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Serial Lung Perfusion Scintigraphy After Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals. 法洛四联症合并主动脉-肺主干支系修复后的连续肺灌注显像。
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1177/21501351231162959
Lisa Wise-Faberowski, Jin Long, Michael Ma, Helen R Nadel, Jennifer Shek, Jeffrey A Feinstein, Elisabeth Martin, Frank L Hanley, Doff B McElhinney

Background: In patients with tetralogy of Fallot and major aortopulmonary collaterals (MAPCAs), pulmonary blood supply is highly variable. Our approach to this condition emphasizes complete unifocalization of the pulmonary circulation, incorporating all lung segments and addressing stenoses out to the segmental level. Post-repair, we recommend serial lung perfusion scintigraphy (LPS) to assess short-term changes in pulmonary blood flow distribution.

Methods: We reviewed post-discharge and follow-up LPS performed through three years post-repair and analyzed serial changes in perfusion, risk factors for change, and the relationship between LPS parameters and pulmonary artery reintervention.

Results: Of 543 patients who had postoperative LPS results in our system, 317 (58%) had only a predischarge LPS available for review, while 226 had 1 (20%) or more (22%) follow-up scans within three years. Overall, pulmonary flow distribution prior to discharge was balanced, and there was minimal change over time; however, there was considerable patient-to-patient variation in both metrics. On multivariable mixed modeling, time after repair (P = .025), initial anatomy consisting of a ductus arteriosus to one lung (P < .001), and age at repair (P = .014) were associated with changes on serial LPS. Patients who had follow-up LPS were more likely to undergo pulmonary artery reintervention, but within that cohort, LPS parameters were not associated with reintervention risk.

Conclusion: Serial LPS during the first year after MAPCAs repair is a noninvasive method of screening for significant post-repair pulmonary artery stenosis that occurs in a small but important minority of patients. In patients who received follow-up LPS beyond the perioperative period, there was minimal change over time in the population overall, but large changes in some patients and considerable variability. There was no statistical association between LPS findings and pulmonary artery reintervention.

背景:在法洛四联症和主要主动脉肺侧支(MAPCAs)患者中,肺血供是高度可变的。我们对这种情况的治疗方法强调肺循环的完全统一,包括所有肺段,并在肺段水平上解决狭窄。修复后,我们推荐连续肺灌注显像(LPS)来评估肺血流分布的短期变化。方法:我们回顾了修复后3年的出院后和随访LPS,分析了灌注的一系列变化、变化的危险因素以及LPS参数与肺动脉再介入的关系。结果:在543例术后LPS结果的患者中,317例(58%)只有出院前LPS可用于复查,而226例(20%)或更多(22%)在三年内随访扫描。总体而言,出院前的肺血流分布是平衡的,随着时间的推移变化很小;然而,这两个指标在患者之间存在相当大的差异。在多变量混合模型中,修复后的时间(P = 0.025),由动脉导管到一个肺的初始解剖(P = 0.014)与连续LPS的变化相关。随访LPS的患者更有可能进行肺动脉再干预,但在该队列中,LPS参数与再干预风险无关。结论:在MAPCAs修复后的第一年,连续LPS是一种非侵入性的方法,用于筛查发生在少数但重要的少数患者的明显修复后肺动脉狭窄。在围手术期后接受后续LPS治疗的患者中,随着时间的推移,总体人群的变化很小,但在一些患者中变化很大,而且存在相当大的可变性。LPS的发现与肺动脉再介入之间没有统计学关联。
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引用次数: 2
Surgical Repair of Anomalous Origin of the Left Subclavian Artery From the Pulmonary Artery Using a Supraclavicular Approach. 锁骨上入路修复左锁骨下动脉源自肺动脉的异常起始点。
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1177/21501351221149901
Ilya A Soynov, Yuriy Y Kulyabin, Alexey N Arkhipov, Sergey M Ivanzov, Meline G Galstyan, Alexey V Voitov

Anomalous origin of the left subclavian artery from the pulmonary artery is a rare congenital cardiac malformation. We describe a case of anomalous origin of the left subclavian artery from the pulmonary artery in a patient who presented with symptoms of vertebrobasilar insufficiency and underwent reimplantation of the left subclavian artery into the left common carotid artery from the supraclavicular approach.

摘要左锁骨下动脉起源于肺动脉异常是一种罕见的先天性心脏畸形。我们描述了一例左锁骨下动脉从肺动脉异常起源的病例,该患者表现出椎基底动脉功能不全的症状,并从锁骨上入路将左锁骨下动脉重新植入左颈总动脉。
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引用次数: 0
Hepatic Fibrosis Risk Factors in Extracardiac-Fontan Patients: Observations From a Single Center. 心外纤维化患者肝纤维化危险因素:单中心观察
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1177/21501351231154216
William N Evans, Ruben J Acherman, Alvaro Galindo, Abraham Rothman, Michael L Ciccolo, Juan Lehoux, Humberto Restrepo

Objective: We reviewed our experience with transvenous liver biopsy-derived hepatic fibrosis scores and possible associated risk factors in those postextracardiac Fontan patients. Methods: We identified extracardiac-Fontan patients with postoperative durations <20 years who underwent cardiac catheterizations with transvenous hepatic biopsies between April 2012 and July 2022. If a patient underwent two liver biopsies, we averaged the two total fibrosis scores and concurrent time, pressure, and oxygen saturation data. We grouped patients by the following factors: (1) sex, (2) venovenous collaterals, and (3) type of functionally univentricular heart. We identified potential hepatic fibrosis risk factors as the following: female, presence of venovenous collaterals, and a functional univentricle of right-ventricular type. For statistical analysis, we used Kruskal-Wallis nonparametric testing. Results: We identified 127 patients who underwent 165 transvenous biopsies, with 38 patients undergoing 2 biopsies. We found that females with two additional risk factors had the highest median total fibrosis scores, 4 (1-8); males with <2 risk factors had the lowest median total fibrosis scores, 2 (0-5); and females with <2 additional risk factors and males with two risk factors were in the middle, median total fibrosis score 3 (0-6), P =.002; and there were no statistical differences for the other demographic or hemodynamic variables. Conclusions: For extracardiac-Fontan patients with similar demographic and hemodynamic variables, identifiable risk factors are associated with the degree of hepatic fibrosis.

目的:我们回顾了经静脉肝活检肝纤维化评分和可能的相关危险因素在心外方丹患者中的应用经验。方法:我们根据术后持续时间、性别、(2)静脉侧支和(3)功能单室心脏的类型来确定心外- fontan患者。我们确定了潜在的肝纤维化危险因素如下:女性,静脉静脉侧支的存在,以及右心室型的功能单心室。对于统计分析,我们使用了Kruskal-Wallis非参数检验。结果:127例患者接受了165次经静脉活检,其中38例接受了2次活检。我们发现,具有两个额外危险因素的女性具有最高的中位总纤维化评分,为4 (1-8);男性,P = 0.002;其他人口统计学或血流动力学变量没有统计学差异。结论:对于具有相似人口统计学和血流动力学变量的心外- fontan患者,可识别的危险因素与肝纤维化程度相关。
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引用次数: 0
Invited Commentary: The Fate of MAPCAs. 特邀评论:MAPCAs的命运。
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1177/21501351231162913
Frank Cetta
Pulmonary valve atresia with ventricular septal defect (PA/VSD) rep-resents the most extreme form of tetralogy of Fallot. In contradistinc-tion to patients with tetralogy of Fallot, there is no continuity between the right ventricle and the pulmonary artery tree. Therefore, pulmonary blood supply in these patients is dependent on extracardiac sources. These sources may be the ductus arteriosus, collateral arteries from the thoracic aorta
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引用次数: 0
Anomalous Origin of Left Circumflex Coronary Artery From Right Pulmonary Artery: An Unusual Cause of Sudden Cardiac Arrest. 左旋冠状动脉异常起源于右肺动脉:心脏骤停的一个不寻常原因。
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1177/21501351231151664
Martin O Schmiady, Robert Cesnjevar, Yakup Yakupoglu, Ojuola B Adjibodou, Andreas Spirig, Dominique Bettex, Lukas Meier, Thierry Carrel

Anomalous origin of the left circumflex coronary artery from the right pulmonary artery is an extremely rare coronary anomaly out of the group of anomalous coronary arteries arising from the pulmonary artery. We present the case of a 27-year-old male, in whom the diagnosis of an anomalous left circumflex coronary artery from the pulmonary artery was made after sudden cardiac arrest. The diagnosis was confirmed by multimodal imaging and the patient underwent successful surgical correction. Abnormal origins of a coronary artery may become symptomatic later in life and may occur as an isolated cardiac malformation. Due to a potentially unfavorable clinical course, surgical correction should be considered as soon as a diagnosis is made.

左旋冠状动脉异常起源于右肺动脉是一种极为罕见的冠状动脉异常,起源于肺动脉。我们提出的情况下,一个27岁的男性,其中诊断为异常左旋冠状动脉从肺动脉是在心脏骤停后作出。该诊断经多模态影像证实,患者接受了成功的手术矫正。冠状动脉起源异常可能在以后的生活中出现症状,并可能作为孤立的心脏畸形发生。由于潜在的不利的临床过程,手术矫正应考虑尽快诊断。
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引用次数: 0
False Aneurysm of the Proximal Sano Shunt in a Patient With Hypoplastic Left Heart Syndrome After Bidirectional Superior Cavopulmonary Connection. 双向上腔肺连接后左心发育不良综合征患者近端萨诺分流术中的假性动脉瘤
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 Epub Date: 2023-03-14 DOI: 10.1177/21501351221151056
S A Grishin, M D Svechkov, S E Shorokhov, A A Avramenko

The case describes the surgical treatment of a patient with a false aneurysm of the proximal anastomosis of the Sano shunt in a patient with hypoplastic left heart syndrome midterm after bidirectional cavo-pulmonary anastomosis. The diagnostic algorithm included a physical examination, echocardiography, and multispiral computed tomography. Surgical treatment included closure of the right ventricular defect and removal of blood clots from the cavity of the false aneurysm.

本病例描述了一名左心发育不全综合征患者在双向腔肺吻合术后中期,因萨诺分流管近端吻合处出现假性动脉瘤而接受手术治疗的过程。诊断算法包括体格检查、超声心动图和多螺旋计算机断层扫描。手术治疗包括关闭右心室缺损和清除假动脉瘤腔内的血凝块。
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引用次数: 0
Successful Management of a Very Unusual Coronary Pattern in Transposition of the Great Arteries. 大动脉转位中一种非常不寻常冠状动脉形态的成功治疗。
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1177/21501351231154201
Anand K Mishra, Javid Raja, Vidur Bansal, Nitish Kumar, Manoj Kumar Rohit, Anmol Bhatia

Coronary artery anatomy is the key to a successful arterial switch operation in transposition of the great arteries. We came across an unusual coronary pattern in a child with transposition in which the three major coronary arteries were seen arising from all three aortic sinuses. This coronary pattern is the first of its kind in transposition, and this case report emphasizes the difficulty in translocating such a rare coronary pattern while performing an arterial switch operation.

冠状动脉解剖是大动脉转位手术成功的关键。我们遇到了一个不寻常的冠状动脉模式的儿童转位,其中三个主要的冠状动脉是由三个主动脉窦产生的。这种冠状动脉模式是这种类型的第一次转位,本病例报告强调了在进行动脉转换手术时,这种罕见的冠状动脉模式的易位的困难。
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引用次数: 0
Adolescents and Adults With Congenital Heart Disease: Why Are They Lost to Follow-Up? 患有先天性心脏病的青少年和成人:为什么他们没有随访?
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1177/21501351221149897
Tianwei Liu, Alun C Jackson, Samuel Menahem

Almost 90% of infants with congenital heart disease (CHD) now reach adulthood but require long-term surveillance to recognize and manage residual and/or evolving lesions. Yet many are lost to follow-up. A scoping review identified four specific domains that pose barriers to consistent follow-up. There are multiple issues associated with transition from pediatric to adult care which included-the lack of a seamless transfer, the establishment of a new trusting relationship, promoting the right balance of patient autonomy and addressing knowledge gaps. Additional issues related to logistic problems of time, distance, cost, and the availability of specialized care, are further compounded by the psychosocial factors and the heterogeneity of the cardiac abnormality affecting our patients. Further study of all these issues is warranted to improve ongoing engagement.

近90%患有先天性心脏病(CHD)的婴儿现已成年,但需要长期监测以识别和处理残余和/或发展中的病变。然而,许多人失去了后续行动。范围审查确定了四个具体领域,这些领域对一致的后续行动构成障碍。从儿科到成人护理的过渡有许多问题,包括缺乏无缝的转移,建立新的信任关系,促进患者自主权的适当平衡和解决知识差距。与时间、距离、成本和专业护理的可用性等后勤问题相关的其他问题,由于影响我们患者的心理社会因素和心脏异常的异质性而进一步复杂化。有必要进一步研究所有这些问题,以改善正在进行的接触。
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引用次数: 0
Can Isolated Discordant Atrioventricular Connections Survive Without Interatrial or Interventricular Shunt? 孤立的不协调房室连接能在没有房间或室间分流的情况下存活吗?
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1177/21501351221145169
Pranav Subbaraya Kandachar, Eapen Thomas, Areej Al Maskary, Andrew Campbell

Clinical presentation of isolated discordant atrioventricular connections is akin to transposition of the great arteries. In the absence of a significant intracardiac shunt, profound cyanosis is expected at birth. We report one such 5-month-old infant who had only mild cyanosis. The left-sided tricuspid valve straddled the interventricular septum with a closed interventricular communication, a type of "Double Outlet Left Atrium with three atrioventricular valves," which provided the necessary "left to right" shunt while severe regurgitation through the straddling part and a patent ductus arteriosus provided the effective pulmonary blood flow.

孤立性房室连接不协调的临床表现类似于大动脉转位。在没有明显的心内分流的情况下,出生时可能出现深度紫绀。我们报告一个这样的5个月大的婴儿谁只有轻微的紫绀。左侧三尖瓣跨立于室间隔,闭合性室间相通,是一种“双出口左心房,三个房室瓣”,提供了必要的“左向右”分流,而严重的反流通过跨立于部分和动脉导管未闭提供了有效的肺血流。
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引用次数: 0
Invited Commentary: Effect of Breastmilk After Congenital Heart Surgery. 特邀解说:先天性心脏手术后母乳的效果。
IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1177/21501351231163530
Minso Kim
Human breastmilk offers immunologic bene fi ts to neonates. It provides antibodies and stimulates neonatal immune system development. 1 Lactoferrin, lactadherin, bile salt stimulating lipase, milk fat globule, and epidermal growth factor increase protection from bacterial and viral infections. These bene fi ts have been increasingly demonstrated in population-based studies over the past three decades. The Millennium Cohort Study from the United Kingdom showed the bene fi t of exclusive breastfeeding in the prevention of gastrointestinal or chest infection in over 15 000 infants. 2 In preterm and very low birth weight newborns, population studies on breastmilk showed lower risks of late-onset sepsis and necrotizing enterocolitis (NEC). 3 There are emerging data on the long-term effect of breastmilk on cardiovascular health. Lucas and colleagues from the United Kingdom followed pre-mature neonates born under birth weight of 1,850 g since 1984 for long-term effects of diet on health. 4 A 25-year follow-up study from this cohort showed higher biventricular end-diastolic volume and right ventricular function for those who had been exclusively breastmilk-fed compared to those exclusively formula-fed. 5 Breastmilk was postulated to affect cardiovascular development via its vascular endothelial growth factors. Finally, the American Board of Pediatrics recommended exclusive breastmilk for a minimum of six months of age. Speci fi c
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引用次数: 0
期刊
World Journal for Pediatric and Congenital Heart Surgery
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