an overall accuracy of 100%, F=1 and a Cohen's kappa value (κ) of 1.
DISCUSSION
The significant contributions are highlighted: A novel GMM-based efficient methodology is proposed for estimating the characteristics of A and P. A novel OLR-based [Formula: see text] is defined to replace the current state-of-the-art criterion for evaluating the split degree of S. Considering respiration phases combined with CR are proposed for the high-precision diagnosis of S wide split.
Topics: Humans; Heart Sounds; Heart Auscultation; Aortic Valve; Heart Rate; Thorax
PubMed: 37714021
DOI: 10.1016/j.cmpb.2023.107777 -
Prognostic implications of pulmonary vascular resistance in transcatheter aortic valve implantation.Heart (British Cardiac Society) Dec 2023
Topics: Humans; Transcatheter Aortic Valve Replacement; Prognosis; Aortic Valve; Aortic Valve Stenosis; Vascular Resistance; Treatment Outcome; Risk Factors
PubMed: 37553140
DOI: 10.1136/heartjnl-2023-323094 -
Advances in Experimental Medicine and... 2024d-Transposition of the great arteries (d-TGA) is the most common form of congenital heart disease that presents with cyanosis in a newborn. The aorta arises from the... (Review)
Review
d-Transposition of the great arteries (d-TGA) is the most common form of congenital heart disease that presents with cyanosis in a newborn. The aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. It constitutes 3-5% of all congenital heart defects. In a simple d-TGA (about two-thirds of patients), there is no other cardiac abnormality other than a patent foramen ovale (PFO) and a patent ductus arteriosus (PDA). In a complex d-TGA additional cardiac abnormalities such as VSD, pulmonary stenosis or coronary abnormalities are present. About one-third to 40% of patients with d-TGA have an associated ventricular septal defect. Among patients with d-TGA, 6% of those with intact ventricular septum and 31% of those with ventricular septal defect have associated pulmonary stenosis. Coronary abnormalities are of importance with regard to the complexity of surgical repair.
Topics: Transposition of Great Vessels; Humans; Infant, Newborn; Heart Septal Defects, Ventricular; Cardiac Surgical Procedures; Pulmonary Valve Stenosis
PubMed: 38884740
DOI: 10.1007/978-3-031-44087-8_38 -
Advances in Experimental Medicine and... 2024Truncus arteriosus (TA, also known as common arterial trunk) consists of only one great artery ("the truncus") with a semilunar valve (truncus valve) arising from the...
Truncus arteriosus (TA, also known as common arterial trunk) consists of only one great artery ("the truncus") with a semilunar valve (truncus valve) arising from the heart and an additional ventricular septal defect and (Fig. 50.1). This great artery is positioned above the ventricular septal defect and gives rise to the coronary arteries, the pulmonary arteries, and the aortic arch. Historically, TA has been classified by Collet and Edwards in three types, where in type I there was a common pulmonary artery truncus, in type II the left and right PA arise separately but close to each other, in type III both PA arise independently; in addition, there was a type IV that was later characterized as pulmonary atresia with VSD and major aortopulmonary collateral arteries arising from the descending aorta.
Topics: Humans; Pulmonary Artery; Pulmonary Atresia; Truncus Arteriosus; Truncus Arteriosus, Persistent
PubMed: 38884752
DOI: 10.1007/978-3-031-44087-8_50 -
Circulation May 2024Tricuspid valve disease is an often underrecognized clinical problem that is associated with significant morbidity and mortality. Unfortunately, patients will often... (Review)
Review
Tricuspid valve disease is an often underrecognized clinical problem that is associated with significant morbidity and mortality. Unfortunately, patients will often present late in their disease course with severe right-sided heart failure, pulmonary hypertension, and life-limiting symptoms that have few durable treatment options. Traditionally, the only treatment for tricuspid valve disease has been medical therapy or surgery; however, there have been increasing interest and success with the use of transcatheter tricuspid valve therapies over the past several years to treat patients with previously limited therapeutic options. The tricuspid valve is complex anatomically, lying adjacent to important anatomic structures such as the right coronary artery and the atrioventricular node, and is the passageway for permanent pacemaker leads into the right ventricle. In addition, the mechanism of tricuspid pathology varies widely between patients, which can be due to primary, secondary, or a combination of causes, meaning that it is not possible for 1 type of device to be suitable for treatment of all cases of tricuspid valve disease. To best visualize the pathology, several modalities of advanced cardiac imaging are often required, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, to best visualize the pathology. This detailed imaging provides important information for choosing the ideal transcatheter treatment options for patients with tricuspid valve disease, taking into account the need for the lifetime management of the patient. This review highlights the important background, anatomic considerations, therapeutic options, and future directions with regard to treatment of tricuspid valve disease.
Topics: Humans; Tricuspid Valve; American Heart Association; United States; Heart Valve Diseases; Tricuspid Valve Insufficiency; Heart Valve Prosthesis Implantation
PubMed: 38660790
DOI: 10.1161/CIR.0000000000001232