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Main Author:	Renato Samy ASSAD
Format:	Artículo científico
Language:	pt
Published:	Sociedade Brasileira de Cirurgia Cardiovascular 2007
Subjects:	Medicina cirurgia Contenedores Artéria pulmonar Dilatação com balão Assistência paliativa
Online Access:	https://www.redalyc.org/articulo.oa?id=398941862010
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Nova bandagem ajustável das artérias pulmonares na síndrome de hipoplasia de câmaras esquerdas Renato Samy ASSAD Marina M. ZAMITH Maria Fernanda SILVA Petrônio Generoso THOMAZ Leonardo Augusto MIANA Vitor Coimbra GUERRA Carlos Augusto Cardoso PEDRA Miguel BARBERO-MARCIAL Medicina cirurgia Contenedores Artéria pulmonar Dilatação com balão Assistência paliativa Objetivo: A Síndrome de Hipoplasia de Câmaras Esquerdas representa um grande desafio para cirurgiões do mundo inteiro. Atualmente, tem sido proposto procedimento paliativo alternativo, por meio da bandagem bilateral das artérias pulmonares associada à colocação de stent no canal arterial e atrioseptostomia. No entanto, as bandagens utilizadas são fixas, podendo tornar-se inadequadas após o fechamento do esterno ou com o rápido crescimento somático do paciente. Descrevemos a primeira aplicação clínica do novo dispositivo miniaturizado de bandagem ajustável das artérias pulmonares em neonato portador da síndrome de hipoplasia de câmaras esquerdas, o qual permitiu ajustes percutâneos precisos do fluxo sangüíneo pulmonar. Método: Através de esternotomia mediana, neonato de 5 dias de vida foi submetido à bandagem pulmonar bilateral, usando este novo dispositivo, combinada com interposição de tubo de PTFE entre o tronco pulmonar e o tronco braquiocefálico. Resultados: O paciente apresentou boa evolução pós- operatória. Três ajustes percutâneos das bandagens foram necessários para manter a saturação arterial de oxigênio entre 75-85%. No 48 o dia de vida, o paciente foi submetido a atrioseptostomia com colocação de stent (6 mm) para tratamento de comunicação interatrial restritiva. No 106 o dia de vida, realizou-se operação de Norwood associada à anastomose cavopulmonar bilateral. As bandagens foram removidas, sem distorção das artérias pulmonares.Conclusões: O uso clínico deste sistema inovador de bandagem ajustável das artérias pulmonares mostrou-se factível, seguro e eficaz. Permitiu o ajuste fino do fluxo pulmonar de acordo com as necessidades clínicas, proporcionando um equilíbrio preciso entre as circulações pulmonar e sistêmica. 2007 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398941862010 pt http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.1 Vol.22

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// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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