RESUMEN
The surgical treatment of prosthetic mechanical valve thrombosis involves redo valve replacement and removal of the thrombi layers. The hinges and near-hinge areas of the bi-leaflet mechanical valve are a 'stagnation area' where blood flow is typically unsteady and can give rise to thrombi; however, these zones are not easily accessed with surgical instruments. Here, we present a case in which high-flow CO2 was used to facilitate the removal of microthrombi in the stagnation area around a prosthetic mechanical valve.
Asunto(s)
Enfermedades de las Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Trombosis , Dióxido de Carbono , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/cirugíaRESUMEN
Intraoperative assessment of graft patency is pivotal for successful coronary revascularization. In the present study we aimed to propose a new, easy to perform tool to assess anastomotic quality intraoperatively, and to investigate its potential reliability in predicting early graft failure. Intraoperative graft flowmetry of 63 consecutive patients undergoing CABG were prospectively collected. Transit time flowmetry and its derivatives were recorded. Coronary resistances were calculated according to Hagen-Poiseuille equation both during cardioplegic arrest and after withdrawal from cardiopulmonary bypass. Angiographic evidence of graft occlusion at follow-up was cross-checked with intraoperative recordings. After a mean follow-up of 10.4 ± 6.0 months, 22 grafts were studied, and occlusion was documented in five (22.7%). Occluded grafts showed lower flows and higher resistances recorded during aortic cross-clamping. Coronary resistances, recorded during aortic cross-clamping, greater than 2.0 mmHg/mL/min, showed a sensitivity of 80% and a specificity of 100% to predict graft failure. We propose the routine recording of coronary resistances during aortic cross-clamping as an additional tool to overcome the acknowledged limitation of TTF to predict graft occlusion at 1 year.