ABSTRACT
RESUMEN El ultrasonido es una herramienta ampliamente utilizada en Medicina, en diferentes áreas como ginecología, cirugía y neurología, tiene una gran variedad de indicaciones, tales como: el estudio del vasoespasmo en hemorragia subaracnoidea, cambios de flujo en estenosis intracraneana e incluso evaluar "in vivo" la actividad de algunas medidas terapéuticas. A continuación se presenta una serie de los casos más relevantes recogidos en el Hospital Universitario Mayor que fueron llevados a dúplex transcraneal y sus resultados. De igual manera una breve revisión sobre las patologías más frecuentes que se pueden encontrar mediante este estudio. El dúplex transcraneal ofrece entonces un medio diagnóstico de rápida evaluación que otorga información fehaciente para la toma de decisiones tanto en el servicio de urgencias como en hospitalización, pero se trata de una herramienta con la que se tiene poca experiencia en el país, por lo que estos hallazgos son pioneros y deben complementarse con estudios de mayor peso.
SUMMARY Ultrasound is a tool that is widely used in medicine in different areas such as gynecology or surgery. In neurology, it has a broad variety of indications, related to the study of vasospasm and subarachnoid haemorrhage, besides of flux changes in intracranial stenosis and it helps to evaluate the activity of some therapeutic measures. In this article we present some of the most relevant cases collected in the Hospital Universitario Mayor, wich were taken to a trans cranial duplex and we provide a short revision about most frequent pathologic that can be found through this study. The transcranial duplex offers a diagnose possibility of fast evaluation that takes reliable information to make choices in the emergency room as in the hospitalized. Although this procedure does not have many experience in the country, it is important to mention that these findings turn out to be an innovating solution to a quick diagnose that should be complemented with further information.
Subject(s)
Atrial Fibrillation , Subarachnoid Hemorrhage , Intracranial Thrombosis , Craniocerebral TraumaABSTRACT
PURPOSE: Combined coronary artery bypass (CAB) and valve surgery is one of the most challenging surgical procedures, but the operative results have improved over the years. MATERIALS AND METHODS: From 1989 through 2004, combined CAB and valve operations were performed in 125 patients. Mean age was 63 years, and 86 patients were male. Forty-six patients were diagnosed with coronary artery disease during preoperative evaluation for valvular heart disease (VHD). All patients underwent CAB, and one or more underwent valve replacement or repair (mitral: 54, aortic: 61, tricuspid: 3, DVR: 7) simultaneously. RESULTS: Mean number of distal graft was 1.98 +/- 1.07, and LIMA was used in 68% of patients. Early mortality occurred in 6 patients (4.8%), and the causes were heart failure (4) and sepsis (2). Mean follow-up duration was 91.4 +/- 40.9 months (range: 47-245), and late mortality occurred in 4 patients. Kaplan Meier estimated survival rates at 1, 5, and 10 years were 94.4%, 92.3%, and 89.9%, respectively. CONCLUSION: Combined coronary and valve operations can be performed safely with optimal surgical results. Although the surgical mortality of coexisting coronary and VHD is higher than either isolated coronary or valvular operations, it may not affect the long-term survival.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Age Factors , Coronary Artery Bypass/methods , Coronary Artery Disease/mortality , Coronary Vessels/pathology , Heart Valve Diseases/mortality , Sex Factors , Treatment OutcomeABSTRACT
PURPOSE: Combined coronary artery bypass (CAB) and valve surgery is one of the most challenging surgical procedures, but the operative results have improved over the years. MATERIALS AND METHODS: From 1989 through 2004, combined CAB and valve operations were performed in 125 patients. Mean age was 63 years, and 86 patients were male. Forty-six patients were diagnosed with coronary artery disease during preoperative evaluation for valvular heart disease (VHD). All patients underwent CAB, and one or more underwent valve replacement or repair (mitral: 54, aortic: 61, tricuspid: 3, DVR: 7) simultaneously. RESULTS: Mean number of distal graft was 1.98 +/- 1.07, and LIMA was used in 68% of patients. Early mortality occurred in 6 patients (4.8%), and the causes were heart failure (4) and sepsis (2). Mean follow-up duration was 91.4 +/- 40.9 months (range: 47-245), and late mortality occurred in 4 patients. Kaplan Meier estimated survival rates at 1, 5, and 10 years were 94.4%, 92.3%, and 89.9%, respectively. CONCLUSION: Combined coronary and valve operations can be performed safely with optimal surgical results. Although the surgical mortality of coexisting coronary and VHD is higher than either isolated coronary or valvular operations, it may not affect the long-term survival.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Age Factors , Coronary Artery Bypass/methods , Coronary Artery Disease/mortality , Coronary Vessels/pathology , Heart Valve Diseases/mortality , Sex Factors , Treatment OutcomeABSTRACT
Objective: To review the experience of valvuloplasty in children aged 4 months to 6 years. Methods: 199 children aged 4 months to 6 years (mean age, 2.94 years) and weight 3.1 kg to 22.0 kg (mean, 11.7 kg) underwent valvuloplasty under CPB from January 1990 to December 2001. 21 patients with isolated valvular lesions mitral incompetence(MI) in 7, tricuspid incompetence(TI) in 6, aortic incompetence(AI) in 1, aortic stenosis(AS) in 1, MI and TI in 2, MI and AI in 2, MI and AS in 1,MI and mitral stenosis in 1, the remain 178 patients had valvular disease with other pathologies (MI=122, TI=26, AI=9, MI+TI=13, tricuspid stenosis=2, AS=2, MI and AI=2, MI+AS=2). The procedures of valvuloplasty included leaflet resection and repair, annulus remodeling, choral shortening, transferal etc. depended on the anatomical variation of the lesions. Associated cardiac anomalies were corrected simultaneous. Results: There were 4 early deaths (2.0%) including 2 heart failure, 1 severe infection and 1 pulmonary hypertension. No late death was encountered during the period of 4.7 years (range 2 months-8 years) follow-up. Conclusion: Good result may be expected in valvuloplasty in children aged 4 months to 6 years.