RESUMO
The Waterston anastomosis has been performed with no deaths in 11 consecutive neonates during the past 24 months. Seven neonates had pulmonary atresia with either single ventricle or hypoplastic right ventricle, 3 had tetralogy of Fallot, and one had severe pulmonary stenosis with a normal right ventricle. Six neonates were one day old and only one was older than 7 days. All have obtained symptomatic and documented (increase Po2) benefit. This level of success is attributed to (1) minimal delay between the recognition of cyanosis and operation (mean time between hospital admission and catheterization was 3 hours and between catheterization and operation, 4 hours); (2) correction of any base deficit prior to, during, and after operation; (3) accurate construction of the anastomosis to avoid excessive size, and (4) careful postoperative management of the pulmonary subsystem by experienced personnel. We have demonstrated that the high mortality rate previously reported for the Waterston anastomosis in the neonate can be markedly improved by an appropriate patient management program.
Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Cardiopatias Congênitas/cirurgia , Doenças do Recém-Nascido/cirurgia , Aorta Torácica/cirurgia , Gasometria , Cianose/cirurgia , Seguimentos , Humanos , Hipóxia/cirurgia , Lactente , Recém-Nascido , Pulmão/anormalidades , Derrame Pericárdico/cirurgia , Cuidados Pós-Operatórios , Valva Pulmonar/anormalidades , Tetralogia de Fallot/cirurgia , Veia Cava Superior/cirurgiaAssuntos
Procedimentos Cirúrgicos Cardíacos/instrumentação , Sistema de Condução Cardíaco/cirurgia , Eletricidade , Eletrocardiografia/instrumentação , Eletrofisiologia , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/prevenção & controle , Sistema de Condução Cardíaco/anatomia & histologia , Sistema de Condução Cardíaco/fisiologia , Marca-Passo Artificial , Complicações Pós-Operatórias/prevenção & controleAssuntos
Glucose/uso terapêutico , Insulina/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Potássio/uso terapêutico , Animais , Cálcio/sangue , Cloretos/sangue , Cães , Cardioversão Elétrica , Eletrocardiografia , Pancreatectomia , Fosfatos/sangue , Potássio/sangue , Sódio/sangue , Fatores de Tempo , Fibrilação Ventricular/tratamento farmacológicoAssuntos
Comunicação Interventricular/cirurgia , Artéria Pulmonar/cirurgia , Animais , Aorta Torácica/fisiopatologia , Velocidade do Fluxo Sanguíneo , Determinação da Pressão Arterial , Débito Cardíaco , Cães , Eletrocardiografia , Comunicação Interventricular/fisiopatologia , Humanos , Artéria Pulmonar/fisiopatologiaAssuntos
Cardiomegalia/diagnóstico , Átrios do Coração/anormalidades , Cardiopatias Congênitas/diagnóstico , Estenose da Valva Mitral/congênito , Angiocardiografia , Cateterismo Cardíaco , Ecocardiografia , Eletrocardiografia , Circulação Extracorpórea , Átrios do Coração/cirurgia , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Masculino , Estenose da Valva Mitral/cirurgiaAssuntos
Aorta Abdominal/cirurgia , Aneurisma Aórtico/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/mortalidade , Arteriosclerose/complicações , Humanos , Métodos , Infarto do Miocárdio/mortalidade , Complicações Pós-Operatórias , Radiografia , Tromboembolia/complicaçõesRESUMO
Study was made of 95 survivors of aortic valve replacement during the early years of this procedure (1964 to 1970). The average follow-up time was 50.2 months. Survival was not related to hemodynamic parameters, such as cardiac index or left ventricular pressure, and did not appear to be influenced by the type of preoperative valve lesion. A history of angina pectoris and a New York Heart Association Class IV grouping were associated with shorter survival. Associated coronary artery disease was a leading cause of death in those patients surviving less than 2 years and angina pectoris the leading cause of morbidity in the long-term survivors. Sudden death occurred in five patients. Once a patient survived 36 months after the operation, the prognosis was excellent.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica , Próteses Valvulares Cardíacas , Adulto , Idoso , Insuficiência da Valva Aórtica/mortalidade , Débito Cardíaco , Doença das Coronárias/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Fatores de TempoRESUMO
A 66-year-old man developed fever, chills, myalgias, three erythematous skin lesions, and transient left eyelid lag. Because of persistent fever, he was hospitalized 4 weeks after the onset of disease; a peripheral blood smear showed Babesia microti in 3% of his erythrocytes. Eighteen hours later, he died unexpectedly. Autopsy showed pancarditis with a diffuse lymphoplasmacytic infiltrate, and spirochetes were found in the myocardium. Antibody titers to both the Lyme disease spirochete Borrelia burgdorferi and Babesia microti were elevated. The finding of spirochetes in the myocardium and the elevated antibody titers to Borrelia burgdorferi suggest that the patient died from cardiac involvement of Lyme disease.
Assuntos
Babesiose/complicações , Cardiopatias/etiologia , Coração/microbiologia , Doença de Lyme/complicações , Idoso , Animais , Anticorpos Antibacterianos/análise , Borrelia/imunologia , Endocardite/etiologia , Cardiopatias/microbiologia , Humanos , Doença de Lyme/microbiologia , Masculino , Miocardite/etiologia , Pericardite/etiologiaRESUMO
Between 20 July and 15 Octoboer 1975, five cases of human infection with Babesia microti were diagnosed on Nantucket Island, Massachusetts. The illness was characterized by fever, drenching sweats, shaking chills, myalgia, arthralgia, extreme fatigue, and a mild-to-moderate hemolytic anemia. None of the patients had a history of splenetomy. Although all patients responded symptomatically to treatment with oral chloroquine phosphate, parasitemia and fatigue frequently persisted for several weeks to months.