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BACKGROUND/OBJECTIVES: The direct bridge to urgent heart transplant (HT) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support has been associated with high morbidity and mortality. The objective of this study is to analyze the morbidity and mortality of patients transplanted with VA-ECMO and compare the presumed differences between various eras over a 17-year timeline. METHODS: This is a prospective, observational study on consecutive patients stabilized with VA-ECMO and transplanted with VA-ECMO from July 2007 to December 2023 at a reference center (98 patients). Objective variables were mortality and morbidity from renal failure, venous thromboembolic disease (VTD), primary graft dysfunction (PGD), the need for tracheostomy, severe myopathy, reoperation, post-transplant ECMO, vascular complications, and sepsis/infection. RESULTS: The percentage of patients who reached transplantation without the need for mechanical ventilation has increased over the periods studied. No significant differences were found between the study periods in 30-day mortality (p = 0.822), hospital discharge (p = 0.972), one-year mortality (p = 0.706), or five-year mortality (p = 0.797). Survival rates in these periods were 84%, 75%, 64%, and 61%, respectively. Comorbidities were very frequent, with an average of 3.33 comorbidities per patient. The most frequent were vascular complications (58%), the need for post-transplant ECMO (57%), and myopathy (55%). The development of myopathy and the need for post-transplant ECMO were higher in recent periods (p = 0.004 and p = 0.0001, respectively). CONCLUSIONS: VA-ECMO support as a bridge to HT allows hospital discharge for 3 out of 4 transplanted patients. This survival rate has not changed over the years. The comorbidities associated with this device are frequent and significant.
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INTRODUCTION AND OBJECTIVES: Heart transplant (HT) represents a major physiological stress, resulting in elevated levels of analytical biomarkers. This study aimed to determine whether changes in biomarker levels after HT can identify patients with a poor prognosis. METHODS: A prospective longitudinal noninterventional study was conducted in 149 consecutive patients undergoing HT from July 2017 to July 2023. Biomarkers were assessed before HT and at 6, 24, 48, 72, and 96hours after HT. The biomarkers analyzed were high-sensitivity troponin T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatinine, and lactic acid. The primary outcome was a composite of death and severe primary graft failure (PGF). RESULTS: NT-proBNP and troponin levels remained highly elevated throughout the period and stabilized from the first 24hours post-HT. Lactate levels stabilized after the first 24hours, and creatinine from the second day onward. Exitus occurred in 23 (15%) of the patients, and severe PGF in 26 (17%). All biomarkers were significantly associated with the incidence of the combined event (P <.0001). Receiver operating characteristic curve analysis at 24hours showed significant areas under the curve (P=.0001). The greatest discriminatory power was observed for the NT-proBNP curve. A value of 10 000 pg/mL had a sensitivity of 90% and specificity of 80%. CONCLUSIONS: A significant elevation of post-HT analytical biomarkers was associated with mortality and/or severe PGF. Among the biomarkers analyzed, NT-proBNP was the most accurate in classifying patients.
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Inflammatory myofibroblastic tumor is a neoplasm with uncertain behavior. We describe a case in a 66-year-old female who underwent resection of a left atrial tumor suspected to be a cardiac myxoma which was subsequently diagnosed as an inflammatory myofibroblastic tumor. After three years' follow-up the patient underwent a second operation to remove tumoral occurrence in the right atrium, diagnosed as an intimal sarcoma. It cannot be confirmed whether the tumoral recurrence with a different diagnosis (intimal sarcoma) was a progression from the primary tumor or the metachronous appearance of a spontaneous sarcoma.
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Apêndice Atrial , Neoplasias Cardíacas , Sarcoma , Feminino , Humanos , Idoso , Sarcoma/diagnóstico , Sarcoma/patologia , Sarcoma/cirurgia , Diagnóstico Diferencial , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgiaAssuntos
Fibroelastoma Papilar Cardíaco , Angiografia por Tomografia Computadorizada/métodos , Acidente Vascular Cerebral/etiologia , Afasia de Broca/etiologia , Fibroelastoma Papilar Cardíaco/diagnóstico por imagem , Fibroelastoma Papilar Cardíaco/cirurgia , Ecocardiografia Transesofagiana , Hemianopsia/etiologia , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A giant coronary artery aneurysm is an infrequent anomaly encountered as an incidental finding. An even more rare condition is its association with a coronary artery fistula. We report the case of a 61-year-old woman that combines two of the rarest coronary anomalies: a 70-mm giant circumflex aneurysm with an arteriovenous fistula tract draining to the superior vena cava. Considering the unique display of anatomy, the surgery was guided with 3-dimensional printing technology. Direct fistula occlusion near its outflow union, orifice source closure, aneurysmal sac exclusion, and two coronary artery bypass grafts were surgically performed. The postoperative course was satisfactory.
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Fístula Arteriovenosa/cirurgia , Aneurisma Coronário/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Impressão Tridimensional , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Superior/anormalidades , Fístula Arteriovenosa/diagnóstico , Aneurisma Coronário/diagnóstico , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Veia Cava Superior/diagnóstico por imagemRESUMO
Thorough study is required to decide the appropriate management of hepatic tumors in children. We present a case report of a hepatic embryonal undifferentiated sarcoma with unfavorable prognosis in a nine-year-old girl. After undergoing a detailed cancer characteristics and extension study, a two-stage surgery approach was decided. The hepatic tumor resection was the first procedure to be performed. One week later, under cardiopulmonary bypass, deep hypothermia, and circulatory arrest, thrombectomy of the inferior vena cava and right atrium was accomplished, plus thromboendarterectomy of the right pulmonary artery. During a four-year follow-up, the patient continues to be disease-free.
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Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Neoplasias Cardíacas/cirurgia , Neoplasias Hepáticas/cirurgia , Sarcoma/cirurgia , Criança , Ecocardiografia , Feminino , Átrios do Coração , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/secundário , Humanos , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética , Sarcoma/diagnóstico , Sarcoma/secundário , Tomografia Computadorizada por Raios XRESUMO
Aberrant right subclavian artery is the most frequent anomaly of the aortic arch, and in 60% of cases is associated with Kommerell diverticulum. It is usually asymptomatic but may present with dysphagia or asthma due to esophageal and tracheal compression. Indications for surgical repair have not been established; however, when Kommerell diverticulum is complicated by aortic dissection the treatment is surgery. We present the case of a 54-year-old man with thoracic pain due to dissection of an aberrant right subclavian artery associated with Kommerell diverticulum. Elective surgical treatment was performed.
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Aneurisma Aórtico , Dissecção Aórtica , Anormalidades Cardiovasculares , Artéria Subclávia/anormalidades , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/fisiopatologia , Dissecção Aórtica/cirurgia , Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Aorta/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/fisiopatologia , Aneurisma Aórtico/cirurgia , Anormalidades Cardiovasculares/diagnóstico por imagem , Anormalidades Cardiovasculares/fisiopatologia , Anormalidades Cardiovasculares/cirurgia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Artéria Subclávia/cirurgiaRESUMO
The incidence of allergic reactions due to mechanical prosthesis or rings is not well established. We report the case of a 56-year-old man who presented a persistent urticarial rash and anaphylactic shock after a mitral valve repair operation. Prick skin tests were positive for nickel. After the nucleus from the mitral annulus was removed, the urticarial rash disappeared.