RESUMEN
Bronchopulmonary sequestration is an uncommon congenital anomaly. Although systemic arterial supply to the abnormal lung tissue is usually derived from the aorta, other nutrient vascular sources have also been described, including, infrequently, the coronary circulation. A right-sided aortic arch is another rare vascular abnormality, generally present in the setting of a vascular ring. We report a case of pulmonary sequestration receiving arterial supply from the right coronary artery, in the presence of a right-sided aortic arch, a constellation of anomalies not previously described.
RESUMEN
OBJECTIVE: Patients who undergo successful percutaneous transluminal coronary angioplasty (PTCA) may subsequently require operative myocardial revascularization. This review examines whether prior successful PTCA alters outcomes following subsequent coronary artery bypass grafting (CABG). The costs of interventional cardiology procedures and definitive surgery were also examined. METHODS: From January 1981 through December 1997, 361 patients underwent CABG following initially successful PTCA (interval group). This group was compared with 11,909 patients who underwent CABG as the primary intervention for coronary artery disease (control group). RESULTS: The average time interval to CABG following initial PTCA was 13.7 months. The post-CABG myocardial infarction rate was 4% for patients in the interval group and 3% for patients in the control group. The 30-day mortality was similar for both patient groups (2%). For the interval group, the average cost of total interventional management was 24,220 dollars per patient. This included average costs of 13,873 dollars for CABG and 10,347 dollars for all preoperative interventional cardiology procedures. CONCLUSION: There is little doubt that PTCA procedures may provide successful myocardial revascularization. However, these procedures often need to be repeated over time and may serve only to delay coronary surgery, at substantial financial and personal cost.
Asunto(s)
Angioplastia Coronaria con Balón , Puente de Arteria Coronaria , Enfermedad Coronaria/terapia , Adulto , Anciano , Anciano de 80 o más Años , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/economía , Angioplastia Coronaria con Balón/mortalidad , Distribución de Chi-Cuadrado , Angiografía Coronaria/economía , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/economía , Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/cirugía , Costos y Análisis de Costo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Selección de Paciente , Complicaciones Posoperatorias , Estudios Prospectivos , Resultado del TratamientoAsunto(s)
Carcinoma Papilar/diagnóstico , Neoplasias Ováricas/diagnóstico , Estruma Ovárico/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/cirugía , Antígeno Ca-125/sangre , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía , Femenino , Histocitoquímica , Humanos , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Estruma Ovárico/patología , Estruma Ovárico/cirugía , Tiroglobulina/análisis , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugíaRESUMEN
Ludwig's angina, although uncommon, remains a potentially life-threatening condition because of the risk of impending airway obstruction. Effective treatment is based on early recognition of the clinical process, with the appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection. We present a case of Ludwig's angina together with a brief review of the relevant literature.