Prognostic nutritional index and mortality in children and adolescents underwent cardiac surgery / Índice nutricional prognóstico e mortalidade entre crianças e adolescentes submetidos à cirurgia cardíaca

Abstract Objectives: to analyze the prognostic nutritional index and factors associated with mortality in children and adolescents with heart disease who underwent cardiac surgery. Methods: this is a longitudinal, retrospective study that included 98 children and adolescents with heart disease from 0 to 14 years old, and assessed the prognostic nutritional index and nutritional status, through the body mass index for age, weight for height, weight for age and height for age. Multiple logistic regression analysis was performed. Results: malnutrition was present in 27 patients, 68 were categorized as having a low prognostic nutritional index and 16 died. In the adjusted analysis, malnutrition (OR=4.11; CI95%=1.26-13.40; p=0.019), the low body mass index for age (OR=4.14; CI95%=1.26-13.61; p=0.019), low weight for height (OR=4.15; CI95%=1.29-13.35; p=0.017) and low weight for age (OR=5.20; CI95%=1.39-19.43; p=0.014) were associated with mortality. Conclusions: malnutrition, low body mass index for age, weight for height and weight for age had shown a significant association with mortality. Despite being an easily applicable indicator of nutritional status, the findings suggest no association between the prognostic nutritional index and mortality in patients with congenital heart disease after cardiac surgery.

Resumo Objetivos: analisar o índice nutricional prognóstico e os fatores associados a mortalidade em crianças e adolescentescardiopatas submetidas à cirurgia cardíaca. Métodos: estudo longitudinal, retrospectivo, que incluiu 98 crianças e adolescentes cardiopatas entre zero a 14 anos e avaliou o índice nutricional prognóstico e o estado nutricional, através dos indicadores índice de massa corporal para idade, peso para estatura, peso para idade e estatura para idade. Foi realizada análise de regressão logística múltipla. Resultados: a desnutrição esteve presente em 27 pacientes, 68 foram categorizados como baixo índice nutricional prognóstico e 16 foram a óbito. Na análise ajustada, a desnutrição (OR=4,11; IC95%=1,26-13,40; p=0,019), o baixo índice de massa corporal para idade (OR=4,14; IC95%=1,26-13,61; p=0,019), o baixo peso para estatura (OR=4,15; IC95%=1,29-13,35; p=0,017) e baixo peso para idade (OR=5,20; IC95%=1,39-19,43; p=0,014) apresentaram associação com a mortalidade. Conclusão: desnutrição, baixo índice de massa corporal para idade, peso para estatura e peso para idade mostraram associação significativa com a mortalidade. Apesar de ser um indicador do estado nutricional de fácil aplicação não foi observada associação do índice nutricional prognóstico com a mortalidade em pacientes com cardiopatias congênitas após cirurgia cardíaca.

Biomarcadores associados à defechos clínicos pós-cirurgia cardíaca em terapia intensiva pediátrica / Biomarcadores relacionados con resultados clínicos en el posoperatorio de cirugía cardíaca en cuidados intensivos pediátricos / Biomarkers associated with postoperative cardiac surgery clinical outcomes in pediatric intensive care

Resumo Objetivo: Sintetizar e analisar criticamente a literatura a respeito de potenciais biomarcadores associados à desfechos clínicos no pós-operatório de cirurgia cardíaca em lactentes e crianças em cuidados intensivos. Métodos: Revisão integrativa, cuja busca ocorreu nos meses de setembro e dezembro de 2019, nas bases de dados MEDLINE, ISI of Knowledge, CENTRAL Cochrane, EMBASE, CINAHL, Science Direct e LILACS para responder à questão norteadora: "Quais as evidências científicas acerca de potenciais biomarcadores relacionados à desfechos clínicos no pós-operatório de cirurgia cardíaca de lactentes e crianças em cuidado intensivo?" Foram incluídos artigos originais publicados entre 2000 e 2019, nos idiomas inglês, português ou espanhol. Excluiu-se toda a literatura cinzenta. Resultados: A amostra final foi constituída por oito artigos, sendo seis estudos observacionais prospectivos descritivos e dois coortes prospectivas. Na maioria dos estudos os pacientes pediátricos foram submetidos à técnica de Bypass Cardiopulmonar (BCP) intraoperatória durante cirurgia de cardiopatia congênita. Os potenciais biomarcadores analisados foram moléculas participantes de processos imune-inflamatórios, predominantemente citocinas pró-inflamatórias tais como IL-1β, IL-6, IL-8 e o fator de necrose tumoral-α (TNF-α) e seu receptor, ou citocinas anti-inflamatórias como a IL-10. Conclusão: As citocinas IL-6, IL-8 e IL-10, o cortisol e o lactato, apresentaram-se como moléculas promissoras para elucidação de mecanismos subjacentes a desfechos clínicos no pós-operatório de cirurgia cardíaca em lactentes e/ou crianças em cuidado intensivo. Tais moléculas podem assumir um caráter preventivo, podendo futuramente ser utilizadas como ferramentas diagnósticas e prognósticas alternativas para um regime que permita identificar pacientes sob alto risco de desenvolver complicações clínicas nos pós-operatórios.

Resumen Objetivo: Sintetizar y analizar críticamente la literatura sobre potenciales biomarcadores relacionados con resultados clínicos en el posoperatorio de cirugía cardíaca de lactantes y niños en cuidados intensivos. Métodos: Revisión integradora, cuya búsqueda ocurrió en los meses de septiembre y diciembre de 2019, en las bases de datos MEDLINE, ISI of Knowledge, CENTRAL Cochrane, EMBASE, CINAHL, Science Direct y LILACS para responder la pregunta orientadora: "¿Cuáles son las evidencias científicas sobre potenciales biomarcadores relacionados con resultados clínicos en el posoperatorio de cirugía cardíaca de lactantes y niños en cuidados intensivos?". Se incluyeron artículos originales publicados entre los años 2000 y 2019, en idioma inglés, portugués o español. Se excluyó toda la literatura gris. Resultados: La muestra final fue formada por ocho artículos, de los cuales seis eran estudios observacionales prospectivos y dos cohortes prospectivas. En la mayoría de los estudios, los pacientes pediátricos fueron sometidos a la técnica de bypass cardiopulmonar (BCP) intraoperatoria durante la cirugía de cardiopatía congénita. Los potenciales biomarcadores analizados fueron moléculas participantes de procesos inmunoinflamatorios, predominantemente citocinas proinflamatorias tales como IL-1β, IL-6, IL-8 y el factor de necrosis tumoral-α (TNF-α) y su receptor, o citocinas antinflamatorias como la IL-10. Conclusión: Las citocinas IL-6, IL-8 e IL-10, el cortisol y el lactato, se presentaron como moléculas promisorias para explicar mecanismos subyacentes de los resultados clínicos en el posoperatorio de cirugía cardíaca de lactantes o niños en cuidados intensivos. Estas moléculas pueden asumir un carácter preventivo y, en un futuro, pueden utilizarse como herramientas alternativas de diagnóstico y pronóstico para un régimen que permita identificar pacientes con alto riesgo de presentar complicaciones clínicas en el posoperatorio.

Abstract Objective: To summarize and critically analyze the literature on potential biomarkers associated with clinical outcomes in the postoperative cardiac surgery period in infants and children under intensive care. Methods: Integrative review, whose search was carried out in September and December 2019 in the databases MEDLINE, ISI Web of Knowledge, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, Science Direct, and Latin America and Caribbean Center on Health Sciences Information to answer the following guiding question: "What is the scientific evidence on potential biomarkers associated with clinical outcomes in the postoperative cardiac surgery period in infants and children under intensive care?". Original articles published between 2000 and 2019 in English, Spanish, or Portuguese were included. Gray literature was excluded. Results: Eight articles made up the final sample (six descriptive observational prospective studies and two prospective cohort studies). Most studies, pediatric patients were submitted to the intraoperative cardiopulmonary bypass technique during congenital heart disease surgeries. The potential biomarkers analyzed were molecules that participate in immune-inflammatory processes, mainly proinflammatory cytokines such as IL-1β, IL-6, IL-8, and tumor necrosis factor-alpha and its receptor, as well as anti-inflammatory cytokines such as IL-10. Conclusion: The IL-6, IL-8, and IL-10 cytokines, cortisol, and lactate showed as promising molecules for elucidating mechanisms underlying clinical outcomes in the postoperative cardiac surgery period in infants and/or children under intensive care. These molecules can take on a preventive role by being used as a diagnostic and prognostic tool in the future in a protocol that allows to identify patients with high risk to develop clinical complications during the postoperative period.

Giant left atrium associated with massive thrombus formation 14 years after orthotopic heart transplantation

Abstract We report the case of a 60-year-old patient who underwent orthotopic heart transplant 14 years earlier. Routine echocardiography showed giant masses in the left atrium. There were no symptoms or thromboembolic events in the past. Magnetic resonance imaging study revealed very enlarged left atrium (8.7 × 10.6 cm) occupied by irregular smooth mass (7 × 5 × 6.1 cm) with a stalk that was attached to the posterior left atrial wall in the area of graft suture lines. Intraoperative examination revealed a massive thrombus (12 × 10 cm) that filled almost the entire left atrial area.

Unusual hydatid cysts: cardiac and pelvic-ilio femoral hydatid cyst case reports and literature review

Abstract Introduction: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly seen in the liver and lungs. The hydatid cyst is rarely seen in the heart and iliofemoral region, representing less than 2% of all cases. In this article, we report our cases of hydatid cysts in unusual loci. Methods: Between 2015 and 2018, 6 rare cases of hydatid cysts were diagnosed at the Cardiovascular Surgery Department of Harran University. Four of these patients had cardiac localization and two patients had their cysts located in the iliofemoral region, extending to the pelvic zone. All patients were female. Three patients had no other organ involvement. One patient with cardiac hydatid cyst underwent normothermic cardiopulmonary bypass + total pericystectomy + Cooley-like aneurysmectomy. Total pericystectomy was performed in three other patients with intrathoracic locus by normothermic cardiopulmonary bypass. Two patients who were referred to our clinic with palpable iliofemoral mass were evaluated with appropriate imaging methods and diagnosed accordingly. Multiple iliofemoral cysts were managed with pericystectomy and drainage by a single incision made over the inguinal ligament. Conclusion: Hydatid cyst disease can develop in cardiac chambers and inguinal region with or without hepatic or pneumatic involvement. Normothermic cardiopulmonary bypass can be safely used in patients with cardiac hydatid cysts, and capitonnage similar to ventricular aneurysm repair in patients with a widely involved cystic lesion can be very useful for the protection of ventricular functions.

Three-dimensional printing: is it useful for cardiac surgery?

Abstract Introduction: The medical use of three-dimensional (3-D) images has been a topic in the literature since 1988, but 95% of papers on 3-D printing were published in the last six years. The increase in publications is the result of advances in 3-D printing methods, as well as of the increasing availability of these machines in different hospitals. This paper sought to review the literature on 3-D printing and to discuss thoughtful ideas regarding benefits and challenges to its incorporation into cardiothoracic surgeons' routines. Methods: A comprehensive and systematic search of the literature was performed in PubMed and included material published as of March 2020. Results: Using this search strategy, 9,253 publications on 3-D printing and 497 on "heart" 3-D printing were retrieved. Conclusion: 3 -D printed models are already helping surgeons to plan their surgeries, helping patients and their families to understand complex anatomy, helping fellows and residents to practice surgery, even for rare cases, and helping nurses and other health care staff to better understand some conditions, such as heart diseases.

The world database for pediatric and congenital heart surgery: A collaboration with the Registro Nacional de Cirugía Cardiaca Pediátrica / La base de datos mundial de cirugía cardíaca pediátrica y congénita: una colaboración con el Registro Nacional de Cirugía Cardiaca Pediátrica (RENACCAPE)

Abstract Objective: Following the notable work accomplished by the Mexican Association of Specialists in Congenital Heart Disease (Asociación Mexicana de Especialistas en Cardiopatías Congénitas) with the development of a national registry for congenital cardiac surgery, the World Society for Pediatric and Congenital Heart Surgery has implemented an international platform to collect data and analyze outcomes of children with congenital heart disease. Methodology: This manuscript proposes a possible collaboration between Mexico's national congenital cardiac database (Registro Nacional de Cirugía Cardíaca Pediátrica) and the World Database for Pediatric and Congenital Heart Surgery. Conclusion: Such a partnership would advance the countries' desire for the ongoing development of quality improvement processes and improve the overall treatment of children with congenital heart disease.

Resumen Objetivo: Siguiendo el notable trabajo realizado por la Asociación Mexicana de Especialistas en Cardiopatías Congénitas (Asociación Mexicana de Especialistas en Cardiopatías Congénitas: AMECC) con el desarrollo de un registro nacional para la cirugía cardíaca congénita, la Sociedad Mundial de Pediatría y Cirugía Cardíaca Congénita ha implementado una plataforma internacional para recopilar datos y analizar los resultados de los niños con cardiopatía congénita. Metodología: Este manuscrito propone una posible colaboración entre la base nacional de datos cardiacos congénitos de México (RENACCAPE) y la Base de Datos Mundial para la Cirugía Cardíaca Pediátrica y Congénita (WDPCHS). Conclusión: Esta asociación promovería el deseo de los países de seguir desarrollando procesos de mejora de la calidad y mejorar el tratamiento general de los niños con cardiopatía congénita.

Hidatidosis cardíaca: tratamiento quirúrgico para recidiva de quiste hidatídico en ventrículo izquierdo / Cardiac hydatid disease: surgical treatment for recurrent hydatid cyst in the left ventricle

INTRODUCCIÓN: El quiste hidatídico cardiaco es una patología infrecuente, producida por la llegada de Equinococcus granulosus a la circulación coronaria. MATERIALES Y MÉTODO: Hombre de 52 años, con antecedente de quiste hidatídico cardiaco operado hace 27 años, insuficiencia cardiaca y enfermedad coronaria. Presentó disnea progresiva de un año de evolución. Estudio con radiografía de tórax, ecocardiografía y tomografía computada que mostró imagen compatible con hidatidosis cardiaca recidivada en el ventrículo izquierdo, arteria pulmonar e hilio pulmonar izquierdo, rodeando por completo el tronco coronario común izquierdo y parte proximal de la arteria descendente anterior. Se constató fracción de eyección de ventrículo izquierdo aproximadamente de 30%. No se encontró evidencia de enfermedad hidatídica extracardiaca. Se decidió tratamiento quirúrgico. Se abordó por esternotomía media y en circulación extracorpórea, se observaron lesiones compatibles con quiste hidatídico multiloculado de ubicación miocárdica en ventrículo izquierdo, con incontables vesículas hijas. Se realizó quistectomía más periquistectomía hidatídica sin incidentes. Presentó hemorragia postoperatoria por lo que requirió reintervención quirúrgica precoz. Evolucionó favorablemente y fue dado de alta sin complicaciones. A seis años de seguimiento se encuentra asintomático, sin evidencia tomográfica y ecocardiográfica de recidiva. DISCUSIÓN: La hidatidosis es una zoonosis endémica en Chile. La ubicación cardiaca es infrecuente, correspondiendo al 0,5 al 2% de los casos. Suele asociarse a la presencia de quistes extracardiacos. La ubicación más frecuente es la pared libre del ventrículo izquierdo a nivel intramiocárdico. El tratamiento médico suele ser insuficiente, por lo que se recomienda la resección quirúrgica.

INTRODUCTION: Cardiac hydatid cyst is a rare disease caused by Echinococcus granulosus arrival of the coronary circulation. MATERIAL AND METHOD: 52 years old man with a history of cardiac hydatid cyst operated 27 years ago, heart failure and coronary artery disease. He presented with a history of one year of progressive dyspnoea. Study with chest radiography, echocardiography and computed tomography showed an image compatible with cardiac hydatid disease recurrence in relation to the left ventricle, pulmonary artery and anterior descending artery. Ejection fraction of the left ventricle was approximately 30%. No evidence of extracardiac hydatid disease was found and surgical treatment was decided. Addressed by median sternotomy and extracorporeal circulation, a multiloculated myocardial hydatid cyst, with hundreds of daughter vesicles of different size was found. Pericystectomy of the hydatid cyst was performed without incident. The patient presented postoperative bleeding which required early reoperation. Posteriorly, was discharged without complications. DISCUSSION: Hydatid disease is an endemic zoonosis in Chile. Heart location is infrecuent and correspond to 0.5 to 2% of the cases, usually associated with the presence of extracardiac cysts. The most common location is the free wall of the left ventricle at intramyocardial level. Medical treatment is often inadequate and surgical resection is recommended.

Avances, tendencias y controversias en hemodinamia pediátrica / Advances, trends, and controversies in pediatric hemodynamics

El cateterismo cardíaco en niños ha mostrado un avance significativo en las últimas décadas, transformándose de un procedimiento casi exclusivamente diagnóstico en sus inicios a un método predominantemente terapéutico en la actualidad. Para ello han contribuido la aparición de múltiples tecnologías de imágenes, así como el creciente desarrollo de materiales de muy bajo perfil y gran versatilidad que permiten el empleo de dispositivos cada vez más específicos para tratar adecuadamente un sinnúmero de enfermedades cardíacas con gran eficacia y seguridad. Esta tendencia continúa creciendo día a día, con la ayuda de nuevas modalidades de tratamiento híbrido donde cardiólogos intervencionistas y cirujanos cardiovasculares interactúan para ayudarse mutuamente, de manera tal de resolver los problemas existentes o aquellos que se van generando con el correr de los años y que afectan la vida de nuestros pacientes. Existen aún como es lógico controversias en algunos casos especiales, que se irán resolviendo paulatinamente en base a la evidencia reunida con las diferentes terapéuticas médicas utilizadas para mejorar el presente y futuro de los niños con cardiopatías (AU)

Cardiac catheterization in children has shown significant progress in recent decades, transforming from an initially almost exclusively diagnostic procedure to a predominantly therapeutic method today. The emergence of multiple imaging technologies has contributed to this progress, as has the growing development of very low-profile and highly versatile materials that allow the use of increasingly specific devices to adequately treat different types of heart disease with great efficacy and safety. This trend continues to grow day by day, with the help of new hybrid treatment modalities where interventional cardiologists and cardiovascular surgeons interact with mutual support, in order to solve existing problems or those that are generated over the years affecting the lives of our patients. Obviously, there are still controversies in specific cases, which will gradually be resolved based on the evidence that becomes available with the use of different medical therapies used to improve the present and future of children with heart disease.(AU)

Patients risk factors as predictors of surgical wound infection following open heart surgery

Background: Median sternotomy wound infections are infrequent yet potentially fatal complication following cardiac surgery. The reported incidence of sternal infections ranges from 0.9 to 20%, and the incidence of mediastinitis is 1­2% in most studies. Several studies have examined and identified possible causes and risk factors associated with sternal infections. They include patient-related risk factors, and procedure-related factors. Aim of the study is the assessment of the patient's risk factors related to incidence of infection. Patients and Methods: ninety-eight cardiac surgery patients operated via median sternotomy were included in the study and the role of patient related factors (age, gender, obesity and diabetes mellitus) in the incidence of postoperative superficial and deep sternal wound infection was accessed. Results: Sternal wound infection (SWI) developed in 18 patients (18.36%). 15 patients (15.3%) had superficial SWI while 3 patients (3.06%) had deep SWI. The most common causative organism in our study was staph. aureus especially MRSA.Conclusion: Patient-related risk factors such as age, gender, obesity and diabetes mellitus are important risk factors in the development sternal wound infection

The cardiopulmonary bypass and cancer dissemination puzzle

Abstract Early cancer diagnosis, new therapies that increased survival of patients, besides the increasingly elderly population are some factors would be associated with possible cancer dissemination in patients under cardiopulmonary bypass (CPB) cardiac surgery. Also, the benefits, and risks, regarding long-term survival, have not yet been established. Therefore, cardiac surgery morbimortality may be superior in patients with cancer disease. Also, immunologic and inflammatory changes secondary to CPB can also increase tumor recurrence. After a brief introduction and CPB immunologic the two main topic subjects included: 1) Combined heart surgery and lung resection and; 2) Possible influence of neoplasia type. After observing the relative literature scarcity, we keep the opinion that "CPB has a modest association with cancer progression" and that "CPB and cancer dissemination should be a logical but unlikely association."

Emergências cardiológicas: avaliação nutricional - parte I / Cardiological emergences: nutritional assessment - Part I

As emergências cardiológicas podem causar rápidas e profundas alterações na resposta metabólica e sistêmica. Essas alterações contribuem acentuadamente para a mobilização das reservas corporais que repercutirão no estado nutricional. A avaliação nutricional, ainda que não seja realizada na fase crítica da assistência interdisciplinar, deverá ser realizada o quanto antes, visando a adoção da alimentação adequada e reposição hídrica e de eletrólitos. O uso de ferramentas subjetivas capazes de estimar o risco nutricional global é de fácil aplicação devido a sua praticidade e rapidez. Entre essas destaca-se o Nutritional Risk Score ­ NRS 2002. Sempre que possível, a avaliação nutricional global deve ser complementada pela avaliação nutricional objetiva e pelo uso de marcadores nutricionais bioquímicos, os quais auxiliarão na avaliação mais precisa do estado nutricional do paciente crítico. Essas ferramentas devem ser utilizadas por nutricionistas treinados e os resultados devem ser discutidos pela equipe multidisciplinar de terapia nutricional que decidirá as estratégias mais adequadas para o início da terapia nutricional precoce nos quadros de emergências cardiológicas

Cardiac emergencies can cause rapid and profound changes in the metabolic and systemic response. These changes contribute significantly to the mobilization of body reserves, which will affect nutritional status. Nutritional evaluation, although not performed in the critical phase of interdisciplinary care, should be carried out as early as possible in order to ensure an adequate diet, and water and electrolyte replacement. The use of subjective tools capable of estimating the global nutritional risk is easy to apply due to its effective and rapid application. One such tool is the Nutritional Risk Score ­ NRS 2002. Whenever possible, the global nutritional assessment should be complemented with objective nutritional assessment and the use of biochemical nutritional markers, which will help obtain a more accurate evaluation of the nutritional status of the critically ill patient. These tools should be applied by trained nutritionists, and the results should be discussed by the multidisciplinary nutritional therapy team, which will decide on the most appropriate strategies for the initiation of early nutritional therapy in cardiac emergency situations

Morbilidad posquirúrgica en pacientes pediátricos operados por cardiopatías congénitas en la UMAE de Yucatán / Post-surgical morbidity in paediatric patients undergoing surgery for congenital heart disease in the UMAE of Yucatan, Mexico

Resumen: Objetivo: Describir la evolución clínica de pacientes pediátricos operados por cardiopatías congénitas en la UMAE de Yucatán. Métodos: Encuesta descriptiva sobre expedientes de pacientes pediátricos intervenidos quirúrgicamente por cardiopatía congénita del 1 de noviembre de 2011 al 30 de noviembre de 2013. Resultados: Las cardiopatías más frecuentes fueron la persistencia del conducto arterioso (37.6%) y la transposición de grandes vasos. La estancia en cuidados intensivos fue de 3 días (mediana). El 11.76% fallecieron por choque séptico (44.4%) en la mayoría de los casos. Las complicaciones más frecuentes fueron sepsis (5.9%), síndrome de bajo gasto (4.7%), paro cardíaco, bloqueo AV y taquicardia ventricular (2.4% cada uno). Existe una correlación positiva moderada entre las complicaciones trans y posquirúrgicas y la sobrevida o muerte del paciente. Conclusiones: El volumen de pacientes quirúrgicos es menor comparado con centros de referencia de cirugía cardiovascular. Existe una marcada tendencia a la realización de cirugías correctivas y paliativas en patologías específicas en pacientes con riesgos agregados o con «mala¼ anatomía cardiaca que impiden la corrección total de primera intención. Se deben realizar estudios epidemiológicos y clínicos prospectivos para conocer el comportamiento de las cardiopatías congénitas atendidas en la región. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract: Objective: To describe the clinical course of paediatric patients undergoing surgery for congenital heart disease in UMAE of Yucatan. Methods: Descriptive review was performed on the records of paediatric patients undergoing surgery for congenital heart disease from 1 November 2011 to 30 November 2013. Results: The most frequent heart diseases were persistent ductus arteriosus (37.6%) and trans- position of the great vessels. The median intensive care stay was 3 days. Mortality was 11.76%, with septic shock (44.4%) in most cases. The most frequent complications were sepsis (5.9%), low cardiac output syndrome (4.7%), cardiac arrest, and AV block and ventricular tachycardia (2.4% each). There was a moderate positive correlation between surgical complications and survival or death. Conclusions: The number of surgical patients is lower compared to reference centres for cardiovascular surgery. There is a marked tendency to perform corrective and palliative surgeries in specific disease in patients with added risk or 'bad' cardiac anatomy that prevent full correction at the first attempt. Prospective epidemiological and clinical studies should be conducted to understand the behaviour of congenital heart diseases treated in the region. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

A concomitant intramyocardial and pulmonary hydatid cyst: a rare case report

Abstract Cardiac hydatid cyst is an uncommon but potentially fatal disease. In cystic Echinococcus humans are an accidental host. Liver and lungs are the most frequently involved organs. Herein a unique case of intramyocardial hydatid cyst of left ventricle along with pulmonary hydatid cyst in a 38-year-old lady is reported. Surgical removal of the cardiac hydatid cyst was done with the aid of cardiopulmonary bypass followed by removal of pulmonary hydatid cyst.

Cirugía cardíaca en pacientes infectados por virus de inmunodeficiencia humana / Cardiac Surgery in HIV positive patients

La infección del virus de inmunodeficiencia humana (VIH) se adquiere principalmente a través del contagio sexual y los pacientes infectados siguen aumentando en el mundo. El tratamiento antirretroviral (TARV) moderno es capaz de suprimir la replicación viral y mejorar el recuento de linfocitos T CD4+, aumentando la supervivencia de los pacientes. De esta manera, aumenta el riesgo de presentar enfermedades crónicas siendo las cardiovasculares las más frecuentes. Objetivo: Comunicar nuestra experiencia en pacientes con infección por VIH sometidos a cirugía cardiovascular. Pacientes y Método: Estudio retrospectivo en que se revisó la base de datos del Servicio de Cirugía Cardiovascular entre los años 2009 y 2015. Identificamos a los pacientes con infección por VIH sometidos a cirugía cardiovascular. Resultados: Catorce pacientes presentaban esa condición. La mayoría estaba en control y con TARV (11 casos) logrando que la carga viral fuera indetecta-ble. La principal vía de infección fue la sexual (13/14 casos). Durante la cirugía se tomaron las precauciones universales de protección para el equipo quirúrgico, las que fueron efectivas en todos los casos. La enfermedad más frecuentemente tratada fue la cardiopatía coronaria (9 casos), seguido de valvulopatías severas (4 casos) en que solo uno presentaba Endocarditis Infecciosa. No hubo mortalidad asociada al procedimiento ni en el seguimiento a tres años de la cirugía. Conclusión: Los pacientes con infección por VIH están expuestos a desarrollar enfermedades cardiovasculares que requieren de tratamiento quirúrgico. Estos pueden ser realizados en forma segura con gran beneficio en su calidad de vida y de su supervivencia.

Infection with human immunodeficiency virus (HIV+) is primarily acquired through sexual transmission and the number of infected people continues to increase. Anti-retroviral therapy (HAART) suppress viral replication and improves CD4 T cell count, increasing survival and the risk of developing chronic diseases. Cardiovascular disease is prevalent among these patients. Objective: To report our experience in patients positive for HIV undergoing cardiovascular surgery. Patients and Methods: We reviewed the Cardiovascular Surgery Service database from 2009 to 2015 to identify HIV-infected patients that underwent cardiovascular surgery. Results: There were 14 HIV positive patients. Most of them were receiving HAART and the viral load was undetectable in 11 patients Thee main route of infection was sexual (13/14 cases). Universal precautions to protect the surgical team were taken during surgery. These were effective in all cases. Coronary artery disease was the most common condition treated (9 cases), followed by severe valve disease (4). Only one patients had infective endocarditis. There was no mortality associated with the procedure. Al patients were alive and asymptomatic 3 years after surgery. Conclusion: Patients with HIV infection are likely to develop cardiovascular diseases requiring surgical treatment. These can be performed safely with great benefit in quality of life and survival.

Fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca: revisão sistemática / Oropharyngeal dysphagia and related factors in post-cardiac surgery: a systematic review

RESUMO Objetivo Identificar os principais fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca, por meio de uma revisão sistemática de literatura. Método Foi realizada pesquisa bibliográfica nas bases PubMed e ScienceDirect, utilizando os termos cardiac surgery, deglutition disorders e dysphagia. Critérios de seleção Foram selecionados artigos sem limitação de ano escritos em português, inglês ou espanhol e que referissem disfagia orofaríngea no pós-operatório de cirurgia cardíaca. Apenas os estudos disponíveis na íntegra foram incluídos. Análise dos dados Cada artigo passou pela análise de títulos e resumos, sendo posteriormente submetido à avaliação na íntegra por dois juízes cegados. Os seguintes dados foram extraídos: autores/ano, desenho do estudo, amostra, variáveis avaliadas e principais resultados. Resultados Os principais fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca foram: idade avançada, presença de comorbidades e outras doenças associadas, tempo de intubação e condições cirúrgicas. Conclusão Os estudos foram bastante heterogêneos, demonstrando que sujeitos submetidos a procedimentos cirúrgicos cardíacos, em especial idosos, apresentam diversos fatores relacionados à disfagia orofaríngea no pós-operatório, como o uso de circulação extracorpórea e ecocardiografia transesofágica, comorbidades associadas, desenvolvimento de sepse pós-operatória e condições cardíacas prévias.

ABSTRACT Purpose To identify the main factors associated with oropharyngeal dysphagia following cardiac surgery through a systematic review of the literature. Methods A bibliographic search was conducted in the PubMed and ScienceDirect databases using the following keywords: “cardiac surgery”, “deglutition disorders”, and “dysphagia”. Selection criteria Articles published in Portuguese, English, or Spanish addressing oropharyngeal dysphagia following cardiac surgery were selected with no time limitation. Only studies available in full were included. Data analysis First, articles were screened for title and abstract. Subsequently, they were submitted to full assessment by two blinded referees. The following data were extracted: authors, year of publication, study design, sample size, variables evaluated, and main results. Results The main factors related to oropharyngeal dysphagia in post-cardiac surgery were advanced age, presence of comorbidities and other diseases, intubation time, and surgical conditions. Conclusion The studies showed high heterogeneity, demonstrating that individuals who undergo cardiac surgical procedures, especially the elderly, present several factors related to oropharyngeal dysphagia postoperatively, such as cardiopulmonary bypass, transesophageal echocardiography, associated comorbidities, development of postoperative sepsis, and previous heart conditions.

Robin Williams' suicide: a case study / O suicídio de Robin Williams: estudo de caso

Abstract Introduction: The world renowned comedian and four-time Oscar nominated actor Robin Williams died on August 11, 2014. From the outset, the news indicated that his death was believed to be a suicide and this was later confirmed to be true by the autopsy reports. Williams had been suffering from severe depression, which is believed to be the leading contributor to his suicide. In this case study, I will highlight the event of the actor's suicide and the main risk factors along with depression leading to his tragic death. As of the end of 2015, no other case study seemed to have addressed or explored the links between the cause (or causes) and events leading to Robin Williams' suicide. Case description: Robin Williams was suffering from relationship problems, financial problems, drug addiction, and major depression. All of these factors led to his suicide. Comments: The chances of committing suicide drastically increase in the presence of any of the key risk factors. Unfortunately, the actor Robin Williams was dealing with four of the major risk factors all together, which put him at a high risk of committing suicide and eventually led to his tragic death.

Resumo Introdução: O ator Robin Williams, comediante reconhecido internacionalmente e quatro vezes indicado ao Oscar, faleceu no dia 11 de agosto de 2014. Desde o início, os noticiários indicavam que sua morte provavelmente resultara de suicídio, e isso foi confirmado posteriormente nos relatórios da autópsia. Williams vinha sofrendo de depressão severa, a qual, acredita-se, foi o fator que mais contribuiu para seu suicídio. Neste estudo de caso, vou discorrer sobre o suicídio do ator e sobre os principais fatores de risco, além da depressão, que levaram à sua morte trágica. Do final de 2015 para cá, nenhum outro estudo de caso parece ter abordado ou explorado as associações entre a causa (ou as causas) e os eventos que levaram ao suicídio do ator Robin Williams. Descrição do caso: Robin Williams vinha sofrendo com problemas de relacionamento, problemas financeiros, abuso de drogas e depressão severa. Todos esses fatores levaram ao seu suicídio. Comentários: As chances de cometer suicídio aumentam drasticamente na presença de qualquer fator de risco chaves. Infelizmente, o ator Robin Williams estava exposto a quatro fatores de risco chaves simultaneamente, colocando-o sob um alto risco de cometer suicídio, o que eventualmente culminou com sua trágica morte.

Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry / Complicações após Procedimentos Cirúrgicos em Portadores de Dispositivos Cardíacos Eletrônicos Implantáveis: Resultados de um Registro Prospectivo

Abstract Background: Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. Objective: To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Methods: Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. Results: A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III­-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Conclusions: Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease.

Resumo Fundamento: Complicações após procedimentos cirúrgicos em portadores de dispositivos cardíacos eletrônicos implantáveis (DCEI) são um problema emergente devido ao aumento crescente na taxa destes procedimentos e ao envelhecimento da população, com consequente aumento de comorbidades. Objetivos: Identificar as taxas de complicações pós-operatórias, mortalidade e readmissão hospitalar, e pesquisar fatores de risco para a ocorrência desses eventos. Métodos: Registro prospectivo e unicêntrico que incluiu todos os indivíduos submetidos a procedimentos cirúrgicos em DCEI no período de fevereiro a agosto de 2011. Os pacientes foram distribuídos por tipos de procedimento nos seguintes grupos: implantes iniciais (coorte 1), troca de gerador (coorte 2) e procedimentos em cabos-eletrodos (coorte 3). Os desfechos foram avaliados por um comitê independente. Empregou-se a análise univariada e multivariada para a pesquisa de fatores de risco e o método de Kaplan-Meier para análise de sobrevida. Resultados: Foram incluídos 713 pacientes, sendo 333, 304 e 76 distribuídos nas coortes 1, 2 e 3, respectivamente. Complicações pós-operatórias foram detectadas em 7,5%, 1,6% e 11,8% dos pacientes nas coortes 1, 2 e 3, respectivamente (p = 0,014). Durante os 6 meses de seguimento, houve 58 (8,1%) óbitos e 75 (10,5%) readmissões hospitalares. Preditores de readmissão hospitalar incluíram o uso de cardioversor-desfibrilador implantável ( odds ratio [OR] = 4,2), classe funcional III-IV (OR = 1,8) e uso de warfarina (OR = 1,9). Preditores de mortalidade incluíram idade acima de 80 anos (OR = 2,4), disfunção ventricular (OR = 2,2), classe funcional III-IV (OR = 3,3) e uso de warfarina (OR = 2,3). Conclusões: Complicações pós-operatórias, readmissões hospitalares e óbitos foram frequentes. Esses eventos estiveram fortemente relacionados ao tipo de procedimento realizado, tipo de DCEI e gravidade da doença cardíaca do paciente.

Efecto de las estrategias de conservación sanguínea sobre la transfusión en pacientes con circulación extracorpórea / Effect of blood conservation strategies on the transfusion for patients with extracorporeal circulation

Introducción: Los pacientes sometidos a cirugía cardiaca son candidatos a recibir múltiples transfusiones sanguíneas homólogas por causas como el sangrado; el desarrollo de estrategias de conservación sanguínea (ECS) ha permitido proteger al paciente y limitar el riesgo de enfermedades infectocontagiosas, inmunológicas e inflamatorias. Objetivo: Analizar el efecto de las estrategias de conservación sanguínea sobre la transfusión de hemoderivados en los pacientes sometidos a cirugía cardiaca con derivación cardiopulmonar. Material y métodos: Estudio no experimental, exploratorio y transversal. Muestra no probabilística (n = 105) incluyó a pacientes adultos y pediátricos sometidos a cirugía cardiopulmonar con circulación extracorpórea (CEC) que utilizaron las ECS. Recolección de datos con cédula ex profeso de las variables demográficas, hematológicas y transfusionales, CEC, ECS. Datos analizados con frecuencias, porcentajes, medidas de tendencia central y de dispersión; así como prueba de Pearson, U de Mann Whitney y T de Student; significancia p < 0.05. Resultados: Prevalecieron las valvulopatías (42%), cirugías correctivas (98%), tipo de sangre O+. Se recuperaron 120,511 ml de sangre, en promedio 1,161 ml por paciente. Tiempo de CEC relacionado con volumen sangre transfundido (r = 0.318, p = 0.000). Mayor número ECS en la cirugía correctiva (Z = -2.467, p = 0.014), en pacientes con cirugías previas se recupera un mayor volumen (t = 2.072, p = 0.039), cantidad de sangre transfundida durante la CEC es mayor en la bomba centrífuga (t = -4.022, p = 0.000), pero no hay diferencias por sexo (t = 1.488, p = 0.137). La hemoglobina y hematocrito antes y después de la CEC fue semejante (p > 0.05). Conclusiones: Las ECS son una excelente opción de uso para evitar la transfusión homóloga, ya que logran recuperar una gran cantidad de sangre autóloga, potencializándose sus beneficios. (AU)

Background: Patients undergoing cardiac surgery are eligible to receive multiple blood transfusions counterparts for reasons such as bleeding; the development of blood conservation strategies (BCS) has protected the patient and limit the risk of infectious, immunologic and inflammatory diseases. Objective: To analyze the effect of blood conservation strategies on blood transfusion in patients undergoing cardiac surgery with cardiopulmonary bypass. Material and methods: Non-experimental, exploratory and transversal study. Probabilistic sample (n = 105) included adult and pediatric patients undergoing ardiopulmonary surgery with extracorporeal circulation (ECC) using the BCS. Data collection with charter expressly demographic, blood transfusion and variables, ECC, BCS. Data analyzed using frequencies, percentages, measures of central tendency and dispersion; and Pearson test, Mann Whitney and tudent t; significance p < 0.05. Results: A prevalence of valvular heart disease (42%), corrective surgeries (98%), blood type O+. 120,511 ml blood was recovered 1,161 ml per patient. ECC time related to transfused blood volume (r = 0.318, p = 0.000). BCS largest number in corrective surgery (Z = 2467, p = 0.014) in patients with previous surgeries increased volume (t = 2.072, p = 0.039), amount of blood transfused during ECC is recovered is greater in the pump centrifuge (t = 4,022, p = 0.000), but no sex differences (t = 1.488, p = 0.137). Hemoglobin and hematocrit before and after ECC was similar (p > 0.05). Conclusions: The BCS is an excellent choice for use to avoid homologous transfusion, and who manage to recover a large amount of autologous, enhancing its benefits. (AU)