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1.
J Clin Med ; 13(17)2024 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-39274299

RESUMO

(1) Background: Previous research has investigated the relationship between cognitive impairment, optical coherence tomography (OCT), visual fields (VF), and VF reliability in smaller patient samples using various cognitive assessment tools. This study analyzed the relationship between cognitive function scores using the Mini-Cog test and inner macular thickness (IMT) and VF sensitivity in glaucoma patients. (2) Methods: A retrospective analysis was conducted on 984 patients with 1897 eyes. Assessments included age, sex, intraocular pressure (IOP), and Mini-Cog test scores. Abnormal Mini-Cog scores were observed in 89 patients (9%). Using a mixed-effects model adjusted for background factors, the association between Mini-Cog scores and IMT, parafoveal (PF)-IMT, mean deviation (MD), pattern standard deviation, fixation losses (FL), false negatives (FN), and false positives (FP) was analyzed. (3) Results: Abnormal Mini-Cog scores (≤2) were associated with thinning of the IMT and PF-IMT, worse MDs, and higher FN and FP rates but not with PSD or FL. (4) Conclusions: Glaucoma patients with low cognitive function scores exhibited more advanced glaucoma-related changes in VF testing and morphological tests. Further longitudinal studies are needed to explore the relationship between glaucoma and cognitive impairment.

2.
Biomedicines ; 12(8)2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39200171

RESUMO

This study explored the link between different types of glaucoma and cognitive function in a cohort of 620 Japanese patients. Participants were categorized into primary open-angle glaucoma (PG), exfoliation glaucoma (EG), and non-glaucomatous control groups. The findings revealed a significant decline in cognitive function as indicated by the Mini-Cog test in the EG group (mean ± SD: 4.0 ± 1, 95% CI: 3.9 to 4.2) compared to the PG group (4.4 ± 0.1, 4.3 to 4.5, p < 0.0001). Levels of fingertip measured advanced glycation end-products (AGEs) were significantly higher in the EG group (mean ± SD: 0.45 ± 0.006, 95% CI: 0.44 to 0.46) compared to the PG group (0.43 ± 0.004, 0.42 to 0.44, p = 0.0014). Although the multivariate analysis initially showed no direct association between glaucoma types and Mini-Cog scores, the EG group exhibited higher age and intraocular pressure (IOP) compared to the PG group. Further analysis revealed that high levels of AGEs were associated with cognitive decline and decreased mean visual fields in the EG group. Age was identified as a cofounding factor in these associations. An inverse correlation was observed between the accumulation of AGEs and skin carotenoid levels. Early detection of cognitive decline in glaucoma patients could enable timely intervention to preserve visual fields. Fingertip measurements of skin carotenoids and AGEs offer promising potential as non-invasive, straightforward diagnostic tools that could be widely adopted for monitoring ophthalmic and cognitive health in glaucoma patients.

3.
J Clin Med ; 13(15)2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39124777

RESUMO

(1) Background: In glaucoma patients, it is observed that intraocular pressure (IOP) in non-surgical eyes decreases during hospitalization, but detailed data have not been reported. This study aimed to examine changes in IOP in the non-surgical eyes of patients admitted for glaucoma surgery. (2) Methods: This retrospective study included 487 patients (254 males, 233 females). Statistical analysis was performed separately for groups that were and were not under medication treatment. (3) Results: In non-surgical eyes, the difference in IOP between admission and discharge was -1.6 ± 4.8 mmHg (95% confidence interval (CI), -2.1 to -1.2; p < 0.0001) with a significant decrease in the medication group (n = 414), while it was -0.6 ± 4.8 mmHg with no significant change observed (95% confidence interval (CI), -1.7 to 0.57; p = 0.33) in the non-medication group (n = 73). Multiple regression analysis of the medication group showed that IOP at admission (p < 0.0001) and older age (p = 0.03) were associated with the reduction or the rate of reduction in IOP. (4) Conclusions: IOP in the non-surgical eyes of patients admitted for glaucoma surgery with medication decreased during hospitalization. The reduction was more pronounced in individuals with higher IOP at admission and in older patients. It is possible that improved medication adherence contributes to the lowering of IOP.

4.
Ann Thorac Surg ; 114(2): e141-e144, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34896411

RESUMO

Mitral valvuloplasty using GORE-TEX as the artificial chordae is often associated with difficulties in determining the length of the artificial chordae, achieving the correct artificial chordae length, and preventing knot slippage, especially for beginners. We describe a simple technique involving a novel device called the "Mitral Plate," which enables surgeons to automatically determine the correct length of the artificial chordae and tie slippery knots without performing excessive saline tests.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Procedimentos Cirúrgicos Cardíacos/métodos , Cordas Tendinosas/cirurgia , Humanos , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Politetrafluoretileno , Reimplante
5.
Ann Vasc Surg ; 69: 324-331, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32505681

RESUMO

BACKGROUND: The Fitzgerald classification expresses the extension of hematoma from the ruptured abdominal aortic aneurysm (rAAA) and is related to a patient's preoperative status. The objective of this study was to propose a new decision-making method for emergency surgeries, endovascular aortic repair (EVAR), or open repair (OR) for rAAA based on the Fitzgerald classification using preoperative computed tomography images. MATERIALS AND METHODS: A multicenter observational study was performed with a questionnaire survey of rAAA from August 2010 to July 2015 in Hokkaido, Japan, and sent to 20 institutions participating in the Hokkaido Society of Aortic Stent Graft. We included 205 patients who could be stratified by the Fitzgerald classification as the subjects of this study. We categorized these patients into Fitzgerald classes I and II (first category, n = 72) and classes III and IV (second category, n = 133). The short-term results of both EVAR and OR cases were examined in the 2 categories. RESULTS: In the first category, patients in the EVAR group were older than those in the OR group. Nonetheless, the in-hospital mortality rate was lower in the EVAR group than in the OR group (0% vs. 18%; P = 0.019). In the second category, there was no difference in preoperative factors between the groups. The EVAR group showed a higher incidence rate of postoperative abdominal compartment syndrome than the OR group (12% vs. 2%; P = 0.042). The in-hospital mortality rate was comparable between the groups (24% vs. 25%; P = 0.80). Although there were no deaths in the EVAR group without preoperative shock, in-hospital mortality in the EVAR group of the second category with shock was 41% (vs. 28% in the OR group; P = 0.27). Furthermore, mortality in the EVAR group with Fitzgerald class IV was 100% (vs. 29% in the OR group; P = 0.049). CONCLUSIONS: EVAR is recommended in Fitzgerald class I or II and also in Fitzgerald class III or IV without shock because the results of EVAR were better than those of OR. Because all patients who underwent EVAR died in Fitzgerald class IV, OR would be beneficial in this patient population.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Aortografia , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Técnicas de Apoio para a Decisão , Procedimentos Endovasculares , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/classificação , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Ruptura Aórtica/classificação , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Resultado do Tratamento
6.
PLoS One ; 15(4): e0224713, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32315296

RESUMO

Atrial metabolic disturbance contributes to the onset and development of atrial fibrillation (AF). Autophagy plays a role in maintaining the cellular energy balance. We examined whether atrial gene expressions related to fatty acid metabolism and autophagy are altered in chronic AF and whether they are related to each other. Right atrial tissue was obtained during heart surgery from 51 patients with sinus rhythm (SR, n = 38) or chronic AF (n = 13). Preoperative fasting serum free-fatty-acid levels were significantly higher in the AF patients. The atrial gene expression of fatty acid binding protein 3 (FABP3), which is involved in the cells' fatty acid uptake and intracellular fatty acid transport, was significantly increased in AF patients compared to SR patients; in the SR patients it was positively correlated with the right atrial diameter and intra-atrial electromechanical delay (EMD), parameters of structural and electrical atrial remodeling that were evaluated by an echocardiography. In contrast, the two groups' atrial contents of diacylglycerol (DAG), a toxic fatty acid metabolite, were comparable. Importantly, the atrial gene expression of microtubule-associated protein light chain 3 (LC3) was significantly increased in AF patients, and autophagy-related genes including LC3 were positively correlated with the atrial expression of FABP3. In conclusion, in chronic AF patients, the atrial expression of FABP3 was upregulated in association with autophagy-related genes without altered atrial DAG content. Our findings may support the hypothesis that dysregulated cardiac fatty acid metabolism contributes to the progression of AF and induction of autophagy has a cardioprotective effect against cardiac lipotoxicity in chronic AF.


Assuntos
Fibrilação Atrial/genética , Autofagia , Ácidos Graxos/metabolismo , Idoso , Fibrilação Atrial/metabolismo , Diglicerídeos/metabolismo , Proteína 3 Ligante de Ácido Graxo/genética , Proteína 3 Ligante de Ácido Graxo/metabolismo , Feminino , Átrios do Coração/metabolismo , Humanos , Masculino , Proteínas Associadas aos Microtúbulos/genética , Proteínas Associadas aos Microtúbulos/metabolismo , Pessoa de Meia-Idade , Regulação para Cima
7.
Gen Thorac Cardiovasc Surg ; 68(1): 30-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31230181

RESUMO

OBJECTIVES: The slope in the preload recruitable stroke work relationship is a highly linear, load-insensitive contractile parameter. However, the perioperative change of the slope has not been reported before. We examined the perioperative slope from a steady-state single beat in patients with functional mitral regurgitation and assessed the correlation with brain natriuretic peptide (BNP) levels. METHODS: The study included 16 patients with non-ischemic dilated cardiomyopathy and refractory heart failure: 10 patients underwent mitral valve plasty and left ventricular plasty (MVP + LVP group) and 6 patients who underwent mitral valve replacement and papillary muscle tugging approximation (MVR + PMTA group). The left ventricular ejection fraction was assessed by the modified Simpson method; the slope was assessed by the single-beat technique using transthoracic echocardiography. BNP levels were measured by chemiluminescent immunoassay. RESULTS: The left ventricular ejection fraction and slope did not significantly change from pre- to early post-surgery in the MVP + LVP group. Both the left ventricular ejection fraction and slope significantly increased 6 months after surgery in the MVR + PMTA group. Postoperative BNP level was low in the MVR + PMTA group. While the postoperative left ventricular ejection fraction did not correlate with BNP levels, the postoperative slope significantly correlated with BNP level after surgery in the MVP + LVP group and in the total functional mitral regurgitation group. CONCLUSIONS: The change of slope was dependent on surgical procedures. In functional mitral regurgitation, the slope may be a more sensitive parameter in reflecting the left ventricular contractile function than the left ventricular ejection fraction.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Insuficiência Cardíaca/cirurgia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Biomarcadores/metabolismo , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia , Feminino , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , Peptídeo Natriurético Encefálico/metabolismo , Músculos Papilares/fisiologia , Assistência Perioperatória , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia
8.
Ann Vasc Dis ; 12(1): 95-98, 2019 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-30931069

RESUMO

Postoperative ischemic complications, especially cerebral infarction due to atheroembolization following thoracic endovascular aortic repair, can be catastrophic. Herein, we present a maneuver of prevention of cerebral infarction using temporary cerebral arterial perfusion from the femoral artery, with the extracorporeal circuit including roller pump and filter in case of severe atherosclerotic change in thoracic aorta.

9.
Gen Thorac Cardiovasc Surg ; 67(10): 849-854, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30877646

RESUMO

OBJECTIVES: While it was reported that patients with residual moderate mitral regurgitation (MR) after surgical aortic valve replacement (SAVR) had a poorer prognosis than those without it, the risk factors for residual MR have not been fully elucidated. The aim of the study was to evaluate risk factors for residual MR after SAVR. METHODS: Of the 222 patients who underwent isolated SAVR from 2001 to 2018, 33 (11 men; age: 74 ± 7 years) had functional moderate MR before surgery. The risk factors for residual MR were evaluated by comparing patients with residual moderate MR (n = 11, 33%) with those who exhibited improved post-surgery MR (n = 22, 67%). RESULTS: The left atrial diameter was significantly larger in the residual MR group (51 ± 7 mm) than in the improved MR group (46 ± 5 mm; P = 0.049). The mean pressure gradient at the aortic valve was significantly smaller in the residual MR group (52 ± 18 mmHg) than in the improved MR group (69 ± 22 mmHg; P = 0.043). A ratio of left atrial diameter (mm) and mean aortic valve pressure gradient (mmHg) greater than 0.9 predicted residual MR with a sensitivity of 70% and a specificity of 74% (area under the ROC curve: 0.779; P = 0.015). CONCLUSIONS: In patients with severe aortic valve stenosis and moderate MR, a high ratio of preoperative left atrial diameter and mean aortic valve pressure gradient would be a parameter predicting residual moderate MR post-SAVR.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/etiologia , Complicações Pós-Operatórias , Idoso , Estenose da Valva Aórtica/diagnóstico , Progressão da Doença , Ecocardiografia , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/epidemiologia , Fatores de Risco , Resultado do Tratamento
10.
J Artif Organs ; 22(2): 177-180, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30603818

RESUMO

Transvalvular leakage (TVL) of a prosthetic heart valve is not negligible regurgitant flow in patients with critically low contractile function. Although the opening function of prosthetic valves has been reported, its closing function is not well understood. A man in his 70 s had a history of mitral valve replacement (MVR) with a Magna Mitral® valve for ischemic mitral valve regurgitation. He presented with dyspnea 2 years postoperatively. Echocardiography showed moderate TVL. The pulmonary capillary wedge pressure and cardiac index were 37 mmHg and 1.65 L/min/m2, respectively. Because we considered his TVL relevant, we performed re-do MVR with a mechanical valve and papillary muscle approximation and suspension ("papillary muscle tugging approximation"). His cardiac function improved postoperatively; he was discharged with New York Heart Association class I. For MVR in patients with critically low contractile function, prosthetic valves, such as mechanical valves, with small TVL are recommended.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Isquemia Miocárdica/complicações , Idoso , Bioprótese , Ecocardiografia , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Músculos Papilares , Falha de Prótese , Reoperação
11.
Ann Thorac Surg ; 107(6): e427-e429, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30641062

RESUMO

The surgical approach is challenging for patients with severe functional mitral regurgitation with nonischemic/ischemic dilated cardiomyopathy who are unsuitable for heart transplantation or ventricular assist device implantation. We developed a new surgical treatment named papillary muscle tugging approximation combined with mitral valve replacement. This technique is safe and feasible, with excellent midterm outcomes.


Assuntos
Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Músculos Papilares/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Terapia Combinada , Implante de Prótese de Valva Cardíaca , Humanos
12.
J Artif Organs ; 22(2): 126-133, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30456661

RESUMO

Ideally, an annuloplasty ring's shape should be changed intraoperatively if mitral valve repair is unsuccessful because of a short coaptation length or systolic anterior motion. Several post-implantation adjustable rings have been developed, but they are not freely deformable and are unsuitable for asymmetric repair of the valvular annulus. We developed a novel thermally deformable mitral annuloplasty ring to address these problems and assessed the ring's mechanical properties and its effect on the mitral valve anatomy. This ring was made of polycaprolactone. Tensile and bending tests were performed to evaluate the ring's mechanical properties. The ratio of the transverse and septal-lateral length was determined as 4:3. Using 10 pig hearts, we measured the post-deformation coaptation length and minimum distance from the coaptation to the ventricular septum, which is a factor of abnormal systolic anterior motion of the mitral valve. In the mechanical tests, the ring's yield point was greater than the deformation force of the annulus in humans. In pigs with deformation from "4:3" to "4:2", the coaptation length was significantly increased in each mitral valve part. In pigs with deformation from "4:3" to "4:4", the minimum distance from the coaptation to the ventricular septum was significantly increased. Asymmetrical ring deformation increased the coaptation length only at the deformed area. In conclusion, this new thermally deformable mitral annuloplasty ring could be "order-made" to effectively change the coaptation length in all parts of the mitral valve and the distance from the coaptation to septum post-deformation via intraoperative heating.


Assuntos
Próteses Valvulares Cardíacas , Anuloplastia da Valva Mitral/instrumentação , Valva Mitral , Animais , Análise de Elementos Finitos , Temperatura Alta , Teste de Materiais , Insuficiência da Valva Mitral/cirurgia , Desenho de Prótese , Suínos , Sístole
13.
Gen Thorac Cardiovasc Surg ; 67(1): 187-191, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28932974

RESUMO

OBJECTIVE: Operative mortality and morbidity after thoracoabdominal aortic surgery remain high. We report our strategy and outcomes, especially those of spinal cord protection. METHODS: Outcomes of 178 patients (age: 26-88 years) who underwent thoracoabdominal aortic replacement were retrospectively analyzed. 65 had aortic dissection, 14 had infected aneurysms, and 22 presented with rupture. Operations were non-elective in 24 and redo through re-thoracotomy in 21. Extent of replacement was Crawford-I in 39, II in 26, III in 78, and IV in 35. Staged repair was recently preferred, which resulted in decrease in extent II repair and increase in redo since 2009. Operations were performed under distal aortic perfusion and multi-segmental sequential repair to maximize collateral blood flow, and deep hypothermic circulatory arrest was preserved for those requiring open aortic anastomosis (n = 20). A total of 166 separate grafts were used for intercostal reconstruction in 88 patients, which was guided by preoperative feeding artery localization. Their patency was studied by postoperative MD-CT in 74 patients for 145 grafts. RESULTS: There were 3.9% hospital mortality and 5.1% spinal cord injury. Preoperative feeding artery localization resulted in reduced number of reconstruction and improved patency, and grafts connecting to the feeding artery were patent in 92%. Results of redo operations were not different (no mortality and spinal cord injury) from the de novo operations. CONCLUSIONS: Our concept of spinal cord protection, which was based on selective intercostal reconstruction while maximizing spinal cord collateral blood flow, seems justified.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Parada Circulatória Induzida por Hipotermia Profunda , Traumatismos da Medula Espinal/prevenção & controle , Isquemia do Cordão Espinal/prevenção & controle , Medula Espinal/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Dissecção Aórtica/cirurgia , Circulação Colateral , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
14.
J Artif Organs ; 22(1): 61-67, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30311021

RESUMO

Thoracic endovascular aortic repair (TEVAR) is expected to be minimally invasive, especially in older patients. However, clinical results of TEVAR in octogenarians including medical costs are limited. Between 2010 and 2016, a total of 57 patients over 80 years of age (mean age 84.1 ± 3.4 years) underwent TEVAR at our hospital. The proximal landing zone (PLZ) was zone 0 in 7 patients (12.3%), zone 1 in 10 patients (17.5%), zone 2 in 9 patients (15.8%), zone 3 in 13 patients (22.8%), and zone 4 in 18 patients (31.6%). The mean follow-up time was 23 ± 19 months (range 1-71 months). The follow-up rate was 96.5%. The hospital mortality rate was 1.8%. Stroke occurred in three patients (zone 0: 2, zone 3: 1, 5.3%). The mean hospital stay was 21.8 ± 21.4 days (range 5-98 days), and the rate of being discharged home was 84.2%. The 1-year and 3-year survival rates were 76.1% and 55.1% and the 1-year and 3-year re-intervention-free rates of the thoracic aorta were 97.6% and 94.5%, respectively. The mean total cost by the time of hospital discharge was ¥5,360,000 ± 2,360,000. The clinical results of TEVAR in patients over 80 years of age are acceptable with early postoperative recovery, low mortality and morbidity, and midterm durability.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/economia , Procedimentos Endovasculares/economia , Custos de Cuidados de Saúde , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/economia , Aneurisma da Aorta Torácica/mortalidade , Análise Custo-Benefício , Feminino , Mortalidade Hospitalar/tendências , Humanos , Japão/epidemiologia , Tempo de Internação , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Kyobu Geka ; 71(7): 484-487, 2018 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-30042251

RESUMO

Surgical strategy for non-ischemic dilated cardiomyopathy (NIDCM) is currently controversial. Subjects were 20 patients who underwent left ventriculoplasty(LVP) from 2006 to 2013 and 6 patients who underwent papillary muscle tugging approximation (PMTA) after 2015. PMTA is a new trans-mitral approach combined with valve replacement without left ventriculotomy. Another group of patients( n=14)who were registered for heart transplantation( HTx) after 2013 was also analyzed for left ventricular assist device(LVAD) free survival. Mw( slope in the preload recruitable stroke work relationship) calculated by single beat technique using echocardiography was employed as a load-independent cardiac functional parameter. The baseline characteristics and Mw were not different between the LVP and PMTA groups. One-year survival was significantly lower in the LVP group(53%)than in the PMTA group(100%)[log-rank:p=0.024]. In the HTx group, early LVAD implantation was necessary in the patients who had low Mw(<20)at the time of registration. In conclusion, PMTA would be one option for NIDCM patients( non-HTx candidates) with severe mitral regurgitation. Early LVAD implantation might be predicted in HTx candidates with low Mw(<20).


Assuntos
Cardiomiopatia Dilatada/cirurgia , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Coração Auxiliar , Insuficiência da Valva Mitral/cirurgia , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/mortalidade , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Ventrículos do Coração/cirurgia , Humanos , Insuficiência da Valva Mitral/complicações , Músculos Papilares/cirurgia , Resultado do Tratamento
16.
J Artif Organs ; 21(3): 363-366, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29541945

RESUMO

Antiphospholipid syndrome (APS) is a complex autoimmune disease often related to systemic lupus erythematosus. Although adequate anticoagulation is important for APS patients during cardiopulmonary bypass, clotting tests can be potentially misleading due to antiphospholipid antibodies. We performed cardiac surgery safely in two APS patients under anticoagulation monitoring determined using preoperative heparin titration. We performed heparin titration for activated clotting time to determine the appropriate heparin concentration during cardiac surgery. We changed the targeted heparin concentration considering each patient's thrombotic risks: 3 U/ml of heparin for a normal-risk APS patient and 5 U/ml for a high-risk APS patient with a history of antiphospholipid-antibody-associated thrombocytopenia. A higher targeted heparin concentration might be necessary for patients with high thrombotic risks.


Assuntos
Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/cirurgia , Ponte Cardiopulmonar/métodos , Heparina/uso terapêutico , Insuficiência da Valva Mitral/cirurgia , Trombose/prevenção & controle , Anticoagulantes/administração & dosagem , Síndrome Antifosfolipídica/complicações , Coagulação Sanguínea/efeitos dos fármacos , Feminino , Heparina/administração & dosagem , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações
17.
Ann Vasc Dis ; 11(4): 562-564, 2018 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-30637017

RESUMO

We report a rare case of delayed paraplegia triggered by gastrointestinal (GI) bleeding 8 months after thoracic endovascular aortic repair (TEVAR). A 78-year-old male underwent TEVAR of a descending thoracic aortic aneurysm without a postoperative neurological deficit and was discharged. Magnetic resonance image showed spinal cord infarction from Th8 to L1, and enhanced computed tomography showed a patent Adamkiewicz artery. The ostium of the intercostal artery connected with the Adamkiewicz artery was occluded. Patients with a history of TEVAR might be more vulnerable to spinal cord ischemia around the Adamkiewicz artery, which can be triggered by common hemorrhagic diseases, such as GI bleeding, even remote from the procedure.

18.
J Cardiol ; 71(1): 65-70, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28807550

RESUMO

BACKGROUND: Post-operative atrial fibrillation (POAF) frequently occurs after cardiac surgery. However, the mechanisms of POAF have not been fully elucidated. We aimed to examine whether pre-operative atrial gene expression related to cardiac metabolism is changed in patients with POAF. METHODS: Right atrial tissue was obtained during surgery from 38 patients who underwent cardiac surgery from 2013 to 2015. Atrial expression levels were determined by reverse transcription polymerase chain reaction for the following genes: glucose transporter type 4, peroxisome proliferator-activated receptor-α, fatty acid translocase, carnitine palmitoyltransferase 1B, and fatty acid binding protein 3 (FABP3). To investigate fatty acid ß-oxidation and tricarboxylic acid cycle capacities in the mitochondria, ß-hydroxyacyl CoA dehydrogenase and citrate synthase activity levels were spectrophotometrically determined. RESULTS: POAF within 7 days after surgery was observed in 18 (47%) patients. POAF patients were significantly older, had a larger left atrial diameter, and had reduced expression of FABP3, a fatty acids transport gene in the cytosol, compared to those in the non-POAF group. Reduced FABP3 expression predicted POAF independent of age and atrial size. In contrast, fatty acid ß-oxidation enzymatic activity was comparable between the groups. CONCLUSIONS: FABP3 gene expression in the atrium was reduced in patients with POAF. These findings suggest a potential link between altered fatty acid transport in the atrium and increased AF onset after cardiac surgery.


Assuntos
Fibrilação Atrial/genética , Proteína 3 Ligante de Ácido Graxo/genética , Complicações Pós-Operatórias/genética , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Expressão Gênica , Átrios do Coração/metabolismo , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório
19.
J Cardiol ; 71(4): 329-335, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29126782

RESUMO

BACKGROUND: Although non-transplant surgical interventions for non-ischemic dilated cardiomyopathy (NIDCM) are relatively effective, their feasibility and limitations have not been fully elucidated. The aim of this study was to define the feasibility and limitations of mitral valve repair, with or without surgical ventricular reconstruction for patients with NIDCM in terms of postoperative low cardiac output syndrome (LOS). METHODS: Twenty non-transplant candidates (aged 57±13 years) with NIDCM and significant mitral regurgitation had undergone mitral valve repair combined with submitral procedures. Using a 72-mL plastic ellipsoidal sizer, left ventricular reconstruction was performed concomitantly in 14/20 (70%) patients with extremely large ventricles. Total stroke volume, deceleration time of early trans-mitral flow wave, and the slope (Mw) in the preload recruitable stroke-work relationship were assessed using transthoracic echocardiography. LOS was defined as in-hospital death due to heart failure or a cardiac index less than 2.2L/min/m2 before discharge. RESULTS: There were three in-hospital deaths and four patients with postoperative cardiac index less than 2.2L/min/m2 [n=7 (35%), LOS group]. Preoperative total stroke volume, deceleration time, and the Mw were significantly lower in the LOS group compared to those in the non-LOS group; the predicted cut-off values for LOS were 84mL/beat (p=0.008), 133ms (p=0.015), and 45ergcm-3×103 (p=0.036), respectively. Preoperative left ventricular ejection fraction and ventricular size could not predict postoperative LOS. The one-year survival rate was 0% in the LOS group and 84% in the non-LOS group (p<0.001). CONCLUSIONS: Mitral valve repair, with or without left ventricular reconstruction, could be contraindicated for NIDCM patients with low total stroke volume, deceleration time, and Mw in terms of high postoperative incidence of LOS. For high-risk patients, other therapeutic strategies might be necessary.


Assuntos
Baixo Débito Cardíaco/etiologia , Cardiomiopatia Dilatada/cirurgia , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Baixo Débito Cardíaco/mortalidade , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/fisiopatologia , Ecocardiografia , Estudos de Viabilidade , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/mortalidade , Período Pós-Operatório , Estudos Retrospectivos , Volume Sistólico , Taxa de Sobrevida , Função Ventricular Esquerda
20.
Ann Vasc Dis ; 10(1): 51-53, 2017 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-29034022

RESUMO

Perigraft seromas are uncommon after surgical repair of the thoracic aorta with woven polyester grafts. A 50-year-old woman required redo sternotomy for the treatment of a perigraft seroma 6 months after total arch replacement for acute type A dissection. After removal of a jelly-like mass, a prosthetic graft was covered with fibrin glue, and the bilateral pleurae beside the graft were opened widely for drainage of effusion into the bilateral pleural cavities. Bacterial culture and laboratory and histological examination of the content confirmed the final diagnosis of perigraft seroma. No evidence of recurrence was observed 4 months after drainage.

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