摘要:

The patent ductus arteriosus (PDA) was the first congenital heart lesion to be treated surgically and also the first to be treated with nonsurgical catheter intervention. Surgical ligation and division of the ductus remains the gold standard for consistently achieving complete occlusion. Transaxillary muscle-sparing thoracotomy and video-assisted thoracoscopic ligation, however, have evolved as surgical altematives with reduced trauma, shorter hospitalization, and excellent cosmetic result but are associated with a significant rate of residual or recurrent duct patency. With aggressive application of critical pathway methods, significant reduction in cost has been achieved for surgical PDA closure. Nonsurgical transcatheter closure nevertheless has gained widespread acceptance, mostly employing detachable or nondetachable stainless steel coils. Coils have superseded the previously popular Rashkind PDA occluder (USCI/Bard, Tewksbury, MA) because of significantly lower cost, less cumbersome handling, smaller delivery catheters, and superior occlusion rates. Various coil implantation techniques and detachment mechanisms have been devised. Large PDAs with smallest diameter greater than 5 mm, however, still are better treated surgically until appropriate devices become available.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The optimal interventional management of coarctation of the aorta (CoA) remains controversial. Although some are strong advocates for surgery, the timing of operation in elective cases has been a matter of debate. Among those who advocate balloon angioplasty, some recommend dilation only of recurrent CoA. Others recommend dilation of native CoA, but only beyond a certain age. Finally, some are strong proponents of balloon angioplasty, even in the neonatal period, recognizing the need for reintervention (balloon dilation or surgery) in a significant proportion of patients. Recent reports suggest similar or slightly superior acute results of balloon dilation for native compared with recurrent CoA. Balloon-expandable stents are being used increasingly in complex CoAs and in failed dilations. A large multicenter study is required to determine the respective clinical roles of surgery and balloon dilation in the management of CoA.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Fewer than 50 pediatric lung transplants are performed each year. Surgical advances in the field have resulted in improved operative outcomes and in technical innovations that have broadened both the target population and the donor pool. At the same time, late referral of critically ill patients and shortage of donor organs result in death prior to transplantation for many children, and substantial biological barriers exist that prevent achievement of satisfactory long-term outcomes for the many who do undergo a successful surgical procedure. Until we can better understand and overcome these barriers, lung transplantation must be considered a palliative rather than curative procedure. In this article, a brief overview of pediatric lung transplantation is offered, and contributions to the recent literature are summarized.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID