Surgical and medical results of complete atrioventricular canal: A ten year review

Clapp, Sandra K.; Perry, Burton L.; Farooki, Zia Q.; Jackson, William L.; Karpawich, Peter P.; Hakimi, Mehdi; Arciniegas, Eduardo; Green, Edward W.

doi:10.1016/0002-9149(87)90955-6

Cited by 42 publications

(20 citation statements)

References 23 publications

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“…The total expected survival rates observed of 80.9% at five years, 75.4% at ten and 67.2% at fifteen years of follow up were similar to those observed in children submitted to similar corrections but did not evolve with bradycardia or the necessity of artificial heart pacing [14][15][16][17][18][19][20][21][22][23][24].…”

Section: Fig 1 -Analysis Using the Kaplan-meier Methods Of The Survivsupporting

confidence: 61%

“…On the other hand, children submitted to palliative corrections, with residual defects after total corrections or those with valve replacements, either in the anatomic position or in valved tubular grafts, have presented with worse evolutions [14][15][16][17][18][19][20][21][22][23][24][25]. Spevak et al [25] reported survival rates of 73% and 51% after one and five years of follow up respectively in children of up to five years old submitted to valve replacement.…”

Section: Commentsmentioning

confidence: 99%

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<![CDATA[Permanent cardiac pacing in children with postoperative bradycardia: long-term follow-up]]>

Costa¹,

Silva²,

Filho³

et al. 2005

Braz. j. cardiovasc. surg.

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RBCCV 44205-777Marca-passo cardíaco definitivo em crianças com bradicardia pós-operatória: resultados tardios Permanent cardiac pacing in children with postoperative bradycardia: long-term follow-up Abstract Objective: To evaluate the long-term outcomes of children submitted to permanent cardiac pacing due to postoperative bradycardia and to identify risk factors for mortality.Methods: From 1980 to 2004, 120 children were submitted to permanent pacemaker implantation. Interval between the defect correction and pacemaker implantation was 1.2 ± 2.8 years on average (median = 21 days). Atrioventricular blocks were present in 94.2% of patients. Transvenous leads (78.3%) and ventricular pacemaker systems (79.2%) were used in most cases. Risk factors were studied using the Cox proportional model. The Kaplan-Meier method and the LogRank test were used to analyze survival.Results: After a mean of 5.7 ± 5.9 years (maximum = 22.5 years) of follow-up, 97 patients were alive and 23 were lost from the follow-up study. The main causes of death were terminal heart failure (10), infection not related to implantation (six), and sudden death (three). The 5-, 10-, and 15-year survival rates were 80.9 ± 4.1%, 75.4 ± 5.5% and 67.2 ± 7.4%, respectively. The persistence of hemodynamic problems (palliative procedures, the use of valve prostheses or the presence of residual defects) was identified as the only independent risk predictors for mortality, with significant alterations in the survival curves (p=0.0123).Conclusion: The implant of permanent pacemakers in children provided good survival expectancy, mainly depending on the underlying disease and the type of the correction made. Palliative corrections, such as the presence of residual defects or the use of valve prostheses were the only predictors of poor results in these children. Resultados: Após 5,7 ± 5,9 anos de seguimento (máximo= 22,5 anos), 97 pacientes estavam vivos e 11 haviam sido perdidos para o seguimento. As principais causas de morte foram insuficiência cardíaca (10), infecção não relacionada ao marca-passo (seis) e morte súbita (três). A expectativa de sobrevida aos cinco, 10 e 15 anos de seguimento mostrou, respectivamente, índices de 80,9 ± 4,1%, 75,4 ± 5,5% e 67,2 ± 7,4%. A persistência de problemas hemodinâmicos após a correção (correções paliativas, uso de próteses valvares ou defeitos residuais) foi identificada como única variável preditora independente de risco para mortalidade, alterando significativamente as curvas de sobrevivência (p = 0,0123). DescriptorsConclusões: O implante de marca-passo em casos de bradicardia pós-operatória possibilitou boa expectativa de sobrevida. A realização de correções paliativas, assim como a presença de defeitos residuais ou de próteses valvares, foram os únicos fatores preditores de mau prognóstico para essas crianças.Descritores: Estimulação cardíaca artificial. Bloqueio cardíaco. Pediatria. Procedimentos cirúrgicos cardíacos. Complicações pós-operatórias.

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Section: Fig 1 -Analysis Using the Kaplan-meier Methods Of The Survivsupporting

confidence: 61%

Section: Commentsmentioning

confidence: 99%

<![CDATA[Permanent cardiac pacing in children with postoperative bradycardia: long-term follow-up]]>

Costa¹,

Silva²,

Filho³

et al. 2005

Braz. j. cardiovasc. surg.

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“…A mortalidade no lactente está relacionada a ICC-insuficiência cardíaca congestiva; SBV-sobrecarga biventricular; AC-área cardíaca; TVP-trama vascular pulmonar; HP-hipertensão pulmonar ICC e, na infância, ocorre em decorrência da doença vascular pulmonar oclusiva 4,5,8,9 . Vários autores 4,5,7 têm sugerido que crianças com síndrome de Down desenvolvem mudanças vasculares pulmonares mais precoce e rapidamente progressivas, que crianças não portadoras da síndrome, embora este último grupo se apresente com mais sintomas.…”

Section: Discussionunclassified

“…Dentre os aspectos morfológicos, é importante notar a predominância do tipo A de Rastelli nos dois grupos, enquanto que os tipos B e C foram encontrados exclusivamente em pacientes com a síndrome genética (p<0,005), relatado também em outras séries 2,6,8,9 . A magnitude da malformação da VAV esteve relacionada ao quadro clínico, sendo maior nos pacientes com cromossomas normais (p<0,009, ).…”

Section: Discussionunclassified

Defeito total do septo atrioventricular. Correlação anatomofuncional entre pacientes com e sem síndrome de Down

Ferrin

Atik

Ikari

et al. 1997

Arq. Bras. Cardiol.

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Purpose - Métodos -Foram estudados 80 pacientes com idade <2 anos, sendo 55 (69%) com síndrome de Down -grupo I (GI) e 25 (31%) sem síndrome de Down -grupo II (GII). Avaliaram-se a idade de manifestação dos sintomas, sua intensidade, classe funcional (CF), repercussão clínica, tipo anatômico e grau de malformação da valva atrioventricular (VAV). Resultados -A idade média de manifestação dos sintomas foi de 50 (±75) dias nos dois grupos. A CF II (NYHA) predominou no GI (31 casos -56,5%) e a CF III-IV no GII

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“…Some authors have suggested that many of the better results have come from highly selected series and that the overall mortality is substantially higher. 2 We reviewed the management and outcome of all children with complete AV canal defect present-ing for repair since December 1986 to identify current risk factors for death, need for reoperation, and left AV valve insufficiency. No child was excluded from repair or this study due to unfavorable anatomy, other associated cardiac defects, or the presence of pulmonary hypertention.…”

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confidence: 99%

Atrioventricular Canal Defects: Results of Repair in the Current Era

Ross¹,

Nanton

Gillis³

et al. 1991

J Cardiac Surgery

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Between December 1986 and December 1990, 37 consecutive patients underwent repair of complete atrioventricular (AV) canal with the two-patch technique. Mean age at repair was 22 months and 51% were less than 1 year of age. Eighteen (48.6%) had undergone previous palliative operations. Two operative deaths (5.4%) occurred and another patient died in-hospital for an early mortality of 8.1%. One late death (2.9%) has occurred from a respiratory infection. Actuarial survival is 87.7% at 3 years. Small size (p less than 0.05), unbalanced ventricular size (p less than 0.05), New York Heart Association (NYHA) Class IV (p less than 0.05), and severe preoperative AV valve insufficiency (p less than 0.05) were significant preoperative risk factors for death. Five survivors (14.7%) required reoperation for severe AV valve insufficiency (two) or patch leaks (three). The risk for reoperation was increased in non-Down's patients (p less than 0.02). All survivors are in NYHA Class I (93%) or II (7%). The risk for early AV valve insufficiency was increased in patients who did not have the cleft sutured (p less than 0.05), and in those with unbalanced ventricles (p less than 0.01). Risk of late AV valve insufficiency was increased only by small size (p less than 0.02). Previous pulmonary artery banding did not increase the risk of repair or of postoperative AV valve insufficiency. Complete AV canal can be repaired with low mortality. Pulmonary artery banding may still have a role to play in the very small (4-5 kg) infant in refractory heart failure.

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Surgical and medical results of complete atrioventricular canal: A ten year review

Cited by 42 publications

References 23 publications

<![CDATA[Permanent cardiac pacing in children with postoperative bradycardia: long-term follow-up]]>

<![CDATA[Permanent cardiac pacing in children with postoperative bradycardia: long-term follow-up]]>

Defeito total do septo atrioventricular. Correlação anatomofuncional entre pacientes com e sem síndrome de Down

Atrioventricular Canal Defects: Results of Repair in the Current Era

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