Assuntos
Doenças Fetais/diagnóstico por imagem , Hidropisia Fetal/diagnóstico por imagem , Pneumopatias/congênito , Pulmão/embriologia , Linfangiectasia/congênito , Ultrassonografia Pré-Natal , Adulto , Aberrações Cromossômicas , Diagnóstico Diferencial , Feminino , Doenças Fetais/patologia , Humanos , Hidropisia Fetal/etiologia , Pulmão/patologia , Pneumopatias/embriologia , Pneumopatias/patologia , Linfangiectasia/embriologia , Linfangiectasia/patologia , Linfangioma Cístico/diagnóstico por imagem , Linfangioma Cístico/embriologia , Medição da Translucência Nucal , GravidezAssuntos
Neoplasias Cardíacas/secundário , Melanoma/secundário , Adulto , Diagnóstico Diferencial , Ecocardiografia , Evolução Fatal , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/fisiopatologia , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/fisiopatologia , Metástase NeoplásicaAssuntos
Ecocardiografia Transesofagiana/métodos , Átrios do Coração , Neoplasias Cardíacas/complicações , Embolia Intracraniana/etiologia , Células Neoplásicas Circulantes , Sarcoma/complicações , Biópsia por Agulha , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundário , Diagnóstico Diferencial , Ecocardiografia Doppler , Endossonografia , Lobo Frontal/patologia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Embolia Intracraniana/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cintilografia , Sarcoma/diagnóstico , Sarcoma/secundário , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/secundárioRESUMO
We report a case of general anesthesia for transurethral resection of the bladder in a 74-year-old male patient with uncorrected tetralogy of Fallot. This case illustrates the pertinent pathophysiology of the complex cardiac lesion related to tetralogy of Fallot as well as the feasibility and issues with regard to the anesthetic management.
Assuntos
Anestesia , Cistectomia/métodos , Tetralogia de Fallot/complicações , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Estudos de Viabilidade , Humanos , Masculino , Tetralogia de Fallot/fisiopatologia , Neoplasias da Bexiga Urinária/complicaçõesRESUMO
BACKGROUND: Transcatheter techniques have evolved as alternatives to surgical closure of interatrial communications due to its less invasive nature and low morbidity. The technique may be limited by the inability to deploy the device and, thus, may be complicated by significant residual shunting. Mobile or redundant septal tissue has been implicated as a possible cause of unsuccessful closure. METHODS: To determine if atrial septal hypermobility precludes successful transcatheter device closure of interatrial communications, 69 patients (mean age 46.4 +/- 17.5 years [male:female ratio 34:35]) with periprocedural transesophageal echocardiograms were reviewed. Septal excursion was defined as the maximal transit of the interatrial septum between either side of the plane connecting the superior and inferior attachment points. Unsuccessful closure was defined as subsequent cardiac surgery to close the defect, inability to deploy the device, recurrent attempts at closure, device malalignment, residual shunting greater than mild in degree on follow-up transthoracic study, and procedural complications. RESULTS: Reasons for closure were the following: embolic events (n = 48); platypnea/orthodeoxia (n = 15); atrial septal defect with right ventricular dilatation and paroxysmal atrial tachycardia (n = 2); atrial septal defect (n = 3); and prophylactic patent foramen ovale closure in a scuba diver (n = 1). Successful closure occurred in 76% of patients (n = 53). Compared with those patients with successful transcatheter closure, the mean septal excursion in patients with failed closure was 0.66 +/- 0.56 cm versus 0.76 +/- 0.47 cm (P = not significant [NS]). CONCLUSION: Our results do not support the concern that exaggerated septal mobility compromises successful device closure of interatrial communications.
Assuntos
Oclusão com Balão/métodos , Ecocardiografia Transesofagiana/métodos , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/terapia , Adulto , Cateterismo Cardíaco , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Probabilidade , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Adenocarcinoma/patologia , Isquemia Encefálica/etiologia , Infarto Cerebral/etiologia , Endocardite/etiologia , Neoplasias Hepáticas/patologia , Fígado/patologia , Adenocarcinoma/complicações , Adenocarcinoma/secundário , Afasia/etiologia , Transtornos da Coagulação Sanguínea/complicações , Encéfalo/patologia , Isquemia Encefálica/diagnóstico , Infarto Cerebral/diagnóstico , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Evolução Fatal , Cefaleia/etiologia , Hemiplegia/etiologia , Humanos , Rim/diagnóstico por imagem , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Síndrome , Tromboflebite/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Percutaneous transcatheter closure of patent foramen ovale (PFO) is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with paradoxical embolism and PFO. METHODS AND RESULTS: We report the immediate and long-term clinical and echocardiographic outcome of 110 consecutive patients (58 males, mean age 47+/-14 years) who underwent transcatheter closure of PFO because of paradoxical embolism between 1995 and 2001. Procedural success, defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement), was achieved in all (100%) patients. There was no in-hospital mortality, 1 device migration requiring surgical intervention (0.9%), and 1 episode of cardiac tamponade (0.9%) requiring pericardiocentesis. A progressive increment in full occlusion was observed (44%, 51%, 66%, and 71% at 1 day, 6 months, and 1 and 2 years, respectively, after device placement). At a mean follow-up of 2.3 years, 2 patients experienced recurrent neurological events (1 fatal stroke and 1 transient ischemic attack), representing an annual risk of recurrence of 0.9%. In addition, 4 (3.6%) of the patients required reintervention for device malalignment or significant shunt. Kaplan-Meier analysis showed a freedom from recurrent embolic events and reintervention of 96% and 90% at 1 and 5 years, respectively. CONCLUSIONS: Transcatheter closure of PFO is a safe and effective therapy for patients with paradoxical embolism and PFO. It is associated with a high success rate, low incidence of hospital complications, and low frequency of recurrent systemic embolic events.