Rev Bras AnestesiolINFORMAÇÃO CLÍNICA 2008; 58: 2: 165-171 CLINICAL REPORT RESUMO Bisinotto FMB, Cardoso RP, Abud TMV -Edema Agudo Pulmonar Associado à Obstrução das Vias Aéreas. Relato de Caso. JUSTIFICATIVA E OBJETIVOS:O edema pulmonar por pressão negativa tem sido definido como edema não-cardiogênico, com transudação de líquido para o interstício pulmonar, por aumento na pressão negativa intratorácica, ocasionado pela obstrução das vias aéreas superiores. Descreveu-se o caso de paciente hígida, submetida à anestesia geral, que apresentou edema agudo pulmonar após a extubação traqueal. RELATO DO CASO:Paciente de 23 anos, sexo feminino, estado físico ASA II, submetida à anestesia geral para videolaparoscopia ginecológica. O procedimento durou 3 horas, sem intercorrências. Após a extubação, a paciente apresentou laringoespasmo e diminuição da saturação de oxigênio. Houve melhora após colocação de cânula oral e administração de oxigênio, sob pressão positiva, com máscara facial. Estabilizado o quadro, foi encaminhada à sala de recuperação pós-anestésica, onde, logo após a admissão, apresentou edema agudo de pulmão com eliminação de secreção serossanguinolenta. O tratamento constou de elevação do dorso, oxigênio sob máscara, furosemida e restrição hídrica. A radiografia torácica mostrou imagem compatível com edema agudo pulmonar e área cardíaca normal. O eletrocardiograma (ECG), ecocardiografia e enzimas cardíacas estavam normais. A paciente apresentou boa evolução, recebendo alta hospitalar no dia seguinte, assintomática.CONCLUSÕES: O edema agudo de pulmão associado à obstrução das vias aéreas superiores é condição clínica que pode agravar procedimentos cirúrgicos de baixa morbidade e que aparece sobretudo em pacientes jovens. O tratamento deve ser instituído precocemente, pois a resolução também é rápida e, na maioria das vezes, sem seqüelas.Unitermos: COMPLICAÇÕES: edema pulmonar; VIAS AÉREAS: pressão negativa; obstrução. SUMMARYBisinotto FMB, Cardoso RP, Abud TMV -Acute Pulmonary Edema Associated with Obstruction of the Airways. Case Report. BAKGROUND AND OBJECTIVES:Negative pressure pulmonary edema has been defined as non-cardiogenic edema, with transudation of fluid to the interstitial space of the lungs due to an increase in negative intrathoracic pressure secondary to obstruction of the upper airways. This is the case of a healthy patient who underwent general anesthesia and developed acute pulmonary edema after extubation. CASE REPORT:A 23-year old female patient, physical status ASA II, underwent gynecologic videolaparoscopy under general anesthesia. The procedure lasted 3 hours without intercurrence. After extubation the patient developed laryngeal spasm and reduction in oxygen saturation. The patient improved after placement of an oral cannula and administration of oxygen under positive pressure with a face mask. Once the patient was stable she was transferred to the recovery room where, shortly after her arrival, she developed acute pulmonary edema with elimination of bloody serous secretion. Treatm...

Objectives:The ductus arteriosus (DA) emerged from the pulmonary trunk and connects with the descending aorta. The normal Doppler evaluation depends on gestational age and the pulsatility index (PI) must be greater than 1.9. Anatomical and functional problems can occur as aneurysm of DA and DA with restrictive flow. DA anatomical changes can be caused by changes in blood flow and / or morphology of DA especially in the last trimester. Methods: Description of cases: 10 cases of anatomical changes of DA in fetuses with gestational age (GA) ranging from 28 to 37 weeks: 2 aneurysms DA (diameters of 5 and 8 mm) and 8 with morphological alteration with elongated, tortuous duct but with normal diameter with no points of constriction. Doppler flow changes was present with systolic velocity > 155 cm/s IP ranging from 1.7 to 2.5. Predominance of right heart chambers and tricuspid regurgitation was presented in 3 fetuses. ControI examinations were performed weekly or every two weeks. Results: Four women were found on routine obstetric ultrasound and three with suspected restrictive DA in previous fetal echo. One patient presented an excessive intake of grape juice, no use of drugs NSAIDs. All newborns born at term without significant symptoms and evolved with spontaneous closure of the DA. Conclusions: Changes of morphology in DA can be identified in the third trimester mainly because in this period the arteries and cardiac output pressures are greater and the proliferation of the intima occurs in DA preparing for postnatal closure. Evaluation with Doppler mainly using the PI help in the differential diagnosis of restrictive ductus arteriosus. Pediátrica, Clinica CardioFetal, São Paulo, Brazil; 2 Medicina Fetal, CPDT, Rio de Janeiro, Brazil; 3 Medicina Fetal, HNSL, São Paulo, Brazil; 4 Medicina Fetal, HLMB, São Paulo, Brazil Objectives: To assess fetuses with ectopia cordis (ec), association with cardiac and extra-cardiac malformation, chromosomal anomalies, pre and postnatal outcome. Methods: In a series of 13.664 fetal echocardiograms performed between May/1993 March/2011 using a Philips HD11EX ultrasound machine, 10 cases had ec. 4D echocardiography was performed in 2 pats. Gestational age ranged between 11-40 weeks. Diagnosis confirmed with postnatal echo and autopsy. The reason for fetal echo was the presence of heart exstrophy in all cases (10). OP07.06 Ectopia cordis in prenatal lifeResults: Ectopia cordis was diagnosed in 10 (3.3%) cases out of 623 cardiac malformations. Of these, 6 (60%) had the heart completely outside of the chest and 4 (40%) partially. Cardiac anomalies were detected in 9 fetuses: 2 (22.2%) dorv, 2 (22.2) vsd, 2 (22.2%) tetralogy of Fallot, 1 (11.1%) truncus arteriosus, 1 (11.1% ) avsd, 1 (11.1%), pulmonary atresia. Cardiac anatomy was not visualized in 11 week fetus with further termination of pregnancy. Exomphalos was detected in 7 (70%), gastrochisis in 2 (20%), 2 cystic hygroma (20%) and 1 single umbilical artery (10%). Autopsy in 5 pats showing midline thoracic-abdominal wall defect...