RESUMEN
Este mapa de evidências apresenta uma síntese gráfica de estudos clínicos sobre a aplicação da Ozonioterapia em casos de COVID-19. A partir de uma ampla busca bibliográfica 11 estudos clínicos foram incluídos no mapa e categorizados por tipo de intervenção e por desfechos. Os estudos avaliaram o efeito de 4 tipos de intervenção com Ozonioterapia: auto-hemoterapia maior, auto-hemoterapia menor, insuflação retal e solução salina ozonizada; para 6 grupos de desfechos relacionados à COVID-19: Melhora clínica; Internação hospitalar; Marcadores inflamatórios, tromboembólicos, infecciosos ou metabólicos; Aspectos radiológicos; Infecção viral; e Eventos adversos. Os círculos localizados nas intersecções entre as intervenções e os desfechos representam os estudos identificados e a quantidade. A cor do círculo representa o desenho do estudo: Verde para os Ensaios Clínicos Randomizados (RCTs), Amarelo para os Ensaios Clínicos não Randomizados (Non RCTs) e Estudos Clínicos quasi-experimental, e Vermelho para os Relatos de Caso e Estudos de Casos e Controle.
This evidence map presents a graphical summary of clinical studies on the application of Ozone Therapy in cases of COVID-19. From a wide bibliographic search, 11 clinical studies were included in the map and categorized by type of intervention and outcomes. The studies evaluated the effect of 4 types of intervention with Ozone Therapy: Major Autohemotherapy, Minor Autohemotherapy, Rectal Insufflation and Ozonized Saline; for 29 outcomes related to COVID-19, which on the map are divided into 6 groups: 1- clinical improvement; 2-hospitalization; 3- inflammatory, thromboembolic, infectious or metabolic markers; 4- radiological aspects, 5- viral infection and 6- adverse events. Circles located at the intersections between interventions and outcomes represent the identified studies and quantity. The color of the circle represents the study design: Green for Randomized Clinical Trials (RCTs), Yellow for Non-Randomized Clinical Trials (Non RCTs) and Quasi-experimental Clinical Studies, and Red for Case Reports and Case-Control Studies.
Asunto(s)
Humanos , Ozono/uso terapéutico , COVID-19/terapia , Resultado del TratamientoAsunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Presión Sanguínea/fisiología , Factores de Edad , Envejecimiento , Índice de Masa Corporal , Estudios de Cohortes , Estudios Longitudinales , Caracteres Sexuales , Reino UnidoRESUMEN
Aortic dissection is a cardiovascular event of high mortality if not early diagnosed and properly treated. In Stanford type A aortic dissection, there is the involvement of the ascending aorta, whereas in type B the ascending aorta is not affected. The treatment of type A aortic dissection is mainly surgical. The hospital mortality of type B aortic dissection surgical treatment is approximately 20%, while medical therapy is 10%. However, half the patients who are discharged from hospital after medical treatment, progress to aortic complications in the following years, and the mortality in three to five years may reach 25-50%. In addition, the surgical treatment of aortic complications after medical treatment, has also a significant mortality. This way, the endovascular treatment comes up as an interesting alternative of a less invasive treatment for this disease. They presented a mortality rate lower than 10% with more than 80% success rate of occlusion and thrombosis of the false lumen. The INSTEAD TRIAL, which randomized patients with uncomplicated type B aortic dissection for optimal medical therapy and endovascular treatment in addition to optimal medical therapy, showed that after three years of follow up, patients who underwent endovascular treatment had lower mortality and aorta-related complications. Therefore, there is a current tendency to recommend the endovascular treatment as a standard for the treatment of type B aortic dissection.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Procedimientos Endovasculares/métodos , Disección Aórtica/mortalidad , Aneurisma de la Aorta Torácica/mortalidad , Procedimientos Endovasculares/mortalidad , Mortalidad Hospitalaria , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
Aortic dissection is a cardiovascular event of high mortality if not early diagnosed and properly treated. In Stanford type A aortic dissection, there is the involvement of the ascending aorta, whereas in type B the ascending aorta is not affected. The treatment of type A aortic dissection is mainly surgical. The hospital mortality of type B aortic dissection surgical treatment is approximately 20%, while medical therapy is 10%. However, half the patients who are discharged from hospital after medical treatment, progress to aortic complications in the following years, and the mortality in three to five years may reach 25-50%. In addition, the surgical treatment of aortic complications after medical treatment, has also a significant mortality. This way, the endovascular treatment comes up as an interesting alternative of a less invasive treatment for this disease. They presented a mortality rate lower than 10% with more than 80% success rate of occlusion and thrombosis of the false lumen. The INSTEAD TRIAL, which randomized patients with uncomplicated type B aortic dissection for optimal medical therapy and endovascular treatment in addition to optimal medical therapy, showed that after three years of follow up, patients who underwent endovascular treatment had lower mortality and aorta-related complications. Therefore, there is a current tendency to recommend the endovascular treatment as a standard for the treatment of type B aortic dissection.
A dissecção da aorta é um evento cardiovascular de alta mortalidade quando não diagnosticado precocemente e tratado adequadamente. Na dissecção de aorta do tipo A de Stanford há o envolvimento da aorta ascendente enquanto na do tipo B este a aorta ascendente não está acometida. O tratamento da dissecção de aorta do tipo A é predominantemente cirúrgico. A mortalidade hospitalar do tratamento cirúrgico da dissecção da aorta do tipo B é de aproximadamente 20%, enquanto a do tratamento clínico é de 10%. Entretanto, metade dos pacientes que recebem alta hospitalar após o tratamento clínico, evoluem com complicações aórticas nos anos subsequentes, sendo que a mortalidade em três a cinco anos pode atingir 25 a 50%. Além disto, o tratamento cirúrgico das complicações aórticas, após o tratamento clínico, também apresenta alta mortalidade. Desta forma, o tratamento endovascular surge como interessante alternativa para o tratamento menos invasivo desta doença. Inicialmente indicado apenas para os casos complicados, apresentavam mortalidade hospitalar menor que 10% com mais de 80% de sucesso de oclusão e trombose da falsa luz. O INSTEAD TRIAL, que randomizou pacientes com dissecção de aorta do tipo B não complicada para o tratamento médico otimizado e para o tratamento endovascular em adição ao tratamento médico otimizado, demonstrou que após três anos de acompanhamento, aqueles pacientes submetidos ao tratamento endovascular apresentaram menor mortalidade e complicações relacionados a aorta. Portanto, atualmente há uma tendência em se indicar o tratamento endovascular como padrão para o tratamento da dissecção de aorta do tipo B.
Asunto(s)
Humanos , Disección Aórtica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Procedimientos Endovasculares/métodos , Disección Aórtica/mortalidad , Aneurisma de la Aorta Torácica/mortalidad , Procedimientos Endovasculares/mortalidad , Mortalidad Hospitalaria , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
OBJECTIVE: This paper demonstrates the initial and pioneering experience implant of the Inovare prosthesis implant through transfemoral or iliac artery route. METHODS: Six patients underwent transcatheter aortic valve implantation. The access was femoral or iliac through which the delivery device, a latex balloon catheter with the crimped prosthesis, was inserted. Through the femoral introducer 24 Fr Gore® DrySeal sheath, an extra stiff guide wire with non-traumatic tip was positioned in the left ventricle by passing through the valve ring. After balloon valvuloplasty, in cases of native valve stenosis, the prosthesis implantation was performed after hypotension induced by tachycardia and controlled by temporary pacemaker. The valve positioning was guided by TEE (transesophageal ecocardiography) and fluoroscopy, aiming to position a third of the length of the prosthesis into the left ventricle cavity. RESULTS: The successful valve implantation was possible in six cases. There was no need of conversion to open surgery due to inability to access or graft migration. There were no intraoperative or hospital deaths. We observed a significant reduction in the mean gradient of 66.84115.46 mmHg to 19.74110.61 mm Hg postoperatively (P=0.002), a reduction of 70.46%. CONCLUSION: Inovare prosthesis, implanted by femoral or iliac artery was feasible, and determined adequate hemodynamic performance in the postoperative follow-up, showing no mortality in this small series.
Asunto(s)
Válvula Aórtica/cirugía , Cateterismo Cardíaco/métodos , Arteria Femoral , Implantación de Prótesis de Válvulas Cardíacas/métodos , Arteria Ilíaca , Anciano , Ecocardiografía , Estudios de Factibilidad , Femenino , Prótesis Valvulares Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: The gold standard surgical treatment for heart failure is cardiac transplantation, however, due to difficulties of this treatment, other surgical proposals have been reported, including the implantation of cardiac resynchronizer. OBJECTIVE: To analyze the left ventricular function by echocardiography in patients with advanced heart failure with interventricular dyssynchrony undergone implantation of cardiac resynchronizer. METHODS: Between June 2006 and June 2012, 24 patients with average age of 61.5 ± 11 years were evaluated, carriers of advanced congestive heart failure functional class III and IV (NYHA), interventricular dyssynchrony and optimal drug therapy, and submitted implantation of cardiac resynchronizer and postoperative echocardiographically evaluated in six months. RESULTS: There was significant improvement of the analyzed echocardiography parameters. The average left ventricular diastolic diameter decreased from 69.6 ± 9.8 mm to 66.8 ± 8.8 mm, systolic diameters from 58.6 ± 8.8 mm to 52.7 ± 8.8 mm, and ejection fraction, average of 31 ± 8% to 40 ± 7% with level of significance, respectively, of 0.019, 0.0004 and 0.0002, statistically significant with a significance level of 0.05. CONCLUSION: There was a significant improvement of left ventricular function analyzed by echocardiography at six months, in patients with advanced heart failure undergone implantation of cardiac resynchronizer.
Asunto(s)
Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca/terapia , Ventrículos Cardíacos/fisiopatología , Función Ventricular Izquierda/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Dispositivos de Terapia de Resincronización Cardíaca , Ecocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Periodo Preoperatorio , Resultado del TratamientoRESUMEN
Woman, 84 years-old, with Stanford type A thoracic aortic dissection committing aortic arch and descending aorta. Proposed and accepted endovascular treatment according to the severity of the clinical picture. Common femoral artery dissection bilaterally was done. Aortography confirmed the exclusion of the false lumen and patency of the coronary ostia.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Procedimientos Endovasculares/métodos , Anciano de 80 o más Años , Disección Aórtica/patología , Aorta Torácica/patología , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/patología , Ecocardiografía , Femenino , Humanos , Stents , Resultado del TratamientoRESUMEN
OBJETIVO: O presente trabalho tem por objetivo demonstrar a experiência inicial e pioneira do implante da prótese Inovare pela via transfemoral ou ilíaca. MÉTODOS: Seis pacientes foram submetidos ao implante valvar aórtico transcateter. A via de acesso foi femoral ou ilíaca, por onde foi inserido o dispositivo de entrega, que consiste em um cateter balão de látex com a prótese "crimpada" sobre o mesmo. Com auxílio de introdutor femoral da marca Gore® DrySeal 24 Fr, posicionava-se uma guia extrarrígida com a ponta atraumática no ventrículo esquerdo, passando-se pelo anel valvar. Após valvuloplastia com cateter balão nos casos de estenose valvar nativa, implante da prótese foi realizado após hipotensão induzida por taquicardia controlada por marcapasso temporário. O posicionamento da valva foi orientado por ecocardiograma transesofágico (ETE) e radioscopia, objetivando posicionar um terço da extensão da prótese para dentro da cavidade ventricular esquerda. RESULTADOS: O implante valvar com sucesso foi possível nos 6 casos. Não houve necessidade de conversão para cirurgia convencional por impossibilidade de acesso ou migração da prótese. Não houve mortalidade intraoperatória ou hospitalar. Houve redução significativa do gradiente médio pré-operatório de 66,84115,46 mmHg para 19,74110,61 mmHg, no pós-operatório (P=0,002), significando redução de 70,46%. CONCLUSÃO: A prótese Inovare, implantada por via femoral ou ilíaca, foi factível do ponto de vista técnico, apresentando adequado desempenho hemodinâmico no seguimento pós-operatório e não apresentando mortalidade nesta pequena casuística.
OBJECTIVE: This paper demonstrates the initial and pioneering experience implant of the Inovare prosthesis implant through transfemoral or iliac artery route. METHODS: Six patients underwent transcatheter aortic valve implantation. The access was femoral or iliac through which the delivery device, a latex balloon catheter with the crimped prosthesis, was inserted. Through the femoral introducer 24 Fr Gore® DrySeal sheath, an extra stiff guide wire with non-traumatic tip was positioned in the left ventricle by passing through the valve ring. After balloon valvuloplasty, in cases of native valve stenosis, the prosthesis implantation was performed after hypotension induced by tachycardia and controlled by temporary pacemaker. The valve positioning was guided by TEE (transesophageal ecocardiography) and fluoroscopy, aiming to position a third of the length of the prosthesis into the left ventricle cavity. RESULTS: The successful valve implantation was possible in six cases. There was no need of conversion to open surgery due to inability to access or graft migration. There were no intraoperative or hospital deaths. We observed a significant reduction in the mean gradient of 66.84115.46 mmHg to 19.74110.61 mm Hg postoperatively (P=0.002), a reduction of 70.46%. CONCLUSION: Inovare prosthesis, implanted by femoral or iliac artery was feasible, and determined adequate hemodynamic performance in the postoperative follow-up, showing no mortality in this small series.
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Válvula Aórtica/cirugía , Cateterismo Cardíaco/métodos , Arteria Femoral , Implantación de Prótesis de Válvulas Cardíacas/métodos , Arteria Ilíaca , Ecocardiografía , Estudios de Factibilidad , Prótesis Valvulares Cardíacas , Reproducibilidad de los Resultados , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: The gold standard surgical treatment for heart failure is cardiac transplantation, however, due to difficulties of this treatment, other surgical proposals have been reported, including the implantation of cardiac resynchronizer. OBJECTIVE: To analyze the left ventricular function by echocardiography in patients with advanced heart failure with interventricular dyssynchrony undergone implantation of cardiac resynchronizer. METHODS: Between June 2006 and June 2012, 24 patients with average age of 61.5 ± 11 years were evaluated, carriers of advanced congestive heart failure functional class III and IV (NYHA), interventricular dyssynchrony and optimal drug therapy, and submitted implantation of cardiac resynchronizer and postoperative echocardiographically evaluated in six months. RESULTS: There was significant improvement of the analyzed echocardiography parameters. The average left ventricular diastolic diameter decreased from 69.6 ± 9.8 mm to 66.8 ± 8.8 mm, systolic diameters from 58.6 ± 8.8 mm to 52.7 ± 8.8 mm, and ejection fraction, average of 31 ± 8% to 40 ± 7% with level of significance, respectively, of 0.019, 0.0004 and 0.0002, statistically significant with a significance level of 0.05. CONCLUSION: There was a significant improvement of left ventricular function analyzed by echocardiography at six months, in patients with advanced heart failure undergone implantation of cardiac resynchronizer.
FUNDAMENTOS: O tratamento cirúrgico da insuficiência cardíaca padrão-ouro é o transplante cardíaco, porém, em decorrência das dificuldades desse tratamento, outras propostas cirúrgicas têm sido relatadas, entre elas o implante de ressincronizador cardíaco. OBJETIVO: Analisar a função ventricular esquerda, por meio da ecocardiografia, de pacientes portadores de insuficiência cardíaca avançada com dissincronia interventricular submetidos a implante de ressincronizador cardíaco. MÉTODOS: Entre junho de 2006 a junho de 2012, foram avaliados 24 pacientes com idade média de 61,5 ± 11 anos, portadores de insuficiência cardíaca congestiva avançada em classe funcional III e IV (NYHA), dissincronia interventricular e tratamento medicamentoso otimizado. Esses pacientes foram submetidos ao implante de ressincronizador cardíaco e avaliados ecocardiograficamente no pós-operatório de seis meses. RESULTADOS: Houve melhora significativa dos parâmetros ecocardiográficos analisados. A média dos diâmetros diastólicos ventriculares esquerdos reduziu de 69,6 ± 9,8 mm para 66,8 ± 8,8 mm, diâmetros sistólicos de 58,6 ± 8,8 mm para 52,7 ± 8,8 mm e a fração de ejeção, média de 31 ± 8% para 40 ± 7% com nível de significância, respectivamente, de 0,019, 0,0004 e 0,0002, estatisticamente significativos com nível de significância de 0,05. CONCLUSÃO: Houve melhora da função ventricular esquerda analisada por meio da ecocardiografia, em seis meses, de pacientes portadores de insuficiência cardíaca avançada submetidos a implante de ressincronizador cardíaco.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca/terapia , Ventrículos Cardíacos/fisiopatología , Función Ventricular Izquierda/fisiología , Dispositivos de Terapia de Resincronización Cardíaca , Ecocardiografía , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca , Ventrículos Cardíacos , Periodo Posoperatorio , Periodo Preoperatorio , Resultado del TratamientoRESUMEN
Aortic dissection type A has a great mortality in its acute phase with low annual survival without surgical treatment. Although the chronic cases are exceptions the late complications exist and should be treated.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Disección Aórtica/complicaciones , Procedimientos Endovasculares/métodos , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Humanos , Masculino , RadiografíaRESUMEN
We present a patient with severe aortic valvular bioprosthesis dysfunction implanted for 11 years, presenting with acute pulmonary edema due to severe valvular insufficiency with severe systolic dysfunction (EF <30%) and comorbid conditions that amounted operative risk (STS score > 10). We carried out the transcatheter aortic valve implantation (Inovare® - Braile Biomedica), which was implemented successfully by transfemoral access and good patient outcomes.
Asunto(s)
Válvula Aórtica/cirugía , Bioprótesis , Cateterismo Cardíaco/métodos , Arteria Femoral , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Anciano , Humanos , Masculino , Falla de Prótesis , Medición de Riesgo , Resultado del TratamientoRESUMEN
Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprising benign histological characteristics in 75% of these cases. Myxomas account for approximately 50% of these neoplasms. As regards location, 75-80% of myxomas are in the left atrium, 18% in the right atrium, and more rarely in the ventricles. We report a case of a patient in functional class (FC) IV New York Heart Association (NYHA) and postoperative histological diagnosis of multilobular myxoma originating in the posterior left atrial wall. Clinical evaluation 3 months after surgery suggested NYHA functional class I and echocardiographic absence of intracardiac masses.
Asunto(s)
Atrios Cardíacos , Neoplasias Cardíacas , Mixoma , Neoplasias Primarias Múltiples , Adulto , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Humanos , Masculino , Mixoma/diagnóstico por imagen , Mixoma/cirugía , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Primarias Múltiples/cirugía , UltrasonografíaRESUMEN
Os tumores primários cardíacos são infrequentes, apresentando incidência entre 0,001% a 0,2%, com características histológicas benignas em 75% dos casos. Os mixomas correspondem a aproximadamente 50% dessas neoplasias. Quanto à localização, 75 a 80% dos mixomas estão no átrio esquerdo, 18% no átrio direito, e mais raramente nos ventrículos. Relatamos o caso de um paciente em classe funcional (CF) IV New York Heart Association (NYHA) e diagnóstico anatomopatológico pós-operatório de mixoma multilobular originário na parede posterior atrial esquerda. À avaliação clínica no 3º mês pós-operatório se encontrava em CF I NYHA e a ecocardiográfica com ausência de massas intracardíacas.
Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprising benign histological characteristics in 75% of these cases. Myxomas account for approximately 50% of these neoplasms. As regards location, 75-80% of myxomas are in the left atrium, 18% in the right atrium, and more rarely in the ventricles. We report a case of a patient in functional class (FC) IV New York Heart Association (NYHA) and postoperative histological diagnosis of multilobular myxoma originating in the posterior left atrial wall. Clinical evaluation 3 months after surgery suggested NYHA functional class I and echocardiographic absence of intracardiac masses.
Asunto(s)
Adulto , Humanos , Masculino , Atrios Cardíacos , Neoplasias Cardíacas , Mixoma , Neoplasias Primarias Múltiples , Atrios Cardíacos/cirugía , Atrios Cardíacos , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas , Mixoma/cirugía , Mixoma , Neoplasias Primarias Múltiples/cirugía , Neoplasias Primarias MúltiplesRESUMEN
OBJECTIVE: To determine, even during postoperative period, the confiability of the cardiac index correlate with the data data given by a central atrial venous blood gasometry in patients who underwent cardiac surgery. METHODS: From the sample of arterial and venous blood of right atrium gathered in postoperative of cardiac surgery, it was determinated the hemoglobin concentration and the gasometric study through what was observed of the venous oxygen saturation (SvO2) and the partial pressure of oxygen from venous blood gathered in right atrium (PvO2), add to the calculation of artery-venous difference of the oxygen content--radial artery / right atrium (C( a-v )O2). Afterwards, these parameters were compared with the cardiac index determined by thermodilution. RESULTS: There was good correlation between SvO2, C(av)O2 of the venous right atrial blood and cardiac index measured by thermodilution method, with sensibility and specificity good and high positive predict value and negative predict value. The PvO2 demonstrated poor sensibility in the estimative of low output. CONCLUSION: In cardiac surgery postoperative, the SvO2 and the C(a-v)O2 were safe parameters correlated with low cardiac output. The PvO2 demonstrated poor sensibility in the estimative of low output in postoperative cardiac surgery.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Hemodinámica/fisiología , Oxígeno/sangre , Arteria Radial , Adulto , Anciano , Análisis de los Gases de la Sangre , Gasto Cardíaco , Gasto Cardíaco Bajo/sangre , Cateterismo de Swan-Ganz/métodos , Métodos Epidemiológicos , Femenino , Atrios Cardíacos , Humanos , Masculino , Persona de Mediana Edad , Presión Parcial , Periodo Posoperatorio , Termodilución/métodosRESUMEN
OBJETIVO: Determinar a confiabilidade em se correlacionar o índice cardíaco com os dados fornecidos pela gasometria do sangue venoso atrial direito em pacientes submetidos à cirurgia cardíaca, durante o período pós-operatório. MÉTODOS: A partir das amostras de sangue arterial e venoso do átrio direito, colhidas no pós-operatório de cirurgia cardíaca, foram determinados os parâmetros de oxigênio do sangue venoso do átrio direito. Estes parâmetros foram então comparados com o índice cardíaco determinado pela termodiluição. RESULTADOS: Houve boa correlação entre a saturação de oxigênio do sangue venoso do átrio direito (SvO2), diferença artério-venosa do conteúdo de oxigênio do sangue colhido no átrio direito e o índice cardíaco aferido pela termodiluição, com boa sensibilidade e especificidade e alto valor preditivo positivo e negativo. A pressão do sangue do átrio direito (PvO2) apresentou baixa sensibilidade na estimativa de baixo débito cardíaco. CONCLUSÃO: No pós-operatório de cirurgia cardíaca, a SvO2e a diferença artério-venosa do conteúdo de oxigênio (C(av)O2) apresentaram-se como parâmetros confiáveis correlacionados a baixo débito cardíaco. A PvO2 foi pouco sensível no diagnóstico de baixo débito no pós-operatório de cirurgia cardíaca.
OBJECTIVE: To determine, even during postoperative period, the confiability of the cardiac index correlate with the data data given by a central atrial venous blood gasometry in patients who underwent cardiac surgery. METHODS: From the sample of arterial and venous blood of right atrium gathered in postoperative of cardiac surgery, it was determinated the hemoglobin concentration and the gasometric study through what was observed of the venous oxygen saturation (SvO2) and the partial pressure of oxygen from venous blood gathered in right atrium (PvO2), add to the calculation of artery-venous difference of the oxygen content - radial artery / right atrium (C( a-v )O2). Afterwards, these parameters were compared with the cardiac index determined by thermodilution. RESULTS: There was good correlation between SvO2, C(av)O2 of the venous right atrial blood and cardiac index meansured by termodiluition method, with sensibility and especificity good and high positive predict value and negative predict value. The PvO2 demonstrated poor sensibility in the estimative of low output. CONCLUSION: In cardiac surgery postoperative, the SvO2and the C(a-v)O2 were safe parameters correlated with low cardiac output. The PvO2 demonstrated poor sensibility in the estimative of low output in postoperative cardiac surgery.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Cardíacos , Hemodinámica/fisiología , Oxígeno/sangre , Arteria Radial , Análisis de los Gases de la Sangre , Gasto Cardíaco , Gasto Cardíaco Bajo/sangre , Cateterismo de Swan-Ganz/métodos , Métodos Epidemiológicos , Atrios Cardíacos , Presión Parcial , Periodo Posoperatorio , Termodilución/métodosRESUMEN
Purpose: The development of an experimental model of myocardiopathy induced by Doxorubicin in rats. Methods: 16 wistar male rats were randomized in two groups: Group I (placebo) and Group II (Doxorubicin - 5mg/kg). After six months, the animals were subjected to cardiotomy and their hearts were weighted and submitted to transversal cuts, from which fragments for a macro and micro study were obtained. These fragments were studied considering their external and internal diameters and the thickness of the left ventricle (LV). The histological pieces were analyzed for the presence of fibrosis, cytoplasmic vacuolization, necrosis and size of nucleus variation. Data obtained was submitted to statistical analysis with Student's t test. Results: The hearts of the animals in Group II increased 41 percent in relation to their weight; 33 percent in the internal diameter and 14 percent in the external diameter of the LV cavity; and 24 percent in the thickness of the wall. Fibrosis of the myocardial tissue was observed in 75 percent of the animals of Group II; all the animals presented miocyte cytoplasmatic vacuolization; myocardial necrosis was present in 75 percent of the animals; and 87/ percent presented variation in the size of myocite nuclei. The presence of polymorphonuclear cells was also observed. Conclusion: Doxorubicin was effective in the promotion of macro and microscopic alterations in the cardiac tissue of rats, possibly constituting a model for the experimental study of myocardiopathy.
Objetivo: Desenvolver um modelo experimental de miocardiopatia induzida por doxorrubicina em ratos. Métodos: 16 ratos Wistar machos foram randomizados em 2 grupos: Grupo I (placebo) e Grupo II (doxorrubicina 5mg/kg). Após 6 meses, os animais foram submetidos a cardiotomia e seus corações foram pesados e submetidos a cortes transversais. Estes fragmentos foram estudados considerando seus diâmetros externos e internos e a espessura do ventrículo esquerdo. As peças histológicas foram analisadas quanto à presença de fibrose, vacuolização citoplasmática, necrose e variação do tamanho do núcleo. Os resultados foram submetidos a análise estatística pelo teste t de Student. Resultados: Os corações dos animais do grupo II aumentaram 41 por cento em relação ao peso; 33 por cento no diâmetro interno e 14 por cento no diâmetro externo; e 24 por cento na espessura da parede do VE. Fibrose do tecido miocárdico foi observada em 75 por cento dos animais do grupo II; todos os animais apresentaram vacuolização citoplasmática dos miócitos; Houve necrose miocárdica em 75 por cento dos animais e 87 por cento apresentaram variação no tamanho do núcleo. A presença de células polimorfonucleares também foi observada. Conclusão: A doxorrubicina foi efetiva na promoção de alterações macro e microscópicas no tecido cardíaco de ratos, possivelmente constituindo-se num modelo experimental para estudo da miocardiopatia.
Asunto(s)
Animales , Masculino , Ratas , Antibióticos Antineoplásicos/toxicidad , Cardiomiopatías/inducido químicamente , Cardiomiopatías/patología , Modelos Animales de Enfermedad , Doxorrubicina/toxicidad , Necrosis , Distribución Aleatoria , Ratas WistarRESUMEN
Purpose: The development of an experimental model of myocardiopathy induced by Doxorubicin in rats. Methods: 16 wistar male rats were randomized in two groups: Group I (placebo) and Group II (Doxorubicin - 5mg/kg). After six months, the animals were subjected to cardiotomy and their hearts were weighted and submitted to transversal cuts, from which fragments for a macro and micro study were obtained. These fragments were studied considering their external and internal diameters and the thickness of the left ventricle (LV). The histological pieces were analyzed for the presence of fibrosis, cytoplasmic vacuolization, necrosis and size of nucleus variation. Data obtained was submitted to statistical analysis with Student's t test. Results: The hearts of the animals in Group II increased 41 percent in relation to their weight; 33 percent in the internal diameter and 14 percent in the external diameter of the LV cavity; and 24 percent in the thickness of the wall. Fibrosis of the myocardial tissue was observed in 75 percent of the animals of Group II; all the animals presented miocyte cytoplasmatic vacuolization; myocardial necrosis was present in 75 percent of the animals; and 87/ percent presented variation in the size of myocite nuclei. The presence of polymorphonuclear cells was also observed. Conclusion: Doxorubicin was effective in the promotion of macro and microscopic alterations in the cardiac tissue of rats, possibly constituting a model for the experimental study of myocardiopathy.(AU)
Objetivo: Desenvolver um modelo experimental de miocardiopatia induzida por doxorrubicina em ratos. Métodos: 16 ratos Wistar machos foram randomizados em 2 grupos: Grupo I (placebo) e Grupo II (doxorrubicina 5mg/kg). Após 6 meses, os animais foram submetidos a cardiotomia e seus corações foram pesados e submetidos a cortes transversais. Estes fragmentos foram estudados considerando seus diâmetros externos e internos e a espessura do ventrículo esquerdo. As peças histológicas foram analisadas quanto à presença de fibrose, vacuolização citoplasmática, necrose e variação do tamanho do núcleo. Os resultados foram submetidos a análise estatística pelo teste t de Student. Resultados: Os corações dos animais do grupo II aumentaram 41 por cento em relação ao peso; 33 por cento no diâmetro interno e 14 por cento no diâmetro externo; e 24 por cento na espessura da parede do VE. Fibrose do tecido miocárdico foi observada em 75 por cento dos animais do grupo II; todos os animais apresentaram vacuolização citoplasmática dos miócitos; Houve necrose miocárdica em 75 por cento dos animais e 87 por cento apresentaram variação no tamanho do núcleo. A presença de células polimorfonucleares também foi observada. Conclusão: A doxorrubicina foi efetiva na promoção de alterações macro e microscópicas no tecido cardíaco de ratos, possivelmente constituindo-se num modelo experimental para estudo da miocardiopatia.(AU)
Asunto(s)
Animales , Masculino , Adulto , Ratas , Cardiomiopatías/inducido químicamente , Doxorrubicina/efectos adversos , Miocardio/patología , Modelos Animales , Ratas , Trastornos Relacionados con SustanciasRESUMEN
PURPOSE: The development of an experimental model of myocardiopathy induced by Doxorubicin in rats. METHODS: 16 wistar male rats were randomized in two groups: Group I (placebo) and Group II (Doxorubicin - 5mg/kg). After six months, the animals were subjected to cardiotomy and their hearts were weighted and submitted to transversal cuts, from which fragments for a macro and micro study were obtained. These fragments were studied considering their external and internal diameters and the thickness of the left ventricle (LV). The histological pieces were analyzed for the presence of fibrosis, cytoplasmic vacuolization, necrosis and size of nucleus variation. Data obtained was submitted to statistical analysis with Student's t test. RESULTS: The hearts of the animals in Group II increased 41% in relation to their weight; 33% in the internal diameter and 14% in the external diameter of the LV cavity; and 24% in the thickness of the wall. Fibrosis of the myocardial tissue was observed in 75% of the animals of Group II; all the animals presented miocyte cytoplasmatic vacuolization; myocardial necrosis was present in 75% of the animals; and 87/% presented variation in the size of myocite nuclei. The presence of polymorphonuclear cells was also observed. CONCLUSION: Doxorubicin was effective in the promotion of macro and microscopic alterations in the cardiac tissue of rats, possibly constituting a model for the experimental study of myocardiopathy.
Asunto(s)
Antibióticos Antineoplásicos/toxicidad , Cardiomiopatías/inducido químicamente , Cardiomiopatías/patología , Modelos Animales de Enfermedad , Doxorrubicina/toxicidad , Animales , Masculino , Necrosis , Distribución Aleatoria , Ratas , Ratas WistarRESUMEN
OBJECTIVE: To evaluate the results of the surgical treatment of atrial fibrillation for ablation of the posterior left atrial wall using electrocautery in mitral valve surgery. METHODS: From May 2004 to December 2006, 23 patients underwent surgical correction of mitral valve disease and treatment of atrial fibrillation using the conventional electrocautery for the accomplishment of lines of endocardial ablation in the left atrium. The mean age of the patients was 59 years, and 60.8% were female. The left atrium mean diameter was 50.3 +/- 5.09 mm and the left ventricular ejection fraction was 53.6 +/- 11.03%. RESULTS: The mean time of extracorporeal circulation was 52.5 +/- 13.3 min; aortic clamping, 35.6 +/- 12.9 min; atrial ablation, 3.05 +/- 0.16 min. All the patients were free of atrial fibrillation after the procedure; on hospital discharge, 69.5%; at 6 months, 91.3%; at 12 months, 76.4%; at 18 months, and at 24 months, 68.4%. At 12 months, left atrium mean diameter was 42.1 +/- 3.5 mm; left ventricular ejection fraction was 59.2 +/- 3.48%; In addition, left atrial contraction was present in 68.8% of the patients. CONCLUSION: The surgical treatment of the atrial fibrillation with electrocautery in mitral valve surgery was capable to determine the reversion of this arrhythmia in a significant number of patients during short- and middle-term clinical follow-up without mortality and fewer complications.