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2.
Cardiol Young ; 29(5): 684-688, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31118113

RESUMO

BACKGROUND: Residual right ventricular outflow obstruction during Tetralogy of Fallot repair necessitates peri-operative revision often requiring trans-annular patch with its negative sequels. Bidirectional Glenn shunt in this setting reduces trans-pulmonary gradient to avoid revision. METHODS: Bidirectional Glenn shunt was added during Tetralogy repair in patients with significant residual obstruction. A total of 53 patients between January, 2011 and June, 2018 were included. Final follow-up was conducted in July, 2018. RESULTS: Mean age at operation was 5.63±3.1 years. Right to left ventricular pressure ratio reduced significantly (0.91±0.09 versus 0.68±0.05; p<0.001) after bidirectional Glenn, avoiding revision in all cases. Glenn pressures at ICU admission decreased significantly by the time of ICU discharge (16.7±3.02 versus 13.5±2.19; p<0.001). Pleural drainage ≥ 7 days was seen in 14 (26.4%) patients. No side effects related to bidirectional Glenn-like facial swelling or veno-venous collaterals were noted. Mortality was 3.7%. Discharge echocardiography showed a mean trans-pulmonary gradient of 32.11±5.62 mmHg that decreased significantly to 25.64±5 (p<0.001) at the time of follow-up. Pulmonary insufficiency was none to mild in 45 (88.2%) and moderate in 6 (11.8%). Mean follow-up was 36.12±25.15 months (range 0.5-90). There was no interim intervention or death. At follow-up, all the patients were in NYHA functional class 1 with no increase in severity of pulmonary insufficiency. CONCLUSION: Supplementary bidirectional Glenn shunt significantly reduced residual right ventricular outflow obstruction during Tetralogy of Fallot repair avoiding revision with satisfactory early and mid-term results.


Assuntos
Técnica de Fontan , Tetralogia de Fallot/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Criança , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Valva Pulmonar/anormalidades , Insuficiência da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/congênito , Reoperação , Tetralogia de Fallot/complicações , Fatores de Tempo , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/complicações
3.
J Vet Cardiol ; 21: 93-97, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30797449

RESUMO

A 10-week-old male intact mixed breed dog presented for evaluation of suspected right-sided congestive heart failure. Echocardiographic imaging revealed a perforate cor triatriatum dexter (CTD), along with pulmonary valve stenosis and tricuspid and mitral valve dysplasia. In typical CTD cases, there is unidirectional blood flow across the dividing membrane, from the caudal into the cranial right atrial chambers. Owing to right-sided pressure alterations caused by the concurrent valvar defects, color Doppler imaging demonstrated bidirectional flow across the CTD membrane.


Assuntos
Coração Triatriado/veterinária , Doenças do Cão/fisiopatologia , Insuficiência da Valva Mitral/veterinária , Estenose da Valva Pulmonar/veterinária , Insuficiência da Valva Tricúspide/veterinária , Animais , Coração Triatriado/complicações , Coração Triatriado/patologia , Coração Triatriado/fisiopatologia , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/patologia , Cães , Ecocardiografia/veterinária , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem
4.
Int J Cardiol ; 280: 43-45, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30665803

RESUMO

Transcatheter implantation of pulmonary valve has emerged as a reliable approach in congenital heart patients presenting with chronic right ventricular volume or pressure overload after primary repair. Initial experience was limited by relatively narrow range of working diameter of transcatheter valves. Nowadays, improved technology allows extending this option to patient with large right ventricular outflow tract or conduit. A stable landing zone is of paramount importance before considering valve implantation. We present two cases of right ventricular outflow tract pre-stenting using the BeGraft® stent, which may become an interesting add to our tool kit in the preparation of valve landing zone.


Assuntos
Implante de Prótese de Valva Cardíaca/instrumentação , Estenose da Valva Pulmonar/cirurgia , Stents , Obstrução do Fluxo Ventricular Externo/cirurgia , Adulto , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pessoa de Meia-Idade , Estenose da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/complicações , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem
5.
Pediatr Cardiol ; 40(3): 526-536, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30353312

RESUMO

BACKGROUND: Patients with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis (PAIVS/CPS) have wide variation in right ventricle (RV) size, systolic function, and diastolic function at birth. Establishment of antegrade pulmonary blood flow creates the potential for RV dilation from chronic pulmonary insufficiency. Future surgical decisions are based on RV size and function, largely supported by longitudinal studies of patients with Tetralogy of Fallot (TOF). Given potential differences in RV physiology and lack of similar data in PAIVS/CPS, the objective of this study was to determine differences in RV size, systolic function, and diastolic function between patients with PAIVS/CPS versus TOF. METHODS: We retrospectively collected cardiovascular magnetic resonance (CMR) data in 27 patients with PAIVS/CPS (ages 13.3 ± 8.8 years) and 78 with TOF (11.4 ± 5.4 years). RV volumes, ejection fraction (EF), regurgitant fraction, end-diastolic forward flow across the pulmonary valve, and right atrial cross-sectional area were calculated. RESULTS: There was no difference between the groups in RV end-diastolic volume (RVEDVi), RVEF, or pulmonary regurgitation. RVEF tended to decrease in TOF when RVEDVi exceeded 164 ml/m2. In PAIVS/CPS, RVEDVi less frequently reached 164 ml/m2 and was not associated with RVEF. There was worse RV diastolic dysfunction in PAIVS/CPS, with 1.5 times larger right atrial area and two times higher pulmonary end-diastolic forward flow (p < 0.0001). CONCLUSIONS: Patients with PAIVS/CPS have similar RV size, systolic function, and pulmonary regurgitation as TOF. However, impaired RV diastolic function may limit extremes of RV dilatation and impact long-term management of PAIVS/CPS.


Assuntos
Cardiopatias Congênitas/fisiopatologia , Ventrículos do Coração/fisiopatologia , Atresia Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/fisiopatologia , Tetralogia de Fallot/fisiopatologia , Função Ventricular Direita/fisiologia , Adolescente , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Estudos Transversais , Ecocardiografia/métodos , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Atresia Pulmonar/complicações , Atresia Pulmonar/cirurgia , Estenose da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/cirurgia , Estudos Retrospectivos , Volume Sistólico , Tetralogia de Fallot/cirurgia , Resultado do Tratamento , Adulto Jovem
6.
Pediatr Cardiol ; 40(2): 374-383, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30539241

RESUMO

There is paucity of long-term data on adult survivors after biventricular repair of pulmonary atresia with intact ventricular septum (PAIVS) and pulmonary stenosis (PS). This study aimed to determine the cardiac and non-cardiac outcomes of adult survivors after biventricular repair of PAIVS and PS. The cardiac, neurodevelopmental and liver problems of 111 adults, 40 with PAIVS and 71 with PS, were reviewed. The median follow-up duration of our patients was 26.5 years (range 14.8-55 years). The freedom from reintervention at 30 years was 17.4% and 73.3% for PAIVS and PS patients (p < 0.001), respectively. Compared with PS patients, PAIVS patients had significantly greater prevalence of right atrial and right ventricular (RV) dilatation, and moderate to severe tricuspid and pulmonary regurgitation (all p < 0.05), and cardiac arrhythmias (22.5% vs. 8.5%, p = 0.047). The freedom from development of cardiac arrhythmias at 30 years of 68.4% and 91.6%, respectively, in PAIVS and PS patients (p = 0.03). Cox proportional hazards model identified PAIVS as an independent risk factor for reintervention (HR 4.0, 95% CI 2.1-7.6, p < 0.001) and development of arrhythmias (HR 4.1, 95% CI 1.1-14.4, p = 0.03). Neurodevelopmental problems were found in 17.5% of PAIVS patients and 7.0% of PS patients (p = 0.11). Liver problems occurred in 2 (5%) PAIVS patients, both of whom required conversion to 1.5 ventricular repair. In conclusion, long-term problems, including the need for reinterventions, cardiac arrhythmias, RV dilation, pulmonary regurgitation, and neurodevelopmental and liver issues are more prevalent in adult PAIVS than PS survivors.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/cirurgia , Atresia Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Adulto , Arritmias Cardíacas/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ecocardiografia/métodos , Feminino , Seguimentos , Cardiopatias Congênitas/complicações , Ventrículos do Coração/cirurgia , Humanos , Masculino , Atresia Pulmonar/complicações , Estenose da Valva Pulmonar/complicações , Reoperação/estatística & dados numéricos , Fatores de Risco , Sobreviventes , Resultado do Tratamento
8.
An. pediatr. (2003. Ed. impr.) ; 89(5): 294-301, nov. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-177119

RESUMO

Introducción y objetivos: Las cardiopatías congénitas (CC) son las malformaciones congénitas más frecuentes. En España no hay datos de su incidencia a nivel nacional. El objetivo del estudio es analizar la incidencia y evolución de las CC en España. Métodos: Estudio observacional retrospectivo utilizando el conjunto mínimo básico de datos durante 10 años (2003-2012), en menores de un año, seleccionando las altas hospitalarias con códigos de CC (Clasificación Internacional de Enfermedades, 9.a revisión, modificación clínica). Se describió la evolución anual de la incidencia acumulada y su distribución geográfica, y se analizó mediante riesgos relativos de incidencia y razón de incidencias estandarizadas por comunidad autónoma. Resultados: Durante el periodo analizado 64.831 menores de un año fueron diagnosticados de CC al alta hospitalaria sobre 4.766.325 nacimientos con una incidencia del 13,6‰. La incidencia excluyendo la comunicación interauricular fue del 7,29‰. Los códigos más frecuentes fueron: comunicación interauricular (6,31‰), comunicación interventricular (3,48‰), ductus arteriosus persistente (2,71‰), coartación de aorta (0,55‰), estenosis pulmonar (0,50‰), trasposición de grandes vasos (0,49‰), canal auriculoventricular (0,45‰) y tetralogía de Fallot (0,41‰). La distribución geográfica de las cardiopatías graves y muy graves no resultó uniforme presentando Castilla y León junto con Extremadura la mayor incidencia, y Madrid y Cantabria la menor. Conclusiones: Durante el tiempo de estudio se observa un aumento de cardiopatías leves que puede estar influido por la mejora de las técnicas diagnósticas, el uso extendido de la ecocardiografía y la propia codificación Clasificación Internacional de Enfermedades, 9.a revisión, modificación clínica y una disminución de las cardiopatías muy graves cuyo análisis presenta mayor validez al estar menos influido por factores externos. La incidencia de cardiopatías graves y muy graves no fue uniforme en España


Introduction and objectives: Congenital heart disease (CHD) represents the most common congenital malformation. The objective of this study was to analyse the incidence of CHD in Spain, and it is the first nationwide study so far. Methods: A retrospective observational study was performed in order to evaluate the incidence of CHD in Spain. The administrative database (minimum basic data set) from 2003 to 2012 was analysed in children less than one year old admitted to hospital with codes of CHD (International Classification of Diseases, 9 th Revision, clinical modification). Cumulative incidence, Incidence relative risk, and standardised incidence ratio were calculated to study geographic variations. Results: There were 64,831 infants with CHD among the 4,766,325 births analysed during the period studied, with an incidence of 13.6‰. The incidence excluding atrial septal defect was 7.29 ‰.The most frequent CHD were atrial septal defect (6.31‰), ventricular septal defect (3.48‰), patent ductus arteriosus (2.71‰), coarctation of the aorta (0.55‰), pulmonary stenosis (0.50‰), transposition of the great arteries (0.49‰), atrioventricular septal defect (0.45‰), and tetralogy of Fallot (0.41‰). Castilla and Leon, together with Extremadura, showed the highest risks for severe and very severe CHD, while Madrid and Cantabria showed the lowest. Conclusions: An increase of mild CHD was observed during the period analysed. This could have been influenced by improvements in diagnostic techniques, extended use of echocardiography, and the International Classification of Diseases, 9 th Revision, clinical modification coding system, and to a decrease in very severe CHD, which is less influenced by external factors. Significant geographical differences were found in the incidence of severe and very severe CHD


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/classificação , Espanha/epidemiologia , Estudo Observacional , Estudos Retrospectivos , Estenose da Valva Pulmonar/complicações , Ecocardiografia , Classificação Internacional de Doenças
11.
Pediatr Cardiol ; 39(8): 1663-1668, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30105464

RESUMO

Pressure difference (PD) is an important parameter in evaluating the degree of stenotic lesion. However, PD is influenced by the blood flow volume passing through the stenosis. In patients with tetralogy of Fallot (TOF), pulmonary valve regurgitation (PR) and pulmonary valve stenosis (vPS) are common post-operative complications. The aim of this study was to evaluate the influence of PR on the PD. First, we examined the relationship between the peak-to-peak PD and the valve orifice area in 7 patients with vPS from their cardiac catheterization data. Second, an estimated PD, i.e., PD assuming no PR, was calculated in 8 patients with TOF with vPS and PR from their valve orifice area using the relational equation in patients with vPS. Moreover, an excess of PD, equating to the difference between the measured and estimated PD, was calculated. Finally, the relationship between the regurgitant fraction (RF) and the excess PD was analyzed. There was a strong relationship between the reciprocal of the valve orifice area and the PD in patients with vPS (r = 0.904, p = 0.0053). The excess PD showed a significant correlation with the RF in patients with TOF (r = 0.889, p = 0.0032). PR of over 25% in RF augmented the PD depending on the regurgitant volume. Severity of vPS could be overestimated in post-operative patients with TOF who had significant PR when their RF was above 25%.


Assuntos
Insuficiência da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/complicações , Valva Pulmonar/fisiopatologia , Tetralogia de Fallot/cirurgia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Estudos Retrospectivos , Tetralogia de Fallot/complicações
12.
Catheter Cardiovasc Interv ; 92(1): 88-91, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29659133
13.
Pediatr Cardiol ; 39(5): 906-910, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29520463

RESUMO

Deletion of 22q11.2 (del22q11) is associated with adverse outcomes in patients with tetralogy of Fallot (TOF). We sought to investigate its contribution to perioperative outcome in patients with a severe form of TOF characterized by pulmonary atresia (PA) or severe pulmonary stenosis (PS) and major aortopulmonary collateral arteries (MAPCAS). We conducted a retrospective review of patients with TOF/MAPCAS who underwent staged surgical reconstruction between 1995 and 2006. Groups were compared according to 22q11.2 deletion status using t-tests or the Wilcoxon Rank sum test. We included 26 subjects, 24 of whom survived the initial operation. Of those, 21 subjects had known deletion status and constitute the group for this analysis [15 with no deletion present (ND) and 6 del22q11 subjects]. There was no difference with respect to occurrence of palliative procedure prior to initial operation, or to timing of closure of the ventricular septal defect (VSD). Other than higher prevalence of prematurity (50%) in the del22q11 group versus no prematurity in the ND, the groups were comparable in terms of pre-operative characteristics. The intra- and post-operative course outcomes (length of cardiopulmonary bypass, use of vasopressors, duration of intensive care and length of hospital stay, tube-feeding) were also comparable. Although the del22q11 had longer mechanical ventilation than the ND, this difference was not significant [68 h (range 4-251) vs. 45 h (range 3-1005), p = 0.81]. In this detailed comparison of a small patient cohort, 22q11.2 deletion syndrome was not associated with adverse perioperative outcomes in patients with TOF, PA, and MAPCAS when compared to those without 22q11.2 deletion syndrome. These results are relevant to prenatal and neonatal pre-operative counseling and planning.


Assuntos
Circulação Colateral , Síndrome de DiGeorge , Comunicação Interventricular , Atresia Pulmonar , Tetralogia de Fallot , Estudos de Casos e Controles , Circulação Colateral/genética , Circulação Colateral/fisiologia , Síndrome de DiGeorge/complicações , Feminino , Idade Gestacional , Comunicação Interventricular/complicações , Comunicação Interventricular/cirurgia , Humanos , Recém-Nascido , Masculino , Atresia Pulmonar/complicações , Atresia Pulmonar/genética , Atresia Pulmonar/cirurgia , Estenose da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/genética , Estudos Retrospectivos , Tetralogia de Fallot/complicações , Tetralogia de Fallot/genética , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/cirurgia , Resultado do Tratamento
14.
Rev. esp. anestesiol. reanim ; 65(3): 165-169, mar. 2018. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-171358

RESUMO

La oximetría cerebral «near infrared spectroscopy»(NIRS) determina la oxigenación tisular cerebral. Describimos el caso clínico de un niño de 12 meses de edad con hemiparesia derecha secundaria a infarto de arteria cerebral media izquierda hacía 8 meses. El niño fue sometido a una ampliación del tracto de salida del ventrículo derecho por estenosis pulmonar mediante bypass cardiopulmonar. En periodos del bypass cardiopulmonar se detectan asimetrías NIRS entre ambos hemisferios cerebrales con descensos críticos en hemisferio derecho lo que indica estados de perfusión y consumo de oxígeno diferentes entre los 2 hemisferios. La utilización de neuromonitorización multimodal NIRS-BIS permitió actuar sobre la presión de perfusión y profundidad anestésica para equilibrar la balanza entre el aporte y el consumo de oxígeno cerebral. No se detectó daño neurológico sobreañadido en el postoperatorio. Consideramos necesaria la monitorización NIRS bilateral para detectar asimetrías entre los 2 hemisferios, que aunque no se manifiesten en el registro basal, pueden surgir en el periodo intraoperatorio, permitiendo detectar y tratar la isquemia-hipoxia cerebral en el hemisferio sano, que provocaría un daño neurológico sobreañadido (AU)


Cerebral oximetry based on near infrared spectroscopy (NIRS) technology is used to determine cerebral tissue oxygenation. We hereby present the clinical case of a 12-month old child with right hemiparesis secondary to prior left middle cerebral artery stroke 8 months ago. The child underwent surgical enlargement of the right ventricular outflow tract (RVOT) with cardiopulmonary bypass. During cardiopulmonary bypass, asymmetric NIRS results were detected between both hemispheres. The utilization of multimodal neuromonitoring (NIRS-BIS) allowed acting on both perfusion pressure and anesthetic depth to balance out the supply and demand of cerebral oxygen consumption. No new neurological sequelae were observed postoperatively. We consider bilateral NIRS monitoring necessary in order to detect asymmetries between cerebral hemispheres. Although asymmetries were not present at baseline, they can arise intraoperatively and its monitoring thus allows the detection and treatment of cerebral ischemia-hypoxia in the healthy hemisphere, which if undetected and untreated would lead to additional neurological damage (AU)


Assuntos
Humanos , Masculino , Lactente , Ponte Cardiopulmonar/métodos , Infarto Cerebral/cirurgia , Oximetria/métodos , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Consumo de Oxigênio/fisiologia , Monitorização Neurofisiológica Intraoperatória/métodos , Estenose da Valva Pulmonar/complicações
16.
Heart ; 104(14): 1148-1155, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29326110

RESUMO

Congenitally corrected transposition of the great arteries (ccTGA) can occur in isolation, or in combination with other structural cardiac anomalies, most commonly ventricular septal defect, pulmonary stenosis and tricuspid valve disease. Clinical recognition can be challenging, so echocardiography is often the means by which definitive diagnosis is made. The tricuspid valve and right ventricle are on the systemic arterial side of the ccTGA circulation, and are therefore subject to progressive functional deterioration. The natural history of ccTGA is also greatly influenced by the nature and severity of accompanying lesions, some of which require surgical repair. Some management strategies leave the right ventricle as the systemic arterial pump, but carry the risk of worsening heart failure. More complex 'double switch' repairs establish the left ventricle as the systemic pump, and include an atrial baffle to redirect venous return in combination with either arterial switch or Rastelli operation (if a suitable ventricular septal defect permits). Occasionally, the anatomic peculiarities of ccTGA do not allow straightforward biventricular repair, and Fontan palliation is a reasonable option. Regardless of the approach selected, late cardiovascular complications are relatively common, so ongoing outpatient surveillance should be established in an age-appropriate facility with expertise in congenital heart disease care.


Assuntos
Transposição dos Grandes Vasos/diagnóstico , Transposição dos Grandes Vasos/cirurgia , Bloqueio Atrioventricular/etiologia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Humanos , Imagem Cinética por Ressonância Magnética , Complicações Pós-Operatórias , Estenose da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Taquipneia/etiologia , Transposição dos Grandes Vasos/complicações , Valva Tricúspide/anormalidades , Valva Tricúspide/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/etiologia
17.
Rev Esp Anestesiol Reanim ; 65(3): 165-169, 2018 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28958609

RESUMO

Cerebral oximetry based on near infrared spectroscopy (NIRS) technology is used to determine cerebral tissue oxygenation. We hereby present the clinical case of a 12-month old child with right hemiparesis secondary to prior left middle cerebral artery stroke 8 months ago. The child underwent surgical enlargement of the right ventricular outflow tract (RVOT) with cardiopulmonary bypass. During cardiopulmonary bypass, asymmetric NIRS results were detected between both hemispheres. The utilization of multimodal neuromonitoring (NIRS-BIS) allowed acting on both perfusion pressure and anesthetic depth to balance out the supply and demand of cerebral oxygen consumption. No new neurological sequelae were observed postoperatively. We consider bilateral NIRS monitoring necessary in order to detect asymmetries between cerebral hemispheres. Although asymmetries were not present at baseline, they can arise intraoperatively and its monitoring thus allows the detection and treatment of cerebral ischemia-hypoxia in the healthy hemisphere, which if undetected and untreated would lead to additional neurological damage.


Assuntos
Ponte Cardiopulmonar , Hipóxia-Isquemia Encefálica/diagnóstico , Infarto da Artéria Cerebral Média/metabolismo , Complicações Intraoperatórias/diagnóstico , Monitorização Intraoperatória/métodos , Oximetria/métodos , Estenose da Valva Pulmonar/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Circulação Cerebrovascular , Forame Oval Patente/complicações , Humanos , Hipóxia-Isquemia Encefálica/prevenção & controle , Lactente , Infarto da Artéria Cerebral Média/complicações , Complicações Intraoperatórias/prevenção & controle , Masculino , Doenças do Sistema Nervoso/prevenção & controle , Consumo de Oxigênio , Paresia/etiologia , Complicações Pós-Operatórias/prevenção & controle , Deficiência de Proteína C/complicações , Estenose da Valva Pulmonar/complicações , Espectroscopia de Luz Próxima ao Infravermelho , Obstrução do Fluxo Ventricular Externo/complicações
19.
Urol Int ; 100(4): 488-490, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-27577938

RESUMO

Ureteroinguinal herniation is a rare event, usually diagnosed during the surgical repair of inguinal hernias. Here, we describe the first case of a kidney blow out due to this condition in a male infant.


Assuntos
Hérnia Inguinal/cirurgia , Nefropatias/etiologia , Doenças Ureterais/cirurgia , Obstrução Ureteral/cirurgia , Comunicação Interventricular/complicações , Hérnia Inguinal/complicações , Humanos , Hidronefrose/complicações , Lactente , Masculino , Estenose da Valva Pulmonar/complicações , Síndrome de Sotos/complicações , Ureter/patologia , Doenças Ureterais/complicações
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