RESUMO
In patients with an ascending aorta aneurysm, restructuring of all its layers and, first of all, the intima and media was revealed. The thickness of the intima was 79.3±63.1 µm in patients with aortic diameter <55 mm (group Ao<55) and 162.7±177.4 µm (p<0.05) in patients with aortic diameter ⩾55 mm (Ao⩾55 group), the thickness of the aortic media was 1184.0±198.2 and 1144.3±288.4 µm, respectively. In patients of the Ao<55 group, aortic dilatation was accompanied by compensatory thickening of the inner and middle layers of the aorta. In the Ao⩾55 group, thinning of the aortic media, fragmentation of elastic fibers, and its cystic degeneration were revealed. c-kit+ Stem cells were detected in the subendothelium of the thickened intima of the dilated ascending aorta. The appearance of c-kit+ cells correlated with intimal remodeling and its colonization with CD34+ and CD44+ myofibroblast-like cells.
Assuntos
Aneurisma , Espessura Intima-Media Carotídea , Humanos , Aorta Torácica/diagnóstico por imagem , Aorta , Dilatação PatológicaRESUMO
BACKGROUND: Unsolved problems of cerebral protection in operations on the aortic arch, especially in a combination with extension of dissection to the brachiocephalic arteries determine search for variants making it possible to carry out adequate cerebral perfusion. AIM: To propose a new technique and initial experience of using cerebral perfusion through a temporary shunt from the basin of the left subclavian artery at the stage of prosthetic repair of brachiocephalic arteries. PATIENTS AND METHODS: At the Department of Reconstructive Surgery and Aortic Root of A.N. Bakulev National Medical Research Centre of Cardiovascular Surgery, a total of 6 patients (5 men) with type A aortic dissection underwent a stage of restoration of brachiocephalic arteries with the use of a temporary arterial shunt. The mean age was 48±15 years. The patients had chronic aortic dissection involving brachiocephalic arteries, primary fenestration in the aortic arch. All were found to have signs of chronic cerebrovascular insufficiency (dizziness, loss of consciousness); 2 patients had a history of transitory focal impairments. All patients were subjected to prosthetic repair of the ascending portion, aortic arch and all brachiocephalic arteries in conditions of adaptive perfusion with the use of adaptive loop from arterial lines. Supracoronary reconstruction of the ascending aorta was performed in 4 patients, Bentall operation in 2 subjects, with all undergoing total aortic arch replacement according to the elephant trunk technique. Brachiocephalic arteries were repaired using a trifurcated vascular grafts. RESULTS: Mean duration of cerebral perfusion along the temporary shunt amounted to 34±12 min. At all stages of operation, the level of haemoglobin oxygen saturation (rSO2) according to cerebral oximetry was within the reference values. All patients were discharged averagely on POD 12. CONCLUSION: A novel technique of cerebral perfusion along a temporary shunt will make it possible to extend the capabilities of heart surgeons in complicated combined interventions on the aortic arch and brachiocephalic arteries.
Assuntos
Implante de Prótese Vascular , Circulação Cerebrovascular , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Dissecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Saturação de OxigênioRESUMO
AIM: to investigate changes in the diameter and length of hypertrophic cardiomyocytes (CMCs) in the dilated left ventricle (LV). SUBJECTS AND METHODS: Light microscopy, morphometry, and statistical analysis were used to investigate the status of the contractile apparatus and changes in the length, diameter of CHC and diameter of CMC nuclei, by using intraoperative dilated LV biopsy samples from 31 patients with valvular disorders and dilated cardiomyopathy. Morphological findings were compared with the clinical parameters of the patients. RESULTS: CMCs in the patients with the dilated LV were hypertrophic and were at different stages of restructuring with progressive myofibrillar loss (PML). In 81% of patients, the diameter of CMCs was not significantly changed as their zones of PML extended. The length of CMCs, which correlated with the enlarged LV cavity, was increased in 52% of patients during cell restructuring with PML. In 42% of patients, the CMC nuclear diameter increased during restructuring with PML, which appeared to be associated with CMC polyploidization; in some of these patients (19% of the total number of patients), the diameter of CMCs increased in parallel with the higher diameter of their nuclei. CONCLUSION: The findings suggest that after completion of their transverse growth, hypertrophic CMCs are involved in a restructuring process with PML. The findings are consistent with the hypothesis that dilatation of the hypertrophied LV cavity is related to the preferential elongation of CMCs with an inadequate increase in their diameter. The results of the investigation may assume that the higher CMC diameter that brings to completion before the entry of the cells into the restructuring process with PML, resumes in the cells, the ploidy of which increases in the course of restructuring with PML, triggering an additional mechanism for raising the CMC diameter at this stage of myocardial hypertrophy. The results are indicative of different mechanisms for increasing the diameter and length of hypertrophic CMCs, since the diameter of CMCs directly correlates with that of their nuclei, and the length increases as the zones of PML extend in the CMCs.
Assuntos
Cardiomegalia/patologia , Cardiomiopatia Dilatada/patologia , Hipertrofia Ventricular Esquerda/patologia , Miócitos Cardíacos/patologia , Adulto , Biópsia , Cardiomegalia/cirurgia , Cardiomiopatia Dilatada/cirurgia , Feminino , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Hipertrofia Ventricular Esquerda/cirurgia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologiaRESUMO
Precapillary artery--arterial (bronchial artery--pulmonay artery) anastomoses, come into play in cases where the locking artery open and alveoli washed arterialized blood. Normally, these anastomoses are closed. Intrapulmonary shunts carry blood supply acinar hinder extraordinary circumstances (chronic pulmonary embolism, surgery, occurring in cardiopulmonary bypass, when the flaw of blood through the Iungs is suspended for the duration of cardiopulmonary bypass). Patients operated on the ascending aorta with the expansion of intervention on the nortic arch during the correction of pathology carry blood supply only the central nervous system. All other organs and systems at this time were protected by mild hypothermia. However, during circulatory arrest, required for correction of pathology acinar damage as a result of hypoxia, probably because there is no blood flow in the pulmonary artery and there is no blood flow in the bronchial arteries. Last, in the ordinary course of artificial circulation, capable due to arterio-arterial pulmonary anastomoses prevent hypoxic damage to acinar, not lead to persistent hypoxemia in the immediate postoperative period in these patients, as a result of violations of lung diffusion capacity.
Assuntos
Aorta/cirurgia , Oxigênio/sangue , Complicações Pós-Operatórias/etiologia , Insuficiência Respiratória/etiologia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Aorta Torácica/cirurgia , Circulação Extracorpórea , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Complicações Pós-Operatórias/diagnóstico , Testes de Função Respiratória , Insuficiência Respiratória/diagnósticoRESUMO
The aim of the work was to carry out expert assessment of complexity of operations and to study interrelationship of the average score of complexity of the interventions with lethal outcome and duration of treatment in the Intensive Care Unit (exemplified by comparison with the outcomes of operations on cardiac valves performed in 2009 in the setting of artificial circulation in adult patients). Complexity was assessed by a total of 13 cardiovascular surgeons specialized in operations aimed at correcting valve defects (4 of them were from the A. N. Bakulev Scientific Centre for Cardiovascular Surgery), with none of the participants being aware of the therapeutic outcomes of each type of the operation performed. An average expert-defined score was assigned for each of the 33 names of the operations. The Kendall coefficient of concordance for all operations amounted to 0.29 (p<0.001); consensus in the complexity-score (from 69 to 85%) was achieved for 48.5% of the operations thus considered. The values of the mean scores of complexity of operations, defined by the specialists form the SCCS (2.02±0.54) were significantly lower (Wilcoxon's test; p<0.001) as compared with the average score assigned by specialists from other facilities (2.28±0.43). The duration of the stay at the ICU of the patients subdivided into groups depending on the expert score was found to differ significantly (p=0.007). The area under the ROC curve using the EuroSCORE (0.59) is suggestive of its lower accuracy in assessing the lethal outcome as compared to the expert score (0.68). The obtained findings strongly suggest advisability of using expert score of operations' complexity for solving complicated non-formalized tasks on allied problems of cardiovascular surgery and organization of public health care (accrediting of medical facilities, formation of the government order, and planning of the budget of medical facilities).
Assuntos
Procedimentos Cirúrgicos Cardíacos , Doenças das Valvas Cardíacas/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Medição de Risco/métodos , Bases de Dados Factuais , Doenças das Valvas Cardíacas/mortalidade , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/tendências , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Federação Russa/epidemiologia , Resultado do TratamentoRESUMO
Results of surgical treatment of patients with cardiac valves prosthetic endocarditis are discussed. General hospital lethality was 15.4%. Immediate results of operations using different type of prosthetic cardiac valves were analyzed. Biological grafts permits to decrease the rate of prosthetic endocarditic recurrence on hospital stage. Urgency of repeated surgery and also radical resection of infected focus with possible reconstruction of fibrous ring integrity influence hospital lethality.
Assuntos
Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Próteses Valvulares Cardíacas/microbiologia , Adulto , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidadeRESUMO
Tactical and technical features of treatment of patients with mitral restenosis are discussed. The results (surgical lethality was 6.41%) confirm the necessity of surgical treatment of mitral restenosis with artificial circulation. Close commissurotomy may be regarded as the stage of the treatment of mitral stenosis, particularly under real existing Russian conditions.