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Objective: Balloon atrioseptostomy is an emergency procedure in congenital heart diseases requiring an atrial septal defect to increase cardiac output in right-sided obstructive lesions or to improve mixing in patients with transposition of the great arteries. This procedure is currently performed with both fluoroscopy and echocardiography. The main objective is to describe our experience with the use of balloon atrioseptostomy under echocardiographic and fluoroscopic guidance in patients under 3 months. Materials and methods: A descriptive, comparative and retrospective study in patients in whom balloon atrioseptostomy was performed under echocardiographic and fluoroscopic guidance between 2018 and 2023 in a referral hospital in Peru. Results: 36 patients were analyzed, of which 21 were from the fluoroscopy group. and 15 patients from the echocardiography group. More than 2/3 of the cases were males, and more than 60% of patients in both groups had transposition of the great vessels. No significant differences were found in terms of ventilatory support and inotropic support. The success of the procedure was 100% in both groups, without complications. Conclusion: Both balloon atrioseptostomy performed by fluoroscopy and those performed by echocardiography were successful and without complications, emphasizing that the one performed by echocardiography is performed in the patient's crib, avoiding the transfer of the critical unit to the angiography room and without the use of radiation.
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Resumo Fundamento O forame oval permanece pérvio em cerca de 25% da população adulta. Na vida adulta, trombos se formam na circulação venosa e podem atravessar o septo interatrial e desencadear um acidente vascular cerebral isquêmico - fenômeno chamado de embolia paradoxal. O tratamento pode ser realizado através do fechamento percutâneo do forame oval patente (FOP), porém ainda é pouco realizado no Brasil por não estar disponível na rede pública. Objetivos Avaliar a reprodutibilidade dos resultados dos ensaios clínicos em estudos de vida real devido ao escasso número de registros publicados sobre o tema. Métodos Este estudo é uma coorte retrospectiva onde foram incluídos 121 pacientes submetidos ao fechamento percutâneo do FOP para profilaxia secundária de acidente vascular cerebral isquêmico entre janeiro de 2012 e junho de 2022. Resultados Observamos idade média de 50,3 anos e a maioria do sexo feminino. O shunt interatrial grave foi observado em 82,6% e a presença de aneurisma de septo atrial em 84,2%. Após 6 meses do procedimento, nenhum paciente permaneceu com shunt residual. Não houve complicações hemorrágicas ou vasculares graves. A recidiva de novo evento cerebrovascular isquêmico ocorreu em 1,6% dos pacientes. Conclusão Observamos uma recidiva de novos eventos neurológicos isquêmicos muito baixa e ausência de complicações graves associadas ao procedimento.
Abstract Background The foramen ovale remains patent in about 25% of the adult population. In adult life, thrombi form in the venous circulation and can cross the interatrial septum and trigger an ischemic stroke - called paradoxical embolism. The treatment can be performed through percutaneous closure of the patent foramen ovale (PFO), but still rarely performed in Brazil because it is not available in the public health care. Objectives To evaluate the reproducibility of clinical trial results in real-life studies due to the low number of records published about the topic. Methods This study is a retrospective cohort study including 121 patients who underwent percutaneous PFO closure for secondary prophylaxis of ischemic stroke between January 2012 and June 2022. Results We observed a mean age of 50.3 years and most females . Severe interatrial shunt was observed in 82.6% and the presence of atrial septal aneurysm in 84.2%. After 6 months of the procedure, no patient still had a residual shunt. There were no serious bleeding or vascular complications. Recurrence of a new cerebrovascular event occurred in 1.6% of patients. Conclusion We observed a low recurrence of new ischemic neurological events and lack major complications related to the procedure.
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Humanos , Masculino , Pessoa de Meia-Idade , Septo Interatrial/anatomia & histologia , Forame Oval Patente/complicações , Forame Oval Patente/etiologia , Síndrome de Platipneia Ortodeoxia/congênito , Procedimentos Cirúrgicos Cardiovasculares/instrumentação , Cateterismo/métodos , Ecocardiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Ecocardiografia Transesofagiana/métodos , Eletrocardiografia/métodos , Cardiopatias Congênitas/diagnóstico por imagemRESUMO
Resumen La hipertrofia lipomatosa del septum interauricular (HLSI) es una entidad cardiaca rara y benigna, que se caracteriza por la acumulación de tejido adiposo dentro de algunos segmentos del septum interatrial. Generalmente, los pacientes son asintomáticos y estas lesiones se descubren de manera incidental mediante estudios de imagen realizados por otras razones, o en el contexto de una autopsia. Se han descrito casos de muerte súbita por alteración del ritmo cardiaco en estos pacientes. El diagnóstico diferencial de la HLSI incluye principalmente tumores cardiacos. Se expone el caso de un paciente de 61 años que, después de un estudio de resonancia magnética cardiaca, realizado por una alteración del ritmo cardiaco, presenta una masa en el septum auricular. El paciente es llevado a cirugía y el estudio histopatológico de la lesión confirma el diagnóstico. Se realiza una revisión de las características clínicas y patológicas de la HLSI.
Abstract Lipomatous Hypertrophy of the Interatrial Septum (LHIS) is a rare and benign cardiac entity that is characterized by the accumulation of adipose tissue within some segments of the interatrial septum. Patients are generally asymptomatic, and these lesions are discovered incidentally by imaging studies performed for other reasons, or in the context of an autopsy. In these patients, there have been described cases of sudden death due to disturbance of the heart rhythm. The differential diagnosis of LHIS mainly includes cardiac tumors. Here we present a case of a 61-year-old patient in whom, after a cardiac magnetic resonance study performed for an abnormal heart rhythm, it was documented a mass in the atrial septum. The patient was taken to surgery, and the histopathological study of the lesion confirmed the diagnosis. We conduct a review of the clinical and pathological characteristics of LHIS.
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Humanos , Masculino , Pessoa de Meia-Idade , Septo Interatrial/patologia , Neoplasias Cardíacas/diagnóstico , Lipoma/diagnóstico , HipertrofiaRESUMO
Objective: In this study, we aimed to compare clinical outcomes of superior transseptal approach with the conventional left atriotomy in patients undergoing mitral valve surgery. Methods: Between January 2010 and November 2012, a total of 91 consecutive adult patients (39 males, 52 females; mean age: 54.0±15.4 years; range, 16 to 82 years) who underwent mitral valve surgery in the Division of Cardiovascular Surgery at Koşuyolu Training Hospital were included. The patients were randomized to either superior transseptal approach (n=47) or conventional left atriotomy (n=44). Demographic characteristics of the patients, comorbidities, additional interventions, intraoperational data, pre- and postoperative electrophysiological study findings, and postoperative complications were recorded. Results: Of all patients, 86.7% (n=79) were in New York Heart Association Class III, while 12 were in New York Heart Association Class IV. All patients underwent annuloplasty (42.9%) or valve replacement surgery (57.1%). There was no significant difference in pre- and postoperative electrocardiogram findings between the groups. Change from baseline in the cardiac rhythm was statistically significant in superior transseptal approach group alone (P<0.001). There was no statistically significant difference in mortality rate between the groups. Permanent pacemaker implantation was performed in 10.6% of the patients in superior transseptal approach group and 4.5% in the conventional left atriotomy group. No statistically significant difference in bleeding, total length of hospital and intensive care unit stay, the presence of low cardiac output syndrome was observed between the groups. Conclusion: Our study results suggest that superior transseptal approach does not lead to serious or fatal adverse effects on sinus node function or atrial vulnerability, compared to conventional approach. .
Objetivo: O objetivo deste estudo é comparar os resultados clínicos da abordagem septal superior com a atriotomia esquerda convencional em pacientes submetidos à cirurgia valvar mitral. Métodos: Entre janeiro de 2010 e novembro de 2012, foi incluído um total de 91 pacientes adultos consecutivos (intervalo de 16 a 82 anos, média 54,0±15,4 anos; 39 homens, 52 mulheres) submetidos à cirurgia valvar mitral no Serviço de Cirurgia Cardiovascular no Hospital Training Koşuyolu. Os pacientes foram randomizados para abordagem septal superior (n=47) ou atriotomia esquerda convencional (n=44). Foram registradas características demográficas dos pacientes, comorbidades, intervenções adicionais, dados intraoperatórios, achados do estudo eletrofisiológico pré e pós-operatório e complicações pós-operatórias. Resultados: Do total de pacientes, 86,7% (n=79) estavam na Classe III e 12 na Classe IV da New York Heart Association. Todos os pacientes foram submetidos à anuloplastia (42,9%) ou cirurgia de troca valvar (57,1%). Não houve diferença significativa nos resultados do eletrocardiograma pré e pós-operatórios entre os grupos. Mudança da linha de base no ritmo cardíaco foi estatisticamente significativa apenas no grupo abordagem septal superior (P<0,001). Não houve diferença estatisticamente significativa na taxa de mortalidade entre os grupos. Marca-passo definitivo foi implantado em 10,6% dos pacientes no grupo abordagem septal superior e em 4,5% dos pacientes no grupo atriotomia esquerda convencional. Não houve diferença estatisticamente significativa no sangramento, tempo total de internação e de permanência na UTI, tendo sido observada síndrome de baixo débito cardíaco entre os grupos. Conclusão: Nossos resultados sugerem que a ...
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Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Septos Cardíacos/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Eletrocardiografia , Átrios do Coração/fisiopatologia , Átrios do Coração/cirurgia , Septos Cardíacos/fisiopatologia , Doenças das Valvas Cardíacas/fisiopatologia , Tempo de Internação , Valva Mitral/fisiopatologia , Período Pós-Operatório , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Resultado do TratamentoRESUMO
Objetivo: describir las características epidemiológicas y los resultados del tratamiento quirúrgico de los defectos septales atriales en los pacientes intervenidos por esta patología en un centro de alta complejidad en Colombia. Métodos: estudio observacional de tipo descriptivo, retrospectivo, de una cohorte que incluye todos los pacientes intervenidos mediante cirugía por defectos septales atriales en el periodo comprendido entre octubre de 1996 y julio de 2012. Resultados: se incluyeron en total 329 pacientes, de los cuales 216 (65,6%) pertenecía al género femenino. La mediana de la edad fue de 34 años (RIC 15-49). El 77,8% de los defectos fueron tipo ostium secundum. En 80% se realizó reparo del defecto mediante parche de pericardio autólogo. En 7,6% de los casos se utilizó técnica de cirugía cardiaca mínimamente invasiva. Se realizaron cuatro cirugías de rescate (1,21%) por complicaciones relacionadas con la colocación de dispositivos percutáneos. Se documentó una sola muerte intraoperatoria (tasa de mortalidad del 0,3%) y una morbilidad global asociada de 7,6%, sin ninguna secuela y representada por: reintervención por sangrado en ocho casos (2,4%), infección profunda de la herida esternal en tres pacientes (0,9%), empiema en tres pacientes (0,9%), colecciones pleurales residuales en cuatro pacientes (1,2%), infecciones superficiales en cinco pacientes (1,5%), disección arterial femoral secundaria a canulación arterial en un paciente (0,3%) y bloqueo cardiaco completo con necesidad de marcapaso permanente en un paciente (0,3%). La mediana del tiempo de estancia en UCI fue de 24 horas (RIC 20 – 25). La mediana del tiempo de ventilación mecánica fue de 3 horas (RIC 0-5). La mediana del tiempo de estancia hospitalaria fue de 4 días (RIC 3-5). Conclusiones: los resultados obtenidos reflejan que en nuestro medio la corrección quirúrgica de los defectos septales atriales es segura y efectiva, con una tasa de mortalidad con tendencia al 0% y una muy baja morbilidad asociada, acorde con los estándares internacionales. De igual forma, la cirugía cardiaca mínimamente invasiva ha permitido mejorar los resultados del procedimiento y ha tenido gran aceptación por parte de los pacientes, por lo que constituye el abordaje de elección actual para el manejo quirúrgico de esta patología en el servicio de Cardiología de la institución.
Objective: to describe the epidemiological characteristics and outcomes of surgical treatment of atrial septal defects in patients operated for this condition on a tertiary care center in Colombia. Methods: an observational, descriptive, retrospective study of a cohort including all patients undergoing surgery for atrial septal defects in the period between October 1996 and July 2012. Results: we included a total of 329 patients, were 216 (65.6%) were female. The mean age was 34 years (IQR 15-49). 77.8% of the defects were ostium secundum type. In 80% the defect repair was performed using autologous pericardial patch. In 7.6% of cases we used minimally invasive cardiac surgery technique. Four rescue surgeries (1.21%) were performed due to complications related to the placement of percutaneous devices. We documented only one operative death (mortality rate 0.3%) and an associated overall morbidity of 7.6% without any sequelae and represented by re-operation for bleeding in eight cases (2.4%), deep sternal wound infection in three patients (0.9%), empyema in three patients (0.9%), residual pleural collections in four patients (1.2%), superficial infections in five patients (1.5%), femoral arterial dissection secondary to arterial cannulation in one patient (0.3%) and complete heart block requiring permanent pacemaker in one patient (0.3%). The median length of stay in ICU was 24 hours (IQR 20-25). The median duration of mechanical ventilation was 3 hours (IQR 0-5). The median hospital stay was 4 days (IQR 3-5). Conclusions: the results obtained show that in our environment, surgical correction of atrial septal defects is safe and effective, with a mortality rate tending to 0% and a very low associated morbidity, in line with international standards. Similarly, minimally invasive cardiac surgery has improved the results of the procedure and has been widely accepted by the patients, thus constituting the current preferred approach in the Cardiology service of the institution for the surgical management of this pathology.
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Septo Interatrial , Cirurgia Torácica , Morbidade , MortalidadeRESUMO
Fundamento: el defecto de septación auricular, también conocido con el término de comunicación interauricular es la cardiopatía congénita más frecuente en la edad adulta con predominio en el sexo femenino sobre el masculino. Muchos de los niños y jóvenes con comunicación interauricular se encuentran asintomáticos y los hallazgos físicos son insignificantes, por lo que la supervivencia hasta la edad adulta es la norma. Objetivo: profundizar en los diversos aspectos anatómicos, fisiopatológicos y clínicos de los pacientes adultos con defecto de septación auricular, con vistas a facilitar un diagnóstico precoz y un manejo adecuado por sus médicos de asistencia. Desarrollo: se realizó una revisión bibliográfica acerca del tema en las que se utilizaron las bases de datos de Medline e Hinari. La sobrecarga volumétrica crónica de las cavidades derechas puede tener efectos deletéreos, tales como arritmias auriculares, enfermedad vascular pulmonar irreversible y, eventualmente insuficiencia cardiaca y embolismos paradójicos. La ecocardiografía transesofágica constituye la técnica de elección para evaluar la localización anatómica de la comunicación interauricular y su relación con las estructuras vecinas. Conclusiones: el diagnóstico de una comunicación interauricular se realiza a partir de criterios clínicos, ecocardiográficos y angiográficos. El cierre de una comunicación interauricular ostium primum y seno venoso se realiza exclusivamente a través de la vía quirúrgica. La vía de elección para el cierre de una comunicación interauricular ostium secundum, siempre y cuando cumpla con determinados criterios, es la percutánea donde el Amplatzer septal occluder el dispositivo más utilizado. El cierre de un defecto septal auricular esta contraindicado en pacientes con hipertensión pulmonar secundaria también denominada fisiología de Eisenmenger.
Background: atrial septal defect also known as atrial communication is the most frequent congenital cardiopathy in adults with marked prevalence in women. Many of children and young people with atrial septal defects are asymptomatic and physical findings are insignificant, that´s why survival until the adulthood is the norm. Objective: to deepen knowledge on the diverse anatomical, psychopathological, clinical and diagnostic aspects of the adult’s patients with atrial septal defects with a view to provide an early diagnosis and an appropriate management by their primary physicians. Development: a bibliographic review on the subject was performed. Medline and HINARI databases were used. The chronic volumetric overdrive of the right cardiac cavities may cause deleterious effects such as atrial arrhythmias, irreversible lung vascular disease and, possibly heart failure and paradoxical embolisms. The transesophageal echocardiography constitutes the election technique to evaluate the anatomical localization of the atrial septal defect and its relationship with neighbour’s structures. Conclusions: the diagnosis of an atrial septal defect is carried out starting from clinical, echocardiography and angiography criteria. The closure of an atrial septal defect ostium primum and sinus venosus types is carried out exclusively through the surgical way. The closure of an atrial septal defect ostium secundum provided it meets certain criteria, is the percutaneous one, being the Amplatzer septal occluder device the most commonly used. The closure of atrial septal defect is contraindicated in patients with secondary pulmonary hypertension also called Eisenmenger physiology.