“asi
UNIUERSIDÊDE FEHERQL DE SANTA ~CñTñR1Nñ
` CENTRO DE CIENCIA85Dfi SAUDE
DEPHRTGMHNTQ DE CLINICG MEDICA
Florianópolis, novwmhvofldw 1990 :.. CIRURGIA NA ENDOCARDITE INFECCIOSQ Charlefi Machado Carlos R.Borto1ini
CM
221_
CIRURGIA Nñ ENDOCQRDITE INFECCIOSH w Charles Machado * Carlos RuBovt01ini ** Roberto H. Heinisch "~ .. .K ...' . .. . ., I' 1" \ '\ ' ' '
M Umuzwrmndum da í¿d fuma do burma da Mwd:fi:na M Ufinixw df
\ - Lnänfinmfi da Gmúdm da UFSC"
›|iúl Un|v‹rw|i1||u
\
W Mddlgu dm hwvv|çu da Lm@vgênc|a do Homp 11 .' fi'5
UFfiü"
fiw Uvukmhfivtm H" Hwlnlmch
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ñqvmdecimwntoau
vala mvuentuçäu ú muhllau wrwmtmdu»
mm Dr"Ldc|m Botelho pwlm diuwmfiiaäm
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-.. z _,_ 3 .~\ \J u u u n u u u INTRODUÇ%0"»" RESULTHDOQ" z DI$&l. H. =;; .A U; «*\ \/ u u CÍ()PJ(I!".Ll$š?$().. H ñB8TRfiCT"»" R |::. I" lr. R N Í: Í Ê: ff; u n nz u n u n u MGTERIAL E NH ft! `›› 1: ra an zu zu :v lv ‹| `()[7()$3 1: 1: nn ‹\ nu ra || 1: un nn nz |› un vn 11 ‹| BLBLIO U M ñ R T O u n vn vn vz vn vv vn nu |\ cn u n u n n n URÊFIFMQH www. .L "`| I| -_.: › .¿7» ׿» iiCIRURGIA CÊRDIACA Nfi ENDOCARDITE INFECCIOSA
RESUMO
Rdlatmmmd H hxpdriêncim dd instituiu da Umrdimiwmimynm
fuuu «tiva du huduuúrditu infimgcimmm cum 0 fiatudd rwtrmmwwctiww
dfi #8 cafimm,nm mwrindu da Jandira dd 1989 m mmrum da 199W"
O diagnómtico Fmi mdtmhwlficidu wfiid duadrm
c1inicm,hdm0cu1turm¶, `
duucmrdimgrmmm Q ~ mahmdmm
mnmtmmowmtológicmdn `
A média da idade Fui dw 3®,8 anda (Í U 7”
wmciwntem (ói,9%) mrmm dd memo masculina m id wmvifnici äH,í%)
cha sâfirflu -Fdniin incinñ inëciia iie ciimfié inizwrwwachnm -Vmi d@~ QR
'Quanto m dtiwldgia Fmrmm idmntiiicmdmm,
fiurwmm mm 17 wmfiimntfim (88,Ó%),8trmwtoudflmm Uiridmnfi em 3 (ó,8%)
fitrdwtmcuudm dntdrmcoco Gm É (d,5%), Strdptmcmud x hwmwiitium mm
i íH,2%),$trfiwtmcwum H hfimmliticd um 1 (R,2%),$trewtmflmum do
gruwm D dm 1 (R,2%),K1ebmim1ä mm 2 í¢,5%),Cmndidm ñihicmnm mm E
fid,5%) H Pddudmmdnmfl dm 1(H,2%)"Ohtivdmwd culturmm nmgutivmm dm
id waciwntdm (3í,8Z)" `.
A cirurgia Fui indifimda wm 32 wmcidntdd <7ó,íK) wdr ICC
rmiratária no controla üiinicoypür dimiunufim da wrdtefiw dm Ó
(í4,2%) H Ffinômmnmfi Trmmbmmmbóiicmm wm 1 (2,RZ)" .›¿¬_ ›. -= vw ' “ "Z zz.. fz .__ 1-: ,.¬ _¬__~ _. rf, z '_: ": `-~' _.. 5 ';= 1.1
Cirurgia da trama da vaivfi "
(3®,9Z),Trmca dd valvm mórticm mm ii cmfium ñ2Ó,iZ),dum1m trdfim
dm 13 cmwmfi (3®,9%) Q rfitrocm dm mrátdwfi mm 5 cummm (1ñ,?%D"
M taxa da mortmiidmdw foi dw H&,ÉZ"m hmuvw mwihnrm am
i iuiiintfifi (?fl,8%)" «_ ,- ,.› ^, 1 ...~ 1.: ^ .^. V :'71 ^. Ziz- Ç1 ‹ ~. U :=,- .‹
L
1:N'rRoL›uc:?â‹›
. . ¿ . . .. ¬ . ,
Na eva wvéwantnhlóuiüm m hndmcard|tw lfi+ücfl¡mfim nhfll»
. . . `
` . .¬ . . . . 1::
www nnvmrlmvwlmentw fmumlnbmm m inmtnhulumu M»
. . . . u ‹ .
mnt1h›wt¡cot@vap|m, fimmm Uwqäü twVmwêutsum,v@m fimndm mbtada um~
,z ' ,z, ,,
. .J
mfilhmvm clínica em torna da 79% A QWX dum amava" 'nf i§,1w
No ‹'~`. nixniu :a"::, fi'g al uns wmcicntwm nfim rflnundvm hfm U ‹'i~
fi* ¬~
_
-_,
ahmvdmflfim, ndm um prügnófitico fimmbrim; mfifl Mquwlvw wmhvúnh
pnrtmdmvmm de LUG grava Q HH dufíhnl zwntrwlm, mdwmâ
. . . vu . f . .,_ zu
WüV¶I$t@Htfiy €VlÚ@HCIä ÚH HHÍÉHÊHQ |HÍVü“fiüFflÍHfiä ÚH §HTHfiCHU,
wvfifimnma de mnwuvimmm mícótifim, mmhmliwmçüufi rfinmVvmnt¢',
inmuF¡ci@nfi¡a Venal, mndmcmrdite fimhre prótwmwfi Q Vúngiüufi, wmx
nmmtmfi mmdmiidadmfi de endocmvd|te, m mortalndmdw mm§tva~mfi mandú
wlmvadau (i,4,1ü,i3,ñó)
Nwätam civcunmtânciaw cnnmidwva se U nwwfim dm
trmtmmfintu fi¡vúrgium"Pmvém, wendm um gvuwm mwlwcimnmdm, um mwJ~,
qua tava uma wvoluufim nãm matimfatóvim mntmfi dm uivurgim H
wwvcmntual da dbitmm tenda m mar maior"
O wvmwmmtfi Qwtudm tam wmv mhJ@t|vm mvml‹mv um wmcuwntvw
'S
cum findmcmrduta hactarsanaywuhmwtiflmfi m crruvglm, mnmlnmmndn
válvulam acommtidmäy U tiwm da mifivmmvgmnimmm wrwvmlwntv,
indicuçöwm cirdrgiuaw, 0 tiwm de wrmumdimfatn v‹«1¡nHHu, h‹m
' '“
. .. .. , . _. .. ,. ' /.\.
..
CUWU ä GVUIUÇHO Úfiätü ümU$tVHQQM QUÊ VfiDVU$QHtM H HHWH¡IwHLIn
.J
fi¡VÚV9ifim' dm Inmtitutm dm Cuvdimlmyiu da FHHHHHCH duvmntu «W
\/\ ( M ñ T E R T A L E M E T O D O fivmliammm,vmtvow@ativmmant@, um wvfln .'f`. vz I¿'¬ A ,_._ _._ . fz ' ¡. . . ' . ¡. . zz' .. .. . . ' ¿. . " . ,_'› .. .. ' J ( H I ) W! ¡ ¡ |.¿._ ¡ H fz (_-_‹.¡.~ H ¡.-- -Ig, H-|
dv i1H PP¡wÕd|u« dv |ndu‹úvd|‹v íníwfâlw
um Tnfl*iTu%fi dv Umrdinlngiu da Fundflüäfi Hu*w'f¬1Hr df “nn?u
1W@®" Defite totmk Foram $ubmmt|dmfi ä âsluvmem umfdimnn 42
1 W
QM
. .. .. ..._ _
nmÍ|fiQtem (3/,b%) hm Fmfiw ativa da dmwnçm"
wmdm da Nficvówsiau
'_-».
Vmtmwana (F«H"8"U»),nw wwvímdm da Jmnwlrfl d~ .iäü h matam HH
`O diagnófiiicu da hnln mbwdmümu na flwgunntmm cw|túv|ufiH
E ~" ficflfimchl c:|VLh"g iccw H/cn; cniliflirzx dv* vm1\¢m <nwõn“afhn“
3 W üumdvo clínica cmmwmtfvfil w hwmofiultuvm wmwitivmfl
d|nqwÁ$|vfi"
z-«
4 M Quadro clínico compmtfvfil Q uunfivmmmfin wffirvmvw
5 W Quadro clínico comwatfvml H fiulfuvm da wmrän da
finivüdfl puuutlvmfl
Ó W.Qumdvm clínico comwmtfvwl cmm vwmwmmtm tmrmwâuticau
Hšcultuvm da vmlva"
O figfinte fiêrmlógrcm Fm: |dwHtx+|‹~dm,qumndw wmwmfvwl
«tvmvém dm 8 A) HLmncu1tuvm; B)fiu1tuvm N~'nurlu dm fintvmdm;
Das êfl waciwntmfi, E6 (óí,9%? fivmm du ׋mm mmâfiulxnm H
.'
.
':
~.›.z «-.¬ vv °‹
I),ümm bafifi mm wwtudm de mmmfitrmgfim da dm›n»fi nJ
J
Para cmlmtm das dmdwm Vu| mlmhmrmdn umw Ficha (fiNKY
1%) vvúm du fiwxm fmminino, cum idadw média da Hü,3 numa
(vmv|mndo da / a bb mnnm)" z .z-« -«_¢ _ N -«f~ ._, '< =z~z É
mvmfitevfmtacmm . \ do hUupwU@1ru, du mymntm uílušmglwn, trmkmmwntm
P fiwwkuçämn
Os dmdmm Llfnifimfl dm gvuwm gwrul (H ííä), Fmvam por nám
«rvfiruxvn vwvwhwwam mnálnmfi wfitatfmtlcm Gm vemultmdmm vmlmtivmw m wvmluufim wwlu métmdm dm Qruwm u1ín¡cmdo X H" H
Hwrmmmntudwfi Qm cmnclmvfi ciwntffico Q mwtfiw puhlifimdmm í?)"
Afi cirurqlmfi Foram V@al|Hmdam na mvfimm inmtitusçam um
¬ 'Ííl Li (3555 P `‹`:`I.iÍÍ I (~l~';_|'lÍ l'^Í-ÍÊÊS I H ÍÍ (" |"` Yi 2':'\ I”
221 ITI l"I (~I-Í'€iÉ- Ef 13' V' IJÍÍÍHÍÍ 'IÍ3 ..
* 1
, .
5 Foi nnflwfvwl iH@H%iF¡rfiv 0% micvumvwuulmmum zmuhúduvén .‹¡-¡ z.~. v.. . .. 1.,-_ _ ~ l R E S U L T A D O 3 \ 1
Dehtvw na wvincipalä lndscúçüwz â;vúrg|cmm dm mruww
w”%udufln, wmd@mm$ demtmcmvfl ICC vHPvn%úriH (?ó,i%) Q dimPunü%n
dv wvótufim (i4,2%) como um maifi Fvmquvnteu" (TñBKLñ I?
/ TABELA *I ~ INDICAÇÃO CIRURGICG NG FASE ATIUñ Dñ
KNDOCARDITE INFECCIOSÊH To Nä Z Indifimçë: ICC Rwfvatávim Ú . . ~. D|$Funuam de pvótemm
Falência dm Tto Clínica
Fmnômfino Embólifim Total 4 fr I.`.. .r % 1 f `1 :'> -f H -‹.- _: _.- /' \.) y J. í4\? 12', 1 _ 1: , :za _ zâ. ~:z› â-11 ,. ~:f› Fmntwä P"H"S"C" ~ lnmt|?utm da Cmvdlmlmgâa - ~- fi- rt» '_ Harum de ñ98® U Jnnv‹rm d@ 1››w -. ~ . .I .J .. . .. . .. . . .. :T a'v¶ :âà"á:v à :.`:“'2 aê 'ë> là '"--a:ci~# fc ' 5
~?r«wiug0um% X hfimmlfticmw mfiwmcimdm a K|‹hH|ml« m wuL:u
vw
dm IMI" atrmvéfi da hmmmculturm, culturú du nulla du unärúdu,
fullwrú du v 1 ‹ urv|~d« P culíurà dú vnnlfl dv ‹~l~1«1 úm PU
\wmuivnfP5 (ó3,á%)" Cabm aqui citar que R wmciwniwfi ñpwmmfintmvnm
|mul&«n‹1m«niv |nP‹‹.Wu w›v F h|‹1/rsww, ,fud«‹ Í |Hw
Obswrvmmom maior mmvtmlidmdw Hu dwvn»‹
cmufimdom mor Stmfilucmcofi Auvmmfi H gvmm nwgmtiv
uma Hmqufilefi dwvido m Stwfiptmcocmfi, cmnfmrmf
'\ tl
THBELÊ II"
TABELA WII ~ RELACfi0 ENTRE AGENTES
- ' ENDOCARDITE INFECCIO$fi figwntç fitiulógico Ná (K) .... .... .... .... .... ¬... .z.. ..-- .W .‹›. .... .... .... .... ..- .... z... .... -.›. .... .... .... .... .... .... .... ... :mama Aurwwm 17(38,ó) :ocmm Uívidmnm ¿3(`ó,9) :maos Ent@Vmfi0co$ _ R( 4,5) “ ;›'w yr - .-‹ :-1 =-zw ~.» . ..- .- _›.~ ~.‹ . ‹-‹h ff» ¢"- f? -: ¬ -: r:= ez zr- ».~_ _'., .z, ~, L.: 1.2 L: - .^?' ."? .^°'. ›-_' ¢“: f`. fã "~ _: ' w- ~_- L* A z-. A À ' :mcmw M"%j: ' " fx ,.._~ :ft ._.. .-,. >_: ^: -¿» ¬‹ xr /\ :-_ ^ ' ¬.» ._.¡ . .". ' ¬-‹ 1-* _ § '_:›.;`.§ - .v...». . . 1-` a-\z-\ ‹¬ .1\.~\f\ ff! vw- _›. .~. v' s.- fitveptwc0cm$ N hvmnl:I|‹u 2,2) fitwmwtococmm gvupm D 2,2) ~4,ü) zfiândida ñlhicmnu 4,5) Pmwudmmonafi R,ü) Úultuvmfi nügativafi H,w
Iontfifl .FHHHSHCH W Inwtrtutu da Uavdumlmgsw
Harum da 198% a Jmnwirm de 1990
OÉES F7 I" (17 (II (~Í'Í' (II I I`|l(-Í'.`I`1`II (INÊS (ÍÍ I I” |.ÍI" 53] I (II (Iifšš I" (~Í~I'EÊ`t I
I I-I~IÍZ`:'‹(II (INB 4... ¿:'&íÍ'¡ I I.I.'›I I" ë`:`\(I ll
nm TMBKLQ III"
TQBELG III ~ PROCEDIMENTOS CIRÚGICOQ REfiLIZfiD0$
NA ENDOCQRDITE INFECCIOSQH =L`z ›¬:5 `.z'?×';s Õhlnum Nwfifi) Ó 'Rb HI 1 H .mIv4) zu K-ZH '~.- ‹zf.I'|'|‹"': ¬ || x ..-'›. ‹~ ..: ¡. .-`_ ~‹ .` V* 1 ($® \ .`¡ |'I 415;; 1" :rf (I ` ( Iufif I f-'~` `/-`\l IIII ETIOLÕGIC08 E HORIALHM ~ CQSOS CIRURGICO$ 13:/ -_-› PHÚBEDIMENTO NR K z_:~ Tvwfim da Umlva Mitrml 'I H®,W ,, , \ 1, . /,. '›f :___: Ç -Í _ . .-. z-; -az -: *-2 .-` 3-J < 53: : f-' ø . ( ,É :_ ^;^' 'E ~z __. :'.`. j_>. _. .. .. . '.`, .I (Z " .. . .. Í Hwtrmfla da I nrótfifim h III* TøTmL 42 «mw ~
Imntfifl F"H"$«C» W Immtytutm de Cardxmlmgun
Março da 1989 a Jmnfiiwm da i99®
/ ' \ Iii' ' \J › |›<wz-=--z‹~..z-«v--.-.v-.›».-z-“¢›‹.@~ .- ....›-w--»¬..¢...-_..._»--_-....-..._.,..=. .¬ . ¬- ~‹ ‹.,. iii- I 2 uwyw
/ \
\
A murTa1idmdw Hncmntradm no gvuwm c|rúr¶|vm Fm: da ii
mmciwntmfi (26 2%). wnquuntm Qua nm Qruwm aum wmfifihwu Twmtmmwnín
clfnicm iwml \ y , ‹ ` ' '
"
'H)" íTAU¡IA IU?- mdm +01 dfi dö wmc|ent@w .› /'\ :Rã ."' . ~.v ~‹ =.=ETABELA IU W EUOLUÇAO DOS PACIENTES COM ENDOCARUITE
INFECCIOSA CONFORME TERAPÊUTICA Tfivmwêuticm M . N hWOÃUGHO .., . &mhwwv|v@nte TOTAL 7®(í®®) 4fl(1W®) íífifiíüfiä XR* ®,®74 mN$ O tvwtw da
W
|Hdwwfindant@m‹niw do tvútamentu swf filfnlfim mu cnrfivusvmu
Tratamento Ívatumwntm Uvwww
¬‹¢ - .. -V _ H-,H "H ¬ V ,W Llwnlcm (¿> &|vdrg|Lu(À) hwrml âúâ w 5®(71,5 Pmntfiü VHHHSHDH \./ .'. ': -.v §..›. 1-` \_: -: .'. 'Z vw- ~: ff”. Obitwm H®(29,5) ií(fió,R) W lnmt|tutm de Cuvd:m1mw|v arma da í98® a Janairo da 19?ü . nu
HHÊVQ Hfi VüVÍáV€I$ Hfiüllfiüflääyfifl fifijüyüfi Óh¡ÍU* ULUIV(¡uW
Ó
LL; .‹~\
H $í(7Ê,@7
›' /5)
51-
1
D I $ C U Q S Ã O
A mortalidade dod pmcidntfim cum HUINQUW dmmwnvmivfim
ICD, 'rwfratárim omcilm entra 7? m 99%, nfiw mhwkmntw A
inêõt itL1i‹;äc1 ‹1@ arit it›i‹3t ic×ni:er'uç›i«
'~ :a°: ' 11 zâxwzf :â Q _: .-o- 'T H .~ ,.» .¬ z-.A ‹-. .~ ...f z- A ¬ Ê'?~ .LÊ xy ~: ^. :=; :Ez :É ¡-«lx A: :ft .^. ;~_: T"`§ rw '..1 ~_¡i -z*: z-›. :*1' -'12 ~./ "-`:
havia êxitd dm me intdrvir cirurgirmmmntfiy nm Fwmw wäivm dm
dmwnçaf H mbmrdmgdm cirúrgica pmdwdu H ddr cmnmidarmdw now flmwmm
dm uma hd dfifidnvoivimfinto dd ICC durmmtw m mvmiuçfio da dddnda,
pmrmimtêdcia do quadro infecciosa Q/ou ocmrrênfiia da Fmnflmwnwm
trdmhdwmhdlicmfiu (5,íí,18,í5)
A cirdrgia vida, hmfiiuumfimte, rdmtmhmimcer m eduilihrim
hdmddinâmicm, vifito que m wrdcemmm infwcuimmm gwrmimentd é
umntrdimdu com m uma-de amtihidticmmu (b,ib>
Em ndmmm Cadufatica apwmmm uma pfidumnm wwrcwmtmgam dm
wmfiidntmm (7,1%) foi m uirdrgim wmr mwrwmdmtmr pmrmidtèmcim `dfi
mumdrd imfdccimduu A ICC refratária, qua ainda da ummmtitui na
maior imdifimçäo cirúrgifim num paciwntmm com EHIH, mm dwvd
wrinfiimmimdntd à idmmdm drdvalvulmrmm mgudam (wrinuiwmimwntfi
mdrticm H mitrml), dápsim, dmholim cmrmmdriai dhdcwdmn
midcárdicm mu miduarditw hmmt@rimnm"(3> Nm mrfifiwntd wwtudd, IRC
rdiwmtárim am trmtmmfimtm clinico wrfidmminwu uwmw indicmufid
1: i v'Lii* 9 i cizâ , c:‹ti"ctrâ ii af 6313 , Siífi , ci fiiiior et fisi:zá alex aii: «iv ‹i ci ctânin ea
litwrmturau (í,R,3,9,í4) A
Gabe md dum m End" , " W z,)mFmtm wrddmminmntwmmntd u
vmlvm mitrmln (2,í®,í3,iü) Entrmtmhto dm nmwwfl cmfiuimtifim hmuvfi
prdwmrçäm mdmdihmnta dd mümmmtimdntd dam vmivmm mitrmi íH®,¶%) H
adrtica (RÓ,i%)"0d paciwntmfi com endmcarditm na vaivw mdrtifim
dwmdnvdivdm cum maimr Frdquênciayiüfi dm difimii cmntrmlw
ulfniam, secundária mm cmmmrdmmtimfintm dm Fundàm mimuärdium
fimdufirda, tmrnmndm me mimtwr a intwrvfinçfim fiirúrgium" 41,9)
No qua dim rmdwwitm uma agwntwm wtimiúgiuum, haciimw
drum nfigmtivmm Q Fungmw tdnddm m um prmgndmtifim rwfimrvmdm devido
mm grande mudar de demtru|¢fio damtwfl agfintmm" íh,i¿,i4fi
O Stmfiidcdcmm ñurddd gwralmfintfi wrmdwminnm urmmwtwndm
vmiwmfi dddimfi ddätruindu md adm rmmidwx, mndumnüm dum,dfi
dnddcmrditmd Fddgifiad, cuja curmd É mgrmmwivm? mfid da dificil
“. ^. z=~ = f~. 1-& Ç Z z, .-~. 41 . -, ^. ,¬ ..» ,.= J 1 #1 J ^. ^ _... p-É fz' ,_ *fz F9-Az A À- '~¬. ,_z. Ê-2 ¬ , '_-. ,..
ii? (Í) I I`|'i(Í3¡" 'Í" I €Eši`|l(Í7 CI U ({-É ¡':\ Cl (Í'/ ({~Íi"I Çi 2':`\ '‹':'\ É?-155 |.Àlii('Í'Í
y Iii I Ii'I('Í-É I 'Ef 1:1 ii (Í| (Í) (ÍHà |" 7:1 *.š§~ i:". '|"(-Í-Í"ÍÍ`, (LÊ (-Ê" É`:'~
y
dmtmw mcurrmm wdhrmtudm dm tdmimâmmnow Q smhrw wrdtddwm"
1 âmhrfivida nfid pmmmm dd HGH adm U .¬. :_E_Ê j..\ fã `.z~ ~1 xr -v .¢_ 37' . -; z :E .,. . ri' .'32 . ._,E . >..: F? I _. A =..= : :E ., . ». ,.› ›. -. trmümmwntm ciinifid immlmdmu «-\
f :"'
«z
z
_.‹-
“mamar do númfiro Vwduflidm da wmclwntfifi acmmwt|d0% wmv Klmhmnwlm
íövfifi) m mbituávim Fui dfi fiüfifl 0hfi@rvmmmm,' haium incidânmim dm
Í
"`.
_-z :"¡'
ITI (É-É I"l (III I” 2':`\ Q I" 553 fši I V I \'II 2`:`( (II ('32 (II (-I'Í Êšš II (-I? I`|I I (II I'" (I)(Í1I" Éjj Ízl I"| I (E5 III (I) (II (IJ ITI IIII (Í.1?:`\ I" (~I~I Éíš IÍ7 (Í) ÉÊE- íz'\ |1
Hmuva HU pvwmfinte Imvuntamfinto pvfidwmimâncim dm
\.. . .‹-~ ,uz .. . ,.. ,,.
'fintmcmcow Vividanm (Ó,H%), wvmvmvwlmmnüfi dwvidm um (mim dfl
tratumfintm clfnncmu
Na wvwsmntw ua%ufmt|ca fincmntvmu ma um númmrm wlwwmdw
‹1m In m‹u|;1Iru'‹w ln* "
mudam negativmv a hmmocultuwm mfim indmfirmwy mntrm wlwwfl
aula nrövlú (AIÕ ? ~vmflnà‹ J, m1«r~~:u«¬: mn~ d›
mnt|b|mt|umt@Vw: 1 1'z 1 wzz I xa @"¶à I ' :'“f"¿w~ ¶^;a
7
cvwficimentm lwntu (mui Cmvynwha f": *I f. ~2mmnwh= ,z
E Pecifií ^ › I-. _- ,; : U 5 1 z-' _ _; . .- V. ft 'Ê Ê-2 . -, 1 ft ,, . {': -: É . ‹_. .J f? .^ ‹_› /- . -, \_» z~ /-2 7,›`
flI|Imcmcmfi Auvmofi (d8,mÁ) cum mnrtmlldmdw mlwvmdm íJ®,Ó¿› H
|n(Iu@nHa,hIkwn@Ila cmvvmdmnm), mluwumvgmnnmmmw qua n@fififi§|tam
Iunqu›,N‹|› â||«,H¡u‹‹lI~¡, Izwnvl I
de hactérimm,vfruw,wndocmvdite dm cmvmuäm divfiitm H uvmmimn ø'\ ;...». Q. ...‹
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E R R A T A
Na pág. Ol, primeira linha do primeiro parágrafo, on
de se lê: "... experiência do Instituto de Cardiologia, na fase ati_
va da Endocardite Infeciosa ...", leia-se: "... experiência do Insti
tuto de Cardiologia, em cirurgia, na fase ativa da Endocardite Infec
ciosa ...".
Na pág. O7, sêtima linha do terceiro parágrafo, onde
P-' o\0
se lê: 83,3%, leia -se: 76, .
Na pág. 10, no ABSTRACT onde se lê: wich, leia-se; /
which.
Na pág. ll, na quarta referência bibliográfica,onde
QR
II" -'.‹‹
EXÊMES COMPLEfi§NTâRE5 = na äiagnóâticm
Ê. Hemsgrama _ 3:3”. * énemša § i = i ) ~ Leucocitnqfl 5 ã ) N ( >` . W
L€ucüpznša"
S'{ } N í 3» Ê.iU.Hz5z ~'UäÍ0r C. Alteraçäa no écocardšngrama ' N QI! UIUULO Am \/'-.×*\..f ñlteragëeâ na cateteriâmø N E. âltevçäaã-na aletracardingrama š N TRÉÍÊHENTÚ H. Tvfiäâmanâa filfnšca = ` ântânâóâêz@<5> V . * Poânlogša,...,,..;àdfi5ed¡áfia,z.flz.«.duração.. B. Tratamento cirúrgico = S ( > N i ) 1 -' z-'“ _. ~ ¿nd;ca»ao ~ ~ Tiwo de Procedimenâõ = VIII. EVOLUÇÃO U IIH H. \J 'zzsz ;.^ -Z=`lU}(D A A '‹./ \›.1` /*à xi ê. Ohšto ~ ' B. Cura > C. Melhorado ( ' . QNATOHIA PÊTOLÕGICâ. ( ) ( ) üuai í 3 Quai Quai znnunnnwzâ-~n{ fz 'i 'ÊÊ N E X O I
PROTOCOLO \ .ENDOCARDITE BQCTERIANÊ
` .
.I. IDENIIFÉCÊÊÂOS
Nã~Reg¡5tro
Data da Interflaêãm
Sata da alta ou óbito
Nã de dias internada * Idade f.-`;š»:~::-:ca - šntewflaçz 2 fl-"í N N/ ¬ v"` V n
XE. CARQCTERÍSTICQS HICRQBIQLÕBECÊÊ
›â9€nte is) isõladm ía? Por
Métødo empregada
(ii Hemocultura ~ S í É N ( )
(2) Cultura da~pQrta de eñtrada ~ .3
III. CâRâCTERÍSTÍEâS DO HGSFEQEIRO
`‹=z.
BI
5..
Doença subjacente cardíaca S ( ) N
›Qua1 ? `
Doença näe cardíaca subjacente S <
Qual ? Y» ~ `‹- , › í Porta d€ enirada S í Ê N i ) Quaä ? '
IU. QUADRO CLINICO = ñguda â š 8uh~aguda
L›+IIm'¬fl1UE1üJ$ uuurlnnlniv mw 1";/'\ ZZ Éh 1/'W Febre ) E ' Sopro ) ') Manifestações cutâneas Fsplenomegalia S ( 2
Baquateamento doa deâos Q ( ) N í
Fenômenos emhdlicos S.í ) N ( 1
Manifestaçães renal É < >
Nanãfestacoes neuraššgicas Q 1 E
Insuficiêncaa cardíaca cmngestàva_ S
0293 /'\r" 21' v"~ 21 Z /¬-. ~‹./' Outras S ( 3 N í 3 Qual ? r*›. Fla '*-..›' Q em UTI ' 5 ã ` N f 3 Quanta tempm'? .‹"~ PJ ›-._.« ` N í E 3. ' 'N ( 3 ) Qual ? Qual Qual ( ) rx _: Qual ) N ( )
-TCC UFSC
CM
0221 Ex.l N-Chflm~ TCC UFSC CM 0221Autor: Machado, Charles
Título: Cirurgia na endocardite infeccio
' 972814201 Ac. 253410
