RESUMEN
We reviewed 22 cases of primary pediatric cardiac tumors followed at our institution from January 1981 through November 1997, analyzing them by subtype, age and manner of presentation, location, associated findings, interventions, and clinical course. Rhabdomyomas were the most common (11), followed by intrapericardial teratomas (2), myxomas (1), fibromas (1), hemangiomas (1), mesotheliomas (1), and rhabdomyosarcomas (1), with 4 undetermined tumors. The majority (77%) of tumors were diagnosed before the age of one year, including six prenatally. The most common presentations were murmurs (5), arrhythmias (5), and abnormal screening fetal ultrasound examinations (4). Tumors were located most frequently in the right ventricle (13) and left ventricle (7), with multiple tumors being present in 10 cases. Eight patients (36%) had associated arrhythmias or conduction abnormalities, and of the 11 patients with rhabdomyomas, tuberous sclerosis was diagnosed in 8. Eight patients underwent cardiac catheterization, including two for electrophysiologic study with radiofrequency ablation, and seven patients had complete or partial tumor resection. The follow-up period ranged from 2 months to 15 years, and there were 3 tumor-related deaths. Therefore, despite the benign histology of most primary pediatric cardiac tumors, there may be significant associated morbidity and occasional mortality. As echocardiographic techniques such as fetal ultrasonography have continued to improve, however, these cardiac tumors have increasingly been detected early before significant symptoms develop.
Asunto(s)
Neoplasias Cardíacas/clasificación , Neoplasias Cardíacas/epidemiología , Distribución por Edad , Edad de Inicio , Niño , Preescolar , Ecocardiografía/métodos , Femenino , Neoplasias Cardíacas/patología , Ventrículos Cardíacos , Hemangioma/diagnóstico , Hemangioma/epidemiología , Hemangioma/cirugía , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Mesotelioma/diagnóstico , Mesotelioma/epidemiología , Mesotelioma/cirugía , Mixoma/diagnóstico , Mixoma/epidemiología , Mixoma/cirugía , Ohio/epidemiología , Pronóstico , Sistema de Registros , Rabdomioma/diagnóstico , Rabdomioma/epidemiología , Rabdomioma/cirugía , Rabdomiosarcoma/diagnóstico , Rabdomiosarcoma/epidemiología , Rabdomiosarcoma/cirugía , Factores de Riesgo , Distribución por Sexo , Tasa de Supervivencia , Teratoma/diagnóstico , Teratoma/epidemiología , Teratoma/cirugíaRESUMEN
Postoperative chylothorax may occur following any intrathoracic surgical procedure in children. From January 1979 through February 1987, 18 children aged 1 month to 9 years had chylothorax listed among their discharge diagnoses. Initial therapy for all patients consisted of chest tube placement for pleural space drainage and nutritional support with either enteral formulas enriched with medium-chain triglycerides or total parenteral nutrition. Both total parenteral nutrition and medium-chain triglyceride-enriched enteral regimens provided adequate nutritional support in these children. Five of the 18 experienced lymphopenia secondary to chylous lymphocyte loss. Infections were diagnosed in 5 patients during hospitalization; one was a fatal viral pneumonitis. No correlation between infectious complications and lymphocyte count could be demonstrated.
Asunto(s)
Infecciones Bacterianas/prevención & control , Quilotórax/complicaciones , Nutrición Enteral , Nutrición Parenteral Total , Complicaciones Posoperatorias/terapia , Virosis/prevención & control , Pérdida de Peso , Infecciones Bacterianas/etiología , Niño , Preescolar , Quilotórax/cirugía , Quilotórax/terapia , Drenaje , Nutrición Enteral/métodos , Femenino , Alimentos Formulados , Humanos , Lactante , Recién Nacido , Linfopenia/complicaciones , Linfopenia/etiología , Masculino , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Conducto Torácico/cirugía , Resultado del Tratamiento , Virosis/etiologíaAsunto(s)
Angina de Pecho/terapia , Esfuerzo Físico , Angina de Pecho/fisiopatología , Presión Sanguínea , Ensayos Clínicos como Asunto , Puente de Arteria Coronaria , Prueba de Esfuerzo , Estudios de Seguimiento , Oclusión de Injerto Vascular/diagnóstico , Frecuencia Cardíaca , Humanos , Distribución Aleatoria , Factores de TiempoRESUMEN
Between July, 1963, and July, 1983, a total of 69 patients (35 boys and 34 girls) underwent ostium primum defect repair. There were four perioperative deaths and four patients were subsequently lost to follow-up, leaving 61 children followed for 6 months to 20 years (mean 5 years). Results of surgery were assessed by cardiac catheterization in 17 of 61 patients, while the remaining patients were evaluated noninvasively. Postoperative mitral insufficiency was found to be absent in 19 patients, mild to trivial in 35, moderate in four, and severe in two. Four patients were found to have large residual atrial septal defects. Significant late postoperative arrhythmias were found in 14 of 61 patients. The types of arrhythmias included isolated complete atrioventricular block in 5 of 14, complete atrioventricular block with sinus node dysfunction in 2 of 14, and isolated sinus node dysfunction in 7 of 14. Pacemakers have been implanted in 8 of 14 of these patients. Based on this 20-year review of a large number of children: (1) ostium primum defect repair is associated with a low mortality rate, (2) residual mitral insufficiency although common is usually mild to trivial and nonprogressive, and (3) significant arrhythmias are a frequent complication and often require pacemaker implantation.
Asunto(s)
Defectos del Tabique Interatrial/cirugía , Adolescente , Adulto , Arritmias Cardíacas/complicaciones , Cateterismo , Niño , Preescolar , Electrocardiografía , Femenino , Defectos del Tabique Interatrial/mortalidad , Prótesis Valvulares Cardíacas , Humanos , Hipertensión Pulmonar/complicaciones , Masculino , Insuficiencia de la Válvula Mitral/complicaciones , Cuidados Posoperatorios , Complicaciones PosoperatoriasRESUMEN
A new type of vascular ring formed by a hemitruncal pulmonary artery is described. Early reimplantation of the hemitruncal pulmonary artery resulted in resolution of the respiratory distress, protection of the pulmonary arterial bed from obstructive vascular disease, and preparation of the pulmonary artery for future surgical correction.
Asunto(s)
Arteria Pulmonar/anomalías , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Radiografía , Insuficiencia Respiratoria/etiologíaRESUMEN
A 14 month old boy with suprasystemic right ventricular pressure secondary to pulmonary valvular stenosis and anular size of 10 mm underwent percutaneous balloon valvuloplasty with a 12 mm balloon. Right ventricular pressure almost doubled after valvuloplasty and the electrocardiogram revealed development of severe right ventricular strain. Both findings persisted on the following day. A postvalvuloplasty right ventriculogram demonstrated a severe systolic infundibular obstruction not present before. The patient underwent surgical relief of infundibular obstruction; successful opening of the pulmonary valve by the balloon valvuloplasty was observed. It is concluded that a balloon size 20% larger than anular size can be safe in human subjects and that infundibular obstruction may appear or even worsen after balloon valvuloplasty. Such an obstruction may be related to the severity of pulmonary valvular obstruction and a hypercontractile infundibulum.
Asunto(s)
Angioplastia de Balón/efectos adversos , Contracción Miocárdica , Estenosis de la Válvula Pulmonar/terapia , Constricción Patológica/etiología , Constricción Patológica/terapia , Ventrículos Cardíacos/fisiopatología , Humanos , Lactante , Masculino , Arteria Pulmonar/patología , Arteria Pulmonar/fisiopatología , Estenosis de la Válvula Pulmonar/fisiopatologíaAsunto(s)
Marcapaso Artificial , Adolescente , Adulto , Niño , Preescolar , Falla de Equipo , Femenino , Bloqueo Cardíaco/terapia , Humanos , Lactante , Recién Nacido , Masculino , Marcapaso Artificial/efectos adversos , Marcapaso Artificial/mortalidad , Pericarditis/etiología , Reoperación , Síndrome del Seno Enfermo/terapia , Infecciones Estafilocócicas/etiologíaAsunto(s)
Anestesia Intravenosa , Gasto Cardíaco/efectos de los fármacos , Diazepam/farmacología , Hemodinámica/efectos de los fármacos , Volumen Sistólico/efectos de los fármacos , Anciano , Cateterismo Cardíaco , Puente de Arteria Coronaria , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana EdadRESUMEN
Bacteriologic cultures of sputum and specimens obtained at thoracotomy from 17 patients with cystic fibrosis were compared. All organisms found in the surgical specimens were found in the sputum. Only two surgical specimens failed to yield any organisms. The most frequently isolated organisms were Pseudomonas aeruginosa (41%) and Pseudomonas cepacia (35%). Serotypes of P. aeruginosa and antibiogram results on both P. aeruginosa and P. cepacia further supported the concordance of the isolates from the two sources. In addition, anaerobic cultures were obtained in specimens from 10 patients with CF and revealed two patients with anaerobic colonization of the lower respiratory tract. These findings also correlated well with the sputum cultures. The correlation of sputum and lung specimen culture results supports the value of sputum culture in the management of lung disease in CF.
Asunto(s)
Fibrosis Quística/microbiología , Pulmón/microbiología , Infecciones por Pseudomonas/microbiología , Esputo/microbiología , Adolescente , Adulto , Técnicas Bacteriológicas , Infecciones por Bacteroides/microbiología , Biopsia con Aguja , Femenino , Infecciones por Haemophilus/microbiología , Humanos , Masculino , Pseudomonas aeruginosa/clasificación , SerotipificaciónRESUMEN
Arteriovenous fistula of the innominate artery occurred in a patient 3 weeks after retrograde brachial arterial catheterization was performed 1 day before aortocoronary bypass surgery. Intramural dissection was noted at catheterization, and a mediastinal hematoma at operation. Exploration of the hematoma in the course of catheterization might have prevented the arteriovenous fistula, which necessitated a second operation 3 weeks after the first. To our knowlege this complication of retrograde brachial catheterization has not previously been described. We recommend that known injuries to cervical or thoracic arteries occurring just before operations requiring extracorporeal circulation be explored to prevent late complications. Recent injuries to the cervical and thoracic arteries that are not acessible to external compression should be exposed and treated during sternotomy to prevent late complications if heparinization is contemplated.