RESUMO
Eighty patients with evidence of impaired ventricular function by ventriculography were reviewed. On the basis of the ejection fraction, these patients were divided into three groups. Those with ejection fractions less than 0.2 were considered in very poor condition, those with ejection fractions of 0.2 to 0.4 were considered in poor condition, and those with ejection fractions with between 0.4 and 0.6 were considered fair. Suitability of vessels for bypassing and the presence or absence of collateral cirulation on the cinearteriograms was also noted for possible influence on result. Operative mortality rate in patients having complete repair, defined as bypassing all major vessels with significant obstruction, was 7 per cent. In 26 patients having incomplete repair, the operative mortality was 30 per cent. However, the late mortality rate was not favorably influenced by complete repair, 75 per cent are in improved or good clinical condition, as compared with 65 per cent in the incomplete repair group. As patients with impairment of ventricular contractility are at high risk, it is believed that they should continue to be evaluated on an individual basis for bypass surgery and not categorically denied treatment.
Assuntos
Ventrículos do Coração/fisiopatologia , Revascularização Miocárdica/mortalidade , Adulto , Idoso , Angina Pectoris/cirurgia , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Cineangiografia , Circulação Colateral , Circulação Coronária , Doença das Coronárias/diagnóstico , Doença das Coronárias/diagnóstico por imagem , Feminino , Insuficiência Cardíaca/complicações , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Complicações Pós-Operatórias/mortalidade , PrognósticoRESUMO
One hundred thirty-one consecutive patients who received 5, 6, and 7 bypass grafts are analyzed. Ages ranged from 31 to 74 years. The male-to-female ratio was 7:1. As an indication of severity of disease, 25% were classified as having impending myocardial infarction and 46.6% were classified in New York Heart Association Functional Class IV. Left ventricular function was impaired in 37.4%, and 30% of the patients had left main coronary obstruction. Nonfatal perioperative myocardial infarction occurred in 4.6%. The hospital mortality was 3%. One hundred percent follow-up (5 to 55 months) revealed 4 late deaths, 3 presumably of cardiac origin. Only 7 patients in the postoperative follow-up group have complained of angina; 1 has since undergone successful reoperation.
Assuntos
Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Veia Safena/transplante , Adulto , Idoso , Angina Pectoris/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Transplante AutólogoRESUMO
The evaluation of excessive hemorrhage was carried out in 774 patients after cardiopulmonary bypass. Excessive hemorrhage was defined in any adult patient as chest tube drainage of more than 600 ml within the first eight hours after operation. Using the prothrombin time, partial thromboplastin time, fibrinogen level, and tri-F titer tests, it was possible to differentiate medical from surgical bleeding. Hyperfibrinolytic bleeding was the most frequently identifiable coagulation disorder and occurred in 159 patients (20%). All these patients were successfully treated with Amicar (epsilon-aminocaproic acid) alone, or with Amicar supplemented with cryoprecipitate or fresh-frozen plasma. Three patients (0.4%) were noted to have residual heparin and required additional protamine sulfate. Five patients (0.6%) had normal coagulation studies and required immediate reexploration. The overall blood consumption per patient was 2.1 units of packed cells. Whole blood and platelets were not used.
Assuntos
Aminocaproatos/uso terapêutico , Ácido Aminocaproico/uso terapêutico , Transfusão de Sangue , Ponte Cardiopulmonar , Hemorragia/terapia , Complicações Pós-Operatórias/terapia , Protaminas/uso terapêutico , Ácido Aminocaproico/administração & dosagem , Ponte Cardiopulmonar/efeitos adversos , Eritrócitos , Fibrinólise , Hemorragia/etiologia , Humanos , Plasma , Protaminas/administração & dosagemRESUMO
The paper presents a simulation of the transient temperature distribution in the human body caused by induced eddy currents during magnetic resonance imaging (MRI). In a first simulation the validity of the used heat conduction equation was proven using a simple example of a cool-down-process of a sphere. Thereafter the heating of a phantom model with an implanted electrode placed in a MRI-System (active body coil) was examined. The resulting increase in temperature was compared with existing measurements. Finally the implications of the heating of the tissue are discussed based on the observed experimental and numerical results.
Assuntos
Regulação da Temperatura Corporal/efeitos da radiação , Campos Eletromagnéticos/efeitos adversos , Imageamento por Ressonância Magnética/efeitos adversos , Humanos , Análise Numérica Assistida por Computador , Imagens de Fantasmas , TermodinâmicaRESUMO
The present study defines excessive bleeding in patients who undergo cardiopulmonary bypass, and evaluates the use of coagulation testing to predict those patients that bleed excessively. Evaluation of 774 consecutive patients undergoing aortocoronary bypass surgery was carried out. Cardiopulmonary bypass consisted of a bloodless prime and a Harvey bubble oxygenator. In the postoperative period, excessive hemorrhage was defined as that exceeding 600 ml chest tube drainage in the first eight hours. One hundred and sixty-three patients (21%) were noted to be in this category. Excessive bleeding postoperatively was best predicted by a PTT greater than 45 seconds, a PT greater than 19 seconds, a fibrinogen level less than 225 mg/dl and a TFT equal to or less than 1:32. These laboratory findings occur singly or in combination. The assessment of platelet, numbers or function and fibrin(ogen) split products were of no prognostic value. Using these criteria, the re-exploration rate for excessive hemorrhage and/or tamponade was 0.6 per cent (5 out of 774 patients). No preoperative laboratory test of hemostatic function was useful in predicting coagulopathies resulting from cardiopulmonary bypass.