RESUMO
Cardiac surgery with cardiopulmonary bypass (CBP) is essential for different cardiac procedures in order to perform surgery with a clear sight field.To safely perform surgery with CPB and preserve brain, kidney, and patient tissue from ischemic damage, cold cardioplegia, and mild to deep hypothermia are induced during the operation.Cryoglobulinemia is a hematological/infective-related disease (in certain cases idiopathic) in which temperature-dependent antibodies tend to aggregate and form emboli in the vascular system causing tissue damage if exposed to low temperature.The patient with cryoglobulinemia (known and unknown) can be at risk of a major ischemic event during CPB and induced hypothermia.This article's aim is to evaluate the present scientific literature in order to understand how, in years, the therapeutic or preventive approach, is evolving, and to analyze and make improvements to the management of a cryoglobulinemic patient who must undergo elective or emergency cardiac surgery.In the last part of our article, we expose our single-center experience during a 32-month-long period of survey.In all cases, our medical team (anesthesiologists, perfusionists, and cardiac surgeons) opted for a normothermic cardiopulmonary bypass to lower the risk of cryoglobulin-associated complications.In our experience, along with therapeutic intervention to lower the cryoglobulin titer, normothermic management of cardiopulmonary bypass is as safe as hypothermic management.Notwithstanding our results, further studies with a larger population are needed to confirm this perioperative management in a cardiac surgery setting.
RESUMO
According to the American Heart Association (AHA), primitive dilated cardiomyopathy (PDCM) is a "progressive dilation of the left or both ventricles and a depressed contractility in the absence of abnormal load conditions". It evolves in progressive heart-failure. The term "cardiogenic dementia" expresses the intimate connection between heart diseases and cognitive functions. The association between PDCM and the neuropsychological functions is unclear: the main pathophysiological hypotheses are cerebral hypoperfusion and cardiogenic emboli. The aim of this study is to evaluate the impact that the PDCM has on neuropsychological decline and to detect early echocardiographic markers of cognitive impairment. We enrolled 235 patients: 168 suffering from PDCM as sample group and 67 suffering from hypertensive dilated cardiomyopathy (HTCM) as control group. They underwent a cardiology examination and a neuropsychological assessment. A p<0.05 was considered significant. The two groups showed no differences in risk factors, demographic and cardiovascular parameters (except for dimensions of aortic root, left atrium and ventricle which appeared greater in PDCM and left ventricle ejection fraction that appeared lower in PDCM). Among administered neuropsychological tests, only the Stroop Test (which explores executive and attentive functions) appeared significantly lower in PDCM (p = 0.029). Moreover left ventricle end-diastolic diameter was inversely related to the Stroop Test Score (r= -0.32). PDCM doesn't appear to be at the basis of a generalized cognitive and neuropsychological decline. Only the executive functions seem impaired in PDCM. Left ventricle dilation seems to be associated to attentive and executive functions decline.