ABSTRACT
BACKGROUND: Transcatheter aortic-valve implantation (TAVI) was introduced in 2002 and the first implants in our country were performed in 2010. AIM: To review the TAVI experience in our hospital, considering the technology improvements and gained experience throughout this period. MATERIAL AND METHODS: All patients undergoing TAVI in our center were included. Results and complications were adjudicated according to the Valve Academic Research Consortium-2 (VARC-2) criteria. Patients were divided in 3 groups, according to procedural year: Period 1: 2010-2015 (n = 35); Period 2: 2016-2018 (n = 35); Period 3: 2019-2021 (n = 41). Mortality up to one year after the procedure was recorded. RESULTS: Between 2010 and 2021, 111 TAVI procedures were performed. The mean age of patients was 82 years and 47% were women. Risk scores for in-hospital mortality were STS 6.7%, EUROSCORE II 8.0% and ACC/STS TAVR Score 4.9%. The trans-femoral route was used in 88% and a balloon-expandable valve was chosen in 82% of patients. A successful implant was achieved in 96%, with an in-hospital mortality of 1.8%. Mortality at 30 days and 1-year were 2.7 and 9.0%, respectively. During period 3, 100% of implants were successful, with no in-hospital mortality, less vascular complications (p < 0.01), less stroke (p = 0.04), less severe paravalvular leak (p = 0.01) and significantly lower rate of acute complications (p < 0.01). CONCLUSIONS: TAVI achieves excellent results. With greater experience and better available technologies, these results are even more favorable.
Subject(s)
Humans , Male , Female , Aged, 80 and over , Aortic Valve Stenosis/surgery , Heart Valve Prosthesis/adverse effects , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/methods , Risk Factors , Treatment OutcomeABSTRACT
La morfología y dimensiones de ciertas estructuras anatómicas varían de población a población, así como de individuo a individuo; el canal nasopalatino (CNP) es una de estas estructuras, este se encuentra ubicado en la línea media del paladar y aloja el nervio nasopalatino y la rama terminal de la arteria nasopalatina. El propósito de este estudio es determinar la morfología y dimensiones promedio del CNP en la población mexicana mediante tomografía computarizada de haz cónico (CBCT). Se analizaron 120 CBCT de manera coronal, transversal y sagital; y se clasificaron siguiendo los parámetros de Bornstein. Para el análisis estadístico se determinó la normalidad de las variables empleando la prueba de Shapiro Wilk y la significancia estadística mediante la prueba de UMann Whitney. Los resultados mostraron diferencias estadísticas significativas en las variables analizadas del canal nasopalatino entre hombres y mujeres. De acuerdo con los datos obtenidos se puede establecer que la morfología del CNP es muy variable y se recomienda realizar un estudio morfológico y dimensional antes de cualquier intervención quirúrgica relacionada con esta zona.
Certain human structures present different dimensions and morphologies in each population and individual, the nasopalatine canal being one of these. It is located in the midline of the palate, and it contains the nasopalatine nerve and the terminal branch of the nasopalatine artery. The purpose of this study was to analyze and record measurements of the nasopalatine duct in Mexican population by Cone Beam Computed Tomography (CBCT). A total of 120 CBCT coronal, transversal and sagittal views were analyzed. The data were classified according to Bornstein´s parameters. The normality of the variables was determined with the Shapiro Wilk test and the statistical significance was determinate by U-Mann Whitney test. A statistically significant difference was found in the evaluated variables of the nasopalatal canal between men and women. The data obtained determined that the morphology of the nasopalatine canal is variable and a morphological and dimensional analysis before any surgical intervention related with the area is recommended.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Palate/anatomy & histology , Nose/anatomy & histology , Cone-Beam Computed Tomography , Palate/diagnostic imaging , Sex Factors , Nose/diagnostic imaging , MexicoABSTRACT
Introducción: las intervenciones educativas (IE) dirigidas al cuidador primario (CP) se tornan efectivas para la adopción de estilos de vida saludables al fomentarse el autocuidado, el cambio de conductas nocivas para la salud, la prevención y el tratamiento de síndromes agudos, así como en el aprendizaje de habilidades asociadas al cuidado. Su implementación es frecuente, sin embargo en ocasiones se omiten aspectos fundamentales en su desarrollo. Objetivo: analizar la producción científica de las IE dirigidas al CP a partir de los componentes utilizados para describir la calidad de las intervenciones educativas: estructura, proceso y resultado. Métodos: de acuerdo con los lineamientos de la declaración PRISMA se realizó una búsqueda a través bases de datos especializadas como: Pubmed, Scielo, Biblioteca Virtual en Salud, Biblioteca Digital UNAM, Cochrane, Medigraphic e Imbiomed. Se utilizaron los términos DeCS: Estilo de Vida, Autocuidado, Cuidadores, Intervención Educativa y Estudio de Intervención; así como los términos MeSH: Life-style, Selfcare, Caregivers y Health Cate Educational Interventions. Se seleccionaron publicaciones sobre IE para mejorar el autocuidado y/o estilos de vida del CP, de acceso libre a texto completo, publicados desde enero 2014 a noviembre 2018 en español, inglés y portugués. Se analizaron 21 investigaciones. Resultados: el 66% de las IE no mencionan la teoría desde la que dan sustento a su acción educativa, la práctica educativa fue de tipo unidireccional controladora tecnológicamente. Se observó que el 100% de las IE son efectivas. Conclusiones: la mayor parte de las IE son efectivas, sin embargo no fue posible identificar en gran parte de estas los aspectos fundamentales para su desarrollo, replica o evaluación.
Introduction: Educational interventions (El) aimed at the primary caregiver (CP) become effective for the adoption of healthy lifestyles by promoting self-care, changing harmful behaviors for health, prevention and treatment of acute syndromes, as well as in learning skills associated with care. Its implementation is frequent, however sometimes fundamental aspects are omitted in its development. Objective: To analyze the sdentific production of Els directed to the CP based on the components used to describe the quality of educational interventions: structure, process and result. Methods: According to the guidelines of the PRISMA statement, a search was conducted through specialized databases such as: Pubmed, Scielo, Virtual Health Library, UNAM Digital Library, Cochrane, Medigraphic and Imbiomed. The DeCS terms used were: Lifestyle, Self-care, Caregivers, Educational Intervention and Intervention Study; as well as the MeSH terms: Life-style, Selfcare, Caregivers and Health Care Educational Interventions. Publications on El were selected to improve the self-care and or lifestyles of the CP, with free access to full text, published from January 2014 to November 2018 in Spanish, English and Portuguese. 21 investigations were analyzed. Results: The 66% of the El do not mention the theory from which they sustain their educational action, the educational practice was technologically controlling unidirectional type. It was observed that 100% of El are effective. Conclusions: Most of the El are effective, however it was not possible to identify in a large part of these fundamental aspects for their development, replication or evaluation.
Subject(s)
Humans , Remedial Teaching , Self Care , Review Literature as Topic , Review , Caregivers , Life Style , MexicoABSTRACT
Resumen Objetivo: Describir un caso de histocitosis de células de Langerhans en un paciente pediátrico. Método: Paciente de 4 años con proptosis, diplopía, fiebre y pérdida de agudeza visual, con imagen en tomografía computarizada evidente de masa orbitaria con erosión ósea. Se realizó biopsia excisional por craneotomía coronal, el resultado histopatológico fue histiocitosis de células de Langerhans. Resultados: El estudio anatomopatológico transoperatorio mostró una neoplasia de células pequeñas redondas y azules, compatible con rabdomiosarcoma. Las pruebas de inmunohistoquímica concluyeron el diagnóstico de histiocitosis de células de Langerhans. Conclusión: La histiocitosis de células de Langerhans es una enfermedad poco frecuente que requiere de una sospecha clínica y diagnóstico oportuno, adecuar el tratamiento y mejorar la sobrevida de los pacientes.
Abstract Objective: To describe a case of Langerhans cell histiocytosis in a pediatric patient. Method: A 4-year-old patient with proptosis, diplopia, fever and loss of visual acuity, with evident image in a computed tomography of orbital mass with bone erosion. An excisional biopsy was performed by coronal craniotomy. The histopathological result was Langerhans cell histiocytosis. Results: The anatomopathological study showed a neoplasm of small round and blue cells, compatible with Rhabdomyosarcoma. Immunohistochemical tests concluded the diagnosis of Langerhans cell histiocytosis. Conclusion: Langerhans cell histiocytosis is a rare disease that requires clinical suspicion and a timely diagnosis to adjust the treatment and improve the survival of patients.
ABSTRACT
Las presentes recomendaciones han sido elaboradas en base a nuestra experiencia, con el propósito de entregar algunas pautas sobre analgesia, sedación y anestesia para cateterismos diagnósticos y/o terapéuticos en pacientes pediátricos con cardiopatías congénitas, de acuerdo a la clasificación de riesgo de los mismos. El propósito de ésta es contribuir a disminuir la incidencia de eventos adversos asociados a morbilidad y mortalidad.
Recommendations based con clinical experience with analgesia, sedation and anesthesia in diagnostic or therapeutic cardiac catheterization in pediatric patients with congenital heart disease are outlined. These recommendations, based on clinical experience at a single institution (Catholic University Hospital in Santiago, Chile) are intended to help reduce de incidence of adverse effects, morbidity and mortality in this patient population.
Subject(s)
Humans , Child , Cardiac Catheterization/adverse effects , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/therapy , Anesthesia and Analgesia/adverse effects , Postoperative Care , Preoperative Care , Cardiac Catheterization/standards , Risk Factors , Risk Assessment , Intraoperative CareABSTRACT
Background: Mitral balloon valvuloplasty (MBV) is the therapy of choice for the treatment of symptomatic mitral stenosis with suitable anatomy. Although its short and mid-term results are favorable, there is a paucity of information about long-term follow-up. Aim: To assess the late results of MBV. Material and Methods: A cohort of 225 patients aged 8 to 20 years who were subjected to a MBV from 1989 to 2001, was studied. All variables at the time of the procedure, short and long-term results and major events during follow-up (new mitral intervention and mortality) were recorded. Uni and multivariate analysis were used to assess prognosis. Results: The mean follow-up lapse was 13.5 years (range 8 to 20 years). During this period, 88 patients (39.1%) remained event-free and in acceptable functional capacity. Eight percent died, 8% required a second MBV and 43.5% required a surgical mitral valve replacement. A post-procedural area equal or greater to 1.9 cm² was associated with a greater likelihood of free-event survival (log rank test: p = 0.02/Cox proportional regression model: coefficient 0.54, p = 0.04). Conclusions: MBV is effective, although there is a high chance of new interventions in the long-term follow-up. A larger post-procedure mitral area is associated with a better prognosis.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Balloon Valvuloplasty/methods , Mitral Valve Stenosis/surgery , Age Factors , Balloon Valvuloplasty/mortality , Epidemiologic Methods , Mitral Valve Stenosis/mortality , Mitral Valve Stenosis , Mitral Valve/surgery , Mitral Valve , Postoperative Complications , Time Factors , Treatment OutcomeABSTRACT
Objetivos: Reportar nuestra experiencia en el tratamiento endovascular de la Coartación Aórtica (CoAo). Métodos: Se revisaron los registros clínicos de los pacientes mayores de 4 años intervenidos por una CoAo nativa o recoartación en el Hospital Clínico de la Universidad Católica entre los años 2007 y 2012. Se realizaron estadísticas descriptivas y se utilizó el test de Wilcoxon signed rank, con una p <0,05. Resultados: En ese período se realizaron 27 intervenciones en pacientes con CoAo. El promedio de edad fue 20.6 años (5 - 64); 8 (30 por ciento) eran mujeres y 8 (30 por ciento) menores de 14 años. Quince pacientes (55 por ciento) tenían una cardiopatía congénita asociada, de los cuales 9 (33 por ciento) tenían válvula aórtica bicúspide, 3 (11 por ciento) una comunicación interventricular (CIV) y 3 coexistencia de ambas entidades (11 por ciento). Nueve (33 por ciento) pacientes eran hipertensos. En 20 (74 por ciento) pacientes la intervención fue sobre una coartación aórtica nativa y en 7 (26 por ciento) sobre una recoartación (2 con cirugía previa y 5 con angioplas-tia anterior). Se implantó un stent en 23 (85 por ciento) pacientes y se utilizó sólo balón en 4 (15 por ciento). En 26 pacientes (96 por ciento) se logró una reducción del gradiente a menos de 20 mmHg (gradiente pre 32 vs gradiente post 6 mmHg, p<0,01). Hubo complicaciones del sitio de punción en 3 pacientes (2 hematomas y 1 disección focal en el origen de la arteria ilíaca externa) y complicaciones mayores en 2 pacientes (disección aórtica tipo B) que requirieron tratamiento intervencional (uno percutáneo y uno quirúrgico). No hubo mortalidad en nuestra serie. Conclusiones: La intervención endovascular es una opción de tratamiento efectiva para la CoAo.
Aim: There is an increasing interest in the endovascular therapy of both native and recurrent aortic coarcta-tion (Aco). In this article we report the results of endo-vascular treatment of ACo in children and adults at our institution, from 2007 to 2012. Method and Results: The clinical, angiographic and hemodynamic data of all patients submitted to endovascular repair of ACo at the Endovascular Therapy Center of the Catholic University Hospital were reviewed. Children under 4 years of age were excluded. A total of 27 subjects were included. Mean age was 20.6 years (range 5-64); 30 per cent were females and 30 per cent were under 14 years of age. 15 patients had associated congenital defects: bicuspid aortic valve ( 9), VSD (3), or both VSD and bicuspid aortic valve (3). Hypertension was present in 33 per cent of patients. 74 per cent had endovas-cular repair of a native Aco and 26 per cent of a re-coarctation (2 of them post surgical treatment and 5 post endovas-cular repair). 85 per cent of cases had stent implantation. Repair resulted in a significant (p<0.01) decrease in aortic pressure gradient (mean 32 vs 6 mmHg). There was no mortality associated to the procedure. Two patients developed aortic dissection post procedure, successfully treated by surgery or endovascular repair. There were no instances of stent migration. Conclusion: Endovascular repair is an effective means of correcting Aco. Potential complications need careful technique and monitoring during the procedure.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Aortic Coarctation/surgery , Thoracic Surgical Procedures/methods , Postoperative Complications , Treatment OutcomeABSTRACT
Introducción: La microembolización se asocia a más eventos cardiovasculares adversos (MACE) especialmente en angioplastía (PTCA) de puentes venosos aortocoronarios (PAC) o en síndrome coronario agudo (SCA). El stent MGuard evitaría la embolización distal. Nuestro objetivo: evaluar el stent con micromalla de dacron como alternativa de protección embólica. Métodos: Registro prospectivo de PTCA con stent MGuard en de SCA de PAC y vasos nativos. Resultados: 15 angioplastias, de ellas 53 por ciento con infarto agudo miocárdico con supradesnivel de ST (IAM con SDST). PTCA en vasos nativos: 60 por ciento y PAC: 40 por ciento (antigüedad: 13 +/- 3 años). El 53 por ciento tuvo flujo inicial TIMI 0-1, alto contenido trombótico (66 por ciento: 4-5 en escala de trombos TIMI). Se predilató la lesión en 73 por ciento de los casos, se empleó Reopro en 2 casos, no se usó filtros de protección ni aspirador de trombos. Las dimensiones del stent MGuard: 22.2 +/- 4.4 mm de largo por 3.7 +/- 0.44 mm de diámetro. El 100 por ciento con flujo TIMI 3 final, 93 por ciento con impregnación miocárdica grado 3. Subgrupo de IAM con SDST: 71 por ciento obtuvo < 23 cuadros TIMI/segundo, 100 por ciento con regresión del SDST mayor de 50 por ciento a 90 minutos de PTCA. Subgrupo de PTCA de PAC: (excepto caso de PTCA de PAC en IAM c/SDST) no se registró elevación de la CK total o MB post PTCA. Seguimiento: un caso de trombosis al mes. Conclusión: El MGuard stent parece ser efectivo en la protección de la microcirculación. Se requieren estudios para evaluar la seguridad clínica y eficacia en protección embólica.
Background: Coronary angioplasty (PTCA) is associated to a greater incidence of major adverse cardiac events (MACE) in patients with stenosis of saphenous vein grafts (SVG) and in those with acute coronary syndromes (ACS). The MGuard stent, a device with a dacron micro mesh, is currently being evaluated for the prevention of distal thrombotic embolization in these patients. Aim to evaluate the MGuard stent, for the prevention of distal embolization. Methods: analysis of a prospective registry of patients submitted to PTCA for ACS in native coronary arteries or occluded SVG using the MGuard stent. Results: 15 PTCA procedures were performed, 53 percent in patients with ST segment elevation acute myocardial infarction (STE-MI). PTCA was performed in native vessels in 60 percent patients and in SVG in 40 percent. Interval from surgery in these patients was 13+/-3 years. 53 percent of patients had initial TIMI fow rate 0-1 and 66 percent had a thrombotic load of 4-5 (TIMI scale). Lesions were predilated in 73 percent of cases; abxicimab was used in 2 patients and no protection filters or thrombus aspiration were performed. MGuard stent dimensions were 22.2+/-4.4 mm in length, and 3.7+/-0.44 mm in diameter. Final TIMI 3 fow was observed in all patients; 93 percent of then had grade 3 myocardial impregnation. In the subgroup of patients with STE-MI, a 23 frames/sec TIMI frame count was observed with >50 percent reduction of ST elevation 90 min after PTCA. In patients with SVG, except one patient with ACS, no elevation of total or MB- CK was observed. Follow up revealed reocclusion in 1 patient, 1 month after the procedure. Conclusion: The MGuard stent appears to be an effective device to protect the microcirculation form distal embolization during PTCA. Studies with larger number of patients and extended periods of follow up are encouraged by these results.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Angioplasty, Balloon, Coronary/instrumentation , Embolism/prevention & control , Stents , Acute Coronary Syndrome/therapy , Angioplasty, Balloon, Coronary/methods , Follow-Up Studies , Prospective Studies , Prostheses and ImplantsABSTRACT
Introducción : Se ha sostenido que el tratamiento de elección del infarto agudo al miocardio (IAM) sería la Angioplastía Primaria (AP). Para optimizar el resultado de la AP, esta debe ser efectuada sin demoras. En nuestro país existe escasa información acerca del cumplimiento de las recomendaciones internacionales al respecto. Objetivo: Estudiar los tiempos transcurridos entre el inicio del dolor hasta la realización de la AP, y evaluar si existen o no diferencias respecto al horario en que ocurrió el evento. Método: Estudio retrospectivo de los pacientes (pac) con IAM sometidos a una AP desde enero de 2002 a junio de 2003 en nuestro centro. Los horarios de la AP fueron definidos como hábil (HA), nocturno (HN) y festivo (HF). Los resultados se expresan como promedio ± DS y las comparaciones entre los grupo se efectuaron con ANOVA. Resultados: Se analizaron 103 pac, edad 59± 12 años, 78 por ciento hombres.