RESUMEN
Anomalous coronary arteries arising from the pulmonary trunk is a rare but potentially fatal condition. We report the clinical presentation, surgical treatment and long-term follow-up of seven surgical cases of anomalous left coronary and one case of anomalous right coronary artery arising from the pulmonary artery. Age ranged from 7 months to 13 years (average: 5.09+/-3.7 years) and weight ranged from 7 to 50 kg (average: 19.9+/-8.8 kg). Follow-up was 100% complete: average 78 months (S.D.: 52.7 months). Direct reimplantation was the surgical technique in six cases, Takeuchi procedure in one case and subclavian artery interposition in one case. Concomitant mitral valve repair was undertaken in two cases. In two children the coronary artery anomaly was diagnosed and treated only after a first surgery for other congenital heart anomaly. Left ventricle ejection fraction was restored in those cases of pre-operative dysfunction. Mortality was not observed and all children are asymtomatic and free of reoperation.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Anomalías de los Vasos Coronarios/cirugía , Arteria Pulmonar/cirugía , Adolescente , Implantación de Prótesis Vascular , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Niño , Preescolar , Anomalías de los Vasos Coronarios/fisiopatología , Femenino , Humanos , Lactante , Masculino , Arteria Pulmonar/anomalías , Reimplantación , Volumen Sistólico , Arteria Subclavia/cirugía , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
OBJECTIVES: Our aim is to describe our surgical approach in dealing with patients having atrioventricular septal defect with common atrioventricular junction and ventricular shunting associated with tetralogy of Fallot over the last 8 years, and to present our results in mid-to-long term follow-up. METHODS: Between November 1995 and January 2004, we performed surgical correction in 8 consecutive children with atrioventricular septal defect, common atrioventricular junction, interventricular shunting, and associated tetralogy of Fallot. The age at surgical correction varied from 8 months to 20 years, with a mean of 45 months, and standard deviation of 74 months. A palliative systemic-to-pulmonary shunt had previously been performed in 3 patients. Follow-up ranged from 57 to 135 months, with a mean of 93.5 months, and standard deviation of 32 months. We used a two-patch technique to repair of the atrioventricular septal defect, and a pericardial transjunctional patch for relief of the obstruction in the right ventricular outflow tract. RESULTS: There were no deaths, nor reoperations either in the postoperative period or during follow-up. All patients are asymptomatic, or in the second class created by the New York Heart Association. The mean period of cardiopulmonary by-pass was 136 minutes, and the mean stay in hospital was 11.8 days. At the last examination, pulmonary valvar insufficiency was considered severe in 2 patients, and moderate in another 2. No patient developed more than a trace of regurgitation across the reconstituted left atrioventricular valve. CONCLUSIONS: The two-patch technique, associated with ventriculotomy and a transjunctional pulmonary patch is safe and efficient when correcting atrioventricular septal defect associated with tetralogy of Fallot, resulting in good mid-to-long term clinical outcomes.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interventricular/cirugía , Tetralogía de Fallot/cirugía , Adolescente , Adulto , Niño , Preescolar , Ecocardiografía Doppler , Estudios de Seguimiento , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interatrial/fisiopatología , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/fisiopatología , Humanos , Lactante , Periodo Posoperatorio , Reoperación , Estudios Retrospectivos , Tetralogía de Fallot/diagnóstico por imagen , Tetralogía de Fallot/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular/fisiologíaRESUMEN
OBJECTIVES: To analyze the feasibility, the safety, and the primary outcomes of a minimally invasive thoracotomy for the occlusion of ligamentum arteriosum (ductus arteriosus) in preterm infants. METHODS: Between October 1991 and June 2003, 273 preterm infants and very low birth weight preterm infants were submitted to a surgical occlusion of the ligamentum arteriosum (ductus arteriosus) through muscle-sparing thoracotomy under general anesthesia in the neonatal ICU. Pre-operative demographic data, mortality outcomes, and adverse events were retrospectively analyzed through medical records consultation. RESULTS: There were no deaths related to surgery, and 234 (86%) patients were discharged from hospital. Thirty-nine deaths have occurred between the 1st and the 51st days. The cause of death was sepsis (14 patients); intracranial bleeding (11 patients); and necrotizing enterocolitis (9 patients). All causes were related to prematurity. In five patients the cause of death was not established or could not be found in the medical records. The most frequent adverse events related to the surgery were: pneumothorax: 3.3% (9 patients), bleeding: 1.4% (4 patients). CONCLUSIONS: The minimally invasive thoracotomy technique for the occlusion of the ligamentum arteriosum (ductus arteriosus) when performed in preterm infants and very low birth weight infants is feasible, safe, efficient, related to low morbidity, and not dependent of hospital resources.
Asunto(s)
Conducto Arterioso Permeable/cirugía , Toracotomía/normas , Estudios de Factibilidad , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/normas , Neumotórax/etiología , Hemorragia Posoperatoria/etiología , Estudios Retrospectivos , Toracotomía/efectos adversos , Resultado del TratamientoRESUMEN
We report our results on surgical treatment of complete atrioventricular septal defects using the two-patch technique. Forty patients with complete atrioventricular septal defects were operated on in the period from November 1995 to January 2004 and retrospectively analyzed. The age at the time of surgery ranged from 4 months to 20 years (average=18.8+/-37 months). Their weights ranged from 3 to 39 kg (average=7.6+/-5.8 kg). Associated tetralogy of Fallot was present in 20% of the cases (8 patients). Monitoring was complete until January 2007, corresponding to a follow-up ranging from 36 to 135 months (average=74+/-33.7 months). The surgical mortality rate was 2.5% and the hospital mortality rate was 5%. A third patient died from a brain abscess two years after surgery. Over the long-term, two patients needed further operations: one was submitted to mitral plasty due to severe residual mitral insufficiency, one year later; the other underwent a resection of a sub-aortic membrane after three years. Differences were evaluated using the Student-t or Mann-Whitney tests. Surgical treatment of complete atrioventricular septal defect using the two-patch technique results in low morbidity and mortality in early-to-mid term follow-up.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interventricular/cirugía , Tetralogía de Fallot/cirugía , Adolescente , Adulto , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Niño , Preescolar , Estudios de Seguimiento , Defectos del Tabique Interatrial/mortalidad , Defectos del Tabique Interventricular/mortalidad , Mortalidad Hospitalaria , Humanos , Lactante , Reoperación , Estudios Retrospectivos , Tetralogía de Fallot/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Objetivo: Avaliar a aplicabilidade, segurança e resultados iniciais da toracotomia minimamente invasiva para ligadura do canal arterial em prematuros. Métodos: Entre outubro de 1991 e julho de 2003, 273 prematuros e prematuros extremos foram submetidos à ligadura cirúrgica do canal arterial por toracotomia miopreservadora, com anestesia geral, em UTI neonatal...
Asunto(s)
Humanos , Masculino , Recién Nacido , Conducto Arterioso Permeable , Cardiopatías Congénitas , Recien Nacido Prematuro , Estudios Retrospectivos , ToracotomíaRESUMEN
As atelectasias pulmonares provocadas por obstruçäo endo-brônquica säo uma das causas mais comuns de complicaçäo pulmonar, em pacientes críticos sob assistência ventilatória mecânica. Estas obstruçöes ocorrem por acúmulo de secreçäo respiratória, ocasionando colapso pulmonar, em graus variados. Com a instalaçäo atelectasia, a broncoscopia torna-se imperativa para aspiraçöes e colheita de material para análise laboratorial. De um total de 214 broncoscopias efetuadas pela Clínica de Cirurgia Cardiotorácica do Hospital Naval Marcílio Dias, em 40 meses, 12 (58,6//) foram em pacientes de unidades críticas, dos quais 7 (58,3// dos 12) eram pós-operatórios, 4 (33,3//) portadores de D.P.O.C. e 1 era politraumatizado. Os autores abordam os aspectos clínicos, laboratoriais e, principalmente, radiológicos do tratamento. Em mais de 65// dos casos, houve melhora Clínica e radiológica, evidente, após o procedimento endoscópico, levando a uma expansäo pulmonar e, conseqüentemente, à diminuiçäo do tempo de internaçäo na U.T.I.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Atelectasia Pulmonar/terapia , Respiración Artificial/métodos , Análisis de los Gases de la Sangre , Broncoscopía , Atelectasia Pulmonar/sangre , Atelectasia Pulmonar/diagnóstico , Radiografía TorácicaRESUMEN
Apresentamos um estudo retrospectivo de 53 casos de Pneumotórax Expontâneo (PE), tratados na Clínica de Cirurgia Cardiotorácica do HNMD no período de janeiro de 1981 a fevereiro de 1989. Foram analisadas a magnitude, manifestaçöes clínicas, terapêuticas instituída e evoluçäo. Os pacientes foram divididos em 4 grupos de acordo com o grau de colapso pulmonar, assim distribuídos: Grupo I - menor que 30%; Grupo II - menor que 30%; Grupo II - entre 30 e 50%; Grupo III - acima de 50% e Grupo IV - hipertensivo. Os pacientes do Grupo I foram submetidos a tratamento conservador, exceto aqueles cujos sintomas clínicos indicavam comprometimento respiratório, nos quais com os de mais grupos, instituiu-se o tratamento cirúrgico. A drenagem pleural fechado foi o procedimento mais realizado. A evoluçäo foi satisfatória na grande maioria dos casos e a toracotomia foi necessária em apenas 10 casos (18%). O acompanhamento tardio ambulatorial demonstrou que os pacientes do Grupo I, tratados consevadoramente, apresentaram o maior índice de recidiva (62,5%). Näo foram observadas recorrências nos pacientes submetidos a pleurodese cirúrgica, enquanto que nos tratados simplesmente através da drenagem de tórax, o índice chegou a 13% (Grafico I). A drenagem instituída nos pacientes com pequenos PE, abreviou o tempo de hospitalizaçäo, de convalescença, proporcionou maior segurança ao tratamento, menor índice de recidiva, menor morbidade e menor custo institucional quando comparados aos pacientes do mesmo grupo, submeti