ABSTRACT
RESUMEN Objetivo: El músculo cardíaco no puede estar anatómicamente libre en el tórax y sin un soporte para cumplir con su función hemodinámica. Por tanto, se analizó la posibilidad de la existencia de un punto de apoyo que actuara a modo de palanca. Material y métodos: Se utilizaron: 1) disección cardíaca en diez corazones bovinos jóvenes (dos años) (800-1000 g); 2) disección cardíaca en ocho corazones humanos: un embrión de 23 semanas de gestación; uno de 10 años, 250 g; y seis adultos, peso medio 300 g. La banda miocárdica se desenrolló en su totalidad. Las piezas extraídas fueron analizadas por anatomía e histología. Se completó la investigación con estudios de imágenenes radiograficas simples, resonancia nuclear magnética y tomografia computada. Resultados: En investigaciones anatómicas hemos encontrado en todos los corazones humanos y bovinos estudiados un núcleo subyacente al trígono derecho de estructura histológica ósea-condroide-tendinosa. El análisis microscópico reveló en corazones bovinos una matriz osteocondral trabecular (fulcro). En todos los corazones humanos se encontró que el fulcro se halla formado por tejido condroide. En esta estructura, no descrita por otros autores, tienen inserción muscular el origen y el final de las fibras miocárdicas. Las técnicas con imágenes confirmaron su existencia. Conclusiones: El fulcro cardíaco encontrado en la investigación anatómica de corazones humanos y bovinos aclararía sobre el necesario punto de apoyo del músculo miocárdico para completar sus movimientos de torsión.
ABSTRACT Objective: The cardiac muscle cannot be anatomically free in the thorax. Therefore, it was thought and analyzed that there could be a myocardial support point (lever fulcrum). Material and Methods: Cardiac dissection in ten young (two years old) bovine hearts (800-1000 g); and in eight human hearts ( one embryo, 4 g; one 10 years old, 250 g; and six adult, mean weight 300 g) were performed. The myocardial band was unrolled in its entirety. The extracted pieces were analyzed by anatomy and histology. A study with magnetic resonance images, tomography and simple radiology was also carried out. Results: In anatomical investigations we have found in all the human and bovine hearts studied a nucleus underlying the right trigone of bone, chondroid or tendon histological structure. The microscopic analysis revealed in bovine hearts a trabecular osteochondral matrix (fulcrum). In the ten year old human heart and in the fetus, a central area of the fulcrum formed by chondroid tissue was found. Histology found a tendon matrix in adult human hearts. This fulcrum is attached to the myocardium and would serve to support both the origin and the end of the myocardium. The images showed evidence of the cardiac fulcrum. Conclusions: The cardiac fulcrum found in the anatomical investigation of bovine and human hearts would clarify the point of support of the myocardial muscle to complete its rotating function.
ABSTRACT
Extracorporeal membrane oxygenation (ECMO) was originated from heart-lung machine for cardiac surgery. This technique that receive the blood from venous system, oxygenate it and support to selected patients with severe respiratory or cardiac failure as flow and oxygen. ECMO can provide partial or total support, is temporary, and requires systemic anticoagulation. ECMO controls gas exchange and perfusion, stabilizes the patient physiologically, decreases the risk of ongoing iatrogenic injury, and allows enough time for decision, diagnosis, treatment, and recovery from the primary injury or disease. The two major ECMO modalities are venoarterial and venovenous. Until 1980s, ECMO usually used to pediatric respiratory failure. However after H1N1 influenza epidemic in the world, venovenous ECMO support for adult has been increased rapidly. Venoarterial ECMO support for cardiac failure and resuscitation also abruptly has been increased. As a support modality, cannula position and possibility of complication is different. Survival rate of ECMO has a range from 30% in extracorporeal cardiopulmonary resuscitation to 70% for acute myocarditis and acute respiratory distress syndrome in adult, and better in neonate and pediatrics. Advancing ECMO technology and increasing experience with ECMO techniques have improved patient outcomes, reduced complications and expanded the potential applications of ECMO. Awareness of the indications and implications of ECMO among physicians managing patients with severe but potentially reversible respiratory or cardiac failure may help facilitate better communication between health care teams and improve patient recovery.