جستجوی مقالات مرتبط با کلیدواژه "cyanotic heart disease" در نشریات گروه "پزشکی"

We herein describe 2 neonates with cyanotic-type congenital heart disease and COVID-19. The first case was a boy at 37 weeks of gestational age (GA) who had cyanosis (SpO2 <90%) on the second day of the birth. He was transferred to the neonatal intensive care unit (NICU) for COVID-19 patients for infection treatment following a positive COVID-19 PCR test. Finally, he had a cardiopulmonary arrest, and cardiopulmonary resuscitation failed. The second case was a boy at 38 weeks of GA. His fetal echocardiography showed a hypoplastic right ventricle with decreased contractility, an atretic tricuspid valve, a hypoplastic pulmonary valve, and a small echogenic focus in the left ventricle. He was then diagnosed with COVID-19 and treated with Kaletra. Follow-up echocardiography showed a functioning shunt, a relieved pericardial effusion, and a normal ejection fraction. He was discharged a week later in good general condition. 

Generally, 2 types of surgical operations are available for the treatment of cyanotic heart diseases: corrective and palliative. The goal of palliative surgery is to increase the pulmonary blood flow via systemic-to-pulmonary arterial shunting.  

In this case-series study, we evaluated patients older than 15 years old with documented cyanotic heart diseases who underwent palliative shunting in Rajaie Cardiovascular Medical and Research Center between 2001 and 2015.  

Forty-seven patients at a mean age of 24.74 ± 5.67 years were enrolled in this study. Twenty-two (46.8%) patients were male. Nearly half of the study population (23 patients) had central shunting, 23 patients Glenn shunting, and 1 patient Blalock–Taussig shunting. Following surgery, there was a significant rise in the mean partial pressure of O2 and O2 saturation, a significant drop in the hemoglobin concentration, and a significant increase in the platelet count. Five (10.6%) patients expired during the study period. The mortality rate of Blalock–Taussig shunting and Glenn shunting was 12.5% and 8.69%, respectively.  

In this case-series study, all the patients showed dramatic improvements in the New York Heart Association functional class, O2 saturation, the partial pressure of O2, the partial pressure of carbon dioxide, hemoglobin levels, and ferritin levels in the first postoperative year; however, these improvements were greater in arterial shunts. The following 10 years saw a decline in these improvements; nonetheless, the clinical status and lab data were good by comparison with the baseline. In adults with congenital cyanotic heart diseases, palliative shunting is a good option and should be considered in patients who are inoperable due to structural problems or high risk of anesthesia or surgery. (Iranian Heart Journal 2020; 21(4): 60-66)

The definite treatment of tetralogy of Fallot (TOF) as the most common cyanotic congenital heart disease is open heart surgery and the operation technique depends on the coronary artery anatomy.

We aimed to evaluate the sensitivity and specificity of various root Aortogram views to detect abnormal coronary artery configuration and course in these patients.

In this retrospective study, the reports of coronary anatomy in angiography and operation notes of TOF patients since 2005 to 2018 were evaluated. The sensitivity and specificity of the two common root Aortogram views including the left anterior oblique/cranial (LAO/CRA) and left anterior oblique/caudal (LAO/CAU) were determined.

Four hundred and fifty one patients with the median age of 28 months (3 - 432 months) were included. All patients had LAO/CRA views and 199 patients had both LAO/CRA and LAO/CAU views. The rate of coronary abnormalities reported by surgery was 8%, and abnormal origin of the left anterior descending artery from the right coronary artery was the most common reported anomaly (4.4%). The sensitivity of the LAO/CAU view was 100%, but LAO/CRA view was about 75% in detecting abnormal coronary configuration. Both of them had excellent specificity (~100%). No significant sex difference was seen between different coronary anatomy abnormalities.

The Caudal root angiogram is an essential view to evaluate coronary artery anatomy in TOF patients and it seems that there is no need for other views like lateral view, but relying on LAO/CRA view alone may lead to significant misdiagnosis of the coronary arteries, crossing the right ventricular outflow tract (RVOT).