Assuntos
Âmnio/cirurgia , Medida do Comprimento Cervical , Terapias Fetais/métodos , Hidrotórax/cirurgia , Cavidade Pleural/cirurgia , Toracentese/métodos , Adulto , Âmnio/embriologia , Âmnio/patologia , Colo do Útero/patologia , Feminino , Humanos , Hidrotórax/embriologia , Cavidade Pleural/embriologia , Cavidade Pleural/patologia , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Resultado do TratamentoAssuntos
Ruptura Prematura de Membranas Fetais/cirurgia , Transfusão Feto-Fetal/epidemiologia , Transfusão Feto-Fetal/cirurgia , Fetoscopia/mortalidade , Gravidez de Gêmeos , Âmnio/patologia , Líquido Amniótico , Feminino , Ruptura Prematura de Membranas Fetais/patologia , Transfusão Feto-Fetal/patologia , Fetoscopia/métodos , Idade Gestacional , Humanos , Incidência , Poli-Hidrâmnios/patologia , Poli-Hidrâmnios/cirurgia , Gravidez , Resultado da GravidezRESUMO
OBJECTIVE: To describe changes in fetal Doppler parameters during a novel technique for open fetal microneurosurgery for open spina bifida (OSB) repair. METHODS: This was a prospective study of 44 fetuses undergoing open fetal surgery for OSB repair using a novel microneurosurgery approach that is characterized by a mini-hysterotomy (diameter of 15 mm), minimal fetal manipulation and maintenance of a constant normal amniotic fluid volume throughout the procedure. Doppler velocimetry of the umbilical artery (UA), fetal middle cerebral artery (MCA) and ductus venosus (DV) was performed before the start of surgery and at prespecified timepoints during fetal surgery. UA pulsatility index (PI) > 95th percentile, DV-PI > 95th percentile, MCA-PI < 5th percentile and cerebroplacental ratio (CPR) < 5th percentile were considered abnormal. RESULTS: Median gestational age at fetal surgery was 25.2 weeks (range, 22.9-27.9 weeks). Doppler recordings were successfully obtained in all cases during all timepoints throughout the surgery. As compared with Doppler values before surgery, there was a significant increase in the proportion of fetuses with MCA-PI < 5th percentile (63.6% vs 13.6%; P < 0.001), CPR < 5th percentile (65.9% vs 15.9%; P < 0.001) and DV-PI > 95th percentile (22.7% vs 0%; P = 0.01) and a non-significant increase in the proportion of fetuses with UA-PI > 95th percentile (11.4% vs 0%; P = 0.12) during fetal surgery. None of the fetuses showed absent or reversed end-diastolic velocity in the UA or absent or reversed DV a-wave at any stage during OSB repair. All abnormal Doppler parameters returned to normal after surgery. CONCLUSIONS: During open fetal surgery for OSB repair, a small hysterotomy, reduced fetal manipulation and maintenance of a normal amniotic fluid volume seem to prevent severe fetal Doppler abnormalities. The mild Doppler changes observed during fetal surgery could be a manifestation of fetal adaptation to the stress of fetal surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Assuntos
Espinha Bífida Cística/cirurgia , Adulto , Líquido Amniótico , Velocidade do Fluxo Sanguíneo , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Gravidez , Estudos Prospectivos , Fluxo Pulsátil , Resultado do Tratamento , Ultrassonografia Doppler , Artérias Umbilicais/diagnóstico por imagem , Adulto JovemRESUMO
OBJECTIVE: To determine the relationship between QRS duration and dispersion and the occurrence of ventricular arrhythmias in early stages of acute myocardial infarction (AMI). DESIGN: A retrospective, longitudinal descriptive study was carried out. SETTING: Hospital General Universitario "Camilo Cienfuegos", Sancti Spíritus, Cuba. Secondary health care. PATIENTS OR PARTICIPANTS: A total of 209 patients diagnosed with ST-segment elevation AMI from January 2012 to June 2014. MAIN VARIABLES OF INTEREST: The duration and dispersion of the QT interval, corrected QT interval, and QRS complex were measured in the first electrocardiogram performed at the hospital. The presence of ventricular tachycardia/fibrillation was assessed during follow-up (length of hospital stay). RESULTS: Arrhythmias were found in 46 patients (22%); in 25 of them (15.9%), arrhythmias originated in ventricles, and were more common in those subjects with extensive anterior wall AMI, which was responsible for 81.8% of the ventricular fibrillations and more than half (57.1%) of the ventricular tachycardias. The widest QRS complexes (77.3±13.3 vs. 71.5±6.4ms; P=.029) and their greatest dispersion (24.1±16.2 vs. 16.5±4.8ms; P=.019) were found on those leads that explore the regions affected by ischemia. The highest values of all measurements were found in extensive anterior wall AMI, with significant differences: QRS 92.3±18.8ms, QRS dispersion 37.9±23.9ms, corrected QT 518.5±72.2ms, and corrected QT interval dispersion 94.9±26.8ms. Patients with higher QRS dispersion values were more likely to have ventricular arrhythmias, with cutoff points at 23.5ms and 24.5ms for tachycardia and ventricular fibrillation, respectively. CONCLUSIONS: Increased QRS duration and dispersion implied a greater likelihood of ventricular arrhythmias in early stages of AMI than increased duration and dispersion of the corrected QT interval.
Assuntos
Arritmias Cardíacas/fisiopatologia , Eletrocardiografia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Idoso , Arritmias Cardíacas/complicações , Feminino , Humanos , Estudos Longitudinais , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicaçõesRESUMO
Prevention is important in the case of the most common sustained arrhythmia-atrial fibrillation, with the intention of obtaining both medical and economic benefits. Electrocardiographic parameters have been tested as predictors of atrial fibrillation in different settings, and indices of P-wave have been assiduously studied.Increased P-wave dispersion has been described in different illnesses and correlated with several echocardiographic and clinical parameters. Several studies have demonstrated the relationship between P-wave dispersion with the first episode or paroxysmal atrial fibrillation, as well as with the recurrence of atrial fibrillation after conversion to sinus rhythm. Despite of some critics, the current evidencesentitleus to continue studying P-wave dispersion and use it for identifying patients with risk for atrial fibrillation.