RESUMO
Seventeen patients with diagnosis of acute myocardial infarction with right ventricular extension were studied. All of them had evidence of contractile impairment of the right ventricle as shown by elevated filling pressure of the right ventricle, low systolic pulmonary pressure and low left ventricular filling pressure and cardiac output. These patients were treated with fluid infusion into the pulmonary artery besides other treatment measures for myocardial infarction in order to improve the filling pressure of the left ventricle and the cardiac output without stressing the right ventricle. The results obtained with this approach, which was maintained for 22 hours, showed a significant improvement in the stroke work indices of both ventricles and also in the cardiac output with a decrease in peripheral resistence without ever loading the ventricles. We analyze the physiological basis for using this procedure and also the complications that can occur. Our results show that the infusion of fluid into the pulmonary artery improves the hemodynamic situation of these patients and protects a damaged right ventricle.
Assuntos
Glucose/uso terapêutico , Infarto do Miocárdio/terapia , Artéria Pulmonar , Idoso , Pressão Sanguínea , Resistência Capilar , Débito Cardíaco , Feminino , Glucose/administração & dosagem , Insuficiência Cardíaca/prevenção & controle , Ventrículos do Coração/fisiopatologia , Humanos , Infusões Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Volume SistólicoRESUMO
Se estudiaron 17 pacientes con diagnostico de infarto agudo del miocardio con extension al ventriculo derecho y que tuvieron datos de falla mecanica de este ultimo, caracterizada por presion de llenado del ventriculo derecho elevada, presion sistolica pulmonar disminuida, junto con datos de bajo gasto cardiaco. A estos enfermos se les infundieron liquidos en la arteria pulmonar como parte del tratamiento del infarto con el fin de mejorar el llenado del ventriculo izquierdo y el gasto cardiaco, sin sobrecargar volumetricamente al ventriculo derecho. Los resultados obtenidos con este sistema de tratamiento por un lapso promedio de 22 horas indican una mejoria significativa en los indices de trabajo de ambos ventriculos y en el gasto cardiaco con una disminucion de las resistencias perifericas, sin evidencia de sobrecarga ventricular. Se analizan los mecanismos fisiologicos que justifican este procedimiento y tambien las complicaciones atribuibles al mismo. Nuestros resultados indican que la infusion de liquidos en la arteria pulmonar mejora las condiciones hemodinamicas de los pacientes y protege a un ventriculo derecho lesionado
Assuntos
Humanos , Infusões Intra-Arteriais , Infarto do Miocárdio , Artéria Pulmonar , Ventrículos do CoraçãoRESUMO
Following the historical introduction concerning the evolution of our present knowledge of the W-P-W syndrome, we discuss a unique case of complete transposition of the great vessels with an unusual type of pre-excitation. We attributed this excitation to an uncommonly placed bundle of Kent, which, to our knowledge, has not been previously reported as coexisting with the aforementioned congenital heart malformation. A review of the literature, a discussion of other congenital heart diseases associated with disturbances of A-V conduction, as well as the clinical and para-clinical data upon which we base our diagnosis are presented.