Recém-nascidos pré-termos submetidos à cirurgia seletiva da persistência do canal arterial: ainda há espaço para esses procedimentos?

  • Renán Prado Hospital Santa Marcelina, Faculdade Santa Marcelina, São Paulo
  • José Carlos Arteaga Camacho Hospital Santa Marcelina, Faculdade Santa Marcelina, São Paulo
  • Raul Armando Micalay Paredes Hospital Santa Marcelina, Faculdade Santa Marcelina, São Paulo
  • Fernando Magalhães Coutinho Hospital Santa Marcelina, Faculdade Santa Marcelina, São Paulo
  • Mariane Albuquerque Lima Ribeiro Laboratório de Delineamentos de Estudos e Escrita Científica. Centro Universitário Saúde ABC. Santo André, SP/ Centro de Ciências da Saúde e do Desporto. Universidade Federal do Acre, UFAC. Acre
  • Andrés Ricardo Pérez Riera Laboratório de Delineamentos de Estudos e Escrita Científica. Centro Universitário Saúde ABC. Santo André, SP
Palavras-chave: Persistência do Canal Arterial, Cirurgia Cardíaca, Cardiopatias Congênitas, Recém-Nascido Prematuro, Recém-Nascido de Baixo Peso

Resumo

Introdução: O canal arterial é uma pequena estrutura fetal que comunica duas grandes artérias (aorta e pulmonar), mas que se torna patológica quando se mantem após o nascimento. As morbidades associadas à persistência do canal arterial (PCA) podem levar à conclusão de que a melhor conduta seja o tratamento cirúrgico precoce. No entanto, há evidências de que a conduta cirúrgica expectante (seletiva), poderia diminuir os riscos de cirurgias desnecessárias e suas complicações. Objetivo: Analisar o perfil clínico-cirúrgico dos recém-nascidos pré-termos (RNPT) submetidos à cirurgia seletiva de correção da Persistência do Canal Arterial. Método: Este trabalho contempla uma série de casos, onde foram descritos retrospectivamente (2009-2016) todos os recém-nascidos submetidos ao tratamento cirúrgico de PCA em RNPT através da análise de prontuários do Hospital Santa Marcelina, SP-Brasil.

Resultados: Neste período, observou-se 13 casos de prematuros que foram submetidos à correção cirúrgica seletiva da PCA. A idade gestacional média foi de 26,92 semanas, a idade materna variou entre 15 e 44 anos. O peso ao nascimento variou entre 650 e 1500g e houve prevalência do sexo feminino (61,54%). O diâmetro do canal arterial variou entre 1,7 e 5 mm, quatro recém-nascidos apresentaram cardiopatia congênita complexa (30,77%). A média de ciclos de indometacina foi de 1,77. A insuficiência cardíaca congestiva se evidenciou em 11 recém-nascidos (84,62%); a idade média no ato cirúrgico foi de 27,69 dias e a média do tempo de intubação orotraqueal foi de 22,62 dias. O peso no momento do ato cirúrgico variou entre 900 e 1820g. As complicações pós-operatórias foram em sua maioria infecciosas, observando-se nove recém-nascidos com broncopneumonia (69,23%); um paciente apresentou pneumotórax. Ocorreram sepse em dois casos (15,35%) que evoluíram para óbito por esta mesma complicação (15,35%). Conclusão: Todos os RNPT que foram submetidos a cirurgia tiveram peso ao nascimento menor de 1500g. A média de canal arterial foi de 3,05 mm de diâmetro. A idade gestacional média foi de 26,92 semanas e 62% dos casos eram do sexo feminino. A técnica cirúrgica mais frequente foi a da tripla clipagem, não houve sangramento ou reoperação nesta série de casos. A cirurgia seletiva de PCA ainda se faz necessária nos dias atuais.

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2019-12-12
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