RESUMO
Here, we report our unique "non-pledget commissural suture technique" to avoid complete atrioventricular block during surgical aortic valve replacement, whereby all commissural stiches are made in a figure-of-eight fashion without a pledget. Then, standard stiches in a non-everting fashion are made using pledget sutures and a prosthetic valve is implanted at the supra-annular position. Among 152 evaluated patients, only five patients experienced complications, including three left bundle branch blocks, one postoperative pacemaker implantation, and one moderate paravalvular leak. Based on the high success rate, our technique may be a reasonable alternative for surgical aortic valve replacement.
Assuntos
Estenose da Valva Aórtica , Bloqueio Atrioventricular , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/prevenção & controle , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Técnicas de Sutura , Resultado do TratamentoRESUMO
A myxoma is one of the most common tumors in cardiac surgery, with most of them originating from the left or right atrial walls and causing embolic complications. An 84-year-old woman was referred to our institution after echocardiography showed an interatrial septum tumor that was presumed to be a thrombus; however, postoperative pathological examination revealed it to be a cardiac myxoma. This atypical myxoma was covered with a solid capsule containing connective tissue and substantial calcifications, which had made it difficult to establish a diagnosis of myxoma.
RESUMO
Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is a rare complication, but has a high mortality. An 86-year-old female with symptomatic severe aortic stenosis underwent TAVR at our hospital and she was discharged without complication after 10 days. She was readmitted with high fever and acute heart failure 1 month later. Blood culture revealed Staphylococcus, and echocardiography showed vegetation on the septal cusp of the tricuspid valve and perforation at the membranous ventricular septum. We decided to perform emergency operation due to active infection and intracardiac complication despite appropriate antibiotic treatment. The infected valve was replaced with a bioprosthetic valve and the right ventricular (RV)-left ventricular (LV) communication was closed with a bovine pericardial patch. The patient received the antibiotics for 6 week and was transferred to the previous facility.
Assuntos
Estenose da Valva Aórtica/cirurgia , Endocardite Bacteriana/cirurgia , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/cirurgia , Infecções Estafilocócicas/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Doença Aguda , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Valva Aórtica , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/etiologia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: Several controversial matters still remain unresolved in the management of Takayasu's arteritis, especially after vascular intervention. First, a definitive diagnostic tool has not been established to assess disease activity correctly. Second, the optimal medical regimen has not been established to prevent restenosis of the vascular lesion. Surgical treatments have been rarely performed to relieve critical vascular stenosis in isolated pulmonary Takayasu's arteritis, but their postoperative courses on long-term follow-up periods have not been sufficiently reported. CASE PRESENTATION: A 48-year-old man underwent a successful graft replacement for severe right main pulmonary artery stenosis due to isolated pulmonary Takayasu's arteritis. The patient had remained asymptomatic with no clinical inflammatory signs under adequate anticoagulation therapy since then. However, stenosis of the prosthetic graft accompanied by marked pulmonary hypertension was detected 18 months after surgery. Anti-inflammatory treatment with only 5 mg/day of oral prednisolone was then implemented, and the stenosis remained unchanged with the patient being stable for the next 16 months. CONCLUSIONS: This is the first published case report that describes the actual clinical course with a long-term follow-up period after surgery for isolated pulmonary Takayasu's arteritis, including images of the stenosed prosthetic graft. This case suggests that patients should be followed with multiple complementary diagnostic techniques on the assumption that restenosis is highly possible and unpredictable even after surgery. Besides, sufficient anti-inflammatory treatment should be applied as soon as possible after surgery no matter how inactive the disease appears to be, although its optimal regimen especially during the inactive inflammatory phase needs to be further established.
Assuntos
Anti-Inflamatórios/uso terapêutico , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Oclusão de Enxerto Vascular/tratamento farmacológico , Prednisolona/uso terapêutico , Artéria Pulmonar/cirurgia , Arterite de Takayasu/complicações , Arteriopatias Oclusivas/etiologia , Oclusão de Enxerto Vascular/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Arterite de Takayasu/cirurgiaRESUMO
BACKGROUND: A mismatch between thallium-201 ((201)Tl) and iodine-123 ((123)I)-beta-methyl iodophenyl pentadecanoic acid (BMIPP) dual single-photon emission computed tomography (SPECT) reflects a dysfunctional but viable myocardium, such as stunned or hibernating myocardium, in patients with coronary artery disease (CAD). However, the cardiac function does not always improve after revascularization. The present study aimed to determine whether serial (201)Tl and (123)I-BMIPP dual SPECT can predict improvements in cardiac function after coronary artery bypass graft surgery (CABG) in patients with CAD. MATERIALS AND METHODS: The study included 98 patients with CAD requiring CABG and having a left ventricular ejection fraction (LVEF) less than 50%. The total defect score (TDS) was calculated from (201)Tl and (123)I-BMIPP dual-SPECT images acquired before and 3 weeks after CABG. The LVEF, left ventricular end-diastolic volume index, and end-systolic volume index were determined by means of contrast left ventriculography before and 6 months after CABG. RESULTS: After 6 months, LVEF improved by 5% or more in 62 patients (group A) but did not improve in the remaining 36 patients (group B). Baseline Tl-TDS was significantly lower (9.1±4.6 vs. 14.6±6.5, P<0.001), and the mismatch score (BMIPP-TDS-Tl-TDS) was significantly higher (6.9±4.2 vs. 4.2±3.9, P=0.002) in group A than in group B. The extent of change in BMIPP-TDS 3 weeks after CABG compared with that before (delta-BMIPP-TDS) was significantly greater in group A than in group B (-5.9±3.0 vs. 2.8±4.3, P<0.001). Stepwise multivariate analysis selected delta-BMIPP-TDS as a significant independent predictor of improvement in LVEF at 6 months after CABG (multivariate ß-coefficient=-0.718, P<0.001). The degree of change in LVEF 6 months after CABG compared with that before significantly and negatively correlated with delta-BMIPP-TDS (r=-0.631, P<0.001). CONCLUSION: The delta-BMIPP-TDS evaluated by serial (201)Tl and (123)I-BMIPP dual SPECT can predict improvements in cardiac function during the chronic phase of CAD.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Ácidos Graxos , Iodobenzenos , Recuperação de Função Fisiológica , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Radioisótopos do Iodo , Masculino , Pessoa de Meia-Idade , Volume SistólicoRESUMO
AIM: The goal of the study was to investigate the relationships between coronary artery disease (CAD) and risk factors, including the serum levels of high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a) (Lp(a)) and homocysteine, in Japanese patients with peripheral arterial disease (PAD). METHODS: Coronary angiography was performed in 451 patients with PAD, among whom the prevalence and clinical characteristics of CAD were analyzed. A multiple logistic analysis was used to evaluate the relationships between CAD and the risk factors. The relationships between the severity of coronary arterial lesions and the risk factors were evaluated using multiple regression analysis. RESULTS: The prevalence of CAD (≥70% luminal diameter narrowing or a history of CAD) and coronary artery stenosis (≥50%) was 55.9% and 74.1%, respectively, and the rate of CAD (≥70%) with single-, double- and triple-vessel disease was 25.9%, 13.5% and 10.6%, respectively. The prevalence of diabetes was higher among the patients with CAD than among those without. The serum levels of hs-CRP, Lp(a), and homocysteine were higher in the patients with CAD, whereas the estimated glomerular filtration rates and HDL-cholesterol levels were lower in these patients. According to the multiple logistic analysis, CAD was related to diabetes (hazard ratio [HR]: 2.253; 95% confidence interval [CI]: 1.137-4.464, p=0.020), hs-CRP (HR: 1.721; 95% CI: 1.030-2.875, p=0.038), Lp(a) (HR: 1.015; 95% CI: 1.001-1.029, p=0.041) and homocysteine (HR: 1.084; 95% CI: 1.012-1.162, p=0.021). Furthermore, diabetes and the D-dimer and LDL-cholesterol levels exhibited significant relationships with the number of stenotic coronary lesions in the stepwise multiple regression analysis (pï¼0.05). CONCLUSIONS: Diabetes, hs-CRP, Lp(a), homocysteine and lipid abnormalities are critical risk factors for CAD in Japanese patients with PAD.
Assuntos
Biomarcadores/sangue , Proteína C-Reativa/análise , Doença da Artéria Coronariana/etiologia , Diabetes Mellitus/fisiopatologia , Homocisteína/sangue , Lipoproteína(a)/sangue , Doença Arterial Periférica/complicações , Idoso , Estudos de Coortes , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/epidemiologia , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/sangue , Prognóstico , Fatores de RiscoRESUMO
A 59-year-old female underwent surgery for a primary malignant pericardial mesothelioma. She presented with progressive dyspnea, and several imaging studies demonstrated a 65 × 22 mm tumor in the aortopulmonary window, accompanied by massive pericardial effusion. The tumor was successfully excised with clean surgical margins under cardiopulmonary bypass, followed by patch reconstruction of the pulmonary artery, and was diagnosed as an epithelioid type of malignant pericardial mesothelioma. The patient tolerated the operation and subsequent adjuvant chemotherapy without any complications. She remained alive and asymptomatic for almost 3 years after surgery, despite the fact that the median survival of this disease is 6-10 months. This patient is the second longest postoperative survivor of this extremely rare, aggressive neoplasm.
Assuntos
Neoplasias Cardíacas/cirurgia , Neoplasias Pulmonares/cirurgia , Mesotelioma/cirurgia , Sobreviventes , Feminino , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Imageamento por Ressonância Magnética , Mesotelioma/complicações , Mesotelioma/diagnóstico , Mesotelioma/patologia , Mesotelioma Maligno , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Derrame Pericárdico/etiologia , Pericárdio , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 50-year-old man underwent repeat surgery for a benign vagal schwannoma in the middle mediastinum. He had undergone tumor enucleation at another hospital 4 months before presentation. The tumor (99 × 88 × 76 mm) was located in the aortopulmonary window and arose from the left vagus nerve. It had been enucleated, leaving its sheath behind to preserve the nerve. Imaging studies showed tumor regrowth without distant metastasis, and the tumor was extirpated along with the involved nerve during cardiopulmonary bypass. There was no nerve dysfunction, recurrence, or metastasis 6 months after the operation. A benign vagal schwannoma can be excised with nerve transection or enucleated without nerve transection. The present case suggests that a vagal mediastinal schwannoma should be extirpated along with the nerve because insufficient enucleation might lead to tumor regrowth.
Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias do Mediastino/cirurgia , Recidiva Local de Neoplasia , Vagotomia , Doenças do Nervo Vago/cirurgia , Nervo Vago/cirurgia , Biomarcadores Tumorais/análise , Biópsia , Neoplasias dos Nervos Cranianos/química , Neoplasias dos Nervos Cranianos/patologia , Humanos , Imuno-Histoquímica , Masculino , Neoplasias do Mediastino/química , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Neoplasia Residual , Reoperação , Esternotomia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Nervo Vago/química , Nervo Vago/patologia , Doenças do Nervo Vago/metabolismo , Doenças do Nervo Vago/patologiaRESUMO
A 74-year-old woman presented with progressive dyspnea on exertion. Transthoracic echocardiography (TTE) demonstrated significant left ventricular outflow tract (LVOT) obstruction with a pressure gradient of 100 mmHg caused by a sigmoid septum (SS). Mitral regurgitation (MR) of a mild to moderate degree occurred due to systolic anterior motion (SAM) of the anterior mitral leaflet (AML), with no intrinsic mitral valve (MV) abnormality. Myectomy of the hypertrophied septal bulge ameliorated the pressure gradient to 8 mmHg with similar MR. However, just before the sternal closure, hemodynamic status deteriorated drastically to ventricular fibrillation. MR exacerbated to a severe degree with an uncertain etiology; thus, a mechanical prosthetic valve was implanted. The postoperative course was complicated by prolonged mechanical ventilation due to massive pulmonary edema and complete atrioventricular block (CAVB) requiring permanent pacemaker implantation. One year postoperatively, the patient is asymptomatic and TTE revealed no residual pressure gradient with an iatrogenic ventricular septal defect (VSD). This case, the first published surgical experience of SS, may indicate that secondary MR, which is usually relieved by sufficient myectomy in hypertrophic cardiomyopathy (HCM), can exacerbate markedly, and that myectomy might not be advisable in SS. The therapeutic strategy must be considered carefully before embarking on surgical intervention.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiomegalia/cirurgia , Septos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/etiologia , Obstrução do Fluxo Ventricular Externo/etiologia , Idoso , Biópsia , Cardiomegalia/complicações , Cardiomegalia/diagnóstico , Cardiomegalia/fisiopatologia , Progressão da Doença , Ecocardiografia Doppler em Cores , Feminino , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Fatores de Risco , Índice de Gravidade de Doença , Esternotomia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/etiologia , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/fisiopatologiaRESUMO
AIM: The goal of this study was to analyze differences in risk factors, including the level of brain natriuretic peptide (BNP) and the distribution of lesions, between cases of critical limb ischemia (CLI) and intermittent claudication (IC) among patients with peripheral arterial disease. METHODS: Risk factors and clinical characteristics were prospectively investigated in 817 consecutive patients, including 185 patients with CLI and 632 patients with IC. RESULTS: The patients in the CLI group were older than those in the IC group (pï¼0.001). The prevalence of diabetes and cerebral infarction and the proportion of women were higher in the CLI group (pï¼0.05). The plasma BNP levels in the CLI group were higher than those observed in the IC group (333±538 vs. 136±354 pg/mL, pï¼0.001). In contrast, the levels of homocysteine and fibrinogen were higher and the levels of albumin and the estimated glomerular filtration rate were lower in the CLI group (pï¼0.05). According to a multiple logistic analysis, the BNP level, diabetes, female gender, the albumin level, body mass index (BMI) and ankle-brachial pressure index (ABI) were associated with CLI (pï¼0.05). Aortoiliac artery lesions were less common, whereas femoropopliteal and below-the-knee (BK) lesions were more common, in the CLI group (pï¼0.05). The number of affected BK arteries was also higher in the CLI group (pï¼0.001). Correlations were found between the presence of aortoiliac lesions and smoking and a low HDL cholesterol level, while femoropopliteal lesions were found to correlate with age, BMI and hypertension and BK lesions were found to correlate with diabetes, age, female gender and BMI (pï¼0.05). The plasma BNP level correlated with the number of affected BK arteries (pï¼0.05). CONCLUSIONS: A high BNP level, diabetes, female gender, a low albumin level, ABI and BMI are risk factors for CLI. In this study, differences in the levels of anatomical lesions and correlated risk factors were found between the CLI and IC groups.
Assuntos
Claudicação Intermitente/sangue , Isquemia/sangue , Perna (Membro)/patologia , Peptídeo Natriurético Encefálico/sangue , Doença Arterial Periférica/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminas/metabolismo , Angiografia , Índice Tornozelo-Braço , Povo Asiático , Índice de Massa Corporal , Colesterol/sangue , Feminino , Fibrinogênio/metabolismo , Taxa de Filtração Glomerular , Homocisteína/sangue , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , FumarRESUMO
A 48-year-old man underwent surgery to treat pulmonary stenoses of unknown origin. The right main pulmonary artery was severely stenotic, and the orifice of the left pulmonary artery was focally constricted. The patient was nearly asymptomatic, despite marked pulmonary hypertension and right heart strain. The pressure gradients beyond the stenotic regions were 88 mmHg bilaterally. The cause of the stenoses could not be established before operation. The right main pulmonary artery and ascending aorta were successfully replaced. It was suspected that the ascending aorta was involved because it was markedly thickened and adhered tightly to the right pulmonary artery. It was therefore also replaced. However, only the transected right pulmonary artery showed histological evidence consistent with a diagnosis of Takayasu's arteritis. The postoperative course was uneventful. The patient was completely free of symptoms six months after the operation. To our knowledge, this is the thirteenth surgically treated case of isolated pulmonary Takayasu's arteritis to be reported.
Assuntos
Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Artéria Pulmonar/cirurgia , Arterite de Takayasu/cirurgia , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/fisiopatologia , Pressão Arterial , Biópsia , Constrição Patológica , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Pulmonar/patologia , Artéria Pulmonar/fisiopatologia , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Mortality from gastrointestinal (GI) hemorrhage caused by antiplatelet or anticoagulant therapy (or both) is quite high after cardiac surgery. We previously reported that proton pump inhibitor (PPI) therapy is indispensable in preventing postoperative GI complications. PPIs are usually administered intravenously immediately after surgery and subsequently by oral formulations. We conducted a prospective study to evaluate whether intravenous PPI followed by oral administration is more efficient as prophylaxis than oral-only administration. METHODS AND RESULTS: We enrolled 40 patients scheduled to undergo coronary artery bypass grafting with cardiopulmonary bypass and randomly assigned them to receive oral PPIs alone (group 1) or intravenous PPI followed by oral administration (group 2). Postoperative upper GI endoscopy evaluations showed no evidence of GI bleeding. Only gastritis, esophagitis, and hiatal hernia were observed at similar incidences in the groups. Mean hospital stays were also similar, but the cost of PPI treatment was significantly lower in group 1. CONCLUSION: No additional benefits of intravenous PPIs over oral formulations were demonstrated. Oral PPIs alone were effective and economical as prophylaxis against GI complications. Intravenous PPIs might be unnecessary in selected patients after cardiac surgery.
Assuntos
Ponte de Artéria Coronária/métodos , Doença das Coronárias/cirurgia , Hemorragia Gastrointestinal/prevenção & controle , Prevenção Primária/métodos , Inibidores da Bomba de Prótons/administração & dosagem , Administração Intravenosa , Administração Oral , Idoso , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Ponte de Artéria Coronária/efeitos adversos , Doença das Coronárias/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Japão , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Radiografia , Valores de Referência , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of the study was to examine the prevalence and risk factors for cerebral infarction (CI) and carotid artery stenosis (CAS) in patients with peripheral arterial disease (PAD) compared with normal controls. METHOD: A cross-sectional analysis was performed in 857 subjects (PAD: 543, controls: 314). CI and lacunar infarction (LI) were evaluated using brain computed tomography. Intima-media thickening (IMT) and CAS were measured with ultrasound. RESULTS: The prevalences of CI and LI were higher in patients with PAD than in controls (15.0% vs. 9.8%, 41.0% vs. 13.4%, respectively, p < 0.05). In multiple logistic analysis, CI was associated with diabetes mellitus, low HDL cholesterol and CAS ≥ 70% (p < 0.05). LI was associated with age, PAD, diabetes mellitus, and estimated glomerular filtration rate (p < 0.05). The prevalences of CAS ≥ 70% and CAS ≥ 50% were higher in patients with PAD than in controls (5.2% vs. 0.6%, 17.6% vs. 3.8%, respectively, p < 0.01). Mean and max IMT differed significantly between the two groups (PAD vs. controls: 1.01 ± 0.45 vs. 0.90 ± 0.28, 2.67 ± 2.00 vs. 1.73 ± 1.05 mm, respectively, p < 0.001). CAS ≥ 70% correlated with high LDL cholesterol, and CAS ≥ 50% with age and PAD. IMT was positively correlated with PAD, high LDL cholesterol, age, and hypertension (p < 0.05). CONCLUSIONS: Prevalences of CI and CAS were markedly higher in patients with PAD than in controls, indicating that PAD is a meaningful risk factor for CI, LI, and CAS. This suggests that screening for CI and CAS is important for managements in PAD, as with screening for PAD in patients with stroke.
Assuntos
Estenose das Carótidas/epidemiologia , Infarto Cerebral/epidemiologia , Doença Arterial Periférica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Espessura Intima-Media Carotídea , Estenose das Carótidas/diagnóstico por imagem , Estudos de Casos e Controles , Infarto Cerebral/diagnóstico por imagem , Distribuição de Qui-Quadrado , Comorbidade , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença Arterial Periférica/diagnóstico por imagem , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: The goal of the study was to examine possible sex-related differences in the clinical characteristics and risk factors in Japanese patients with peripheral arterial disease (PAD). METHODS: Sex-related differences in clinical profiles, risk factors and treatments were examined in 730 consecutive patients with PAD (148 women (20.3%) and 582 men (79.7%)). RESULTS: The mean age of the women was higher than that of the men (73.6 ± 11.2 vs. 70.9 ± 9.1 years old, p = 0.002) and the proportion of subjects aged ≥ 75 years old was also higher in women (P=0.005). Women more frequently had critical limb ischemia (P < 0.001) and diabetes mellitus (P = 0.026), but less frequent smoking and alcohol intake, compared to men (P< 0.001). Total cholesterol (P < 0.001) and LDL cholesterol (P = 0.014) were higher in women. Fontaine stages were correlated with age, diabetes, cerebral infarction and women (p < 0.001). The prevalence of iliac artery lesions was higher in men (p< 0.001), whereas that for below the knee lesions was higher in women (p < 0.001). The number of affected below the knee arteries was also higher in women than in men (p < 0.001). The prevalence of medical treatment was higher in women (P = 0.009) and major amputation tended to be higher in women (p = 0.056). CONCLUSIONS: Women had more severe symptomatic states and uncontrolled risk factors. The prevalence of iliac artery lesions was lower, but below the knee lesions were more severe in women.
Assuntos
Povo Asiático/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Valor Preditivo dos Testes , Prevalência , Prognóstico , Radiografia , Análise de Regressão , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores SexuaisRESUMO
We experienced a case in which a total arch replacement and an open stent implantation were performed for a distal aortic arch aneurysm using a newly developed stent graft (Ube CL-0201; Ube Medical, Tokyo, Japan). This novel stent graft is composed of a woven polyester graft and a nickel-titanium alloy stent, and has been under evaluation in clinical trials at four institutions in Japan, including our hospital, since 2008. The patient was weaned from the respirator on the day after surgery, and 9 months have passed since the surgery with no complications. A follow-up computed tomography scan showed that the stent part was sufficiently open, and no complications, such as an endoleak, have been observed.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Stents , Idoso , Aneurisma da Aorta Abdominal/diagnóstico , Feminino , Seguimentos , Humanos , Desenho de Prótese , Técnicas de Sutura , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: Continuous low-dose infusion of human atrial natriuretic peptide (hANP) in patients undergoing cardiac surgery on cardiopulmonary bypass (CPB) inhibits the renin-angiotensin-aldosterone system and compensates for the adverse effects of CPB. BACKGROUND: We examined the influence of hANP infusion on cardiac and renal function in patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG). METHODS: The subjects were 133 patients who underwent CABG and had a pre-operative ejection fraction < or =35%. They were randomized to receive 0.02 microg/kg/min of hANP from the initiation of CPB (hANP group) or placebo (saline) infusion. RESULTS: Early post-operative mortality did not show a significant difference between the 2 groups, but perioperative complications were significantly less frequent in the hANP group (p = 0.015). Long-term all-cause mortality showed no difference, but the cardiac death-free rate at 5 or 8 years post-operatively was 98.5% in the hANP group and 85.5% in the placebo group (p = 0.0285). Post-operative ejection fraction was significantly larger and the post-operative brain natriuretic peptide level was significantly lower in the hANP group. Serum creatinine was significantly lower in the hANP group than the placebo group at 1 month, 6 months, and 1 year post-operatively, whereas the estimated glomerular filtration rate was significantly higher in the hANP group at these times. CONCLUSIONS: In patients with left ventricular dysfunction undergoing CABG, hANP showed renal- and cardio-protective effects and reduced post-operative complications. It also improved the long-term prognosis. We suggest that hANP should be considered as part of perioperative management of patients with cardiac dysfunction undergoing cardiac surgery. (NU-HIT trial for LVD; UMIN000001652).