RESUMO
La muerte súbita de un atleta o deportista siempre es un hecho trágico de gran exposición mediática, que genera gran impacto social. Afortunadamente es un hecho extremadamente raro que tiene una incidencia entre 1:80 000 y 1:200 000 atletas/año. Sus causas son distintas de acuerdo con la edad del atleta o deportista. En aquellos menores de 35 años predominan las miocardiopatías y las anomalías congénitas de las arterias coronarias; en los mayores de 35 años, la principal causa es la enfermedad coronaria aterosclerótica adquirida. Es común para ambos grupos la muerte súbita arrítmica con corazón estructuralmente normal. La tarea del equipo de salud que asiste a esta población reside en conocer y detectar las potenciales causas para restringir la participación en el deporte de los atletas en riesgo (prevención primaria). Pero también debemos estar preparados para asistir las muertes súbitas de los atletas en el campo de juego con programas de asistencia para emergencias cardiovasculares que incluyan desfibriladores externos automáticos (prevención secundaria). (AU)
The sudden death of an athlete is always a tragic event that leads to a great media exposure that generates great social impact. Fortunately, it is an extremely rare event with an incidence of 1: 80,000 to 1: 200,000 athletes per year. The causes vary according to the age of the athlete. In those < 35 years old, predominantly cardiomyopathies, and congenital anomalies of the coronary arteries. Whereas in the > 35 years, the main cause is generally acquired atherosclerotic coronary disease. In both groups, it is common to experience arrhythmic sudden death despite having a structurally normal heart. It is the task of the health teams that treat this population to know and detect potential causes to restrict participation in sport for the athletes at risk (primary prevention). But we must also be prepared to attend sudden deaths of athletes in the field with assistance programs for cardiovascular emergencies including automated external defibrillators (secondary prevention). (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Morte Súbita Cardíaca/etiologia , Atletas/estatística & dados numéricos , Prevenção Primária , Esportes/estatística & dados numéricos , Exercício Físico/fisiologia , Fatores Sexuais , Fatores Etários , Morte Súbita Cardíaca/prevenção & controle , Doença das Coronárias/mortalidade , Anomalias dos Vasos Coronários/mortalidade , Sistema Médico de Emergência , Desfibriladores , Prevenção Secundária , Cardiomiopatias/mortalidadeRESUMO
Abstract Objective: Transposition of the great arteries is a common congenital heart disease. Arterial switch is the gold standard operation for this complex heart disease. Arterial switch operation in the presence of intramural coronary artery is surgically the most demanding even for the most experienced hands. We are presenting our experience with a modified technique for intramural coronary arteries in arterial switch operation. Methods: This prospective study involves 450 patients undergoing arterial switch operation at our institute from April 2006 to December 2013 (7.6 years). Eighteen patients underwent arterial switch operation with intramural coronary artery. The coronary patterns and technique used are detailed in the text. Results: The overall mortality found in the subgroup of 18 patients having intramural coronary artery was 16% (n=3). Our first patient had an accidental injury to the left coronary artery and died in the operating room. A seven-day old newborn died from intractable ventricular arrhythmia fifteen hours after surgery. Another patient who had multiple ventricular septal defects with type B arch interruption died from residual apical ventricular septal defect and sepsis on the eleventh postoperative day. The remainder of the patients are doing well, showing a median follow-up duration of 1235.34±815.26 days (range 369 - 2730). Conclusion: Transposition of the great arteries with intramural coronary artery is demanding in a subset of patients undergoing arterial switch operation. We believe our technique of coronary button dissection in the presence of intramural coronary arteries using coronary shunt is simple and can be a good addition to the surgeons' armamentarium.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Transposição das Grandes Artérias/métodos , Anomalias dos Vasos Coronários/cirurgia , Transposição dos Grandes Vasos/cirurgia , Transposição das Grandes Artérias/mortalidade , Derivação Arteriovenosa Cirúrgica/métodos , Anomalias dos Vasos Coronários/mortalidade , Seguimentos , Comunicação Interventricular/cirurgia , Estimativa de Kaplan-Meier , Ilustração Médica , Duração da Cirurgia , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento , Transposição dos Grandes Vasos/mortalidadeRESUMO
A origem anômala das artérias coronárias é uma doença potencialmente letal, sobretudo em lactentes e atletas jovens. O entendimento da fisiopatologia da doença permitiu a diferenciação entre as diferentes apresentações clínicas. Apesar de ser causa de isquemia miocárdica, os exames indutores de isquemia podem ser normais. A cineangiocoronariografia foi durante muito tempo considerada o exame ideal para o diagnóstico da doença, mas os exames de imagem cardiovascular não-invasivos têm mostrado uma melhor definição da origem e do trajeto das artérias coronararias. O tratamento cirúrgico deve ser indicado em pacientes sintomáticos, principalmente em crianças com origem anômala da artéria coronária esquerda da artéria pulmonar. O manejo ideal para os pacientes assintomáticos permanece indefinido.
The anomalous origin of the coronary arteries is a potentially lethal pathology, especially in neonates and young athletes. The understanding of the pathophysiological pattern of the disease has allowed the recognition of the different forms of clinical presentation. Despite being a cause of myocardial ischemia, functional tests can be normal. Coronary angiography used to be the gold standard for the diagnosis of this pathology, but non-invasive cardiovascular imaging tests have shown better definition of the origin and course of coronary arteries. Surgical treatment should be indicated for symptomatic patients, mainly in children with the anomalous origin of the left coronary artery from the pulmonary artery. The ideal management of asymptomatic patients remains undefined.
Assuntos
Humanos , Masculino , Feminino , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/história , Anomalias dos Vasos Coronários/mortalidade , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem , Morte Súbita/etiologia , Morte Súbita/patologia , Técnicas de Diagnóstico CardiovascularRESUMO
Sudden cardiac deaths in athletes are usually due to underlying cardiovascular disease. The final pathway is usually ventricular fibrillation following hypertrophic cardiomyopathy and coronary artery anomalies in young persons below the age of 30 years. Sudden cardiac death in young is rare but remains as a source of concern. A postmortem study was conducted to ascertain the cardiac causes of sudden death in persons below the age group 30 years following exercise in games or otherwise. Out of 15 cases in autopsy finding, hypertrophic cardiomyopathy (n=7) was the commonest cause followed by coronary artery anomalies (n=4). Sudden unexpected death is a source of concern and careful screening of history and physical examination for potential athletes should identify majority of people at risk.