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1.
Asian Cardiovasc Thorac Ann ; 22(5): 604-6, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24867048

RESUMO

Cardiac lipomas are extremely rare benign tumors. They usually remain asymptomatic and are detected incidentally. We report an unusual case of a 60-year-old man who presented with a large epicardial lipoma found unexpectedly during coronary artery examinations. Coronary angiography revealed advanced 3-vessel coronary artery disease. We successfully performed simultaneous curative surgery for the large cardiac lipoma and coronary artery bypass grafting. Histopathology confirmed the diagnosis of lipoma; it weighed 450 g and had a stalk connected to the left atrium.


Assuntos
Doença da Artéria Coronariana/complicações , Neoplasias Cardíacas/complicações , Lipoma/complicações , Angiografia Coronária , Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Achados Incidentais , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Carga Tumoral
2.
Ann Vasc Dis ; 6(2): 189-94, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23825500

RESUMO

OBJECTIVE: Our study focuses on the long term result of open surgery and endovascular abdominal aortic aneurysm repair (EVAR) using the Zenith stentgraft. PATIENTS AND METHODS: A total of 237 patients underwent elective abdominal aortic aneurysm (AAA) repair between April 1999 and December 2006. Nineteen patients underwent EVAR, whereas 218 patients underwent open surgery. The mean follow-up time for EVAR group was 73.8 ± 49 months (range; 25-150 months), and 69.7 ± 46 months (range; 1-156 months) for open surgery group. RESULTS: One open surgery patient (1/218, 0.46%) died of aspiration pneumonia, whereas all the EVAR patients survived the operation. Remote complications requiring reintervention occurred in 8 patients (8/174, 4.6%) in open surgery group. Six EVAR patients (6/19, 31.6%) developed late aneurysm expansion, among whom four patients (4/19, 21.1%) required reinterventions after 3 or more years postoperatively. The need for reintervention persisted even at 11 years after initial EVAR. There was no significant intergroup difference in late mortality. CONCLUSIONS: There was no statistically significant intergroup difference in early and long term mortality. Complications requiring reinterventions, however, were more frequent in EVAR than in open surgery, especially in the late period. Long term follow-up is mandatory for comparison of the clinical results between open surgery and EVAR.

3.
Ann Thorac Surg ; 94(6): e145-7, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23176957

RESUMO

A 69-year-old man with a history of infectious abdominal aortic aneurysm, which had resulted in removal of the infrarenal abdominal aorta and bilateral axillofemoral bypass 9 years previously, underwent total arch replacement for an aortic arch aneurysm. The patient had the interrupted abdominal aorta and highly atherosclerotic proximal aorta, which precluded the possibility of endovascular stent grafting in combination with arch vessel debranching technique. Therefore, open arch repair was the only treatment option. The operation was successful with his axillofemoral bypass graft being exposed and used for arterial inflow during cardiopulmonary bypass, including integrated selective antegrade cerebral perfusion.


Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Stents , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Anastomose Cirúrgica/métodos , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Tomografia Computadorizada por Raios X
4.
Interact Cardiovasc Thorac Surg ; 14(5): 683-5, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22286601

RESUMO

Discrete subaortic stenosis (DSS) is uncommon in adults after surgical correction of congenital heart defects. There are only a few published reports on the occurrence of DSS in adults. We present an adult case with DSS after repair of a ventricular septal defect (VSD). The case was a 44-year old female patient who underwent VSD closure at 7 years of age. Thirty-seven years later, she presented with congestive heart failure associated with severe subaortic membranous stenosis and atrial fibrillation (AF) that required surgical repair. We report successful surgical treatment of this adult patient with DSS and AF 37 years after repair of a VSD.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estenose Subaórtica Fixa/etiologia , Comunicação Interventricular/cirurgia , Adulto , Fibrilação Atrial/etiologia , Criança , Estenose Subaórtica Fixa/diagnóstico , Estenose Subaórtica Fixa/cirurgia , Ecocardiografia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Reoperação , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
J Vasc Surg ; 53(2): 472-4, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21093203

RESUMO

We report a 79-year-old patient who presented with a fever and abdominal pain. The patient was initially thought to have a retroperitoneal fibrosis or inflammatory abdominal aortitis in a normal-sized caliber aorta. Broad-range polymerase chain reaction (PCR) and DNA sequencing revealed the presence of Enterobacter. We finally diagnosed nonaneurysmal infectious aortitis, and we performed a successful surgical resection. Establishing a diagnosis of aortic infection before formation of an aneurysm is difficult. The molecular diagnostic technique was particularly useful in specifying the microbial species and diagnosis.


Assuntos
Aortite/diagnóstico , Enterobacter/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Técnicas de Diagnóstico Molecular , Dor Abdominal/microbiologia , Idoso , Antibacterianos/uso terapêutico , Aortite/microbiologia , Aortite/terapia , Aortografia/métodos , Implante de Prótese Vascular , DNA Bacteriano/isolamento & purificação , Enterobacter/genética , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/terapia , Febre/microbiologia , Humanos , Masculino , Reação em Cadeia da Polimerase , Valor Preditivo dos Testes , Ribotipagem , Análise de Sequência de DNA , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Ann Thorac Surg ; 88(6): 2029-31, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19932291

RESUMO

Two patients with chronic type B aortic dissection underwent endovascular repair. The interval between the onset of aortic dissection and stent grafting was 1 year, 7 months in both patients. The entry closure was successful and postoperative course was uneventful for each patient. However, intimal injury developed at the bottom end of the stent graft 6 years after endovascular repair in 1 patient, and at 2 years in the other patient. The former patient underwent graft replacement of the descending thoracic aorta, and the latter underwent placement of additional stent grafts.


Assuntos
Aneurisma Roto/cirurgia , Angioscopia/métodos , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Túnica Íntima/cirurgia , Idoso , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Roto/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia , Doença Crônica , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea , Tomografia Computadorizada por Raios X , Túnica Íntima/diagnóstico por imagem
7.
J Clin Microbiol ; 47(7): 2340-3, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19458178

RESUMO

Legionella anisa is rarely associated with human disease. Its gene was identified by broad-range PCR in whole blood and excised tissue from a patient with a culture-negative mycotic aneurysm and was considered as a possible pathogen. This case report is potentially useful for the future diagnosis of intravascular infection.


Assuntos
Aneurisma Infectado/microbiologia , Legionella/isolamento & purificação , Legionelose/diagnóstico , Legionelose/microbiologia , Idoso , Aneurisma Infectado/cirurgia , Sangue/microbiologia , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Humanos , Legionelose/complicações , Masculino , Reação em Cadeia da Polimerase/métodos , RNA Ribossômico 16S/genética , Radiografia Abdominal , Análise de Sequência de DNA
8.
Ann Thorac Cardiovasc Surg ; 14(4): 230-7, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18818572

RESUMO

BACKGROUND: Although off-pump coronary artery bypass (OPCAB) has become an increasingly common surgical procedure, recent concerns have been raised regarding the existence of a hypercoagulable or prothrombotic state associated with OPCAB. To determine the optimal antiplatelet regimen after OPCAB, we investigated the effects of aspirin alone and of combined therapy with aspirin + cilostazol on platelet aggregation in patients after OPCAB. MATERIAL AND METHODS: Twenty patients scheduled to undergo OPCAB were randomized to one of two antiplatelet regimens: aspirin alone (n=10) and aspirin + cilostazol (n=10). Anti-platelet agents had not been received for at least 1 week before surgery and were initiated on the afternoon of postoperative day 1. Platelet aggregability and hemostatic parameters were evaluated at four time points: before and 3, 7, and 14 days after OPCAB. We measured agonist-and shear stress-induced platelet aggregation (SIPA) using a modified cone-plate viscometer. RESULTS: No complications resulting from postoperative antiplatelet therapy-related bleeding were seen in either group. Collagen-and arachidonate-induced platelet aggregation and SIPA were significantly inhibited in the aspirin + cilostazol group compared with the aspirin-alone group (collagen-and arachidonate-induced aggregation, p<0.0001; SIPA, p=0.0367). Adding cilostazol to aspirin augmented the inhibitory effects on platelet aggregation induced by collagen and arachidonate. adenosine diphosphate (ADP)-induced platelet aggregation tended to be inhibited in the aspirin + cilostazol group compared with the aspirin-alone group (p=0.0534). CONCLUSION: The results of this study suggest that combined therapy with aspirin + cilostazol is more effective than aspirin monotherapy in reducing platelet aggregation in patients after OPCAB. This combination therapy may represent a new therapeutic option for an anti-thrombotic regimen in patients after OPCAB.


Assuntos
Aspirina/uso terapêutico , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Agregação Plaquetária/efeitos dos fármacos , Tetrazóis/uso terapêutico , Trombose/prevenção & controle , Idoso , Cilostazol , Quimioterapia Combinada , Feminino , Fibrinogênio/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Testes de Função Plaquetária , Trombose/sangue , Trombose/etiologia , Fatores de Tempo , Resultado do Tratamento , Fator de von Willebrand/metabolismo
9.
J Vasc Surg ; 48(5): 1306-14, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18639416

RESUMO

OBJECTIVE: Persistent endoleak and endotension, complications after endovascular aortic repair, may be caused by an unorganized thrombus inside the aneurysm. The experimental study was designed to evaluate the effectiveness of stent grafts (S/Gs) with slow release of basic fibroblast growth factor (bFGF) for the organization. METHODS: The S/Gs were constructed of self-expanding Z stent covered with expanded polytetra fluoroethylene graft, and coated with elastin to be able to bind and slowly release bFGF. Five elastin-coated S/Gs with bFGF (bFGF-S/Gs) and without bFGF (C-S/Gs) were placed in the normal canine aorta respectively. The thoracic aortic aneurysm models were surgically created with a jugular vein patch in 12 beagles. S/Gs with six holes, for creating endoleaks, were used in the experiment of aneurysmal repair. The bFGF-S/Gs (n = 6) and C-S/Gs (n = 6) were implanted. The beagles were sacrificed at two weeks after the endovascular procedure and examined histologically. RESULTS: The bFGF-S/Gs induced six times the intimal proliferation of the C-S/Gs in normal aorta. Twelve animals had successfully created aneurysms, and had endoleaks just after the endovascular procedure. At two weeks after the endovascular procedure, the percentage of fibrous area in the aneurysmal cavity treated with bFGF-S/G (35.7 +/- 4.3%) was significantly greater than C-S/G (13.6 +/- 2.2%) (P < .01). CONCLUSION: bFGF-S/Gs are effective for accelerating organization of the aneurysm cavity and developing neointima. Further research on bFGF-S/Gs would clarify the association of endoleaks.


Assuntos
Aorta Torácica , Aneurisma da Aorta Torácica , Implante de Prótese Vascular/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Stents Farmacológicos , Fator 2 de Crescimento de Fibroblastos/administração & dosagem , Túnica Íntima , Animais , Aorta Torácica/efeitos dos fármacos , Aorta Torácica/patologia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/tratamento farmacológico , Aneurisma da Aorta Torácica/patologia , Aneurisma da Aorta Torácica/cirurgia , Proliferação de Células/efeitos dos fármacos , Preparações de Ação Retardada , Modelos Animais de Doenças , Cães , Elastina , Estudos de Viabilidade , Fibrose , Humanos , Politetrafluoretileno , Desenho de Prótese , Proteínas Recombinantes/administração & dosagem , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/patologia , Túnica Íntima/cirurgia
10.
J Endovasc Ther ; 14(3): 333-41, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17723003

RESUMO

PURPOSE: To investigate the transient computed tomographic (CT) findings and morphological characteristics of the descending thoracic aorta following endovascular repair of thoracic aortic aneurysm (TAA). METHODS: Of 50 TAAs repaired using custom-made endoprostheses between May 1997 and September 2005, 35 (25 men; mean age 67 years) were successfully treated and followed for >3 months by thoracic CT. The TAA etiologies were 22 degenerative/atherosclerotic, 7 dissection-related from intramural hematoma, 2 traumatic, 2 anastomotic, and 2 penetrating ulcers. The CT findings following stent-graft placement were retrospectively studied. RESULTS: Over a mean follow-up of 27.0+/-25 months (range 3-92), periaortic changes were observed in 17 (48.6%) patients, and the amount of pleural effusion increased in 13 (37.1%). In all cases, these findings disappeared without specific treatment during the follow-up period. Late secondary endoleak was observed in 1 (2.9%) patient, and there was 1 (2.9%) caudal migration of the proximal end of the stent-graft. Five (14.3%) aneurysms increased in size. Two patients, both with dissection, showed aortic neck dilatation. There was a positive relationship between neck dilatation and dissection-related TAA etiology (p = 0.035). CONCLUSION: Although aortic neck dilatation is less common after endovascular TAA repair than after abdominal repairs, patients with dissection-related TAA may be a subgroup prone to aneurysm neck dilatation.


Assuntos
Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Stents , Tomografia Computadorizada por Raios X , Adulto , Idoso , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Kyobu Geka ; 59(8 Suppl): 674-80, 2006 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-16910513

RESUMO

We have performed transluminal stent-graft placements (TSGPs) to seal the primary entry site to treat and prevent complications of aortic dissection since 1997. Sixty patients with a primary intimal tear in descending aorta underwent TSGP. TSGP was performed in 27 acute onset dissections (AOD) with dissection-related complications instead of emergency surgery. Fourteen AOD without complications were treated to prevent aneurysmal enlargement. Nineteen chronic dissections were treated to prevent rupture. TSGP was technically successful in all cases. The hospital mortality rate was 4.9% in AOD and 0% in chronic dissections. The primary success rate was 87.8% in AOD. After hospital discharge, 2 patients died during an average follow-up of 56.2 months. Actuarial survival rate at 5 years was 90.0% in AOD. We conclude that TSGP is a reasonable treatment option for aortic dissection. However, intimal tear formations caused by the stent-graft is a problem that requires further developments of stent-grafts.


Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Prótese Vascular , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Stents , Doença Aguda , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Circulation ; 114(1 Suppl): I378-83, 2006 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-16820604

RESUMO

BACKGROUND: Endovascular aortic repair by stent grafts (S/Gs) has been developed as a less invasive treatment for aortic aneurysms. However, some aneurysmal cavities can remain without organization, causing re-expansion. We demonstrated previously that transplantation of a cell combination (myoblasts and fibroblasts) promoted thrombus organization in a rat model. We also developed basic fibroblast growth factor (bFGF) slow-delivery S/Gs coated with elastin and impregnated with bFGF. Here, we evaluated the effects of cell transplantation combined with bFGF slow release on canine thoracic aortic aneurysmal sacs after S/Gs repair. METHODS AND RESULTS: Thoracic aortic aneurysms were surgically created with jugular vein patches in 15 beagles. Myoblasts and fibroblasts of autologous skeletal muscle were isolated and cultured for cell transplantation. The S/Gs had 6 holes and produced endoleaks in the excluded cavities. Collagen gel (gel group, n=5) or a mixture of skeletal myoblasts and fibroblasts with collagen gel (cell group, n=5) were injected into the aneurysmal sacs excluded by the S/Gs. We also studied the effects of combined therapy of bFGF slow-release S/Gs and cell transplantation (hybrid group, n=5). After 14 days, histological analyses revealed that the excluded aneurysmal cavities of the gel group were filled with fresh thrombus, whereas the excluded cavities in the cell-transplanted groups were occupied by organized tissue. The percentages of the organized areas relative to the excluded cavities, evaluated by Masson's trichrome staining, were 18.1+/-4.0%, 52.6+/-4.0%, and 77.1+/-6.9% in the gel, cell, and hybrid groups, respectively. Collagen fibers had already appeared, and increased numbers of alpha-smooth muscle actin-positive cells were observed in the hybrid group. CONCLUSIONS: Cell transplantation accelerated thrombus organization. Moreover, slow release of bFGF enhanced the effects of cell transplantation. Cell transplantation into unorganized spaces may improve the outcomes of endovascular treatments of aortic aneurysms.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Fator 2 de Crescimento de Fibroblastos/uso terapêutico , Fibroblastos/transplante , Implantes Experimentais , Mioblastos/transplante , Stents , Animais , Aneurisma da Aorta Torácica/tratamento farmacológico , Aneurisma da Aorta Torácica/patologia , Coagulação Sanguínea , Cateterismo , Células Cultivadas/transplante , Colágeno/administração & dosagem , Terapia Combinada , Cães , Implantes de Medicamento , Elastina , Desenho de Equipamento , Falha de Equipamento , Fator 2 de Crescimento de Fibroblastos/administração & dosagem , Fator 2 de Crescimento de Fibroblastos/genética , Fibrose , Géis , Humanos , Implantes Experimentais/efeitos adversos , Músculo Esquelético/citologia , Politetrafluoretileno , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Aço Inoxidável , Stents/efeitos adversos , Transplante Autólogo
13.
Ann Thorac Cardiovasc Surg ; 12(1): 71-3, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16572081

RESUMO

Abdominal aortic aneurysm (AAA) is sometimes associated with coronary artery and valvular disease. We report the successful treatment of a 76-year-old woman diagnosed with an infrarenal AAA, associated with severe mitral regurgitation and double-vessel coronary artery disease. First, AAA repair, using temporary axillo-femoral bypasses on both sides was done. Second, after 77 days, we simultaneously undertook coronary artery bypass grafting (CABG) and mitral valve repair. This staged operation achieved an excellent result. This rarely used abdominal aortic surgical procedure contributed to minimizing variations in afterload, an important consideration in high risk cardiac patients.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Doença das Coronárias/cirurgia , Insuficiência da Valva Mitral/cirurgia , Idoso , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/fisiopatologia , Procedimentos Cirúrgicos Cardíacos , Comorbidade , Ponte de Artéria Coronária , Doença das Coronárias/epidemiologia , Feminino , Humanos , Insuficiência da Valva Mitral/epidemiologia , Risco , Volume Sistólico , Função Ventricular Esquerda
14.
Clin Imaging ; 30(1): 22-6, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16377480

RESUMO

BACKGROUND: There are two graft materials for endovascular repair of aortic diseases, i.e., polyester and expanded polytetrafluoroethylene (ePTFE). The latest reports have suggested that there is graft-specific difference in outcomes. The purpose of this article was to evaluate the difference in terms of aneurysm shrinkage. PATIENTS AND METHODS: Eighty-six patients who underwent endovascular repair of aortic diseases were included. Forty patients had true aortic aneurysms, 8 had aortic pseudoaneurysms, and 38 had aortic dissections. Eighteen patients with true aortic aneurysms were treated with stent grafts fabricated with polyester, while the other 68 patients, including 22 patients with true aneurysms, 8 patients with pseudoaneurysms, and 38 patients with aortic dissections, were treated with stent grafts fabricated with ePTFE. All patients were followed-up by computed tomography (CT) for more than 1 year. The mean follow-up term was 28 months. Computed tomography confirmed that there were sufficiently long necks, and the aneurysm or the entry tear was completely excluded without any endoleak in all patients. The diameter of the preoperative lesion was compared with that measured on follow-up CT at 1 year and at the end of the follow-up term. Increase or decrease in the diameter by more than 5 mm was defined as a significant diameter change. RESULTS: Aneurysm shrinkage was observed in 40% of patients with true aneurysms, 88% of patients with pseudoaneurysms, and 55% of patients with aortic dissections at 1 year. There was no significant increase in patients with aneurysm shrinkage at the end of follow-up in any groups. In the case of true aortic aneurysms, shrinkage of aneurysms was observed more frequently with polyester-fabricated stent grafts (67%, 13/18) than with ePTFE-fabricated ones (18%, 4/22) at 1 year (P<.01). In contrast, expansion of aneurysms was observed only in patients treated with ePTFE (14%, 3/22). Shrinkage of the descending aorta was observed in 55% of patients with acute aortic dissections and 36% of patients with chronic aortic dissections. There was no case with aortic enlargement in either group. There was no significant difference between acute and chronic dissection in terms of shrinkage of the descending aorta. CONCLUSION: Expanded polytetrafluoroethylene appears to be effective for the treatment of pseudoaneurysms and aortic dissections. However, polyester seems to be more effective than ePTFE when true aneurysms are to be treated.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Prótese Vascular , Polietileno , Politetrafluoretileno , Dissecção Aórtica/patologia , Falso Aneurisma/patologia , Aneurisma Aórtico/patologia , Implante de Prótese Vascular/métodos , Seguimentos , Humanos , Desenho de Prótese , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Ann Thorac Surg ; 80(5): 1914-6, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16242485

RESUMO

Pyoderma gangrenosum is rarely associated with Takayasu's arteritis. We report the successful surgical treatment of a 34-year-old woman who was diagnosed with pyoderma gangrenosum associated with thoracic aortic aneurysm and dissection due to Takayasu's arteritis. She underwent graft replacement of the thoracic aortic aneurysm under cardiopulmonary bypass, with perioperative management using prednisolone and cyclosporine A. She has had no evidence of the development of skin lesions or the progression of Takayasu's arteritis.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Pioderma Gangrenoso/fisiopatologia , Arterite de Takayasu/cirurgia , Adulto , Aneurisma da Aorta Torácica/patologia , Feminino , Humanos , Pioderma Gangrenoso/etiologia , Arterite de Takayasu/complicações
16.
Radiology ; 237(2): 458-64, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16170013

RESUMO

PURPOSE: To prospectively evaluate the accuracy of first-pass contrast material-enhanced magnetic resonance (MR) imaging during stress and delayed contrast-enhanced MR imaging in the detection of significant coronary artery disease in patients before elective repair of aortic aneurysm. MATERIALS AND METHODS: The study was approved by the institutional ethics committee, and informed consent was obtained from all patients. MR imaging was performed in 49 patients (42 men and seven women; mean age, 72.2 years; age range, 58-85 years) before the elective repair of atherosclerotic aortic aneurysms. Thirty-two patients had an abdominal aneurysm, 12 had a thoracic aneurysm, and five had a thoracoabdominal aneurysm. First-pass contrast-enhanced MR images were obtained with short-axis sections encompassing the entire left ventricular myocardium in the resting state and during pharmacologic stress. Inversion-recovery-prepared delayed contrast-enhanced MR images were obtained with breath holding to evaluate for the presence of infarction. All patients underwent coronary angiography within 2 weeks of MR imaging, and these findings were used as the standard of reference. The diagnostic results of first-pass contrast-enhanced MR imaging, delayed contrast-enhanced MR imaging, and a combination of both MR imaging methods in the detection of significant coronary artery disease were expressed as sensitivity, specificity, and accuracy. RESULTS: Coronary angiography depicted a clinically significant stenosis (>70% luminal diameter narrowing) in the coronary artery in 34 of the 49 patients (69%). First-pass contrast-enhanced MR imaging depicted stress-induced hypoenhancement in 27 of those 34 patients (79%). Delayed myocardial enhancement was observed in 17 of the 34 patients (50%). The overall sensitivity of rest-stress first-pass contrast-enhanced MR imaging and delayed contrast-enhanced MR imaging combined in the prediction of at least one coronary artery with significant stenosis was 88% (30 of 34 patients). The specificity and accuracy of MR imaging were 87% (13 of 15 patients) and 88% (43 of 49 patients), respectively. CONCLUSION: Contrast-enhanced MR imaging had an accuracy of 88% in the detection of significant coronary artery disease in patients with aortic aneurysm.


Assuntos
Aneurisma Aórtico/complicações , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Angiografia por Ressonância Magnética/métodos , Idoso , Idoso de 80 Anos ou mais , Aneurisma Aórtico/cirurgia , Meios de Contraste , Angiografia Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade
17.
Circulation ; 112(9 Suppl): I111-6, 2005 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-16159801

RESUMO

BACKGROUND: Endovascular aortic repairs have been developed as less invasive treatments for aortic aneurysms. Some aneurismal cavities, however, remain without organization, causing a re-expansion of the aneurysms. We studied cell transplantation into the aneurismal sac to promote the organization of thrombus for the complete healing of aneurysms. METHODS AND RESULTS: Skin fibroblasts and skeletal myoblasts were isolated from rats for cell transplantation. An intraarterial thrombus model was made by ligation of the carotid artery. Culture medium (medium group, n=11), collagen gel (gel group, n=11), fibroblasts with collagen gel (F group, n=15), myoblasts with collagen gel (M group, n=12), or mixture of fibroblasts and myoblasts with collagen gel (F+M group, n=14) were injected into the thrombus. After 28 days, histologically, the arterial lumens of the F and M groups were partly filled with fibrous tissues, whereas in the F+M group organization was almost completed and luminal sizes diminished. Immunohistochemical staining demonstrated that alpha-smooth muscle actin-positive cells were more abundantly contained in the organized area of the F+M group than in the other groups. We also analyzed cellular function in vitro with immunofluorescence; coculture of fibroblasts and myoblasts showed that the fraction of alpha-smooth muscle actin-positive fibroblasts increased. This phenomenon accounts for the rapid organization of thrombus in the F+M group in vivo. CONCLUSIONS: Cell transplantation accelerated thrombus organization. Especially, myoblasts enhanced differentiation of fibroblasts into myofibroblasts, contributing to rapid thrombus organization. Cell transplantation into unorganized spaces seems applicable to endovascular treatment of aneurysms.


Assuntos
Trombose das Artérias Carótidas/cirurgia , Fibroblastos/transplante , Células Musculares/transplante , Mioblastos/transplante , Aneurisma/patologia , Animais , Doenças das Artérias Carótidas/patologia , Trombose das Artérias Carótidas/patologia , Diferenciação Celular , Células Cultivadas/transplante , Técnicas de Cocultura , Colágeno/administração & dosagem , Géis , Injeções Intra-Arteriais , Músculo Esquelético/citologia , Ratos , Ratos Endogâmicos Lew , Pele/citologia
18.
Circulation ; 111(22): 2951-7, 2005 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-15927978

RESUMO

BACKGROUND: Transluminal stent-graft placements (TSGPs) are a new, less invasive procedure now recognized as the choice for aortic disease repair. Treatment of aortic dissections with TSGPs has resulted in good early results, but the long-term results and changes in the false lumen have not been elucidated in detail. METHODS AND RESULTS: TSGPs were performed in 49 patients with primary tears in their descending aortas, and the follow-up period ranged from 4 months to 6 years. The patients were divided into 32 acute-onset and 17 chronic dissections; of the acute-onset cases, there were 15 Stanford type A retrograde dissections. Periodic enhanced spiral CT was conducted after TSGP. The false lumen in the ascending aorta in 14 (93%) of the Stanford type A cases was obliterated completely within 3 months. The CT study was continued for >2 years for 17 acute-onset dissection and 11 chronic dissection patients. The average false lumen diameters of the proximal, middle, and distal descending aorta before treatment were 15.9, 16.2, and 15.6 mm in the acute-onset dissection group and 28.1, 25.2, and 21.0 mm in the chronic dissection group, respectively. The false lumen diameters 2 years after treatment were 3.0, 3.7, and 3.1 mm in the acute-onset dissection group and 10.6, 10.5, and 11.9 mm in the chronic dissection group, respectively. Two years after TSGPs, the false lumen of the thoracic aorta totally disappeared in 76% of the acute-onset dissection group and 36% of the chronic dissection group. No cases showed rupture after TSGP. CONCLUSIONS: Complete obliteration of the false lumen is more likely in acute-onset cases than in chronic cases.


Assuntos
Aneurisma Aórtico/terapia , Dissecção Aórtica/terapia , Prótese Vascular , Stents , Idoso , Dissecção Aórtica/complicações , Aneurisma Aórtico/complicações , Prótese Vascular/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Stents/efeitos adversos , Trombose/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Transpl Int ; 18(4): 408-11, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15773959

RESUMO

With increasing numbers of living-donor liver transplantations (LDLTs) for hepatocellular carcinoma (HCC), cases with some arterial troubles are encountered; because most HCC cases waiting for LDLT have undergone interventional treatments. In these patients, the reconstruction of the graft artery needs to be planned preoperatively. We report a 52-year-old male, with hepatitis C-related liver cirrhosis and advanced HCC, who for 4 years repeatedly underwent continuous intraarterial chemotherapy through an implanted reservoir port. A suitable artery was not available for arterial reconstruction and the patient underwent LDLT using an autologous radial artery conduit based on the infrarenal aorta. Postoperatively, the patient is well with normal liver function and efficient arterial flow. Autologous radial artery can be safely and successfully used as an aortic-based arterial conduit when HCC patients waiting for LDLT have undergone long-term repeated intraarterial chemotherapy.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Artéria Radial/transplante , Angiografia , Carcinoma Hepatocelular/diagnóstico por imagem , Artéria Hepática/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Transplante Autólogo , Resultado do Tratamento
20.
J Thorac Cardiovasc Surg ; 128(3): 357-63, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15354092

RESUMO

OBJECTIVE: Accumulation of smooth muscle cells and extracellular matrix in the intima of artery bypass grafts induces neointimal hyperplasia, resulting in graft failure. We investigated the inhibitory effect of locally applied cilostazol, an inhibitor of cyclic adenosine monophosphate phosphodiesterase III, on neointimal hyperplasia and the role of tenascin-C synthesis and smooth muscle cell proliferation in free artery grafts. Methods and results We established a distal anastomotic stricture model of free artery graft stenosis using rat abdominal aorta. In this model, neointimal hyperplasia was observed not only in the distal anastomotic site but also in the graft body at postoperative day 14 and was markedly progressed at day 28. Strong expression of tenascin-C was found in the media and neointima of the graft body. When cilostazol was locally administered around the graft using Pluronic gel, neointimal hyperplasia of the graft was significantly suppressed in comparison with gel-treated control graft. The mean neointima/media area ratio was reduced by 86.6% for the graft body and by 75.8% for the distal anastomotic site versus the control. Cilostazol treatment decreased cell proliferation and tenascin-C expression in the neointima. In an in vitro experiment using cultured smooth muscle cells isolated from rat aorta, cilostazol completely suppressed the tenascin-C mRNA expression induced by platelet-derived growth factor-BB. CONCLUSION: A single topical administration of cilostazol may suppress neointimal hyperplasia by inhibiting cell proliferation and tenascin-C synthesis in free artery grafts, presenting the potential for clinical use in vascular surgery.


Assuntos
Artérias/efeitos dos fármacos , Inibidores de Fosfodiesterase/farmacologia , Tenascina/antagonistas & inibidores , Tenascina/biossíntese , Tetrazóis/farmacologia , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/patologia , Administração Tópica , Animais , Artérias/citologia , Divisão Celular , Células Cultivadas , Cilostazol , Hiperplasia , Técnicas In Vitro , Masculino , Músculo Liso/citologia , Músculo Liso/efeitos dos fármacos , Ratos , Ratos Endogâmicos Lew
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