RESUMO
Residual ventricular septal defect after surgical repair for tetralogy of Fallot can occasionally be hemodynamically important requiring re-intervention. Transcatheter closure using ventricular septal defect devices is an attractive option for such defects. We describe two such cases where the Amplatzer duct occluder was used as an innovative, less costly alternative for closure of residual membranous ventricular septal defects. Complete occlusion of the residual ventricular septal defect with significant symptomatic improvement could be accomplished in both patients.
Assuntos
Adolescente , Oclusão com Balão/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares , Criança , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Feminino , Comunicação Interventricular/diagnóstico , Humanos , Implantação de Prótese/métodos , Tetralogia de Fallot/cirurgiaRESUMO
The introduction of insulin analogues, of which insulin lispro is the prototype, marks a very important milestone in the management of patients with diabetes mellitus. It differs from regular human insulin in its quicker onset and shorter duration of action. In various clinical trials, insulin lispro was found to be superior to regular human insulin in controlling postprandial hyperglycemia without increasing the risk of hypoglycemia. It improved the quality of life of diabetic patients by providing more flexibility to meal plans. Recently, another short acting insulin analogue called insulin aspart has been tried in clinical studies with benefits similar to insulin lispro. The turn of the millennium is now witnessing the development of long acting insulin analogues like insulin glargine, which can provide continuous low-level basal insulin concentrations similar to natural settings. In this review, we discuss the potential of insulin analogues in the modern management of diabetes with emphasis on insulin lispro.