The Long-Term Change of Arrhythmias after Transcatheter Closure of Perimembranous Ventricular Septal Defects

Objectives. To observe and analyze the long-term change of different types of arrhythmias after transcatheter closure of perimembranous ventricular septal defect (pmVSD). Methods. We retrospectively collected the data of patients who underwent pmVSD closure in our institution from March 2002 to December 2010. Results. One hundred thirty-nine patients met the inclusion criteria, of which 265 (25.5%) had early arrhythmia. They were classified into two categories: conduction abnormality (191/1039; 18.4%) and origin abnormality (94/1039; 9.0%), including 20 patients with both types of arrhythmias. The median follow-up time was 84.5 months, and 103 patients (103/191; 53.9%) with early conduction block got permanent arrhythmias, while only three patients (3/94; 3.2%) with early anomalous origin arrhythmias still had an abnormal electrocardiogram. Serious arrhythmias (28/1039; 2.7%), including II° atrioventricular block (AVB), III° AVB, and complete left bundle branch block (CLBBB), can appear immediately in the early postoperative period (21 patients) or in the late outset (seven patients) after several months or even years (6 months to 8.3 years). Twenty patients (20/21; 95.2%) with serious arrhythmia in the early postoperative period improved after early treatment, but six patients relapsed or worsened during follow-up. At the endpoint, severe arrhythmia persisted in 13 patients, of which four patients got permanent pacemaker implanted, and one patient with recurrent CLBBB died from heart failure. Conclusions. The probability of delayed CAVB or bundle branch block after VSD closure is low but often occurs several years after surgery. Therefore, long-term ECG follow-up should last for several years or even decades. Serious arrhythmias that appear early after transcatheter pmVSD closure may impose a risk of recurrence although they have been cured already. Close attention should be paid to the changes of cardiac function in patients with CLBBB after VSD closure, and the severity of such arrhythmia should be taken seriously and reexamined.

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Follow-Up Study of Electrocardiographic Indices in 252 Children with Ventricular Septal Defect after Minimally Invasive Transthoracic Closure

The Heart Surgery Forum ◽

10.1532/hsf.4009 ◽

2021 ◽

Vol 24 (6) ◽

pp. E1057-E1064

Author(s):

Yanan Sun ◽

Minglei Gao ◽

Ping Wen

Keyword(s):

Ventricular Septal Defect ◽

Minimally Invasive ◽

Septal Defect ◽

Early Postoperative Period ◽

Multivariate Logistic Regression ◽

Bundle Branch Block ◽

Severe Arrhythmia ◽

Third Degree Atrioventricular Block

Objective: The aim of this study was to explore the efficacy and safety of minimally invasive transthoracic closure (MITC) in treating ventricular septal defect (VSD). Methods: A total of 252 children with VSD were investigated between August 2013 and March 2015. Their electrocardiographic indices were monitored at different time points (before surgery [T0], immediately after surgery [T1], and 3 days/7 days/1 month/3 months/6 months after surgery [T2–6]) and followed up every year. Related adverse events also were recorded. Results: All children with VSD successfully underwent MITC. The average follow-up time was 5 years, during which no changes in the heart rate or corrected QT interval were found. The PR and QRS intervals were prolonged in the early postoperative period (T3); the SV1+RV5 amplitude decreased significantly at T6, and the left axis deviation significantly recovered at T6 (P < 0.05). A total of 32 patients developed arrhythmia within 3 days after surgery; however, no severe arrhythmia, including ventricular tachycardia, ventricular fibrillation, second-and third-degree atrioventricular block, complete left or right bundle branch block, and delayed arrhythmia, occurred during the follow-up period. Binary multivariate logistic regression revealed that the longer the surgery time and the larger the VSD diameter, the higher the risk of arrhythmia. Conclusions: The incidence of long-term arrhythmia after MITC is low, and the outcomes are good.

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One-Stage Repair of Aortic Arch Hypoplasia Associated With Ventricular Septal Defect

Ukrainian journal of cardiovascular surgery ◽

10.30702/ujcvs/20.3905/025052-056 ◽

2020 ◽

pp. 52-56

Author(s):

Y. Truba ◽

R. Sekelyk ◽

I. Dzyurii ◽

L. Prokopovych ◽

O. Golovenko ◽

...

Keyword(s):

Aortic Arch ◽

Postoperative Period ◽

Balloon Dilation ◽

Early Postoperative Period ◽

Long Term Results ◽

One Stage ◽

The Mean ◽

Aortic Arch Hypoplasia

Background. Aortic arch hypoplasia is a congenital anomaly of the development of the aortic arch characterized by ground. Aortic arch hypoplasia is a congenital anomaly of the development of the aortic arch characterized by hemodynamically significant narrowing of one or more segments of the aortic arch. Aortic arch hypoplasia combined ynamically significant narrowing of one or more segments of the aortic arch. Aortic arch hypop with ventricular septal defect (VSD) characterizes a special category of children who are in serious condition and need ptal defect (VSD) characterizes a special category immediate surgery. Despite the improvement in the results of surgical treatment of this abnormality in recent years, the gery. Despite the imp issue of choosing treatment tactics remains debatable. g The aim. To analyze immediate and long-term results of one-stage aortic arch hypoplasia repair and VSD repair in infants. Materials and methods. From 2011 to 2019, 55 infants underwent simultaneous aortic arch hypoplasia repair in ypoplasia rep conjunction with VSD repair at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and junction with VSD repair at the National Amosov Institute of Cardiovascular Surgery Ukrainian Children’s Cardiac Center. There were 30 (55%) male patients and 25 (45%) female patients. The mean age of (55%) male patients and 25 (45%) female patients. The mean ag the patients was 1.3 ± 1.2 months (from 0.1 to 9.1 months), the average body weight was 3.9 ± 1.3 kg (from 2.4 to 8.7 patients was 1.3 ± 1.2 months (from 0.1 to 9.1 months), the average body weight was 3.9 ± 1.3 kg ( kg). The mean body surface area was 0.27 ± 0.1 m2. Antegrade selective cerebral perfusion was performed in 23 (42%) g). The mean body patients during the aortic arch reconstruction. g Results.The hospital mortality rate was 1.8% (n = 1). The average duration of artificial circulation was 108.5 ± 38.6 minpital mortality rate was 1.8% (n = 1). The averag utes (from 55 to 204 minutes), aortic clamping time was 56.9 ± 36.4 minutes (from 21 to 126 minutes), the time of selec(from 55 to 204 minutes), aortic clamping time was 56.9 ± 36.4 minutes (from 21 to 126 minutes) tive cerebral perfusion was 26.4 ± 11.5 minutes (14 to 49 minutes). In eight patients (14.5%) the sternum was spread perfusion was 26.4 ± 11.5 minutes (14 to 49 minutes). In eight patients (14.5%) the sternum was sp apart in the early postoperative period. Echocardiography before discharge revealed the average pressure gradient at the part in the early postoperative period. Echocardiograp site of plasticity of the aortic arch of 20.5 ± 14.9 mm Hg. plasticity of the aortic arch of 20.5 ± 14.9 mm Hg. The mean long-term follow-up was 2.6 ± 2.1 years (from two months to 8.1 years). There were no fatal cases in the reg-term follow-up was 2.6 ± 2.1 years (from two months to 8.1 years) mote period. In 5 (9.1%) patients aortic arch restenosis occurred in the postoperative period; it was successfully treated period. In 5 (9.1%) patients aortic arch restenosis occurred in the postoperative period; it was successfully endovascularly by balloon dilation in 3 patients, the other 2 of them underwent repeated aortic arch repair. Long-term y by balloon dilation in 3 patients, the other 2 of them underwent repeated aortic arch repair. Long follow-up of other patients showed good results with respect to the pressure gradient at the aortic arch. There were p of other patients showed good results with respect to the pressure g no hemodynamically significant gradient after VSD closure. There were no neurological complications in the long-term follow-up. p Conclusions. One-stage complete repair is an effective and safe treatment for infants which provides good immedige complete repair is an effective and safe treatment for infants which provides g ate and long-term results. This surgical strategy may be an acceptable alternative to two-stage surgical treatment of this g complex pathology.

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A 6-year experience of the Ross procedure in children with congenital aortic valve disease

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2020-48-049 ◽

2020 ◽

Vol 48 (4) ◽

pp. 240-245

Author(s):

D. S. Akatov ◽

V. A. Belov ◽

D. E. Khomich ◽

O. N. Bukhareva ◽

A. A. Makarov ◽

...

Keyword(s):

Aortic Valve ◽

Pulmonary Artery ◽

Postoperative Period ◽

Early Postoperative Period ◽

Ross Procedure ◽

Optimal Method ◽

Advantages And Disadvantages ◽

The Mean

Background: The choice of an optimal method for correction of aortic valve stenosis or insufficiency remains the matter of debate. Some clinicians prefer transluminal balloon angioplasty, some would perform an open type commissurotomy, or aortic valve replacement, or to valve leaflets repair with various materials, while others opt for the Ross procedure. Each of these techniques has its advantages and disadvantages both in the early postoperative period and in the long-term.Aim: To assess the results of the Ross procedure, its complications, survival, and probability of reoperations in the long-term.Materials and methods: We retrospectively analyzed the results of 32 Ross procedures performed from the end of 2012 to the beginning of 2019 in children aged from 3 days to 18 years. Eight children were below 1 year of age, including one newborn. A pulmonary autograft was placed into the aortic position in all children. In 31 children, a homograft was placed into the pulmonary artery. In one patient, an aortic autograft was implanted instead of the pulmonary artery valve. The mean patient age was 6.8 years, mean bodyweight 27.7 kg (range, 3.9–74.6 kg).Results: Two patients died in the early postoperative period (mortality 6.25%). We examined 26 patients at the follow-up, with its mean duration of 2.5 years. There were no indications for replacement of the homograft during the follow-up. One patient, in whom we had implanted an aortic autograft into the pulmonary position, required its replacement after 4.5 years. We have no data on death rates in the long-term.Conclusion: The Ross procedure provides satisfactory results in the early and intermediate postoperative period. Continuous follow-up is needed to determine the time points and the proportion of repeated interventions with a pulmonary homograft and aortic valve.

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INTRAOPERATIVE MITOMYCIN C AND 5 FLUOROURACILAPPLICATION DURING PRIMARY TRABECULECTOMY : A COMPARATIVE STUDY

10.36106/6444126 ◽

2021 ◽

pp. 15-17

Author(s):

Gopal Prasad Singh ◽

Urvashi Singh ◽

Alka Jha

Keyword(s):

Postoperative Complications ◽

Mitomycin C ◽

Postoperative Period ◽

Early Postoperative Period ◽

The Other ◽

Average Period ◽

Medical College ◽

Primary Glaucoma

Aim: To compare the outcome variables of these 2 commonly used anti-metabolites 5-Fluorouracil and Mitomycin-C in trabeculectomy surgeries in primary glaucoma. Material & methods: The present study was conducted on 50 eyes of 39 patients of primary glaucoma who underwent trabeculectomy over a period from January 2019 to August 2020 at Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga.The patients were randomly categorized into 2 groups of 25 each. One group received 5-Fluorouracil in the dose of 50 mg/ml for duration of 4 to 5 minutes intraoperatively. The other group received intraoperative Mitomycin-C in the dose of 0.4 mg/ml applied over duration of 2 to 3 minutes. Result:Maximum complications were seen during early postoperative period in which maximum number were seen with POAG (9 cases) followed by PACG (5 cases). Late postoperative complications were seen in POAG and PACG (2 in each). Conclusion:Long-term complications may only become apparent many years later. Since our study had average period follow up of about 42 weeks, we are not able to comment on the long-term complications following the use of these drugs. In this study both 5-Fluorouracil and Mitomycin-C were found to be equally safe.

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Transcatheter closure with domestic occluder in treatment of patent ductus arteriosus complicated with severe pulmonary arterial hypertension in adults:a long-term follow-up study

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2009.00975 ◽

2009 ◽

Vol 29 (8) ◽

pp. 975-977

Author(s):

Man-li YU ◽

Ke WANG ◽

Jing LIU ◽

Xian-xian ZHAO ◽

Yong-wen QIN

Keyword(s):

Pulmonary Arterial Hypertension ◽

Transcatheter Closure ◽

Ductus Arteriosus ◽

Follow Up Study ◽

Long Term Follow Up ◽

Pulmonary Arterial ◽

Severe Pulmonary Arterial Hypertension ◽

Patent Ductus

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Long-term postoperative opioid prescription after cholecystectomy or gastric by-pass surgery: a retrospective observational study

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0150 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Viktoria Larsson ◽

Cecilia Nordenson ◽

Pontus Karling

Keyword(s):

Observational Study ◽

Postoperative Period ◽

Medical Records ◽

Early Postoperative Period ◽

Retrospective Observational Study ◽

Opioid Use ◽

Opioid Prescription ◽

Post Surgery ◽

Gastric By Pass

Abstract Objectives Opioids are commonly prescribed post-surgery. We investigated the proportion of patients who were prescribed any opioids 6–12 months after two common surgeries – laparoscopic cholecystectomy and gastric by-pass (GBP) surgery. A secondary aim was to examine risk factors prior to surgery associated with the prescription of any opioids after surgery. Methods We performed a retrospective observational study on data from medical records from patients who underwent cholecystectomy (n=297) or GBP (n=93) in 2018 in the Region of Västerbotten, Sweden. Data on prescriptions for opioids and other drugs were collected from the patients` medical records. Results There were 109 patients (28%) who were prescribed opioids after discharge from surgery but only 20 patients (5%) who still received opioid prescriptions 6–12 months after surgery. All 20 of these patients had also been prescribed opioids within three months before surgery, most commonly for back and joint pain. Only 1 out of 56 patients who were prescribed opioids preoperatively due to gallbladder pain still received prescriptions for opioids 6–12 months after surgery. Although opioid use in the early postoperative period was more common among patients who underwent cholecystectomy, the patients who underwent GBP were more prone to be “long-term” users of opioids. In the patients who were prescribed opioids within three months prior to surgery, 8 out of 13 patients who underwent GBP and 12 of the 96 patients who underwent cholecystectomy were still prescribed opioids 6–12 months after surgery (OR 11.2; 95% CI 3.1–39.9, p=0,0002). Affective disorders were common among “long-term” users of opioids and prior benzodiazepine and amitriptyline use were significantly associated with “long-term” opioid use. Conclusions The proportion of patients that used opioids 6–12 months after cholecystectomy or GBP was low. Patients with preoperative opioid-use experienced a significantly higher risk of “long-term” opioid use when undergoing GBP compared to cholecystectomy. The indication for being prescribed opioids in the “long-term” were mostly unrelated to surgery. No patient who was naïve to opioids prior surgery was prescribed opioids 6–12 months after surgery. Although opioids are commonly prescribed in the preoperative and in the early postoperative period to patients with gallbladder disease, there is a low risk that these prescriptions will lead to long-term opioid use. The reasons for being prescribed opioids in the long-term are often due to causes not related to surgery.

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The use of enoxaparin as bridge to therapeutic INR after LVAD implantation

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01373-y ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Zubair Shah ◽

Ioannis Mastoris ◽

Prakash Acharya ◽

Aniket S. Rali ◽

Moghni Mohammed ◽

...

Keyword(s):

Postoperative Period ◽

Left Ventricular ◽

Early Postoperative Period ◽

Index Admission ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Bleeding Events ◽

Ventricular Assist ◽

Safety Outcome

Abstract Background Left ventricular assist devices (LVAD) have been increasingly used in the treatment of end-stage heart failure. While warfarin has been uniformly recommended in the long-term as anticoagulation strategy, no clear recommendation exists for the post-operative period. We sought to evaluate the feasibility of enoxaparin in the immediate and early postoperative period after LVAD implantation. Methods This is a two-center, retrospective analysis of 250 consecutive patients undergoing LVAD implantation between January 2017 and December 2018. Patients were bridged postoperatively to therapeutic INR by either receiving unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were followed while inpatient and for 3 months after LVAD implantation. The efficacy outcome was occurrence of first and subsequent cerebrovascular accident while safety outcome was the occurrence of bleeding events. Length of stay (LOS) was also assessed. Results Two hundred fifty and 246 patients were analyzed for index admission and 3-month follow up respectively. No statistically significant differences were found between the two groups in CVA (OR = 0.67; CI = 0.07–6.39, P = 0.73) or bleeding events (OR = 0.91; CI = 0.27–3.04, P = 0.88) during index admission. Similarly, there were no differences at 3 months in either CVAs or bleeding events (OR = 0.85; 0.31–2.34; p = 0.76). No fatal events occurred during the study follow-up period. Median LOS was significantly lower (4 days; p = 0.03) in the LMWH group. Conclusions LMWH in the immediate and early postoperative period after LVAD implantation appears to be a concurrently safe and efficacious option allowing earlier postoperative discharge and avoidance of recurrent hospitalizations due to sub-therapeutic INR.

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Transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder

Cardiology in the Young ◽

10.1017/s1047951102000501 ◽

2002 ◽

Vol 12 (3) ◽

pp. 224-228 ◽

Cited By ~ 1

Author(s):

Haifa Abdul Latiff ◽

Mazeni Alwi ◽

Hasri Samion ◽

Geetha Kandhavel

Keyword(s):

Transcatheter Closure ◽

Standard Procedure ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Term Outcome ◽

Long Term Follow Up ◽

One Year ◽

The Right

This study reviewed the short-term outcome of transcatheter closure of the defects within the oval fossa using an Amplatzer® Septal Occluder. From January 1997 to December 2000, 210 patients with defects within the oval fossa underwent successful transcatheter closure. We reviewed a total of 190 patients with left-to-right shunts, assessing the patients for possible complications and the presence of residual shunts using transthoracic echocardiogram at 24 h, 1 month, 3 months and one year. Their median age was 10 years, with a range from 2 to 64 years, and their median weight was 23.9 kg, with a range from 8.9 to 79 kg. In 5 patients, a patent arterial duct was closed, and in 2 pulmonary balloon valvoplasty performed, at the same sitting. The median size of the Amplatzer® device used was 20 mm, with a range from 9 to 36 mm. The median times for the procedure and fluoroscopy were 95 min, with a range from 30 to 210 min, and 18.4 min, with a range from 5 to 144 min, respectively. Mean follow-up was 20.8 ± 12.4 months. Complete occlusion was obtained in 168 of 190 (88%) patients at 24 h, 128 of 133 (96.2%) at 3 months, and 103 of 104 (99%) at one year. Complications occurred in 4 (2.1%) patients. In one, the device became detached, in the second the device embolized into the right ventricular outflow tract, the lower end of the device straddled in the third, and the final patient had significant bleeding from the site of venupuncture. There were no major complications noted on follow-up. We conclude that transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder is safe and effective. Long-term follow-up is required, nonetheless, before it is recommended as a standard procedure.

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Association of Long-Term Change and Variability in Glycemia with Risk of Incident Heart Failure among Patients with Type 2 Diabetes Mellitus – A Secondary Analysis of the ACCORD Trial

10.2337/figshare.12273155.v2 ◽

2020 ◽

Author(s):

Matthew W. Segar ◽

Kershaw V. Patel ◽

Muthiah Vaduganathan ◽

Melissa C. Caughey ◽

Javed Butler ◽

...

Keyword(s):

Standard Deviation ◽

Secondary Analysis ◽

Glycemic Variability ◽

Baseline Risk ◽

Absolute Difference ◽

Cox Models ◽

Term Change ◽

Alternative Measures

Objective: Evaluate the associations between long-term change and variability in glycemia with risk of HF among patients with T2DM. Research Design and Methods: Among participants with T2DM enrolled in the ACCORD trial, variability in HbA1c was assessed from stabilization of HbA1c following enrollment (8 months) to 3 years of follow-up as follows: average successive variability (ASV=average absolute difference between successive values), coefficient of variation (CV=standard deviation/mean), and standard deviation. Participants with HF at baseline or within 3 years of enrollment were excluded. Adjusted Cox models were used to evaluate the association of % change (from baseline to 3 years of follow-up) and variability in HbA1c over the first 3 years of enrollment and subsequent risk of HF. Results: The study included 8,576 patients. Over a median follow-up of 6.4 years from the end of variability measurements at year 3, 388 patients had an incident HF hospitalization. Substantial changes in HbA1c were significantly associated with higher risk of HF [HR (95% CI) for ≥10% decrease = 1.32 (1.08-1.75), ≥10% increase = 1.55 (1.19-2.04), ref: <10% change in HbA1c]. Higher long-term variability in HbA1c was significantly associated with higher risk of HF [HR (95% CI) per 1 SD of ASV = 1.34 (1.17-1.54)] independent of baseline risk factors and interval changes in cardiometabolic parameters. Consistent patterns of association were observed using alternative measures of glycemic variability. Conclusions: Substantial long-term changes and variability in HbA1c were independently associated with risk of HF among patients with T2DM.

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