RESUMO
Hypertrophic cardiomyopathy (HCM) with left ventricular outflow tract obstruction that doesn't improve with pharmacological management often requires septal myectomy. However, there are few centers with experience in the practice of this procedure in our country. We describe the clinical and echocardiographic characteristics and postoperative outcomes of patients with HCM indicated for septal myectomy at a reference center in Colombia. MATERIALS AND METHODS: Retrospective cohort study. Patients undergoing septal myectomy between 2010 and 2023 were included. Data were collected before and two years after surgery. RESULTS: 18 patients were included. The mean age was 50 years. The predominant functional class was NYHA II/III (94 %). Asymmetric septal variant (83.3 %) was the most frequent as well as obstructive phenotype (88.8 %). After myectomy, 70.5 % improved to NYHA I and 62.4 % had no significant gradient (<30 mmHg), and the most of patient improved SAM. One patient died post-procedure, anymore complications were presented. DISCUSSION/CONCLUSIONS: Septal myectomy is a safe procedure, with clinical and echocardiographic improvement, with low complication rates.
Assuntos
Cardiomiopatia Hipertrófica , Ecocardiografia , Septos Cardíacos , Humanos , Cardiomiopatia Hipertrófica/cirurgia , Pessoa de Meia-Idade , Masculino , Feminino , Estudos Retrospectivos , Septos Cardíacos/cirurgia , Septos Cardíacos/diagnóstico por imagem , Resultado do Tratamento , Ecocardiografia/métodos , Adulto , Obstrução do Fluxo Ventricular Externo/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Colômbia/epidemiologia , Idoso , Miotomia/métodosRESUMO
Introducción El deterioro cognitivo secundario a eventos cerebrovasculares es una complicación frecuente en las intervenciones de reemplazo de válvula aórtica. Nuestro objetivo es el estudio del perfil de deterioro de los pacientes sometidos a reemplazo valvular quirúrgico o implantación de prótesis transcatéter (TAVI) y si éste resulta diferente según la intervención a la que son sometidos y los factores de riesgo basales. Pacientes y métodos Estudio observacional prospectivo, con dos grupos no equivalentes de pacientes (grupo TAVI y grupo quirúrgico). Se realizaron comparaciones intergrupo en varios dominios cognitivos, con una evaluación basal y mediciones de seguimiento seis y 12 meses después la intervención. Resultados El grupo TAVI presentó resultados inferiores al grupo quirúrgico en funciones ejecutivas y visuoespaciales, puntuaciones parcialmente determinadas por la edad (p < 0,01) y el nivel intelectual previo (Pearson cociente intelectual previo-medias escalares en los test: 0,665; p < 0,001). La media de puntuaciones en los tres momentos de medición indica una disminución del rendimiento en funciones ejecutivas a los seis meses, que se recupera a los 12 meses. En memoria se registraron incrementos sostenidos en ambos momentos, en tanto que la función visuoespacial y la denominación no mostraron recuperación posterior de los niveles basales. Estas tendencias son similares en los dos grupos. Conclusión Los resultados obtenidos no confirman la instauración de un proceso específico de deterioro neurocognitivo postintervención en la estenosis aórtica complicada. El perfil de deterioro no presenta diferencias significativas entre los grupos, pero es más evidente en los pacientes con TAVI, debido a la influencia de las variables de selección de la muestra. (AU)
INTRODUCTION Cognitive impairment secondary to cerebrovascular events is a common complication of aortic valve replacement interventions. Our aim is to study the deterioration profile of patients who have undergone surgical valve replacement or transcatheter valve implantation (TAVI) and whether it differs according to the intervention they underwent and their baseline risk factors. PATIENTS AND METHODS We conducted a prospective observational study with two non-equivalent groups of patients (TAVI group and surgical group) Intergroup comparisons were carried out in several cognitive domains, with a baseline assessment and follow-up measurements six and 12 months after the intervention. RESULTS The TAVI group performed less well than the surgical group in executive and visuospatial functions, with scores partially determined by age (p < 0.01) and prior intellectual level (Pearson prior intelligence quotient-scalar test means: 0.665; p < 0.001). Mean scores at the three measurement points indicate a decline in executive function performance at six months, which is restored at 12 months. Sustained increases in memory were recorded at both time points, while visuospatial function and naming showed no subsequent recovery of the baseline levels. These trends are similar in both groups. CONCLUSION. The results obtained do not confirm the appearance of a specific process of post-intervention neurocognitive impairment in complicated aortic stenosis. The deterioration profile does not show any significant differences between groups, but is more evident in TAVI patients, due to the influence of variables related to sample selection. (AU)
Assuntos
Disfunção Cognitiva , Estenose da Valva Aórtica/reabilitação , Implante de Prótese de Valva Cardíaca/reabilitação , Estudos ProspectivosRESUMO
INTRODUCTION: Cognitive impairment secondary to cerebrovascular events is a common complication of aortic valve replacement interventions. Our aim is to study the deterioration profile of patients who have undergone surgical valve replacement or transcatheter valve implantation (TAVI) and whether it differs according to the intervention they underwent and their baseline risk factors. PATIENTS AND METHODS: We conducted a prospective observational study with two non-equivalent groups of patients (TAVI group and surgical group) Intergroup comparisons were carried out in several cognitive domains, with a baseline assessment and follow-up measurements six and 12 months after the intervention. RESULTS: The TAVI group performed less well than the surgical group in executive and visuospatial functions, with scores partially determined by age (p < 0.01) and prior intellectual level (Pearson prior intelligence quotient-scalar test means: 0.665; p < 0.001). Mean scores at the three measurement points indicate a decline in executive function performance at six months, which is restored at 12 months. Sustained increases in memory were recorded at both time points, while visuospatial function and naming showed no subsequent recovery of the baseline levels. These trends are similar in both groups. CONCLUSION: The results obtained do not confirm the appearance of a specific process of post-intervention neurocognitive impairment in complicated aortic stenosis. The deterioration profile does not show any significant differences between groups, but is more evident in TAVI patients, due to the influence of variables related to sample selection.
TITLE: Deterioro cognitivo tardío en pacientes con estenosis aórtica tratados con sustitución valvular quirúrgica y con implantación transcatéter de válvula aórtica: estudio comparativo.Introducción. El deterioro cognitivo secundario a eventos cerebrovasculares es una complicación frecuente en las intervenciones de reemplazo de válvula aórtica. Nuestro objetivo es el estudio del perfil de deterioro de los pacientes sometidos a reemplazo valvular quirúrgico o implantación de prótesis transcatéter (TAVI) y si éste resulta diferente según la intervención a la que son sometidos y los factores de riesgo basales. Pacientes y métodos. Estudio observacional prospectivo, con dos grupos no equivalentes de pacientes (grupo TAVI y grupo quirúrgico). Se realizaron comparaciones intergrupo en varios dominios cognitivos, con una evaluación basal y mediciones de seguimiento seis y 12 meses después la intervención. Resultados. El grupo TAVI presentó resultados inferiores al grupo quirúrgico en funciones ejecutivas y visuoespaciales, puntuaciones parcialmente determinadas por la edad (p < 0,01) y el nivel intelectual previo (Pearson cociente intelectual previo-medias escalares en los test: 0,665; p < 0,001). La media de puntuaciones en los tres momentos de medición indica una disminución del rendimiento en funciones ejecutivas a los seis meses, que se recupera a los 12 meses. En memoria se registraron incrementos sostenidos en ambos momentos, en tanto que la función visuoespacial y la denominación no mostraron recuperación posterior de los niveles basales. Estas tendencias son similares en los dos grupos. Conclusión. Los resultados obtenidos no confirman la instauración de un proceso específico de deterioro neurocognitivo postintervención en la estenosis aórtica complicada. El perfil de deterioro no presenta diferencias significativas entre los grupos, pero es más evidente en los pacientes con TAVI, debido a la influencia de las variables de selección de la muestra.
Assuntos
Estenose da Valva Aórtica , Disfunção Cognitiva , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Medição de Risco , Resultado do Tratamento , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Fatores de Risco , Disfunção Cognitiva/etiologia , Instrumentos CirúrgicosRESUMO
Propósito: Las metástasis cerebrales constituyen el tipo más común de tumor cerebral en adultos, causando un incremento de morbilidad y mortalidad en pacientes con cáncer. En la actualidad el tratamiento electivo en la mayoría de los casos es la radiocirugía. Material y métodos: Presentamos la valoración de la respuesta a la radiocirugía mediante tomografía por emisión de positrones (PET) y resonancia magnética nuclear (RMN) en un paciente con hidrocefalia y metástasis cerebrales (circunstancia excepcional en la práctica asistencial diaria). Resultados: Ambas exploraciones PET-FDG y RMN identificaron las lesiones metastásicas cerebrales, detectándose mediante PET la afectación multiorgánica del carcinoma de pulmón. La respuesta a la radiocirugía, en este caso la viabilidad tumoral persistente, fue valorada correctamente por PET- FDG. Conclusiones: Creemos que es necesario una utilización conjunta de la PET y de la RMN como método óptimo y complementarios para estimar con mayor exactitud el grado de respuesta a la radiocirugía en el tratamiento de las metástasis cerebrales. (AU)
Assuntos
Adulto , Masculino , Humanos , Hidrocefalia , Neoplasias Pulmonares/patologia , Neoplasias Encefálicas/secundário , Tomografia Computadorizada de Emissão , Radiocirurgia , Evolução Fatal , Espectroscopia de Ressonância Magnética , Metástase NeoplásicaRESUMO
A total of 10 cases of non-bacterial thrombotic endocarditis (NBTE) were found among 1640 adult patients, autopsied in a 24-year period. Eight out of 10 patients had an underlying malignant tumor, NBTE was more common in cancer patients than in patients without malignancy (1.25% vs 0.2%, P less than 0.05). Patients with adenocarcinoma were at higher risk than patients with other malignant processes (2.70% vs 0.47%, P less than 0.05); especially in cases of pancreatic cancer in comparison with other kinds of adenocarcinoma (10.34% vs 1.55%, P less than 0.05). Systemic embolization was the main cause of morbidity. Any thromboembolic event in cancer patients should prompt a search for NBTE. NBTE may be present in undisseminated cancers in otherwise curable patients.
Assuntos
Endocardite/epidemiologia , Neoplasias/complicações , Trombose/epidemiologia , Adenocarcinoma/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/complicações , Endocardite/etiologia , Endocardite/patologia , Feminino , Histiocitoma Fibroso Benigno/complicações , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Trombose/etiologia , Trombose/patologiaRESUMO
A 44-year-old male was diagnosed in August 1980 as having a retroperitoneal germ cell tumor (classic seminoma with anaplastic areas). After treatment with cisplatin-based chemotherapy, he reached complete clinical and pathological remission. Eighty-eight months later, in December 1987, he was diagnosed as having a testicular mixed germ cell tumor (embryonal carcinoma with anaplastic seminoma areas) after right orchiectomy. The potential mechanisms by which the latter tumor could have developed are discussed.
Assuntos
Neoplasias Embrionárias de Células Germinativas/secundário , Neoplasias Retroperitoneais/secundário , Neoplasias Testiculares/patologia , Adulto , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/patologia , Segunda Neoplasia Primária , Neoplasias Retroperitoneais/patologiaRESUMO
An 80-year-old male developed ascites as the first indication of an adenocarcinoma of the gastroesophageal junction. Laparoscopy was performed during the diagnostic study of the ascites and, 7 days later at the point of introduction of the laparoscope, a metastasis developed in skin and subcutaneous cellular tissue. This is the third case of subcutaneous neoplastic implantation following laparoscopy to appear in the literature. The two previously described cases dealt with patients with ovarian adenocarcinoma. The literature reporting cases of tumor dissemination following technical procedures is reviewed.
Assuntos
Adenocarcinoma Mucinoso/secundário , Laparoscopia/efeitos adversos , Inoculação de Neoplasia , Neoplasias Cutâneas/secundário , Neoplasias Gástricas/patologia , Músculos Abdominais/patologia , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Junção Esofagogástrica , Humanos , Masculino , Neoplasias Cutâneas/patologia , Neoplasias Gástricas/diagnósticoRESUMO
The experience of the Radiotherapy Service, Clínica Puerta de Hierro, Madrid (Spain), in the treatment of intracranial tumors with risk of neural axis dissemination is analyzed. In 15 years (1964-1979) 415 primary central nervous system tumors were studied and treated; 67 corresponded to tumors with risk of meningeal dissemination. Clinical dissemination in cerebrospinal fluid was proven in 14 patients. The actuarial survival of 10 years for patients with neural axis dissemination, without prophylactic treatment to the neuroaxis, is 14% with an average survival of 10.5 months. In approximately 20% of meduloblastomas, ependymal and pineal region tumors, meningeal metastases at some distance from the primary tumor can take place. Patients at risk wtih these types of neoplasia must be identified, and an adequate radical therapeutic focus devised, not only for the primary tumor, but also for the risk of dissemination.
Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias do Sistema Nervoso/secundário , Adolescente , Adulto , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Neoplasias Cerebelares/radioterapia , Criança , Pré-Escolar , Ependimoma/radioterapia , Humanos , Lactente , Meduloblastoma/radioterapia , Neoplasias do Sistema Nervoso/mortalidade , Neoplasias do Sistema Nervoso/radioterapia , Glândula Pineal , RiscoRESUMO
From 1964-1977, 242 previously untreated patients with a oral cavity carcinoma were treated in the Service of Radiotherapy in the Clínica Puerta de Hierro of Madrid. The actuarial survival at five years was 52,5% (26 T1, 96 T2, 120 T3). The presence of nodes in the moment of treatment was of great prognostic value. And so the actuarial survival at five years of the N(+) was 31% vs 64% in the No (p less than or equal to 005). Of 161 patients without adenopathies (No), 73 patients were treated with prophylactic irradiation of the neck, and 88 patients were kept under observation without any cervical treatment; ganglionary relapses appeared in the 5,5% of the first group vs 26% in the patients who had no cervical treatment at all (p less than or equal to 001), wich reaffirms the value of prophylactic or elective radiotherapy.
Assuntos
Neoplasias Bucais/radioterapia , Humanos , Metástase Linfática , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , PrognósticoAssuntos
Adenocarcinoma/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias do Colo do Útero/radioterapia , Adenocarcinoma/patologia , Adulto , Idoso , Braquiterapia , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Dosagem Radioterapêutica , Neoplasias do Colo do Útero/patologiaRESUMO
Thirteen patients with medulloblastoma were admitted to the Clinica Puerta de Hierro (Department of Radiotherapy) between 1964 and 1977. Two subtypes of medulloblastoma (classical and desmoplastic) with different histologic pattern, age of onset, clinical manifestations and clinical course have been identified. Radical surgery does not increase overal survival. X-ray treatment should be applied according to the following principles: a) the central nervous system should be irradiated; b) dosage on the posterior cranial fossa over 5,000 rad (50 Gy); c) dosage on the neuroaxis under 2,000-3,000 rad (25-30 Gy). Tumor recurrences should be treated in order to obtain a more comfortable life and a prolonged survival. Association of chemotherapy to surgery and radiotherapy have yielded promising results.