Assuntos
Aorta Torácica/diagnóstico por imagem , Doenças Respiratórias , Anel Vascular , Adulto , Humanos , Imageamento Tridimensional , Masculino , Doenças Respiratórias/complicações , Doenças Respiratórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Anel Vascular/complicações , Anel Vascular/diagnóstico por imagemRESUMO
AIM: The aim of the study is to evaluate extracorporeal life support system (ECLS) employed in neonates in pediatric cardiac intensive care unit. MATERIAL AND METHODS: Twenty-five neonates that required ECLS in between November 2010 and November 2015 were evaluated. RESULTS: The median age was 12 days (range 3-28 days) and the median body weight was 3 kg (range 2.5-5 kg). Venoarterial ECLS was performed in all of the cases. Ascendan aorta-right atrial cannulation in 22 patients and neck cannulation in three patients were performed. The reason for ECLS was E-CPR in two patients, inability to wean from cardiopulmonary bypass (CPB) in seven patients, respiratory insufficiency and hypoxia in nine patients, low cardiac output (LCOS) in seven patients. Median duration of ECLS was four days (range 1-15). Hemorrhagic complications developed in 15, renal complications in 13, pulmonary complications in 12, infectious complications in 11, neurologic complications in three and mechanical complications in two of the patients. Weaning was successful in 15 of the patients. Eleven patients were successfully discharged. CONCLUSION: ECLS is an important treatment option that is performed successfully in many centers around the world to maintain life support in patients unresponsive to medical treatment. The utilization of this modality especially in newborns with congenital heart disease should be taken into consideration.
Assuntos
Baixo Débito Cardíaco/terapia , Oxigenação por Membrana Extracorpórea/métodos , Cardiopatias Congênitas/terapia , Unidades de Terapia Intensiva Pediátrica , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Desmame do Respirador/métodos , Baixo Débito Cardíaco/etiologia , Ecocardiografia , Feminino , Cardiopatias Congênitas/complicações , Humanos , Recém-Nascido , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
The utilization of mechanical life support due to respiratory insufficiency and serious cardiac pathologies have been increasing. Anticoagulation to prevent clot formation is mandatory and unfractioned heparin is the standard therapy in use. But rarely heparin induced thrombocytopenia (HIT) might develop as an immunologic side effect of heparin. Development of thrombosis as a result of HIT increases the morbidity and mortality. We present a neonate with HIT treated successfully with fondaparinux under extracorporeal life support.
RESUMO
Graft preference is a key point for long-term patency in coronary artery bypass grafting. We present a patient with multivessel coronary artery disease who underwent coronary artery bypass grafting 18 years ago. Revascularization of the left coronary system was performed by using a combined internal mammary artery (IMA) graft, which consisted of an end-to-end anastomosis of left IMA (in situ) and right IMA (free), with the interposition of a small piece of vein. A coronary angiography at the 18-year follow-up revealed patency of all sequential anastomoses with an enlarged combined IMA graft.
