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van de Woestijne P, Mokhles M, van Beynum I, de Jong P, Wilschut J, Bogers A. Staged correction of pulmonary atresia, ventricular septal defect, and collateral arteries. J Card Surg 2022; 37:960-966. [PMID: 35142386 PMCID: PMC9303625 DOI: 10.1111/jocs.16299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
Objectives Pulmonary atresia (PA) with ventricular septal defect (VSD) and systemic‐pulmonary collateral arteries (SPCAs) presents with variable anatomy with regard to the pulmonary vasculature, requiring personalized surgical treatment. A protocol consisting of staged unifocalization and correction was employed. Methods Since 1989, 39 consecutive patients were included (median age at first operation 13 months). In selected cases, a central aorto‐pulmonary shunt was performed as the first procedure. Unifocalization procedures were performed through a lateral thoracotomy. Correction consisted of shunt takedown, VSD closure, and interposition of an allograft between the right ventricle and the reconstructed pulmonary artery. Echocardiographic data were obtained postoperatively and at interval follow‐up. Results In 39 patients 66 unifocalization procedures were performed. Early mortality was 5%. Seven patients were considered not suitable for correction, of which four have since died. One patient is awaiting further correction. A correction was performed successfully in 28 patients. Operative mortality was 3% and late mortality was 11%. Median follow‐up after the correction was 19 years. Eleven patients required homograft replacement. Freedom from conduit replacement was 88%, 73%, and 60% at 5, 10, and 15 years respectively. Right ventricular function was reasonable or good in 75% of patients. All but one patient were in NYHA Class I or II. Conclusions After complete unifocalization 30/37 patients (81%) were considered correctable. The staged approach of PA, VSD, and SPCAs results in adequate correction and good functional capacity. RV function after correction remains reasonable or good in the majority of patients.
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Affiliation(s)
- Pieter van de Woestijne
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mostafa Mokhles
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ingrid van Beynum
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter de Jong
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Adult Congenital Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ad Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Shults OG, Shults AA, Orlinskaya NY. [Huge periprosthetic (peritransplant) seroma of a femoropopliteal bypass graft]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:188-193. [PMID: 31503265 DOI: 10.33529/angid2019322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Presented herein is a clinical case report of a huge periprosthetic seroma of a femoropopliteal bypass graft made of polytetrafluoroethylene with a follow-up period and unsuccessful conservative management of more than one year. At 15 months after the primary operation, the bypass graft was retrieved and replaced by a knitted vascular graft made of polyester and impregnated with absorbable modified gelatine to decrease porosity, without relapse of the process of transudation into the periprosthetic space. Histological study of the retrieved conduit demonstrated the absence of formation of the intimal layer on the inner surface of the graft and fibrous capsule on the external surface of the main part of the length of the prosthesis, which, apparently, had provided a possibility of long-term preservation of porosity of the material.
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Affiliation(s)
- O G Shults
- University Clinic, Research Medical University of the Volga Region under the RF Ministry of Public Health, Nizhny Novgorod
| | - A A Shults
- University Clinic, Research Medical University of the Volga Region under the RF Ministry of Public Health, Nizhny Novgorod
| | - N Yu Orlinskaya
- University Clinic, Research Medical University of the Volga Region under the RF Ministry of Public Health, Nizhny Novgorod
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Giglia TM, Massicotte MP, Tweddell JS, Barst RJ, Bauman M, Erickson CC, Feltes TF, Foster E, Hinoki K, Ichord RN, Kreutzer J, McCrindle BW, Newburger JW, Tabbutt S, Todd JL, Webb CL. Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease. Circulation 2013; 128:2622-703. [DOI: 10.1161/01.cir.0000436140.77832.7a] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Saphenous vein wrapping for the treatment of a perigraft seroma: Report of a case. Surg Today 2011; 41:549-51. [DOI: 10.1007/s00595-009-4302-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 05/19/2009] [Indexed: 10/18/2022]
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Zanow J, Kruger U, Settmacher U, Scholz H. Treatment of Perigraft Seroma in Expanded Polytetrafluoroethylene Grafts by Sequential Fibrin Sealing of the Outer Graft Surface. Ann Vasc Surg 2010; 24:1005-14. [DOI: 10.1016/j.avsg.2010.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 11/29/2009] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
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Diniz PPVDP, Wood M, Maggi RG, Sontakke S, Stepnik M, Breitschwerdt EB. Co-isolation of Bartonella henselae and Bartonella vinsonii subsp. berkhoffii from blood, joint and subcutaneous seroma fluids from two naturally infected dogs. Vet Microbiol 2009; 138:368-72. [PMID: 19560291 DOI: 10.1016/j.vetmic.2009.01.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 01/21/2009] [Accepted: 01/26/2009] [Indexed: 11/24/2022]
Abstract
This report describes the clinical presentation, isolation and treatment of two dogs naturally infected with Bartonella henselae and Bartonella vinsonii subsp. berkhoffii. Chronic and progressive polyarthritis was the primary complaint for dog #1, from which B. henselae and B. vinsonii subsp. berkhoffii were cultured on three independent occasions from blood and joint fluid samples, despite administration of nearly 4 months of non-consecutive antibiotic therapy. A clinically atypical and progressively severe trauma-associated seroma was the primary complaint for dog #2, from which B. henselae and B. vinsonii subsp. berkhoffii were isolated from serum, blood and seroma fluid. Dogs can be co-infected with two Bartonella spp. and infection with these organisms should not be ruled out if specific antibodies are not detected. Specialized culture techniques should be used for isolation and to assess antibiotic efficacy.
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Ahmad U, Fatimi SH, Naqvi I, Atiq M, Moizuddin SS, Sheikh KB, Shahbuddin S, Naseem TM, Javed MA. Modified Blalock–Taussig Shunt: Immediate and Short-Term Follow-Up Results in Neonates. Heart Lung Circ 2008; 17:54-8. [PMID: 17683985 DOI: 10.1016/j.hlc.2007.06.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2006] [Revised: 05/31/2007] [Accepted: 06/04/2007] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The modified Blalock-Taussig shunt (MBTS) is the most commonly created systemic-pulmonary shunt in neonates with cyanotic heart disease. Morbidity and mortality after MBTS is associated with several factors including age, pulmonary artery diameter and the baseline cardiac anatomy. The objective of this research was to describe the immediate and short-term follow-up results of MBTS in Pakistani neonates. METHODS AND RESULTS A retrospective review of patient charts was done to select 22 neonatal cases of various types of cyanotic heart diseases who had undergone MBTS creation from 1999 to 2005. Clinical and echocardiographic data were collected. Patients were followed up on their post-operative visits. Twenty-two neonates, 14 males and 8 females, mean age 11.2+/-6.9, underwent MBTS surgery during the six-year period of study. Pulmonary artery diameters were 3+/-0.2 and 2.9+/-0.2 for the right and left arteries, respectively. All patients received a 4mm Gor-Tex shunt through a postero-lateral thoracotomy approach. The mean duration of post-operative mechanical ventilation was 3.9+/-4.5 days. Three neonates (13.6%) died within one month of surgery while another three (13.6%) died after three months of surgery. Among these deaths, two were due to shunt occlusion/failure (9%) and the rest were due to non-cardiac causes. Another two patients underwent revision of surgery after shunt failure. Pulmonary atresia with intact interventricular septum was the most common cardiac anomaly in our series. CONCLUSIONS The mortality rate in neonates is highest during the first post-operative month. Shunt thrombosis and occlusion can be sudden and fatal therefore coagulation profile should be carefully monitored especially in the peri-operative period. PA-IVS was the most common anatomical variant in our limited experience and had high morbidity and mortality rate after surgery.
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Affiliation(s)
- Usman Ahmad
- Department of Surgery, Division of Cardiothoracic Surgery, Aga Khan University, Karachi, Pakistan
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Saxena AK, Haxihja E, Kleinlein B, Höllwarth ME. Lymphoceles in premature infants after congenital diaphragmatic hernia repair: Thoracoscopic management. J Thorac Cardiovasc Surg 2007; 133:584-5. [PMID: 17258613 DOI: 10.1016/j.jtcvs.2006.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 09/25/2006] [Indexed: 11/19/2022]
Affiliation(s)
- Amulya K Saxena
- Department of Pediatric Surgery, Medical University of Graz, Graz, Austria.
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Tevaearai HT, Schmidli J, Mohacsi P, Rothen HU, Eckstein FS, Carrel TP. Leakage of the Arterial Prosthesis of an Impella RVAD. Ann Thorac Surg 2006; 82:1527-9. [PMID: 16996976 DOI: 10.1016/j.athoracsur.2006.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 01/31/2006] [Accepted: 02/03/2006] [Indexed: 11/16/2022]
Abstract
Seromas occurring around a vascular graft are a rare complication. We report a life-threatening plasma leakage that occurred through the polytetrafluoroethylene vascular prosthesis of an Impella right ventricular assist device (Impella RD [Impella Cardiosystems GmbH, Aachen, Germany]) implanted in a 62-year-old patient with acute right ventricular failure after cardiac transplantation. The leakage became progressively massive. Weaning the patient from the right ventricular assist device was not possible. The prosthesis was thus wrapped within a pericardial patch to contain the leakage. Three days later the patient could be successfully weaned and the pump was removed. The clinical evolution was favorable.
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Takeda K, Uemura H, Kagisaki K, Yagihara T, Silvagni P. Histologic findings after explantation of a modified expanded polytetrafluoroethylene graft used for clinical systemic-to-pulmonary shunting. J Thorac Cardiovasc Surg 2005; 130:934-5. [PMID: 16153973 DOI: 10.1016/j.jtcvs.2005.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Accepted: 03/22/2005] [Indexed: 11/17/2022]
Affiliation(s)
- Koji Takeda
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
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Matsuyama K, Matsumoto M, Sugita T, Matsuo T. Slowly developing perigraft seroma after a modified Blalock-Taussig shunt. Pediatr Cardiol 2003; 24:412-4. [PMID: 12522648 DOI: 10.1007/s00246-002-0373-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a 26-year-old patient with slowly developing perigraft seroma 15 years after a modified Blalock-Taussig shunt with an expanded polytetrafluorethylene graft. The mediastinal mass was first observed on a chest x-ray film 8 years after the shunt operation. The mass contained massive gelatinous or organic tissues with a severely calcified pseudocapsule, and it was adjacent to the calcified but functioning graft. No fluid collections were noted. The histological findings were compatible with a seroma. No recurrence was noted on last follow-up 1 year postoperatively.
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Affiliation(s)
- K Matsuyama
- Department of Cardiovascular Surgery, Tenri Hospital, 200 Mishima, Tenri, Nara 632-8552, Japan
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Ugurlu BS, Sariosmanoglu ON, Metin SK, Hazan E, Oto O. Pleural flap for treating perigraft leak after a modified Blalock-Taussig shunt. Ann Thorac Surg 2002; 73:1638-40. [PMID: 12022570 DOI: 10.1016/s0003-4975(01)03365-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Plasa oozing through the graft after a modified Blalock-Taussig shunt is a troublesome complication. We encountered a massive leak following a modified Blalock-Taussig shunt in a 2 1/2 year-old-girl which required reexploration. The leak was treated by wrapping the polytetrafluoroethylene shunt with the parietal pleura flap harvested from the adjacent chest wall. The patient had an uneventful recovery. Covering of the polytetrafluoroethylene shunt with parietal pleura appears to stop plasma leak through the graft following a modified Blalock-Taussig shunt.
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Affiliation(s)
- Baran Sevket Ugurlu
- Department of Thoracic and Cardiovascular Surgery, Dokuz Eylul University Medical School, Izmir, Turkey.
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van Rijn RR, Berger RMF, Lequin MH, Robben SGF. Development of a perigraft seroma around modified Blalock-Taussig shunts: imaging evaluation. AJR Am J Roentgenol 2002; 178:629-33. [PMID: 11856688 DOI: 10.2214/ajr.178.3.1780629] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The modified Blalock-Taussig shunt is a synthetic shunt between the subclavian and pulmonary artery, frequently used in the treatment of children with pulmonary hypoperfusion caused by congenital heart disease. The development of a perigraft seroma is a known complication of this procedure. We sought to describe the imaging features of a perigraft seroma and to define an optimal diagnostic strategy in patients with a suspected perigraft seroma. MATERIALS AND METHODS Between January 1993 and December 1998, 96 children underwent 105 modified Blalock-Taussig shunt procedures. In eight children, 11 cases of perigraft seromas were identified. The mean age of these children at the time of operation was 3 years (range, 6 days to 5 years 8 months). Pre- and postoperative chest radiographs were routinely performed in the children in whom seromas had been found. Additional postoperative radiologic investigations consisted of thoracic sonography (in 11 cases), CT (in eight cases), and MR imaging (in two cases). In all cases of perigraft seroma, the modified Blalock-Taussig shunts were constructed through a posterolateral thoracotomy at the fourth intercostal space. RESULTS On average, the chest radiographs showed the first signs of the seroma on day 10 after the surgery (range, day 1-day 30). Using thoracic sonography, it was possible to visualize the perigraft seroma and the modified Blalock-Taussig shunt in eight (73%) of 11 cases. CT and MR imaging performed equally well in revealing perigraft seromas. CONCLUSION As was found in these critically ill children, sonography has an advantage over CT and MR imaging because of its portability and, therefore, capability for bedside use. We recommend the use of sonography as the initial imaging modality in suspected cases of perigraft seroma development.
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Affiliation(s)
- Rick R van Rijn
- Department of Paediatric Radiology, Sophia Children's Hospital, University Hospital Rotterdam, Ste. D-205, P. O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Sobrinho G, Henriques SP. Perigraft seromas complicating prosthetic bridge arteriovenous fistula--solution with autogenous vein interposition. Eur J Vasc Endovasc Surg 2001; 22:469-71. [PMID: 11735188 DOI: 10.1053/ejvs.2001.1482] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- G Sobrinho
- Department of Surgery 3, Hospital de São José, Rua Tomás da Anunciação 169 1 D, 1350-326 Lisbon, Portugal
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Okur FF, Tavli V, Kayhan B, Kirman M, Atalay CS, Tekdoğan M. Blalock-Taussig Shunt Using Fresh Saphenous Vein Homograft. Asian Cardiovasc Thorac Ann 2000. [DOI: 10.1177/021849230000800310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The occurrence of life-threatening early and late complications following the use of expanded polytetrafluoroethylene grafts for modified Blalock-Taussig shunts prompted the application of saphenous vein homografts instead. In 21 patients with cyanotic congenital heart disease, fresh saphenous vein homografts were used for Blalock-Taussig shunts from February 1998. The veins were obtained from blood-group matched patients undergoing coronary bypass grafting in the next operating room. There was no early or late mortality. Clinical and echocardiographic studies showed that all shunts were patent and functioning well at an average follow-up of 11 months. This simple homograft technique has no ischemic time and requires no chemical or antibiotic contact.
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Affiliation(s)
| | - Vedide Tavli
- Department of Pediatric Cardiology Şifa Heart Center I·zmir, Turkey
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Salzer-Muhar U, Pabinger-Fasching I, Zacherl-Wightman S. Is there a possible role for haemostasis in the development of perigraft reaction complicating the modified Blalock Taussig shunt? Cardiol Young 2000; 10:261-4. [PMID: 10824908 DOI: 10.1017/s1047951100009203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The perigraft reaction is an unusual complication found in patients in whom a modified Blalock Taussig shunt has been created using a polytetrafluoroethylene graft. We found that, in two infants, consistent laboratory findings during such a perigraft reaction were hypofibrinogenemia, increased levels of thrombin-antithrombin III complex, prothrombin fragment 1 and 2 and products of degradation of fibrin. Normalization of the levels of fibrinogen produced resolution of the perigraft reaction.
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Affiliation(s)
- U Salzer-Muhar
- Department of Pediatric Cardiology, General Hospital Vienna, University of Vienna, Austria.
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