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2012, Número 6

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Cir Cir 2012; 80 (6)


Mortalidad de la ruptura de septum interventricular posterior a infarto agudo del miocardio con manejo quirúrgico

Espinosa-Ledesma A, Ramírez-Orozco F, Herrera-Camacho G, Macías-Amezcua MD, González-Ojeda A, Fuentes-Orozco C

Idioma: Español
Referencias bibliográficas: 45
Paginas: 496-503
Archivo PDF: 218.80 Kb.


RESUMEN

Introducción: la ruptura del septum interventricular es una complicación rara secundaria a infarto agudo de miocardio; es la complicación mecánica más grave. Se describe la mortalidad hospitalaria.
Material y métodos: serie de casos de pacientes con ruptura del septum interventricular posterior a infarto agudo de miocardio. Se hizo una revisión retrospectiva de los expedientes de pacientes con cirugía de cierre intervenidos entre diciembre de 2005 y diciembre de 2010.
Resultados: se incluyeron 20 pacientes con edad media de 56 años (límites 48 y 65 años). 16 casos (80%) de sexo masculino, lo que da una relación hombre: mujer de 4:1. Diez (50%) pacientes fallecieron, en 5 la causa fue insuficiencia orgánica múltiple, en 1 sepsis por neumonía intrahospitalaria, en 2 fibrilación ventricular y en otros 2 choque resistente secundario a insuficiencia biventricular durante el acto quirúrgico. Los factores de mal pronóstico identificados fueron: tiempo promedio de derivación cardiopulmonar de 145 minutos e insuficiencia renal aguda en 6 casos que requirieron terapia sustitutiva.
Conclusiones: la ruptura del septum interventricular es una complicación rara, con alta mortalidad. Sin tratamiento quirúrgico, la mortalidad puede ser incluso de 100%. En nuestro hospital la mortalidad de pacientes con esta afección a quienes se hace cirugía de cierre fue de 50%, similar a lo reportado en la bibliografía. Nuestros hallazgos confirman que, aunque la cirugía de la ruptura del septum interventricular tiene alta mortalidad, debe realizarse porque es una urgencia quirúrgica.


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