RESUMO
Acute pulmonary embolism (APE) is a well-described complication following surgical procedures. The incidence of such a complication can be related to the presence of a peculiar patient's condition. Cryoglobulinemia, which consists in the presence of one or more immunoglobulins in the serum that precipitate at temperatures below 37°C and redissolve on warming, seems to increase the risk of thrombotic events. Treatment options of APE, according to clinical severity, include systemic thrombolysis, surgical embolectomy, and systemic anticoagulation. Thrombolysis is considered the first-line treatment, whereas surgery is reserved in case of extremely-compromised hemodynamic conditions related to massive central embolism, and in case of contraindication to thrombolysis. Here, we report a case of acute massive pulmonary embolism occurring at the end of a surgical procedure for a thymic carcinoma resection, in a patient with cryoglobulinemia, which required an emergent surgical pulmonary embolectomy.
Assuntos
Crioglobulinemia/complicações , Embolectomia/métodos , Posicionamento do Paciente/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Doença Aguda , Ecocardiografia Transesofagiana , Emergências , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Índice de Gravidade de Doença , Toracotomia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: In this prospective, single-center, observational study, we investigated the association between repeated short periods of circulatory arrest with moderate hypothermia during pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and different neuropsychological dimensions. METHODS: We examined 70 patients with CTEPH, >18 to 80 years of age, who had been treated with PEA. Neuropsychological testing was performed. RESULTS: Learning ability and delayed memory remained well within the normal range for patients' age. We found a statistically significant post-surgical improvement in motor speed, which was accompanied by a better quality of life and reduced symptoms of depression and anxiety. CONCLUSION: PEA with repeated short periods of circulatory arrest in CTEPH did not result in any neuropsychological complications and may even lead to post-surgical psychological improvements.
Assuntos
Endarterectomia/psicologia , Parada Cardíaca Induzida/psicologia , Hipertensão Pulmonar/terapia , Hipotermia Induzida/psicologia , Artéria Pulmonar/cirurgia , Tromboembolia/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Endarterectomia/métodos , Feminino , Parada Cardíaca Induzida/métodos , Humanos , Hipertensão Pulmonar/complicações , Hipotermia Induzida/métodos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estudos Prospectivos , Tromboembolia/complicações , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
A case of isolated ventricular non-compaction associated to three-vessel disease and a mitral regurgitation is described. The patient underwent triple coronary artery bypass graft and restrictive mitral annuloplasty. The postoperative course was unsuccessful despite the very depressed left ventricular (LV) function. At two years follow-up, no major adverse cardiac event has occurred and the LV function was slightly improved.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Implante de Prótese de Valva Cardíaca , Miocárdio Ventricular não Compactado Isolado/complicações , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/terapia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia Doppler em Cores , Feminino , Humanos , Miocárdio Ventricular não Compactado Isolado/fisiopatologia , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
In 10 patients, a free-wall plication of inferior or lateral scar was performed. The procedure was done on cardiopulmonary bypass and aortic cross-clamping by means of four or five wide U-stitches. Six patients underwent concomitant mitral annuloplasty and one mitral valve replacement. One patient died postoperatively. There was a sudden and significative end-systolic volume reduction with a rise in ejection fraction. These hemodynamic benefits were partially lost during the follow-up but the mitral regurgitation grade remained unchanged.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiomiopatias/cirurgia , Ventrículos do Coração/cirurgia , Técnicas de Sutura , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Estudos RetrospectivosAssuntos
Falso Aneurisma/cirurgia , Aorta Torácica/cirurgia , Artéria Axilar/cirurgia , Implante de Prótese Vascular/métodos , Cateterismo Periférico , Falso Aneurisma/diagnóstico , Aorta Torácica/fisiopatologia , Velocidade do Fluxo Sanguíneo , Prótese Vascular , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medição de Risco , Toracotomia/métodos , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
An 84-year-old patient underwent combined aortic valve replacement and left lower lobectomy (LLL) for bronchogenic cancer. At surgery, which was performed via median sternotomy, the fissure was found to be totally fused. The fissure, artery, and bronchus were treated off pump, while the left inferior pulmonary vein and the inferior ligament were sectioned on pump. Finally, the stenotic aortic valve was replaced with a bioprosthesis. The postoperative course was smooth and the patient discharged on the ninth day. The simultaneous treatment of lung cancer and cardiac disease has been widely described. LLL, on the other hand, represents a surgical challenge because the left ventricle obscures the pulmonary hilum. We have performed LLL combined to aortic valve replacement using a mixed approach, partly on pump and partly off pump to reduce bleeding and hemodynamic instability, which are well-known complications.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Carcinoma de Células Escamosas/cirurgia , Implante de Prótese de Valva Cardíaca , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Ponte Cardiopulmonar , Terapia Combinada , Eletrocoagulação , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Esternotomia , Grampeadores Cirúrgicos , Tomografia Computadorizada por Raios XRESUMO
The outcome of patients with thoracic vascular prostheses is usually uneventful. We report two cases of collapse of thoracic vascular prostheses which occurred ten and forty years, respectively, after the implantation. The diagnoses were obtained preoperatively by CT-scan or NMR and angiography. Both patients were successfully treated with prosthetic replacement by an open approach.