ABSTRACT
Background: Currently, there is a spreading worldwide tendency to characterize health issues and to propose alternative solutions via the creation of computerized databases. The aim of this study was to present the results in a computerized database of pediatric cardiac surgeries developed under the auspices of the Mexican Association of Specialists in Congenital Heart Diseases (Asociación Mexicana de Especialistas en Cardiopatías Congénitas A.C) and coordinated by the collegiate group of Pediatric Cardiology and Surgery as petitioned by the National Institutes of Health and High Specialty Hospitals Coordinating Commission. Methods: We analyzed all cases registered in the database during a 1-year observation period (August 1, 2011 to July 31, 2012) by all major Health Ministry-dependent institutes and hospitals offering surgical services related to pediatric cardiopathies to the non-insured population. Results: Seven institutions participated voluntarily in completing the database. During the analyzed period, 943 surgeries in 880 patients with 7% reoperations (n = 63) were registered. Thirty-eight percent of the surgeries were performed in children <1 year of age. The five most common cardiopathies were patent ductus arteriosus (n = 96), ventricular septal defect (n = 86), tetralogy of Fallot (n = 72), atrial septal defect (n = 68), and aortic coarctation (n = 54). Ninety percent of surgeries were elective and extracorporeal circulation was used in 62% of surgeries. Global mortality rate was 7.5% with the following distribution in the RACHS-1 score categories: 1 (n = 4, 2%), 2 (n = 19, 6%), 3 (n = 22, 8%), 4 (n = 12, 19%), 5 (n = 1, 25%), 6 (n = 6, 44%), and non-classifiable (n = 2, 9%). Conclusions: This analysis provides a representative view of the surgical practices in cardiovascular diseases in the pediatric population at the national non-insured population level. However, incorporating other health institutions to the national registry database will render a more accurate panorama of the national reality in surgical practices in the population <18 years of age.
ABSTRACT
Los aneurismas de la arteria innominada son una entidad poco frecuente. Los mecanismos patogénicos son variados y los pacientes suelen cursar asintomáticos, aunque pueden presentar diversos cuadros clínicos. El tratamiento quirúrgico depende de las características anatómicas y debe realizarse para prevenir las complicaciones. Se describe el caso de un hombre de 77 años de edad con angina inestable por aterosclerosis coronaria y enfermedad multivascular, en quien incidentalmente durante una revascularización miocárdica se encontró un aneurisma sacular con un diámetro de 2 cm en el origen de la arteria innominada. Después de la revascularización, una vez fuera de la derivación cardiopulmonar y en el mismo tiempo quirúrgico, se realizó aneurismorrafia sin complicaciones, con resultados satisfactorios y sin secuelas neurológicas.
Innominate artery aneurysms are an uncommon pathology. There are several pathogenic mechanisms involved in their formation, and patients are usually asymptomatic. However, different clinical presentations are possible. Management varies according to anatomic characteristics. Surgical treatment is recommended in order to avoid complications. We present a case of a patient with an innominate artery aneurysm found incidentally during surgery for myocardial revascularization. A 77-year-old male with unstable angina secondary to multivascular ischemic heart disease was subjected to surgery. Coronary angiography did not evaluate the aortic arch and its branches. During the surgical procedure we found a 2-cm saccular aneurysm at the origin of the innominate artery. After completing the revascularization procedure and once the patient was no longer on cardiopulmonary bypass, aneurysmorrhaphy was successfully done.