A Hybrid Strategy for Geometrical Reshaping of the Main Pulmonary Artery and Transcatheter Pulmonary Valve Replacement.

Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approach in patients with dysfunctional right ventricular outflow tract. However, in certain cases, an unfavorable anatomy might complicate optimal valve deployment and stability. Several techniques have been described to reshape the landing zone and allow proper implantation of the transcatheter valve. Among them, the hybrid approach has gained attention as an interesting method for off-pump pulmonary valve replacement in patients with dilated right ventricular outflow tract. But to date, there is no standardized method to resize and reshape the landing zone for the stented valve. Here, we describe a reproducible method based on simple geometric rules to allow adequate remodeling of the main pulmonary artery to the desired dimensions in a single attempt, followed by perventricular implantation of a Venus P-valve.

Oxigenoterapia por Cánula Nasal de Alto Flujo / Oxygen therapy with High-Flow Nasal Cannula

Las infecciones respiratorias agudas bajas (IRAB) son una de las principales causas de consulta en los servicios de atención ambulatoria, pudiendo representar hasta el 36% de las consultas a servicios de Emergencias, 25% de los ingresos hospitalarios y 55 % de los requerimientos de asistencia ventilatoria mecánica (AVM), siendo la bronquiolitis la principal entidad clínica. El pilar fundamental del tratamiento de pacientes con IRAB e insuficiencia respiratoria aguda es la oxigenoterapia. De acuerdo al flujo entregado, la misma se divide en bajo y alto flujo. Cabe destacar que los sistemas de bajo flujo presentan algunas desventajas, como la imprecisión para entregar una FiO2 constante y cuantificable, insuficiente humidificación y calentamiento, inadecuada relación entre el flujo entregado y la demanda inspiratoria del paciente y riesgo de re-inhalación de CO2 con el uso de máscaras. En este contexto surge la oxigenoterapia por medio de cánulas nasales de alto flujo, que son sistemas abiertos y de fácil utilización, en el cual se basará la revisión del presente artículo.

Acute lower respiratory infections are one of the most common causes of ambulatory visits, accounting for up to 36% of the emergency department consults, 25% of hospital admissions and 55% of the requirement of invasive ventilation. The main responsible clinical entity is acute viral bronchiolitis. a. Médico de Planta Unidad 8. HNRG b. Médico de Planta Unidad de Terapia Intensiva- HNRG c. Jefe de Residentes Clínica Médica. HNRG d. Instructor de Residentes Clínica Médica. HNRG Correspondencia: Cristian Barbaro: drcristianbarbaro@gmail.com Conflicto de interés: ninguno que declarar. Oxigenoterapia por Cánula Nasal de Alto Flujo. Una revisión Oxygen therapy with High-Flow Nasal Cannula. A review Cristian Barbaroa , Ezequiel Monteverdeb , Julian Rodriguez Kibrikc , Guillermo Schvartzc y Gonzalo Guiñazúd The basic treatment for patients with acute respiratory insufficiency is oxygen therapy. According to the flow rate of the oxygen delivery, this therapy can be divided into high or low flow. The later has some disadvantages, like the lack of precision in delivered FiO2 , insufficient humidity and warmth of gas mixture, inadequate matching between oxygen delivery and the patient's inspiratory effort, and the risk of CO2 rebreathing. In this context, the High-Flow Nasal Cannula appears as a non-invasive and easy to use method, which will be reviewed in this article.