RESUMEN
Percutaneous treatment of patent ductus arteriosus (PDA) in extreme premature infants is technically difficult, and therefore, often not consider as an alternative to surgery. The main objective of our work was to compare respiratory status prior and post ductal closure and morbi-mortality, in our series of preterm infants with percutaneous PDA closure versus surgical ligation in the same time-period. Retrospective review of all premature infants submitted to percutaneous and surgical PDA closure from January 2011 to December 2016. All the antenatal, perinatal, and postnatal characteristics were collected. The main outcome was the assessment of the pulmonary status before and after ductal closure using a pulmonary score. Secondary outcomes included moderate-severe disability in neurodevelopment, death before discharge, moderate-severe chronic lung disease, and morbidity at discharge. 25 patients with a mean weight of 1330 g (± 280) underwent percutaneous closure of PDA with ADO-II-AS, and a total of 53 underwent surgical ligation. 28/53 with similar gestational age, birth weight, and procedure weight to those in the percutaneous group, were selected to perform the comparative study. Ductal closure (percutaneous and surgical) resulted in improved respiratory status. However, percutaneous group achieved a fastest respiratory improvement, than surgical group. The surgical closure group associated higher morbidity among survivors (HIV, number of sepsis, need, and duration of inotropics post-interventionism). The incidence of recurrent laryngeal nerve palsy among the surgical group was 17%. Percutaneous closure of PDA in carefully selected low-weight preterm infants is a safe and reliable alternative to surgical ligation.
Asunto(s)
Cateterismo Cardíaco/métodos , Procedimientos Quirúrgicos Cardíacos/métodos , Conducto Arterioso Permeable/cirugía , Ligadura/métodos , Pulmón/fisiopatología , Peso al Nacer , Cateterismo Cardíaco/efectos adversos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Conducto Arterioso Permeable/mortalidad , Conducto Arterioso Permeable/fisiopatología , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Ligadura/efectos adversos , Masculino , Complicaciones Posoperatorias/epidemiología , Terapia Respiratoria/estadística & datos numéricos , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Mid-line sternotomy is the routine approach for surgical repair of congenital heart diseases. However, its noticeable scar is a constant reminder of having undergone heart surgery. Several alternative approaches have been developed for simple cardiac conditions to hide the scar. Our series, consisting of 26 patients with axillary closure of atrial septal defect, is presented. The median age was 5.45 years (range 3-13), and median weight was 19.84 Kg. (range 13-37). The defect was closed directly in 13 cases, and with an autologous pericardial patch in the other 13. The number of surgical steps and time taken were the same as in median sternotomy. Functional recovery, intensive care unit stay, and hospital discharge were also standard. The cosmetic result, assessed both by patients and relatives, was excellent.
Asunto(s)
Defectos del Tabique Interatrial/cirugía , Adolescente , Axila , Procedimientos Quirúrgicos Cardíacos/métodos , Niño , Preescolar , HumanosRESUMEN
A four-month-old infant with anomalous origin of the left coronary artery from the pulmonary artery developed severe left ventricular failure after aortic reimplantation, despite prolonged supportive cardiopulmonary bypass with high level inotropic support and several abortive attempts for discontinuation. The Batista procedure was performed and the patient was successfully weaned from bypass. Postoperative recovery was uneventful, and at one-year follow-up she remains asymptomatic.
Asunto(s)
Puente de Arteria Coronaria , Anomalías de los Vasos Coronarios/cirugía , Ventrículos Cardíacos/cirugía , Complicaciones Posoperatorias/cirugía , Reimplantación , Disfunción Ventricular Izquierda/cirugía , Femenino , Humanos , Lactante , Disfunción Ventricular Izquierda/etiologíaRESUMEN
La mayoría de los casos de quilopericardio en la infancia aparecen tras cirugía torácica, especialmente tras cirugía cardiaca, aunque de forma excepcional también se producen en niños sin estos antecedentes, como los 2 pacientes presentados en este artículo. El primero se trata de un niño de 9 años con un episodio de quilopericardio como primera manifestación de una linfangiomiomatosis, y el segundo de una niña de 15 meses con antecedentes de síndrome de Down y enteropatía autoinmune, catalogado como quilopericardio congénito primario. Además, se realiza una revisión bibliográfica de los casos publicados en los últimos 13 años y se analiza el manejo de esta rara entidad (AU)
Most cases of chylopericardium in childhood are secondary to thoracic surgery, especially after cardiac surgery. However, it can also be present in children without this history, as we show in this report. First, a nine year-old boy in whom chylopericardium was the first manifestation of a lymphangiomatosis, and the second one, a fifteen months old girl with a history of Down's syndrome and autoimmune enteropathy, which was classified as primary congenital chylopericardium. Also, a review of literature over the last 13 years is made, and management of this rare entity is discussed (AU)
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Niño , Derrame Pericárdico/diagnóstico , Taponamiento Cardíaco/diagnóstico , Linfangioleiomiomatosis/diagnóstico , Síndrome de Down/complicacionesRESUMEN
Most cases of chylopericardium in childhood are secondary to thoracic surgery, especially after cardiac surgery. However, it can also be present in children without this history, as we show in this report. First, a nine year-old boy in whom chylopericardium was the first manifestation of a lymphangiomatosis, and the second one, a fifteen months old girl with a history of Down's syndrome and autoimmune enteropathy, which was classified as primary congenital chylopericardium. Also, a review of literature over the last 13 years is made, and management of this rare entity is discussed.
Asunto(s)
Derrame Pericárdico , Niño , Quilo , Femenino , Humanos , Lactante , Masculino , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapiaAsunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH/complicaciones , Sarcoidosis/complicaciones , Enfermedades de la Piel/complicaciones , Adulto , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Sarcoidosis/patología , Sarcoidosis Pulmonar/complicaciones , Sarcoidosis Pulmonar/patología , Enfermedades de la Piel/patologíaRESUMEN
OBJECTIVE: To determine the incidence of postoperative junctional ectopic tachycardia (JET), we reviewed 343 consecutive patients undergoing surgery between 1997 and 1999. The impact of this arrhythmia on in-hospital morbidity and our protocol for treatment were assessed. METHODS: We reviewed the postoperative course of patients undergoing surgery for ventricular septal defect (VSD; n=161), tetralogy of Fallot (TOF; n=114), atrioventricular septal defect (AVSD; n=58) and common arterial trunk (n=10). All patients with JET received treatment, in a stepwise manner, beginning with surface cooling, continuous intravenous amiodarone, and/or atrial pacing if the haemodynamics proved unstable. A linear regression model assessed the effect of these treatments upon hours of mechanical ventilation, and stay on the cardiac intensive care unit (CICU). RESULTS: Overall mortality was 2.9% (n=10), with three of these patients having JET and TOF. JET occurred in 37 patients (10.8%), most frequently after TOF repair (21.9%), followed by AVSD (10.3%), VSD (3.7%), and with no occurrence after repair of common arterial trunk. Mean ventilation time increased from 83 to 187 h amongst patients without and with JET patients (P<0.0001). Accordingly, CICU stay increased from 107 to 210 h when JET occurred (P<0.0001). Surface cooling was associated with a prolongation of ventilation and CICU stay, by 74 and 81 h, respectively (P<0.02; P<0.02). Amiodarone prolonged ventilation and CICU stay, respectively, by 274 and 275 h (P<0.05; P<0.06). CONCLUSIONS: Postoperative JET adds considerably to morbidity after congenital cardiac surgery, and is particularly frequent after TOF repair. Aggressive treatment with cooling and/or amiodarone is mandatory, but correlates with increased mechanical ventilation time and CICU stay. Better understanding of the mechanism underlying JET is required to achieve prevention, faster arrhythmic conversion, and reduction of associated in-hospital morbidity.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/mortalidad , Cardiopatías Congénitas/mortalidad , Cardiopatías Congénitas/cirugía , Taquicardia Ectópica de Unión/complicaciones , Taquicardia Ectópica de Unión/mortalidad , Amiodarona/administración & dosificación , Análisis de Varianza , Estimulación Cardíaca Artificial , Procedimientos Quirúrgicos Cardíacos/métodos , Niño , Preescolar , Femenino , Cardiopatías Congénitas/diagnóstico , Defectos del Tabique Interventricular/diagnóstico , Defectos del Tabique Interventricular/mortalidad , Defectos del Tabique Interventricular/cirugía , Humanos , Lactante , Recién Nacido , Modelos Lineales , Masculino , Complicaciones Posoperatorias/mortalidad , Periodo Posoperatorio , Probabilidad , Pronóstico , Respiración Artificial , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Taquicardia Ectópica de Unión/terapia , Tetralogía de Fallot/diagnóstico , Tetralogía de Fallot/mortalidad , Tetralogía de Fallot/cirugíaAsunto(s)
Prótesis Valvulares Cardíacas , Femenino , Humanos , Persona de Mediana Edad , Válvula Mitral , Diseño de PrótesisRESUMEN
Se presenta el caso de un varón de 54 años que fue sometido a trasplante pulmonar bilateral por neumopatía consecutiva a inhalación accidental de amoníaco, con la vía aérea colonizada por PSeudomonas aeruginosa desde el comienzo del cuadro. En los cinco meses transcurridos hata el trasplante aparecieron las lesiones pulmonares típicas por la inhalación masiva de ese gas: bronquiolitis obliterante y bronquiectasias cilíndricas. Falleció tres meses después del trasplante. La autopsia sugirió el papel decisivo de la infección pulmonar en la mala evolución del trasplante, condicionado por las lesiones de las vías respiratorias altas (AU)
Asunto(s)
Masculino , Persona de Mediana Edad , Humanos , Trasplante de Pulmón/métodos , Trasplante de Pulmón , Amoníaco/efectos adversos , Bronconeumonía/complicaciones , Bronconeumonía/diagnóstico , Bronconeumonía/mortalidad , Bronconeumonía/microbiología , Quemaduras Químicas/complicaciones , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/cirugía , Quemaduras Químicas/etiología , Traqueostomía/métodos , Traqueostomía , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etiología , Hemoptisis/diagnóstico , Hemoptisis/etiología , Tomografía Computarizada por Rayos X , Tomografía Computarizada de Emisión/métodos , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Broncodilatadores/administración & dosificación , Broncodilatadores/uso terapéutico , Pseudomonas aeruginosa/aislamiento & purificación , Bronquiectasia/complicaciones , Bronquiectasia/diagnóstico , Bronquiectasia/etiología , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/cirugía , Enfermedades Pulmonares/complicaciones , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Inhalación/fisiología , Accidentes de Trabajo , Traumatismos Torácicos/cirugía , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/patología , Eritema/complicaciones , Eritema/diagnóstico , Mucosa Laríngea/patología , Derrame Pleural/complicaciones , Derrame Pleural/diagnóstico , Pulmón/lesiones , Pulmón/patologíaAsunto(s)
Fibrosis Quística/cirugía , Enfermedades Pulmonares Fúngicas/etiología , Trasplante de Pulmón , Pulmón/microbiología , Hongos Mitospóricos , Complicaciones Posoperatorias/microbiología , Antifúngicos/uso terapéutico , Farmacorresistencia Microbiana , Resultado Fatal , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/cirugía , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Masculino , Hongos Mitospóricos/aislamiento & purificación , Recurrencia , ReoperaciónRESUMEN
We present four patients with intramural hematomas in the ascending aorta. Diagnostic suspicion was aortic dissection in two of them. Prompt surgical procedures were performed in all of them. After reviewing other series, we conclude that ascending aorta hematomas should be treated as true aortic dissections.
Asunto(s)
Enfermedades de la Aorta , Hematoma , Anciano , Disección Aórtica/diagnóstico , Aorta , Aneurisma de la Aorta/diagnóstico , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/cirugía , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Hematoma/diagnóstico , Hematoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Lung transplantation has become the therapeutic hope of terminal respiratory patients. Infections are among the main causes of morbidity and mortality in these patients. We therefore analyze infections suffered after lung transplants performed at Clínica Puerta de Hierro over a two-year period. The cases of 14 transplanted patients, 6 bilateral and 8 unilateral, were analyzed. Pre-transplant data available for all included analysis of serum antibodies to several viruses, as well as bacterial and fungal cultures, and Ziehl's sputum test. All received prophylactic antibiotic, antifungal and antiviral treatment according to protocol. The bronchial aspirate of the donor, and recipient specimens of bronchial aspirate, bronchoalveolar lavage and biopsies obtained by bronchoscopy after transplantation were cultured. Bronchoscopies were performed according to protocol, based on clinical picture. Other cultures were obtained as needed. We recorded 27 respiratory infections, among which 4 were pneumonia transmitted by the donor, 3 were tuberculosis, 3 were Aspergillus infections, 5 were cytomegalovirus pneumonitis and one, P. carinii pneumonia. Lung infections have a strong impact on outcome of lung transplant patients. Knowledge of the chronological development of infections made appropriate prophylaxis and early detection possible, such that survival during the first two years after transplantation was approximately 70% in our hospital.
Asunto(s)
Infecciones/etiología , Enfermedades Pulmonares/microbiología , Trasplante de Pulmón/efectos adversos , Adulto , Femenino , Humanos , Infecciones/epidemiología , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Automatic Implantable Cardioverter Defibrillator (AICD) has become a therapeutic option to malignant ventricular tachyarrhythmias. Its bulky device responds for discomfort and the likelihood of generator extrusion or migration, when implanted under the subcutaneous tissue. Among alternative sites, pre-peritoneal location has several advantages but hides its own risks. We present a generator peritoneal migration from a pocket made behind the rectus abdominis.
Asunto(s)
Desfibriladores Implantables/efectos adversos , Migración de Cuerpo Extraño , Peritoneo , Anciano , Humanos , Masculino , Recto del AbdomenRESUMEN
Anomalous origin of left coronary artery from pulmonary artery is a rare congenital anomaly (0.25-0.46%). Mortality is high in the first months (65%). Paradoxically, some patients reach adulthood because of a net made of collaterals from the right coronary artery. Thus, we classify the entity in two ways of clinical onset: childhood and adulthood. Ideally, the best surgical approach is the arrangement of a double coronary system. The most well-known technique is the one described by Takeuchi, that links the aorta and the left coronary artery by a tunnel through the pulmonary artery, made from a pulmonary artery frontal wall flap (closing the defect with a pericardial patch). We present a case of anomalous origin of the left coronary artery in an adult, treated in our institution using a modified Takeuchi technique.
Asunto(s)
Anomalías de los Vasos Coronarios/cirugía , Adulto , Femenino , Humanos , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
A 39-years-old male patient with chronic venous insufficiency, deep venous thrombosis and recurrent pulmonary embolism in the past medical history. After syncopal event was diagnosed of bilateral chronic pulmonary embolism, pulmonary hypertension and right ventricular failure. Fibrinolytic treatment was no effective therapeutic modality. Under cardiopulmonary bypass, bilateral pulmonary thromboendarterectomy with extension into lobe arteries, plus insertion of caval filter was performed. We present our experience with this case and a review of the literature.