Assuntos
COVID-19/diagnóstico , Ruptura Cardíaca/diagnóstico , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/terapia , Infarto do Miocárdio/diagnóstico , Idoso , COVID-19/complicações , COVID-19/fisiopatologia , COVID-19/terapia , Diagnóstico Tardio , Diagnóstico Diferencial , Feminino , Ruptura Cardíaca/fisiopatologia , Ruptura Cardíaca/terapia , Humanos , Insuficiência da Valva Mitral/genética , Insuficiência da Valva Mitral/fisiopatologia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Resultado do TratamentoRESUMO
Left ventricular rupture is an infrequent but potentially fatal complication of mitral valve replacement. In spite of the fact that several methods of repair have previously been described, the mortality rate remains nearly 85%. The use of the intra-aortic balloon pump counterpulsation may increase the possibilities of success in the repair of this dreaded complication. We present here three cases of left ventricular rupture associated to mitral valve prosthesis implantation successfully treated with the aid of intra-aortic balloon pump counterpulsation.
Assuntos
Ruptura Cardíaca/terapia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Balão Intra-Aórtico/métodos , Valva Mitral/cirurgia , Idoso , Feminino , Ruptura Cardíaca/etiologia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Despite safer surgical procedures, left ventricular rupture remains a rare but potentially lethal complication of mitral valve replacement. The use of fibrin sealant has substantially improved the outcome of many difficult bleeding episodes after cardiac surgery. We describe a case of left ventricular rupture successfully treated with fibrin sealant combined with external Teflon-pledgeted sutures.
Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Ruptura Cardíaca/terapia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hemostasia Cirúrgica/métodos , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Adesivos Teciduais/uso terapêutico , Desenho de Equipamento , Feminino , Ruptura Cardíaca/etiologia , Ruptura Cardíaca/patologia , Ventrículos do Coração/patologia , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Estenose da Valva Mitral/complicações , Politetrafluoretileno , Índice de Gravidade de Doença , Suturas , Resultado do TratamentoRESUMO
We describe two women with interventricular septal rupture secondary to a myocardial infarction due to a total obstruction of the anterior descendent coronary artery. With the aim to stabilize the hemodynamic state of the patients before the surgical closure of the defect, we inserted a balloon-catheter introducing it to the left ventricle from the aorta and inflating it in the right ventricle after passing it through the septal orifice. After occlusion, we observed decreases in the pulmonary to systemic blood flow ratio (6% in one patient and 26% in the other) and in the arteriovenous blood flow shunt (8 and 31%); a 10% systemic blood flow increase was observed in one patient. Since the pulmonary arterial pressure did not change and the pulmonary blood flow increased, an increase of the pulmonary arterial resistance was observed but no modification of the pulmonary and systemic arterial pressure occurred. In the following days, the oxymetric differences between the pulmonary artery and the right atrium showed a tendency to remain below the figures before occlusion and the pulmonary blood flow and pressure showed a tendency to decrease. One patient died 14 days after the surgical closure of the rupture, and the other, seven days after the balloon occlusion of the rupture before any surgery. We present the physiological evolution of the patients.
Assuntos
Ruptura Cardíaca/etiologia , Septos Cardíacos/patologia , Infarto do Miocárdio/complicações , Idoso , Cateterismo Cardíaco , Cateterismo , Terapia Combinada , Vasos Coronários/patologia , Diabetes Mellitus Tipo 2/complicações , Evolução Fatal , Feminino , Ruptura Cardíaca/sangue , Ruptura Cardíaca/cirurgia , Ruptura Cardíaca/terapia , Septos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Oxigênio/sangue , Cuidados Paliativos , Complicações Pós-Operatórias , Próteses e Implantes , Circulação Pulmonar , Telas CirúrgicasRESUMO
Las secuelas tempranas o tardias que se desarrollan en los pacientes que han sufrido un trauma cardiaco, son relativamente frecuentes. Estas lesiones comunmente pasan inadvertidas en el momento del trauma y se diagnostican posteriormente mediante la aparicion de un soplo cardiaco o una falla cardiaca refractaria. En esta revision se informa de dos casos tratados con exito por la Seccion de Cirugia Cardiovascular del Hospital Universitario San Juan de Dios. Se analizan la incidencia, el diagnostico y el tratamiento de este tipo de lesiones
Assuntos
Adulto , Humanos , Masculino , Feminino , Traumatismos Cardíacos , Fístula Arteriovenosa/terapia , Colômbia , Ecocardiografia , Traumatismos Cardíacos/complicações , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Traumatismos Cardíacos/terapia , Ruptura Cardíaca/cirurgia , Ruptura Cardíaca/terapiaRESUMO
Septal rupture (SR) during acute myocardial infarction (AMI) was found in 23 patients of 4 300 consecutive cases of AMI. In 55% the SR was diagnosed clinically by the appearance of a murmur, in 23% by shock and in 22% by heart failure. Eventually every patient developed a pan-systolic murmur. In 82% of the cases the murmur was best heard at the lower left sternal border. In half of the patients the location of the murmur suggested the possibility of papilary muscle rupture or dysfunction. In 68% of cases the rupture occurred during the first week after the onset of AMI. Cardiac catheterization was performed in 17 patients, pulmonary hypertension was found in all of them. Pulmonary blood flow was twice the systemic blood flow (P less than 0.005). Coronary angiograms performed in 6 patients showed three vessel disease in 5 cases. Five patients underwent surgery. Three of them survived. All of the 17 patients who had medical treatment died. Ten within the first week after AMI, 5 within the first month and 2 late deaths. Autopsy was performed in 15 cases. Eighty percent had coronary narrowing in several vessels. SR measured between 5 and 20 millimeters in 78% and was found in the anterior septum in 61%. In the cases who were in shock, the ventricular myocardium was extensively damaged. We conclude that once the diagnosis of SR is established, the patient should undergo surgical closure of the SR and coronary revascularization if necessary. Early surgical indication is particularly important in patients at risk of developing shock.