RESUMO
A case of fatal upper gastrointestinal bleeding from a Mallory-Weiss tear after transoesophageal echocardiography during cardiac surgery is reported. After the echo-cardiographic examination, which is considered a safe procedure, a nasogastric tube was inserted which immediately revealed bright red blood. Eventually the patient lost 9 litres of blood. The role of the echo-probe and the nasogastric tube in causing the Mallory-Weiss tear is discussed. Although this case is not conclusive about the mechanism of oesophageal damage, it is suggested that the safety recommendations for transoesophageal echocardiography also apply for instrumentation of the oesophagus with a nasogastric tube after the transoesophageal echocardiographic examination.
Assuntos
Ponte de Artéria Coronária/métodos , Ecocardiografia Transesofagiana/efeitos adversos , Intubação Gastrointestinal/efeitos adversos , Síndrome de Mallory-Weiss/etiologia , Idoso , Perda Sanguínea Cirúrgica , Ecocardiografia Transesofagiana/instrumentação , Evolução Fatal , Humanos , Intubação Gastrointestinal/instrumentação , Masculino , Síndrome de Mallory-Weiss/complicações , Síndrome de Mallory-Weiss/terapia , Insuficiência de Múltiplos Órgãos/etiologiaRESUMO
In a randomised study, we investigated the sound production of mechanical heart valve prostheses and the complaints related to this sound. The CarboMedics, Björk-Shiley monostrut and StJude Medical prostheses were compared. A-weighted levels of the pulse-like sound produced by the prosthesis were measured in 25 patients after aortic valve replacement. Additionally, 141 patients, 117 after aortic valve replacement, 20 after mitral valve replacement and 4 after double valve replacement were interviewed. The average sound pulse pressure levels were 46.0 +/- 2.9 dB(A) in the Carbomedics group, 55.4 +/- 1.2 dB(A) in the Björk-Shiley monostrut group and 44.1 +/- 4.4 dB(A) in the StJude Medical group, measured at a distance of 1 cm from the chest. The Björk-Shiley monostrut was louder than the other two prostheses (p less than 0.0005). Twenty (14.2%) of all patients had complaints related to the valve sound such as sleeping disturbances, irritation, nervousness or fear. Significantly more patients with a Björk-Shiley monostrut could hear their valve or had complaints when compared to the other two prostheses. Younger patients and patients with a mitral valve prosthesis could hear their valve more often than older patients or patients after aortic valve replacement. We conclude that sound characteristics and related complaints differ considerably among heart valve prostheses.
