Biomedical subjects

Samuel Ramírez

Publications and source records attributed to Samuel Ramírez.

9 recordsLinked to original sources

PubMedDate not supplied

[Surgical treatment results of congenital heart defects in children with Down's syndrome].

We made a retrospective study of patients with Down's syndrome that were surgically treated for correction or palliation for their congenital heart disease between january 1996 to december of the 2000 in the National Institute of Cardiology "Ignacio Chávez". We analyzed these variables: age at the surgical moment, sex, congenital heart defect, pulmonary arterial pressure, type of surgery, time of stay in the intensive care unit, complications and mortality. In this period they were surgically treated 37 patients. The mean age was of 2 years with 8 months with a range of 2 months to 17 years. The interventricular defect was the most frequent one (35%) and it was associated to persistent ductus arteriosus in the 61% of the cases. Six patients (16%) had atrioventricular septal defect, the half of them type A and other half type C of Rastelli classification. Twelve patients (32%) had one lesion persistent ductus arteriosus. Three patients had tetralogy of Fallot and two atrial septal defect. Pulmonary hypertension was found in 90% of the patients, in 23 was severe (62%), moderate in 5 and slight in 6 (16%). The surgical treatment was corrective in 89% patients and the average time of stay in intensive care unit was of 2.5 days. The most frequent complication was rhythm and conduction disorders, in 8 patients (22%), three with complete AV block and the mortality was of 8%. In the patients with Down's syndrome is important a complete clinical evaluation with an eye toward establishing an opportune surgical treatment.

Adolescent↗

PubMedDate not supplied

[Modification of a hydraulic device for controlled banding of the trunk of the pulmonary artery in dogs].

UNLABELLED: Different congenital or acquired diseases increase the right ventricular systolic pressure. The elevation is achieved by pulmonary artery banding with linen tape or hydraulic devices. We introduce a new hydraulic device to be used in experimental subjects of less than 15 kilograms. METHODS: An experimental laboratory phase was conducted. In this phase, the hydraulic devices were tested against pressures as high as 80 mm Hg; later on the hydraulic devices were placed on the dogs' main pulmonary artery; the right ventricular systolic pressure, pulmonary artery pressure, and their differences were obtained. The values are expressed in average +/- standard deviation. RESULTS: The average weight of the dogs was 12.6 +/- 2.2 kg. The average diameter found in the main pulmonary artery was 12.4 +/- 1.4 mm and 27.5 +/- 1.6 mm length. Right ventricular systolic pressure of basal condition to maximum pressure obtained was 25.5 +/- 1.9 mm Hg vs 50.3 +/- 6.9 mm Hg, p < 0.0001; pulmonary artery pressures under the same conditions were 24.7 +/- 2 mm Hg vs 21.5 +/- 6.9 mm Hg, p < 0.043; and the differences between them were 0.8 +/- 1.4 mm Hg vs 28.8 +/- 4.2 mm Hg, p < 0.0001, developed by the hydraulic device respectively. CONCLUSIONS: The hydraulic device allows attaining a controlled acute increase in right ventricular systolic pressure.

Animals↗

PubMedDate not supplied

[Surgical radiofrequency catheter ablation of accessory pathways in Ebstein's anomaly].

Thirteen patients with Ebstein anomaly and atrioventricular reentrant tachycardia and at least one accessory pathway were included in this study. One accessory pathway in 7 (53.8%) patients and multiple accessory pathways in 6 (46.1%) were found. Mahaim accessory pathway was observed in 5 (38.4%) patients. A total of 22 accessory pathways was found, 2 (9%) were concealed. In all (100%), the accessory pathways were located in the tricuspid ring. The most frequent regions were right lateral free wall with 11 (50%) and 5 right posteroseptal (22.7%). Ten patients underwent surgical radiofrequency catheter ablation and three subjected to surgical section. We obtained success in 100%. No complications were observed during the procedures. In conclusion, surgical ablation therapy in patients with accessory pathways and Ebstein's anomaly is safe and effective.

Adolescent↗

PubMedDate not supplied

[Fontan operation: short- and long-term risk factors].

The purpose of this retrospective study was to determine the outcome of patients who underwent a Fontan procedure at National Heart Institute "Ignacio Chávez", Mexico, from January 1989 to December 2003. We had 81 patients with a mean age of 7 years old: 53 with tricuspid atresia, 14 with pulmonary atresia and intact septum, 11 with univentricular atrioventricular connection and 3 with Ebstein's anomaly. An intra-atrial tunnel was performed on 61 patients and an extracardiac conduit on the rest. Of all, 53 underwent a fenestration. The surgical mortality was 13% for tricuspid atresia and 25% for the other diseases. We had an overall mortality of 28.4%, being the main causes cardiogenic shock and arrhythmia. The global survival was 71% in 55 months of following. Takedown was indicated on 5 patients. The patients without fenestration showed to have 2.8 times more risk of death. The mean pulmonary artery pressure > or = 20 mmHg plus the left atrium pressure > or = 10 mmHg increased the death risk 3.6 times. Of the 52% who required readmission, the main causes were hemodynamical failure and infections. The more relevant complications were: arrhythmia (38%), protein-losing enteropathy (8%) and thrombotic cerebral events (1.4%).

Adolescent↗

PubMedDate not supplied

Diverticulum of Kommerell.

A case of an 11-months-old girl with vomiting and laryngeal stridor is presented, and in whom a Kommerell diverticulum was demonstrated, which is a rare variant of the incomplete vascular ring. It is well known that the magnetic resonance is the best study to define this malformation. In this patient, it was the cardiac catheterization which allowed to define the structures that constituted the vascular ring. The patient was surgically treated in a successful way. The embryological knowledge of the transformations of the aortic arches offers great assistance in the understanding of all the types of vascular rings.

Aorta, Thoracic↗

PubMedDate not supplied

[Anomalous origin of the right pulmonary artery and left pulmonary vein stenosis].

We present a case of a 9 month old female with a history of cyanosis. The cardiovascular evaluation included angiocardiogram and magnetic resonance. The diagnosis was: origin of the right pulmonary artery from the ascending aorta, stenosis of the left superior pulmonary vein, patent ductus arteriosus and severe pulmonary hypertension. Surgical treatment consisted in correcting all congenital heart defects. The patient is doing well at home.

Constriction, Pathologic↗

PubMedDate not supplied

[Clinic aspect of criss-cross: a case report].

A 1-month-old girl was referred at our Institution with a history of heart failure and cyanosis. We established diagnosis of multiple congenital heart disease with criss-crossed atrioventricular connections but concordant. This type of anomaly has a variety of presentations of high diagnostic complexity. The multiple lesions included double outlet of the right ventricle, right subaortic stenosis, ventricular septal defect, coarctation of the aorta with hypoplasia of the arch, and persistent patency of the arterial duct, established through echocardiography, angiocardiography and magnetic resonance. These findings prompted palliative surgery and correction of the aortic arch.

Crisscross Heart↗

PubMedDate not supplied

[Ebstein anomaly].

We evaluated the results for primary repair of Ebstein anomaly in 61 patients, both adults and children. The records were reviewed of patients undergoing repair of Ebstein anomaly at the Congenital Heart Surgery Service of the National Institute of Cardiology "Ignacio Chávez" from January 1993 to August 2003. Functional, demographic, and echocardiographic parameters were studied both preoperatively and postoperatively, along with functional status and adverse events. The repair technique involved vertical plication of the atrialized ventricle and valve leaflet reimplantation after clockwise rotation or replacement of tricuspid valve. Ebstein repair has good functional outcomes in patients despite residual tricuspid regurgitation, likely because of reduction in right ventricular volume loading and relative annular and ventricular plasticity. Intraoperative radiofrequency ablation represents an important adjunctive treatment for intractable arrhythmias, which may now represent relative indications for operative intervention.

Adolescent↗

PubMedDate not supplied

[Surgical treatment of atrial fibrillation associated with mitral valve disease].

The modified Cox maze procedure is the gold standard for ablation of atrial fibrillation in patients undergoing mitral valve surgery, and new approaches to atrial fibrillation ablation must be compared with it. Therefore, we sought to determine the time-related prevalence of atrial fibrillation and its risk factors after combined Cox maze and mitral valve surgery. In some patients undergoing mitral valve surgery and a Cox maze procedure, atrial fibrillation recurs over time, mandating close, long-term follow-up of heart rhythm. Earlier operation should be considered to improve results in selected patients.

Atrial Fibrillation↗