Eficacia y seguridad del cierre quirúrgico del conducto arterioso permeable por el cirujano pediatra general: ensayo clínico
| Autor: | María T Martínez-González, Alejandra Peña-Juárez, Francisco Vidrio-Patrón, Elizabeth López-Villalobos, Brenda N. Arias-Uribe, Irene L. Velarde-Briceño, Miguel A. Medina-Andrade, Oscar E. Ceja-Mejía, José Manuel González-Sánchez, Humberto Murguía-Guerrero, Antonio F. Gallardo-Meza, Paulina Armas-Quiroz, Humberto Vázquez-Jackson |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Tratamiento quirúrgico Group ii Heart defect Pediatrics Ductus arteriosus medicine Initial treatment Humans Major complication General hospital Cardiac Surgical Procedures Posterolateral thoracotomy Child Premature birth Ductus Arteriosus Patent Retrospective Studies Gynecology Surgical treatment business.industry Infant Newborn Infant Surgical correction Recién nacido prematuro Treatment Outcome Recien nacido Child Preschool General Surgery Female Cardiology and Cardiovascular Medicine business Artículo De Investigación Conducto arterioso permeable |
| Zdroj: | Archivos de Cardiología de México |
| ISSN: | 1665-1731 1405-9940 |
| Popis: | Antecedentes El conducto arterioso permeable (CAP) es un defecto cardiaco congenito y se considera un problema de salud publica. Se presenta en un alto porcentaje de recien nacidos y en algunos mayores de 1 mes. El cierre farmacologico es el tratamiento inicial preferido, ya que ha tenido excelentes resultados; sin embargo, en aquellos casos en los que no es posible, esta indicado el cierre quirurgico. Objetivo Evaluar la eficacia y la seguridad del cierre quirurgico del CAP por cirujanos pediatras sin especialidad en cirugia cardiovascular. Metodo Ensayo clinico realizado en pacientes del Hospital General de Occidente, centro hospitalario publico de segundo nivel, con diagnostico de CAP, que requirieron correccion quirurgica. Se revisaron en forma retrospectiva los expedientes de enero de 2001 a diciembre de 2018. Resultados Se incluyeron 224 pacientes divididos en dos grupos: grupo I, con 184 (82%) recien nacidos, y grupo II, con 40 (18%) ninos grandes de 2 meses a 8 anos de edad. A todos se les realizo cierre quirurgico: 3 por toracoscopia y 221 por toracotomia posterolateral izquierda. Presentaron complicaciones 36 pacientes, lo que representa el 16% del total; solo el 5.3% fueron complicaciones mayores. Fallecieron 24 pacientes en el posoperatorio, lo que representa una mortalidad del 10.7%; ninguno fallecio por complicaciones transquirurgicas. El CAP es un defecto cardiaco congenito que se presenta en alto porcentaje en pacientes prematuros. El cierre farmacologico es el principal tratamiento por tener excelentes resultados en recien nacidos; sin embargo, en aquellos casos en los que no sea posible esta indicado el cierre quirurgico. Todos los pacientes fueron operados por cirujanos pediatras generales, con una sobrevida global del 92%. Conclusiones En los hospitales donde no hay cirujano cardiovascular pediatrico ni cardiologo intervencionista, la correccion quirurgica del CAP puede ser llevada a cabo por un cirujano pediatra. La tecnica es reproducible, facil de realizar y con minimas complicaciones. Background The Patent Ductus Arteriosus (PDA) is congenital heart defect and is considered a public health problem. It occurs in a high percentage of newborns and in some older than 1 month. Pharmacological closure is the preferred initial treatment, as it has had excellent results; however, in those cases where it is not possible, surgical closure is indicated. Objective The objective is to evaluate the efficacy and safety of the surgical closure of the patent PDA when it is carried out by pediatric surgeons without specialization in cardiovascular surgery. Methods This study was conducted at the West General Hospital, a 2nd level public hospital, with the diagnosis of patent ductus arteriosus that required surgical correction. For the collection of the information, the files from January 2001 to December 2018 were retrospectively reviewed. Results 224 patients were included; divided into two groups: Group I: 184 (82%) “newborns” and Group II: 40 (18%) “big children” with ages from 2 months to 8 years. All had a surgical closure; 3 by thoracoscopy and 221 by left posterolateral thoracotomy. 36 patients presented complications representing 16% of the total of patients, only 5.3% were major complications. 24 patients died in the postoperative period, representing a mortality of 10.7%, none died due to trans-surgical complications. PDA is a congenital heart defect that occurs in a high percentage of premature patients. The pharmacological closure is the principal treatment because it has had excellent results in newborns; however, in those cases where it is not possible, surgical closure it´s indicated. All patients were operated by general pediatric surgeons, with a global survival of 92%. Conclusions We conclude that in hospitals where there is no pediatric cardiovascular surgeon or interventional cardiologist, the surgical correction of the PDA can be carried out by a general pediatric surgeon. The technique is reproducible, easy to perform and with minimal complications. |
| Databáze: | OpenAIRE |
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