RESUMO
A saphenous vein graft was inadvertently placed from the aorta to the coronary vein adjacent to the proximal left anterior descending coronary artery in a 53-year-old man with symptomatic coronary artery disease. The post-operative finding of a continuous murmur led to cardiac catheterization and successful surgical correction. The postoperative finding of a continuous murmur must alert the clinician to this possible technical error.
Assuntos
Ponte de Artéria Coronária/efeitos adversos , Auscultação Cardíaca , Sopros Cardíacos , Doença das Coronárias/cirurgia , Vasos Coronários/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Veias/cirurgiaRESUMO
Case histories of 80 patients undergoing mitral valve procedures over a 2 year period were analyzed to determine the preoperative and intraoperative factors favoring reconstruction. Of 34 patients undergoing valve reconstruction, 31 (90 per cent) were women, and the average age of patients undergoing reconstruction was 41 versus 51 for patients who underwent replacement. Absence of calcification on fluoroscopic study and at operation favored reconstruction, as did the finding of good leaflet mobility by preoperative echocardiograms and operative assessment. Pure lesions, i.e., stenosis or insufficiency, favored reconstruction. In this regard, the use of new annuloplasty techniques has facilitated the surgeon's ability to reconstruct regurgitant mitral valves. No operative deaths and excellent functional and clinical results obtained in 80 per cent of patients undergoing mitral reconstruction justify the aggressive application of this technique in properly selected patients.
Assuntos
Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Adulto , Idoso , Animais , Feminino , Seguimentos , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Valva Mitral/transplante , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/etiologia , Estenose da Valva Mitral/cirurgia , Cardiopatia Reumática/complicações , Suínos , Transplante HeterólogoRESUMO
Left ventricular function may be assessed by direct catheter measurements of left atrial pressure or by indirect measurements of pulmonary artery wedge pressure or pulmonary artery end-diastolic pressure. Controversy exists as to how closely the indirect measurements correlate with true left atrial pressure and to which is the most accurate. To clarify this probelm, we studied 43 patients undergoing cardiac surgical procedures with cardiopulmonary bypass. Both left atrial catheters for direct measurement and Swan-Ganz catheters were placed at the time of surgery. All patients were monitored continuously for 48 hours and hourly measurements were recorded. The resultant 1,620 left atrial pressure and pulmonary artery wedge pressure figures and 1,860 left atrial pressure and pulmonary artery end-diastolic wedge pressure measurements were subjected to computer analysis. The following conclusions have been found: (1) Pulmonary artery wedge pressure is a better indirect measure of left atrial pressure than is pulmonary artery end-diastolic wedge pressure (pooled correlation coefficient 0.629); (2) direct left atrial pressure measurement is more reliable and has fewer complications than indirect measurements; (3) there is no consistent correlation between left atrial pressure and central venous pressure (pooled correlation coefficient 0.3). A discussion of our results and the problems associated with left atrial catheters and Swan-Ganz catheters is presented.
Assuntos
Determinação da Pressão Arterial/métodos , Coração/fisiologia , Hemodinâmica , Função Atrial , Pressão Sanguínea , Cateterismo Cardíaco , Ponte Cardiopulmonar , Ensaios Clínicos como Assunto , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Artéria Pulmonar/fisiologiaRESUMO
The first report of coincident IHSS and ostium secundum ASD is corroborated and successful septal myotomy and myectomy with patch closure of the ASD is described.
Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Comunicação Interatrial/cirurgia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cineangiografia , Ecocardiografia , Eletrocardiografia , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Myocardial hypothermia with multidose cardioplegia has not been compared with single-dose cardioplegia and myocardial surface cooling with a cooling jacket in patients having coronary artery bypass grafting. In this study, 20 patients with three-vessel disease undergoing coronary bypass at 28 degrees C with bicaval cannulation, caval tapes, and pulmonary artery venting (4.9 +/- 0.7 grafts per patient) were prospectively randomized equally into group I (multidose cardioplegia) and group II (single-dose cardioplegia with a cooling jacket). The initial dose of cardioplegic solution was 1000 ml. Group I then received 500 ml of cardioplegic solution every 20 minutes, delivered into the aortic root and available grafts. In group II, after the cardioplegic solution had been administered, a cooling jacket covering the right and left ventricles was applied. In both groups temperatures were recorded every 30 seconds at five ventricular sites: (1) right ventricular epicardium; (2) right ventricular myocardium or cavity, 7 mm; (3) left ventricular epicardium; (4) left ventricular myocardium or cavity, 15 mm; and (5) septum, 20 mm. Group mean temperatures at each site at various times were compared within each group and between the two groups by analysis of variance. Aortic crossclamp time was 60.3 +/- 12.1 minutes in group I and 52.8 +/- 7.3 minutes in group II (p = 0.12); cardiopulmonary bypass time was 103.7 +/- 11.1 minutes in group I versus 87.7 +/- 12.7 minutes in group II (p less than 0.01). One minute after the cardioplegic solution was initially given, temperatures between groups at each site were not statistically different, but left ventricular epicardial temperatures within both groups were significantly higher than in the other four sites. Nineteen minutes after administration of the cardioplegic solution, temperatures in group I at all sites were higher than in group II. Similarly, throughout the entire period of aortic crossclamping, mean temperatures (except left ventricular myocardial site), maximum temperatures, and percentage of time all temperatures were 15 degrees C or higher were greater in group I than in group II. The following conclusions can be reached: 1. Initial myocardial cooling with 1000 ml of cardioplegic solution is not significantly limited by coronary artery disease but is suboptimal (16 degrees or 17 degrees C) in the inferior left ventricular epicardium because of continual warming from the aorta and subdiaphragmatic viscera. 2. Without myocardial surface cooling, excessive external myocardial rewarming to 18 degrees to 22 degrees C occurs within 20 minutes at all sites after delivery of the cardioplegic solution.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Temperatura Corporal , Soluções Cardioplégicas/administração & dosagem , Ponte de Artéria Coronária , Coração/fisiologia , Hipotermia Induzida , Idoso , Humanos , Pessoa de Meia-IdadeRESUMO
A 51 year old woman with angina pectoris due to combined valvular aortic stenosis, hypertrophic subaortic stenosis and coronary artery disease is described. The diagnosis was first suspected following echocardiography. Discussed is the importance of excluding associated coronary artery disease and hypertrophic subaortic stenosis in patients with valvular aortic stenosis. A pre- and post-PVC aortic pressure response is described pathognomonic of coexistent valvular and hypertrophic subaortic stenosis. The patient underwent successful surgical correction of all three lesions.
Assuntos
Estenose da Valva Aórtica/cirurgia , Cardiomiopatia Hipertrófica/cirurgia , Doença das Coronárias/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Doença das Coronárias/complicações , Doença das Coronárias/diagnóstico , Feminino , Humanos , Métodos , Pessoa de Meia-IdadeAssuntos
Aneurisma Cardíaco/diagnóstico , Ventrículos do Coração , Insuficiência da Valva Mitral/diagnóstico , Ponte de Artéria Coronária , Diagnóstico Diferencial , Eletrocardiografia , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Radiografia , Veia Safena/transplante , Transplante AutólogoAssuntos
Aorta Torácica/lesões , Aneurisma Aórtico/etiologia , Traumatismos Torácicos/complicações , Adolescente , Adulto , Aorta Torácica/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Ruptura Aórtica/etiologia , Ruptura Aórtica/cirurgia , Aortografia , Prótese Vascular , Feminino , Artéria Femoral/cirurgia , Átrios do Coração/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias , Fraturas das Costelas/complicações , Esterno/lesões , Artéria Subclávia , Traumatismos Torácicos/diagnóstico por imagemRESUMO
The advantages of a bloodless field and total cardiac relaxation have popularized the technique of deep hypothermia and total circulatory arrest for the correction of complex congenital cardiac defects in infancy. There is, however, a significant potential for cerebral and pulmonary complications. Presently, the most common technique is that of using a combination of surface cooling and cardiopulmonary bypass cooling and rewarming. Normal neurological development has been claimed with the present technique of hypothermia at 20 degrees C and total circulatory arrest for periods up to an hour; however, there are reports of seizure activity in the early postoperative period. There is also a disturbing incidence of respiratory insufficiency and, occasionally, hemorrhagic pulmonary edema. This study, using growing puppies and subjecting them to deep hypothermia and total circulatory arrest for varying periods of time, disclosed that animals subjected to 60 min of circulatory arrest recovered neurologically; however, there were histological changes of anoxia in the brain. Animals subjected to 30 min of total circulatory arrest were normal neurologically and there was no histological evidence of anoxic damage to brain tissue. Puppies that were continuously on cardiopulmonary bypass had no significant pulmonary changes caused by increasing the inspired oxygen tension in the ventilator; however, striking changes were noted when limited cardiopulmonary bypass was employed for core cooling and total circulatory arrest combined with pulmonary ventilation with 100% oxygen. We conclude from this experimental study that the use of surface cooling and core cooling with subsequent total circulatory arrest at 20 degrees C is a safe procedure, providing the period of time of cardiac arrest is kept around 30 min. We also conclude that the alveolar oxygen tension should be maintained at the lowest level possible during the interval of circulatory arrest to avoid the apparent rapid onset of post-traumatic pulmonary insufficiency.
Assuntos
Ponte Cardiopulmonar , Circulação Extracorpórea , Parada Cardíaca Induzida , Hipotermia Induzida , Complicações Pós-Operatórias , Animais , Anuros , Encéfalo/patologia , Pulmão/patologia , Pneumopatias/etiologia , Doenças do Sistema Nervoso/etiologia , Fatores de TempoRESUMO
Fatal infectious endocarditis involving a left ventricular apicoaortic valve-bearing conduit occurred in a 20-year-old man. Risk factors included early postoperative wound infection, broad spectrum suppressive antibiotic administration, and inadequate dental prophylaxis against infectious indocarditis. Palliative therapy included intravenous antibiotic administration and removal of the conduit. Lessons learned are discussed.