RESUMO
BACKGROUND: Sacubitril/valsartan, being both a neprilysin inhibitor and angiotensin receptor blocker, exhibits a renin-angiotensin-aldosterone system (RAAS) inhibitory effect. However, no study has investigated the administration of sacubitril/valsartan in patients early after surgery using cardiopulmonary bypass. METHODS AND RESULTS: This was a prospective observational study of 63 patients who underwent open heart surgery and were treated with sacubitril/valsartan. No serious adverse events occurred. Among the 63 patients, sacubitril/valsartan was discontinued in 13 due to hypotension (n=10), renal dysfunction (n=2), and dizziness (n=1). Atrial natriuretic peptide concentrations increased significantly from Day 3 of treatment (P=0.0142 vs. Postoperative Day 1) and remained high thereafter. In contrast, plasma renin activity was significantly suppressed from Day 3 onwards (P=0.00206 vs. Postoperative Day 1). A decrease in creatinine concentrations and an increase in the estimated glomerular filtration rate were observed on Day 3; this improvement in renal function was not observed in the historical control group, in which patients did not receive sacubitril/valsartan. New postoperative atrial fibrillation was less frequent in the study group compared with the historical control (12.7% vs. 38.0%; P=0.0034). CONCLUSIONS: Sacubitril/valsartan administration was safe immediately after open heart surgery in patients without postoperative hypotension. It enhanced serum atrial natriuretic peptide concentrations and suppressed RAAS activation.
Assuntos
Aminobutiratos , Antagonistas de Receptores de Angiotensina , Compostos de Bifenilo , Ponte Cardiopulmonar , Combinação de Medicamentos , Neprilisina , Sistema Renina-Angiotensina , Valsartana , Humanos , Idoso , Masculino , Feminino , Neprilisina/antagonistas & inibidores , Neprilisina/sangue , Ponte Cardiopulmonar/efeitos adversos , Sistema Renina-Angiotensina/efeitos dos fármacos , Pessoa de Meia-Idade , Estudos Prospectivos , Aminobutiratos/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Antagonistas de Receptores de Angiotensina/farmacologia , Fator Natriurético Atrial/sangue , Renina/sangue , Tetrazóis/uso terapêutico , Tetrazóis/farmacologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversosRESUMO
A 75-year-old woman was diagnosed with type B acute aortic dissection 14 years ago and 3-channeled aortic dissection 7 years ago. She received total arch replacement 6 years ago and descending aortic replacement with double barrel anastomosis technique for distal anastomosis 5 years ago. Computed tomography( CT) revealed giant thyroid tumor and thoracoabdominal aortic aneurysm( 58 mm in diameter). She suffered from back pain during her follow-up period. CT revealed ruptured thoracoabdominal aortic aneurysm. First, the false lumen of descending aorta was closed by thoracic endovascular aortic repair, and then thoracoabdominal aortic replacement was performed uneventfully.
Assuntos
Aneurisma da Aorta Torácica , Aneurisma da Aorta Toracoabdominal , Dissecção Aórtica , Ruptura Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Feminino , Idoso , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aorta/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Anastomose Cirúrgica , Resultado do TratamentoRESUMO
An 81-year-old man underwent total arch replacement for thoracic aortic aneurysm 8 years ago and catheter ablation for paroxysmal atrial fibrillation 1 year ago. Transthoracic echocardiography revealed a mass in the right atrium, and the patient was admitted for close examination and treatment. Transesophageal echocardiography revealed a 23×17 mm large well-defined mass above the cavotricuspid isthmus. Two venous drainage cannulas were inserted directly to the superior vena cava and to the inferior vena cava via the right femoral vein, in order to avoid the direct contact with the right atrium prior to institution of cardiopulmonary bypass. The right atrial tumor was found attached to the cavotricuspid isthmus, and was resected together with the right atrial wall. Pathological examination showed myxomatous tissue. Postoperative course was uneventful. He was discharged 23 days after the operation.
Assuntos
Ablação por Cateter , Átrios do Coração , Neoplasias Cardíacas , Mixoma , Humanos , Mixoma/cirurgia , Mixoma/diagnóstico por imagem , Masculino , Idoso de 80 Anos ou mais , Neoplasias Cardíacas/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Átrios do Coração/cirurgiaRESUMO
Persistent sciatic artery( PSA) is a rare congenital anomaly and often results in aneurismal or occlusive changes. A 82-year-old woman was reffered with diagnosis of Stanford type A acute aortic dissection complicated cardiac tamponade. Emergent aortic arch replacement was performed. Cardiopulmonary bypass was established by central cannulation into true lumen of aortic arch because of asceding aortic rupture during the operation, axillary arteries dissection and hypoplastic femoral arteries. Post-operative course was uneventful. She was transferred to the local hospital 32 days after the operation for the purpose of rehabilitation.
Assuntos
Dissecção Aórtica , Humanos , Feminino , Idoso de 80 Anos ou mais , Dissecção Aórtica/cirurgia , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Doença Aguda , Ruptura Aórtica/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/complicações , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Resultado do TratamentoRESUMO
An 82-year-old woman suddenly developed chest pain and apoplexy. Computed tomography (CT) showed acute type A aortic dissection, the true lumen in the brachicephalic artery was severely compressed by the faulse lumen. Pulsation in the either leg was not detected during induction of anesthesia. We evaluated the cerebral blood flow and lower extremity blood flow using near infrared spectroscopy (NIRS) during the operation, tissue oxygenation index (TOI) was continuously monitored during the operation. Cardiopulmonary bypass( CPB) was established by puncturing the true lumen in the ascending aorta and bicaval venous drainage. TOI was returned to normal range by CPB. Although the central repair (ascending aorta replacement) was performed, leg ischemia persisted. We performed ascending aorta-bifemoral bypass. After the operation, leg ischemia disappeared and CT revealed patency of the bypass graft. Postoperative course was uneventful without deterioration of neurological function. She was discharged 49 days after the operation.
Assuntos
Dissecção Aórtica , Perna (Membro) , Feminino , Humanos , Idoso de 80 Anos ou mais , Perna (Membro)/irrigação sanguínea , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aorta/cirurgia , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Isquemia/cirurgia , Extremidade Inferior/cirurgiaRESUMO
An 85-year-old woman underwent aortic arch replacement and thoracic endovascular aortic repair (TEVAR) 5 years ago. She suffered from chest and back pain. Computed tomography (CT) demonstrated enlargement of the aortic aneurysm by a type â ¢b endoleak. TEVAR was performed to close a type â ¢b endoleak with a relining technique uneventfully. Intraoperative completion aortography and postoperative CT confirmed the disappearance of a type â ¢b endoleak. She was discharged 27 days after the treatment.
Assuntos
Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Feminino , Humanos , Idoso de 80 Anos ou mais , Prótese Vascular , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Endoleak/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Correção Endovascular de Aneurisma , Stents , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Resultado do Tratamento , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Estudos RetrospectivosRESUMO
An 97-year-old woman was diagnosed with complete atrioventricular block and underwent pacemaker implantation( PMI). Three days after the PMI, computed tomography revealed cardiac perforation and migration of the lead to the abdominal cavity. Surgical procedure through median sternotomy was performed, and the penetrated lead was removed. The holes of the right ventricle and diaphragm were repaired. Abdominal organ was not injured. She was discharged 14 days after the surgical procedure.
Assuntos
Traumatismos Cardíacos , Marca-Passo Artificial , Feminino , Humanos , Idoso de 80 Anos ou mais , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Diafragma/diagnóstico por imagem , Diafragma/cirurgia , Marca-Passo Artificial/efeitos adversos , Tórax , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgiaRESUMO
A 59-year-old woman was transferred to our hospital because of a sudden onset of chest and back pain. Computed tomography (CT) demonstrated Stanford type A acute aortic dissection with cardiac tamponade and right airway bleeding. Hemorrhage from ruptured false lumen extended along the pulmonary artery (PA), compression of the right PA were recognized due to hematoma surrounding the PA. An emergency operation was performed. The primary tear was located at the distal aortic arch, and total arch replacement with frozen elephant trunk was performed. During the operation, she had airway bleeding. The bleeding was thought to be due to the hematoma extending along the pulmonary artery. She was extubated 7th postopratively. She was discharged 44 days after the operation.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Feminino , Humanos , Pessoa de Meia-Idade , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aorta Torácica/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/cirurgia , Hematoma/cirurgia , Pulmão/cirurgiaRESUMO
A 76-year-old man had been under observation for nephrotic syndrome. He suffered from hypotension and transient loss of consciousness. He was diagnosed with thoracic aortic aneurysm and severe aortic valve stenosis. Ascending aorta replacement concomitant with aortic valve replacement was performed uneventfully. He was diagnosed with light chain amyloidosis by pathological examination of the resected ascending aorta. He was received referral treatment for amyloidosis.
Assuntos
Aneurisma da Aorta Torácica , Aneurisma Aórtico , Estenose da Valva Aórtica , Masculino , Humanos , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Aneurisma Aórtico/cirurgia , Aorta/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicaçõesRESUMO
A 73-year-old man underwent drug eluting stent (DES) implantation in the left anterior descending artery (LAD) 11 years ago and in the right coronary artery (RCA) 8 years ago. He suffered from chest tightness and was diagnosed with severe aortic valve stenosis. Perioperative coronary angiography revealed no significant stenosis and thrombotic occlusion of the DES. Five days before operation, antiplatelet therapy was discontinued. Aortic valve replacement was performed uneventfully. But he developed chest pain and transient loss of consciousness, electrocardiographic changes were observed on the 8th postoperative day. Emergency coronary angiography revealed thrombotic occlusion of the drug eluting stent in the RCA, despite the postoperative oral adoministration of warfarin and aspirin. Percutaneous catheter intervention (PCI) restored the stent patency. Dual antiplatelet therapy (DAPT) was initiated immediately after the PCI, and anticoagulation therapy with warfarin was continued. Clinical symptons of stent thrombosis disappeared immediately after the PCI. He was discharged 7 days after the PCI.
Assuntos
Stents Farmacológicos , Intervenção Coronária Percutânea , Masculino , Humanos , Idoso , Valva Aórtica/cirurgia , Stents Farmacológicos/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Varfarina , Período PerioperatórioRESUMO
A 53-year-old man presented to the emergency department with chest and back pain. Contrast-enhanced computed tomography( CT) revealed a Stanford type A acute aortic dissection with a pseudo-lumen occlusion. On the same day, the patient underwent emergent aortic arch replacement with frozen elephant trunk. When introducing cardiopulmonary bypass, arterial cannula was inserted into the right femoral artery. The day after surgery, swelling of the right lower leg appeared with CK and intramuscular compartment pressure elevation. Thus, the patient was diagnosed with compartment syndrome and decompressive fasciotomy was performed. Although there was no preoperative blood flow disturbance in the lower extremities on preoperative CT, lower limbs ischemia happened. Necrotic muscles in his right leg required debridement, but amputation was not needed. The patient was discharged unaided utilising orthotics on the day 120. In muscular, young male patients, care should be taken in the method of blood delivery.
Assuntos
Dissecção Aórtica , Síndromes Compartimentais , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Perna (Membro) , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Ponte Cardiopulmonar , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgiaRESUMO
An 86-year-old woman who suffered from cardiac tamponade due to acute Stanford type A aortic dissection was admitted to our hospital. An emergency operation was performed uneventfully. She suffered from abdominal pain 13 days after the operation. Computed tomography( CT) scan revealed pericholecystic fluid and unclear gallbladder wall, revealing acalculous necrotizing cholecystitis. We performed open cholecystectomy and abdominal cavity drainage. No gallstones were observed. She underwent intensive treatment. She was discharged without complications 44 days after the cholecystectomy.
Assuntos
Dissecção Aórtica , Vesícula Biliar , Feminino , Humanos , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Tomografia Computadorizada por Raios X , NecroseRESUMO
A 78-years-old woman was referred to our institution for the treatment of right subclavian artery (SCA) aneurysm. She previously underwent total arch replacement via median sternotomy approach. Preoperative computed tomography revealed a 55 mm sized SCA aneurysm. Stent graft was inserted from brachiocephalic artery to right common carotid artery via the graft anastomosed. The orifice of the right SCA was covered with stent graft inserted into the right common carotid artery-brachiocephalic artery and the right SCA was occluded with coils distal to the aneurysm, carotid-SCA bypass was performed with 8 mm ePTFE graft. Postoperative examination conï¬rmed complete exclusion of the aneurysm and patency of the bypass graft. We thought that hybrid treatment for this patient was a less invasive alternative to conventional surgical procedure.
Assuntos
Aneurisma , Implante de Prótese Vascular , Feminino , Humanos , Idoso , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/cirurgia , Stents , Tomografia Computadorizada por Raios X , Implante de Prótese Vascular/métodosRESUMO
An 85-year-old man received simultaneous coronary artery bypass grafting (CABG) and the ascending aorta to bifemoral bypass with a Dacron graft 11 years ago. He suffered from intermittent claudication. Angiography demonstrated a localized stenosis in a non-anastomotic site, straight portion of the graft. He received percutaneous transluminal angioplasty. The right ankle-brachial pressure index (ABI) improved from 0.58 to 0.74 and left ABI improved from 0.52 to 0.71. One year later, intermittent claudication appeared again, right ABI decreased to 0.53 and left ABI decreased to 0.52. Computed tomography( CT) demonstrated restenosis at the same portion of the graft. A re-do operation was performed, stenotic portion was removed and replaced by a new ePTFE graft. No restenosis was seen three years after the second operation. We thought that repeated temporary compression of the graft might have led to a clot formation in the non-anastomotic site.
Assuntos
Aorta , Claudicação Intermitente , Idoso de 80 Anos ou mais , Angioplastia , Aorta/diagnóstico por imagem , Aorta/cirurgia , Constrição Patológica/cirurgia , Ponte de Artéria Coronária , Humanos , MasculinoRESUMO
A 36-year-old woman with severe aortic valve stenosis was admitted to our hospital. She had been diagnosed with antiphospholipid syndrome complicated with systemic lupus erythematosus (SLE) and had been taking prednisolone( 10 mg/day) for 22 years. As SLE patients with prolonged steroid use are known to be at risk of an aortic dissection and aneurysm, femoral artery was chosen for arterial perfusion to reduce a risk of aortic dissection. Aortic valve replacement was performed uneventfully, because the aorta was treated carefully during the operation. Negative microbial culture and pathological examination of the resected aortic valve demonstrated an atypical vegetation, the findings of which were typically characteristic of Libman-Sacks endocarditis in SLE. She was discharged without complications 23 days after the operation.
Assuntos
Dissecção Aórtica , Endocardite , Próteses Valvulares Cardíacas , Lúpus Eritematoso Sistêmico , Adulto , Dissecção Aórtica/complicações , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Endocardite/complicações , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Lúpus Eritematoso Sistêmico/complicaçõesRESUMO
A 76-year-old man with thoracic aortic aneurysm was admitted to our hospital. Aortic arch replacement was performed uneventfully. He suffered from abdominal pain 17 days after the operation. Computed tomography (CT) scan revealed a strangulated bowel obstruction, and we performed emergent open abdominal surgery. During the operation, we found an adhesion between the greater omentum and the retroperitoneum. The small intestine was intussuscepted into this site, and strangulated with necrosis of a 35-cm length. We performed a partial resection of the small intestine. We encountered rare strangulated bowel obstruction after open heart surgery due to adhesion of the great omentum in a patient without a history of abdominal surgery.
Assuntos
Aorta Torácica , Obstrução Intestinal , Masculino , Humanos , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Hérnia Interna , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Intestino Delgado/patologia , Aderências Teciduais , Necrose/etiologiaRESUMO
A 84-year-old man was diagnosed with complete atrioventricular block and underwent pacemaker implantation( PMI). Two days after the PMI, chest X-ray revealed left pneumothorax, and a chest tube was inserted. The pneumothorax did not improve, and computed tomography revealed left lung injury by the right ventricular lead. Surgical procedure through median sternotomy was performed, and the penetrated lead was removed. The injured right ventricle and left lung were repaired. Ten days after the surgical procedure, intravenous implantation of new right ventricular lead was performed. He was discharged 38 days after the surgical procedure.
Assuntos
Traumatismos Cardíacos , Lesão Pulmonar , Marca-Passo Artificial , Pneumotórax , Idoso de 80 Anos ou mais , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Humanos , Pulmão , Lesão Pulmonar/diagnóstico por imagem , Lesão Pulmonar/etiologia , Lesão Pulmonar/cirurgia , MasculinoRESUMO
A 73-year-old woman suffered from premature ventricular contraction( PVC) which could not be controlled by medications. Holter 24-hour continuous recording electrocardiogram (Holter ECG) revealed 22,706 PVC beats/day. Upon further examination, she was found to have severe aortic stenosis and mild insufficiency. Preoperative electro-physiological study and standard 12-lead electrocardiogram revealed that the PVC originated from myocardium under the left coronary cusp. Aortic valve replacement and intraoperative cryoablation were performed. Her postoperative course was uneventful, Holter ECG revealed 638 PVC beats/day. Clinical symptons of PVC disappeared immediately after surgery. She was discharged 19 days after the operation.
Assuntos
Próteses Valvulares Cardíacas , Complexos Ventriculares Prematuros , Idoso , Feminino , Humanos , Valva Aórtica/cirurgia , Ventrículos do Coração , Complexos Ventriculares Prematuros/cirurgiaRESUMO
A 66-year-old man was diagnosed with pacemaker pocket infection in the upper abdominal area. His generator was removed with partial resection of the epicardial leads, and a new device was reimplanted in his left prepectoral area. The abdominal wound was left open, and debridement was performed for several times. After the wound was cured, he complicated a chest pain and was diagnosed with residural epicardial pacemaker lead infection. He underwent complete removal of infected epicardial pacemaker leads and omentopexy under extracorporeal circulation via resternotomy. Postoperative course was uneventful. There was no sign of reinfection during the two-year follow-up.
Assuntos
Marca-Passo Artificial , Esternotomia , Idoso , Remoção de Dispositivo , Circulação Extracorpórea , Humanos , MasculinoRESUMO
A 64-year-old woman was diagnosed with dilatation of the pulmonary artery and pulmonary valve stenosis approximately 10 years ago. At the age of 63, she developed hemoptysis and was referred to our hospital. The pulmonary trunk was enlarged to 63 mm with moderate pulmonary valve insufficiency. The transpulmonary valve pressure gradient was 25 mmHg;thus, surgery was performed. A median sternotomy revealed a markedly dilated pulmonary trunk growing into the pericardial cavity. After opening the patient's pulmonary trunk to check the pulmonary valve, a thickened and shortened quadricuspid valve was observed. We replaced the pulmonary valve with a bioprosthetic valve and used a vascular prosthesis to reconstruct the pulmonary artery. The postoperative course was uneventful, and she was discharged 22 days after the surgery. Histopathological examination of the pulmonary artery aneurysm wall revealed cystic medial necrosis.