RESUMO
A case of solitary septal metastasis from a clear cell carcinoma of the kidney is reported in a 55-year-old man who 5 years before had undergone right nephrectomy and adrenalectomy. Since then, he had been successfully treated by means of chemotherapy, radiation therapy, or operated on, at almost yearly intervals, for secondary pancreatic, pulmonary and cerebral single metastases. Diagnosis was obtained by routine computed tomography. The septal mass was surgically removed and the patient was discharged on the 4th postoperative day.
Assuntos
Adenocarcinoma de Células Claras/secundário , Neoplasias Cardíacas/secundário , Neoplasias Renais/patologia , Adenocarcinoma de Células Claras/diagnóstico , Adenocarcinoma de Células Claras/cirurgia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , UltrassonografiaRESUMO
A method for correcting the tube kinking after ascending aortic replacement for acute dissection is described. Its main advantage is the no need for cardiopulmonary by-pass (CPB) and aortic clamping to solve the problem.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Falha de Prótese , Técnicas de Sutura , Doença Aguda , Dissecção Aórtica/classificação , Dissecção Aórtica/fisiopatologia , Aneurisma da Aorta Torácica/classificação , Aneurisma da Aorta Torácica/fisiopatologia , Pressão Sanguínea , Ponte Cardiopulmonar/métodos , Constrição , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Ajuste de Prótese/métodos , Fatores de TempoAssuntos
Corpos Estranhos/cirurgia , Coração , Adulto , Criança , Feminino , Corpos Estranhos/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report a successful transplantation of a human tricuspid valve in a human. We used a fresh tricuspid homograft with its chordae tendineae and papillary muscles, harvested 5 days earlier under sterile conditions from a multiorgan donor a few minutes after cardiectomy (the heart was not suitable for cardiac transplantation) and immediately stored at 4 degrees C. We elected to implant the homograft in a young heroin addict. Our experience demonstrates that the implantation of an atrioventricular homograft in the orthotopic position is technically feasible and can achieve good results, at least in the short term.
Assuntos
Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/transplante , Adolescente , Endocardite/complicações , Heroína , Humanos , Masculino , Infecções Estafilocócicas/complicações , Transtornos Relacionados ao Uso de Substâncias/complicações , Transplante Homólogo , Insuficiência da Valva Tricúspide/etiologiaRESUMO
Fifty-seven patients underwent aortic valve replacement with a stentless glutaraldehyde-fixed bioprosthesis; 27 received a porcine aortic valve and 30 had a bovine pericardial valve. Two groups of 30 patients each who had aortic valve replacement with a tilting-disc mechanical valve or a stented porcine bioprosthesis served as controls. There were no differences in sex, body surface area, valve lesion, and valve size among the four groups. Results were assessed on a Doppler-based determination of maximum velocity across the valve, aortic valve area, and degree of valve regurgitation. Velocity across the valve was significantly less with stentless pericardial valves than with stentless porcine valves, stented bioprostheses, and mechanical valves. Stentless valves had a significantly larger aortic valve area when compared with stented valves. Mild central aortic insufficiency was detected more often with stentless pericardial than with stentless porcine bioprostheses (p = 0.04). Stentless valves showed a higher incidence of complete atrioventricular block when compared with stented valves (p = 0.04). Long-term studies are now warranted to assess the durability of both types of stentless valves.
Assuntos
Bioprótese , Próteses Valvulares Cardíacas , Adulto , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Ecocardiografia Doppler , Feminino , Bloqueio Cardíaco/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Resultado do TratamentoRESUMO
Clinical results with porcine bioprostheses were reviewed for 990 patients who underwent heart valve replacement from January, 1974, to December, 1980. Eight hundred and seventy-four Hancock, 283 Carpentier-Edwards, and 10 Liotta bioprostheses were used. In 23 patients, 26 mechanical prostheses were implanted as well. Overall operative mortality was 60 out of 990 (6.06%): 30 out of 506 (5.9%) for mitral valve replacement (MVR), 13 out of 287 (4.5%) for aortic valve replacement (AVR), 1 out of 4 (25%) for tricuspid valve replacement, 0 out of 2 for pulmonary valve replacement, and 16 out of 191 (8.4%) for multiple valve replacement. Cumulative follow-up covered 1,793 patient-years. (Actuarial survival at 7 years was 76.6 +/- 3% for MVR. At 6 years, it was 83.2 +/- 2.8% for AVR and 55 +/- 13.5% for multiple valve replacement.) Prosthesis-related survival at 7 years was 91.7 +/- 1.9% for MVR, and at 6 years, it was 96.6 +/- 1.5% for AVR and 95.1 +/- 2.2% for multiple valve replacement. Bioprosthesis survival, considering deaths or complications that led to reoperation as final events, was 84.2 +/- 3.7% at 7 years for mitral valves and 87.7 +/- 3.8% at 6 years for aortic valves. Emboli per 100 patient-years numbered 3.2 for MVR, 0.5 for AVR, and 1.6 for multiple valve replacement. Twenty-seven patients underwent reoperation, 12 for perivalvular leak, 5 for endocarditis, 6 for valve thrombosis, and 4 for primary tissue failure (linearized rates of 0.7, 0.3, 0.3, and 0.2% per patient-year, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Bioprótese , Próteses Valvulares Cardíacas , Adolescente , Adulto , Idoso , Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Bioprótese/mortalidade , Endocardite/etiologia , Falha de Equipamento , Feminino , Seguimentos , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/mortalidade , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Reoperação , Tromboembolia/etiologiaRESUMO
We studied 13 porcine bioprostheses removed from patients with endocarditis at our institute during the last 4.5 years. All bioprostheses had been removed at reoperation and were analyzed using anatomical and histological techniques. Each bioprosthesis was found to have developed rather constant lesions which were not related to the type of bioprosthesis. The stage of infection was not related to the duration of implantation. The presence of perivalvular abscesses was an ominous finding, often being the seat of persistent endocarditis. Our good clinical results of reoperation lead us to suggest that this be performed early once valvular or prosthetic malfunction is detected. Bioprostheses are, in our experience, the best choice in the surgical treatment of prosthetic valve endocarditis.