RESUMEN
Shortness of breath after pneumonectomy is a common finding that has multiple causes. We report the cases of two patients with shortness of breath on assuming an upright posture (platypnea) that followed pneumonectomy; these individuals developed right-to-left shunt across a patent foramen ovale (PFO) with normal right-sided intracardiac pressures. Both contrast echocardiography and magnetic resonance imaging (MRI), including a recently introduced dynamic ultrafast imaging technique, proved helpful in diagnosing this condition noninvasively.
Asunto(s)
Disnea/etiología , Defectos del Tabique Interatrial/diagnóstico , Imagen por Resonancia Magnética/métodos , Neumonectomía , Complicaciones Posoperatorias/diagnóstico , Postura/fisiología , Anciano , Defectos del Tabique Interatrial/fisiopatología , Humanos , Neoplasias Pulmonares/cirugía , Masculino , Complicaciones Posoperatorias/etiologíaRESUMEN
UNLABELLED: Recent reports have shown poor survival of some leads currently in use. Long-term survival analysis of 2,444 leads (1,059 atrial and 1,385 ventricular) implanted in this institution since January 1980, and having at least 1 month of follow-up was performed. The survival of 123 different models was compared with the average survival of all the leads implanted in the corresponding chamber. Failure was defined as inactivation of the lead (electrical abandonment, explant, or cap) due to insulator and/or conductor fracture. RESULTS: The mean follow-up was 33 +/- 32 months. The cumulative survival for different atrial lead models was consistent with the average performance in the atrium. No atrial lead showed better or worse survival compared to the others. In the ventricular group, the Medtronic 4012 lead showed statistically significant poorer survival (P = 0.01) compared with the average survival of the ventricular leads. The Cardiac Pacemakers, Inc. (CPI) 4010 lead showed a nonsignificant (P = 0.12) worse performance than the average for ventricular leads. CONCLUSIONS: (1) The Medtronic 4012 had a significantly poorer performance than the rest of the leads. A trend in similar direction was found for the CPI 4010, also in the ventricular group; (2) Atrial lead models showed a stable survival; and (3) Frequent follow-up is required for some leads, especially in pacemaker dependent patients.
