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1.
Niger J Clin Pract ; 24(4): 470-475, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33851666

RESUMO

Objective: The aim of this study was to analyze the complications following secondary voice prosthesis insertion and impact of previous irradiation on their appearance. Methods: This study included 106 totally laryngectomized patients who underwent secondary Provox 2 voice prosthesis insertion. Among them, 79 (74.5%) were irradiated. Surgery, prosthesis, fistula, and voice-related complications were analyzed and presented. Results: Complications occurred in 23 (22%) patients. Fifteen of them were previously irradiated. There were no surgery-related complications. In the group of prosthesis-related complications, one patient had increased negative pressure during swallowing with extremely short prosthesis life time. There were 17 complications in the group of fistula related ones; 3 patients had excessive granulation tissue around the fistula and 14 patients experienced prosthesis displacement (7 had closed esophageal end of the fistula, 5 had the prosthesis turned sideways in an open fistula, one patient inhaled and one ingested the prosthesis). Tracheoesophageal voice was not established in 5 patients. Previous irradiation had no statistically significant influence on the complication rate (P = 0,251). Conclusions: The majority of complications following secondary voice prosthesis insertion are fistula-related ones, among which, displacement of the voice prosthesis is the most common. Previous irradiation does not significantly increase the risk of developing complications.


Assuntos
Fístula , Laringe Artificial , Fístula/epidemiologia , Fístula/etiologia , Humanos , Laringectomia/efeitos adversos , Laringe Artificial/efeitos adversos , Desenho de Prótese , Implantação de Prótese/efeitos adversos
2.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462040

RESUMO

An 86-year-old woman presented with symptomatic hypotony on the left eye since a few weeks, blurry vision and a very sensitive eye. She had a history of bilateral intracapsular cataract extraction (ICCE) in 1982 and secondary intraocular lens implantation in 1988. The patient mentioned a fall on the left side of the head 6 months earlier. The diagnosis of a superior scleral fistula was made, confirmed by gonioscopy and anterior segment optical coherence tomography. Direct surgical repair of the fistula led to a favourable outcome. This case demonstrates the occurrence of symptomatic hypotony due to the traumatic creation of a scleral fistula with an inadvertent filtering bleb many years after ICCE, and the resolution of signs and symptoms after surgical repair. Conventional as well as contemporary modalities can be valuable in the assessment of such fistulae. Management depends on the clinical course and the mechanism and extent of fistulation.


Assuntos
Vesícula/etiologia , Extração de Catarata/efeitos adversos , Fístula/etiologia , Implante de Lente Intraocular/efeitos adversos , Hipotensão Ocular/etiologia , Esclera/lesões , Idoso de 80 Anos ou mais , Vesícula/diagnóstico , Feminino , Fístula/diagnóstico , Humanos , Hipotensão Ocular/diagnóstico
4.
Am J Otolaryngol ; 42(1): 102748, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33068955

RESUMO

BACKGROUND: Laryngectomy remains a common operation in head and neck units. The operation holds significant risk of post-operative morbidity including swallowing dysfunction. The most significant post-operative concern is the formation of a pharyngocutaneous fistula [PCF], the reported incidence of which is between 3% and 65%. The purpose of this systematic review and meta-analysis was to assess the safety of initiating early oral feeding following laryngectomy and the risk of PCF formation. METHODS: A literature search was conducted through online databases: MEDLINE, EMBASE and PubMed. Eligible studies were included which contained cohorts of patients who had undergone laryngectomy, with early oral feeding commencing within seven days compared to late oral feeding. The primary outcome assessed was the incidence of PCF. Studies were excluded if cohorts had not included laryngectomy or if no comment was made on PCF formation. Meta-analysis was used to examine associations between oral feeding and PCF formation using Fixed Effect models. RESULTS: Twelve studies and 1883 patients were included after systematic review. Six studies were non-interventional whereas the remaining were randomized clinical trials. Exposure included those with early oral feeding (before seven days) or late feeding oral feeding (after seven days) and the outcome assessed was the risk of PCF formation. Results from observational studies showed a higher risk of PCF formation for early feeders compared to late feeders [RR = 1.56, 95% CI: 1.15, 2.11]. Higher risk was also observed for RCT but was not significant [RR = 1.40, 95% CI: 0.85, 2.30]. Overall, there was a 50% greater risk of PCF formation for early oral feeding compared to late oral feeding [RR = 1.51, 95% CI: 1.17, 1.96]. CONCLUSION: While early oral feeding can reduce post-laryngectomy patients' hospital stay and improve psychological wellbeing, there is a significant relative risk of PCF development within this group. However, this must be taken in context of the significant heterogeneity that exists within the literature.


Assuntos
Fístula Cutânea/epidemiologia , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Fístula/epidemiologia , Laringectomia/efeitos adversos , Doenças Faríngeas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fístula Cutânea/etiologia , Feminino , Fístula/etiologia , Humanos , Masculino , Doenças Faríngeas/etiologia , Complicações Pós-Operatórias/etiologia , Risco , Fatores de Tempo
5.
Medicine (Baltimore) ; 99(41): e22485, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031281

RESUMO

RATIONALE: Bronchopleural fistula (BPF) is a dreaded complication after lobectomy or pneumonectomy and is associated with high morbidity and mortality. Successful management remains challenging when this condition is combined with empyema, and the initial treatment is usually conservative and endoscopic, but operative intervention may be required in refractory cases. PATIENT CONCERNS: Two patients diagnosed with BPF with empyema were selected to undergo surgery in our hospital because they could not be cured by conservative and endoscopic therapy for 1 or more years. One was a 70-year-old man who had a 1-year history of fever and cough after he received a minimally invasive right lower lobectomy for intermediate lung adenocarcinoma and chemotherapy 2 years ago; the other was a 73-year-old man who had a 2-year history of cough and fever after he underwent a minimally invasive right upper lobectomy for early lung adenocarcinoma 3 years earlier. DIAGNOSIS: Both patients were diagnosed with BPF with empyema. INTERVENTIONS: After receiving conservative and endoscopic therapies, both patients underwent pedicled latissimus dorsi muscle flap transfers for complete filling of the empyema cavity. OUTCOMES: The patients recovered very well, with no recurrence of BPF and empyema during postoperative follow-up. LESSONS: It is crucial to not only completely control infection and occlude BPFs, but also obliterate the empyema cavity. Thus, pedicled latissimus dorsi muscle flap transfer associated with conservative and endoscopic therapies for BPF with empyema is a useful treatment option, offering feasible and efficient management with promising results.


Assuntos
Fístula Brônquica/cirurgia , Empiema Pleural/cirurgia , Fístula/cirurgia , Músculos Superficiais do Dorso/transplante , Idoso , Fístula Brônquica/etiologia , Empiema Pleural/etiologia , Fístula/etiologia , Humanos , Masculino , Pneumonectomia/efeitos adversos , Retalhos Cirúrgicos
6.
Adv Exp Med Biol ; 1252: 101-105, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816268

RESUMO

During pregnancy and lactation, breast vascularity increases and edema occurs in the breast . As a consequence, rate of complications of breast biopsy and surgery like bleeding, infection, delayed healing and wound dehiscence is expected to be higher. Milk fistula is a rare event that may complicate surgery or needle biopsy of the breast in a breastfeeding woman, or in late stages of pregnancy . Suppression of lactation has been proposed in the literature as both a preventive and a therapeutic step. However, the advantages of nursing for both mother and child are numerous, and the author do not propose it as a preventive measure nor as a must in treatment of milk fistula. Prevention and management of milk fistula are discussed in this chapter.


Assuntos
Mama/cirurgia , Lactação , Complicações na Gravidez , Biópsia por Agulha , Aleitamento Materno , Neoplasias da Mama/cirurgia , Feminino , Fístula/etiologia , Fístula/prevenção & controle , Fístula/terapia , Humanos , Lactente , Leite Humano , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia
7.
Medicine (Baltimore) ; 99(29): e21201, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702884

RESUMO

RATIONALE: We hypothesize that with the determination of lymph fistula location 3-dimensionally, application of appropriate pressure would promote fistula healing, and a secondary surgery may be avoided. Ga-labeled 1,4,7-triazacyclononane-N, N', N"-triacetic acid (NOTA) conjugated with truncated Evan blue (NEB) forms a complex with serum albumin in the interstitial fluid after it is locally injected and allows rapid visualization of the lymphatic system. PATIENT CONCERNS: A 44-year-old woman had a chief complaint of left nipple discharge. A 38-year-old woman came to the hospital after sensing a right breast mass. DIAGNOSES: The 2 patients were diagnosed with chylous fistula after breast cancer surgery based on the findings of a novel method, Ga-NOTA-Evans Blue (NEB) positron emission tomography/computed tomography. INTERVENTIONS: We successfully obtained clear images to locate the fistula using Ga-NEB positron emission tomography/computed tomography (PET/CT) for both patients. The lymphatic vessels and lymph nodes could be clearly visualized owing to the Ga-NEB activity during PET/CT. OUTCOMES: Three-dimensional positioning to locate the fistula could direct the application of the pressure dressing and reduce drainage markedly. LESSONS: Ga-NEB PET/CT may be a new method for diagnosing chylous fistula and providing guidance for treatment.


Assuntos
Axila/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Fístula/etiologia , Mastectomia/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Adulto , Axila/anormalidades , Axila/cirurgia , Neoplasias da Mama/complicações , Feminino , Fístula/cirurgia , Humanos , Mastectomia/métodos , Derrame Papilar , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia
9.
Br J Radiol ; 93(1111): 20200049, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32539548

RESUMO

OBJECTIVE: Genitourinary fistulas in pelvic malignancies are abnormal communications occurring due to either locally advanced tumours invading the surrounding organs or post-therapeutic complications of malignancies. In this article we review and describe the role of cross-sectional imaging findings in the management of genitourinary fistulas in pelvic malignancies. METHODS: A retrospective study, for the period January 2012 to December 2018, was undertaken in patients with pelvic malignancies having genitourinary fistulas. The cross-sectional (CT and MRI) imaging findings in various types of fistulas were reviewed and correlated with the primary malignancy and the underlying etiopathology. RESULTS: Genitourinary fistulas were observed in 71 patients (6 males, 65 females). 11 types of fistulas were identified in carcinomas of cervix, rectum, ovary, urinary bladder, sigmoid colon, vault, endometrium and prostate. The commonest were rectovaginal and vesicovaginal fistulas. 13 patients had multiple fistulas. The sensitivity, specificity, positive and negative predictive values of CT and MRI are 98%, 100%, 66%, 98% and 95%, 25%, 88% and 50% respectively. Contrast-enhanced CT with oral and rectal contrast is more sensitive and specific than MRI in the evaluation of genitourinary fistulas. CONCLUSION: Imaging findings significantly influence the management and outcome of genitourinary fistulas in pelvic malignancies. Contrast-enhanced CT is the imaging modality of choice in the evaluation of pelvic fistulas associated with malignancies and MRI is complimentary to it. ADVANCES IN KNOWLEDGE: To our knowledge, this study is the first of its kind wherein the mean duration of occurrence of fistulas in pelvic malignancies is correlated with the underlying etiopathology.


Assuntos
Doenças Urogenitais Femininas/etiologia , Fístula/etiologia , Doenças Urogenitais Masculinas/etiologia , Neoplasias Pélvicas/complicações , Adulto , Idoso , Meios de Contraste , Feminino , Doenças Urogenitais Femininas/diagnóstico , Doenças Urogenitais Femininas/cirurgia , Fístula/diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Doenças Urogenitais Masculinas/tratamento farmacológico , Doenças Urogenitais Masculinas/cirurgia , Pessoa de Meia-Idade , Imagem Multimodal , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
10.
Am J Otolaryngol ; 41(4): 102557, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497952

RESUMO

PURPOSE: To evaluate the prophylactic, protocolized, and standardized use of a Montgomery tube in preventing pharyngocutaneous fistulas after total laryngectomy and neck dissection. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral centre. SUBJECT AND METHODS: A Montgomery salivary bypass tube was placed in 44 patients undergoing total laryngectomy and neck dissection, observing the percentage of fistula appearance and the time of start of deglutition. Comparison was made with a group of 28 patients prior to the implantation of the protocol in whom the tube was not used. RESULTS: There was a statistically significant decrease in the percentage of fistulas and an earlier onset of deglutition in the salivary bypass tube patients compared to those in whom the tube had not been used. CONCLUSION: Prophylactic and standardized use of the Montgomery salivary bypass tube in patients undergoing total laryngectomy and neck dissection might decrease the incidence of pharyngocutaneous fistula and improve the course of one that is already established.


Assuntos
Fístula Cutânea/prevenção & controle , Drenagem/instrumentação , Fístula/prevenção & controle , Intubação/instrumentação , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Doenças Faríngeas/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Saliva , Idoso , Estudos de Coortes , Fístula Cutânea/etiologia , Deglutição , Feminino , Fístula/etiologia , Humanos , Neoplasias Laríngeas/fisiopatologia , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Doenças Faríngeas/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
11.
Rev. cir. (Impr.) ; 72(3): 241-244, jun. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1115549

RESUMO

Resumen Introducción: Las complicaciones torácicas secundarias a pancreatitis aguda son excepcionales y más aún la presencia de un pseudoquiste mediastinal. Caso Clínico: Hombre de 36 años. Consumidor de marihuana y alcohol. Historia de 6 meses de dolor abdominal y adelgazamiento de 20 kilos. Instalando en la evolución sintomatología respiratoria. Discusión: Se discuten las formas de presentación de esta entidad. Sus etiologías más frecuentes. Se hace énfasis en el rol de la imagenología así como en el análisis del líquido pleural. El enfoque terapéutico es conservador al inicio y en algunos pacientes es quirúrgico en la evolución; con diversas opciones.


Introduction: The thoracic complications secondary to acute pancreatitis are exceptional and even more so the presence of a mediastinal pseudocyst. Case report: 36 year old man. Marijuana and alcohol consumer. History of 6 months of abdominal pain and weight loss of 20 kilos. Installing respiratory symptomatology evolution. Discussion: The forms of presentation of this entity are discussed. Its most frequent etiologies. Emphasis is placed on the role of imaging as well as the analysis of pleural fluid. The therapeutic approach is conservative at the beginning and in some patients it is surgical during evolution; with several options.


Assuntos
Humanos , Masculino , Adulto , Pseudocisto Pancreático/etiologia , Pseudocisto Pancreático/terapia , Pancreatite/complicações , Doenças Pleurais/etiologia , Doenças Pleurais/terapia , Fístula/etiologia , Fístula/terapia , Pseudocisto Pancreático/diagnóstico , Doenças Pleurais/diagnóstico , Período Pós-Operatório , Tomografia Computadorizada por Raios X
13.
BMC Cardiovasc Disord ; 20(1): 219, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32397961

RESUMO

BACKGROUND: Atrioesophageal fistula (AEF) is the most fatal complication associated with catheter ablation for atrial fibrillation and cannot be easily detected when thoracic contrast-enhanced computed tomography (CT) is normal. CASE PRESENTATION: In this report, we described a diagnostic tool for detecting AEF with doubtful chest CT in which we introduced CO2-insufflation esophageal endoscopy with transthoracic echocardiography monitoring. Using this modified esophageal endoscopy, AEF was established due to the presence of both esophageal lesions and bubbles into the left atrium. That way, our patient accepted to be operated in time with good clinical prognosis. CONCLUSIONS: This modified esophageal endoscopy is an alternative tool for early detection of AEF when normal or doubtful CT findings present.


Assuntos
Dióxido de Carbono/administração & dosagem , Ecocardiografia , Embolia Aérea/prevenção & controle , Fístula Esofágica/diagnóstico , Esofagoscopia , Fístula/diagnóstico , Cardiopatias/diagnóstico , Doença Iatrogênica , Insuflação , Dióxido de Carbono/efeitos adversos , Ablação por Cateter/efeitos adversos , Diagnóstico Precoce , Ecocardiografia/efeitos adversos , Embolia Aérea/etiologia , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Esofagoscopia/efeitos adversos , Fístula/etiologia , Fístula/cirurgia , Cardiopatias/etiologia , Cardiopatias/cirurgia , Humanos , Insuflação/efeitos adversos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
14.
J Card Surg ; 35(5): 1152-1155, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32302027
15.
J Vasc Interv Radiol ; 31(4): 667-673, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32113797

RESUMO

PURPOSE: To determine predictors of outcomes for patients who undergo computed tomography (CT)-guided percutaneous abdominal or pelvic drainage catheter placement and to identify which patients benefit from fluoroscopic drainage catheter interrogation (abscessogram). MATERIALS AND METHODS: A retrospective review of 383 patients (mean, 52 years old; range 8-89 years old; 158 males: 225 females) who underwent 442 CT-guided procedures and 489 catheter placements for fluid collections in the abdomen or pelvis from January 1, 2015, to December 31, 2016 was performed. Variables including underlying disease, fluid location, number of collections drained, number of catheter exchanges and follow-up abscessograms performed, catheter size, and fistula detection were analyzed to determine factors associated with fistula formation and increased catheter dwell time. RESULTS: A single abscessogram followed by catheter removal was performed for 217 catheters (44%). An increased number of abscessograms was significantly associated with drainage catheter size (P < .001) and presence of a fistula (P < .001). Fistulae were detected in 95 cases (19%) and were significantly associated with an increased number of drain exchanges (P < .001) and an underlying diagnosis of Crohn's disease (P = .02). Based on these data, a clinical algorithm for drain management is presented. CONCLUSIONS: Abscessograms performed after CT-guided percutaneous drainage catheter placement are useful to detect catheter malposition, occluded catheters, and fistulae but are not necessary for all patients. If performed selectively, particularly in patients with an underlying diagnosis of Crohn's disease or those at high risk for developing fistulae, unnecessary examinations can be avoided, reducing cost, extra hospital visits, and radiation dose.


Assuntos
Abscesso Abdominal/terapia , Drenagem , Radiografia Intervencionista , Tomografia Computadorizada por Raios X , Abscesso Abdominal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateteres , Criança , Drenagem/efeitos adversos , Drenagem/instrumentação , Desenho de Equipamento , Falha de Equipamento , Feminino , Fístula/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pelve , Radiografia Intervencionista/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/efeitos adversos , Resultado do Tratamento , Adulto Jovem
17.
Ann Thorac Surg ; 110(4): e319-e321, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32145198

RESUMO

Aortic right ventricular fistulae have been thoroughly documented as a rare but potentially serious complication of surgical aortic valve replacement. The risk factors and pathogenesis contributing to this complication with respect to transcatheter aortic valve replacement (TAVR), however, remain far less characterized. We describe a post-TAVR aortic root-to-right ventricular fistula with associated pseudoaneurysm requiring surgical aortic root replacement.


Assuntos
Valva Aórtica/cirurgia , Fístula/etiologia , Fístula/cirurgia , Cardiopatias/etiologia , Cardiopatias/cirurgia , Ventrículos do Coração , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Doenças das Valvas Cardíacas/etiologia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino
18.
J Craniofac Surg ; 31(4): 980-982, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32195844

RESUMO

The goals of cleft palate repair are well-established; however, there does exist difference in practice patterns regarding the most appropriate patient age for palatoplasty. The optimal timing is debated and influenced by cleft type, surgical technique, and the surgeon's training. The objective of this study was to compare the rates of post-operative fistula formation and velopharyngeal insufficiency (VPI) in "early" versus "standard" cleft palate repair in a cohort of patients treated at a single craniofacial center.A retrospective chart review identified 525 patients treated for cleft palate from 2000 to 2017 with 216 meeting inclusion criteria. "Early repair" is defined as palatoplasty before 6-months of age (108 patients). "Standard repair" is palatoplasty at or beyond 6-months old (108 patients). Rates of fistula formation were found to be significantly higher in early repairs (Chi-square statistic 9.0536, P value = 0.0026). Development of VPI was not significantly different between the 2 groups (Chi-square statistic 1.2068, P value = 0.27196). As expected, the incidence of post-palatoplasty VPI was significantly higher in patients who had a post-operative fistula when compared to those who healed without fistula formation (Chi-square statistic 4.3627, P value = 0.0367).There is significant debate regarding the optimal timing of cleft repair to maximize speech outcomes and minimize risks. The authors' data show that post-operative fistula formation occurs at a higher rate when performed prior to 6 months old. Furthermore, while the rate of VPI was not significantly affected by age at time of surgery, it was significantly higher in those who experienced a post-operative fistula.


Assuntos
Fissura Palatina/cirurgia , Fístula/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Velofaríngea/epidemiologia , Fístula/etiologia , Humanos , Incidência , Lactente , Estudos Retrospectivos , Fala , Resultado do Tratamento , Insuficiência Velofaríngea/etiologia
19.
Sci Rep ; 10(1): 2751, 2020 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066780

RESUMO

The close proximity of esophagus to the left atrial posterior wall predisposes esophagus to thermal injury during catheter ablation for atrial fibrillation (AF). In this retrospective study, we aimed to investigate risk factors of esophageal injury (EI) caused by catheter ablation for AF. Patients who underwent first-time AF ablation from July 2013 to June 2018 were included. The esophagus was visualized by oral soluble contrast during ablation for all patients and a subset of patients were selected to undergo endoscopic ultrasonography (EUS) to estimate EI post ablation. Degree of EI was categorized as Kansas City classification: type 1: erythema; type 2: ulcers (2a: superficial ulcers; 2b: deep ulcers); type 3: perforation (3a: perforation without communication with the atria; 3b: atrioesophageal fistula [AEF]). Of 3,852 patients, 236 patients (61.5 ± 9.7 years; male, 69%) received EUS (EUS group) and 3616 (63.2 ± 10.9 years; male, 61.1%) without EUS (No-EUS group). In EUS group, EI occurred in 63 patients (type 1 EI in 35 and type 2 EI in 28), and no type 3 EI was observed during follow up. In a multivariable logistic regression analysis, an overlap between the ablation lesion and esophagus was an independent predictor of EI (odds ratio, 21.2; 95% CI: 6.23-72.0; P < 0.001). In No-EUS group, esophagopericardial fistula (EPF; n = 3,0.08%) or AEF (n = 2,0.06%) was diagnosed 4-37 days after ablation. In 3 EPF patients, 2 completely recovered with conservative management and 1 died. Two AEF patients died. Ablation at the vicinity of the esophagus predicts risk of EI. EUS post ablation may prevent the progression of EI and should be considered in management of EI. It remains challenging to identify patients with high risk of EI.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Eritema/patologia , Perfuração Esofágica/patologia , Fístula/patologia , Complicações Pós-Operatórias/patologia , Úlcera/patologia , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Meios de Contraste/administração & dosagem , Endossonografia , Eritema/diagnóstico por imagem , Eritema/etiologia , Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/etiologia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Feminino , Fístula/diagnóstico por imagem , Fístula/etiologia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Átrios do Coração/cirurgia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Úlcera/diagnóstico por imagem , Úlcera/etiologia
20.
Pediatr Cardiol ; 41(1): 217-219, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31897523

RESUMO

We report an asymptomatic 5-year-old boy with coronary artery fistulas to pulmonary parenchyma and to systemic thoracic arteries, like a "natural bypass", detected during a coronary angiography performed 11 months after his heart transplant. One year later, a new coronary angiography showed no fistula. Some changes to immunosuppressive therapy during this time could be related to this evolution.


Assuntos
Doença da Artéria Coronariana/etiologia , Everolimo/efeitos adversos , Fístula/etiologia , Imunossupressores/efeitos adversos , Pré-Escolar , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Fístula/diagnóstico por imagem , Transplante de Coração , Humanos , Masculino
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