Three-dimensional echocardiography in the operating room--assessment of a mitral valvuloplasty.
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Echocardiography, Three-Dimensional↗
Biomedical subjects
Luís Vouga
Publications and source records attributed to Luís Vouga.
Atrial septal closure in adults: surgery versus amplatzer--comparison of results.
OBJECTIVE: To compare the efficacy, safety and morbidity of surgical versus percutaneous atrial septal defect (ASD) closure. POPULATION AND METHODS: We studied all cases of ASD closure (surgical or percutaneous) performed in our hospital during the last 5 years. We analyzed the clinical and echocardiographic characteristics of both groups and compared the success rate of the procedure, events, days of hospital stay and evolution during the 1st year. RESULTS: 63 patients (pts) with ostium secundum ASD were treated in our hospital in the last 5 years; 25 (60% female) underwent surgery (A) while 38 (68% female) underwent percutaneous closure with an Amplatzer device (B); mean age was 38 (13-67) and 40 years (15-72), respectively. Dyspnea and fatigue were the most frequent symptoms in both groups (57% A; 29% B), while the most frequent signs were fixed splitting of S2 (78% A; 88% B) and systolic murmur at the left sternal border (82% A; 87% B). Previous ECG presented incomplete right bundle branch block in 63% of both groups. The size of the ASDs, as well as Qp:Qs, were greater in the surgical group: 24.6 (5-50) vs. 18.97 mm and 3.1 (1.5-6.5) vs. 2.7 (1.2-5.2) respectively. Right cardiac chambers were enlarged in 92% of pts in A vs. 84% in B. Paradoxical interventricular septal motion (PSM) was present in 78% of pts in A and 67% in B. The success rate (100%) was similar in both groups but immediate minor events were more frequent in A (28 vs. 13%). Duration of hospital stay was longer in A: 5.4 days (3-9) vs. 1.5 days (1-4). Normalization of right cardiac chamber diameter was faster in B: 73% in the 1st control echocardiogram (at 0-64 days, mean 29) vs. 60% in A, performed at a later stage (45-455 days after the procedure, mean 155). At the time of reassessment PSM was still present in all the pts of group A and in only 10% of B (p < 0.0001). CONCLUSIONS: The success rate of ASD closure is 100% with both procedures and complications are rare. The percutaneous technique, however, permits a shorter hospital stay, involves less morbidity, and, despite sample limitations, seems to be associated with faster anatomical recovery. Therefore, in our opinion, surgical treatment should be reserved for those cases in which closure with an Amplatzer device is not technically or anatomically possible.
Adolescent↗
[Iatrogenic tracheal rupture: a case report and indications for conservative management].
Tracheal rupture after endotracheal intubation requires immediate intervention. There have been an increasing number of reports that describe nonsurgical management of this issue. We report the case of a 47-year-old woman who experienced an iatrogenic tracheal rupture during endotracheal intubation for a surgical procedure with general anaesthesia. She was successfully managed conservatively with a broad-spectrum antibiotic. We managed it non-operatively, because the patient had a small tear, was hemodynamically stable, show no evidence of infection or respiratory failure, and the diagnosis was not immediate. Bronchoscopy was a good diagnostic tool and it was used to make decisions regarding conservative management, and to detect granulation tissue and rule out any tracheal stenosis after treatment. We review available literature on conservative management of tracheal rupture. Immediate recognition and adequate treatment are very important in managing this potentially fatal situation. The final decision should be based on clinical, radiologic and bronchoscopic findings.
Algorithms↗
Bronchopulmonary sequestration--a 12-year experience.
Bronchopulmonary sequestration (BPS) is a rare malformation of the lower respiratory tract. It consists of a non-functioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and that receives arterial blood supply from the systemic circulation. It is classified as intralobar (ILS) or extralobar (ELS) according to its location within or outside the normal lung. Most sequestrations are intralobar (75%) and occur predominantly in the left lower lobe.
Adult↗