RESUMO
Due to structural abnormalities in the leaflets, patients with bicuspid aortic valve (BAV) may develop isolated aortic valve disease, such as aortic regurgitation, aortic stenosis, or a combination of both. In addition to valvular pathology, numerous studies have indicated that approximately 40% of BAV patients exhibit aortic pathologies characterized by aortic dilatation. According to guidelines for valvular diseases, patients with BAV who require surgical aortic valve replacement (SAVR) and have a diameter of the aortic sinuses or ascending aorta ≥4.5â cm are recommended to undergo concomitant replacement of the aortic sinuses or ascending aorta. However, we encountered a case in 2020 involving a patient with severe aortic regurgitation due to BAV and an ascending aortic diameter of 4.2â cm. This patient underwent SAVR and ascending aortoplasty surgery at our center. Remarkably, three years postoperatively, the patient's aortic diameter rapidly expanded by nearly threefold, which also suggests the risk of encountering a giant aortic root aneurysm during reoperation. Unfortunately, a fatal rupture of a giant aortic root aneurysm was encountered during re-sternotomy. Fortunately, with adequate preoperative planning, we successfully managed to avert this perilous situation. The patient recovered without complications and was discharged on the 8th day. Individualized surgical plans were formulated based on a comprehensive evaluation of the perioperative conditions.
RESUMO
OBJECTIVE: To investigate the influence of continuous low-volume ventilation in cardiopulmonary bypass (CPB) on the expression of krebs von den lungen-6 (KL-6) and perioperative pulmonary function in adults undergoing valve surgery. METHODS: From 2017 Sept. to 2018 Jan., 60 patients who received valve replacement surgery were prospectively comprised in this study. We randomly allocated these patients into control group ( n=30, non-ventilation) and experimental group ( n=30, continuous low-volume ventilation during CPB). At different perioperative time points, we identified the dynamic changes of pulmonary function and biomarkers which expressed in serum and bronchoalveolar lavage fluid (BALF). Meanwhile, we also compared perioperative clinical outcomes of the two groups. RESULTS: The expression of serum KL-6 and BALF KL-6 in the two groups were both statistically significantï¼ Pï¼0.05ï¼. The oxygenation index increased with time and reached to the top point at T 1, then subsequently decreased with time ( Pï¼0.05). The alveolar-arterial oxygen tension difference (P A-aO 2) in the two groups fluctuate with time, the differences have no statistical significance. According to linear correlation, the serum KL-6 level was negatively correlated with oxygenation indexes ( r=ï¼0.525, P=0.003), while it was positively correlated with P A-aO 2 ( r=0.489, P=0.006). There were no significant differences between the two groups in clinical outcomes. CONCLUSION: Continuing low-volume ventilation during CPB could decrease the expression level of KL-6, while it has no significant influence on perioperative outcomes.
Assuntos
Ponte Cardiopulmonar , Doenças das Valvas Cardíacas/cirurgia , Pulmão/fisiologia , Mucina-1/genética , Ventilação Pulmonar , Biomarcadores , Líquido da Lavagem Broncoalveolar , HumanosRESUMO
AIMS: Aortic prosthesis-patient mismatch (PPM) increases left ventricular (LV) afterload and prevents LV mass regression (LVMR) after surgery. This study was designed to investigate the association between the baseline global longitudinal strain (GLS) and the postoperative LVMR, and its relation to adverse outcomes. METHODS: A total of 316 patients with aortic stenosis undergoing isolated mechanical prosthesis implantation were screened, and data from 91 patients with aortic PPM and 165 non-PPM patients were retrospectively collected. All 256 patients underwent measurement of GLS by two-dimensional speckle-tracking echocardiography preoperatively, and were followed up for postoperative changes of LV mass index (LVMi) and other clinical outcomes. RESULTS: During the follow-up, LVMi in PPM patients decreased significantly from 139.6â±â20.8 to 119.6â±â26.5âg/m (Pâ<â0.001). These patients were divided into two groups according to the median value of the reduction rate of LVMi at final follow-up, and preoperative GLS markedly decreased in PPM patients with insignificant reduction in LVMi. Multivariate analysis identified preoperative GLS (odds ratio 3.45, 95% confidence interval 1.27-11.05, Pâ=â0.002) and preoperative LVMi (odds ratio 2.87, 95% confidence interval 1.21-8.13, Pâ=â0.012) as independently associated with an insignificant LVMR. Moreover, PPM patients with limited reduction in LVMi were at an increased risk of cardiac death and major adverse valve-related events. CONCLUSION: In patients with aortic PPM early after surgery, reduced preoperative GLS could be a novel sensitive risk factor for a limited regression of LV hypertrophy, and this is associated with an increased risk of adverse events in PPM patients.
Assuntos
Estenose da Valva Aórtica/cirurgia , Ecocardiografia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Remodelação Ventricular , Adulto , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Hipertrofia Ventricular Esquerda/mortalidade , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Desenho de Prótese , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is the therapeutic choice for type B aortic dissection. One of the most unfavored complications of this procedure is hemorrhage, which has a low incidence but high mortality. Renal hemorrhage (RH) after endovascular aortic repair has been rarely reported. We presented two cases of unexpected RH after TEVAR for complicated type B aortic dissection, and the potential causes, diagnosis and therapeutic management were discussed. CASE PRESENTATION: A 67-year-old female developed hypotension and progressively decrease of hemoglobin within 5 h after TEVAR for acute complicated type B dissection. Bedside ultrasonography and abdominal computed tomography angiography revealed a massive right perinephric hematoma. The right renal angiography detected multiple tortuous vascular branches with diffuse perinephric bleeding. The main trunk of right renal artery was embolized. The patient recovered uneventfully and presented with normal renal function 6 months later. Another patient was a 69-year-old male who was admitted for endovascular repair of a chronic complicated type B aortic dissection. The patient presented with hemodynamic instability early after TEVAR. Bedside ultrasonography showed a giant left retroperitoneal hematoma. The abdominal angiography revealed two active bleeding sits located in the distal branches of left renal artery. A super-selective embolization of the two arteries was performed, however the patient developed abdominal compartment syndrome and died of multiple organ failure. CONCLUSIONS: Unexpected RH after endovascular repair of aortic dissection might be associated with iatrogenic and idiopathic factors. Close surveillance and clinician's awareness of this rare complication is crucial for accurate and prompt diagnosis. Renal angiography and subsequent selective embolization of bleeding vessels are effective interventions for treating this fatal condition.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Hemorragia/etiologia , Idoso , Angiografia por Tomografia Computadorizada , Feminino , Hematoma/etiologia , Humanos , Masculino , Resultado do TratamentoRESUMO
OBJECTIVE: We aim to investigate the role of mitochondrial DNA (mtDNA), a novel endogenous pro-inflammatory cytokine, in the development of ventilator-induced lung injury (VILI). Moreover, the protective effect of epigallocatechin gallate (EGCG) on VILI through inhibiting local mtDNA release was examined. METHODS: From March 2015 to March 2016, bronchoalveolar lavage fluid (BALF) from 36 patients with VILI and well-matched 36 patients without VILI after major surgery were consecutively collected. The expression levels of mtDNA and inflammatory cytokines in BALF were tested. SD rats were divided into five groups: control, low tidal volume (7â¯ml/kg) group, high tidal volume (HTV, 40â¯ml/kg) group, HTV+low dose EGCG and HTV+high dose EGCG groups. BALF were collected to examine the expression levels of mtDNA and several inflammatory cytokines and the lung tissue was harvested for pathological examinations. In addition, cyclic stretch cell culture was used and culture media was collected to analyze expressions of inflammatory cytokines. Administration of mtDNA in a rat model and in vitro cell culturing were used to confirm its pro-inflammatory properties in the development of inflammatory lung injury. RESULTS: A Significant elevation of mtDNA was detected in BALF from patients with VILI (581⯱â¯193â¯vs. 311⯱â¯137, pâ¯<â¯0.05) and also in rats ventilated with HTV. EGCG could significantly inhibit HTV-induced local mtDNA release and attenuate the level of inflammatory lung injuries (reduced infiltration of local inflammatory cells, lower lung wet/dry ratio and expression levels of inflammatory cytokines). The beneficial effects of EGCG on preventing inflammatory lung injuries were in a concentration-dependent manner. Meanwhile, higher expression levels of mtDNA and inflammatory cytokines were observed in the media of cyclic stretched cell culture compared to those in the control group (pâ¯<â¯0.05). Furthermore, intra-tracheal administration of mtDNA in rats could lead to a marked increase of local inflammatory cytokines and subsequent inflammatory lung injuries (pâ¯<â¯0.05). And by adding mtDNA into the cell culture, higher level of inflammatory cytokines in the media was detected (pâ¯<â¯0.05). EGCG also showed preventive effects on inflammatory responses on a concentration-dependent manner (pâ¯<â¯0.05). CONCLUSION: The increased expression level of mtDNA and subsequent inflammatory cytokines overproduction may play an important role in the development of VILI. EGCG may be a potential novel therapeutic candidate for protection against VILI by inhibiting the local release of mtDNA.
Assuntos
Catequina/análogos & derivados , DNA Mitocondrial/efeitos adversos , Inflamação/tratamento farmacológico , Lesão Pulmonar Induzida por Ventilação Mecânica/tratamento farmacológico , Idoso , Animais , Líquido da Lavagem Broncoalveolar , Catequina/farmacologia , Células Cultivadas , Citocinas/metabolismo , Células Epiteliais/efeitos dos fármacos , Feminino , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Ratos , Ratos Sprague-DawleyRESUMO
OBJECTIVE: To evaluate the outcomes of valve replacement of endocarditis using bioprothetic and mechanical valves. METHODS: This study comprised 52 patients [mean age (47±18) yr.,mean follow-up time (6.2±3.8) years] underwent valve endocarditis with bioprotheses,The control group were matched (3â¶1) with 156 patients of endocarditis underwent mechanical valves replacement using the following variables: age±5 yr.,body mass index (BMI)±20%,time of operation±1 year,replacement position and sex ratio. And evaluate the effects of using bioprothetic and mechanical valves on perioperative and long-term outcomes of valve replacement of endocarditis. RESULTS: The perioperative mortality of the patients receiving bioprothetic and mechanical valves were 17.3%±2.2% and 19.9%±1.8%,respectively,which was independent of valve type (P=0.27). Long-term survival were 56.1%±5.2% and 61.2%±8.1%,respectively (P=0.58). Meanwhile,long-term complication-free survival were 75.0%±3.2% and 82.3%±4.4%,respectively (P=0.29). For the patients younger than or equal to 60 yr.,long-term reoperation rates for bioprothetic and mechanical valves were 41.4%±7.2% and 30.5%±5.4% (P=0.02). For the patients older than 60 yr.,however,reoperation rates were 24.1%±8.5% and 14.7%±5.7% (P=0.36). CONCLUSION: Perioperative mortality and long-term survival are independent to valve types in patients with endocarditis. Mechanical valve shows potential advantage compared with bioprothetic valve in the patients younger than 60-year-old.
Assuntos
Bioprótese , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Adulto , Idoso , Seguimentos , Humanos , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Aortoesophageal fistula (AEF) and arch pseudoaneurysm are rare complications induced by a foreign body, and considerable controversy remains regarding the appropriate management strategies. We herein report a successful one-stage hybrid treatment in a patient with AEF and arch pseudoaneurysm. CASE PRESENTATION: The patient, a 40-year-old man, presented to the emergency room because of intense retrosternal discomfort for 3 days and hematemesis for 3 h. The esophagoscopy and thoracic enhanced computed tomography (CT) showed two irregular mural ulcers in the esophagus and a large saccular pseudoaneurysm at the aortic isthmus, respectively. The laboratory examinations confirmed no widespread inflammation and infection. We have successfully performed a successful one-stage hybrid treatment for this patient. Six-month follow-up shows the patient is in good condition and the esophagoscopy reveals the two mural ulcers had completely healed. CONCLUSION: The treatment decision-making process should depend upon the patients' specific situations. Our case suggest the one-stage hybrid treatment could be an valuable alternative in some selected patients.
Assuntos
Falso Aneurisma/etiologia , Fístula Esofágica/etiologia , Corpos Estranhos/complicações , Fístula Vascular/etiologia , Adulto , Animais , Aorta Torácica/patologia , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Galinhas , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Inflammation serves an important role in the pathogenesis of myocardial ischemia/reperfusion (I/R) injury. Fragments of endogenous damagedassociated molecular patterns, recently identified as mitochondrial DNA (mtDNA), have been proven to be a potent proinflammatory mediator. Epigallocatechin3gallate (EGCG) is able to regulate the expression levels of a series of inflammatory cytokines. However, the involvement of endogenous mtDNA in EGCGregulated inflammatory activities in the context of myocardial I/R injury remains to be elucidated. The present study was designed to investigate the role of mtDNA in EGCGmediated myocardial protection in a rat I/R model. Significant positive correlations between elevated plasma mtDNA copy numbers and the expression levels of tumor necrosis factor (TNF) and interleukins (IL)6 and 8 were observed in the myocardial tissue following an I/R injury (P<0.05). However, EGCG administered prior to reperfusion was able to effectively downregulate the expression levels of plasma mtDNA, TNF and IL6 and 8 in the myocardial tissue following an I/R injury (P<0.05). Limited infarct size, reduced severity of myocardial injury and decreased incidence of ventricular arrhythmia were observed in the EGCGtreated group. However, the beneficial effects of EGCG in preventing myocardial I/R injury may be eliminated by a specific phosphoinositide3kinase (PI3K) inhibitor. These results suggested that EGCGmediated cardioprotective effects may be achieved by inhibiting the release of mtDNA from damaged mitochondria and that this protection was at least in part dependent on the PI3K/RACα serine/threonineprotein kinase associated signaling pathway.
Assuntos
Catequina/análogos & derivados , DNA Mitocondrial/metabolismo , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Substâncias Protetoras/farmacologia , Androstadienos/farmacologia , Animais , Catequina/farmacologia , Creatina Quinase/metabolismo , Ensaio de Imunoadsorção Enzimática , Interleucina-6/análise , Interleucina-6/genética , Interleucina-6/metabolismo , Interleucina-8/análise , Interleucina-8/genética , Interleucina-8/metabolismo , L-Lactato Desidrogenase/metabolismo , Masculino , Traumatismo por Reperfusão Miocárdica/patologia , Fosfatidilinositol 3-Quinases/metabolismo , Inibidores de Fosfoinositídeo-3 Quinase , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ratos , Ratos Wistar , Transdução de Sinais/efeitos dos fármacos , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo , WortmaninaRESUMO
OBJECTIVE: This study was designed to investigate whether epigallocatechin-3-gallate (EGCG) postconditioning protects the heart against ischemic-reperfusion injury (IRI), and to explore its potential mechanisms in a rat model. METHODS: Male Wistar rats were subjected to myocardial ischemia (30 min) and reperfusion (up to 2 h) and the rats were divided into sham group (SO) group, ischemia-reperfusion (I/R) model group and EGCG group. EGCG group were treated with EGCG (10 mg/kg) via intravenous infusion 5 min before reperfusion. Electrocardiogram were applied to record ventricular arrhythmia frequency. The severity of myocardial injury [serum level of lactate dehydrogenase (LDH) and creatine kinase (CK), hematoxylineosin (HE) staining] and ventricular arrhythmia, and the serum levels of inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukins-6 (IL-6) and IL-8] were assessed with ELISA, electrocardiogram and Western blot respectively. RESULTS: EGCG given before reperfusion could effectively reduce the serum level of LDH and CK and the incidence of ventricular arrhythmia (P < 0.05, respectively), improved the pathological damage. Meanwhile, EGCG could down-regulate the expression levels of TNF-α, IL-6, IL-8 in the myocardial tissue after IRI (P < 0.05, repectively). The expression levels of p-p85 and p-Akt in the EGCG group were significantly up-regulated compared to those in I/R group (P < 0.05, repectively). CONCLUSION: EGCG-related anti-inflammatory action could attenuate rat myocardial IRI and this cardioprotective effect might be activated through the PI3K/Akt pathway.
Assuntos
Catequina/análogos & derivados , Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais , Animais , Catequina/farmacologia , Creatina Quinase/sangue , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Masculino , Isquemia Miocárdica , Miocárdio/metabolismo , Ratos , Ratos Wistar , Fator de Necrose Tumoral alfa/metabolismo , Regulação para CimaRESUMO
OBJECTIVES: This study was designed to assess the expression levels of bone morphogenic protein-4 (BMP4) in saphenous veins harvested from diabetic patients undergoing coronary artery bypass grafting (CABG), and to investigate its association with in-situ morphological and pathological changes within the venous wall. METHODS: From January 2013 to December 2014, forty patients with type 2 diabetes mellitus (DM) and risk factors matched non-DM controls (n =40) were enrolled prospectively. Of the 40 DM patients, 24 had noninsulin-dependent diabetes (NIDM) and the remaining 16 had insulin-dependent diabetes (IDM). Segments of saphenous vein without surgical dilatation from these 80 patients were obtained. Vessel wall characteristics were evaluated by hematoxylin-eosin (HE) staining, and the expression and distribution of BMP4 was assessed by Western blot assay and immunohistochemistry analysis. RESULTS: The intimal and medial thickness of the saphenous veins harvested from DM patients were higher than those from non-DM controls. Compared with non-DM patients, the expression level of BMP4 was significantly elevated in diabetic veins ( P<0.05), and BMP4 was highly expressed in smooth muscle cells located in the medial layer. Moreover, the expression levels of BMP4 in diabetic veins were significantly correlated with intimal thickness (r =0.655, P<0.01), intimal area (r =0.684, P<0.01), medial thickness (r =0.642, P<0.01) and medial area (r =0.692, P<0.01). CONCLUSIONS: The pre-existing intimal and medial hyperplasia were significantly correlated with the high expression levels of BMP4 in saphenous veins harvested from diabetic patients, implying a potential role of BMP4 in the progression of vein graft stenotic diseases in this cohort of post-CABG patients. Future studies were warranted in investigating novel therapeutic strategy targeting at BMP4 for improving long-term vein graft patency.
Assuntos
Proteína Morfogenética Óssea 4/metabolismo , Ponte de Artéria Coronária , Diabetes Mellitus Tipo 2/patologia , Veia Safena/patologia , Veia Safena/transplante , Estudos de Casos e Controles , Humanos , Revascularização Miocárdica , Miócitos de Músculo Liso/metabolismo , Túnica Íntima/patologiaRESUMO
BACKGROUND: Intestinal barrier dysfunction would lead to a rigorous inflammatory reaction due to the translocation of intestinal lumen-derived bacteria and endotoxins. The aim of the present study was to investigate whether intestinal barrier dysfunction occurs in patients with acute Stanford type A aortic dissection (ATAAD) and to determine its potential relationship with the plasma levels of several inflammatory biomarkers in the progression of ATAAD. DESIGN AND METHODS: Serum samples from a total of 46 patients with ATAAD and 36 healthy volunteers were prospectively collected and analyzed. The serum levels of diamine oxidase (DAO), lactate dehydrogenase (LDH), interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and C-reactive protein (CRP) were measured using colorimetric assay, enzyme-linked immunosorbent assay, and immunoturbidimetric assay. RESULTS: Serum levels of DAO, LDH, IL-6, TNF-α, and CRP in patients with ATAAD were significantly higher than those in healthy participants. A significantly positive correlation between DAO activity and IL-6 (r = .56, P < .001), TNF-α (r = .63, P < .001), and CRP (r = .53, P < .001) was observed. Moreover, the activity of DAO correlated negatively with the Pao 2/fraction of inspired oxygen (Fio 2) ratio (r = -.39, P = .007). CONCLUSIONS: Intestinal barrier dysfunction, reflected by an increased level of serum DAO, may play an important role in the development of systemic inflammatory responses in patients with ATAAD. Therefore, strategies of preserving a normal intestinal barrier function may open new horizons in the treatment of inflammation-related adverse events in the setting of ATAAD.
Assuntos
Aneurisma Aórtico/sangue , Dissecção Aórtica/sangue , Mediadores da Inflamação/sangue , Mucosa Intestinal/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/sangue , Adulto , Idoso , Amina Oxidase (contendo Cobre)/sangue , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/imunologia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/imunologia , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Feminino , Humanos , Interleucina-6/sangue , Mucosa Intestinal/imunologia , L-Lactato Desidrogenase/sangue , Masculino , Pessoa de Meia-Idade , Permeabilidade , Valor Preditivo dos Testes , Estudos Prospectivos , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Fator de Necrose Tumoral alfa/sangueAssuntos
Neoplasias Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Lipoma/complicações , Lipoma/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/etiologia , Ecocardiografia Transesofagiana , Feminino , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Lipoma/cirurgia , Pessoa de Meia-Idade , Obstrução do Fluxo Ventricular Externo/cirurgiaRESUMO
OBJECTIVE: To evaluate the early and mid-outcomes of proximal aorta reconstruction for type A aortic dissection (AAD) patients without intimal tear in aortic arch, and assess the safety and efficacy of this surgical strategy. METHODS: From January 2010 to February 2013, there were 23 AAD patients without intimal tear in the aortic arch received proximal aorta reconstruction surgery. Clinical data of these patients were analyzed retrospectively, the mean age was (48.04 ± 12.37) years old (21-73 yr.). Twelve cases were acute aortic dissection, the others were chronic dissection. Bentall surgery was performed for 13 cases, Cabrol surgery for 2 cases, Wheat surgery for 1 case, ascending aorta replacement and aortic valve repair was employed for 1 patient, simple ascending aorta replacement for 6 cases. The patients received follow-up every 3 to 6 months after the surgery. RESULTS: The duration of CPB time was (182.83 ± 36.98) min, cardiac arrest time was (111.87 ± 18.82) min, circulatory arrest time was (24.22 ± 6.38) min. The complications were lung infection (4 cases, 17.4%), tracheotomy (2 cases), peritoneal dialysis (1 case), 2 cases suffered transient neurological dysfunction. None stroke, paralysis, and permanent neurological dysfunction occurred. All the patients were discharged. Mean time of follow-up was (38.35 ± 11.95) months (18-56 months). All patients were alive and return to normal life, the proportion of false lumen closure was 65.22% (15 cases). None patients need secondary surgery. CONCLUSION: Proximal aorta reconstruction is safe and effective for AAD patient without intimal tear in aortic arch, the operation strategy can be used individually.
Assuntos
Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Procedimentos de Cirurgia Plástica , Procedimentos Cirúrgicos Vasculares , Doença Aguda , Adulto , Idoso , Aorta/patologia , Endotélio Vascular/patologia , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Túnica Íntima/patologia , Adulto JovemRESUMO
OBJECTIVE: To investigate the clinical significances of plasma IL-6, CRP and TNF-alpha concentration changes in aortic dissection. METHODS: Plasma concentrations of IL-6, TNF-alpha and CRP were determined in 68 aortic dissection patients,50 patients with essential hypertensionand 50 healthy volunteers. The changes of plasma IL-6, CRP and TNF-alpha concentration were analyzed in aortic group along with the progression of the disease which was divided into 9 differenttime courses. RESULTS: Compared with essential hypertension and healthy control group, significantly elevated CRP, IL-6 and TNF-alpha concentrations were detected in aortic dissection patients (P<0.05, respectively). All the concentrations of CRP, IL-6 and TNF-alpha reached the peak in acute phase of aortic dissection and then gradually declined in subacute and chronic phase. CONCLUSION: Increased plasma inflammatory factors were significantly associated with aortic dissection.
Assuntos
Aneurisma da Aorta Torácica/sangue , Proteína C-Reativa/análise , Interleucina-6/sangue , Fator de Necrose Tumoral alfa/sangue , Estudos de Casos e Controles , HumanosRESUMO
OBJECTIVES: To investigate the time-dependent changes in plasma levels of interleukin-6, C-reactive protein, and tumor necrosis factor-α in patients with type A aortic dissection (TAAD) who received unoptimal medical management since the onset of dissections. DESIGN AND METHODS: Plasma levels of interleukin-6, C-reactive protein, and tumor necrosis factor-α were detected by ELISA and immuno-turbidimetric assay in 92 TAAD patients at hospital admission. Blood samples from 78 patients with uncontrolled hypertension and 82 healthy volunteers were also analyzed as controls. The occurrence of TAAD-related complication and its relationship with the plasma levels of these inflammatory biomarkers was also investigated. RESULTS: The concentrations of inflammatory mediators were significant higher in TAAD than those in the uncontrolled hypertension and the healthy group. The time to peak plasma level of IL-6.and TNF-α was shorter than that of CRP in TAAD group. In the TAAD group, 51 patients suffered TAAD-related complications, and their plasma level of CRP was significantly higher than that in patients without TAAD-related complications (94.5 ± 58.8 mg/L versus 47.4 ± 47.8 mg/L, p < 0.001). Also, CRP levels strongly correlated with the value of PaO2/FiO2 ratio (r = -0.69, p < 0.001) and creatinine (r = 0.60, p < 0.001). The time to the peak level of CRP was shorter and the duration of persistently high CRP level was longer in the complication group than those in the complication-free group. CONCLUSIONS: Elevated and persistently high levels of plasma CRP, IL-6 and TNF-α were associated with progressively development of the TAAD. The changing pattern of CRP might be a marker for diagnosis and prophylactic treatment of complications. Our findings suggested a critical role of the inflammation in the progression of dissection and TAAD-related complications.
Assuntos
Aneurisma da Aorta Torácica/sangue , Dissecção Aórtica/sangue , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Feminino , Humanos , Inflamação/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Fator de Necrose Tumoral alfa/sangueRESUMO
OBJECTIVES: Recent studies suggested association between impaired left ventricular long-axis function and arrhythmic events early after open heart surgery. This prospective study investigated the predictive value of a depressed intraoperative global longitudinal strain (GLS) for postoperative atrial fibrillation after isolated aortic valve replacement in patients with preserved ejection fraction. METHODS: A total of 107 patients with ejection fraction ≥50% and moderate-to-severe aortic stenosis undergoing isolated aortic valve replacement were enrolled. All patients underwent intraoperative transoesophageal echocardiography before surgical incision (T1) and after closure of the sternotomy (T2) with semiautomated measurement of GLS, and were followed for the occurrence of postoperative atrial fibrillation during the hospitalization. RESULTS: The incidence of postoperative atrial fibrillation was 37/107 (34.6%). Patients with postoperative atrial fibrillation were associated with increased length of hospitalization and a higher risk of low cardiac output syndrome and pulmonary complications. On univariate analysis, significant risk factors associated with postoperative atrial fibrillation were E/e' ratio, left atrial volume index (LAVi), GLST2 and ΔGLS%. On multivariable analysis, GLST2 (odds ratio: 1.21; 95% confidence interval (CI): 1.06-1.56, P = 0.031) and ΔGLS% (odds ratio: 3.66; 95% CI: 1.85-6.79, P = 0.001) were independent predictors of postoperative atrial fibrillation. The best cut-off values for the prediction were GLST2 >-12.75% and ΔGLS% >19.50%, the latter of which had incremental predictive value for postoperative atrial fibrillation. CONCLUSIONS: A significant reduction of intraoperative GLS provides independent information for predicting postoperative atrial fibrillation in patients undergoing aortic valve replacement, and may help to identify patients who are most likely to benefit from targeted prophylaxis.
Assuntos
Estenose da Valva Aórtica/cirurgia , Fibrilação Atrial/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Ventrículos do Coração/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Função Ventricular Esquerda , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , China/epidemiologia , Feminino , Seguimentos , Ventrículos do Coração/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de RiscoAssuntos
Valva Aórtica/anormalidades , Cistos/diagnóstico , Ecocardiografia Transesofagiana/métodos , Cardiopatias/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Valva Aórtica/cirurgia , Doença da Válvula Aórtica Bicúspide , Cistos/etiologia , Cistos/cirurgia , Cardiopatias/etiologia , Cardiopatias/cirurgia , Sopros Cardíacos/diagnóstico , Sopros Cardíacos/etiologia , Sopros Cardíacos/cirurgia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Adulto JovemRESUMO
The infection of cardiac implantable electronic device is a serious and potentially lethal complication. Accurate preoperative evaluation of location of vegetation, cardiac valve pathology is of paramount important. We reported a case of 71-year-old male patient who suffered from pacemaker endocarditis was given suitable surgical treatment under the guidance of real-time three-dimensional trans-esophageal echocardiogram.
Assuntos
Remoção de Dispositivo/métodos , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana/métodos , Endocardite Bacteriana/cirurgia , Marca-Passo Artificial/efeitos adversos , Cirurgia Assistida por Computador/métodos , Infecção da Ferida Cirúrgica/cirurgia , Idoso , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/etiologia , Falha de Equipamento , Seguimentos , Humanos , Masculino , Marca-Passo Artificial/microbiologia , Síndrome do Nó Sinusal/terapia , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/etiologiaRESUMO
Cardiac myxoma arising form right ventricular outflow tract (RVOT) is extremely rare, but could cause major clinical sequelae and pose considerable diagnostic and therapeutic challenges. Here, we report the intraoperative application of real time three-dimensional transesophageal echocardiography (RT3DTEE) in the assessment of a patient with a RVOT myxoma. RT3DTEE clearly assess the characteristics of the mass, such as the size, shape, attachment points, and composition. With the intraoperative guidance of RT3DTEE, the patient underwent successful removal of the mass.
Assuntos
Ecocardiografia Tridimensional/métodos , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Adulto , Ecocardiografia Transesofagiana/métodos , Feminino , Neoplasias Cardíacas/complicações , Humanos , Monitorização Intraoperatória/métodos , Mixoma/complicações , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/prevenção & controleRESUMO
BACKGROUND: The study was designed to evaluate the effects of moderate prosthesis-patient mismatch (defined as 0.65 cm(2)/m(2) Assuntos
Estenose da Valva Aórtica/cirurgia
, Valva Aórtica/cirurgia
, Análise de Falha de Equipamento/métodos
, Próteses Valvulares Cardíacas
, Complicações Pós-Operatórias/epidemiologia
, Função Ventricular Esquerda
, Idoso
, Valva Aórtica/diagnóstico por imagem
, Estenose da Valva Aórtica/diagnóstico por imagem
, Estenose da Valva Aórtica/fisiopatologia
, China/epidemiologia
, Intervalo Livre de Doença
, Ecocardiografia Doppler em Cores
, Feminino
, Seguimentos
, Humanos
, Masculino
, Pessoa de Meia-Idade
, Morbidade/tendências
, Complicações Pós-Operatórias/diagnóstico
, Desenho de Prótese
, Estudos Retrospectivos
, Taxa de Sobrevida/tendências
, Fatores de Tempo
, Resultado do Tratamento