Document Detail


Hybrid procedures can reduce the risk of congenital cardiovascular surgery.
MedLine Citation:
PMID:  18678509     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Minimally invasive operations and percutaneous interventions are well-accepted options in the treatment of congenital heart defects. However, percutaneous interventions may be associated with an increased risk due to limited vascular access or a very tortuous catheter course. In these cases, combining operative and interventional approaches with direct puncture of the heart or the great vessels may facilitate implantation of even large devices. Furthermore, in some situations, cardiopulmonary bypass or circulatory arrest can be omitted when doing a hybrid procedure. PATIENTS: Between January 2000 and April 2007 17 patients were operated in a hybrid fashion. Age ranged from 14 days to 45 years. Operative procedures consisted of implantation of an atrial septal defect occluder via direct puncture of the right atrium (n=4), closure of a ventricular septal defect via direct puncture of the right ventricle (n=1), implantation of isthmus stents via the ascending aorta (n=5), redilation of an isthmus stent (n=1), redilation of a ductal stent (n=1), angioplasty of a pulmonary artery stenosis (n=1), interventional occlusion of an intrahepatic porto-caval shunt (n=1), stent implantation into the right pulmonary artery (n=1) and into the right ventricular outflow tract (n=1) under direct vision as well as atrioseptoplasty combined with a bilateral pulmonary artery banding in one newborn with a single ventricle and very low birth weight (n=1). RESULTS: The planned intervention could be performed in all cases under the assistance of intraoperative fluoroscopy, transesophageal or epicardial echocardiography, or under direct vision. In all cases, the primary hemodynamic objectives were achieved. CONCLUSION: In selected patients, the combination of a surgical procedure and a percutaneous intervention may help to reduce both operative and interventional risks. This concept may enable new treatment options, especially in patients with complex congenital heart defects or complex vascular situations.
Authors:
Christoph Schmitz; Bahman Esmailzadeh; Ulrike Herberg; Nora Lang; Ralf Sodian; Rainer Kozlik-Feldmann; Armin Welz; Johannes Breuer
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Publication Detail:
Type:  Journal Article     Date:  2008-08-03
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  34     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-17     Completed Date:  2009-03-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  718-25     Citation Subset:  IM    
Affiliation:
Department of Cardiac Surgery, University of Munich, Munich, Germany. Christoph.Schmitz@med.uni-muenchen.de
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MeSH Terms
Descriptor/Qualifier:
Echocardiography, Transesophageal
Fluoroscopy
Heart Defects, Congenital / radiography,  surgery*,  ultrasonography
Heart Septal Defects, Atrial / surgery,  ultrasonography
Heart Septal Defects, Ventricular / surgery
Humans
Infant
Infant, Newborn
Middle Aged
Prostheses and Implants
Radiography, Interventional
Stents
Surgical Procedures, Minimally Invasive / methods*
Ultrasonography, Interventional / methods
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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