Sa ne rugam pt Maria lui Irinel!
Raspunsuri - Pagina 15
Mirunaa spune:
Un puiutz luptator.Multa sanatate ii doresc.Si rugaciunile mele se indreapta catre Mariuca!
Toate cele bune!
ana maria spune:
Multa sanatate si sa faca Doamne Doamne o minune mare pentru cea mai mare comoara Maria!!!
Ana Maria si Victor Stefan 
(15 12 2004)
Succes si s-auzim numai de bine!!!
AdrianaMitu spune:
Irinel si George,
Ne rugam din tot sufletul pt sanatatea Mariei si pt voi ca Dumnezeu sa va dea putere si speranta alaturi de ea.
Doamne ajuta Mariei sa se faca bine, sa creasca mare si sanatoasa, si sa aduca numai zambete pe buzele parintilor ei!
Pupici dulci Mariei, lui Danut, Irinei si lui George.
Cu drag, cu dor si cu gandul la voi,
Pupiciii: David, Adriana & Corneliu
Carmenbr spune:
George si Doina, multumim de vesti!
Asa cum George zicea, fiecare zi pt Mariuca este o minune si eu sper ca medicina sa evolueze, sa o poata ajuta pe Mariuca. Sa ii dea Dumnezeu zile multe si sanatate, sa imbatraneasca alaturi de fratiorul ei si sa aduca multa fericire parintilor. E o minune de copil, e atat de dorita si asteptata, eu sunt sigura ca Dumnezeu si Fecioara Maria, caruia Mariuca noastra ii poarta numele, o sa aiba grija de ea.
Cuvine-se cu adevarat, sa Te fericim pe Tine, Nascatoare de Dumnezeu,
Cea pururea fericita si prea nevinovata si Maica Dumnezeului nostru.
Ceea ce esti mai cinstita decat heruvimii si mai marita, fara de asemanare, decat serafimii,
Care fara stricaciune, pe Dumnezeu-Cuvantul ai nascut.
Pe Tine cea cu adevarat Nascatoare de Dumnezeu, Te marim.
Doamne Iisuse Hristoase, pentru rugaciunile preasfintei Maicii Tale, binecuvanteaza, acum si pururea si in vecii vecilor.
Amin.
Carmen & Ericutz (15.06.2004)
www.desprecopii.com/forum/topic.asp?TOPIC_ID=68525 " target="_blank"> Povestea nasterii!
Am un anisor deja!
2 anisori...aproape!
Alyssa spune:
Nu vreau sa par nu stiu cum dar s-a pus macar ca solutie transplantul de inima? Ar fi o optiune pentru Maria? Si daca ar fi ar trebui sa fie pe lista nationala de asteptare...
Maica Domului sa o aiba in grija pe Micuta Maria!
Alice
Irinel spune:
Pulmonary Atresia with Ventricular Septal Defect and Major Aorta-to-Pulmonary Artery Collaterals
Patients with this complex lesion sometimes survive to adulthood without surgery because of adequate pulmonary blood flow from collaterals. Others have shunts or unifocalization procedures or complete repairs.81–83
ANATOMY
The true pulmonary arteries may be absent, hypoplastic, and continuous or discontinuous. The collaterals may be the dominant or only blood supply to the lung or supply only lesser areas of the lung. The VSD is subaortic and usually single. Depending on previous shunts, there may be stenoses in the proximal or distal pulmonary arteries. If repaired there may be a residual VSD, obstruction between RV and PA, and tricuspid valve regurgitation.
PHYSIOLOGY
In order to have arterial saturation of 75% to 84%, these patients with arterial and venous mixing have a left-to-right shunt of between 1:1 and 2:1. Therefore, they all have a variably volume overloaded circulation system. Because of high flow and elevated pressure, they may have developed increased pulmonary vascular resistance in the area of some of the collaterals. The volume overload results in reduced exercise tolerance. The aorta and aortic valve tend to dilate and 50% develop aortic valve regurgitation. Ventricular dilatation and dysfunction can also occur.
PREOPERATIVE EVALUATION
Echocardiography is used to exclude additional VSDs and to evaluate the aortic valve. Angiography is performed to delineate the collaterals and true pulmonary arteries as well as to evaluate transpulmonary gradient, which may be high if there was uncontrolled large collateral flow hypertension. Such elevated gradients may preclude complete repair. MR angiograms with three-dimensional reconstruction give detailed models of the anatomy.
INDICATIONS FOR SURGERY
Patients with inadequate pulmonary blood flow are limited due to cyanosis and may require unifocalization if they have an adequate bed for future repair. If they do not, they may be candidates for a palliative shunt. Patients with excessive pulmonary blood flow and failure can also be treated by unifocalization with reduction of the total flow. The size of the shunt to the unifocalization is crucial to adjust flow to the pulmonary vasculature. After unifocalization on one side (Fig. 56-10), the opposite side is unifocalized 6 months to 1 year later (Fig. 56-11), followed 6 months to 1 year later by a complete repair (Fig. 56-12).
Shunted patients should be repaired if they have an adequate size pulmonary bed, unless they are inoperable because of high pulmonary vascular resistance or poor ventricular function. A residual VSD should be closed in previously repaired patients if the left-to-right shunt is 1.5:1 or above. Conduit or valve obstruction is reoperated when there are symptoms, or if the RV pressure at rest is two thirds to three fourths of systemic pressure. If there is severe pulmonary valve regurgitation with RV dilatation or tricuspid regurgitation, reoperation should be undertaken.
STAGED SURGICAL REPAIR
The goal of surgical management of pulmonary atresia, ventricular septal defect, and multiple aorta-to-pulmonary collateral arteries is closing the ventricular septal defect and establishing continuity between the right ventricle and pulmonary artery. Ultimately, successful definitive repair requires an adequate pulmonary vascular bed, without which VSD closure and RV to PA continuity will lead to RV failure due to a prohibitively high pulmonary vascular resistance. Thus, all efforts during the operative staging are designed to maximize the size, distribution, and normal flow of the pulmonary arteries while preserving myocardial function.
Early palliative procedures in patients with excessive or inadequate pulmonary blood flow are designed to create a balanced pulmonary blood flow and encourage growth of the true pulmonary arteries.
Unifocalization procedures join the multifocal sources of pulmonary flow (true pulmonary arteries and aorta-to-pulmonary artery collaterals) into a single source that can ultimately be accessed in the anterior mediastinum via median sternotomy. The unifocalization procedure is performed through a posterolateral thoracotomy incision. A double-lumen endotracheal tube is employed, when possible, for large children and adults. Single-lung ventilation of the contralateral lung, when tolerated, greatly facilitates exposure. We prefer autologous pericardial tube unifocalization of aortopulmonary collaterals and true pulmonary arteries.
Finally, definitive repair in this disorder entails patch closure of the anterior malaligned ventricular septal defect and establishment of continuity between the right ventricle and the pulmonary arteries. All systemic-to-pulmonary artery shunts, including redundant collaterals and surgically created shunts, have been previously occluded or are readily accessible from the anterior mediastinum for occlusion at the time of definitive biventricular repair. Measurement of the ratio of right ventricle to left ventricle systolic pressure allows intraoperative assessment of the repair. A ratio of 0.75 or less immediately after termination of cardiopulmonary bypass is acceptable, and the ratio can be expected to decrease in the first few days after operation. Higher ratios suggest inadequate pulmonary runoff, and will likely result in right ventricular failure. If the pressure on the right side is near systemic or suprasystemic, perforation of the ventricular septal defect patch may provide survival and reasonable palliation.
OUTCOMES
From 1983 through 2000, 105 children and adults have presented to our institution with pulmonary atresia, ventricular septal defect, and multiple aorta to pulmonary artery collaterals. All patients were subject to a strategy of staged repair. Sixty-four patients in this cohort underwent palliation in the newborn period at a median age of 1 week. Surgical palliation included systemic to pulmonary artery shunts, right ventricular outflow patches, and banding of aorta to pulmonary artery collaterals to reduce high pressure and flow. Interventional cardiac catheterization procedures were performed to promote growth of the pulmonary arteries as necessary.
Ninety-four patients underwent unifocalization at a median of 3.5 years (range, 6 months to 37 years). Fifty-eight (range, 1 to 34 years) of these 94 patients have proceeded to complete repair at a median of 7.2 years. Unifocalization was performed in 19 adults, and of this group, 8 patients have undergone uneventful complete repair. There was neither mortality nor important morbidity in this group. At a median follow-up of 60 months there were a total of 18 deaths for a 17% early and late mortality rate. Survival after initial palliation was 92%, after unifocalization, 91%, and after complete repair, 91%. There were 36 reoperations (12%) and 16 patients required catheter-based interventions after surgery. The mean right ventricle to left ventricle (RV/LV) pressure ratio was 0.46. Nearly all the survivors are asymptomatic and do not exhibit any signs of exercise intolerance.
Although there is some debate about whether a one-stage repair is preferable in neonates and children, patients presenting as adults, with or without prior palliation, may be excellent candidates for the staged approach described above. We prefer a staged approach to one-stage correction in adults whose predominant blood supply to the lungs is from collaterals. In adults with a predominant blood supply from the true pulmonary arteries a one-stage repair may be utilized. The strategy of staged repair for patients with tetralogy of Fallot with MAPCAs (Major Aorto-Pulmonary Collaterals) provides good functional results. The mortality rate and requirements for postoperative interventional cardiac catheterization with this approach are lower than published reports of single-stage repair.
As patients age and mature they will require reoperations to replace right ventricle to pulmonary artery homografts and degenerative bioprostheses in the pulmonary position. Long-standing pressure and volume load on the right ventricle will lead to tricuspid regurgitation and right atrial enlargement that may predispose some patients to atrial arrythmias.
http://photos.yahoo.com/irinoiu
Irina,
Daniel (28 Mai 2004) si 
Maria (20 Aprilie 2006)
Ioanatugs spune:
IRINEL tu si Mariuca sunteti mereu in gandurile noastre si in rugile noastre!!
Cu drag Ioana Tugs
http://photos.yahoo.com/ioanatugs
Irinel spune:
Sunt tare obosita, doar pentru cateva ore acasa ca sa ma joc putin cu Danut, dar o sa dorm vreo ora inainte, asa ca nu pot scrie prea mult, va scrie George ca de obicei deseara. Oricum, Maria a avut o zi buna, altfel nici nu indrazneam sa ma dezlipesc asa mult de langa ea. Era fara masca si rozalie cand am plecat cu toate ca o chinuisera sa ii puna intravenoasa, din fericire au si reusit, asa ca n-o vor mai chinui cu intepaturi cel putin deocamdata. a deschis si ochisorii si s-a uitat in jur (din cauza mastii nu poate deschide ochii, ii sufla aer in ochisori si e si neplacuta pe fata)
Rugaciunile ajuta. Din suflet va multumesc.
http://photos.yahoo.com/irinoiu
Irina, Daniel (28 Mai 2004) si Maria (20 Aprilie 2006)
aida_o spune:
Irina si George,
Dumnezeu sa fie de partea voastra, sa ii dea Mariei puterea de a lupta, iar voua puterea de a va vedea copilul in aceasta lupta si a lupta alaturi de ea (nici nu imi pot imagina durerea voastra, dar - fiind si eu proaspata mamica - ma uit la fetita mea si ma doare sufletul chiar si numai la gindul ca i s-ar putea intimpla o mica raceala, deci o durere si mai mare ar fi ingrozitoare)
Pling de cite ori mi-o imaginez pe Maria cu masca pe fata. Nu stiu, dar ideea ca un copil sufera, face sa mi se stringa inima si sa mi se puna un nod in git. Mi-e greu sa explic asta, si cred ca numai o mama intelege.
Zilnic ma gindesc la Maria, si - in mintea mea - va spun sincer ca sper intr-o minune, ma tot gindesc ca poate, odata ce Maria creste, hei, poate ca inimioara ei o sa "creasca" (o sa se dezvolte) si ea intr-o inima sanatoasa. Ca si atunci cind bebe se naste fara dintisori, si ei cresc pe parcurs. Ce bine-ar fi ca asta sa fie numai ceva temporar.
Doamne Dumnezeule, fa ca Mariuca sa fie o fetita sanatoasa!
Cu mult drag
irina.c. spune:
Irinel,Dumnezeu sa va ajute in continuare,sa va dea putere sa treceti prin toate cu bine,pentru fetita voastra .
....................................................................................................................................................................................................................................Irina si bb Ilinca(26 aprilie '04)"In aceste vremuri, cineva nu poate fi crestin cu jumatate de inima, ci fie in intregime, fie deloc." Serafim Rose.............................................................................................................................................................................................................................................