ABSTRACT
Abstract Introduction: Few reports in the world have shown a differential effect of hypothyroidism in relation to morbidity and mortality following cardiac surgery. Objective: To determine the association between preoperative hypothyroidism, composite and disaggregated outcomes of mortality and complications in patients undergoing first-time isolated myocardial revascularization surgery. Methods: Historical cohort of patients undergoing myocardial revascularization between January 2008 and December 2014, with 626 patients included for evaluation of the composite and disaggregated outcomes of in-hospital mortality and complications (atrial fibrillation, surgical site infection and reoperation due to bleeding). A logistic regression model was used to determine the association between hypothyroidism and the onset of those outcomes. Results: Cohort of 1696 eligible patients for the study, with 1.8 mortality. Median age, female gender and prevalence of arterial hypertension were all significantly higher among hypothyroid patients. No differences were found in other preoperative or intraoperative characteristics. Hypothyroidism was associated with the presence of the composite outcome, RR 1.6 (1.04-2.4) and atrial fibrillation 1.9 (1.05-3.8). No association with mortality, infections or reoperation due to bleeding was found. Conclusion: Hypothyroidism is a disease that affects females predominantly and does not determine the presence of other comorbidities. Hypothyroidism is a risk factor for the onset of postoperative fibrillation in patients undergoing myocardial revascularization surgery. Postoperative care protocols focused on the prevention of these complications in this type of patients must be instituted.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Postoperative Complications/etiology , Atrial Fibrillation/etiology , Hypothyroidism/complications , Myocardial Revascularization/adverse effects , Postoperative Complications/mortality , Atrial Fibrillation/mortality , Comorbidity , Retrospective Studies , Risk Factors , Hospital MortalityABSTRACT
Resumen El fibroelastoma papilar, también conocido como papiloma fibroelástico, es un tumor benigno poco común, que se puede observar en las válvulas cardíacas o, en algunas ocasiones, en el endocardio ventricular. Se describen dos casos; el primero corresponde a un paciente de 72 años con fibrilación auricular paroxística, asintomático por lo demás, en quien en estudio de su fibrilación auricular se evidenció masa pediculada de 1 y 1 cm dependiente de la válvula pulmonar y por riesgo de embolia se llevó a cirugía en la que se resecó masa, sin complicaciones. El reporte de histopatología fue positivo para fibroelastoma papilar. El segundo caso es una paciente de 67 años, sintomática, con angina de esfuerzo en quien, mediante ecocardiograma transtorácico, se documentó masa de 1,5 y 1,5 cm dependiente de la valva coronariana derecha, se consideraron síntomas secundarios a la masa. Se llevó a cirugía por técnica mínimamente invasiva y se resecó la masa. El reporte de histopatología fue positivo para fibroelastoma papilar. Conclusión: el fibroelastoma papilar es una causa poco frecuente pero cada vez más reconocida de fenómenos embólicos. Su identificación oportuna permite la extirpación de la lesión, que es aparentemente curativa, segura y bien tolerada.
Abstract The papillary fibroelastoma, also known as fibroelastic papilloma, is a fairly uncommon benign tumour that can be found in cardiac valves or, in some occasions in the ventricular endocardium. Two cases are presented, with the first corresponding to a 72 year-old patient with intermittent atrial fibrillation, with no other symptoms. During the study of the atrial fibrillation, a pedunculated mass of 1 × 1 cm was observed hanging from the pulmonary valve. Due to the risk of emboli, the patient was taken to surgery where the mass was resected with no complications. The histopathology reported positive for a papillary fibroelastoma. The second case was a 67 year-old patient with symptoms of with angina of effort, which on observing a mass of 1.5 × 1.5 cm hanging from the right coronary valve, they were considered as symptoms secondary induced by the mass. He was taken to surgery, and the mass was resected using a minimally invasive technique. The histopathology reported positive for a papillary fibroelastoma. Conclusion: Papillary fibroelastoma is a rare cause, but increasingly recognised due to its embolic phenomena. Their timely identification allows the lesion to be extirpated, which is apparently curative, safe and well tolerated.