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1.
Rev Med Chil ; 132(5): 556-63, 2004 May.
Article in Spanish | MEDLINE | ID: mdl-15279141

ABSTRACT

BACKGROUND: Norwood procedure is used as the first stage in the palliative treatment of the hypoplastic heart syndrome and can be used, with some technical modifications, in other forms of univentricular heart with aortic stenosis or hypoplasia. These patients have a high mortality (50%), derived from the procedure itself and from their abnormal physiological status. AIM: To report our experience with the Norwood procedure. PATIENTS AND METHODS: Retrospective analysis of all patients subjected to the Norwood procedure between February, 2000 and June 2003. RESULTS: Thirteen patients (9 females, age range 5-60 days and median weight of 3.3 kg) were operated. Eight had hypoplastic heart syndrome and five had a single ventricle with aortic arch hypoplasia. The diagnosis was done in utero in eight patients. All technical variations, according to the disposition and anatomy of the great vessels, are described. Cardiac arrest with profound hypothermia was used in all and regional cerebral perfusion was used in nine. Three patients died in the perioperative period and three died in the follow up (two, four and 10 months after the procedure). Gleen and Fontan procedures were completed in five and one patients, respectively. CONCLUSIONS: Our results with the Norwood procedure are similar to other series. There is an important mortality in the immediate operative period and prior to the Glenn procedure.


Subject(s)
Hypoplastic Left Heart Syndrome/surgery , Palliative Care , Abnormalities, Multiple/surgery , Female , Follow-Up Studies , Fontan Procedure , Heart Ventricles/abnormalities , Heart Ventricles/surgery , Humans , Infant , Infant, Newborn , Male , Retrospective Studies , Treatment Outcome
2.
Rev Med Chil ; 131(4): 390-6, 2003 Apr.
Article in Spanish | MEDLINE | ID: mdl-12870233

ABSTRACT

BACKGROUND: When the ascending aorta and the femoral artery cannot be used for extracorporeal circulation, an emerging alternative is the use of axillary artery. AIM: To report the experience using the axillary artery for extracorporeal circulation. PATIENTS AND METHODS: Between November 1998 and May 2002, 22 patients (14 male) were operated with extracorporeal circulation, cannulating the axillary artery. Briefly, an incision is made below the middle third of the clavicle and a cut is made on major pectoris muscle. Minor pectoris muscle is retracted and axillary artery is exposed. It is cannulated directly or with the aid of a prosthesis. RESULTS: Right axillary artery was used in 21 patients and in 20 it was cannulated with the aid of a prosthesis. Mean flow was 4.5 +/- 0.6 l/min. The most common indications were aortic dissection or aneurysms. The most common procedures done, were ascending aorta replacement in 8 cases and replacement of ascending aorta and aortic arch in 5. Thirty five percent of operations were emergencies and 32% were reoperations. In 15 patients (68%), a circulatory arrest was done. Of these, retrograde brain perfusion was used in 9, antegrade brain perfusion through the same axillary artery was used in 2 and mixed perfusion was used in 2. One patient had a complication related to the axillary cannulation. None had cerebrovascular accidents or thromboembolic complications. Two patients died in the postoperative period. Patients were followed up to 42 months after the procedure and no secondary complications of the cannulation were detected. CONCLUSIONS: When the ascending aorta and the femoral artery cannot be used, axillary artery is a good alternative for extracorporeal circulation.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Axillary Artery , Catheterization, Peripheral/methods , Extracorporeal Circulation/methods , Adult , Aged , Aortic Coarctation/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged
3.
Rev Med Chil ; 130(2): 132-42, 2002 Feb.
Article in Spanish | MEDLINE | ID: mdl-11974525

ABSTRACT

BACKGROUND: The implantation of pacemakers improves cardiac function and quality of life, in particular with dual chamber DDD and DDDR modes. AIM: To evaluate our clinical experience and results on pacemaker implantation, from 1963 to 1998. MATERIAL AND METHODS: Computerized data collected from 2,445 consecutive paced patients was reviewed. A total of 3,554 operative procedures were performed, including 412 procedures for complications and 697 pacemaker replacement. Patient survival was determined from clinical records, inquiry to pacemaker manufacturers and death certificates from Servicio de Registro Civil e Identificación de Chile (Chilean Civil and Identification Registry). RESULTS: Use of dual chamber (DDD and DDDR) pacemakers increased progressively up to 74% from 1988 to 1998. Complication rate was 42% in the 1963-1976 study period, it decreased to 10.6% in the 1977-1987 study period, and to 5.6% by 1988-1998. Only two patients died during surgery in the study period (0.08%). In the 1977-1987 period, pacemakers lasted 10.6 years. Survival rates were 52% at ten years, 33% at 15 years, and 21% at 20 years, with a median survival of 11.7 years, and 7.24 years in patients over 80 years old. CONCLUSIONS: Transvenous permanent pacing can be accomplished today with a low complication rate, mainly due to better technology and surgical procedures.


Subject(s)
Pacemaker, Artificial/statistics & numerical data , Aged , Aged, 80 and over , Cardiac Pacing, Artificial/methods , Cardiac Pacing, Artificial/mortality , Cause of Death , Chi-Square Distribution , Chile/epidemiology , Confidence Intervals , Electrodes, Implanted/classification , Female , Humans , Male , Middle Aged , Pacemaker, Artificial/adverse effects
4.
Rev Med Chil ; 130(1): 9-16, 2002 Jan.
Article in Spanish | MEDLINE | ID: mdl-11961968

ABSTRACT

BACKGROUND: Ischemic mitral regurgitation (IMR) is a severe condition which may be best treated by surgery, notwithstanding a relatively high mortality rate. OBJECTIVES: To evaluate the results of mitral valve replacement or repair in patients with IMR. PATIENTS AND METHODS: Retrospective review of the clinical records in 29 patients with IMR who were surgically treated from 1990 to 1999. They represent 8% of surgical procedures on the mitral valve. RESULTS: Mean age was 67 +/- 9 years. Surgery was performed urgently in 19 patients (66.5%). NYHA functional class was 3.4 +/- 0.8. The mechanism of IMR was annular dilatation and spreading of papillary muscles in 18 patients, papillary muscle rupture in 9 and fibrosis in 2. Mitral valve replacement was performed in 14 patients and mitral valve repair in 15. Twenty four patients (83%) had concomitant myocardial revascularization. Overall surgical mortality was 24%; 26% for mitral replacement and 13% for mitral valve repair (p = 0.215). On follow up of 26 +/- 33 months, one year survival was 76 +/- 0.8% and 5 years survival was 59 +/- 12%. Excluding in hospital mortality, survival was 100% at one year and 78 +/- 14% at 5 years. Functional class improved in all survivors, to 1.4 +/- 0.5. Late echocardiographic evaluation of patients with mitral valve repair showed absence of mitral regurgitation in 58%, 1+ MR in 17% and 2+ MR in 25%. CONCLUSION: In spite of a high perioperative mortality, surgery for IMR is a valuable procedure for patients with an otherwise highly lethal disease.


Subject(s)
Heart Valve Prosthesis , Mitral Valve Insufficiency/surgery , Aged , Aged, 80 and over , Chile/epidemiology , Female , Follow-Up Studies , Heart Valve Prosthesis Implantation/mortality , Humans , Incidence , Male , Middle Aged , Mitral Valve Insufficiency/epidemiology , Retrospective Studies
5.
Rev Esp Cardiol ; 55(2): 135-42, 2002 Feb.
Article in Spanish | MEDLINE | ID: mdl-11852004

ABSTRACT

BACKGROUND: Thrombolysis and angioplasty in the first hours after myocardial infarction minimize necrosis, leading to better early and late survival, but these therapies have limited effect in patients with three-vessel disease and cardiogenic shock. Emergency coronary surgery is an alternative treatment in some cases. AIM: To assess perioperative complications, mortality and long-term survival in patients undergoing coronary surgery within 24 h of myocardial infarction. PATIENTS AND METHODS: We retrospectively studied 57 patients undergoing surgery within 24 h of the onset of symptoms of myocardial infarction between 1982 and 1998. Multiple vessel disease was present in 31 patients (54%), shock or cardiac arrest in 19 (33%) and coronary angiography complications in 7 (12%). The mean time between onset of symptoms and surgery was 6.32 h. At the beginning of surgery 32 patients (56%) were hemodynamically stable, 15 (26%) were in shock and 10 (17%) were in cardiac arrest. RESULTS: The operative mortality was 0% for those who were hemodynamically stable at the start of surgery and 44% (11 of 25 patients) for those in shock or cardiac arrest. Shock or prior cardiac arrest were associated with higher rates of sternal infection and heart failure and longer hospital stays.Follow-up (mean 67 months) was possible for all remaining patients. The 5- and 10-year survival rates were 89 and 82%, respectively, for patients who were hemodynamically stable at the time of surgery. Five-year survival was 55%, however, for those who underwent surgery in shock or cardiac arrest. The overall rate of freedom from myocardial infarction, angioplasty or reoperation was over 95% at 5 years and over 85% at 10 years of follow-up. Age and shock or cardiac arrest were risk factors for a poor long-term outcome. CONCLUSION: The early and long-term outcome of coronary surgery within 24 h of myocardial infarction is good for patients who are hemodynamically stable when surgery begins. Shock and cardiac arrest are important risk factors for complication and death. Coronary artery bypass grafting is a good treatment option in the first hours after myocardial infarction.


Subject(s)
Coronary Artery Bypass , Myocardial Infarction/surgery , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors
6.
Rev. esp. cardiol. (Ed. impr.) ; 55(2): 135-142, feb. 2002.
Article in Es | IBECS | ID: ibc-5690

ABSTRACT

Antecedentes. La trombólisis y la angioplastia efectuadas en las primeras horas de un infarto de miocardio minimizan la necrosis, lo que da lugar a una mejor supervivencia precoz y tardía. Estas terapias son de efectos limitados en pacientes con enfermedad de múltiples vasos y especialmente en shock cardiogénico. La cirugía coronaria de urgencia es una alternativa terapéutica en casos seleccionados. Objetivo. Evaluar la mortalidad perioperatoria y la supervivencia a largo plazo en pacientes sometidos a cirugía coronaria en las primeras 24 h de constituido el infarto de miocardio. Pacientes y métodos. Se estudiaron retrospectivamente 57 pacientes operados entre 1982 y 1998 dentro de las primeras 24 h de los síntomas de inicio del infarto de miocardio. La indicación quirúrgica fue enfermedad de múltiples vasos en 31 pacientes (54 por ciento), shock o paro cardiocirculatorio en 19 (33 por ciento) y complicación de la coronariografía en 7 (12 por ciento). El tiempo promedio entre el inicio de los síntomas y la cirugía fue 6,32 h. El estado hemodinámico al inicio de la cirugía fue estable en 32 pacientes (56 por ciento), shock cardiogénico en 15 (26 por ciento) y paro cardiocirculatorio en 10 (17 por ciento).Resultados. La mortalidad perioperatoria fue del 0 por ciento en aquellos pacientes operados en condiciones hemodinámicas estables y del 44 por ciento (11 de 25 casos) en los operados en shock cardiogénico o paro cardiocirculatorio. Adicionalmente el shock cardiogénico y el paro cardiocirculatorio previo se asociaron a mayor incidencia de infecciones esternales, insuficiencia cardíaca y estancia intrahospitalaria prolongada. Se obtuvo un 100 por ciento de seguimiento en los supervivientes, con un tiempo promedio de 67 meses. La supervivencia a los 5 y 10 años en los pacientes operados en condiciones hemodinámicas estables fue del 89 y el 82 por ciento, respectivamente. En contraste, en los operados en shock cardiogénico o paro cardiocirculatorio la supervivencia a los 5 años fue de un 55 por ciento. Para el grupo total, la probabilidad de estar libre de infarto, angioplastia y reoperación fue de más de un 95 por ciento a los 5 años y superior a un 85 por ciento a los 10 años. La edad y el shock cardiogénico o paro cardiocirculatorio fueron factores de riesgo de mal pronóstico a largo plazo. Conclusión. La cirugía coronaria efectuada dentro de las primeras 24 h de constituido el infarto de miocardio tiene buenos resultados precoces y tardíos en aquellos pacientes operados en condiciones estables. El shock cardiogénico y el paro cardiocirculatorio son importantes factores predictores de morbimortalidad. La cirugía de revascularización miocárdica es una buena estrategia alternativa en la terapia de las primeras horas del infarto de miocardio (AU)


Subject(s)
Middle Aged , Aged , Male , Female , Humans , Coronary Artery Bypass , Time Factors , Myocardial Infarction , Retrospective Studies
7.
Rev Med Chil ; 130(11): 1217-26, 2002 Nov.
Article in Spanish | MEDLINE | ID: mdl-12587503

ABSTRACT

BACKGROUND: During the last five years, 65 patients with univentricular heart have been treated surgically in our institution, according to a protocol of staged operations that have been previously reported. AIM: To evaluate the early and mid-term outcome of those patients that have completed their staging protocol by means of a Fontan procedure. PATIENTS AND METHODS: Between April 1996 and June 2001, 23 patients (age 16 to 223 months) underwent a Fontan procedure, 15 with an intracardiac lateral tunnel technique and 8 with an extracardiac conduit. A retrospective review of their clinical, surgical, echocardiographic, angiographic and hemodynamic data was performed, trying to identify risk factors for both mortality and functional capacity (FC). Follow up was complete in all survivors. RESULTS: Three patients died early after surgery (13.04%). Excessive pulmonary blood flow was a risk factor for early death (p = 0.03). One patient died at 14 months. Follow up was 29.9 months (1-63). For those who survived the operation, five years survival was 93.3%. The majority of patients are in FC I or II, with no related risk factors. CONCLUSIONS: Our current results are comparable with those of larger series. Patients reach good FC and mid-term survival, irrespective of type of single ventricle or the surgical strategy.


Subject(s)
Fontan Procedure/methods , Heart Defects, Congenital/surgery , Heart Ventricles/abnormalities , Ventricular Dysfunction/surgery , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Fontan Procedure/mortality , Heart Bypass, Right/methods , Heart Bypass, Right/mortality , Humans , Infant , Male , Pulmonary Artery/surgery , Retrospective Studies , Risk Factors , Survival Analysis , Treatment Outcome , Venae Cavae/surgery
9.
Rev. esp. cardiol. (Ed. impr.) ; 53(3): 316-320, mar. 2000.
Article in Es | IBECS | ID: ibc-2826

ABSTRACT

Introducción y objetivos. Establecer los resultados obtenidos con la técnica clásica de anastomosis de la arteria descendente anterior. Material y métodos. Entre enero de 1982 y julio de 1997, 154 pacientes fueron sometidos a cirugía de revascularización de la arteria descendente anterior con mamaria usando técnica clásica (esternotomía y circulación extracorpórea). Resultados. En nuestro grupo no hubo mortalidad, infarto perioperatorio ni accidente vascular encefálico. Un paciente (0,6 por ciento) tuvo infección de la herida esternal y otro (0,6 por ciento) presentó sangrado postoperatorio que requirió reoperación. Se obtuvo un 100 por ciento de seguimiento entre 3 y 183 meses (promedio, 64,4 meses). La supervivencia actuarial global a los 5, 10 y 15 años fue del 95,6 ñ 2,1 por ciento; 92,1 ñ 4 por ciento y 85,5 ñ 7,5 por ciento, respectivamente, y la probabilidad actuarial de estar libre de muerte cardíaca fue de 99 ñ 0,9 por ciento; 99 por ciento y 99 por ciento. La probabilidad actuarial de estar libre de infarto a los 5, 10 y 15 años fue de 99 ñ 0,9 por ciento, 99 por ciento ñ 0,9 por ciento y 99 por ciento, y la de estar libre de angina del 95 ñ 2,2 por ciento; 86,9 ñ 4,9 por ciento y 74,5 ñ 12,2 por ciento. Finalmente, la probabilidad actuarial de estar libre de reoperación y de angioplastia a los 5, 10 y 15 años fue del 99 ñ 0,9 por ciento, 99 por ciento, 99 por ciento y 96,9 ñ 1,7 por ciento, 91,4 ñ 4.1 por ciento y 91,4 ñ 4,1 por ciento, respectivamente. La cuenta hospitalaria promedio en el último 10 por ciento de este grupo fue 199,8 UF (6.200 dólares).Conclusión: La revascularización miocárdica a la descendente anterior con arteria mamaria única, con técnica clásica, es un procedimiento seguro, de mínimo riesgo, de bajo coste y de excelentes resultados a los 10 y 15 años (AU)


Subject(s)
Middle Aged , Adult , Aged , Aged, 80 and over , Male , Female , Humans , Retrospective Studies , Coronary Disease , Internal Mammary-Coronary Artery Anastomosis , Extracorporeal Circulation , Follow-Up Studies
10.
Rev. chil. cardiol ; 17(2): 84-91, abr.-jun. 1998. tab, graf
Article in Spanish | LILACS | ID: lil-231649

ABSTRACT

La disección aguda de la aorta ascendente (DAAA) constituye una patología con cifras de mortalidad que alcanzan al 25 por ciento a 24 hrs y más del 50 por ciento a la semana. La reparación quirúrgica precoz es la única alternativa de tratamiento eficaz. Sin embargo, su morbimortalidad continúa siendo elevada. En los últimos años ésta ha disminuido por la introducción de nuevas técnicas quirúrgicas y de manejo intraoperatorio. Entre 1985 y junio de 1997 operamos 65 pacientes (pts) con DAAA, 45 hombres (70 por ciento), edad promedio 52,2 ñ 13,1 años. Un 66 por ciento eran hipertensos y 14 por ciento tenían Síndrome de Marfán. El dolor fue el síntoma de presentación en 94 por ciento y un tercio de los pts se presentó con insuficiencia aórlica masiva o taponamiento en shock cardiogénico. Como examen diagnóstico se utilizó el TAC en 36 pts, angiografía en 27, ecocardiograma de superficie en 40 y transesofágico en 29. La localización más frecuente de la ruptura intimal fue la aorta ascendente (75 por ciento). Un 72 por ciento de los pts fueron operados con menos de 24 h de evolución. En 37pts se utilizó el paro circulatorio en hipotermia profunda y en 28 se asoció perfusión cerebral retrógrada. Los tiempos promedio de CEC, clampeo aótico y paro circulatotio fueron 170, 96 y 40 m, respectivamente. En todos los pts se reemplazó la aorta ascendente, además el arco proximal en 3. En 11 se utilizó un tubo compuesto. En 9 se efectuó RVA y suspensión de velos en 22. En 5 se agregó bypass coronario y en 15 se reimplantó uno o ambos ostium coronarios. La mortalidad operatoria global fue 24 por ciento (16/65). Desde 1995 ha disminuido a 12 por ciento (2/16). Las complicaciones post operatorias fueron: sangramiento 12, IRA y diálisis 3 y AVE en 3 pts. Se completó el seguimiento a un 97 por ciento de los pts con un promedio de 35 meses; tres pts fallecen de progresión de su enfermedad aneurismática y 7 de otras causas. La sobrevida actuarial a 5 años fue de 78 por ciento. En conclusión: nuevas técnicas quirúrgicas y de manejo intraoperatorio sumado a la experiencia acumulada, han permitido disminuir la morbimortalidad perioperatoria en la DAAA y ofrecer adecuada sobrevida a mediano plazo


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cardiovascular Surgical Procedures , Aortic Rupture/surgery , Disease-Free Survival , Aortic Valve Insufficiency/etiology , Marfan Syndrome , Postoperative Complications , Retrospective Studies , Aortic Rupture/complications , Aortic Rupture/diagnosis , Shock, Cardiogenic/etiology
12.
Rev. chil. cir ; 41(2): 167-70, jun. 1989. ilus
Article in Spanish | LILACS | ID: lil-67798

ABSTRACT

La endarterectomía extensa de la arteria descendente anterior es un recurso técnico al que debe recurrirse excepcionalmente para revascularizar arterias difusamente enfermas. Se diseña y describe la aplicación de una técnica que permite efectuarla y simultáneamente usar arteria mamaria interna en la revascularización de la arteria dscendente anterior. En 4 casos en que se usa esta técnica se obtienen excelentes resultados clínicos en el corto plazo


Subject(s)
Middle Aged , Humans , Male , Endarterectomy , Internal Mammary-Coronary Artery Anastomosis , Coronary Disease/surgery , Myocardial Revascularization
15.
Rev. chil. cir ; 40(1): 54-7, mar. 1988. tab, ilus
Article in Spanish | LILACS | ID: lil-58985

ABSTRACT

Se describe la técnica quirúrgica y los resultados de revascularización miocárdica con la arteria mamaria interna en 396 pacientes. En el 87% ésta se usó asociada a puentes venosos aortocoronarios y en 13% la arteria mamaria izquierda, derecha o ambas en forma exclusiva para revascularizar el miocardio. En 338 se anastomosó a la arteria descendente anterior, en 20 a la arteria diagonal, en 13 a la arteria cicunfleja y en 12 a la arteria coronaria derecha. El 89,1% de los pacientes evolucionaron sin complicaciones, el 8,6% presentó complicaciones y la mortalidad operatoria fue de 2,3%. En conclusión, la arteria mamaria interna es muy adecuada para revascularizar cualquier territorio, especialmente la arteria descendente anterior. Con una técnica depurada la morbimortalidad operatória es baja, similar a la técnica de puentes venosos aortocoronarios


Subject(s)
Adult , Middle Aged , Humans , Male , Female , Coronary Artery Bypass , Myocardial Revascularization , Angina Pectoris/surgery
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