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3.
Circ J ; 81(9): 1354-1359, 2017 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-28450668

RESUMO

BACKGROUND: In Ebstein's anomaly (EA) current surgical criteria may not translate into better long-term survival. The aim of this study was therefore to determine if surgical treatment for EA increases survival, and to analyze factors associated with mortality.Methods and Results:A retrospective study was carried out involving 103 patients with surgical indication using current criteria, comparing operated (n=49; 47.5%) and non-operated patients (n=54; 52.4%); the severity of disease was similar in all cases. Overall follow-up was 12 years (range, 1-49 years). There were no differences in mortality: in the surgical and non-surgical groups, survival at 10 years was 92.8% vs. 90.7%; 20 years, 85.7% vs. 81.0%; and 30 years, 78.5% vs. 72.2%, respectively. On multivariate analysis right ventricular fractional shortening (RVFS) was associated with mortality in both groups. Decreasing RVFS was associated with worse survival according to severity: when RVFS was <20%, survival at 20, 40 and 60 years was 58%, 39%, and 12.5%, respectively (P<0.0013). Left ventricular ejection fraction also correlated with survival (P<0.0013). CONCLUSIONS: Surgery did not translate into benefit in terms of survival, and this was clearly associated with RV function; therefore this should be a key factor in the surgical decision making.


Assuntos
Anomalia de Ebstein , Função Ventricular Direita , Adolescente , Adulto , Criança , Pré-Escolar , Intervalo Livre de Doença , Anomalia de Ebstein/mortalidade , Anomalia de Ebstein/fisiopatologia , Anomalia de Ebstein/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
4.
Arch. cardiol. Méx ; 87(1): 18-25, ene.-mar. 2017. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-887490

RESUMO

Resumen: Objetivo: El European System for Cardiac Operative Risk Evaluation (EuroSCORE) estratifica el riesgo quirúrgico en cirugía cardiaca de manera fácil y accesible; se validó en Norteamérica con buenos resultados, pero en muchos países de Latinoamérica se utiliza rutinariamente sin validación previa. Nuestro objetivo fue validar EuroSCORE en pacientes con cirugía valvular en el Instituto Nacional de Cardiología Ignacio Chávez (INCICh) de México. Métodos: Se aplicaron los modelos de EuroSCORE aditivo y logístico para predecir mortalidad en pacientes con cirugía valvular de marzo de 2004 a marzo de 2008. Se usó la prueba de bondad de ajuste de Hosmer-Lemeshow para evaluar la calibración. Se calculó el área bajo la curva ROC para determinar la discriminación. Resultados: Se incluyeron 1,188 pacientes con edades de 51.3 ± 14.5 años, 52% mujeres. Hubo diferencias significativas en la prevalencia de los factores de riesgo entre la población del INCICh y del EuroSCORE. La mortalidad total fue de 9.68% con predichas de 5% y 5.6% por EuroSCORE aditivo y logístico. De acuerdo a EuroSCORE aditivo tenían riesgo bajo 11.3%, intermedio 52.9% y alto 35.9%; para estos grupos la mortalidad fue de 0.7%, 6.4% y 17.4% contra las predichas de 2%, 3.9% y 7.64%. La prueba de Hosmer-Lemeshow tuvo una p < 0.001 para ambos modelos, y el área bajo la curva ROC de 0.707 y de 0.694 para EuroSCORE aditivo y logístico. Conclusión: En el INCICh el 88.7% de los pacientes con cirugía valvular tuvieron riesgo intermedio a alto y EuroSCORE subestimó el riesgo de mortalidad.


Abstract: Objective: The EuroSCORE (European System for cardiac operative risk evaluation) stratifies cardiac risk surgery in easy and accessible manner; it was validated in North America with good results but in many countries of Latin America is used routinely without prior validation. Our objective was to validate the EuroSCORE in patients with cardiac valve surgery at the Instituto Nacional de Cardiología Ignacio Chávez (INCICh) in México. Methods: EuroSCORE additive and logistic models were used to predict mortality in adults undergoing cardiac valve surgery from march 2004 to march 2008. The goodness of fit test of Hosmer-Lemeshow was used to evaluate the calibration. The area under the ROC curve was calculated to determinate discrimination. Results: We included 1188 patients with ages of 51.3 ± 14.5 years, 52% women. There were significant differences in the prevalence of risk factors among the INCICh and the EuroSCORE populations. Total mortality was 9.68% versus 5% and 5.6% predicted by additive and logistic EuroSCORE. According to additive EuroSCORE the risk was low in 11.3%, intermediate in 52.9% and high in 35.9%; for these groups the mortality was .7%, 6.34% and 17.4% against those predicted of 2%, 3.9% and 7.64%. Hosmer-Lemeshow test had a P < .001 for both models and the area under the ROC curve was .707 and .694 for additive and logistic EuroSCORE. Conclusion: In the INCICh 88.7% of patients with cardiac valve surgery had intermediate to high risk and EuroSCORE underestimated the risk of mortality.

5.
Arch Cardiol Mex ; 87(1): 18-25, 2017 Jan - Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-27495386

RESUMO

OBJECTIVE: The EuroSCORE (European System for cardiac operative risk evaluation) stratifies cardiac risk surgery in easy and accessible manner; it was validated in North America with good results but in many countries of Latin America is used routinely without prior validation. Our objective was to validate the EuroSCORE in patients with cardiac valve surgery at the Instituto Nacional de Cardiología Ignacio Chávez (INCICh) in México. METHODS: EuroSCORE additive and logistic models were used to predict mortality in adults undergoing cardiac valve surgery from march 2004 to march 2008. The goodness of fit test of Hosmer-Lemeshow was used to evaluate the calibration. The area under the ROC curve was calculated to determinate discrimination. RESULTS: We included 1188 patients with ages of 51.3±14.5 years, 52% women. There were significant differences in the prevalence of risk factors among the INCICh and the EuroSCORE populations. Total mortality was 9.68% versus 5% and 5.6% predicted by additive and logistic EuroSCORE. According to additive EuroSCORE the risk was low in 11.3%, intermediate in 52.9% and high in 35.9%; for these groups the mortality was .7%, 6.34% and 17.4% against those predicted of 2%, 3.9% and 7.64%. Hosmer-Lemeshow test had a P<.001 for both models and the area under the ROC curve was .707 and .694 for additive and logistic EuroSCORE. CONCLUSION: In the INCICh 88.7% of patients with cardiac valve surgery had intermediate to high risk and EuroSCORE underestimated the risk of mortality.


Assuntos
Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/mortalidade , Feminino , Humanos , Estudos Longitudinais , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
6.
Rev Invest Clin ; 66(6): 520-6, 2014 Nov-Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-25729869

RESUMO

INTRODUCTION: Aortic valve replacement in patients with severe aortic stenosis may be complicated by complete atrioventricular block (CAVB), requiring a permanent pacemaker (PPM) implantation. Predicting this complication could help to plan the surgical. OBJECTIVE: Determine whether electrocardiography and echocardiography are useful methods for predicting the need for PPM. MATERIAL AND METHODS: A retrospective, observational and transversal study was performed. An echocardiography based semi-quantitative classification was implemented to graduate the extent of calcification of the aortic valve. RESULTS: We included 95 patients; 10 of them required PPM implantation (10.52%). In the pre-surgical basal electrocardiogram we observed that 90% of patients that required PPM had conduction abnormalities as opposed to only 24.7% in the other group, p = 0.001. A 1st and 2nd degree AV block (AVB 1 and 2) was identified in 8 patients that subsequently needed PPM (80%) vs. 5 patients (5.9%), in the group that did not required it, p = 0.001.OR 41.7, IC 95% 6.5-68. We found a grade 3 calcification extent in 80% of patients who required PPM implant compared with only 17.6% of patients in the other group, p = 0.04, OR 4.8, IC 95% 0.76-29. The AVB 1 and 2 were the single predictor in multivariate analysis but the calcification 3 + AVB 1 and 2, increased sensibility. CONCLUISON: In patients with aortic stenosis in whom aortic valve replacement was performed, identifying AVB 1 and 2 on the basal electrocardiogram is a useful tool in order to identify requirement of PPM. The grade 3 of calcification extent increased the sensibility of this prediction.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Bloqueio Atrioventricular/etiologia , Calcinose/cirurgia , Estimulação Cardíaca Artificial/métodos , Implante de Prótese de Valva Cardíaca/métodos , Adulto , Idoso , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Bloqueio Atrioventricular/terapia , Calcinose/diagnóstico , Estudos Transversais , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Marca-Passo Artificial , Estudos Retrospectivos
7.
Endocr Res ; 37(1): 1-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-21977925

RESUMO

BACKGROUND: Hyperuricemia has been associated with an increased risk of endothelial dysfunction (ED), cardiovascular and renal disease. The role of uric acid (UA) on vascular damage is still controversial because previous studies have included patients with other risk factor for ED. OBJECTIVE: To determine if the treatment with allopurinol improved endothelial function in hyperuricemic patients without other risk factors for ED. MATERIAL AND METHODS: In order to gain more insight about the contribution of UA to the ED, we screened 369 apparently healthy male individuals for UA in a period of 9 months. Only 9 patients fulfill the inclusion criteria: UA plasma levels > 7 mg/dL without other risk factors for ED such as hypercholesterolemia, obesity, diabetes and hypertension. RESULTS: Endothelial function, assessed by flow mediated dilatation (FMD) in the brachial artery improved significantly after 30 days of allopurinol treatment (9.6% [6.3-13.3%] vs. 13.7% [11-14.7%], p = 0.036), concomitantly with a decrease of about 45% in the uric acid plasma levels. Other parameters were not modified by allopurinol treatment. Any No significant correlation was found (r = -0.367, p = 0.33) between the ΔUA plasma levels (UA after treatment - UA in basal conditions) and ΔFMD (FMD after treatment - FMD in basal conditions). CONCLUSIONS: These results strongly suggest that allopurinol improves flow-mediated vasodilation regardless of uric acid plasma concentrations.


Assuntos
Alopurinol/farmacologia , Endotélio Vascular/efeitos dos fármacos , Supressores da Gota/farmacologia , Hiperuricemia/tratamento farmacológico , Vasodilatação/efeitos dos fármacos , Adolescente , Adulto , Idoso , Alopurinol/uso terapêutico , Artéria Braquial/efeitos dos fármacos , Artéria Braquial/fisiopatologia , Endotélio Vascular/fisiopatologia , Supressores da Gota/uso terapêutico , Humanos , Hiperuricemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ácido Úrico/sangue , Vasodilatação/fisiologia
8.
Arch Cardiol Mex ; 80(4): 229-34, 2010 Oct-Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-21169086

RESUMO

UNLABELLED: In our hospital, the patients that need an elective cardiac surgery are admitted through the admission department on the basis of a waiting list. Since 1999, a fast track to hospitalization program has existed in the National Institute of Cardiology Ignacio Chavez for patients with low surgical risk. Later, in 2004, this program was extended to patients to moderate risk, based on rules accepted worldwide, and our own experience. OBJECTIVES: 1) To compare two ways of admission that are used currently: fast track to hospitalization, against admission department waiting list. We compared major events: death or events that increased the hospital stay by more than 14 days (infections, alterations of rhythm and conduction, reoperations and others), 2) To compare the days of hospitalization and money spent by the hospital. METHODS: We conformed 2 groups of 347 patients. The admission department waiting list group was admitted before doing their preoperative studies, which is the customary form for hospitalization by our admissions department, while the group of fast track to hospitalization was obligated to have their laboratory exams complete and any other diseases resolved or controlled previously. The monetary cost per patient for the hospital was calculated based on the patient's socioeconomic classification. STATISTICAL ANALYSIS: Student t test was conduncted on independent samples and numerical variables, and Chi square for categorical variables. We considered a p <0.05 to be statistically significant. RESULTS: In average in both groups, 75% underwent valve operation and 25% underwent congenital heart disease repair, 49% were women, age 47 15 years. The comparison between the groups fast track to hospitalization and admission department waiting list group were: Mortality: 4.3% vs. 5.8% (p=0.38). Major events that needed a hospital stay of more than 14 days: 73 vs. 97 cases respectively (p = 0.032). Infections: 22 vs. 29 (p = 0.14). Mediastinitis: 2 vs. 9 respectively (p = 0.033). In-hospital stay: were 11 days vs. 20 days (p = 0.0001), the biggest difference was found in the pre-surgical time: 2 vs. 9 days respectively (p = 0.0001). CONCLUSION: The postoperative morbidity in general was lower in fast track to hospitalization group, and the mediastinitis showed a decrease with statistical significance. The time interval between hospital admission an operation in fast track to hospitalization group was significantly shorter. We believe that the decrease in the exposure time to nosocomial pathogens present in the hospital environment was directly related to the low number of mediastinitis. Finally, the decrease in time of hospital stay represented a 32% monetary savings for the hospital.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Custos Hospitalares , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Listas de Espera , Assistência Ambulatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório
9.
Arch Cardiol Mex ; 80(2): 100-7, 2010 Apr-Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-21147573

RESUMO

BACKGROUND: In 1999 so as to decrease the list of cardiac surgery the "fast track" program was started for patients with very mortality low risk. In 2004, this program was extended to moderate risk patients. OBJECTIVES: A prospective, descriptive study to evaluate the clinical and demographic characteristics of "fast track" program patients for elective cardiac surgery. We also analyzed the hospital stay, mortality, complications and readmissions. METHODS: From March 2004 to February we included adult patients with indications for cardiac surgery, low to intermediate risk of mortality and complete preoperative requirements. RESULTS: From a total of 598 patients, 533 were analyzed, aged 47±14 years, 62.5% female. They were classified in four groups: valvular (68%), congenital (25%), coronary artery disease (5%), and mixed (2%). The average hospital stay was: preoperative 1.9, intensive care unit three, postoperative in hospitalization 6.9 and total 11.9 days. We found that 17.8% had a hospital stay longer than 14 days due to: reoperations, pulmonary complications, arrhythmias or infections. The mortality was 4.1 and 2.8% had readmissions three months after surgery. CONCLUSIONS: This program shows a low rate of mortality, hospital stay and readmissions."


Assuntos
Procedimentos Cirúrgicos Cardíacos , Tempo de Internação/estatística & dados numéricos , Adulto , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Listas de Espera
10.
Arch. cardiol. Méx ; 80(4): 229-234, oct.-dic. 2010. tab
Artigo em Espanhol | LILACS | ID: lil-632015

RESUMO

Los pacientes que van a una cirugía electiva de corazón, se internan a través de una lista de espera de admisión hospitalaria. Desde 1999 existe en el Instituto Nacional de Cardiología Ignacio Chávez, la "vía rápida de internamiento" para pacientes de bajo riesgo quirúrgico, que en el 2004 se extendió a riesgo moderado, tomando como base criterios propios y criterios internacionalmente aceptados. Objetivos: 1) comparar las dos alternativas de internamiento utilizadas actualmente: vía de internamiento rápido; y el internamiento a través de la lista de espera del departamento de admisión, tomando en consideración los eventos mayores que presentaron como: muerte o complicaciones que prolongaron la estancia hospitalaria a más de 14 días (Infecciones, reoperación, alteraciones del ritmo y de la conducción y otros). 2) Comparar los días de estancia y consumo de recursos hospitalarios. Métodos: Se tomaron dos cohortes de 347 pacientes, el grupo control fue obtenido de la lista de espera del departamento de admisión, mientras que el grupo de la vía de internamiento rápido, tuvo como requisito tener los estudios preoperatorios completos y a los enfermos con comorbilidad resuelta o compensada. Los gastos generados al hospital por cada paciente se calcularon de acuerdo a la clasificación socioeconómica de los enfermos. Análisis estadístico: Se utilizó la prueba t de Student para muestras independientes y variables numéricas y Ji cuadrada para las variables categóricas, se consideró significativo un valor de p < 0.05. Resultados: Ambos grupos se conformaron por un promedio de 75% con patología valvular y 25% con patología congénita simple, 49.9% fueron mujeres, la edad promedio fue de 47 ± 15 años. Las comparaciones del grupo de la vía de internamiento rápido con el grupo admitido a través de la lista de admisión fueron: Mortalidad: 4.3% vs. 5.8% (p = 0.38). Eventos mayores que ameritaron una estancia hospitalaria mayor a 14 días: 73 vs. 97 casos respectivamente (p = 0.032). Procesos infecciosos en general: 22 vs. 29 (p = 0.14). Mediastinitis: dos vs. nueve respectivamente (p = 0.033). Días de estancia hospitalaria: 11 vs. 20 (p = 0.0001). La mayor diferencia se encontró en el tiempo preoperatorio: dos vs. nueve días respectivamente (p = 0.0001). Conclusión: La morbilidad posquirúrgica en conjunto fue significativamente menor en el grupo de la vía de internamiento rápido, y dentro de esta, las mediastinitis se presentaron con menor frecuencia, con diferencia estadística. El tiempo preoperatorio fue mucho menor en el grupo de la vía de internamiento rápido, esto disminuyó el tiempo de exposición a microorganismos nosocomiales lo que creemos puede explicar la disminución de los eventos de mediastinitis. Finalmente, la reducción en el tiempo de hospitalización en el grupo de la vía de internamiento rápido, dio como resultado un ahorro monetario para el hospital de 32%.


In our hospital, the patients that need an elective cardiac surgery are admitted through the admission department on the basis of a waiting list. Since 1999, a fast track to hospitalization program has existed in the National Institute of Cardiology Ignacio Chavez for patients with low surgical risk. Later, in 2004, this program was extended to patients to moderate risk, based on rules accepted worldwide, and our own experience. Objectives: 1) To compare two ways of admission that are used currently: fast track to hospitalization, against admission department waiting list. We compared major events: death or events that increased the hospital stay by more than 14 days (infections, alterations of rhythm and conduction, reoperations and others), 2) To compare the days of hospitalization and money spent by the hospital. Methods: We conformed 2 groups of 347 patients. The admission department waiting list group was admitted before doing their preoperative studies, which is the customary form for hospitalization by our admissions department, while the group of fast track to hospitalization was obligated to have their laboratory exams complete and any other diseases resolved or controlled previously. The monetary cost per patient for the hospital was calculated based on the patient's socioeconomic classification. Statistical analysis: Student t test was conducted on independent samples and numerical variables, and Chi square for categorical variables. We considered a p < 0.05 to be statistically significant. Results: In average in both groups, 75% underwent valve operation and 25% underwent congenital heart disease repair, 49% were women, age 47± 15 years. The comparison between the groups fast track to hospitalization and admission department waiting list group were: Mortality: 4.3% vs. 5.8% (p=0.38). Major events that needed a hospital stay of more than 14 days: 73 vs. 97 cases respectively (p = 0.032). Infections: 22 vs. 29 (p = 0.14). Mediastinitis: 2 vs. 9 respectively (p = 0.033). In-hospital stay: were 11 days vs. 20 days (p = 0.0001), the biggest difference was found in the pre-surgical time: 2 vs. 9 days respectively (p = 0.0001). Conclusion: The postoperative morbidity in general was lower in fast track to hospitalization group, and the mediastinitis showed a decrease with statistical significance. The time interval between hospital admission and operation in fast track to hospitalization group was significantly shorter. We believe that the decrease in the exposure time to nosocomial pathogens present in the hospital environment was directly related to the low number of mediastinitis. Finally, the decrease in time of hospital stay represented a 32% monetary savings for the hospital.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Custos Hospitalares , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Listas de Espera , Assistência Ambulatorial , Período Pré-Operatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
11.
Arch. cardiol. Méx ; 80(2): 100-107, abr.-jun. 2010. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-631967

RESUMO

Introducción: Para disminuir la lista de espera para la cirugía cardiaca electiva, en 1999 el Instituto Nacional de Cardiología Ignacio Chávez inició un programa de vía rápida para casos de muy bajo riesgo quirúrgico. En 2004, este programa se extendió a pacientes con riesgo intermedio. Objetivos: Estudio prospectivo, descriptivo, para evaluar las características clínicas y demográficas de los pacientes del programa de vía rápida en cirugía cardiaca electiva. También se analizaron la estancia hospitalaria, mortalidad, complicaciones y reingresos. Métodos: De marzo de 2004 a febrero de 2009 incluimos pacientes adultos con indicación de cirugía cardiaca y con riesgo quirúrgico de bajo a intermedio, con requisitos preoperatorios completos antes del internamiento. Resultados: De un total de 598 pacientes ingresados al programa, se analizaron 533, con edad de 47 ± 14 años, 62.5% mujeres. Se clasificaron en cuatro grupos: valvulares (68%), congénitos (25%), isquémicos (5%) y mixtos (2%). Los promedios de días de estancia hospitalaria fueron: preoperatoria 1.9, terapia tres, postoperatoria en piso 6.9 y total 11.9 días. Se evidenció que 17.8 % estuvieron más de 14 días por: reoperaciones, complicaciones pulmonares, arritmias, o infecciones. La mortalidad fue de 4.1% y hubo 2.8% de reingresos en los primeros tres meses posteriores a la cirugía. Conclusiones: Este programa conduce a bajos índices de mortalidad, estancia hospitalaria y reingresos.


Background: In 1999 so as to decrease the list of cardiac surgery the "fast track" program was started for patients with very mortality low risk. In 2004, this program was extended to moderate risk patients. Objectives: A prospective, descriptive study to evaluate the clinical and demographic characteristics of "fast track" program patients for elective cardiac surgery. We also analyzed the hospital stay, mortality, complications and readmissions. Methods: From March 2004 to February we included adult patients with indications for cardiac surgery, low to intermediate risk of mortality and complete preoperative requirements. Results: From a total of 598 patients, 533 were analyzed, aged 47±14 years, 62.5% female. They were classified in four groups: valvular (68%), congenital (25%), coronary artery disease (5%), and mixed (2%). The average hospital stay was: preoperative 1.9, intensive care unit three, postoperative in hospitalization 6.9 and total 11.9 days. We found that 17.8% had a hospital stay longer than 14 days due to: reoperations, pulmonary complications, arrhythmias or infections. The mortality was 4.1 and 2.8% had readmissions three months after surgery. Conclusions: This program shows a low rate of mortality, hospital stay and readmissions.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos , Tempo de Internação/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Listas de Espera
12.
Arch. cardiol. Méx ; 77(4): 313-319, oct.-dic. 2007. ilus
Artigo em Espanhol | LILACS | ID: lil-567017

RESUMO

The Barlow's syndrome is a disease characterized by the presence of mitral valve prolapse and a wide range of signs and symptoms. We know that its manifestations has a great variety existing cases with little clinical expression as those seen frequently in daily practice or the other side opposite completely in which, the syndrome is so complex getting to the patient to present many symptoms secondary to hemodynamics alterations that reduce by much its quality of life and even modify its prognosis.The case that we present is a female patient of 25 years old with Barlow's syndrome and functional class II-III of NewYork Heart Association as a result of the alterations in the contractility function of the heart that finally caused her death.


Assuntos
Adulto , Feminino , Humanos , Cardiomiopatias , Prolapso da Valva Mitral , Evolução Fatal , Índice de Gravidade de Doença , Síndrome
13.
Arch Cardiol Mex ; 77(4): 313-9, 2007 Oct-Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-18361077

RESUMO

The Barlow's syndrome is a disease characterized by the presence of mitral valve prolapse and a wide range of signs and symptoms. We know that its manifestations has a great variety existing cases with little clinical expression as those seen frequently in daily practice or the other side opposite completely in which, the syndrome is so complex getting to the patient to present many symptoms secondary to hemodynamics alterations that reduce by much its quality of life and even modify its prognosis.The case that we present is a female patient of 25 years old with Barlow's syndrome and functional class II-III of NewYork Heart Association as a result of the alterations in the contractility function of the heart that finally caused her death.


Assuntos
Cardiomiopatias/etiologia , Prolapso da Valva Mitral/complicações , Adulto , Evolução Fatal , Feminino , Humanos , Índice de Gravidade de Doença , Síndrome
14.
Arch. cardiol. Méx ; 75(2): 170-177, abr.-jun. 2005. ilus
Artigo em Espanhol | LILACS | ID: lil-631889

RESUMO

La hipertensión ventricular derecha es una entidad esperada en enfermedades cardiopulmonares. La obstrucción mecánica del tracto de salida del ventrículo derecho es una de ellas. Presentamos el caso clínico de un paciente masculino de 69 años de edad con historia de hepatocarcinoma previamente tratado, quien presentó hipertensión ventricular derecha por obstrucción metastásica única al ventrículo derecho. El comportamiento clínico es de un síndrome de hipertensión venosa sistémica. Los estudios no invasivos, como el ecocardiograma y la tomografía axial computarizada la delimitaron. No se demostró actividad neoplásica o metástasis en otros órganos. La neoformación intra-ventricular derecha fue corroborada mediante cardio-angiografía y la biopsia tumoral confirmó el diagnóstico.


Right ventricular hypertension (RVH) is an entity that could be expected in various cardiopulmonary diseases. Mechanical obstruction to the right ventricle outflow tract is a cause of RVH. We present the case of a 69 year-old male with a history of hepatocarcinoma previously treated. The developed RVH due to mechanical obstruction secondary to metastatic infiltration of the right ventricle. The clinical syndrome was characterized by systemic venous hypertension. Non-invasive studies, such as electrocardiogram and computed tomography scan limited the metastasis to the right ventricle; the diagnosis was confirmed by cardio-angiography and endocardial biopsy. The studies did not demonstrate neoplastic activity at any other level. (Arch Cardiol Mex 2005; 75: 170-177).


Assuntos
Idoso , Humanos , Masculino , Carcinoma Hepatocelular/secundário , Neoplasias Cardíacas/secundário , Neoplasias Hepáticas/patologia , Biópsia , Cateterismo Cardíaco , Carcinoma Hepatocelular , Carcinoma Hepatocelular , Ecocardiografia Doppler , Eletrocardiografia , Evolução Fatal , Neoplasias Cardíacas , Neoplasias Cardíacas , Ventrículos do Coração/patologia , Ventrículos do Coração , Ventrículos do Coração , Radiografia Torácica , Disfunção Ventricular Direita/patologia , Disfunção Ventricular Direita , Obstrução do Fluxo Ventricular Externo/patologia , Obstrução do Fluxo Ventricular Externo
15.
Arch. cardiol. Méx ; 71(3): 214-220, jul.-sept. 2001. tab, CD-ROM
Artigo em Espanhol | LILACS | ID: lil-306500

RESUMO

El incremento en la explosión demográfica, el aumento en la esperanza de vida y el desarrollo tecnológico vertiginoso, han hecho que el número de pacientes con padecimientos cardiacos y necesidad de tratamiento quirúrgico se haya venido incrementando en las últimas dos décadas. Esto ha obligado a numerosas instituciones a tener que dar prioridad a los casos avanzados o de mayor gravedad, haciéndose un rezago en el caso de padecimientos cuya naturaleza no implique tanta urgencia operatoria. Con el objeto de conocer, si el establecimiento de una vía de internamiento, diferente a la habitual, que incluyese pacientes con padecimientos con escaso deterioro y poca posibilidad de complicación quirúrgica, pudiese mejorar esta situación, se realizó un estudio prospectivo, contrastando los costos de tratamiento quirúrgico de 70 enfermos, con otros 70 enfermos con patologías similares pero con diferente grado de avance del padecimiento, internados por la vía habitual y operados en el mismo periodo de tiempo. La mortalidad se redujo en un 5.71 por ciento, la morbilidad en un 18.2 por ciento y los costos se abatieron en un 48.7 por ciento. Se señala además la enorme frecuencia entre la comunicación interauricular y la enfermedad de Von Willebrand en nuestro medio. Se propone el mantenimiento y aumento de número de operaciones por esta vía y se señalan las limitaciones de la misma


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doenças Cardiovasculares , Cirurgia Torácica/métodos , Tratamento de Emergência , Instalações de Saúde , Listas de Espera
16.
Arch. Inst. Cardiol. Méx ; 68(6): 462-72, nov.-dic. 1998. tab, ilus
Artigo em Espanhol | LILACS | ID: lil-227597

RESUMO

En 249 pacientes con primer infarto del micardio. Grupo 1. Sin trombolítico, n=119; 2. Trombolisis antes de 6 horas, n=80 y grupo 3. Trombolisis entre las 6 y 12 horas, n=50. Se evaluó la presencia de arritmias malignas en el primer año de sobrevida, la variabilidad de la frecuencia cardiaca, el flujo coronario anterógrado (TIMI) y el flujo coronario colateral (1. Pobre: Rentrop, grados 0-2 y 2. Adecuada: Rentrop grado 3). Los grupos 2 y 3 tuvieron mejor flujo TIMI y colateral que el grupo 1 (p<0.001). La banda espectral de alta frecuencia y la relación entre las bandas de baja y alta frecuencia estuvieron más alteradas en el grupo 1 (p<0.05). El análisis de consolidación conjuntiva mostró que los pacientes con TIMI 0-2 y pobre flujo colateral tuvieron mayores epidosios de arritmias malignas que los pacientes con TIMI 0-2 con adecuado flujo colateral (17/138-12.3 por ciento-vs 0/14-0 por ciento-). Los pacientes con TIMI 0-2 y pobre flujo colateral presentaron mayor mortalidad por eventos arrítmicos que los tenían TIMI 3 o TIMI 0-2 con adecuado flujo colateral (x²=7.22, p=0.028), independientemente del tratamiento trombolítico


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Circulação Coronária , Angiografia Coronária , Vasos Coronários/efeitos dos fármacos , Vasos Coronários/fisiopatologia , Frequência Cardíaca , Reologia , Terapia Trombolítica , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Reperfusão Miocárdica , Condutas Terapêuticas , Fatores de Tempo
17.
Arch. Inst. Cardiol. Méx ; 68(6): 506-14, nov.-dic. 1998. ilus
Artigo em Espanhol | LILACS | ID: lil-227601

RESUMO

Situación General: La relación entre puentes miocárdicos (PM) y enfermedad isquémica del corazón continua siendo tema de controversia. Evidencia reciente sugiere que dicha relación no ocurre al azar. Propósito: realizar un análisis crítico de la evidencia actual de asociación entre PM e isquemia miocárdica así como sus posibles consecuencias. Métodos. Presentamos 2 casos de nuestra serie y revisamos la literatura médica resgistrada en los sistemas Medline y Current Contents en periodo de enero de 1966 a enero de 1998. Resultados y conclusiones. Las principales aportaciones realizadas hasta el momento son: 1) Los PM no son una variante normal; 2) El impacto clínico de los PM depende de sus características anatómicas y del grado de su efecto "exprimidor" sobre la arteria coronaria; 3) El músculo procedente del PM no parece tener la misma histología que el resto de miocitos de otras áreas del corazón, lo que parece tener implicaciones fisiopatológicas especiales. 4) En el segmento con PM, el medio ambiente alrededor de la coronaria parece ser un factor crucial para que se induzcan o no anormalidades cardiacas; 5) El sobrepico sistólico ocasionado por el efecto "exprimidor" del PM sobre la arteria coronaria parece determinar la lesión endotelial que ocurre en la microcirculación de la región post-PM; 6) En algunos casos, por causa aún no muy clara, el daño endotelial sistólico se vuelve progresivo contribuyendo a la liberación de factores que son capaces de reducir la reserva coronaria local llevando a la aparición de fenómenos de isquemia; 7) El papel de la PTCA en esta alteración, requiere ser comprobada. Sugerimos que un tratamiento quirúrgico debe siempre ser contemplado en los casos con evidencia de áreas de isquemia importante, cuya posible causa sea un PM, incluso en aquellos casos que cursen asintomáticos


Assuntos
Humanos , Masculino , Feminino , Adulto , Circulação Coronária/fisiologia , Angiografia Coronária , Doença das Coronárias/fisiopatologia , Vasos Coronários/anatomia & histologia , Vasos Coronários/fisiopatologia , Endotélio Vascular/lesões , Endotélio Vascular/fisiopatologia , Isquemia Miocárdica/etiologia , Reologia , Sístole/fisiologia
18.
Arch. Inst. Cardiol. Méx ; 66(2): 98-115, mar.-abr. 1996. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-180414

RESUMO

El presente estudio prospectivo se realizó con la finalidad de validar un nuevo método de análisis computarizado para el contenido de frecuencias del complejo QRS -que hemos denominado espectrocardiografía de alta fidelidad (EAR)- y valorar si ésta puede documentar episodios de isquemia durante el reto farmacológico (Dipiridamol). También para analizar su sensibilidad y especificidad en comparación con la medicina nuclear (MN) y la prueba de esfuerzo (PE) convencional. Se estudiaron 25 sujetos: 10 con factores de riesgo para enfermedad coronaria, sin infarto previo, y con PE dudosa (Grupo B). El grupo A (Testigo) comprendía 15 sujetos sin evidencia o sospecha de enfermedad cardiaca y sin factores de riesgo coronario, cuyos edad y sexo eran similares a los del grupo B. Se obtuvieron en todos: ECG convencional, ecocardiograma, PE y estudio de MN. Se tomó un registro de electrocardiografía de alta resolución antes y después del reto con Dipiridamol (0.56 mg/Kg/dosis), de manera simultánea con el estudio de MN. El Software, que se generó para el análisis de la señal promediada, se construyó en lenguaje C++: cada 2 mseg se analizaron fragmentos de QRS de 24 mseg. Utilizando la transformación rápida de Fourier, se formaron áreas bajo la curva y gráficos tridimensionales de la potencia espectral (DB). La idea, diseño y aplicación son originales de nuestro instituto. No hubo diferencia significativa en las características demografícas de ambos grupos. La sensibilidad (85 por ciento) y la especifidad (95 por ciento) de la EAR fueron iguales a las obtenidas por MN, pero superiores a las de la PE convencional (p < 0.0001). El mayor cambio en el contenido de frecuencias ocurrió en el intervalo de 130 - 260 Hz. Aunque no se alcanzó significancia estadística, hubo tendencia en el grupo B de prolongar el QRS, mientras que en el grupo A éste se acortó (p= 0.064). El tono simpático, medido por variabilidad de R-R, predominó en el grupo B. El EAR puede ser una prueba alternativa de bajo costo, realizable fuera de hospitales de alta especialización, para la detección de isquemia miocárdica en los casos en que no pueda realizarse o sea dudosa la PE convencional


Assuntos
Humanos , Masculino , Feminino , Dipiridamol/administração & dosagem , Eletrocardiografia , Teste de Esforço , Isquemia Miocárdica/diagnóstico , Medicina Nuclear , Espectrofotometria
20.
Arch. Inst. Cardiol. Méx ; 64(6): 537-42, nov.-dic. 1994. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-188134

RESUMO

En 113 pacientes con estenosis mitral pura o muy predominante, se realizó valvuloplastía miral percutánea con balón (VMPB) de Inoue. Al sexo femenino correspondieron 97 y 16 al masculino. El promedio de edad fue de 40 ñ 11 años con extremos de 18 y 70 años. En ritmo sinusal estaban 95 pacientes, en fibrilación auricular 18. Comisurotomía quirúrgica previa en 13 pacientes, y 5 se encontrarban embarazadas al momento del procedimiento. Los pacientes fueron cuidadosamente seleccionados tanto clínica como ecocardiográficamente y utilizando también el score de Wilkins (SW). Se efectuó ecocardiograma transesofágico (ETE) cuando el transtorácico (ETT) no fue satisfactorio. Previo cateterismo izquierdo y derecha, con abordaje transeptal atrial, se realizó valvuloplastía con catéter balón sencillo de Inoue. En 106 pacientes (93.8 por ciento), se logró un incremento significativo del área mitral (AVM) y en un paciente (0.88 por ciento) no se logró dilatar. Los resultados ecocardiográficos mostraron un incremento del AVM de 0.95 ñ 0.19 a 16.1 ñ 0.34 cm² (p < 0.0001). El gradiente transvalvular mitral (GTM) disminuyó de 16.18 ñ 4.69 a 9.14 ñ 3.20 mmHg (p< 0.0001). La presión sistólica de la arteria pulmonar (PSAP) disminuyó de 46.94 ñ 18.87 a 34.06 ñ 13.33 mmHg (p< 0.0001). La clase funcional mejoró en todos los pacientes que tuvieron seguimiento a mediano y largo plazo. Como complicaciones se tuvo insuficiencia mitral (IM) severa en 6 pacientes, que fueron llevados a cambio valvular mitral: 2 de ellos fallecieron durante la cirugía (uno por sangrado y otro por desgarros no reparables de las aurículas). Un paciente presentó enfermedad vascular cerebral (EVC) a la semana del procedimiento. En 3, se produjo comunicación interatrial (CIA) no significativa. Un paciente falleció 2 meses después del procedimiento por endocarditis bacteriana subaguda (EBSA). La VMPB puede ser considerada como un tratamiento efectivo y seguro para los pacientes con estenosis mitral sintomática.


Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Angioplastia Coronária com Balão/métodos , Cateterismo Cardíaco/métodos , Cineangiografia , Eletrocardiografia/métodos , Estenose da Valva Mitral/terapia , Análise Estatística , Valva Mitral/cirurgia , Doenças Vasculares/terapia
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