Congenital Heart Defects : Antonio F. Corno :
Ali Khavandi. Practical Perioperative Transesophageal Echocardiography. David Sidebotham. Daniel Augustine. Cardiac Surgery. Siavosh Khonsari. Cardiothoracic Surgery. Joanna Chikwe. Every Second Counts. Donald McRae. Your review has been submitted successfully. Not registered?
Forgotten password Please enter your email address below and we'll send you a link to reset your password. Two years later, Dr. Campbell and others are starting to see some very early answers to those questions. As of January , there were 95 centers participating in IMPACT with a total of 45, patient records so far, which will help set national benchmarks for diagnostic and specific interventional procedures.
Just published, the initial report analyzed data, procedural characteristics, and adverse events for 19, procedures entered into the IMPACT Registry from January to March The initial findings offer opportunities to compare individual center results and historical single-center and multicenter results. In an accompanying editorial comment, Dr. One challenge: Dr. Landzberg added. Failure to complete it is unacceptable.
Given the relatively young age of this ACHD population, pregnancy is an important issue. These young women with ACHD are at higher risk of death, heart failure HF , arrhythmia especially supraventricular , stroke, or other CV pregnancy-related complication. Despite the challenges, many of these women choose to have families; indeed, the Euro Heart Survey shows that their pregnancies occur at a higher rate than for age-matched peers in all ACHD diagnostic groups except for Eisenmenger and cyanotic patients. Hayward, MD, and colleagues expressed surprise at evidence that pregnancy complication rates were not nearly as high as expected in women with congenital heart disease.
They analyzed medical records of more than 2. Among this group, 3, women had non-complex congenital heart disease and women had complex congenital heart disease.
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They found:. Hayward, lead author and a cardiac electrophysiology fellow of the University of California in San Francisco, said he and his co-authors were pleased to find the risk of complications lower than expected. At ACC.
The study, now online ahead of print, also found that both of the active groups had greater exercise capacity and lower body mass index compared to those reporting no sports activity. Battle, MD, team cardiologist at the University of Virginia, Charlottesville, gave one example of what you might come across in your office: a year-old female with pulmonary atresia and intact septum, a hypoplastic right ventricle, and a Fontan fenestration closed in Notice that triathlons are not on that list.
Battle finds, too. He advised talking to the patient and parents of younger teens , probably several times, making sure they understand the risks, but in many of these competitive athletes, Dr. Given the pandemic of physical inactivity in the 21st century and epidemic of childhood obesity, Dr. We agree with Tynan et al 27 , who consider that that criterion hinders the diagnosis of double-outlet right ventricle with tetralogy of Fallot. Thus, some examples of double-outlet right ventricle also have tetralogy of Fallot. We believe that that differentiation is interesting for surgical planning without invasive study, because the extension of the patch used to close a ventricular septal defect is greater in the cases of double-outlet right ventricle of the "Fallot type," with a greater risk of postoperative obstruction of the left ventricular outflow tract.
Knowing that the long parasternal axis is the most recommended for assessing the degree of aortic override, one patient had double-outlet right ventricle of the "Fallot type" interpreted as classic tetralogy of Fallot. The patient had a significant chest deformity that did not allow the adequate performance of that section and the correct alignment in regard to the septum, underestimating its override.
Congenital Heart Defects: Decision Making for Cardiac Surgery Volume 2 Less Common Defects
Assessment of the coronary arteries proved to be adequate on echocardiography, because, in 27 patients with transposition of the great arteries, no coronary anomaly was missed, and, in 72 patients with tetralogy of Fallot, only 4 5. In the 4 patients with false-negative results in our case series, the diameter of the right coronary artery was normal, and that valuable indirect signal that would raise that hypothesis was not observed.
A false-positive and a false-negative diagnosis occurred in the patients with truncus arteriosus. In the false-positive case, the pulmonary artery was not defined because it was very hypoplastic, and the pulmonary arteries seemed to originate directly from the aorta, considered a common arterial trunk. During the surgical act, pulmonary atresia with important hypoplasia of the proximal pulmonary artery and ventricular septal defect were observed.
In the false-negative case, an error occurred in the classification of a type III truncus, which was interpreted as type I. The intraoperative findings showed 2 individualized pulmonary arteries with a long left pulmonary artery and a much smaller right pulmonary artery.
The error may be explained by the fact that the right pulmonary artery was not visualized, and the long left branch was interpreted as the pulmonary trunk. That difficulty occurs in type III truncus because the pulmonary arteries are not usually visualized together in the same parasternal plane, the origin of one pulmonary artery being seen in the short parasternal axis and the origin of the other pulmonary artery being more difficult to observe in the suprasternal plane The diagnostic impression of atrial septal defects may often occur in adult patients due to the difficulty of the echocardiographic window, because the atrial septum is located very far away from the transducer, resulting in lack of definition of the tissue of the oval foramen, which is much thinner than the rest of the septum.
Two of the false-positive results in our case series occurred in association with partial anomalous pulmonary venous drainage, which may be explained by the fact that most partial drainages are associated with atrial septal defect, which may have influenced the echocardiographer when interpreting the dubious image. The third unconfirmed diagnosis of atrial septal defect occurred in a young female patient who had an image suggestive of septal discontinuity associated with important tricuspid regurgitation and right chamber dilation. The surgery revealed isolated tricuspid valve dysplasia corrected with valvuloplasty and reduction of the valvular ring.
In a patient with ventricular septal defect, an anomalous right ventricular band was not identified, being interpreted as dynamic reactive hypertrophy, also known as jet lesion. The results of this study showed that the surgery could be performed without previous invasive study, even in more complex cases, because the echocardiography proved to be a highly sensitive and specific method.
The technological evolution has allowed a constant improvement in the quality of the echocardiographic image and increasing reliability as a diagnostic preoperative tool, avoiding the performance of cardiac catheterization, which increases the risks and costs for the patient and health system. Based on these findings, we concluded that echocardiography may be used as a safe and sensitive method for the preoperative assessment of patients with congenital heart diseases, catheterization being reserved for cases with specific indications.
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