RESUMO
An 80-year-old man developed severe haemodynamic instability during a transapical aortic valve implantation. He was not suitable for a conventional surgical approach due to comorbidities and patent aortocoronary bypass grafts also limited further stabilizing actions. As a bail-out procedure, we demonstrate the feasibility of transapical arterial cannulation by crossing a newly implanted TAVI valve in order to establish an emergency bypass circuit.
Assuntos
Estenose da Valva Aórtica/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Perfusão , Terapia de Salvação , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Humanos , Masculino , Resultado do TratamentoRESUMO
OBJECTIVE: We retrospectively performed a comparative analysis of temperature measurement sites during surgical repair of the thoracic aorta. METHODS: Between January 2004 and May 2006, 22 patients (mean age: 63 ± 12 years) underwent operations on the thoracic aorta with arterial cannulation of the aortic arch concavity and selective antegrade cerebral perfusion (ACP) during deep hypothermic circulatory arrest (HCA). Indications for surgical intervention were acute type A dissection in 14 (64%) patients, degenerative aneurysm in 6 (27%), aortic infiltration of thymic carcinoma in 1 (4.5%) and intra-aortic stent refixation in 1 (4.5%). Rectal, tympanic and bladder temperatures were evaluated to identify the best reference to arterial blood temperature during HCA and ACP. RESULTS: There were no operative deaths and the 30-day mortality rate was 13% (three patients). Permanent neurological deficits were not observed and transient changes occurred in two patients (9%). During re-warming, there was strong correlation between tympanic and arterial blood temperatures (r = 0.9541, p<0.001), in contrast to the rectal and bladder temperature (r = 0.7654, p = n.s; r = 0.7939, p = n.s., respectively). CONCLUSION: We conclude that tympanic temperature measurements correlate with arterial blood temperature monitoring during aortic surgery with HCA and ACP and, therefore, should replace bladder and rectal measurements.
Assuntos
Aorta Torácica/cirurgia , Temperatura Corporal/fisiologia , Circulação Cerebrovascular/fisiologia , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Perfusão/métodos , Termometria/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Temperatura , Termometria/instrumentaçãoRESUMO
OBJECTIVE: An aorto-oesophageal fistula is a rare clinical entity, leading to life-threatening gastrointestinal bleeding. Thoracic aortic aneurysms are the most common cause of aorto-oesophageal fistulae; further causes involve foreign body ingestion, trauma (in most cases iatrogenic), carcinoma or, very rarely, aortitis tuberculotica. METHODS: Due to its rarity, there are no large multicentre studies present to evaluate the efficacy of different therapeutic management options. Since it is associated with significant morbidity and mortality, we give a short summary of various treatment approaches performed in our clinical practice in the past three years. The most straightforward therapeutic option may be an endovascular aortic repair and subtotal oesophageal resection followed by gastro-oesophageal reconstruction, but other alternative treatment possibilities are also present, although with probable higher morbidity. CONCLUSIONS: Eliminating the source of bleeding as an emergency, resecting the oesophagus urgently to prevent sepsis and reconstructing the gastrointestinal continuity as an elective case after having the inflammatory processes settled seems to justify the endovascular aortic repair and subtotal oesophageal resection, followed by a gastro-oesophageal reconstruction, as an effective surgical approach.
Assuntos
Doenças da Aorta/patologia , Doenças da Aorta/terapia , Fístula Esofágica/patologia , Fístula Esofágica/terapia , Fístula Vascular/patologia , Fístula Vascular/terapia , Aorta/patologia , Aorta/cirurgia , Doenças da Aorta/complicações , Doenças da Aorta/cirurgia , Fístula Esofágica/complicações , Fístula Esofágica/cirurgia , Esôfago/patologia , Esôfago/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Fístula Vascular/complicações , Fístula Vascular/cirurgiaRESUMO
BACKGROUND: Reactive oxygen species (ROS) play a crucial role in membrane damage in ischemic-reperfusion syndromes. The aim of our work was to determine whether blood samples taken from a peripheral vein are a reliable indicator to reflect the development of oxidative stress following acute heart ischemia and reperfusion. MATERIAL AND METHODS: In a dog model, the left descending coronary artery (LAD) was occluded for 60 min followed by 60 minutes of reperfusion. The lipid peroxidation marker malondialdehyde (MDA), endogenous antioxidants reduced glutathione (GSH), the activity of superoxide dismutase (SOD) enzyme and the stimulated radical production of isolated neutrophil granulocytes (PMN) were measured simultaneously from the peripheral vein and the coronary sinus before and at the end of the LAD occlusion, and again during reperfusion. RESULTS: MDA and SOD values increased during reperfusion. At the end of 1 hour the reperfusion changes in the coronary sinus were significant (p<0.05). GSH increased in the femoral vein, but decreased in the coronary sinus. The radical-producing capacity of PMNs decreased by the end of LAD occlusion, and a further significant decrease was measured during reperfusion in the coronary sinus (p<0.01). In the peripheral venous blood samples the decrease of PMN radical production became significant only at 30 minutes of reperfusion (p<0.02), and the earlier difference between the coronary sinus and the femoral vein tended to level out following 60 minutes of reperfusion. CONCLUSIONS: During early reperfusion following myocardial ischemia coronary sinus blood sampling gives an earlier indication of myocardial damage. At a later phase, peripheral blood samples may also be informative regarding the altered balance between ROS production and the antioxidant capacity.