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Pomerantzeff PMA, Brandão CMDA, Riso A, Jatene FB. The Double-Orifice Technique in Mitral Valve Repair: 35 Years of History. Arq Bras Cardiol 2021; 117:424-425. [PMID: 34550226 PMCID: PMC8462944 DOI: 10.36660/abc.20210067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/03/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Arlindo Riso
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fabio Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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von Stumm M, Subbotina I, Biermann D, Gottschalk U, Mueller G, Kozlik-Feldmann R, Reichenspurner H, Riso A, Sachweh JS. Impact of delayed systemic heparinization on postoperative bleeding and thromboembolism during post-cardiotomy extracorporeal membrane oxygenation in neonates. Perfusion 2020; 35:626-632. [PMID: 32072861 DOI: 10.1177/0267659120906046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Veno-arterial extracorporeal membrane oxygenation is well-established for pediatric patients with post-cardiotomy heart failure. However, extracorporeal membrane oxygenation support is associated with major complications, that is, hemorrhage and thromboembolism. We seek to report our experience with delayed systemic heparinization during neonatal cardiac extracorporeal membrane oxygenation and its impact on bleeding and thromboembolism. METHODS We retrospectively identified 15 consecutive neonates who were placed on extracorporeal membrane oxygenation after congenital heart surgery during a period of 3 years (2015-2017). Our anticoagulation protocol consisted of full heparin reversal by protamine after switching from cardiopulmonary bypass to extracorporeal membrane oxygenation (target activated clotting time: 120 ± 20 seconds). Administration of systemic heparinization was delayed until postoperative drainage volume declined to <1 mL/kg/h. Primary study endpoints were thromboembolism, bleeding, and requirement of blood products on extracorporeal membrane oxygenation. RESULTS Our cohort (mean age: 13 ± 2.6 days; mean weight: 3.1 ± 0.3 kg; 66.7% male) required post-cardiotomy extracorporeal membrane oxygenation with a mean support time of 4.5 ± 2.2 days. Systemic heparinization was delayed averagely for 18.1 ± 9.3 hours. No thromboembolic events were observed on extracorporeal membrane oxygenation or after weaning. Relevant surgical site bleeding occurred in two patients (13.3%) requiring re-thoracotomy on the first postoperative day. Analysis of transfusion volumes revealed 24.5 ± 21.9 mL/kg/d mean packed red blood cells, 9.6 ± 7.1 mL/kg/d mean fresh frozen plasma, and 7.5 ± 5.7 mL/kg/d mean platelets. In-hospital survival was 86.6% (n = 13). CONCLUSION In this retrospective analysis, the results of delayed systemic heparinization in neonatal post-cardiotomy extracorporeal membrane oxygenation could lead one to conclude that this routine is safe and favorable with low risk for thromboembolic events, reduced postoperative hemorrhage, and reduced blood product utilization.
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Affiliation(s)
- Maria von Stumm
- Department of Cardiovascular Surgery, University Heart & Vascular Center, Hamburg, Germany
| | - Irina Subbotina
- Department of Cardiovascular Surgery, University Heart & Vascular Center, Hamburg, Germany
| | - Daniel Biermann
- Department of Cardiac Surgery for Congenital Heart Disease, University Heart & Vascular Center, Hamburg, Germany
| | - Urda Gottschalk
- Department of Paediatric Cardiology, University Heart & Vascular Center, Hamburg, Germany
| | - Goetz Mueller
- Department of Paediatric Cardiology, University Heart & Vascular Center, Hamburg, Germany
| | - Rainer Kozlik-Feldmann
- Department of Paediatric Cardiology, University Heart & Vascular Center, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center, Hamburg, Germany
| | - Arlindo Riso
- Department of Cardiac Surgery for Congenital Heart Disease, University Heart & Vascular Center, Hamburg, Germany
| | - Joerg S Sachweh
- Department of Cardiac Surgery for Congenital Heart Disease, University Heart & Vascular Center, Hamburg, Germany
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Richardet E, Hernandez P, Paradelo M, Acosta L, Molina M, Riso A, Ferreira G, Richardet M. EP1.03-23 Update of the Analysis of the Status of Lymphocyte Infiltration in Patients with NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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von Stumm M, Biermann D, Reichenspurner H, Gottschalk U, Müller G, Kozlik-Feldmann R, Riso A, Sachweh JS. Autologous Tissue Technique to Repair Unilateral Isolated Absence of a Pulmonary Artery. World J Pediatr Congenit Heart Surg 2019; 12:547-559. [PMID: 31018755 DOI: 10.1177/2150135119825588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Isolated unilateral absence of a pulmonary artery (UAPA) is a rare congenital anomaly in which one branch pulmonary artery has no connection to the main pulmonary trunk (most often there is ductal origin). Without treatment, it may lead to ipsilateral pulmonary hypoplasia and contralateral pulmonary artery hypertension. To avoid these complications, early surgical repair of UAPA is necessary. Surgical strategies include direct anastomosis between the "isolated" branch pulmonary artery (PA) and the main pulmonary trunk or creation of an interposition graft using prosthetic material or flap techniques. We describe a surgical technique using a totally autologous interposition tube graft.
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Affiliation(s)
- Maria von Stumm
- Cardiac Surgery for Congenital Heart Disease, 196169University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Eppendorf, Germany.,Department of Cardiovascular Surgery, 196169University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Eppendorf, Germany
| | - Daniel Biermann
- Cardiac Surgery for Congenital Heart Disease, 196169University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Eppendorf, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, 196169University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Eppendorf, Germany
| | - Urda Gottschalk
- Department of Pediatric Cardiology, 234015University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Eppendorf, Germany
| | - Götz Müller
- Department of Pediatric Cardiology, 234015University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Eppendorf, Germany
| | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology, 234015University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Eppendorf, Germany
| | - Arlindo Riso
- Cardiac Surgery for Congenital Heart Disease, 196169University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Eppendorf, Germany
| | - Jörg S Sachweh
- Cardiac Surgery for Congenital Heart Disease, 196169University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Eppendorf, Germany
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von Stumm M, Leps Y, Gasser S, Buchholz C, Kozlik-Feldmann R, Riso A, Biermann D, Sachweh J. Impact of Delayed Sternal Closure on Wound Infections following Paediatric Cardiac Surgery. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. von Stumm
- Abteilung für Herzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - Y. Leps
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - S. Gasser
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - C. Buchholz
- Abteilung für Herzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - R. Kozlik-Feldmann
- Abteilung für Kinderkardiologie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - A. Riso
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - D. Biermann
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - J. Sachweh
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
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von Stumm M, Gasser S, Buchholz C, Riso A, Müller G, Kozlik-Feldmann R, Reichenspurner H, Biermann D, Sachweh J. A Novel Technique to Repair Absence of Right Pulmonary Artery. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. von Stumm
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - S. Gasser
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - C. Buchholz
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - A. Riso
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - G. Müller
- Abteilung für Kinderkardiologie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - R. Kozlik-Feldmann
- Abteilung für Kinderkardiologie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - H. Reichenspurner
- Abteilung für Herzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - D. Biermann
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - J.S. Sachweh
- Abteilung für Kinderherzchirurgie, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
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Gasser S, von Stumm M, Buchholz C, Reichenspurner H, Riso A, Biermann D, Sachweh J. When to Do It from the Front: Surgical Closure of a Patent Ductus Arteriosus in a Patient with Alpha-actin2 Mutation. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S. Gasser
- Department of Pediatric Cardiac Surgery, Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - M. von Stumm
- Department of Pediatric Cardiac Surgery, Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - C. Buchholz
- Department of Pediatric Cardiac Surgery, Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - H. Reichenspurner
- Department of Pediatric Cardiac Surgery, Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - A. Riso
- Department of Pediatric Cardiac Surgery, Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - D. Biermann
- Department of Pediatric Cardiac Surgery, Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - J. Sachweh
- Department of Pediatric Cardiac Surgery, Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
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Seoudy H, Biermann D, Arndt F, von Stumm M, Reichenspurner H, Kozlik-Feldmann R, Riso A, Gottschalk U, Sachweh J. Extracorporeal Membrane Oxygenation and Cardiopulmonary Bypass in Pediatric Drowning Patients. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H. Seoudy
- Department of Cardiovascular Surgery, University Heart Center Hamburg, UKE, Hamburg, Germany
| | - D. Biermann
- Department of Congenital Heart Surgery, University Heart Center Hamburg, UKE, Hamburg, Germany
| | - F. Arndt
- Department of Pediatric Cardiology, University Heart Center Hamburg, UKE, Hamburg, Germany
| | - M. von Stumm
- Department of Cardiovascular Surgery, University Heart Center Hamburg, UKE, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Hamburg, UKE, Hamburg, Germany
| | - R. Kozlik-Feldmann
- Department of Pediatric Cardiology, University Heart Center Hamburg, UKE, Hamburg, Germany
| | - A. Riso
- Department of Congenital Heart Surgery, University Heart Center Hamburg, UKE, Hamburg, Germany
| | - U. Gottschalk
- Department of Pediatric Cardiology, University Heart Center Hamburg, UKE, Hamburg, Germany
| | - J.S. Sachweh
- Department of Congenital Heart Surgery, University Heart Center Hamburg, UKE, Hamburg, Germany
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Biermann D, Eder A, Arndt F, Seoudy H, Reichenspurner H, Mir T, Riso A, Kozlik-Feldmann R, Peldschus K, Kaul MG, Schuler T, Krasemann S, Hansen A, Eschenhagen T, Sachweh JS. Towards a Tissue-Engineered Contractile Fontan-Conduit: The Fate of Cardiac Myocytes in the Subpulmonary Circulation. PLoS One 2016; 11:e0166963. [PMID: 27875570 PMCID: PMC5119816 DOI: 10.1371/journal.pone.0166963] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/06/2016] [Indexed: 11/20/2022] Open
Abstract
The long-term outcome of patients with single ventricles improved over time, but remains poor compared to other congenital heart lesions with biventricular circulation. Main cause for this unfavourable outcome is the unphysiological hemodynamic of the Fontan circulation, such as subnormal systemic cardiac output and increased systemic-venous pressure. To overcome this limitation, we are developing the concept of a contractile extracardiac Fontan-tunnel. In this study, we evaluated the survival and structural development of a tissue-engineered conduit under in vivo conditions. Engineered heart tissue was generated from ventricular heart cells of neonatal Wistar rats, fibrinogen and thrombin. Engineered heart tissues started beating around day 8 in vitro and remained contractile in vivo throughout the experiment. After culture for 14 days constructs were implanted around the right superior vena cava of Wistar rats (n = 12). Animals were euthanized after 7, 14, 28 and 56 days postoperatively. Hematoxylin and eosin staining showed cardiomyocytes arranged in thick bundles within the engineered heart tissue-conduit. Immunostaining of sarcomeric actin, alpha-actin and connexin 43 revealed a well -developed cardiac myocyte structure. Magnetic resonance imaging (d14, n = 3) revealed no constriction or stenosis of the superior vena cava by the constructs. Engineered heart tissues survive and contract for extended periods after implantation around the superior vena cava of rats. Generation of larger constructs is warranted to evaluate functional benefits of a contractile Fontan-conduit.
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Affiliation(s)
- Daniel Biermann
- Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Alexandra Eder
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Florian Arndt
- Department for Paediatric Cardiology, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hatim Seoudy
- Department for Cardiovascular Surgery, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department for Cardiovascular Surgery, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Mir
- Department for Paediatric Cardiology, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arlindo Riso
- Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Kozlik-Feldmann
- Department for Paediatric Cardiology, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kersten Peldschus
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael G. Kaul
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tillman Schuler
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Krasemann
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne Hansen
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Eschenhagen
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jörg S. Sachweh
- Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Seoudy H, Biermann D, Müller G, Reichenspurner H, Kozlik-Feldmann R, Riso A, Sachweh J. Outcomes of Tricuspid Valve Incision for Ventricular Septal Defect Repair. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Biermann D, Arndt F, Eder A, Seoudy H, Hansen A, Reichenspurner H, Mir T, Riso A, Eschenhagen T, Kozlik-Feldmann R, Sachweh J. Fontan Circulation: Generation of a Subpulmonary Neo-Ventricle from Engineered Heart Tissue. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sievers HH, Stierle U, Charitos EI, Takkenberg JJM, Hörer J, Lange R, Franke U, Albert M, Gorski A, Leyh RG, Riso A, Sachweh J, Moritz A, Hetzer R, Hemmer W. A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry†. Eur J Cardiothorac Surg 2015; 49:212-8. [PMID: 25666469 DOI: 10.1093/ejcts/ezv001] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/29/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Conventional aortic valve replacement (AVR) in young, active patients represents a suboptimal solution in terms of long-term survival, durability and quality of life. The aim of the present work is to present an update on the multicentre experience with the pulmonary autograft procedure in young, adult patients. METHODS Between 1990-2013, 1779 adult patients (1339 males; 44.7 ± 11.6 years) underwent the pulmonary autograft procedure in 8 centres. All patients underwent prospective clinical and echocardiographic examinations annually. The mean follow-up was 8.3 ± 5.1 years (range 0-24.3 years) with a total cumulative follow-up of 14 288 years and 662 patients having a follow-up of at least 10 years. RESULTS The early (30-day) mortality rate was 1.1% (n = 19). Late (>30 day) survival of the adult population was comparable with the age- and gender-matched general population (observed deaths: 101, expected deaths: 91; P = 0.29). Freedom from autograft reoperation at 5, 10 and 15 years was 96.8, 94.7 and 86.7%, respectively, whereas freedom from homograft reoperation was 97.6, 95.5 and 92.3%, respectively. The overall freedom from reoperation was 94.9, 91.1 and 82.7%, respectively. Longitudinal modelling of functional valve performance revealed a low (<5%) probability of a patient being in higher autograft regurgitation grades throughout the first decade. Similarly, excellent homograft function was observed throughout the first 15 years. CONCLUSION The autograft principle results in postoperative long-term survival comparable with that of the age- and gender-matched general population and reoperation rates within the 1%/patient-year boundaries and should be considered in young, active patients who want to avoid the shortcomings of conventional prostheses.
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Affiliation(s)
- Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Ulrich Stierle
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Efstratios I Charitos
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jürgen Hörer
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Ulrich Franke
- Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Marc Albert
- Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Armin Gorski
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Rainer G Leyh
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Arlindo Riso
- Paediatric Cardiology/Paediatric Cardiac Surgery, University Heart Center, Hamburg, Germany
| | - Jörg Sachweh
- Paediatric Cardiology/Paediatric Cardiac Surgery, University Heart Center, Hamburg, Germany
| | - Anton Moritz
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Wolfgang Hemmer
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany
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Subbotina I, Biermann D, Arunagirinathan U, Gottschalk U, Müller G, Reichenspurner H, Riso A, Sachweh J. Experience with Initial Full Coagulation Regime after Neonatal Postcardiotomy Extracorporeal Membrane Oxygenation (ECMO). Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Biermann D, Eder A, Seoudy H, Subbotina I, Arndt F, Stumm M, Riso A, Mir T, Hansen A, Reichenspurner H, Eschenhagen T, Sachweh J. Failing Fontan: Towards a Subpulmonary Neo-ventricle from Engineered Heart Tissue. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sachweh J, Rueffer A, Walk J, Biermann D, Mueller G, Reichenspurner H, Riso A, Cesnjevar R. Size matters: Longevity of valved RVOT conduits is mainly related to the conduit diameter. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Biermann D, Subbotina I, Stumm M, Arndt F, Schemm A, Arunagirinathan U, Reichenspurner H, Riso A, Sachweh J. An exceedingly rare coronary anomaly - right coronary artery take-off from the left ventricular outflow tract. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jatene MB, Abuchaim DCS, Tiveron MG, Tanamati C, Miura N, Riso A, Atik E, Lopes AA, Marcial MB. Tratamento cirúrgico da persistência do canal arterial na população adulta. Braz J Cardiovasc Surg 2011; 26:93-7. [DOI: 10.1590/s0102-76382011000100017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 02/15/2011] [Indexed: 11/21/2022] Open
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Jatene MB, Abuchaim DCS, Oliveira JDL, Riso A, Tanamati C, Miura N, Lopes AA, Barbero-Marcial ML. Outcomes of aortic coarctation surgical treatment in adults. Braz J Cardiovasc Surg 2009; 24:346-53. [PMID: 20011882 DOI: 10.1590/s0102-76382009000400014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 06/05/2009] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study is to describe our experience in aortic coarctation surgery in adult patients by assessing the immediate and mid-term outcomes. METHODS From January 1987 to March 2000, 50 consecutive adult patients underwent surgery for correction of aortic coarctation, through left lateral thoracotomy. Of these, forty two (84%) patients presented high blood pressure, with mean systolic arterial pressure of 170.56 mmHg (125-220 mmHg). The mean of pressure gradient in the coarctation area was 51.4 mmHg (18-123 mmHg). Other associated surgical cardiovascular diseases were not treated in the same operative act, except in two cases of patent ductus arteriosus (PDA). Three different techniques were used: aortic coarctation resection with end-to-end anastomosis was performed in 20 (40%) patients, coarctation enlargement with bovine pericardial patch was performed in 22 (44%) patients and synthetic tube interposition was performed in eight (16%) patients. RESULTS Operative morbidity was low; there was one case of bleeding who required reoperation. The most common immediate postoperative event was high blood pressure (98%), but it was easily controlled by intravenous drugs. There was no hospital death. Mean residual pressure gradient was 18.7 (8-33 mmHg). Patients were discharged in 9.5 days (5-30). Postoperative follow-up mean was 46.8 months (1-145 months) in 45 (91.8%) patients. Forty one (91.1%) of these followed-up patients had normal blood pressure, whereas 75.6% of them without drugs intake. 93.3% of these followed-up patients were asymptomatic. Four of them required further surgical operation, one needed a pacemaker implant, other two patients needed a cardiac valve replacement and one had endocarditis. There was one related death due to sepsis secondary to endocarditis. CONCLUSION Surgical treatment of aortic coarctation, even in adult patients, is an efficient therapeutic choice, regardless of the applied surgical technique, with low morbidity and mortality. It reduces efficiently the arterial pressure levels in both immediate and mid-term follow-up.
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Affiliation(s)
- Marcelo Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
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Jatene MB, Miana LA, Pessoa AJ, Riso A, Azeka E, Tanamati C, Gimenez S, Lopes AA, Marcial MB, Stolf NAG. Pediatric heart transplantation in refractory cardiogenic shock: a critical analysis of feasibility, applicability and results. Arq Bras Cardiol 2009; 90:329-33. [PMID: 18516404 DOI: 10.1590/s0066-782x2008000500010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 10/17/2007] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In children with dilated cardiomyopathy who are on the waiting list for heart transplantation, we evaluate the seriousness of their hemodynamic conditions. Some develop cardiogenic shock, and the mortality rate is high. Even with inotropic and respiratory support, heart transplantation is considered an extremely grave circumstance. OBJECTIVE The objective of this study is to report on our experience with children in this condition, in an attempt to analyze the viability, applicability and results of heart transplantation in these children. METHODS From March 2001 to February 2004, 22 children with dilated cardiomyopathy who were on the waiting list for heart transplantation developed cardiogenic shock, requiring transfer to pediatric intensive care unit (ICU), intubation and inotropic support. Their ages ranged from 11 months to 11 years (mean age: 4.3 years), 55% were males, 14 could be listed as clinical priority, and the remaining 8 were removed from the waiting list due to their unfavorable clinical conditions. RESULTS Eight heart transplantations were performed, and 6 children died while on the waiting list (42.9%). Two children died (25%) after transplantation and the remaining 6 were discharged from hospital in good clinical condition. The two main complications were organ rejection in 4 cases and infection in 5 cases. Two patients developed neurological complications, and one of them fully recovered. CONCLUSION Children with cardiomyopathy and cardiogenic shock require immediate heart transplantation; only 57.1% could be transplanted, with an early 25% mortality rate. Those who survived transplantation showed good clinical progress, similar to that of children transplanted on an elective basis.
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Affiliation(s)
- Marcelo Biscegli Jatene
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil.
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Jatene MB, Azeka E, Atik E, Riso A, Tanamati C, Marcial MB, de Oliveira SA. Ascending Aortic Aneurysm After Pediatric Heart Transplantation: Case Report of an Unusual Complication. J Heart Lung Transplant 2005; 24:638-41. [PMID: 15896768 DOI: 10.1016/j.healun.2004.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2002] [Revised: 02/03/2004] [Accepted: 03/01/2004] [Indexed: 11/20/2022] Open
Abstract
A 28-month-old boy, weighing 11 kg, with severe dilated cardiomyopathy, was transplanted on December 1995. Hypertension and supraventricular tachycardia were detected in the immediate post-operative period, with favorable outcome. After 5 months of clinically asymptomatic follow-up, a dilation in the ascending aorta was observed on routine echocardiogram. Nuclear magnetic resonance imaging (NMRI) confirmed an ascending aortic aneurysm, with a diameter of 38 mm. An operation was performed, a bovine pericardium patch was sutured with reconstruction of the aortic wall, excluding the aneurysm. Good recovery was obtained and the child was discharged on Day 7 postoperatively. A post-operative echocardiogram showed absence of the aortic aneurysm and good surgical results. Another NMRI was done 5 months later, showing an intact ascending aorta. After 64 months, the patients clinical condition was confirmed as normal by echocardiogram. Surgical treatment was successful and the positive results have been maintained.
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Atik FA, Atik E, da Cunha CR, Caneo LF, Assad RS, Jatene MB, Riso A, Barbero-Marcial M. Long-term results of correction of tetralogy of Fallot in adulthood. Eur J Cardiothorac Surg 2004; 25:250-5. [PMID: 14747122 DOI: 10.1016/j.ejcts.2003.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The natural history of tetralogy of Fallot (TOF) allows that a minority of patients reach adulthood without any treatment, representing mild forms of the disease. The aim of this study is the long-term evaluation of patients with TOF surgically treated in adulthood, in order to define its real benefit. METHODS Between November 1982 and January 2001, 39 patients older than 18 years of age with tetralogy of Fallot underwent total correction. Mean age was 26.6 years (range 18-67) and 21 patients (53.8%) were females. A previous modified Blalock-Taussig shunt was performed in four patients (10.3%). Fifteen patients (38.5%) were in NYHA functional class III or IV. Mean hematocrit was 53.6+/-10% and the mean gradient across the right-ventricular outflow tract was 93.9+/-24.8 mmHg. The operation was performed via transatrial/transpulmonary approach in 16 patients (41%) and six patients (15.4%) required transannular patch. Pulmonary valvotomy was necessary in 13 patients (33.3%) and pulmonary valve replacement with bioprosthesis in 3 patients (7.7%). RESULTS Hospital and late mortality were 5.1 and 7.7%, respectively. The mean follow-up was 45.1 months (range 1-194 months). Actuarial survival was 91.2+/-4.9%, 85.5+/-7.2% and 68.4+/-16.3% at 3, 7 and 15 years, respectively. In the latest follow-up, 27 (79.4%) of the survivals are presently in NYHA functional class I (P<0.001). Echocardiography has shown moderate/severe pulmonary insufficiency in 9 patients (26.5%), moderate pulmonary stenosis in 3 patients (8.8%) and residual ventricular septal defect in 4 patients (11.8%). Arrhythmias were identified in 38.9% of patients with symptoms suspicious of rhythm disturbances. There was impairment of right-ventricular function in 13 patients (38.2%). Three patients were reoperated on to close residual ventricular septal defects in two patients and for pulmonary valve replacement in one patient. CONCLUSIONS The overall survival of surgically treated adult patients with TOF is acceptable. The great benefit of the complete repair at this age is the functional improvement. On the other hand, late complications closely related to chronic hypoxia, such as arrhythmia and ventricular dysfunction might direct for a more careful follow-up after the surgical correction.
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Affiliation(s)
- Fernando A Atik
- Department of Pediatric Cardiac Surgery and Pediatric Cardiology, Heart Institute, University of São Paulo Medical School, SP, São Paulo, Brazil
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Riso A, Barbero-Marcial M, Tanamati C, Jatene MB, Oliveira SA. Repair of Atrioventricular Septal Defect (AVSD) associated with Tetralogy of Fallot (TOF). Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Eleven children, 4-48 months old, with congenital cyanotic heart defects developed choreoathetoid movements 2-12 days after cardiac surgery with hypothermia and extracorporeal circulation (ECC). The abnormal movements mainly involved the limbs, facial musculature, and tongue, leading to a severe dysphagia. The symptoms had an acute onset, after a period of apparent neurologic normality, and had a variable outcome. Of the nine children that survive, three had abnormal movements when last seen (41 days to 12 months of follow-up). The other six children had a complete regression of the choreoathetoid movements 1-4 weeks after onset. No specific finding was observed in the CT scans, cerebrospinal fluid examination, or EEG that could be related to the abnormal movements. Symptomatic therapy with haloperidol with or without benzodiazepines led to symptomatic improvement in six children, although there was no evidence that this treatment modified the evolution of the disease. The authors conclude that the choreoathetoid syndrome after cardiac surgery with deep hypothermia and ECC is an ill-defined entity requiring additional study to better understand its pathogenesis so that preventive measures can be taken to avoid a condition that can lead to permanent and incapacitating neurologic sequelae.
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Affiliation(s)
- J L Gherpelli
- Department of Child Neurology, Clinics Hospital of the University of São Paulo Medical School, SP, Brazil
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Barbero-Marcial M, Azeka E, Camargo PR, Riso A, Jatene M, Soares J, Snitcowsky R, Auler Júnior JO, Camargo L, Santos S, Coelho V, Atik E, Ebaid M, Jatene A. [Neonate and infant heart transplantation]. Arq Bras Cardiol 1996; 67:165-70. [PMID: 9181709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Heart transplantation has offered children with complex congenital heart diseases and severe cardiomyopathies a chance for survival. The present article was written to show the three year experience of this procedure at the Instituto do Coração-HCFMUSP. METHODS The methodology used was based on heart transplant indication criteria, inclusion criteria for donors, postoperative management, immunosuppression and prophylaxis as well as treatment of potential complications. RESULTS From November 1992 to November 1995, 11 children, aged 12 days old to six years (mean 2.5 years) underwent transplantation. Sixty percent of recipients were male; weight ranged from 3.5 to 17.8 kg (mean 10.3 kg). The mean age of donors was 4.4 years (a range of three weeks to ten years), 80% male, weight ranging from 3.8 to 20 kg (median 14.3 kg). The survival rate was 91% and the remaining 10 children are doing well. The most important complications were systemic hypertension, acute rejection and infection. The number of rejections and infections per patient were 3.5 and 4.7 episodes, respectively. The follow-up was between one month to three years (average 16 months). CONCLUSION In this experience, heart transplantation has given an additional opportunity for children with complex congenital heart diseases and cardiomyopathies, with a survival rate of 91% in three years.
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Barbero-Marcial M, Azeka E, Camargo PR, Jatene MB, Riso A, Auler Júnior JOC, Soares J, Monteiro C, Uip D, Camargo L, Santos S, Coelho V, Atik E, Ebaid M, Jatene AD. Características do transplante cardíaco neonatal e infantil. Braz J Cardiovasc Surg 1996. [DOI: 10.1590/s0102-76381996000200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Garay Echeverria NM, Atik E, Ikari NM, Riso A, Barbero Marcial M, Ebaid M. [Anomalous origin of the left coronary artery. Concomitant correction with valvar replacement for mitral insufficiency]. Arq Bras Cardiol 1995; 65:335-7. [PMID: 8728808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A four year-old boy with an anomalous origin of the left coronary artery (LCA) directly from the right pulmonary artery was reported. He had been underwent to mitral valve replacement by a St Judes no. 29, due to severe mitral insufficiency, secondary to an extensive myocardial infarction including the anterior and posterior papilary muscles, beside the implantation of the LCA in the aorta. Instead of this favorable outcome, it's emphasized the need for earlier recognition to avoid risk sequelae.
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Barbero-Marcial M, Riso A, De Albuquerque AT, Atik E, Jatene A. Left ventricular apical approach for the surgical treatment of congenital mitral stenosis. J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)33746-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Barbero-Marcial M, Riso A, De Albuquerque AT, Atik E, Jatene A. Left ventricular apical approach for the surgical treatment of congenital mitral stenosis. J Thorac Cardiovasc Surg 1993; 106:105-10. [PMID: 8320988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
From June 1987 to October 1991, 12 patients with congenital mitral valve stenosis underwent surgical correction. Their ages ranged from 2 to 74 months. Nine patients were less than 22 months of age. Five patients were in New York Heart Association functional class IV, and seven patients were in class III. In nine, parachute-type mitral stenosis was clearly definite. In three, a complex congenital valvular and subvalvular stenosis was found. Associated anomalies were present in every patient; five had undergone previous operations. Correction of the mitral stenosis was done through an apical left ventriculotomy. The removal of the mitral obstruction starts from below; the papillary muscle was split and the chordae were divided or fenestrated. The commissurotomies were performed from the ventricular aspect of the mitral valve. Associated anomalies were corrected simultaneously. The operative mortality rate was zero. There was one late death, which was unrelated to cardiovascular status. The echocardiographic serial postoperative studies (up to 52 months) showed no significant residual mitral stenosis and normal global and regional function of the left ventricle in all but one patient.
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Barbero-Marcial M, Riso A, Albuquerque Â, Atik E, Jatene AD. A ventriculotomia apical esquerda para tratamento cirúrgico da estenose mitral congênita. Braz J Cardiovasc Surg 1991. [DOI: 10.1590/s0102-76381991000300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Barbero-Marcial M, Riso A, Atik E, Jatene A. A technique for correction of truncus arteriosus types I and II without extracardiac conduits. J Thorac Cardiovasc Surg 1990; 99:364-9. [PMID: 2299877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A new corrective operation for truncus arteriosus without the use of an extracardiac conduit was performed in seven patients with truncus type I (six patients) or type II (one patient) aged from 2 to 9 months. The common truncus arteriosus was septated with a patch into aortic and pulmonary segments and the ventricular septal defect was closed through a ventriculotomy. A direct anastomosis between the pulmonary arteries and the right ventricle was performed, the anterior wall being constructed with a patch with a monocusp valve. There was one death in the immediate postoperative period. In the surviving six patients the postoperative right ventricular/left ventricular peak systolic pressure ratio was less than 0.51 in five and 0.60 in one with a residual ventricular septal defect. All are in functional class I between 1 and 14 months after the operation. On the basis of these results, we propose this technique for patients with truncus type I or II in the first year of life.
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Barbero-Marcial M, Atik E, Ratti M, Kajita LJ, Riso A, Verginelli G, Bittencourt D, Pileggi F, Jatene AD. Novas técnicas cirúrgicas para o tratamento da atresia pulmonar com comunicação interventricular e anomalias de artérias pulmonares incluindo o assim chamado truncus tipo IV. Braz J Cardiovasc Surg 1987. [DOI: 10.1590/s0102-76381987000100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rosenblum MG, Riso A, Gutterman JU. Activation of 2',5'-oligoadenylate synthetase and B-2 microglobulin in cancer patients treated with partially pure gamma interferon: dependence of biological effect on administration route. Cancer Chemother Pharmacol 1986; 16:273-6. [PMID: 3084109 DOI: 10.1007/bf00293991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Partially pure immune (gamma) interferon (IFN-gamma) was administered to patients intramuscularly (IM), by rapid IV bolus, and by 6-h continuous infusion as part of a phase I clinical trial. The activity of 2',5'-oligoadenylate synthetase (2,5 A) in peripheral blood cells and the concentration of beta-2 microglobulin (B-2M) in serum were monitored as indicators of interferon biological activity in vivo. Five patients received IFN-gamma by the IM route in doses ranging from 6.5 X 10(5) to 9.6 X 10(6) antiviral units daily. There was little induction either of serum B-2M or of 2,5A in peripheral blood cells. Eight patients received IFN-gamma by rapid (5 min) IV bolus infusion in doses ranging from 6.5 X 10(5) to 54 X 10(6) antiviral units daily. As with IM administration, there was little significant induction of 2,5A synthetase, but the concentration of B-2M was increased above pretherapy values in most patients. Eleven patients received IFN-gamma by 6-h infusion daily for 10 days at a dosage of 27 X 10(6) units/day. In contrast to IM and IV bolus administration, 6-h infusion of IFN-gamma resulted in significant induction of both B-2M serum concentration and of 2,5A activity in all patients. The induction of 2,5A was highest on days 2 and 4 of therapy and decreased to pretherapy values by day 7. During the second 10-day course of the infusion study 2,5A activity was not induced until day 7 of therapy, and it decreased rapidly thereafter. These studies show clearly that consistent biological activity such as B-2M activation and specific intracellular biochemical events such as 2,5A induction may be optimally obtained by the administration of IFN-gamma by continuous IV infusion.
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Auler Júnior JO, Riso A, do Amaral RV, Bittencourt D, Jatene AD. [Respiratory insufficiency with a bronchopulmonary fistula in the postoperative period of cardiac surgery. Use of high frequency ventilation in a 16-month-old child]. Rev Paul Med 1986; 104:55-6. [PMID: 3749716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Auler JO, Riso A, Gonçalves AT, Esteves A, de Oliveira HA, Berlinck MF, Scanavacca M, Ratti M, Mazzieri R, do Amaral RV. [Hemodynamic monitoring in the postoperative period of children undergoing correction of congenital heart diseases]. Arq Bras Cardiol 1983; 41:279-87. [PMID: 6675623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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