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INVESTIGACIÓN CIENTÍFICA Y TECNOLÓGICA
Paciente embarazada con enfermedad cardiaca*: Manejo periparto basado en la estratificación del riesgo. Serie de casos 2005–2009
Pregnant patient with cardiac diseases*
Germán A. Monsalve**, Catalina M. Martínez***, Tatiana Gallo***, María Virginia González***, Gonzalo Arango***, Alejandro Upegui***, Juan Manuel Castillo***, Juan Guillermo González***, Jorge Rubio****, Leonardo Mojica*****
** Médico Anestesiólogo, Coordinador Unidad de Alta Dependencia Obstétrica Clínica del Prado. Medellín, Colombia.
*** Anestesiólogos Unidad de Alta Dependencia Obstétrica Clínica del Prado. Medellín, Colombia.
**** Anestesiólogo cardiovascular Unidad de Alta dependencia Obstétrica Clínica del Prado. Medellín, Colombia.
***** Anestesiólogo intensivista Unidad de Alta dependencia Obstétrica Clínica del Prado. Medellín, Colombia.
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="st0010">Objetivo</span><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Reportamos nuestra experiencia en el manejo de una serie de pacientes obst&#233;tricas con enfermedad cardiaca de diferentes etiolog&#237;as&#44; utilizando una estrategia de estratificaci&#243;n del riesgo&#44; para elaborar un plan de manejo periparto en el que est&#225; incluido el manejo anest&#233;sico&#46;</p> <span class="elsevierStyleSectionTitle" id="st0015">M&#233;todos</span><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Serie de casos&#46; Revisi&#243;n retrospectiva de 37 pacientes embarazadas con diagn&#243;stico de enfermedad cardiaca de diferentes etiolog&#237;as&#44; ingresadas a la Unidad de Alta Dependencia Obst&#233;trica de la Cl&#237;nica del Prado&#44; de Medell&#237;n&#44; Colombia entre 2005 y 2009&#46;</p> <span class="elsevierStyleSectionTitle" id="st0020">Resultados</span><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Del total de 37 pacientes&#44; 15 presentaron enfermedad cardiaca cong&#233;nita&#59; 13&#44; enfermedad cardiaca valvular&#59; 5&#44; cardiomiopat&#237;a periparto&#44; y las 4 restantes&#44; trastornos del ritmo y enfermedad isqu&#233;mica&#46; Se estratific&#243; el riesgo seg&#250;n la clasificaci&#243;n de lesiones anat&#243;micas y el riesgo de eventos cardiacos basados en el CARPREG&#46; Se identificaron ocho pacientes en el grupo de alto riesgo y el resto&#44; en riesgo intermedio y bajo&#46; La mayor parte de las pacientes fueron manejadas con t&#233;cnicas anest&#233;sicas conductivas &#40;89&#44;2 &#37;&#41;&#46; La decisi&#243;n de ces&#225;rea &#40;35 &#37;&#41; se dio por indicaci&#243;n obst&#233;trica&#46; Se presentaron complicaciones maternas de origen cardiovascular en el 10&#44;8 &#37; de los casos&#46; No se presentaron muertes maternas&#46;</p> <span class="elsevierStyleSectionTitle" id="st0025">Conclusi&#243;n</span><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">La implementaci&#243;n de un protocolo de estratificaci&#243;n del riesgo de muerte y de la aparici&#243;n de complicaciones cardiovasculares en la paciente embarazada con cardiopat&#237;a le permite al anestesi&#243;logo hacer parte integral del grupo interdisciplinario de manejo y&#44; as&#237;&#44; tener impacto en la obtenci&#243;n de un mejor resultado materno y perinatal en este grupo de pacientes&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="st0035">Objetive</span><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">We report a series of obstetric patients with a wide range of cardiac diseases&#44; using a risk based strategy to develop peripartum plans in which the anesthetic management is included&#46;</p> <span class="elsevierStyleSectionTitle" id="st0040">Methodos</span><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Case reports&#46; Retrospective analysis of 37 pregnant patients with a wide range of cardiac diseases admitted to the High Dependency Unit of Cl&#237;nica del Prado&#44; in Medell&#237;n&#44; Colombia from 2005 to 2009&#46;</p> <span class="elsevierStyleSectionTitle" id="st0045">Results</span><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">From a total of 37 patients&#44; 15 had congenital heart disease&#44; 13 valvular disease&#44; 5 postpartum cardiomyopathy&#44; and the other 4 included rhythm abnormalities and ischemic heart disease&#46; CARPREG study criteria were used for risk stratification&#46; Eight patients were identified in the high risk group&#44; and the rest as intermed&#237;ate and low risk&#46; Most of the patients had regional anesthesia management &#40;89&#46;2 &#37;&#41;&#46; The decision for caesarean section was decided for obstetric indication was performed in 35 &#37; of the cases&#46; There were cardiac complications in 10&#46;8 &#37; of the cases and there were no maternal deaths&#46;</p> <span class="elsevierStyleSectionTitle" id="st0050">Conclusions</span><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">The application of a morbidity and mortality cardiac risk stratification protocol in pregnant women allows the anesthesiologist to participate in a multispecialty treatment team&#44; and so they are able to achieve the best possible maternal outcome in this group of patients&#46;</p>"
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ISSN: 01203347
Idioma original: Español
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