Fetal interventions have been performed for some congenital heart diseases. However, these procedures have not gained wide acceptance due to concerns about their efficacy and safety. The aim of this study was to report on a preliminary experience with fetal cardiac interventions in Brazil. Twenty-two cardiac interventions were performed in 21 fetuses. Thirteen fetuses had critical aortic stenosis (CAS), 4 had hypoplastic left heart syndrome (HLHS) and intact interatrial septum or small patent foramen ovale, 1 had pulmonary atresia with intact ventricular septum (IVS), and 3 had critical pulmonary stenosis (CPS). The main outcome variables evaluated were technical success and procedural complications as well as pregnancy and postnatal outcomes. Success was achieved in 20 of 22 procedures (91%) with 1 failed aortic and 1 failed pulmonary valvuloplasties. There was 1 fetal death. No maternal complications occurred. One patient with CAS, severe mitral regurgitation, and hydrops died postnatally within 5 months of age. All patients with HLHS and restrictive atrial septum died after interventional or surgical procedures and prolonged hospitalizations. All patients with CPS/IVS survived and achieved a biventricular (BV) circulation after neonatal valvuloplasty and ductal stenting. A BV circulation was achieved in 4 of 8 patients with CAS and evolving HLHS (one still in utero), including 2 with initial borderline left ventricles (LV) in whom surgical LV overhaul was performed at 9 months of age. In this preliminary experience, the feasibility of fetal cardiac interventions and their outcomes were similar to those previously reported.
Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the short-to-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction.
IntroductionChylothorax is a lymphatic extravasation into pleural cavity and its
incidence is 0.25%-5.3% in children undergoing cardiac surgery.ObjectiveTo evaluate the incidence of chylothorax in pediatrics patients operated,
linking it in each surgical intervention. Evaluate treatment types and
efficiency.MethodsRetrospective study using medical records of children undergoing cardiac
surgery in the Hospital do Coração between 2004 and 2014. For
statistical analysis, qualitative variables by absolute frequency and
relative frequency; quantitative variables, by median of 25 and 75
percentiles, as they did not present normal distribution (Shapiro-Wilk,
P<0.05). The Chi-square test was used for the
association between type of treatment and result. The adopted confidence
level was 95%.ResultsIncidence of chylothorax was 2.1% (0.9% in intracardiac surgery, 1.7%
correction of patent ductus arteriosus and aortic coarctation, 8.3% Glenn's
surgery, 11.8% total cavopulmonary surgery and 3% in others). Among
treatments, fasting associated with total parenteral nutrition (TPN)
resolved 51% of the cases. Hypoglossal diet had failed treatment and
surgical referral in 22% of the cases. Fasting with TPN associated with
octreotide had success in the treatment of chylothorax in a period exceeding
15 days in 78% of cases, and 3.7% were referred for surgery.ConclusionAccording to the results, incidence of chylothorax was 2.18%. Treatment with
fasting and TPN leads to resolutions in 86.5%, and the association with
octreotide was successful in 85.1% of cases, showing an efficient option,
while the treatment with hypoglossal diet had therapeutic failure in 22% of
the cases in which it was used.
Our results showed that exercise capacity long-term after ASO in TGA is well preserved although lower than in healthy children what might be explained by the presence of chronotropic incompetence in the TGA group.
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