RESUMEN
UNLABELLED: In this clinical study, 7 pediatric patients with severe pulmonary artery hypertension, secondary to congenital heart disease, received inhaled nitric oxide at doses of 20 ppm in the acute postoperative management of congenital heart repair for 3.5 days. Monitoring included oxygenation index, alveoloarterial oxygen difference, pulmonary and systemic pressure, measurements were recorded previous to the NO administration; 1, 6, 12, 24, 36, 48 and 72 hours after treatment with NO, nitrous oxide (NO2) and seric methemoglobin also were monitored. RESULTS: Average age was 3.6 years. The oxygenation index before inhaling NO was 166 +/- 100, 72 hours following inhalation of NO the oxygenation index was 210 +/- 98. The alveolo-arterial baseline oxygen difference was 270 +/- 145; 72 hours after inhaling NO, it was 163 +/- 167. No decreases in pulmonary and systemic arterial pressure during NO inhalation occured. The levels of NO2 and seric methemoglobin were not toxic. CONCLUSIONS: Treatment with inhaled NO after cardiac surgery in children with severe pulmonary artery hypertension secondary to congenital heart disease may be useful to improve oxygenation with no changes in pulmonary and systemic arterial pressure. Inhaled NO at 20 ppm did not cause toxicity.
Asunto(s)
Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/cirugía , Hipertensión Pulmonar/etiología , Óxido Nítrico/farmacología , Consumo de Oxígeno/efectos de los fármacos , Adolescente , Niño , Estudios Transversales , Femenino , Cardiopatías Congénitas/metabolismo , Humanos , Hipertensión Pulmonar/metabolismo , Lactante , Recién Nacido , Masculino , Periodo Posoperatorio , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
There are numerous reports concerning left ventricular rupture after mitral valve replacement, and it has been classified according to location, treatment and prognosis. A somewhat less terrific complication has appeared as modifications have been introduced to the surgical technique, decreasing the frequency of rupture, but otherwise increasing the frequency of incomplete laceration, which has seldom appeared in literature. We review the case of a patient with incomplete left ventricular laceration after mitral valve replacement.
Asunto(s)
Rotura Cardíaca/etiología , Prótesis Valvulares Cardíacas/efectos adversos , Ventrículos Cardíacos , Estenosis de la Válvula Mitral/cirugía , Femenino , Humanos , Persona de Mediana Edad , Válvula MitralRESUMEN
The long-term follow-up of patients with bioprosthetic valves manufactured at the Instituto Nacional de Cardiología Ignacio Chávez is presented. From February 1983 to May 1990, 1068 patients were operated and 1252 valves were replaced. Eighty two percent had rheumatic heart disease with one or more injured valves. In 17% it was a replacement of a failing valve. Seventy three percent of the patients had a low or medium-low socioeconomical status. There were 176 perioperative deaths in the first month after the operation and 150 patients were lost to follow-up. The rest (740) are the subject of this report. Mortality associated with valve related complications had a probability of 0.74 +/- 0.05, it had a significative increase after month 70th, with a 88% survival at that time. The functional class in the whole group improved 90%, with confidence limits for binomial distribution between 85 and 97%. There was also a significant reduction in heart enlargement. There were 161 prosthesis dysfunctions due to valve calcification or rupture, 50 were replaced. Twenty-three patients had hemolysis, and 19 infective endocarditis. There were 6.5% with systemic embolism in spite that only one half of those in which there was an indication, different of the valve replacement, received anticoagulant medication. The use of this prosthesis is on economical and medical satisfactory solution for the problem of a great number of our population of patients.
Asunto(s)
Bioprótesis , Prótesis Valvulares Cardíacas , Academias e Institutos , Adolescente , Adulto , Anciano , Válvula Aórtica , Bioprótesis/efectos adversos , Bioprótesis/estadística & datos numéricos , Cardiología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/mortalidad , Prótesis Valvulares Cardíacas/estadística & datos numéricos , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Válvula Mitral , Diseño de Prótesis , Falla de Prótesis , Válvula TricúspideRESUMEN
In order to know the post-operative outcome of patients with valvular replacement due to prosthetic dysfunction, we reviewed the clinical charts of 94 patients operated at the Instituto Nacional de Cardiología "Ignacio Chávez" between January 1986 and December 1988. Eighty four cases were replaced by the first time the remaining 10 by a second time. Diagnosis of prosthetic dysfunction was made by clinical, radiological, echocardiographic and haemodynamic parameters. The most frequent causes of dysfunction were the rupture of prosthetic leaflets, stenosis with calcific deposition and paravalvular leaks. The global mortality rate was 19.15%, higher than the native valve replacement group. The most important predictors of surgical mortality were: 1) poor ventricular function (functional classes III and IV), 2) aortic clamping period, 3) the need of a second prosthetic replacement and 4) the time of prosthetic dysfunction. Thus, we conclude that it is of great importance the early recognition of prosthetic valve dysfunction. The need of special surgical procedures in these cases should be evaluated in order to reduce morbidity and mortality.
Asunto(s)
Prótesis Valvulares Cardíacas , Adolescente , Adulto , Femenino , Prótesis Valvulares Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Falla de Prótesis , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Partial pericardial tamponade is a critical situation frequently misdiagnosed. We describe five patients with this entity during an urgent surgical reintervention performed few hours after the initial one. We found clots compressing cardiac cavities in all, usually in the right atrium. In one of them we found also a clot compressing the left atrium. None of the patients studied had the classical clinical features of cardiac tamponade (Kussmaul's sign: pulsus paradoxus) and we found no difference in blood pressure, quantity of bleeding or pulmonary capillary pressure, considering the reinterventional moment in comparison to the values taken immediately after the initial surgery and the ones registered during the surgical reintervention. There was significative increase in the central venous pressure value, decreased urine output and drop in the cardiac index. Based on this observation, we believe it is possible to have a presumptive diagnosis of partial pericardial tamponade by bidimensional echocardiographic studies just before the surgical reintervention.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Taponamiento Cardíaco/diagnóstico , Pericardio , Adulto , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/fisiopatología , Diuresis , Femenino , Humanos , Masculino , Complicaciones PosoperatoriasRESUMEN
Two-hundred-fifty-eight patients who had cardiac surgery with extracorporeal circulation were studied to determine the frequency and significance of conduction disturbances. Fifty-eight (34%) developed new postoperative conduction defects. Seventeen patients developed new conduction alterations after coronary artery bypass graft. The most common disturbance was transient bifascicular block (right bundle branch block and anterior subdivision block of the left bundle branch of His) (p less than 0.01). After valvular surgery twenty-one patients developed conduction defects. Of those the most common disturbance was high degree AV block (57%). The authors found no relation between the AV block and the number of valves operated on or type of valvular surgery. After congenital heart surgery, twenty patients developed conduction defects. The most common defect was high degree AV block. The frequency of complete heart block was higher after the closure of atrial septal defects (P less than 0.01). None of the conduction defects were related to the amount of time the patient was exposed to extracorporeal circulation or to postoperative myocardial infarction. All conduction defects were transient except complete heart block in some patients with ventricular septal defect surgery. In this study there were no hemodynamic complications or mortality associated with the conduction disturbances.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Circulación Extracorporea/efectos adversos , Bloqueo Cardíaco/etiología , Complicaciones Posoperatorias/etiología , Adulto , Niño , Preescolar , Puente de Arteria Coronaria/efectos adversos , Femenino , Cardiopatías Congénitas/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
In order to know early and late results of pericardiectomy on the treatment of chronic constrictive pericarditis in the Instituto Nacional de Cardiología Ignacio Chávez, we review the records of 58 patients with the diagnosis of constrictive pericarditis who underwent surgical treatment between 1947 to 1987. Tuberculosis was the most frequent cause (68.3%) followed by idiopathic cases (24.1%). Preoperatively 3.4% were in New York Heart Association Class I, 31% in Class II, 48.3% in Class III and 17.2% in Class IV. There were 4 in-hospital deaths (overall operative mortality 6.89%). Operative mortality in the last ten years was 0%. Low output was the most common nonfatal complication of pericardiectomy (15.5%). Accidental right atrial tear happened in 8.6%. Mean post-operative follow-up was 5.6 +/- 6.3 years (longest 25.6 years). Mortality per patient year was 2.04%. Actuarial survival estimates were 82% and 71% at 5 to 10 years respectively. Postoperatively 76% were in New York Heart Association Class I (p less than 0.001), 16% in Class II (p less than 0.001), 8% in Class III (p less than 0.001) and none in Class IV (p less than 0.05). Operative mortality, long-term survival and post-operative functional Class were not significantly influenced by preoperative functional Class nor by the duration of symptoms. We conclude that pericardiectomy is an effective treatment of symptomatic chronic constrictive pericarditis because it provides an important and durable improvement in symptoms and functional Class, and it has a low operative mortality.
Asunto(s)
Pericarditis Constrictiva/cirugía , Pericardio/cirugía , Adolescente , Adulto , Anciano , Gasto Cardíaco Bajo/etiología , Niño , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pericarditis Constrictiva/etiología , Pericarditis Constrictiva/mortalidad , Pericarditis Tuberculosa/complicaciones , Complicaciones Posoperatorias/etiologíaRESUMEN
We studied 28 patients to whom a prosthestic valve of bovine pericardium manufactured in the Instituto Nacional de Cardiología Ignacio Chávez (INCICH) were implanted in aortic position, from February 1983 to May 1985. We analyzed the clinic follow-up and the prosthetic function was studied by Phonocardiography, Echocardiography M mode, Two-Dimensional and pulsed wave Doppler recordings obtained before and after surgery. The patient were 26 males, 2 females whose age varied from 12 to 66 years. The aortic valve disease was rheumatic in 12, congenital in 11 and of other type in 5. After surgery 26 patients are in functional class I, one in class II and one died, but death was not related to prosthetic valve function. In the Phonocardiogram we observed significant diminution of the ventricular ejection time of 32 +/- 2 msec. to 29 +/- 2 msec. (P less than 0.05), the aortic valve opening sound was of less intensity than the valve closure sound, with relation between both of 0.53. All of them had a systolic ejection murmur. In the Echocardiogram we observed a significant decrease of the end diastolic diameter of 53 +/- 11 mm to 45 +/- 10 mm (P less than 0.05), the end systolic diameter decreased from 37 +/- 13 mm to 33 +/- 10 mm., but the difference was not significant. The aortic prosthetic flow by pulsed Doppler Echocardiography had a maximum velocity of 137 +/- 23 cm/sec., it represents a valvular gradient of 7.5 +/- 0.02 mmHg. Early diastolic regurgitant flow was recorded in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Bioprótesis , Prótesis Valvulares Cardíacas , Adolescente , Adulto , Anciano , Válvula Aórtica , Niño , Ecocardiografía , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , FonocardiografíaRESUMEN
Coronary heart disease is the main cause of mortality among uremic patients on chronic hemodialysis (CHD) and is the determinant of the outcome in these cases after renal transplantation, especially in diabetics. In this study we report our experience with two uremic diabetics on CHD with severe coronary artery lesions in whom aortocoronary bypass was performed before renal transplantation. The outcome in the two patients, after 30 and 55 months respectively indicates successful results. We discuss the necessity to perform coronariography in all the high risk patients on CHD, such as diabetics and elderly before planning renal transplantation and achieve aortocoronary bypass surgery in those with severe coronary disease. The technics and difficulties of the surgery in uremics are also analized.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Complicaciones de la Diabetes , Fallo Renal Crónico/terapia , Trasplante de Riñón , Diálisis Renal , Adulto , Enfermedad Coronaria/etiología , Humanos , Masculino , Persona de Mediana Edad , Diálisis Renal/efectos adversosAsunto(s)
Circulación Coronaria , Contrapulsador Intraaórtico , Contracción Miocárdica , Angina Inestable/terapia , Procedimientos Quirúrgicos Cardíacos , Cateterismo/métodos , Humanos , Contrapulsador Intraaórtico/efectos adversos , Contrapulsador Intraaórtico/instrumentación , Choque Cardiogénico/terapiaRESUMEN
UNLABELLED: We studied 120 insertions of the Swan-Ganz catheter in 119 patients who needed hemodynamic monitorization for cardiovascular surgery. All catheter insertions were carried out soon after the anesthetic induction employing the modified Seldinger technique through the internal jugular vein, taking as reference the intracavitary pressure waves to get the pulmonary artery wedge position. The time of insertion, time of use, complications of puncture, difficulty and complications of insertion, thoracic and pulmonary complications, and loop or knot in the catheter were examined. RESULTS: multiple punctures in 15 cases (12.5%), 8 carotid artery punctures (6.6%), 14 hematomas (11.6%), difficulty for pass through the right ventricle in 8 cases (6.6%) and pulmonary artery in 32 (26.6%) impossibility to get the pulmonary wedge position in 13 cases (10.8%), loop of catheter in 3 (2.5%), ectopic atrial beats in 30 cases (25%), atrial tachycardia in 4 (3.3%), ectopic ventricular beats in 73 (60.8%). General arrhythmia incidence was 67.5%, none serious. All complications were minor and not life-threatening. Only in two cases (1.6%) the complications were major, both pulmonary infarction, but were life-threatening to patients; in 20 patients (16.6%) the outcome was without complications. There were no deaths for the catheter use. The results of this study showed that complications caused by the pulmonary artery flotation catheter were smaller than the benefit obtained in the management of these patients.
Asunto(s)
Cateterismo Cardíaco/efectos adversos , Cardiopatías/cirugía , Adolescente , Adulto , Anciano , Arritmias Cardíacas/etiología , Cateterismo Cardíaco/instrumentación , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Embolia Pulmonar/etiologíaRESUMEN
We study the phonocardiogram, M mode, two-dimensional and Doppler pulsed echocardiogram of 30 patients, who underwent implantation of a bovine pericardial bioprosthesis manufactured at the Instituto Nacional de Cardiología Ignacio Chávez. We describe 26 patients with prosthesis in mitral position, 22 females and 4 males, with age between 19 to 60 years. After surgery, 22 were in functional I and 2 in class II of the New York Heart Association Criteria. Two patients (6.6%) died of extracardiac complications. Phonocardiogram: Mitral prosthesis closing click (MPCC) were recorded at all, the interval Q wave-MPCC was of 0.09 +/- 0.02 sec. The interval second sound-mitral prosthesis opening click (S2-MPOC) measured 0.10 +/- 0.01 sec. Mid-diastolic murmur were recorded in 8 patients (30.7%). The O-F slope of the apexcardiogram was of 82 +/- 40 mm/sec. Ten patients had tricuspid insufficiency. Echocardiogram: The D-E velocity of mitral prosthesis opening was of 318 +/- 99 mm/sec and the E-F slope velocity of 15 +/- 6.2 mm/sec. All patients except one showed paradoxical motion of the intraventricular septum. The prosthesis stents distance was of 14.1 +/- 2 mm, the internal diameter of 17.8 +/- 2.9 mm and the valvular area was calculated in 2.5 +/- 0.08 cm2. The flow velocity/diameter was 62.6 +/- 26.8 cm/sec/mm and the flow velocity/opening area of 52.5 +/- 26.1 cm/sec/cm2.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Bioprótesis , Prótesis Valvulares Cardíacas , Adulto , Ecocardiografía , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/fisiopatología , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Fonocardiografía , Diseño de PrótesisRESUMEN
We studied 53 patients within 12 hs from the onset of symptoms of acute myocardial infarction, and 25 healthy controls. We searched for complement split products in plasma treated with EDTA to avoid in vitro complement activation. Therefore the presence of proteolytic degradation products of C3 signals in vivo activation. Sixteen of the 53 cases (30%), had C3 splitting products in EDTA-plasma. In contrast only 2 (8%) controls showed C3 splitting products. In vivo complement activation correlated with the severity of the infarction.
Asunto(s)
Activación de Complemento , Infarto del Miocardio/inmunología , Complemento C3/análisis , Femenino , Humanos , Masculino , Infarto del Miocardio/patologíaRESUMEN
The results obtained with some types of bioprostheses together with the present economical situation of the country pointed out that the manufacture of another type of bioprostheses was necessary. After a careful analysis of the results that had been reported in the literature with the diverse types of bioprostheses had been made, it was concluded that pericardial valves were the best choice for our specific requirements. The first problem that had to be solved was the identification of the adequate fraction of purified glutaraldehyde that would provide for adequate tissue fixation. This was determined using several types of biophysical and biochemical techniques. The next step was to find the adequate manufacturing techniques that would provide us with optimal function valves. This was achieved by testing the functional characteristics of these valves on a cardiac cycle simulator. The first group of 132 patients that received this type of valve includes 9 multiple valve replacements, 24 aortic, 98 mitral and 1 pulmonary valve replacements. All the surviving patients have shown a clear improvement and they all show adequate function of their bioprostheses. The function of the valves has not been involved in any of the patient deaths. Since there has not been any evidence of disfunction, these results show that the manufacturing techniques and the design of these bioprostheses is adequate. Naturally to long-term durability of these valves will have to wait before it can be valorated.
Asunto(s)
Bioprótesis , Prótesis Valvulares Cardíacas , Adolescente , Adulto , Animales , Bovinos , Niño , Estudios de Evaluación como Asunto , Femenino , Fijadores , Glutaral , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pericardio , Diseño de PrótesisRESUMEN
With the purpose of studying coronary collateral circulation and if it has influence in manifestations, complications, prognosis and mortality in patients with ischemic heart disease, we studied 52 patients, 41 male and 11 female, mean age 56 years, who died. All of them had a complete medical record and were seen with regularity until death. They had good quality coronaragraphy and ventriculography. Post-mortem study was done in all of them. They were placed in two groups: group I (27 patients) who had adequate collateral circulation and group II (25 patients) without adequate collateral circulation. We found that group I patients had angina more frequently prior to myocardial infarction (p less than 0.005) with greater duration (30 months). Complications during the acute phase of myocardial infarction were more common in patients without collateral circulation (p less than 0.001). Although we did not find statistically significant differences, we could observe that patients without adequate collateral circulation have less survival, disturbances in ventricular wall mo-motion are more frequently found and there is more incidence of sudden death. There was no significant difference between the apparition of myocardial infarction in patients with or without adequate coronary collateral circulation. Diabetic patients had less collateral circulation than non diabetics (p less than 0.05). We conclude that the protective role of collateral circulation in ischemic heart disease is established, diminishing complications during acute myocardial infarction and providing for longer survival.
Asunto(s)
Angina de Pecho/etiología , Circulación Colateral , Circulación Coronaria , Enfermedad Coronaria/fisiopatología , Adulto , Anciano , Enfermedad Coronaria/complicaciones , Muerte Súbita/etiología , Complicaciones de la Diabetes , Angiopatías Diabéticas/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , PronósticoRESUMEN
Fifteen patients with diagnosis of infective endocarditis underwent surgical treatment. They were divided in two groups, the first one in which the infection rested in the patient's own valve, and the second in which the patients already had had valve replacement. Forty percent had a previous history of invasive procedure. Fifty-three percent had been treated with antibiotics prior to admission. Blood cultures were positive in 60%, gram positive germ such as streptococcus and staphylococcus predominated. Echocardiogram showed vegetation in 73% of our patients. The indications for surgery was: lack of response to medical treatment (34%), septic emboli (27%), heart failure (27%), severe renal damage (13%). The mortality rate was 20%. In none of the cases a relapse of the infection was observed.
Asunto(s)
Endocarditis Bacteriana/cirugía , Adolescente , Adulto , Antibacterianos/uso terapéutico , Terapia Combinada , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Femenino , Prótesis Valvulares Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , ReoperaciónRESUMEN
Hospital mortality was studied in 541 consecutive patients with acute myocardial infarction (AMI) admitted during a three year period to the Coronary Care Unit (CCU) of the Instituto Nacional de Cardiología de México. Total mortality was 15.3%. Two thirds of the deaths occurred in the CCU. In the remaining fatal cases, the patients had been transferred to regular hospital wards at the time of their death. The largest number of deaths (68.7%) were due to pump failure. A smaller number of patients (14.5%) died as a result of cardiac ruptures. Deaths due to primary arrhythmias have practically disappeared at the CCU's. Hospital mortality due to AMI correlates well with the degree of left ventricular dysfunction. In the cardiogenic shock group and in the acute pulmonary edema group mortality was 93.4 and 50.0% respectively. Patients with moderate degrees of heart failure had a lower mortality rate (18.4%) while in those who did not develop clinical or radiological evidence of left ventricle failure mortality was minimal. In patients with AMI there is a direct relationship between the mass of destroyed myocardium and the degree of left ventricular dysfunction. Thus, mortality is greater in patients with previous infarction, with important enzyme elevation, intraventricular conduction defects, larger cardiac size, etc. Four fifths of the cases studied at post-mortem had a left ventricular mass destruction of at least 40% and most of the cases had significant atheromatous lesions of two or of all three coronary vessels. Further reduction in mortality due to AMI would require an early and effective treatment of the syndromes of left ventricular dysfunction.
Asunto(s)
Infarto del Miocardio/mortalidad , Adolescente , Adulto , Anciano , Unidades de Cuidados Coronarios , Femenino , Pruebas de Función Cardíaca , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , México , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapiaRESUMEN
This study comprises the evaluation of 120 surgically excised mitral and aortic valves, in an attempt to clearly define the nature of the underlying process. To this effect histopathological and clinical criteria were established and categorized in 4 levels of diagnostic accuracy for rheumatic fever. Ninety three percent of the mitral valves were recognized as probably or certainly rheumatic in origin, whereas only 38.4% of the aortic cases were classified in this category. Included is a discussion of the various etiopathogenic possibilities, other than rheumatic, regarding chronic valve deformities of the heart.