ABSTRACT
In this work we compare the kVp estimate between CDTN multipurpose instrument, UnforsXI and Radcal 4075 meters under different combinations of voltage and filtration. The non-invasively measurements made using x-ray diagnostic and interventional radiology devices show similar tendencies to increase the kVp estimate when aluminum filters are placed in the path of the x-ray beam. The results reveal that the kVp estimate made by the CDTN multipurpose instrument is always satisfactory for highly filtered beam intensities.
ABSTRACT
The development of pulmonary arteriovenous fistulas after bidirectional cavopulmonary operations, such as the bidirectional Glenn shunt and Kawashima's procedure, has raised concern. Development of these fistulas, which are more frequent than initially thought, can represent a limiting factor in the late outcome of these patients and may even limit the indication for these types of surgery. Whether the fistulas can be reversed by transforming the surgical procedures has yet to be established. In the hope of avoiding this kind of complication, thought to be caused by the lack of passage of a hypothetical hepatic factor through the pulmonary circulation, we have developed an inverted type of bidirectional cavopulmonary connection in which the blood coming from the liver perfuses immediately both lungs. This is made possible by shunting via an intra-atrial tunnel the blood from the superior caval vein directly to the left atrium, and the blood from the inferior caval vein to the right branch of the pulmonary trunk (keeping its bifurcation intact). We describe findings in two patients undergoing successful surgery with this technique. Serial follow-up with contrast echocardiography did not show evidence of arteriovenous pulmonary fistulas. Despite our numbers being small, and the time of follow-up being limited, we believe that it is important to document these and similar cases.
Subject(s)
Heart Bypass, Right/methods , Pulmonary Circulation , Angiography , Arteriovenous Fistula/etiology , Arteriovenous Fistula/physiopathology , Arteriovenous Fistula/prevention & control , Heart Bypass, Right/adverse effects , Humans , Infant , Male , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Treatment Outcome , Vena Cava, Superior/diagnostic imaging , Vena Cava, Superior/surgeryABSTRACT
No Instituto Dante Pazzanese de Cardiologia, as valvoplastias percutâneas para as valvas mitral e aórtica tiveram início em agosto de 1987. Foram realizados 37 procedimentos, sendo 26 para a mitral (VMP) e 1 para aórtica (VAP). Nas 26 VMP, obteve-se sucesso 14 vezes, tendo 4 complicaçoes. Em 3 pacientes, o sucesso nao foi total, sendo que uma paciente com insuficiência mitral recusou cirurgia, outro foi operado e terceiro está assintomático, mas nao houve melhora da área valvar e das pressoes, e deve ser reestudado para posterior avaliaçao. Os 9 pacientes restantes foram operados, sendo realizadas 6 comissurotomias e papilarotomias e 3 substituiçoes valvares. A indicaçao cirurgica se deu por tamponamento cardíaco em 1 caso, rotura de músculo papilar com conseqüente insuficiência em outro, 1 caso de baixo débito, punçao da aorta em 4 casos e nao passagem do cateter para o átrio esquerdo em 2 com suspeita de tamponamento nao confirmada. O paciente submetido a VAP obteve melhora imediata do gradiente, mas faleceu 1 mês após, em insuficiência cardíaca. As valvoplastias percutâneas têm apresentado uma alternativa no tratamento das lesoes valvares e sao uma opçao, principalmente para casos de valvas nao calcificadas e com o aparelho subvalvar nao comprometido. Devem ser lembradas nos casos em que a cirurgia é de alto risco, como em idosos, pneumopatas e nefropatas.
