"1" . . "2"^^ . "RIV/00023884:_____/09:#0003080!RIV12-MZ0-00023884" . . "322518" . "Korekce Ebsteinovy anom\u00E1lie u dosp\u011Bl\u00FDch" . . "3"^^ . "N" . . "RIV/00023884:_____/09:#0003080" . . . . "[9924A806BC25]" . "Korekce Ebsteinovy anom\u00E1lie u dosp\u011Bl\u00FDch"@cs . . . "Cor et Vasa" . . . . "51" . "Popelov\u00E1, Jana" . "Soubor pacient\u016F/metodika: V Nemocnici Na Homolce bylo od prosince 2005 do kv\u011Btna 2008 operov\u00E1no celkem patn\u00E1ct pacient\u016F s Ebsteinovou anom\u00E1li\u00ED (v\u011Bk 21 63 let, medi\u00E1n 45 let). Morfologicky se jednalo o typ A u t\u0159\u00ED pacient\u016F, typ B u \u010Dty\u0159 pacient\u016F a typ C u osmi nemocn\u00FDch. V\u0161ichni operovan\u00ED m\u011Bli v\u00FDznamnou a\u017E masivn\u00ED trikuspid\u00E1ln\u00ED insuficienci, dva z nich kombinovanou se sten\u00F3zou, jeden\u00E1ct pacient\u016F m\u011Blo arytmie (fibrilace nebo flutter s\u00EDn\u00ED, AV nod\u00E1ln\u00ED reentrantn\u00ED tachykardie), u dvou z nich byla p\u0159edopera\u010Dn\u011B provedena radiofrekven\u010Dn\u00ED ablace (CT isthmu a modifikace dvoj\u00ED AV nod\u00E1ln\u00ED dr\u00E1hy). T\u0159i nemocn\u00ED byli t\u011B\u017Ece cyanoti\u010Dt\u00ED (klidov\u00E1 saturace < 85 %). Klinicky bylo deset pacient\u016F symptomatick\u00FDch v\u00FDznamn\u011B (NYHA III IV), t\u0159i st\u0159edn\u011B (NYHA II III) a dva pouze lehce (NYHA I II). P\u0159i chirurgick\u00E9 korekci byla sedmi pacient\u016Fm trikuspid\u00E1ln\u00ED chlope\u0148 nahrazena biologickou chlopn\u00ED, u sedmi byla provedena plastika chlopn\u011B a u jednoho nemocn\u00E9ho byla ponech\u00E1na bez v\u00FDkonu. D\u00E1le byla provedena bidirek\u010Dn\u00ED kavopulmon\u00E1ln\u00ED anastom\u00F3za k odleh\u010Den\u00ED dysfunk\u010Dn\u00ED prav\u00E9 komory u \u0161esti pacient\u016F, uz\u00E1v\u011Br s\u00ED\u0148ov\u00E9ho defektu u p\u011Bti nemocn\u00FDch, MAZE kryoablace u deseti pacient\u016F a plikace atrializovan\u00E9 \u010D\u00E1sti prav\u00E9 komory u \u0161esti pacient\u016F. V\u00FDsledky: \u010Ctrn\u00E1ct pacient\u016F z patn\u00E1cti operovan\u00FDch \u017Eije v klinicky zlep\u0161en\u00E9m stavu 4 32 m\u011Bs\u00EDc\u016F (medi\u00E1n 13) po operaci, jeden pacient zem\u0159el 8. poopera\u010Dn\u00ED den na krv\u00E1cen\u00ED do mozku po p\u0159edchoz\u00EDm napojen\u00ED na ECMO (extracorporeal membrane oxygenation) pro biventrikul\u00E1rn\u00ED selh\u00E1n\u00ED. V\u0161ech sedm pacient\u016F s nahrazenou trikuspid\u00E1ln\u00ED chlopn\u00ED m\u00E1 dobrou funkci biologick\u00E9 chlopn\u011B bez sten\u00F3zy nebo insuficience; ze sedmi operovan\u00FDch s rekonstruovanou trikuspid\u00E1ln\u00ED chlopn\u00ED m\u00E1 \u0161est pacient\u016F m\u00E1lo nebo st\u0159edn\u011B v\u00FDznamnou insuficienci trikuspid\u00E1ln\u00ED chlopn\u011B a jeden pacient v\u00FDznamnou trikuspid\u00E1ln\u00ED regurgitaci. Dvan\u00E1ct pacient\u016F m\u00E1 sinusov\u00FD rytmus, dva jsou dependentn\u00ED na kardiostimul\u00E1toru. Pouze u jednoho se objevil p\u0159echodn\u011B poopera\u010Dn\u011B flutter s\u00EDn\u00ED (u" . "5"^^ . "Soubor pacient\u016F/metodika: V Nemocnici Na Homolce bylo od prosince 2005 do kv\u011Btna 2008 operov\u00E1no celkem patn\u00E1ct pacient\u016F s Ebsteinovou anom\u00E1li\u00ED (v\u011Bk 21 63 let, medi\u00E1n 45 let). Morfologicky se jednalo o typ A u t\u0159\u00ED pacient\u016F, typ B u \u010Dty\u0159 pacient\u016F a typ C u osmi nemocn\u00FDch. V\u0161ichni operovan\u00ED m\u011Bli v\u00FDznamnou a\u017E masivn\u00ED trikuspid\u00E1ln\u00ED insuficienci, dva z nich kombinovanou se sten\u00F3zou, jeden\u00E1ct pacient\u016F m\u011Blo arytmie (fibrilace nebo flutter s\u00EDn\u00ED, AV nod\u00E1ln\u00ED reentrantn\u00ED tachykardie), u dvou z nich byla p\u0159edopera\u010Dn\u011B provedena radiofrekven\u010Dn\u00ED ablace (CT isthmu a modifikace dvoj\u00ED AV nod\u00E1ln\u00ED dr\u00E1hy). T\u0159i nemocn\u00ED byli t\u011B\u017Ece cyanoti\u010Dt\u00ED (klidov\u00E1 saturace < 85 %). Klinicky bylo deset pacient\u016F symptomatick\u00FDch v\u00FDznamn\u011B (NYHA III IV), t\u0159i st\u0159edn\u011B (NYHA II III) a dva pouze lehce (NYHA I II). P\u0159i chirurgick\u00E9 korekci byla sedmi pacient\u016Fm trikuspid\u00E1ln\u00ED chlope\u0148 nahrazena biologickou chlopn\u00ED, u sedmi byla provedena plastika chlopn\u011B a u jednoho nemocn\u00E9ho byla ponech\u00E1na bez v\u00FDkonu. D\u00E1le byla provedena bidirek\u010Dn\u00ED kavopulmon\u00E1ln\u00ED anastom\u00F3za k odleh\u010Den\u00ED dysfunk\u010Dn\u00ED prav\u00E9 komory u \u0161esti pacient\u016F, uz\u00E1v\u011Br s\u00ED\u0148ov\u00E9ho defektu u p\u011Bti nemocn\u00FDch, MAZE kryoablace u deseti pacient\u016F a plikace atrializovan\u00E9 \u010D\u00E1sti prav\u00E9 komory u \u0161esti pacient\u016F. V\u00FDsledky: \u010Ctrn\u00E1ct pacient\u016F z patn\u00E1cti operovan\u00FDch \u017Eije v klinicky zlep\u0161en\u00E9m stavu 4 32 m\u011Bs\u00EDc\u016F (medi\u00E1n 13) po operaci, jeden pacient zem\u0159el 8. poopera\u010Dn\u00ED den na krv\u00E1cen\u00ED do mozku po p\u0159edchoz\u00EDm napojen\u00ED na ECMO (extracorporeal membrane oxygenation) pro biventrikul\u00E1rn\u00ED selh\u00E1n\u00ED. V\u0161ech sedm pacient\u016F s nahrazenou trikuspid\u00E1ln\u00ED chlopn\u00ED m\u00E1 dobrou funkci biologick\u00E9 chlopn\u011B bez sten\u00F3zy nebo insuficience; ze sedmi operovan\u00FDch s rekonstruovanou trikuspid\u00E1ln\u00ED chlopn\u00ED m\u00E1 \u0161est pacient\u016F m\u00E1lo nebo st\u0159edn\u011B v\u00FDznamnou insuficienci trikuspid\u00E1ln\u00ED chlopn\u011B a jeden pacient v\u00FDznamnou trikuspid\u00E1ln\u00ED regurgitaci. Dvan\u00E1ct pacient\u016F m\u00E1 sinusov\u00FD rytmus, dva jsou dependentn\u00ED na kardiostimul\u00E1toru. Pouze u jednoho se objevil p\u0159echodn\u011B poopera\u010Dn\u011B flutter s\u00EDn\u00ED (u"@cs . "CZ - \u010Cesk\u00E1 republika" . "Korekce Ebsteinovy anom\u00E1lie u dosp\u011Bl\u00FDch"@cs . "Korekce Ebsteinovy anom\u00E1lie u dosp\u011Bl\u00FDch" . . "\u010Cern\u00FD, \u0160t\u011Bp\u00E1n" . "Ebstein s anomaly Tricuspid valvuloplasty Right-heart MAZE procedure"@en . "Correction of Ebstein anomaly in adults"@en . "Aim: To evaluate the outcome of correction of Ebstein s anomaly in adult patients undergoing surgery as part of a program of care of adult patients with congenital heart defects. Group of patients/methods: A total of 15 patients with Ebstein s anomaly (age 21 63 years, median 45 years) were operated on from December 2005 through May 2008 at Na Homolce Hospital. In terms of morphology, types A, B, and C were present in three, four, and eight patients, respectively. All patients had significant up to massive tricuspid insufficiency, combined with stenosis in two; eleven patients had arrhythmias (atrial fibrillation or flutter, AV nodal re-entrant tachycardia), with radiofrequency ablation (isthmus CT and modification of dual AV nodal pathway) undertaken preoperatively in two. Three patients were severely cyanotic (resting saturation < 85%). In clinical terms, ten patients were significantly symptomatic (NYHA III IV), three moderately (NYHA II III), with two only mildly (NYHA I II). During surgical correction, the tricuspid valve was replaced by a biological valve prosthesis in seven patients, valvuloplasty was performed in another seven while no procedure was undertaken in one. In addition, bidirectional cavopulmonary anastomosis to relieve the dysfunctional right ventricle was performed in six, atrial defect closure in five, the MAZE procedure using cryoablation in ten, and plication of the atrialized portion of the right ventricle in six patients. Results: Fourteen out of the 15 patients undergoing surgery are alive in a clinically improved condition at 4 32 months (median 13) post-surgery; one patient died on postoperative day 8 from intracerebral hemorrhage after being placed on ECMO (extracorporeal membrane oxygenation) for biventricular failure. All seven patients with tricuspid valve replacement show good function of the biological valve prosthesis free of stenosis or insufficiency; six of the seven patients und"@en . "Correction of Ebstein anomaly in adults"@en . "0010-8650" .