RESUMO
Paciente com timoma e função sistólica normal do ventrículo esquerdo desenvolveu tamponamento cardíaco, revertido por pericardiocentese. Após quatro dias, foi submetida à exérese do tumor e, em aproximandamente uma semana da drenagem, apresentou disfunção sistólica aguda e grave do ventrículo esquerdo, que melhorou com terapia venosa, normalizando o quadro em três dias.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Derrame Pericárdico/patologia , Disfunção Ventricular Esquerda/complicações , Drenagem , Cuidados Pós-Operatórios , Respiração ArtificialRESUMO
A patient with a thymoma and initially normal ventricular systolic function developed cardiac tamponade, which was relieved by pericardiocentesis. After four days, the tumor was removed and, one week after the relief of tamponade, she developed severe left ventricular systolic dysfunction, that recovered in three days with venous therapy.
Assuntos
Tamponamento Cardíaco/etiologia , Drenagem/efeitos adversos , Sístole , Disfunção Ventricular Esquerda/etiologia , Doença Aguda , Idoso , Neoplasias da Mama/complicações , Feminino , Humanos , Timoma/complicações , Neoplasias do Timo/complicaçõesRESUMO
Objetivo - avaliar os resultados imediatos e tardios da cirurgia de revascularizaçäo em pacientes jovens. Métodos - foram estudados retrospectivaemnte 73 pacientes com idades inferiores a 40 anos e submetidos a cirurgia de revascularizaçäo miocárdica no período de 1975 a 1989, utilizando-se a revisäo dos prontuários e o contato telefônico com os pacientes e/ou médicos-assitentes. Resultados - todos os pacientes foram acompanhados por um período de 2 a 185 (média 59, 9 +/- 41,0) meses. Dentre os fates de risco, o tabagismo foi o mais frequente (89,0 por cento). Dezesseis (21,9 por cento) pacientes apresentavam lesäo coronariana uniarterial, 26 (35,6 por cento) tinham doença biarterial e 32 (43,8 por cento) apresentavam doença triarterial. A revascularizaçäo foi considerada completa em 93, 2 por cento dos casos, sendo que 12,3 por cento foram também submetidos à aneurismectomia do ventrículo esquerdo. Desenvolveram infarto agudo do miocárdio perioperatório 7 (9,5 por cento) doentes, tendo ocorrido móbito hospitalar (1,3 por cento). Tardiamente, 6 (8,3 por cento) pacientes faleceram perfazendo probabilidade de sobrevida de 89, 1 por cento em 15 anos e probabilidade de sobrevida livre de eventos de 68,3 por cento em 10 anos. Encontram-se assintomáticos 80,3 dos pacientes, sendo que 72,7 por cento retornaram ao trabalho. Conclusäo a cirurgia de revascularizaçäo miocárdica em pacientes jovens, associada ao tratamento clínico, mostrou bons resultados a curto e longo prazo, com lata percentagem de pacints sobreviventes, assintomáticos e reassumindo suas atividades trabalhísticas.
Purpose - To determine early and late results of surgical myocardial revascularization (SMR) in young patients. Methods - We studied retrospectively 73 patients aging less than 40 years and submitted to SMR between 1975 and 1989. The method used was patient card review and thelephone contact with the patient or his physician. Results - Follow-up was obtained in all cases in a period of 2 to 185 (59.9±41.0) months. Of the coronary risk factors smoking was the most frequent. One vessel coronary artery disease was observed in 16 (21.9%) patients, 2 and 3 vessel coronary artery disease in 26 (35.ó%) and 32 (43.8%) patients respectively. SMR was considered complete in 68(93.2%) patients. An associated procedure was performed on 10 cases: Left ventricular aneurysm repair in 9 (12.3%) and mitral valve replacement in one (1.4%). Perioperative myocardial infarction occured in 7 (9.5%) patients and one of them died (operative mortality: 1.4%). During follow-up, 6 (8.3%) patients died with an actuarial survival rate of 89.1 % at 15years. An eventfree survival rate of 68.3% was observed at 10 years. From 66 survivors,53 (80.3%) were asymptomatic at late follow-up and 48 (72.7%) patients returned to work Conclusion - Surgical myocardial revascularization in young patients associated with medical treatment, has good early and late results with a high percentage of patients asymptomatic and reemployed at a late follow-up
Assuntos
Adolescente , Doença das Coronárias , Revascularização MiocárdicaRESUMO
A 16 month-old baby submitted to systemic-pulmonary shunt with a polytetrafluorethylene prosthesis, who presented hyperthermia, radiologic signs of pulmonary opacifications and positive culture for staphylococcus aureus. Reoperation disclosed a prosthesis pseudoaneurysm, with disconnection of the anastomosis and evidences of infection. This complication has a low diagnostic rate and a high mortality and should always be suspected when signs of systemic infection become apparent in the postoperative period of polytetrafluorethylene systemic-pulmonary shunt.
Assuntos
Infecções Relacionadas à Prótese/etiologia , Infecções Estafilocócicas/complicações , Feminino , Humanos , Lactente , Politetrafluoretileno , ReoperaçãoRESUMO
PURPOSE: Identification of risk factors for mortality in subclavian-pulmonary anastomosis using polytetrafluorethylene (PTFE). PATIENT AND METHODS: Immediate surgical results (30 days) were analyzed in 180 cyanotic patients consecutively operated on from september 1979 to march 1989. RESULTS: The hospital mortality was 12.7% (23 patients) and age at surgery, low weight (less than 3 kg) and preoperative diagnosis were considered risk factors for mortality. Pulmonary artery diameter at echocardiography, date of surgery and diameter of the conduits were associated with increased risk, but this association lacked statistical significance. Sex and previous palliative surgery have not increased hospital mortality. CONCLUSION: We believe that identification of risk factors to PTFE conduit implant plays an important role in the preoperative management of those patients in order to obtain better results in this life saving procedure.