RESUMO
We report the repair of a 6.5 × 5.3-cm left main coronary artery aneurysm by marsupialization of the aneurysm sac and coronary artery bypass grafting.
Assuntos
Procedimentos Cirúrgicos Cardiovasculares/métodos , Aneurisma Coronário/cirurgia , Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Idoso , Aneurisma Coronário/diagnóstico por imagem , Angiografia Coronária , Feminino , Humanos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND/OBJECTIVE: To evaluate the clinical results of patients with infective endocarditis (IE) complicated by acute cerebrovascular accidents (CVAs). METHODS: A total of 44 patients with IE complicated by CVA at admission were retrospectively analyzed in a single medical institute from 2005 to 2011. At the time of admission, 18 patients were diagnosed with hemorrhagic stroke, and 26 patients were diagnosed with ischemic stroke. Fifteen patients received surgical intervention during hospitalization. RESULTS: The hospital mortality rate was 38.9% for the hemorrhagic stroke group and 42.3% for the ischemic stroke group (p = 0.821). The mortality rate was 33.3% for the surgical group and 44.8% for the nonsurgical group (p = 0.531). At 30 days of hospitalization, 45.8% of the patients experienced an adverse event (defined as death due to organ failure, restroke, cardiogenic shock, or septic shock during the treatment period), and the attrition rate was 1.5% per day. Surgery performed after the adverse events increased mortality (80.0%) compared with surgery performed on patients with no adverse events (10.0%; p = 0.017). A Cox regression analysis revealed that creatinine > 2 mg/dL, diabetes, and staphylococcal infection were the risk factors of the adverse events. CONCLUSION: Early surgical intervention for IE with ischemic stroke may prevent adverse events, particularly in patients with impaired renal function, diabetes, or staphylococcal infection. A delay in operation of > 30 days is recommended after hemorrhagic stroke.
Assuntos
Endocardite/complicações , Mortalidade Hospitalar , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Adulto , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Endocardite/diagnóstico , Endocardite/mortalidade , Endocardite/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/mortalidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/cirurgia , Análise de Sobrevida , Taiwan , Resultado do TratamentoRESUMO
We report a modified Norwood stage I procedure for tricuspid atresia, transposition of great arteries, and hypoplastic right aortic arch with complete vascular ring. In this technique, we applied dual arterial cannulation to avoid circulation arrest during neoaortic reconstruction, and also corrected the arch laterality during the Norwood stage I palliation procedure. Pulmonary flow was supplied by the Blalock-Taussig shunt. Postoperative imaging revealed the patent left neoaortic arch, and the vascular ring was relieved with a patent tracheobronchial tree.
Assuntos
Síndromes do Arco Aórtico/cirurgia , Procedimento de Blalock-Taussig/métodos , Prótese Vascular , Procedimentos de Norwood/métodos , Transposição dos Grandes Vasos/cirurgia , Atresia Tricúspide/cirurgia , Humanos , Recém-NascidoRESUMO
Various surgical techniques have been proposed to repair a partial anomalous pulmonary venous connection to the superior vena cava, such as the single-patch, the double-patch, and the caval division (Warden) techniques. The limited growth potential of the artificial patch, stenosis of the cavoatrial channel or rerouted pulmonary vein channel, and the risk of sinus node dysfunction were possible adverse events. We here describe a modified Warden procedure without any patch in a 6-month-old infant. Using the concept of the Senning atrial switch technique, the interatrial septum and the free wall of the right atrium were used to baffle the anomalous pulmonary vein into the left atrium.