ABSTRACT
Infective endocarditis involving the aortic root is associated with a high degree of morbidity and mortality. Native aortic root infections can develop from aggressive organisms or from delays in diagnosis or definitive care, whereas prosthetic valve infections commonly result in extensive destruction of the aortic root and neighboring structures. Early detection, tailored antibiotic therapy, thoughtful pre-operative planning, and multidisciplinary heart team management are the keys to optimizing patient outcomes. Aggressive and complete surgical debridement are mandatory prior to aortic root reconstruction. Surgical experience and patient-centered decision making are critical in selecting the optimal reconstructive strategy for the aortic root and adjacent structures. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-023-01604-6.
ABSTRACT
Agricultural systems have experienced rapid expansion and intensification in the last several decades. In Uruguay, since the beginning of 2000, the most common cropping systems have included soybeans. Currently, this crop is expanding towards lowlands traditionally occupied by rice in rotation with pastures. However, the environmental effects of agricultural intensification and diversification are not well known. Thus, some indices have been proposed to quantify the changes in agricultural production systems and assess water quality. The main goal of this study was to develop a water quality index (WQI) to assess the impacts of the diversification of rice production systems in northwest Uruguay. The study was carried out in an agricultural basin where other summer crops have been incorporated in the rice-pasture sequence. Agriculture intensification and crop diversification indices were calculated using information provided by farmers. Water samples were collected downstream of the production area before crop sowing and after crop harvest (2008-2009 to 2010-2011 and 2016-2017 to 2017-2018). Biochemical oxygen demand, nitrates, total phosphorus, fecal coliforms, and total suspended solids were the variables that mainly explained the effects of the agricultural activities on water quality. The proposed water quality index included these unweighted variables, which allowed for the pre-sowing and post-harvest to be differentiated, as well as the degree of diversification. Therefore, the proposed WQI constitutes a tool that can be used to evaluate the water quality in an agricultural basin. Likewise, it can be used to select agricultural sequences that generate the least possible impacts on the associated water resources.
Subject(s)
Agriculture , Crops, Agricultural , Environmental Monitoring/methods , Water Quality , Conservation of Natural Resources , Farmers , Nitrates/chemistry , Oryza , Phosphorus/chemistry , Seasons , UruguayABSTRACT
Introducción: Durante los últimos años múltiples pacientes con diagnóstico de corazón univentricular han sido tratados quirúrgicamente en nuestra institución mediante una anastomosis cavopulmonar total, de acuerdo al protocolo de corrección quirúrgica por etapas. Objetivo: Evaluar los resultados postoperatorios y la sobrevida de pacientes con síndrome de hipoplasia de corazón izquierdo (SHCI) sometidos a la operación de Fontan en comparación con pacientes con otras formas de corazón univentricular. Pacientes y método: Ciento dos pacientes fueron sometidos a la operación de Fontan entre abril de 1996 y marzo de 2014, 25 con SHCI (grupo I) y 77 con otras formas de corazón univentricular (grupo II). Se analizó la sobrevida, variables demográficas, estudio hemodinámico, morbimortalidad quirúrgica, ventilación mecánica, uso de drenajes, estancia postoperatoria, score de isótropos, necesidad de marcapasos y necesidad de revertir el Fontan take down. Resultados: La mortalidad perioperatoria fue del 4% (n = 1) para el grupo I y del 7,8% (n = 6) para el grupo II (p = 0,451). La única diferencia encontrada fue la estancia hospitalaria, siendo de 17 días (6-47) para el grupo I y 12 (5-103) para el grupo II(p = 0,017). El seguimiento promedio fue de 4,24 ± 2,08 años para el grupo I y de 8,7 ± 4,67 para el grupo II. La sobrevida a 8 años para ambos grupos fue de 88% y de 81% a 10 años para el grupo II. Conclusiones: La cirugía de Fontan tuvo una mortalidad similar en pacientes con SHCI en comparación con aquellos con otras formas de corazón univentricular, mientras que el primer grupo tuvo una mayor estancia hospitalaria. La sobrevida a largo plazo fue similar para ambos grupos.
Introduction: During the last few years, numerous patients with univentricular heart disease have been treated surgically with total cavopulmonary anastomosis according to a staged surgery protocol in our institution. Objective: To evaluate the perioperative outcomes and survival of patients with hypoplastic left heart syndrome (HLHS) after the Fontan procedure and compare them with other types of univentricular heart disease. Patients and method: A total of 102 patients underwent a Fontan procedure between April 1996 and March 2014, 25 with HLHS (group I), and 77 patients with other types of univentricular heart disease (group II). Groups survival, demographics, hemodinamic studies, morbimortality, mechanical ventilation, surgical drains, post-operative stay, isotopes score, pacemaker use, and requiriment of Fontan takedown were analyzed. Results: Intraoperative mortality was 4% (n = 1) for group I, and 7.8% (n = 6) for group II (P = .451). A difference was only found in hospital length of stay (LOS), being 17 days (6-47) for group I and 12 days (5-103) for group II (P = .017). Mean follow-up was 4.24 ± 2.08 years for group I, and 8.7 ± 4.67 for group II. Survival rate at 8 years for both groups was 88%, and 81% at 10 years for group II. Conclusions: The Fontan procedure had similar mortality, but longer LOS, in patients with HLHS compared to those with another types of single ventricle anatomy. Long term survival was comparable between both groups.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Young Adult , Hypoplastic Left Heart Syndrome/surgery , Fontan Procedure/methods , Heart Defects, Congenital/surgery , Time Factors , Survival Rate , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Hospital Mortality , Hypoplastic Left Heart Syndrome/mortality , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/mortality , Intraoperative Complications/epidemiologyABSTRACT
INTRODUCTION: During the last few years, numerous patients with univentricular heart disease have been treated surgically with total cavopulmonary anastomosis according to a staged surgery protocol in our institution. OBJECTIVE: To evaluate the perioperative outcomes and survival of patients with hypoplastic left heart syndrome (HLHS) after the Fontan procedure and compare them with other types of univentricular heart disease. PATIENTS AND METHOD: A total of 102 patients underwent a Fontan procedure between April 1996 and March 2014, 25 with HLHS (group I), and 77 patients with other types of univentricular heart disease (group II). Groups survival, demographics, hemodinamic studies, morbimortality, mechanical ventilation, surgical drains, post-operative stay, isotopes score, pacemaker use, and requiriment of Fontan takedown were analyzed. RESULTS: Intraoperative mortality was 4% (n=1) for group I, and 7.8% (n=6) for group II (P=.451). A difference was only found in hospital length of stay (LOS), being 17 days (6-47) for group I and 12 days (5-103) for group II (P=.017). Mean follow-up was 4.24±2.08 years for group I, and 8.7±4.67 for group II. Survival rate at 8 years for both groups was 88%, and 81% at 10 years for group II. CONCLUSIONS: The Fontan procedure had similar mortality, but longer LOS, in patients with HLHS compared to those with another types of single ventricle anatomy. Long term survival was comparable between both groups.