Tratamiento quirúrgico de la comunicación bucosinusal / Surgical treatment of oral sinus communications

Se realizo un estudio descriptivo, prospectivo, observacional y longitudinal para caracterizar el comportamiento de las comunicaciones bucosinusales post extracción dentaria intervenidas quirúrgicamente en el servicio de Cirugía Máxilo Facial del Hospital General Provincial Universitario Carlos Manuel de Céspedes de Bayamo del 1ro de enero de1998 al 31 de diciembre de 2007. El universo de trabajo lo constituyeron y la muestra coincidieron, 96 pacientes con comunicaciones bucosinusales post extracción dentaria confirmados clínica y radiológicamente e intervenidos quirúrgicamente. Se estudiaron variables como edad, sexo, etiología, localización, tamaño de la apertura, tipo de comunicación bucosinusal, tratamiento empleado, técnicas quirúrgicas empleadas, complicaciones presentadas y resultados alcanzados. A la información se le aplicó las medidas de resumen: razón, promedio, desviación estándar y porcentaje. Predominó la edad de 30-39 años con el 35.4% y una desviación estándar de 8.9 (DE: X.? 33.25± 8.9) y el sexo femenino. La forma simple fue la variedad anatómica mayormente encontrada con el 82.3%. Prevaleció la región del primer molar con 48.0%, y el lado derecho del maxilar para el 57.3%, el 77.1% fue tratado ambulatoriamente, la anestesia local fue utilizada en el 75.0%. La técnica quirúrgica más empleada fue el colgajo vestibular con 55.2 %; el 66,7 % de las complicaciones se encontraron presentes en defectos de más de 5 mm: En 96,0% de los pacientes estudiados el resultado funcional fue evaluado de satisfactorio luego de un seguimiento superior a los seis meses. Se recomendó realizar la maniobra de valsaba a todos los pacientes que se le realice extracciones de molares superiores para detectar las comunicaciones bucosinusales y tratarlas de inmediato

It was performed a descriptive, prospective, observational and longitudinal research to characterize the behavior of the bucosinusal communication post dentary extractions surgically treated at the maxillofacial surgery service in Carlos Manuel de Cespedes hospital in Bayamo, from January 1st 1998 to December 31, 2007. The Universe was made b 96 patients with buccosinusals counications post dentary extraction, clinically and radiologically confirmed and surgically assisted. Some variables were studied like age, sex, etiology, localization, sized of aperture, kind of bucosinusal communication, the applied treatment and surgical technique complications and obtained results. It was applied measures of summary to the information: ration, average, standard deviation and percentage. It prevailed the ages of 30-39 with 35.4% and standard deviation of 8.9(DE: X=33.25± 8.9sex,) and the female. The simple form was the anatomical variety mostly found with the 82.3%, the region of the first molar prevailed with 48% and the right side of maxillary with 57.3%. The77.1% was ambulatory treated. The local anesthesia was used in a 75.0%. The surgical technique mostly applied was vestibular coverage with 58.2%. The 66,7% of the complications ware found in more than 5mm defaults. In 96% of the studied patients the functional results was satisfactorily evaluated after a superior following of six months. It is recommended to make a valsaba maneuver to all of the patients that extraction of superior molar is made t detect the bucosinusal communication and immediately treat them

Atresia of the coronary sinus ostium to the right atrium with a persistent left superior vena cava / Atresia del ostium del seno coronario en el atrio derecho con una vena cava superior izquierda persistente

The coronary sinus has lately assumed an important role in the cardiologic clinic once it has been widely used in invasive procedures of the heart. Commonly, it is used during the electrodes implants for the epimiocardic monitoring of the cardiac rhythm, through a biventricular pace maker. These invasive procedures are not possible in hearts with an atresic coronary sinus ostium. In the presence of this anomaly, another may occur: the development of the "Marchal" vein which is a remaining of the left superior vena cava (LSVC). This happens so that the venous blood from the heart can drain into the right atrium, by a communication between the LSVC and the left brachiocephalic vein. The presence of a LSVC brings difficulties when performing an invasive procedure in order to access the right atrium through the superior vena cava, usually done in the cardiologic clinic. Moreover, the LSVC crossing over the left atrium is vulnerable to cardiovascular surgical interventions, confirmed by clinical reports. In the present study, 400 formalin fixed hearts from male cadavers, aged between 35 and 80 years, were investigated, particularly for the anatomy of the coronary sinus. The obliterated ostium of the coronary sinus to the right atrium associated with a persistent LSVC was present in only one (0.25 percent). We performed a diameter study of these structures since they were dilated due to the venous blood from the heart draining into the right atrium, by a communication between the LSVC and the left brachiocephalic vein. We also perform a literature review of these cases and discuss our finding in relation to its clinical importance.

El seno coronario recientemente ha asumido un papel importante en la clínica cardiológico, siendo ampliamente utilizado en procedimientos invasivos del corazón. Comúnmente, se utiliza en los implantes de los electrodos para el monitoreo epimiocárdico del ritmo cardiaco, a través de un ritmo biventricular establecido. Estos procedimientos invasivos no son posibles en los corazones con una atresia del ostium del seno coronario. En presencia de esta condición, se puede producir otra anomalía: el desarrollo de la vena de "Marchal" la cual es un vestigio de la vena cava superior izquierda (VCSI). Esto provoca que la sangre venosa del corazón pueda drenar en el atrio derecho, por una comunicación entre la VCSI y la vena braquicefálica izquierda. La presencia de una VCSI trae dificultades a la hora de realizar un procedimiento invasivo con el fin de acceder al atrio derecho a través de la vena cava superior, usualmente hecho en la clínica cardiológica. Por otra parte, el cruzamiento de la VCSI sobre el atrio izquierdo es vulnerable en las intervenciones quirúrgicas cardiovasculares, confirmado por informes clínicos. En el presente estudio, 400 corazones fijados en formalina provenientes a cadáveres de sexo masculino, con edades comprendidas entre los 35 y 80 años, fueron investigados, en particular por la anatomía del seno coronario. El ostium obliterado del seno coronario al atrio derecho asociado con una VCSI persistente estuvo presente en sólo una muestra (0,25 por ciento). Se realizó un estudio del diámetro de estas estructuras dilatadas debido a que la sangre venosa drena desde el corazón hacia el atrio derecho, por una comunicación entre la VCSI y la vena braquicefálica izquierda. También se realiza una revisión de la literatura de estos casos y se discuten nuestros hallazgos en relación con su importancia clínica.

Sinus node function in patients operated for mitral valve disease: indirect evaluation with epimyocardial electrodes / Função do nó sinusal em pacientes submetido a correção cirúrgica da valvopatia mitral: avaliação indireta com eletrodos epimiocárdicos

PURPOSE: To study the interatrial conduction times and atrial node performance in patients submitted to mitral valve surgery with the aid of temporary atrial epicardic electrodes. METHODS: The atriograms were carried out in the first postoperative day and before the hospital discharge of ten consecutive patients. RESULTS: Sixty percent of the patients could complete the post-operative study protocol. The main results were: a) Post-operative arrhythmias were detected in 50 percent of the patients; b) There were no statistical differences between the pre and post-operative 12 lead EKGs. c) The interatrial conduction time (IACT) ranged from 90 to 140ms in the first post-operative day, and from 110 to 130ms at hospital discharge; d) The sinus node recovery time (SNRT) ranged from 250 to 560 ms in the first post-operative day and from 180 to 360ms at hospital discharge; e) The sinus atrial conduction time (SACT) remained between 70 and 140ms, both in the first post-operative day and at hospital discharge, and; f) The IACT was normal in patients whose left atrium (LA) was less than 50mm in diameter but supra normal in the remaining cases. CONCLUSIONS: Sinus node function and inter-atrial conduction are not altered by mitral valve operation. Post-operative programmed epicardic atrial stimulation is easy and safe.

OBJETIVO: Estudar os tempos de condução interatrial e a função do nó sinusal em pacientes submetidos a tratamento cirúrgico. MÉTODOS: Foram estudados 10 pacientes adultos consecutivos submetidos à operação de correção de valvopatia mitral. Registraram-se atriogramas usando eletrodos epimiocárdicos cirurgicamente implantados. Os atriogramas foram obtidos no primeiro dia do pós-operatório e antes da alta hospitalar. RESULTADOS: Os principais achados foram: a) A incidência de arritmias atriais até alta hospitalar foi de 50 por cento; b) O tempo de condução interatrial (TCIA) variou de 90 a 140 ms no 1°PO e 110 a130 ms antes da alta hospitalar; c) O tempo de recuperação do nó sinusal (TRNS) variou de 250 a 560 ms no 1°PO e180 a 360 ms antes da alta hospitalar; d) O tempo de condução sinoatrial (TCSA) variou de 70 a 140 ms tanto no 1ºPO, como antes da alta hospitalar e; d) O tempo de condução interatrial (TCIA) foi normal em pacientes com átrio esquerdo menores do que 50 mm e supranormal nos outros casos. CONCLUSÃO: As funções do nó sinusal e a condução interatrial não foram alteradas pelo tratamento cirúrgico da valvopatia mitral. A estimulação atrial epicárdica programada é segura de fácil realização.

Disfunção sinusal em paciente com isomerismo atrial esquerdo / Sinus node dysfunction in a patient with left atrial isomerism / Sinus node dysfunction in a patient with left atrial isomerism

É relatado o caso de uma criança com seis anos de idade, assintomática, portadora de isomerismo atrial esquerdo e comunicação interatrial do tipo seio venoso. Ao exame físico, apresentava vários períodos de ritmo bradicárdico. Durante monitorização eletrocardiográfica de 24 horas, apresentou importante disfunção sinusal, com pausas sinusais de até 2,4 segundos. Foi implantado marcapasso definitivo com evolução satisfatória.

We report the case of an asymptomatic six-year-old child with left atrial isomerism and sinus venosus atrial septal defect. The physical examination revealed several periods of bradycardia. During a 24-hour electrocardiographic monitoring the patient presented a significant sinus node dysfunction with sinus pauses of up to 2.4 seconds. A permanent pacemaker was implanted, with a satisfactory outcome.