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1.
Rev. bras. cir. cardiovasc ; 34(5): 511-516, Sept.-Oct. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1042045

RESUMO

Abstract Objective: This study aimed to evaluate Ebstein's anomaly surgical correction and its early and long-term outcomes. Methods: A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein's anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. Results: Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients' mean age at the time of surgery was 20.5±14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8±6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1±4.9 years after the first procedure. Conclusion: In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.

2.
Braz J Cardiovasc Surg ; 34(5): 511-516, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31364344

RESUMO

OBJECTIVE: This study aimed to evaluate Ebstein's anomaly surgical correction and its early and long-term outcomes. METHODS: A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein's anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. RESULTS: Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients' mean age at the time of surgery was 20.5±14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8±6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1±4.9 years after the first procedure. CONCLUSION: In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.


Assuntos
Anomalia de Ebstein/cirurgia , Valva Tricúspide/cirurgia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Criança , Pré-Escolar , Anomalia de Ebstein/complicações , Anomalia de Ebstein/mortalidade , Feminino , Humanos , Lactente , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Insuficiência da Valva Tricúspide/etiologia , Disfunção Ventricular Direita/etiologia , Adulto Jovem
3.
Arq Bras Cardiol ; 112(2): 130-135, 2019 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30785577

RESUMO

BACKGROUND: The Fontan-Kreutzer procedure (FK) was widely performed in the past, but in the long-term generated many complications resulting in univentricular circulation failure. The conversion to total cavopulmonary connection (TCPC) is one of the options for treatment. OBJECTIVE: To evaluate the results of conversion from FK to TCPC. METHODS: A retrospective review of medical records for patients who underwent the conversion of FK to TCPC in the period of 1985 to 2016. Significance p < 0,05. RESULTS: Fontan-type operations were performed in 420 patients during this period: TCPC was performed in 320, lateral tunnel technique in 82, and FK in 18. Ten cases from the FK group were elected to conversion to TCPC. All patients submitted to Fontan Conversion were included in this study. In nine patients the indication was due to uncontrolled arrhythmia and in one, due to protein-losing enteropathy. Death was observed in the first two cases. The average intensive care unit (ICU) length of stay (LOS) was 13 days, and the average hospital LOS was 37 days. A functional class by New York Heart Association (NYHA) improvement was observed in 80% of the patients in NYHA I or II. Fifty-seven percent of conversions due to arrhythmias had improvement of arrhythmias; four cases are cured. CONCLUSIONS: The conversion is a complex procedure and requires an experienced tertiary hospital to be performed. The conversion has improved the NYHA functional class despite an unsatisfactory resolution of the arrhythmia.


Assuntos
Técnica de Fontan/métodos , Derivação Cardíaca Direita/métodos , Insuficiência Cardíaca/cirurgia , /cirurgia , Adolescente , Adulto , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/cirurgia , Criança , Circulação Coronária , Feminino , Técnica de Fontan/efeitos adversos , Técnica de Fontan/mortalidade , Derivação Cardíaca Direita/mortalidade , Insuficiência Cardíaca/mortalidade , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
Arq. bras. cardiol ; 112(2): 130-135, Feb. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-983830

RESUMO

Abstract Background: The Fontan-Kreutzer procedure (FK) was widely performed in the past, but in the long-term generated many complications resulting in univentricular circulation failure. The conversion to total cavopulmonary connection (TCPC) is one of the options for treatment. Objective: To evaluate the results of conversion from FK to TCPC. Methods: A retrospective review of medical records for patients who underwent the conversion of FK to TCPC in the period of 1985 to 2016. Significance p < 0,05. Results: Fontan-type operations were performed in 420 patients during this period: TCPC was performed in 320, lateral tunnel technique in 82, and FK in 18. Ten cases from the FK group were elected to conversion to TCPC. All patients submitted to Fontan Conversion were included in this study. In nine patients the indication was due to uncontrolled arrhythmia and in one, due to protein-losing enteropathy. Death was observed in the first two cases. The average intensive care unit (ICU) length of stay (LOS) was 13 days, and the average hospital LOS was 37 days. A functional class by New York Heart Association (NYHA) improvement was observed in 80% of the patients in NYHA I or II. Fifty-seven percent of conversions due to arrhythmias had improvement of arrhythmias; four cases are cured. Conclusions: The conversion is a complex procedure and requires an experienced tertiary hospital to be performed. The conversion has improved the NYHA functional class despite an unsatisfactory resolution of the arrhythmia.


Resumo Fundamento: O procedimento de Fontan-Kreutzer (FK) foi amplamente realizado no passado, mas a longo prazo gerou muitas complicações, resultando em falha na circulação univentricular. A conversão para conexão cavopulmonar total (CCPT) é uma das opções de tratamento. Objetivo: Avaliar os resultados da conversão de FK para CCPT. Métodos: Revisão retrospectiva de prontuários de pacientes submetidos à conversão de FK para CCPT no período de 1985 a 2016. Significância p < 0,05. Resultados: Operações do tipo Fontan foram realizadas em 420 pacientes durante este período: CCPT foi realizada em 320, técnica de túnel lateral em 82 e FK em 18. Dez casos do grupo FK foram eleitos para conversão em CCPT. Todos os pacientes submetidos à conversão de Fontan foram incluídos neste estudo. Em nove pacientes, a indicação deveu-se a arritmia não controlada e em um devido à enteropatia perdedora de proteínas. A morte foi observada nos dois primeiros casos. O tempo médio de internação na unidade de terapia intensiva (UTI) foi de 13 dias e o tempo médio de internação hospitalar foi de 37 dias. Uma classe funcional pela melhora da New York Heart Association (NYHA) foi observada em 80% dos pacientes em NYHA I ou II. Cinquenta e sete por cento das conversões devido a arritmias tiveram melhora das arritmias; quatro casos foram curados. Conclusões: A conversão é um procedimento complexo e requer que um hospital terciário experiente seja realizado. A conversão melhorou a classe funcional da NYHA, apesar de uma resolução insatisfatória da arritmia.

5.
Int J Cardiol ; 271: 54-59, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29861103

RESUMO

BACKGROUND: Changes in circulatory physiology are common in Fontan patients due to suboptimal cardiac output, which may reduce the peripheral blood flow and impair the skeletal muscle. The objective of this study was to investigate the forearm blood flow (FBF), cross-sectional area (CSA) of the thigh and functional capacity in asymptomatic clinically stable patients undergoing Fontan surgery. METHODS: Thirty Fontan patients and 27 healthy subjects underwent venous occlusion plethysmography, magnetic resonance imaging of the thigh musculature and maximal cardiopulmonary exercise testing. Muscle sympathetic nerve activity (MSNA), norepinephrine measures, cardiovascular magnetic resonance, handgrip strength and 6-minute walk test were also performed. RESULTS: Fontan patients have blunted FBF (1.59 ±â€¯0.33 vs 2.17 ±â€¯0.52 mL/min/100 mL p < 0.001) and forearm vascular conductance (FVC) (1.69 ±â€¯0.04 vs 2.34 ±â€¯0.62 units p < 0.001), reduced CSA of the thigh (81.2 ±â€¯18.6 vs 116.3 ±â€¯26.4 cm2p < 0.001), lower peak VO2 (29.3 ±â€¯6 vs 41.5 ±â€¯9 mL/kg/min p < 0.001), walked distance (607 ±â€¯60 vs 701 ±â€¯58 m p < 0.001) and handgrip strength (21 ±â€¯9 vs 30 ±â€¯8 kgf p < 0.001). The MSNA (30 ±â€¯4 vs 22 ±â€¯3 bursts/min p < 0.001) and norepinephrine concentration [265 (236-344) vs 222 (147-262) pg/mL p = 0.006] were also higher in Fontan patients. Multivariate linear regression showed FVC (ß = 0.653; CI = 0.102-1.205; p = 0.022) and stroke volume (ß = 0.018; CI = 0.007-0.029; p = 0.002) to be independently associated with reduced CSA of the thigh adjusted for body mass index. The CSA of the thigh adjusted for body mass index (ß = 5.283; CI = 2.254-8.312; p = 0.001) was independently associated with reduced peak VO2. CONCLUSION: Patients with Fontan operation have underdeveloped skeletal muscle with reduced strength that is associated with suboptimal peripheral blood supply and diminished exercise capacity.


Assuntos
Tolerância ao Exercício/fisiologia , Técnica de Fontan/tendências , Força da Mão/fisiologia , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiologia , Adolescente , Adulto , Estudos Transversais , Teste de Esforço/métodos , Teste de Esforço/tendências , Feminino , Seguimentos , Técnica de Fontan/efeitos adversos , Antebraço/irrigação sanguínea , Antebraço/diagnóstico por imagem , Antebraço/fisiologia , Capacidade Residual Funcional/fisiologia , Humanos , Masculino , Músculo Esquelético/irrigação sanguínea , Adulto Jovem
8.
Rev Bras Cir Cardiovasc ; 28(3): 353-63, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24343685

RESUMO

INTRODUCTION: Characteristics of the patient and the coronary artery bypass grafting may predispose individuals to prolonged hospitalization, increasing costs and morbidity and mortality. OBJECTIVE: The objective of this study was to evaluate individual and perioperative risk factors of prolonged hospitalization in intensive care units and wards. METHODS: We conducted a case-control study of 104 patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Patients hospitalized >3 days in the intensive care unit or >7 days in the ward were considered for the study. The association between variables was estimated by the chi-square test, odds ratio and logistic regression; P <0.05 was considered statistically significant. RESULTS: Hospital stay >3 days in the intensive care unit occurred for 22.1% of patients and >7 days in the ward for 27.9%. Among preoperative factors, diabetes (OR=3.17) and smoking (OR=4.07) were predictors of prolonged intensive care unit stay. Combining the pre-, intra-and postoperative variables, only mechanical ventilation for more than 24 hours (OR=6.10) was predictive of intensive care unit outcome. For the ward outcome, the preoperative predictor was left ventricular ejection fraction <50% (OR=3.04). Combining pre- and intraoperative factors, diabetes (OR=2.81), and including postoperative factors, presence of infection (OR=4.54) were predictors of prolonged hospitalization in the ward. CONCLUSION: Diabetes and smoking were predictors of intensive care unit outcome, and ejection fraction <50% of ward outcome. For the set of perioperative factors, prolonged hospitalization after isolated coronary artery bypass grafting was associated with mechanical ventilation >24 hours for the intensive care unit and presence of infection for the ward.


Assuntos
Ponte de Artéria Coronária/estatística & dados numéricos , Complicações Intraoperatórias/etiologia , Tempo de Internação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar , Estudos de Casos e Controles , Complicações do Diabetes , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Valor Preditivo dos Testes , Respiração Artificial , Fatores de Risco , Fumar/efeitos adversos , Estatísticas não Paramétricas , Fatores de Tempo
9.
Rev. bras. cir. cardiovasc ; 28(3): 353-363, jul.-set. 2013. tab
Artigo em Inglês | LILACS | ID: lil-697221

RESUMO

INTRODUCTION: Characteristics of the patient and the coronary artery bypass grafting may predispose individuals to prolonged hospitalization, increasing costs and morbidity and mortality. OBJECTIVE: The objective of this study was to evaluate individual and perioperative risk factors of prolonged hospitalization in intensive care units and wards. METHODS: We conducted a case-control study of 104 patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Patients hospitalized >3 days in the intensive care unit or >7 days in the ward were considered for the study. The association between variables was estimated by the chi-square test, odds ratio and logistic regression; P <0.05 was considered statistically significant. RESULTS: Hospital stay >3 days in the intensive care unit occurred for 22.1% of patients and >7 days in the ward for 27.9%. Among preoperative factors, diabetes (OR=3.17) and smoking (OR=4.07) were predictors of prolonged intensive care unit stay. Combining the pre-, intra-and postoperative variables, only mechanical ventilation for more than 24 hours (OR=6.10) was predictive of intensive care unit outcome. For the ward outcome, the preoperative predictor was left ventricular ejection fraction <50% (OR=3.04). Combining pre- and intraoperative factors, diabetes (OR=2.81), and including postoperative factors, presence of infection (OR=4.54) were predictors of prolonged hospitalization in the ward. CONCLUSION: Diabetes and smoking were predictors of intensive care unit outcome, and ejection fraction <50% of ward outcome. For the set of perioperative factors, prolonged hospitalization after isolated coronary artery bypass grafting was associated with mechanical ventilation >24 hours for the intensive care unit and presence of infection for the ward.


INTRODUÇÃO: Características do paciente e da cirurgia de revascularização do miocárdio podem predispor à internação prolongada, aumentando custos e a morbimortalidade. OBJETIVO: Avaliar fatores de risco individuais e transoperatórios para internação prolongada na unidade de terapia intensiva e na enfermaria. MÉTODOS: Realizou-se estudo de caso-controle com 104 pacientes submetidos à revascularização do miocárdio isolada sob circulação extracorpórea. Consideraram-se casos os pacientes com internação >3 para terapia intensiva ou >7 dias para enfermaria. A associação entre variáveis foi estimada pelo teste do qui-quadrado e pela razão de chances (odds ratio-OR) empregando-se a regressão logística, ao nível de P<0,05. RESULTADOS: A permanência >3 dias na terapia intensiva ocorreu em 22,1% dos pacientes e >7 dias na enfermaria em 27,9%. Entre os fatores pré-operatórios, o diabetes (OR=3,17) e o tabagismo (OR=4,07) foram os preditores para permanência prolongada na terapia intensiva. Combinando-se as variáveis pré-, intra- e pós-operatórias, somente a ventilação mecânica por mais que 24 horas (OR=6,10) foi preditora para o desfecho na terapia intensiva. Para o desfecho na enfermaria, o preditor pré-operatório foi a fração de ejeção ventricular esquerda <50% (OR=3,04). Combinando os fatores pré- e intraoperatórios, o diabetes (OR=2,81) e, somando-se os pós-operatórios, a presença de infecção (OR=4,54), foram os preditores para internação prolongada na enfermaria. CONCLUSÃO: Diabetes e tabagismo foram os preditores para o desfecho na terapia intensiva, e a fração de ejeção <50% para a enfermaria. Para o conjunto dos fatores transoperatórios, internação prolongada após revascularização do miocárdio isolada associou-se à ventilação mecânica >24 horas para terapia intensiva e à presença de infecção para a enfermaria.


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte de Artéria Coronária/estatística & dados numéricos , Complicações Intraoperatórias/etiologia , Tempo de Internação/estatística & dados numéricos , Ponte Cardiopulmonar , Estudos de Casos e Controles , Complicações do Diabetes , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Período Perioperatório , Valor Preditivo dos Testes , Respiração Artificial , Fatores de Risco , Estatísticas não Paramétricas , Fumar/efeitos adversos , Fatores de Tempo
10.
Rev. bras. cir. cardiovasc ; 24(4): 478-484, out.-dez. 2009. tab, graf
Artigo em Inglês, Português | LILACS | ID: lil-540749

RESUMO

Objetivo: A função pulmonar é apontada como preditora do tempo de hospitalização na cirurgia cardíaca. E o teste de caminhada de seis minutos (TC6') tem sido utilizado para caracterizar a capacidade funcional em pacientes cardiopatas, porém há poucos estudos que o correlacione com tempo de internação hospitalar. O objetivo desta pesquisa foi verificar se há correlação da função pulmonar pré e pós-operatória e da capacidade da deambulação pósoperatória com tempo de internação pós-operatória. Métodos: Foi realizada uma coorte prospectiva com 18 pacientes, sendo 8 do gênero masculino e 10 do gênero feminino, com idade acima de 40 anos (média 64,89 ± 6,95 anos), internados para a submissão de cirurgias de revascularização do miocárdio e/ou troca valvar. Para caracterizar a função pulmonar, os pacientes foram submetidos a uma espirometria no pré-operatório e ao 5º dia pós-operatório. Neste último período também foi realizado um teste de caminhada de 6 minutos (TC6') para caracterizar a capacidade de deambulação. RESULTADO: Não houve correlação significativa da função pulmonar pré e pós-operatória com o tempo de internação pós-operatória. Somente a distância percorrida no TC6' apresentou correlação negativa significativa (rho=-0,62) com o tempo de internação pós-operatória. A distância no TC6' obteve correlação positiva significativa com a capacidade vital forçada (r=0,59) e volume expiratório forçado no 1º segundo (r=0,52). Conclusão: Esses resultados sugerem que os pacientes com maior capacidade de deambulação no pós-operatório apresentam menor tempo de internação e sugere-se também que a distância no TC6' pode representar melhor a capacidade funcional desses pacientes do que a função pulmonar isoladamente.


Objective: The lung function is identified as a predictor of time of hospitalization in heart surgery. Meanwhile sixminute walk test has been used to establish functional capacity of cardiac patients, however there are few studies that correlate it with the length of hospital stay. The aim of this research was to determine whether there is correlation of preoperative and postoperative lung function and the ability of walking during the hospital stay. Methods: A prospective cohort with 18 patients was performed, being 8 males and 10 females, with age above 40 years (medium 64.89 ± 6.95 years). Patients where admitted for coronary artery bypass graft surgery and/or exchange valve. To characterize the pulmonary function, patients were submitted to spirometry in preoperative and the 5th postoperative day. In the latter period was also a test for 6 minutes walk (6MWT) to characterize the ability to walk. RESULTS: There was not significant correlation of preoperative and postoperative pulmonary function with length of hospital stay. Only the distance covered in 6MWT showed a significant negative correlation (rho= 0.62) with length of stay. The distance in 6MWT obtained a significant positive correlation with forced vital capacity (r=0.59) and first second of a maximal forced expiratory manoeuvre (r=0.52). Conclusion: These results suggest that patients with increased postoperative capacity to walk have a shorter time of hospitalization and it also suggest that the distance in the 6MWT can better represent the functional capacity of these patients than pulmonary function alone.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos , Teste de Esforço , Tempo de Internação/estatística & dados numéricos , Pulmão/fisiopatologia , Caminhada/fisiologia , Procedimentos Cirúrgicos Cardíacos/reabilitação , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Prospectivos , Espirometria
11.
Rev Bras Cir Cardiovasc ; 24(4): 478-84, 2009.
Artigo em Inglês, Português | MEDLINE | ID: mdl-20305920

RESUMO

OBJECTIVE: The lung function is identified as a predictor of time of hospitalization in heart surgery. Meanwhile sixminute walk test has been used to establish functional capacity of cardiac patients, however there are few studies that correlate it with the length of hospital stay. The aim of this research was to determine whether there is correlation of preoperative and postoperative lung function and the ability of walking during the hospital stay. METHODS: A prospective cohort with 18 patients was performed, being 8 males and 10 females, with age above 40 years (medium 64.89 +/- 6.95 years). Patients where admitted for coronary artery bypass graft surgery and/or exchange valve. To characterize the pulmonary function, patients were submitted to spirometry in preoperative and the 5th postoperative day. In the latter period was also a test for 6 minutes walk (6MWT) to characterize the ability to walk. RESULTS: There was not significant correlation of preoperative and postoperative pulmonary function with length of hospital stay. Only the distance covered in 6MWT showed a significant negative correlation (rho= 0.62) with length of stay. The distance in 6MWT obtained a significant positive correlation with forced vital capacity (r=0.59) and first second of a maximal forced expiratory manoeuvre (r=0.52). CONCLUSION: These results suggest that patients with increased postoperative capacity to walk have a shorter time of hospitalization and it also suggest that the distance in the 6MWT can better represent the functional capacity of these patients than pulmonary function alone.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Teste de Esforço , Tempo de Internação/estatística & dados numéricos , Pulmão/fisiopatologia , Caminhada/fisiologia , Idoso , Procedimentos Cirúrgicos Cardíacos/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Prospectivos , Espirometria
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