Seguimento tardio após correçäo de coarctaçäo da aorta: reintervençäo cirúrgica subsequente / Long-Term Follow-up After Correction of Coarctation of the Aorta. Subsequent Surgical Procedures

PURPOSE--To determine the frequency and main features of subsequent cardiovascular surgery in patients operated on for coarctation of the thoracic aorta. METHODS--One hundred and five patients operated on for coarctation of the aorta with a mean follow-up period of 14 years had their notes analysed. The patients were divided in 4 groups according to age at correction of the coarctation. The incidence of recoarctation repair and other cardiovascular operations were noted. RESULTS--Surgical morbidity was important: 33 per cent . Recoarctation occurred in 14 per cent of the cases, mainly in those who had the coarctation resected during the first year of life. Operation for other cardiovascular defects was necessary in 24.5 per cent of the cases. Among these, correction of left-to-right shunts was done in 50 per cent of the patients who had the coarctation resected in the first year of life. Relief of aortic stenosis was the most frequent procedure (73 per cent ), tends to be more frequent the other is the patient at coarctation repair and more than one procedure may be necessary in some cases. CONCLUSION--Reoperation is frequent in the long term of patients operated on for coarctation of the aorta. The elective coarctation should be repaired after the first year of life hoping to avoid recoarctation. Routine follow-up is advisable for all patients aiming to detect residual left-to-right shunts and left ventricular outflow tract obstruction. Family counseling regarding prognosis after coarctation resection is recommended

Cirurgia cardíaca infantil em hospital geral: procedimentos e resultados em 5 anos de experiência / Pediatric Cardiac Surgery in a General Hospital. Procedures and Results in 5 Years Experience

Objetivo - Estabelecer rotina para cirurgia cardíaca pediátrica em hospital geral, visando diminuiçäo dos riscos, maior certeza diagnóstica, uma abordagem mais precisa e conseqüente melhoria dos resultados. Métodos - Trezentos e noventa crianças portadoras de cardiopatias congênitas foram submetidas a correçäo cirúrgica em período de 5 anos. Entre os procedimentos habituais enfatizam-se o diagnóstico näo invasivo, a internaçäo conjunta com a mäe, a reduçäo do período de hospitalizaçäo, os cuidados com a coleta e preservaçäo do sangue, bem como a preferência pelo sangue fresco, as técnicas de monitorizaçäo, anestesia, circulaçäo extra-corpórea e proteçäo miocárdica, cuidados com a estética das incisöes em pacientes do sexo feminino e cuidados pós-operatórios. Resultados - Evidenciou-se um alto índice de extubaçäo precoce, com diminuiçäo significativa das complicaçöes pulmonares secundárias à ventilaçäo mecânica prolongada. As complicaçöes pós-operatórias como instabilidade hemodinâmica, arritmias bem como sangramento aumentado, näo foram, freqüentes. Os baixos índices de mortalidade e o curto período de internaçäo hospitalar confirmaram os bons resultados. Conclusäo - A elaboraçäo de rotina para cirurgia cardíaca peiátrica, com eliminaçäo ou minimizaçäo dos riscos inerentes a cada etapa, possibilitou uma melhoria progressiva dos resultados cirúrgicos

Purpose - To establish the routines for pediatric cardiac surgery in a general hospital, with a view to acurate diagnostic, a more precise intervention, a reduction of the risks and consequently an improvement of the results. Methods - Three hundred and ninety surgeries were carried out in children with congenital heart disease. The method use highlighted noninvasive diagnosis, joint lodging, reduced period of hospitalization, care with the collection and preservation of blood, as well as the preference for fresh blood, techniques of monitoring, anesthesia, cardiopulmonary bypass and myocardial protection, concern with aesthetic incision for female patients and postoperative critical care. Results - A high rate of early extubation was observed, with a signifcant reduction of the pulmonary complications resulting from prolonged mechanical ventilation. Low haemodynamic instability, arrhythmia and postoperative bleeding rates were uncommon. The low mortality rate and the average hospitalization period confirmed the good results. Conclusion - With the establishment of routines for pediatric cardiac surgery, we observed a progressive improvement of the results, with low rates of morbidity and mortality in a general hospital