Медичні науки 56Український журнал медицини, біології та спорту -№ 3 (5)Мета роботи -аналіз результатів застосування ендоваскулярних методів лікування при синдромі гіпоплазії лівих відділів серця (СГЛВС). Критеріями відбору були діаметр висхідної аорти менше 2 мм та мала вага пацієнтів. Прооперовано 15 пацієнтів: 4 жіночої (26,7%) та 11 (73,3%) чоловічої статі. Се-редній вік пацієнтів склав 9,1±2,4 днів, маса у сере-дньому менше 2,24±0,14 кг. У всіх випадках була проведена гібридна операція з білатеральним зву-женням легеневої артерії (ЛА), доповнена стенту-ванням відкритої артеріальної протоки як перший етап лікування. Після оперативного втручання з 15 пацієнтів четверо (26,7%) були виписані у відпо-відні стаціонарні клініки для продовження лікування.В результаті досліджень встановлено, що, не-зважаючи на високу летальність, гібридні операти-вні втручання необхідно виконувати, оскільки це єдиний шанс на порятунок цих пацієнтів. Ендовас-кулярні оперативні втручання при СГЛВС є опера-ціями вибору, які дозволяють підготувати пацієнта до наступного етапу лікування. Ендоваскулярні втручання при СГЛВС є малотравматичними, що збільшує шанси пацієнтів малої ваги та з ускладне-ною анатомією на виживання, не дивлячись на важкий їх стан при надходженні в стаціонар. Складність оперативного втручання та невелика частота поширення серед усіх інших ВВС потребує концентрувати таких хворих в одному високо-спеціалізованому кардіохірургічному центрі з ме-тою накопичення досвіду, та поступовим покра-щенням результатів лікування. Проведення подібних оперативних втручань потребує досвіду, ретельної підготовки, злагодженості на всіх етапах та усіх служб, що приймають участь у лікуванні даної категорії пацієнтів: діагностичної, транспортної, анестезіологічної, хірургічної, реанімаційної та післяопераційної лікувальної і реабілітаційної.Ключові слова: вроджена вада серця, синд-ром гіпоплазії лівих відділів серця, ендоваскулярні методи.Вступ. Лікування критичних вад серця є однією з найбільш складних проблем в серцево-судинній хірургії. Це обумовлено: незрілістю усіх систем новонародженого, і в першу чергу серцево-судинної [1], яка окрім того ще й ускладнена вро-дженою вадою серця (ВВС); стресовою ситуацією для новонародженого, організм якого перейшов з комфортних умов існування внутрішньоутробно до самостійного життя. Хоча вже сама критична вада -це така патологія розвитку серця, яка не дозволяє забезпечити адекватний серцевий викид з достатнім для життя тиском і насиченням киснем, що призводить до смерті в перші дні життя за від-сутності екстреного хірургічного втручання [3]. При цьому з перших годин життя у пацієнтів розвива-ється серцево-судинна недостатність з гіпоксемі-єю, життєвозагрозливими аритміями, і навіть їх поєднання. Прояв артеріальної гіпоксемії -ціаноз -у більшості випадків є центральним, і тому включає слизові оболонки та є результатом право-лівого шунтування венозної крові і її надходженням до аорти, зниженим легеневим кровотоком.Крім того, звичайне оперативне втручання су-проводжується значною травмою для такого осла...
The aim. To determine the optimally necessary devices for endovascular stenting of coarctation of the aorta (CoA), considering the anatomical features of the defect and the age of the patient. Materials and methods. Examination and endovascular treatment of 189 patients aged 5 to 60 years with CoA of different anatomical and morphological variants was performed. Results and discussion. We presented the clinical features of different anatomical andmorphological variants of CoA. Endovascular treatment of CoA with stenting is considered the best method for adolescents and adults, due to the lower risk of aneurysm formation compared to balloon angioplasty. We were able to successfully reduce the invasive pressure gradient in patients of different ages and to establish dependence of the frequency of complications on the type of the stent used. There were no cases of in-hospital death. The effectiveness of the intervention was 99.4 %. All the patients were discharged from the hospital in good condition 3-7 days (3.3 ± 1.9 days) after the procedure. Currently, 95.7 % are being followed up. During the 5-year follow-up period, 1 patient died due to concomitant heart failure, heart rhythm disturbances (atrial fibrillation) and mitral insufficiency. There were 10.1 % patients (n = 19) with complications: 4.9 % (n = 4) with open-cell stents, 12.1 % (n = 13) with closed-cell stents, 2.2 % (n = 4) with stent-grafts, 7.9 % (n = 16) with uncovered stents. The frequency of reinterventions was 45.0 % in patients older than 25 years, 37.2 % in those aged 5-18 years and 17.6 % in those aged 19-25 years. Conclusions. The choice of optimally necessary devices for endovascular stenting of the aorta is recommended to be carried out considering the anatomical features of the defect and the age of the patient.
OBJECTIVES In upper-income countries, infants undergo low-risk ventricular septal defect (VSD) repair. Children in low- and middle-income countries frequently present at older ages with elevated pulmonary vascular resistance (PVR) and pulmonary arterial hypertension (PAH). Expensive interventions for pulmonary hypertensive crisis are not available, and children are often denied an operation due to the mortality risk. We report our early and late experiences with these patients who underwent VSD closure by traditional patch (TP) or double patch (DP) techniques. METHODS We extracted data from patients with VSD and PAH who underwent VSD closure operations from 1996 to 2016. Information regarding cardiac catheterizations, operations, time in the intensive care unit and follow-up information was found. We identified 129 children and analysed the differences between the TP (89/129) and the DP (40/129) in unidirectional groups. After 2005, the patients were pretreated with sildenafil 3 months before catheterization. RESULTS The TP group was younger (P < 0.001). Hospital mortality (2.5%, DP; 10.1%,TP) was not significantly different (P = 0.17) between the 2 groups despite significant differences in baseline PVR, PVR/systemic vascular resistance and the number of children with a saturation less than 90%. The long-term survival and regression of PAH were better in the DP group (survival over 97% vs 93% in the TP group). Moreover, 61% of children with DP and 75% of those with TP had normal to mild elevations in pulmonary artery pressures at the last follow-up examination (P = 0.046). CONCLUSIONS The DP operation is a low-risk procedure. Moreover, the long-term outcome with the use of this technique in high-risk patients with VSD and high PVR and PAH is favourable with respect to survival and showed a decrease in PAH at the last follow-up.
Objective. To estimate a security of application of moderate hypothermia while performing the aortal arch reconstruction in new-born babies in conditions of selective antegrade cerebral perfusion. Materials and methods. In 2010-2019 yrs period in Amosov National Institute of Cardiovascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardio-Surgery in 64 new-born babies the aortal arch reconstruction was performed in conditions of selective antegrade cerebral perfusion in moderate hypothermia. In the investigation only patients with a two-ventricle physiology, in whom further two-ventricular correction was conducted, were included. There were 48 (75%) boys and 16 (25%) girls. Median age of the patients was (1.6 ± 0.8) mo, median body mass - (3.8 ± 1.1) kg, median square of the body surface - (0.24 ± 0.04) m². Echocardiographic investigation and neurosonography were the main diagnostic procedures. Results. Hospital mortality have constituted 4.7% (3 patients died). The death cases were not connected with the brain protection procedure. Duration of artificial blood circulation period have had constituted (138.4 ± 58.8) min at average, aortal clamping - (83.1 ± 40 min), selective antegrade cerebral perfusion - (24.4 ± 8.8) min. In 10 (15,6%) patients in early postoperative period the sternum persisted open. In 4 (6.2%) patients in early postoperative period convulsions were noted, which were treated successfully medicinally. Median stay in the Department of Reanimation and Intensive Therapy have constituted (7.1 ± 4.1) days. In late follow-up period the patients were seen from 1 mo till 8.5 yrs. No one patient died. While elective neurosonography conduction the brain pathological changes were absent. The neurological complications symptoms were absent as well. Conclusion. Selective antegrade cerebral perfusion with moderate hypothermia constitutes effective and secure method of the brain protection while performance of the aortal arch reconstruction in new-born babies, using median surgical approach in conditions of artificial blood circulation.
Background. The choice of surgical approach for the reconstruction of aortic arch hypoplasia is a rather controversial issue. Traditionally, left lateral thoracotomy is used to correct aortic coarctation with hypoplasia of one or more arc seg-ments. However, in recent years, more and more clinics have begun widespread use of median sternotomy for the surgical treatment of aortic arch hypoplasia. The purpose of the research was to analyze the immediate and long-term results of surgical treatment of isolated hypoplasia of the aortic arch in infants through left thoracotomy. Materials and methods. From 2010 to 2019, 159 infants with coarctation and hypoplasia of one or more segments of the aortic arch underwent reconstruction of the aortic arch at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and Ukrainian Children’s Cardiac Center. The study included only patients with biventricular physiology and subsequent biventricular correction. There were 108 male patients (68%) and 51 female patients (32%). The mean age of the patients was 2.4 ± 0.9 months, the mean body weight was 4.7 ± 2.0 kg. The main method of diagnosis, i.e. determining the defect and assessing the immediate and long-term results, was echocardiographic examination. The study group consisted of 155 patients (97.5%) in whom the reconstruction of the aortic arch was performed through left thoracotomy, in the remaining 4 patients (2.5%) the intervention was performed through median sternotomy. Results. In-hospital mortality was 0.6% (n = 1). The average time of the operation was 126 ± 40 minutes, the aortic cross-clamp time was 24.7 ± 5.1 minutes. The mean duration of mechanical ventilation after the surgery was 41 ± 15.9 hours. The mean follow-up period ranged from 1 month to 13 years. There were no deaths in the long-term period. Ten (6.4%) patients developed aortic arch restenosis in the postoperative period. In 8 patients, the narrowing was treated by endovascular dilatation. Two patients underwent repeated aortic arch repair using median sternotomy. There were no cases of compression of the trachea, main bronchi, neurological complications in the follow-up period. Conclusions. Reconstruction of the aortic arch hypoplasia through left thoracotomy is an effective and safe treatment option in infants associated with good immediate and long-term results. The study indicates that this surgical strategy can be used in most patients with hypoplasia of the isthmus and distal aortic arch.
Objective. To analyze the immediate and late follow-up results of the aortal arch plasty, using anastomosis «end to side». Materials and methods. In 2010 - 2019 yrs period in Amosov National Institute of Cardio-Vascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardiosurgery in 75 new-born babies, suffering coarctation and hypoplasia of one or several segments of aortal arch its reconstruction was done, using ‘end-to-side” anastomosis. Into the investigation only the patients with a two-ventricular physiology and further two-ventricular correction were included. There were 41 (54.6%) boys and 34 (45.4%) girls. Average age of the patients was (2,5 ± 1,2) mo, and average body mass - (3.3 ± 0.6) kg. The main diagnostic method for the failure determination and immediate and late results studying was echocardiographic investigation. Results. Hospital lethality have constituted 6.6% (5 patients died). The lethality causes were not connected with the aortal arch reconstructive procedure, using anastomosis «end to side». Duration of follow-up was 1 mo - 9.3 yrs, (2.8 ± 2.5) yrs at average. In late follow-up period 1 patient died. In 11 (14.6%) patients in postoperative period the aortal arch restenosis have developed. In 7 patients restenosis was eliminated endovascularly, using balloon dilatation. In 4 patients the aortal arch surgical replasty was done. Tracheal and the main bronchi compression, neurological complications in late follow-up period were not observed. Conclusion. After plasty for the aortal arch hypoplasia, using anastomosis «end to side» in new-born babies good immediate and late follow-up results were noted, what witnesses its efficacy. In accordance to results of the investigation accomplished such kind of anastomosis applied may be used in patients, suffering hypoplasia of proximal aorta or in tubular hypoplasia of all aortal arch.
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