RESUMO
Taxine, a yew tree toxin, is highly cardiotoxic. We report the case of a patient who developed severe cardiac failure and ventricular fibrillation after consuming yew leaves and who made a full recovery after extracorporeal life support. Yew poisoning can be added to the list of potential indications of extracorporeal life support for refractory toxic cardiogenic shock.
Assuntos
Circulação Extracorpórea , Intoxicação por Plantas/terapia , Taxus/intoxicação , Arritmias Cardíacas/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Tentativa de SuicídioRESUMO
A 39-year-old woman with a known history of homozygous familial hypercholesterolemia was admitted with chest discomfort. Preoperative echocardiography and coronary angiography showed a heavily stenotic aortic valve as well as a calcific hypoplastic aortic root. Aortic root replacement using an aortic homograft was done.
Assuntos
Aorta/cirurgia , Doenças da Aorta/cirurgia , Estenose da Valva Aórtica/cirurgia , Implante de Prótese Vascular , Calcinose/cirurgia , Hiperlipoproteinemia Tipo II/complicações , Injúria Renal Aguda/etiologia , Adulto , Doenças da Aorta/complicações , Estenose Aórtica Subvalvar/complicações , Estenose Aórtica Subvalvar/cirurgia , Estenose da Valva Aórtica/complicações , Aterosclerose/complicações , Remoção de Componentes Sanguíneos , Prótese Vascular , Calcinose/complicações , Dor no Peito/etiologia , Parada Circulatória Induzida por Hipotermia Profunda , Vasos Coronários/cirurgia , Dispneia/etiologia , Feminino , Parada Cardíaca Induzida , Homozigoto , Humanos , Hiperlipoproteinemia Tipo II/genética , Hipertrofia Ventricular Esquerda/complicações , Anastomose de Artéria Torácica Interna-Coronária , Lipoproteínas LDL/sangue , Cuidados Paliativos , Doenças Vasculares Periféricas/complicações , Derivação Portocava Cirúrgica , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reimplante , Transplante Homólogo , Disfunção Ventricular Esquerda/etiologiaRESUMO
BACKGROUND: Aortic valve replacement (AVR) can be performed through a partial upper sternotomy. In this study we compared the early postoperative outcome in two groups of patients who underwent AVR with a minimally invasive procedure (n = 30) or with a conventional approach (n = 70). The predicted operative mortality (Parsonnet Index) was slightly higher in the conventional group (17.69 +/- 0.85 versus 12.7 +/- 1.02), reflecting the greater mean age of the patients (70.96 +/- 1.17 versus 64.20 +/- 2.57). RESULTS: The distribution of the different etiologies of aortic valve pathology did not differ between groups. There was no postoperative death in the mini-invasive group. Cardiopulmonary bypass time was longer in the mini-invasive group, but the other operative parameters did not differ between groups. Postoperative morbidity regarding the need for blood transfusion, the duration of assisted ventilation, length of stay in the intensive care unit, and abnormalities of cardiac rhythm and conduction was slightly but not significantly reduced in the mini-invasive group. CONCLUSIONS: Our data demonstrate that a partial upper sternotomy is a safe and effective technique for AVR. Postoperative morbidity is not significantly reduced in patients undergoing AVR by this approach. Further studies in a larger patient population are necessary to assess whether postoperative morbidity is significantly reduced.