scholarly journals Single institution experience with the Ladd’s procedure in patients with heterotaxy and stage I palliated single-ventricle

2016 ◽  
Vol 5 (3) ◽  
pp. 319 ◽  
Author(s):  
Kurt D Piggott ◽  
Grace George ◽  
Harun Fakioglu ◽  
Carlos Blanco ◽  
Sukumar Saguna Narasimhulu ◽  
...  
Keyword(s):  
Single Ventricle ◽  
Stage I ◽  
Single Institution ◽  
Ladd’S Procedure

Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved?

2019 ◽  
Vol 10 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Valdano Manuel ◽  
Humberto Morais ◽  
Aida L. R. Turquetto ◽  
Gade Miguel ◽  
Leonardo A. Miana ◽  
...  
Keyword(s):  
Confidence Interval ◽  
African Country ◽  
Single Ventricle ◽  
Hazard Ratio ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Lost To Follow Up ◽  
Single Ventricle Palliation

Introduction: Single ventricle physiology management is challenging, especially in low-income countries. Objective: To report the palliation outcomes of single ventricle patients in a developing African country. Methods: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between March 2011 and December 2017. Preoperative data, surgical factors, postoperative results, and survival outcomes were analyzed. The patients were divided by palliation stage: I (pulmonary artery banding [PAB] or Blalock–Taussig shunt [BTS]), II (Glenn procedure), or III (Fontan procedure). Results: Of the 83 patients who underwent palliation (stages I-III), 38 deaths were observed (31 after stage I, six after stage II, and one after stage III) for an overall mortality of 45.7%. The main causes of operative mortality were multiple organ dysfunction due to sepsis, shunt occlusion, and cardiogenic shock. Twenty-eight survivors were lost to follow-up (22 after stage I, six after stage II). Thirteen stage II survivors are still waiting for stage III. The mean follow-up was 366 ± 369 days. Five-year survival was 28.4 % for PAB and 30.1% for BTS, while that for stage II and III was 49.8% and 57.1%, respectively. Age (hazard ratio, 0.61; 95% confidence interval: 0.47-0.7; P = .000) and weight at surgery (hazard ratio, 0.45; 95% confidence interval: 0.31-0.64; P = .002) impacted survival. Conclusion: A high-mortality rate was observed in this initial experience, mainly in stage I patients. A large number of patients were lost to follow-up. A task force to improve outcomes is urgently required.

Abstract 17543: The Chicken or the Eggs? Examining the Causal Relationship Between the Development of Atrioventricular Valve Regurgitation and Ventricular Dysfunction in Patients With Functionally Single-Ventricle Physiology

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yasuhiro Kotani ◽  
Devin Chetan ◽  
Selvi Senthilnathan ◽  
Arezou Saedi ◽  
Christopher A Caldarone ◽  
...  
Keyword(s):  
Causal Relationship ◽  
Single Ventricle ◽  
Ventricular Dysfunction ◽  
Stage I ◽  
Stage Ii ◽  
Atrioventricular Valve ◽  
Valve Regurgitation ◽  
Ventricular Dilation ◽  
Atrioventricular Valve Regurgitation ◽  
Annular Dilation

Introduction: Development of atrioventricular valve regurgitation (AVVR) with or without ventricular dysfunction (VD) often occurs during the first 6 months of life and has a significant impact on outcomes for single-ventricle patients. Yet, it is not well known whether AVVR causes VD or vice versa. Thus, we sought to identify the timing and causal relationship between AVVR and VD. Methods: Among 156 consecutive single-ventricle patients who had staged palliation (2005- 2012), 28 who had AVV repair at the time of stage II (n=24, 86%) or inter-stage (n=4, 14%) were reviewed. Diagnosis included HLHS in 17 (61%) patients, tricuspid atresia in 2 (7%), and others in 9 (32%). Ventricular morphology was left-dominant in 6 (21%) patients and right-dominant in 22 (79%). AVV morphology included mitral in 6 (21%) patients, tricuspid in 18 (64%), and common in 4 (14%). Serial echocardiograms were reviewed to identify the timing of development of AVVR and/or VD. Results: After stage I palliation, ventricular end-diastolic dimension (VEDD) z-score significantly increased from 4.01 to 5.69 (p<0.01) AVVR (Figure). By the time of stage II palliation, VEDD further increased and subsequent AVV annular dilation occurred, resulting in 23 patients with significant AVVR. None of the patients, however, had significant VD before stage II palliation/AVV repair, but 9 patients developed significant VD after AVV repair. Conclusions: Ventricular dilation occurred immediately after stage I palliation and continued until stage II palliation. Secondary annular dilation occurred inter-stage and this further triggered the development of AVVR. Tangible ventricular dysfunction was not seen before AVV repair, however, important ventricular dysfunction was unmasked after volume unloading surgery. Heart failure management and early intervention to significant AVVR may reduce the incidence of ventricular dysfunction following AVV repair.

Pre‐ and post‐operative cardiovascular CT in Stage I single ventricle palliation

2021 ◽  
Author(s):  
Sheba John ◽  
Laura Schoeneberg ◽  
Christopher E. Greenleaf ◽  
Jorge D. Salazar ◽  
Dilachew A. Adebo
Keyword(s):  
Single Ventricle ◽  
Stage I ◽  
Single Ventricle Palliation ◽  
Cardiovascular Ct

scholarly journals Digoxin Use Is Associated With Reduced Interstage Mortality in Patients With No History of Arrhythmia After Stage I Palliation for Single Ventricle Heart Disease

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
David W. Brown ◽  
Colleen Mangeot ◽  
Jeffrey B. Anderson ◽  
Laura E. Peterson ◽  
Eileen C. King ◽  
...  
Keyword(s):  
Heart Disease ◽  
Single Ventricle ◽  
Stage I ◽  
Interstage Mortality ◽  
History Of

Prospective metastatic risk assignment in clinical stage I nonseminomatous germ cell testis cancer: a single institution pilot study☆

2004 ◽  
Vol 22 (3) ◽  
pp. 174-177 ◽  
Author(s):  
Michael Perrotti ◽  
Murali Ankem ◽  
Anita Bancilla ◽  
Victor deCarvalho ◽  
Peter Amenta ◽  
...  
Keyword(s):  
Pilot Study ◽  
Germ Cell ◽  
Clinical Stage ◽  
Stage I ◽  
Testis Cancer ◽  
Single Institution ◽  
Metastatic Risk

Study of Multiple Systemic-to-Pulmonary Shunts in Single Ventricle Hearts

2012 ◽  
Author(s):  
Mahdi Esmaily Moghadam ◽  
Tain-Yen Hsia ◽  
Bari Murtuza ◽  
Alison Marsden
Keyword(s):  
Blood Flow ◽  
Pulmonary Blood Flow ◽  
Single Ventricle ◽  
Ductus Arteriosus ◽  
Adverse Outcomes ◽  
Flow Dynamics ◽  
Single Institution ◽  
Shunt Occlusion ◽  
Flow Competition ◽  
Blalock Taussig Shunt

For newborns diagnosed with single ventricle hearts and insufficient blood flow to the lungs, their lack of oxygen in the blood can be remedied with a modified Blalock-Taussig shunt (BTshunt) between the innominate and pulmonary artery. However, some surgeons prefer to have two systemic-to-pulmonary shunts, by either leaving the ductus arteriosus open or construct a second BT shunt, to provide additional pulmonary blood flow. There have been clinical reports of premature shunt occlusion when more than one shunt is employed, and a recent audit of shunt operations at a single institution has revealed increased mortality. There are speculation that these adverse outcomes can be due to flow competition between the two shunts, and/or having too much pulmonary blood flow. The flow dynamics and cardiopulmonary physiology in single ventricle circulations where pulmonary blood flow is supplied by more than one shunt has not been studied previously. In this study, we adopted CFD-based multi-domain simulations to compare a range of shunt configurations to examine the issue of flow competition and pulmonary overcirulation.

Surveillance for stage I testicular seminoma: Retrospective analysis of prognostic factors for relapse at a single institution in Japan

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15630-15630
Author(s):  
K. Kakimoto ◽  
Y. Ono ◽  
N. Meguro ◽  
A. Kawashima ◽  
T. Kinouchi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Survival Rate ◽  
Vascular Invasion ◽  
Lymphatic Invasion ◽  
Rete Testis ◽  
Stage I ◽  
Single Institution ◽  
Testicular Seminoma ◽  
Beta Hcg ◽  
Stage I Seminoma

15630 Background: Treatment options for clinical stage I seminoma include adjuvant radiotherapy (RT) as well as surveillance and adjuvant chemotherapy. Although adjuvant RT remains the treatment of choice in most centers, the success of surveillance of patients with stage I nonseminomatous germ cell tumors and the establishment of curative chemotherapy for advanced disease have led to re-examination of the standard treatment approach. Data available from the surveillance and adjuvant RT series suggest that nearly 100% of patients with stage I testicular seminoma are cured, whichever approach is chosen. We report here results of a retrospective analysis of prognostic factors for stage I testicular seminoma. Methods: Between January 1980 and December 2004, surveillance was performed for 61 patients. Tumor characteristics (age at diagnosis, size, elevation of beta hCG level, invasion of the rete testis, vascular invasion, and lymphatic invasion) were examined as factors possibly predictive of relapse. Cause-specific survival rate was calculated using the Kaplan-Meier method. Results: With a median follow-up of 10.5 years (range, 2.35–20.8 years), 7 relapses were observed, with an actuarial 5- year relapse-free rate (RFR) of 89.2%. On univariate analysis, only tumor size (RFR: <8cm, 96%; =8cm, 76%; p=0.029) was predictive of relapse. Age at diagnosis (RFR: <36, 89%; =36, 91%), elevation of beta hCG level (RFR: 93% [normal] v 91% [elevated]), invasion of the rete testis (RFR:92% [absent] v 90% [present]), vascular invasion (RFR:89% [absent] v 86% [present]), and lymphatic invasion (RFR: 89% [absent] v 78% [present]) were not predictive of relapse. The overall relapse rate was 11.5%. Overall 5-year survival rate was 97%. Conclusions: Size of primary tumor was found to be predictive of relapse in patients with stage I seminoma managed with surveillance, on analysis at a single institution in Japan. No significant financial relationships to disclose.

Neuroendocrine carcinoma of the cervix: A single institution’s experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15585-e15585
Author(s):  
Megan Preston ◽  
Georgia Anne-Lee McCann ◽  
David M. O'Malley ◽  
Christina Boutsicaris ◽  
Larry J. Copeland ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Metastatic Disease ◽  
Survival Data ◽  
Early Stage ◽  
Stage I ◽  
Stage Ii ◽  
Advanced Stage ◽  
Single Institution ◽  
Early Stage Disease ◽  
Stage Disease

e15585 Background: Neuroendocrine carcinomas (NEC) of the cervix comprise only 2% of all cervical cancers. As a result, prospective data is limited and treatment guidelines rely on literature from lung NEC. The objective of this study was to examine and report on our experience in the management of this rare, aggressive disease. Methods: This was an IRB-approved, single-institution, retrospective review. Study criteria included patients with cervical NEC diagnosed between 1990-2011. Demographic, treatment and survival data was collected. Progression-free survival (PFS) and overall survival (OS) was defined as the time from date of initial treatment until progression or death respectively, or date of last contact. Results: A total of 24 patients met inclusion criteria. The median age at diagnosis was 43. Median PFS was 13.6 months and median OS was 16.4 months. The majority of patients had advanced-stage disease (61% stage II-IV, 39% stage I). Of the 9 patients with stage I disease, 4 were treated with platinum + etoposide-based neoadjuvant chemotherapy and 5 were treated with initial radical surgery. Seven of the 9 patients had post-operative adjuvant therapy consisting of chemotherapy, chemo-radiation or radiation only. Seven of the 9 patients (78%) were alive at last follow-up. Of the two patients who were deceased, one had metastatic disease found at surgery and the other declined adjuvant therapy and died of recurrence. Patients with stage II-IV disease (n=15) had a median PFS and OS of 11.5 and 12.1 months, respectively. Only 2 had no evidence of disease at last encounter. The remainder died without achieving remission. Patients with metastatic disease had significantly worse survival when compared to those with loco-regional disease with a median OS of 8 vs. 28 months (p = .03), respectively. Conclusions: We report one of the largest single-institution experiences of neuroendocrine cervical cancer. Advanced-stage patients had a poor prognosis regardless of therapy. However, multi-modality therapy in early-stage disease resulted in an excellent prognosis (78% survival) for these rare, highly aggressive tumors. These findings support the goal of curative intent for early-stage disease using multi-modality therapy.

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