RESUMO
Retroperfusion of the coronary sinus does not provide homogeneous distribution of cardioplegic solution. The goal of this study was to analyze the distribution of flow during retrograde cardioplegic infusion in cadaveric human hearts with two different techniques of coronary sinus cannulation: (1) internal occlusion of the coronary sinus by balloon inflation and (2) external occlusion by tightening the orifice of the coronary sinus around a simple catheter. To evaluate differences between the two techniques, angiographic and electron-beam computed tomographic studies were performed. Computed digital angiography was performed on 14 hearts. Angiographic patterns varied according to type of coronary sinus cannulation. With the balloon inflation technique, the marginal vein and the anterior descending vein were perfused first; the posterior descending vein was not perfused. This vein was opacified secondarily through a venovenous anastomosis located at the apex of the heart. Backward flow into the right atrium (steal phenomenon) was demonstrated. At completion of retroperfusion, the inferior part of the septum remained poorly opacified. Conversely, angiographic findings after external occlusion of the coronary sinus revealed simultaneous injection of all venous channels. The entire septum was well opacified at completion of retroperfusion. Electron-beam computed tomographic study was performed on eight hearts with the external occlusion technique and nine with the internal occlusion technique. The computed tomographic findings confirmed the results of digital angiography. The peak myocardial enhancement and the peak rising rate of myocardial enhancement within the interventricular septum were significantly more important (p < 0.0001) when the external coronary sinus occlusion mode was used than when the internal coronary sinus occlusion mode was used. In all hearts except one, the right ventricular wall was not opacified, regardless of the type of cannulation and the type of radiologic analysis. This study demonstrates the importance of coronary sinus cannulation technique in optimizing the protection of the interventricular septum with retrograde cardioplegic infusion.
Assuntos
Soluções Cardioplégicas/administração & dosagem , Angiografia Coronária , Parada Cardíaca Induzida/métodos , Tomografia Computadorizada por Raios X , Adulto , Cateterismo/métodos , Vasos Coronários , Humanos , Técnicas In Vitro , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The aim of this study was to assess the long-term results of use of the radial artery as a conduit for coronary artery bypass grafting. METHODS: After revival of the technique in 1989, the radial artery was used as a conduit in 910 patients undergoing coronary artery bypass grafting. A complete follow-up was obtained for the first 102 consecutive patients from 4 to 7 years after the operation (mean 5.27 +/- 1.30 years). Fifty-nine percent of the patients were receiving calcium-channel inhibitors. An electrocardiographic stress test was obtained for 51 patients, with no contraindications found. Routine follow-up angiography was performed in 50 cases, including those of all patients with symptoms. Thus 64 radial artery and 48 left internal thoracic artery grafts were followed up from 4 to 7 years after the operation (mean 5.6 +/- 1.40 years). RESULTS: The actuarial survival was 91.6% at 5 years, and the actuarial rate of freedom from angina was 88.7% at 5 years. Four patients underwent percutaneous transluminal angioplasty during the period of follow-up, and there were no reoperations for revision of the bypass. The electrocardiographic stress test showed negative results in 73% of cases, electrocardiographic changes alone in 21%, and clinically positive results in 6%. Angiography showed that the patency rate of the radial artery grafts was 83%. The patency rate of the left internal thoracic artery grafts (n = 47) was 91%. The difference in patency could be related to the implantation sites of the grafts, mainly the circumflex artery (51%) for the radial artery grafts and almost exclusively the left anterior descending artery (94%) for the left internal thoracic artery. CONCLUSION: The use of the radial artery for coronary bypass grafting provides excellent clinical and angiographic results at 5 years. Routine use of the radial artery in combination with the left internal thoracic artery can be recommended.
Assuntos
Angiografia Coronária , Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Artéria Radial/transplante , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Doença das Coronárias/mortalidade , Eletrocardiografia , Seguimentos , Humanos , Artéria Torácica Interna/transplante , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Recidiva , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
We report 3 cases of iatrogenic arterial injuries in relation to saphenous vein stripping. In 2 cases the patients sustained acute severe ischemia and required prompt revascularization. The third patient was seen at a later stage with chronic ischemia and claudication. All 3 patients had their limbs salvaged without severe sequelae. The therapeutic strategies for different situations are discussed.
Assuntos
Complicações Intraoperatórias/cirurgia , Veia Safena/lesões , Veia Safena/cirurgia , Adulto , Feminino , HumanosRESUMO
We report a case of partial replacement of the tricuspid valve by a mitral homograft in a young drug addict with right heart endocarditis. Operation was indicated because of sudden severe tricuspid regurgitation and persistence of vegetations despite appropriate antibiotic therapy. Partial tricuspid valve replacement was performed with a segment of mitral homograft reinforced by a semirigid prosthetic ring. At 30-month postoperative follow-up the patient was in excellent clinical condition with a satisfactory echocardiographic result.
Assuntos
Valva Mitral/transplante , Valva Tricúspide/cirurgia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Adulto , Candidíase/complicações , Endocardite/complicações , Humanos , Masculino , Transplante Homólogo , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgiaRESUMO
Mitral valve replacement, using a cryopreserved mitral homograft, was performed in a 49-year-old patient with calcified mitral stenosis. Postoperative course was uneventful. Transesophageal echocardiography performed 6 months later showed normal function of the mitral homograft.
Assuntos
Criopreservação , Estenose da Valva Mitral/cirurgia , Valva Mitral/transplante , Preservação de Órgãos , Ecocardiografia Transesofagiana , Feminino , Humanos , Pessoa de Meia-Idade , Estenose da Valva Mitral/diagnóstico por imagem , Transplante HomólogoRESUMO
The standard surgical approach to the mitral valve is via a longitudinal incision in the left atrium. This is applicable in the vast majority of patients. In cases of small left atrium with poor exposure the standard incision may be modified. We report a biatrial inferior transseptal approach that we have employed in 25 patients over a 2-year period. The technique is simple to execute and is without risk to surrounding structures.
Assuntos
Átrios do Coração/cirurgia , Septos Cardíacos/cirurgia , Valva Mitral/cirurgia , Humanos , Técnicas de SuturaRESUMO
The authors report the case of a 34-year-old woman, of North African origin, with mitral valve disease and abdominal aortitis. The differential diagnosis between Takayasu' disease, embolism of cardiac origin and rheumatic aortitis is discussed. Treatment of these lesions was by combined cardiac and vascular surgery in a single-stage operation.
Assuntos
Aortite/cirurgia , Insuficiência da Valva Mitral/cirurgia , Arterite de Takayasu/complicações , Adulto , Aorta Abdominal , Aortite/etiologia , Feminino , Humanos , Métodos , Insuficiência da Valva Mitral/etiologiaRESUMO
The configuration of the articular cavities of the cervico-occipital region have been demonstrated by an experimental technic of positive contrast arthrography in postmortem specimens.
Assuntos
Artrografia , Vértebras Cervicais/diagnóstico por imagem , Crânio/diagnóstico por imagem , Adulto , Articulação Atlantoccipital/diagnóstico por imagem , Feminino , Humanos , MasculinoRESUMO
The authors report a case of aortic valve myxoma discovered in a 34-year-old patient who had suffered a transient ischemic attack. At operation, a heliocoidal gelatinous mass was found attached to the ventricular side of the right coronary cusp of the aortic valve via a pedicle. Through a ministernotomy approach the mass was excised and the cusp was repaired. Recovery was uneventful.