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Percutaneous coronary interventions (PCI) have become a standard of treatment worldwide. Despite high safety rates, iatrogenic complications caused by stent dislodgements do exist in 0.21% of cases and most require emergency coronary artery by-pass grafting (CABG). Here we present a case of a coronavirus disease 2019 positive 40-year-old male patient presenting with STEMI due to thrombotic lesions in his left coronary trunk. The patient is taken to PCI and stent placement. Stent dislodgement results in the need for emergency CABG and stent removal. Informed consent and ethics approval were obtained.

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In developing countries, limited resources and low health budgets result in slow developments in the field of cardiac surgery. As a consequence, advances in surgery become a challenging process. In Colombia, most institutions do not have the capacity or infrastructure for minimally invasive and video-assisted cardiac surgery, let alone robotic assisted cardiac surgery (RACS). Despite the challenges, efforts to overcome these hurdles are critical for the future of cardiac surgery in low-income settings. Here we describe the first cases of robotic cardiac surgeries performed in Colombia.

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Abstract In developing countries, limited resources and low health budgets result in slow developments in the field of cardiac surgery. As a consequence, advances in surgery become a challenging process. In Colombia, most institutions do not have the capacity or infrastructure for minimally invasive and video-assisted cardiac surgery, let alone robotic assisted cardiac surgery (RACS). Despite the challenges, efforts to overcome these hurdles are critical for the future of cardiac surgery in low-income settings. Here we describe the first cases of robotic cardiac surgeries performed in Colombia.

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Resumen La oxigenación con membrana extracorpórea (ECMO), es una alternativa terapéutica útil en el manejo de la falla respiratoria refractaria en la edad pediátrica. La infección por virus sincitial respiratorio es una patología prevalente en nuestra ciudad con una carga de la enfermedad que supone el 75% de las hospitalizaciones en menores de 2 años diagnosticados con bronquiolitis. Un índice de oxigenación mayor a 40 predice una mortalidad mayor del 80% en estos pacientes, asimismo, se ha encontrado que un pH menor de 7.29 es un factor de riesgo independiente para la mortalidad en el mismo grupo. La ECMO es una terapia que desde el año 1985 ha mostrado tener una sobrevida del 53% en este grupo, llegando a niveles del 63% en los últimos años, particularmente, si la etiología es el virus sincitial respiratorio. Se reportan dos casos de pacientes lactantes menores con falla respiratoria refractaria en quienes se decidió iniciar la ECMO logrando la sobrevida de ambos.

Abstract Extracorporeal membrane oxygenation (ECMO) is a useful alternative therapy when managing refractory respiratory failure in pediatric patients. An infection caused by respiratory syncytial virus is a prevalent condition in our city, with a disease burden that accounts for 75% of hospital admissions in children under to years of age who have been diagnosed of bronchiolitis. An oxygenation index above 40 predicts a mortality of over 80% for these patients; likewise, it has been found that a pH below 7.29 is an independent mortality risk factor for this same group. ECMO is a therapy that has shown survival rates of 53% in this patient group since 1985, reaching a level of 63% over recent years, particularly when the aetiology is respiratory syncytial virus. Two cases of infants with refractory respiratory failure where ECMO therapy was chosen and achieved survival of both children are reported.

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Congenital heart diseases are defined as any heart or large vessel structural abnormality resulting from abnormal embryonic development, usually described between the 3rd and 10th week of gestation. They comprise the second cause of death in children under a year of age in Colombia, with a prevalence of 7.5-9.5 per 1,000 births, including live and still births. We analyzed 33 heart tissue samples collected at the Clínica Shaio (Bogotá, Colombia). Blood and tissue samples were collected from patients with non-syndromic congenital heart disease. Tissue was isolated near the defect. Electropherograms obtained from samples were analyzed using bioinformatic tools: ChromasPro and ClustalW. The whole gen covering its six exons was analyzed in forward and reverse orientation. We identified 17 mutations, including five non-synonymous sequence changes, one synonymous variant and one variation in the 5' UTR, three intronic changes and seven deletions. We found no evidence of gene GATA4 somatic sequence variants in any of the samples analyzed.

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Las cardiopatías congénitas se definen como toda anomalía estructural del corazón o de los grandes vasos, y son consecuencia de las alteraciones del desarrollo embrionario normal del corazón, aproximadamente entre la tercera y la décima semana de gestación. En Colombia, constituyen la segunda causa de muerte en niños menores de un año, con una prevalencia entre 7,5 y 9,5 por 1.000 nacimientos, sin discriminación entre nacidos vivos y muertos. En este estudio se analizaron mediante bioinformática, 33 muestras de tejido cardíaco cercano al defecto y de sangre de pacientes con cardiopatía congénita no sindrómica, de la Clínica Shaio Bogotá (Colombia). Se analizaron en sentido y antisentido cada uno de los seis exones que conforman el gen GATA4. Se identificaron 17 mutaciones, incluyendo cinco cambios no sinónimos en la secuencia, una variante sinónima, una variación de la secuencia en la región 5’UTR, tres cambios intrónicos y siete deleciones. No se encontraron evidencias de variantes somáticas para el gen GATA4, en ninguna de las muestras de la población de estudio.

Congenital heart diseases are defined as any heart or large vessel structural abnormality resulting from abnormal embryonic development, usually described between the 3rd and 10th week of gestation. They comprise the second cause of death in children under a year of age in Colombia, with a prevalence of 7.5-9.5 per 1,000 births, including live and still births. We analyzed 33 heart tissue samples collected at the Clínica Shaio (Bogotá, Colombia). Blood and tissue samples were collected from patients with non-syndromic congenital heart disease. Tissue was isolated near the defect. Electropherograms obtained from samples were analyzed using bioinformatic tools: ChromasPro and ClustalW. The whole gen covering its six exons was analyzed in forward and reverse orientation. We identified 17 mutations, including five non-synonymous sequence changes, one synonymous variant and one variation in the 5’ UTR, three intronic changes and seven deletions. We found no evidence of gene GATA4 somatic sequence variants in any of the samples analyzed.

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El aneurisma de la arteria coronaria derecha es una entidad rara, que se presenta principalmente en mujeres. Las causas más frecuentes de muerte por aneurisma son en su orden: ruptura, trombosis, isquemia. La enfermedad aterosclerótica es la causa más frecuente de aneurisma espontáneo. La mayoría de los pacientes son asintomáticos, y presentan soplo continuo o moderada cardiomegalia, y plétora en la radiografía de tórax. En etapas avanzadas produce cardiopatía isquémica. Para su diagnóstico es necesario un juicio clínico adecuado y exámenes de rutina para enfermedad coronaria. Se exponen dos casos tratados en la Fundación Clìnica A. Shaio, con base en los cuales se analiza el diagnóstico, las complicaciones y el tratamiento realizado.

The aneurysm of the right coronary artery is a rare entity, which occurs primarily in women. The most frequent causes of death in these aneurysms are in its order: rupture, thrombosis and ischemia. Atherosclerotic disease is the most frequent cause of spontaneous aneurysm. Most patients are asymptomatic and have a continuous murmur or moderate cardiomegaly and plethora on chest X-ray. In advanced stages it causes ischemic heart disease. Its diagnosis requires an adequate clinical judgment and routine tests for coronary artery disease.

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La anomalía total del retorno venoso sistémico tiene gran variedad de presentaciones; sin embargo, la patología de más baja frecuencia es el drenaje de vena cava superior derecha a la aurícula izquierda, hecho de peso para que en el mundo se reporten pocos casos. En la Fundación Clínica Abood Shaio se trató el caso de una paciente de seis años de edad con drenaje venoso total de cava superior derecha a la aurícula izquierda, mediante la técnica de movilización de cava superior y anastomosis cavo-atrial, y se obtuvieron buenos resultados. El caso es mención corresponde al número 21 en la literatura mundial.

Total anomalous systemic venous return has a variety of presentations, being the drainage of right superior vena cava into the left atrium a low frequency condition. There are few reported cases in the world. In Shaio Clinic Foundation we have handled a case of total venous drainage of the right superior vena cava into the left atrium in a 6-year old girl, using the superior vena cava mobilization technique and cavo-atrial anastomosis, with good results. This case is reported as case number 21 in the world.

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Los anillos vasculares pertenecen a un grupo de anomalías congénitas de los arcos aórticos en los que la tráquea y el esófago, o ambos, están completamente rodeados por estructuras vasculares. Con frecuencia pueden causar obstrucción y, en consecuencia, alteración de la deglución y dificultad respiratoria, por lo cual deben incluirse en el diagnóstico diferencial de obstrucción de la vía aérea superior. El diagnóstico temprano y la liberación quirúrgica oportuna de la obstrucción de la vía aérea y del esófago, o ambos, pueden mejorar los síntomas en la mayoría de casos. Esta afección debe sospecharse y evaluarse en lactantes o niños pequeños con síntomas respiratorios recurrentes como tos crónica, estridor y sibilancias o, lo que es menos común, con síntomas relacionados con alteración de la deglución. A continuación se ilustra el caso de un niño de seis años con problemas de deglución crónicos y desnutrición a quién se le realizó un diagnóstico incidental del arco aórtico derecho circunflejo retroesofágico con ligamento arterioso izquierdo corregido mediante cirugía.

Vascular rings are a group of congenital anomalies of the aortic arches in which the trachea and esophagus, or both, are completely surrounded by vascular structures. Often, they can cause obstruction and consequently impaired swallowing and respiratory distress, so they must be included in the differential diagnosis of obstruction of the upper airway. Early diagnosis and timely surgical release of obstruction of the airway and esophagus, or both, may improve symptoms in the majority of cases. This condition must be suspected and evaluated in infants or young children with recurrent respiratory symptoms such as chronic cough, stridor, wheezing or, less commonly, with symptoms related to impaired swallowing. We illustrate the case of a six-year-old child with chronic swallowing problems and malnutrition who underwent an incidental diagnosis of circumflex retroesophageal right aortic arch with left ligamentum arteriosum corrected by surgery.

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