RESUMO
Ventricular septal rupture (VSR) complicates acute myocardial infarction (AMI) in less than 0.2% of cases and is usually surgically managed by endocardial patch repair with infarct exclusion. Although successful in 80% of cases, failure of patch repair (often because of patch dehiscence) results in attempts at percutaneous closure as reoperative mortality can be as high as 40%. We describe a case of an AMI in a 63-year-old male with resultant VSR that required repeat surgical patch repair secondary to recurrent leak. We discuss the management of recurrent leaks and surgical techniques aimed at decreasing residual defects.
Assuntos
Fístula Anastomótica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte de Artéria Coronária/métodos , Infarto do Miocárdio/cirurgia , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/cirurgia , Fístula Anastomótica/diagnóstico por imagem , Angiografia Coronária/métodos , Ponte de Artéria Coronária/efeitos adversos , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Seguimentos , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Ruptura Cardíaca Pós-Infarto/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: Prognostic factors and risk factors for positive sentinel lymph node (SLN) biopsy results are important to identify in superficial spreading melanoma (SSM). METHODS: A single-center database and a prospective clinical trial database were reviewed for all patients with diagnoses of SSM. Logistic regression, Kaplan-Meier survival analysis, and univariate and multivariate Cox models were used. RESULTS: A total of 1,643 patients with SSM were identified. Independent risk factors for positive SLN biopsy results were Breslow thickness (BT) ≥2.0 mm, age <60 years, and presence of ulceration. BT ≥2.0 mm, ulceration, lymphovascular invasion, and positive SLN and positive non-SLN biopsy results were independent risk factors for worse disease-free survival. Independent overall survival risk factors included BT ≥2.0 mm, age ≥60 years, ulceration, nonextremity tumor location, lymphovascular invasion, and positive SLN biopsy results. CONCLUSIONS: BT, ulceration, lymphovascular invasion, and SLN and non-SLN status are important risk factors for SSM.