RESUMEN
BACKGROUND: Intimal hyperplasia is a normal adaptive feature of arteries in response to injuries, which include invasive vascular interventions. Its development limits the long-term success of bypass grafts. Various pharmacological agents have been successfully employed in experimental models to reduce the degree of intimal hyperplasia. In our study, we investigated the efficacy of dexamethasone in reducing intimal hyperplasia in rat abdominal aortas after partial transection and primary repair. METHODS: In this study, 20 Wistar Albino rats were randomly selected and divided into four groups to compare the effects of low- and high-dose dexamethasone on intima and media thickness compared to the control. Group A (n=5) was the control group, where only skin incision and laparotomy were performed. For Group B (n=5), a median laparotomy was performed, the abdominal aorta was partially transected, and repaired with an 8.0 prolene suture. Doses of 0.1 mg/kg and 0.2 mg/kg dexamethasone were administered in Group C (n=5) and Group D (n=5), respectively. After two weeks, all rats were euthanized, and the repaired abdominal aortas were excised and examined histopathologically. Intima and media thicknesses were measured using the 'Olympus AnalySIS 5' program (Olympus Corporation, Japan) after digital photos were taken. RESULTS: Based on the measurements, we demonstrated that after transection and repair of the abdominal aorta, the intima/media ratio was not significantly different between the low-dose dexamethasone and non-dexamethasone groups. The intima/media ratio was significantly lower in the high-dose dexamethasone group than in the non-dexamethasone and low-dose dexamethasone groups. CONCLUSION: After vascular interventions, dexamethasone treatment may reduce intimal hyperplasia and increase patency by providing vascular remodeling.
Asunto(s)
Aorta Abdominal , Dexametasona , Hiperplasia , Ratas Wistar , Túnica Íntima , Animales , Dexametasona/farmacología , Dexametasona/uso terapéutico , Dexametasona/administración & dosificación , Aorta Abdominal/cirugía , Aorta Abdominal/patología , Ratas , Hiperplasia/tratamiento farmacológico , Hiperplasia/patología , Hiperplasia/prevención & control , Túnica Íntima/patología , Túnica Íntima/efectos de los fármacos , Modelos Animales de Enfermedad , MasculinoRESUMEN
BACKGROUND: In this study, it was aimed to evaluate morphometrically and morphologically the left fibrous ring, mitral leaflets, tendinous cords, and papillary muscles, which are the components of the left atrioventricular valve complex (LAVC), and to reveal their clinical relationships. MATERIALS AND METHODS: A total of 120 human hearts were examined at the Forensic Medicine Institute. Cases aged 30 years and older, less than 24 hours after their death, were included in the study. Heart length, width, height/width ratio, anteroposterior and mediolateral diameters of the annulus, annular area, length and width of leaflets, number and attachment sites of tendinous cords, number, shape, length, the width of papillary muscles, and distances to various points were recorded to determine their spatial configurations. As well as the measurement data of LAVC components in cases with and without cardiovascular disease (CVD), the relationships of these data with the demographic characteristics of the cases are also explained. RESULTS: In the diagnostic performance test (ROC analysis), it was determined that body mass index (> 26.7), heart weight (> 414 g), heart height/width ratio (≤ 1.24), mitral valve width (> 99.96 mm), left ventricular wall thickness (> 15.08 mm), annular area (> 619.37 mm²) and mediolateral diameter of the annulus (> 30.71 mm) are important diagnostic criteria in determining CVD if they are outside the specified reference values. CONCLUSIONS: This study provides anatomical information about LAVC, as well as recommendations for diagnosis and surgical treatment planning. We therefore believe that our findings will be useful to clinicians.
RESUMEN
INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe disease treated with pulmonary endarterectomy. Our study aims to reveal the differences in liquid modalities and operation modifications, which can affect the patients' mortality and morbidity. METHODS: One hundred twenty-five patients who were diagnosed with CTEPH and underwent pulmonary thromboendarterectomy (PTE) at our center between February 2011 and September 2013 were included in this retrospective study with prospective observation. They were in New York Heart Association functional class II, III, or IV, and mean pulmonary artery pressure was > 40 mmHg. There were two groups, the crystalloid (Group 1) and colloid (Group 2) liquid groups, depending on the treatment fluids. P-value < 0.05 was considered statistically significant. RESULTS: Although the two different fluid types did not show a significant difference in mortality between groups, fluid balance sheets significantly affected the intragroup mortality rate. Negative fluid balance significantly decreased mortality in Group 1 (P<0.01). There was no difference in mortality in positive or negative fluid balance in Group 2 (P>0.05). Mean duration of stay in the intensive care unit (ICU) for Group 1 was 6.2 days and for Group 2 was 5.4 days (P>0.05). Readmission rate to the ICU for respiratory or non-respiratory reasons was 8.3% (n=4) in Group 1 and 11.7% (n=9) in Group 2 (P>0.05). CONCLUSION: Changes in fluid management have an etiological significance on possible complications in patient follow-up. We believe that as new approaches are reported, the number of comorbid events will decrease.
Asunto(s)
Hipertensión Pulmonar , Embolia Pulmonar , Humanos , Estudios Retrospectivos , Estudios Prospectivos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Morbilidad , Endarterectomía/efectos adversos , Arteria Pulmonar/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Thromboangiitis obliterans (TAO) causes vascular insufficiency due to chronic inflammation and abrupt thrombosis of the medium and small arteries of the extremities. In our study, we aimed to determine biomarkers for the diagnosis of TAO by evaluating 15 male TAO patients with Shinoya diagnostic criteria and 5 healthy controls who did not have TAO-related symptoms in their family histories. METHODS: The Clariom D Affymetrix platform was used to conduct microarray analysis on total RNA extracted from whole blood. A total of 477 genes (FC ≤ 5 or >5) common to the fifteen patient and five control samples were selected using comparative microarray analysis; among them, 79 genes were upregulated and 398 genes were downregulated. RESULTS: According to FC ≤ 10 or >10, in the same TAO patient and control group, 13 genes out of 28 were upregulated, whereas 15 genes were downregulated. The 11 key genes identified according to their mean log2FC values were PLP2, RPL27A, CCL4, FMNL1, EGR1, EIF4A1, RPL9, LAMP2, RNF149, EIF4G2, and DGKZ. The genes were ranked according to their relative expression as follows: FMNL1 > RNF149 > RPL27A > EIF4G2 > EIF4A1 > LAMP2 > EGR1 > PLP2 > DGKZ > RPL9 > CCL4. Using protein-protein interaction network analysis, RPL9, RPL27A, and RPL32 were found to be closely related to EIF4G2 and EIF4A1. The Reactome pathway found pathways linked to 28 genes. These pathways included the immune system, cellular responses to stress, cytokine signaling in the immune system, and signaling by ROBO receptors. CONCLUSIONS: By figuring out the protein expression levels of the genes that have been found to explain how TAO disease works at the molecular level, it will be possible to figure out how well these chosen transcripts can diagnose and predict the disease.
Asunto(s)
Tromboangitis Obliterante , Humanos , Masculino , Tromboangitis Obliterante/genética , Tromboangitis Obliterante/diagnóstico , Transcriptoma/genética , Biomarcadores , Transducción de Señal , Extremidades , ForminasRESUMEN
Background: This study aims to investigate the protective effects of glutamine against cerebral injury resulting from cerebral ischemia-reperfusion by bilateral carotid occlusion in rats. Methods: Eighteen Wistar albino rats were randomly divided into three equal groups: 1) control group; 2) ischemia-reperfusion group which underwent clamping of the carotid artery for 20 min; and 3) ischemiareperfusion + glutamine group which was treated with two doses of glutamine (1 g/kg) prior to the same clamping procedure as the ischemia-reperfusion group. All rats were sacrificed 24 h after the experiment. Their brain tissue was removed, separated into right and left hemispheres, and sent for analysis. Biochemical analysis was used to determine the oxidant parameters, antioxidant parameters, and glutathione levels in brain tissue. In the histopathological analysis of the brain tissue, ischemic markers such as red neurons, spongiosis, and satellitosis were examined. Results: Biochemical examination revealed that the levels of malondialdehyde and ferric reducing antioxidant power in the ischemia-reperfusion group were significantly higher than those in the control and ischemia-reperfusion + glutamine groups (p<0.05). The histopathological findings revealed that the levels of red neurons, satellitosis, and spongiosis in the ischemia-reperfusion group were significantly higher than those in the control group (p<0.05). The red neuron and spongiosis levels in the ischemia-reperfusion + glutamine group were significantly higher than those in the control group (p<0.05). Conclusion: Our study findings indicate that glutamine treatment has a protective effect against ischemia-reperfusion-induced brain damage in rats.
RESUMEN
INTRODUCTION: The aim of this study was to investigate the effect of chronic occlusive vascular disease on anxiety with adverse outcome with health-related quality of life (HRQoL). MATERIAL AND METHODS: Three hundred and thirty-five patients who were treated for peripheral arterial occlusive disease were enrolled in this study. 187 patients who had undergone percutaneous transluminal angioplasty and 148 patients who had one or more surgical revascularizations enrolled in the study. Mean age of the patients was 62.6 ±10 years. Two hundred and eighty-nine patients were male, 46 patients were female. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 335 patients filled out the SF-36 and STAI, and 304 patients (90.7 % of the series) filled them out at 6-month follow-up. RESULTS: There was no mortality and no significant morbidity after vascular interventions in the series. Significant improvement was found in two of eight health domains. The score of social functioning increased to 60.4 from 52.6 (p < 0.03) and general health perception increased to 75.1 from 60.5 (p < 0.04) at 6-month follow-up. The two STAI sub-scores, the State Anxiety Inventory (STAI-S) and the Trait Anxiety Inventory (STAI-T) were found high (≥ 40) both preoperatively and 6 months postoperatively. Postoperatively there was no significant decrease of the levels of anxiety. CONCLUSIONS: This study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status in patients suffering from lower extremity peripheral arterial occlusive disease.
RESUMEN
INTRODUCTION: The aim of this study was to investigate the effect of elective cardiac surgery on health-related quality of life (HRQoL). MATERIAL AND METHODS: One hundred and eight (35 women and 73 men, mean age 62.3 ±12.7 years) patients undergoing open heart surgery were enrolled in the study. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire, and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 108 patients filled out the SF-36 and STAI, and 102 patients at 6-month follow-up. RESULTS: It was found that there was significant improvement in three out of eight health domains: physical functioning (p < 0.02), role physical (p < 0.01), and social functioning (p < 0.04), at 6-month follow-up. The two STAI sub-scores: the State Anxiety Inventory and the Trait Anxiety Inventory were found to be high (≥ 40) both preoperatively and 6 months postoperatively. Postoperatively there was not any statistically significant decrease in the levels of anxiety. CONCLUSIONS: This study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status and HRQoL in patients after cardiovascular surgery. Furthermore, the assessment of preoperative well-being should be integrated in routine care in order to identify and support patients with higher levels of anxiety.
RESUMEN
BACKGROUND: This study was designed to investigate the anatomical relationship of the different levels of aortic root. MATERIALS AND METHODS: The morphological features of the aortic root were examined using of 12 adult hearts from fixed male cadavers who had expired due to noncardiac causes by magnetic resonance imaging and applied mathematical analyses to the results. The measurements of the aortic root were done at four levels: at the ventriculoarterial junction (annulus), at the largest level of the Valsalva sinuses (sinus), at the level of commissures (sinotubular junction [STJ]), and at 1 cm above the STJ (aorta ascendens). We derived an equation that allows calculation of the appropriate diameter of the aortic root from four levels. Statistical analysis among the variation of the diameters at the four levels of aortic root was achieved using test one-way analysis of variance. RESULTS: The data showed a geometric pattern of the aortic root. The comparison of the values from four levels showed that the narrowest at the sinotubular junctional level and the widest at the sinus level. CONCLUSION: The analysis of our data shows that the aortic root has a consistent shape with varying size and that is a definable mathematical relationship between root diameter.
RESUMEN
OBJECTIVE: The present study was designed to evaluate the relationship between gender and coexisting anxiety in patients undergoing coronary artery surgery. Materials and Methods: A total of 137 patients (41 women and 96 men with a mean age 66.1 ± 6.0 years) patients underwent state and trait anxiety evaluation at baseline (preoperatively) and at six months after (postoperatively) coronary artery bypass graft (CABG). Anxiety symptoms were assessed at enrollment using the Spielberger State-Trait Anxiety Inventory (STAI). Psychological, social, clinical, and surgical data were assessed statistically. Results: There were statistically significant differences between female and male patient characteristics for the mean age, mean education year, and mean body mass index. The women were found to be statistically younger and less educated, and more likely to be overweight, diabetic, and hyperlipidemic. The mean hospitalization time, wound infection, and extreme postoperative pain complaints were found to be higher in the female group. 61 patients (33 female and 28 male) (44.5%) were classified as presenting clinically significant anxiety symptoms (STAI score of ≥ 40). The female patients' STAI scores were significantly higher than men in state and trait anxiety, both preoperatively and six months postoperatively. Postoperatively, there was not any significant decrease in the level of trait anxiety when comparing the level of state anxiety in female patients. Conclusion: Even after adjusting for known risk factors for compromised STAI, women do not show the same long-term quality benefits of CABG surgery that men do. The results indicate that the STAI is a valuable instrument for identifying and supporting patients with higher levels of anxiety, which can aid in determining patients that may have poor adjustment after CABG surgery.
Asunto(s)
Ansiedad/epidemiología , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Dolor Postoperatorio/complicaciones , Medición de Riesgo , Anciano , Ansiedad/psicología , Comorbilidad/tendencias , Enfermedad de la Arteria Coronaria/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/psicología , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Tasa de Supervivencia , Turquía/epidemiologíaRESUMEN
This study determined the prevalence of retinal arteriolar emboli risk factors in 148 patients (86 males) diagnosed with coronary artery disease who required coronary artery bypass graft surgery (mean +/- SD age 59.1 +/- 12.9 years). The prevalence of smoking was 50.7%, hypertension was 49.3%, diabetes mellitus was 27.0% and obesity was 31.1%. Retinal arteriolar emboli were detected using binocular indirect ophthalmoscopy of both eyes. They were found in 10 patients (6.8%) and identified as the cholesterol type. Patients were divided according to their baseline low-density lipoprotein cholesterol (LDL-C) serum level; retinal arteriolar emboli were significantly more frequent in patients with LDL-C levels > 100 mg/dl. These results demonstrate that the prevalence of hypercholesterolaemia and high LDL-C were increased in patients with retinal arteriolar emboli. Identification and treatment of modifiable risk factors, such as high LDL-C and hypercholesterolaemia, might be beneficial in these individuals.
Asunto(s)
LDL-Colesterol/sangre , Enfermedad de la Arteria Coronaria/complicaciones , Embolia/etiología , Hipercolesterolemia/sangre , Arteria Retiniana , Enfermedades de la Retina/etiología , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/cirugía , Embolia/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Enfermedades de la Retina/sangre , Factores de RiesgoRESUMEN
BACKGROUND AND AIM OF THE STUDY: Small valve size and patient-prosthesis mismatch (PPM) generate high postoperative transvalvular gradients and may decrease both early and long-term survival. The study aim was to evaluate whether mismatch affected early mortality after aortic valve replacement (AVR) for isolated aortic stenosis (AS). METHODS: A total of 701 patients (437 males, 264 females; mean age 53.3 +/- 15.1 years; range: 14-84 years) with pure AS underwent AVR at the authors' institution between 1985 and 2005. The majority of patients (92%) received a mechanical valve. PPM was considered severe if the indexed effective orifice area was < or =0.65 cm2/m2, and moderate if > 0.65 but < or = 0.85 cm2/m2. RESULTS: Moderate-severe PPM was present in 47% of patients, and severe PPM in 13%. The early mortality was 5.4% (n=38). Multivariate analysis revealed age > or = 70 years (p < 0.001), female gender (p = 0.04) and severe PPM (p = 0.003) as independent predictors of early mortality. Moderate mismatch was not a predictor of early mortality on both univariate and multivariate analysis. Left ventricular dysfunction (ejection fraction < or = 40%) was a risk factor for early mortality only in patients with severe PPM. CONCLUSION: Patient-prosthesis mismatch should be prevented in patients undergoing AVR for isolated AS, especially in those with left ventricular dysfunction.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Prótesis Valvulares Cardíacas/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Válvula Aórtica/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Adulto JovenRESUMEN
Herein, we present a retrospective analysis of our experience with acquired pseudoaneurysms of the left ventricle over a 20-year period.From February 1985 through September 2004, 14 patients underwent operation for left ventricular pseudoaneurysm in our clinic. All pseudoaneurysms (12 chronic, 2 acute) were caused by myocardial infarction. The mean interval between myocardial infarction and diagnosis of pseudoaneurysm was 7 months (range, 1-11 mo). The pseudoaneurysm was located in the inferior or posterolateral wall in 11 of 14 patients (78.6%). In all patients, the pseudoaneurysm was resected and the ventricular wall defect was closed with direct suture (6 patients) or a patch (8 patients). Most patients had 3-vessel coronary artery disease. Coronary artery bypass grafting was performed in all patients. Five patients died (postoperative mortality rate, 35.7%) after repair of a pseudoaneurysm (post-infarction, 2 patients; chronic, 3 patients). Two patients died during follow-up (median, 42 mo), due to cancer in 1 patient and sudden death in the other. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients. Surgical repair is warranted particularly in cases of large or expanding pseudoaneurysms because of the propensity for fatal rupture.
Asunto(s)
Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Puente Cardiopulmonar , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/cirugía , Infarto del Miocardio/complicaciones , Anciano , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Femenino , Estudios de Seguimiento , Rotura Cardíaca Posinfarto/prevención & control , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Técnicas de Sutura , Resultado del Tratamiento , TurquíaRESUMEN
BACKGROUND AND AIM OF THE STUDY: The purpose of this study is to analyze the outcome results of reoperations in Marfan syndrome patients. METHODS: Between 1985 and December 2004, 49 patients with Marfan syndrome were operated for aortic aneurysms. Of these 49 patients, 9 (18,4%) required > or =1 reoperations after a mean duration of 32.2 +/- 26.6 months. The mean duration of follow-up was 52.0 +/- 46.8 months, a total of 39 patient/years. Survival free of reoperation was calculated by Cox regression analysis. RESULTS: Surgical indication for operation was a chronic aneurysmal dilatation of the ascending or abdominal aorta in seven patients (77.8%) and aortic dissection in two (22.2%) at the initial operation. In the reoperations, repair of thoracoabdominal aortic aneurysm with separated graft interposition in six patients (66.7%), replacement of ascending aorta in one (11.1%), replacement of ascending and hemiarchus aorta in one (11.1%), and mitral valve replacement in three patients (33.3%) were performed. The hospital mortality was 11.1% with one patient. Among the survivors, one expired in the follow-up five months after the second operation (12.5%). With the Cox regression analysis, survival without reoperation for 13, 24, and 123 months are 95.56 +/- 3.04%, 90.66 +/- 4.40%, and 60.32 +/- 12.63%, respectively. Mean survival for reoperated patients is 99 +/- 14 months (95% confidence interval 72-127 months). CONCLUSIONS: Reoperations can be done with low morbidity and mortality. Patients should be kept under close follow-up using imaging techniques infinitely.
Asunto(s)
Procedimientos Quirúrgicos Cardiovasculares , Síndrome de Marfan/cirugía , Adulto , Disección Aórtica/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Enfermedad Crónica , Dilatación Patológica/cirugía , Supervivencia sin Enfermedad , Circulación Extracorporea , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Masculino , Modelos de Riesgos Proporcionales , Reoperación , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: The purpose of our study is to compare the results of the sheathed and sheathless techniques for intraaortic balloon pump (IABP) insertion and to determine the rate of vascular complications in both conditions. METHODS: A total of 1211 patients were examined representing a period of 19 years. Three hundred five sheathless (Group I) and 906 sheathed (Group II) IABP catheters were evaluated retrospectively. Data were analyzed with univariate analysis and logistic regression. Relative risk (RR) values were calculated in order to examine the effect of sheath. RESULTS: Limb ischemia was seen in 129 patients (10.9%). Although the incidence of peripheral arterial disease (PAD) was relatively higher in Group I (11.1% vs. 3.6%), the ischemic complication rate was lower in Group I (5.2% vs. 12.4%; p = 0.001). Presence of PAD (p = 0.001) and diabetes mellitus (DM) (p = 0.007) was found to be the risk factors of ischemia related to IABP use in all cases. In logistic regression analysis, presence of PAD, DM, and sheathed method was found to be the risk factors of ischemia. The patients who had all of these risk factors suffered from limb ischemia (RR value: 35.17). CONCLUSION: PAD, DM, and sheathed insertion technique are the major risk factors of ischemia during IABP use. Among all these risk factors, the only modifiable risk factor is the use of introducer sheath. With the presence of PAD and DM, the choice of sheathed method would increase the probability of ischemia almost 35 times. Sheathless method of insertion should be preferred in patients with DM and PAD.
Asunto(s)
Extremidades/irrigación sanguínea , Contrapulsador Intraaórtico , Isquemia/etiología , Selección de Paciente , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Catéteres de Permanencia , Diseño de Equipo , Seguridad de Equipos , Femenino , Insuficiencia Cardíaca/cirugía , Mortalidad Hospitalaria , Humanos , Contrapulsador Intraaórtico/efectos adversos , Contrapulsador Intraaórtico/instrumentación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
OBJECTIVE: Internal thoracic artery (ITA) grafting to the left anterior descending artery (LAD) may have catastrophic consequences and can be fatal due to "ITA malperfusion syndrome." We have investigated the efficacy of a second graft in this syndrome. METHODS: A total of 35 patients, 29 males (82.9%) and 6 females (17.1%), with a mean age of 53.0 +/- 8.7, (range: 38 to 70) undergoing coronary artery bypass grafting required a second supply to LAD due to ITA malperfusion syndrome. This was performed using a saphenous vein graft. The mean number of distal anastomosis was 2.7 +/- 0.45 per patient (range: 1 to 5). The decision for an additional grafting procedure was made in the first operation for 18 patients (51.4%) (Group I). For the remaining 17 patients (48.6%) (Group II), the additional grafting procedures were performed during a reoperation after the development of ischemic complications in the intensive care unit (ICU). RESULTS: The early mortality rate was 8.6% (3 of 35). Two patients had perioperative myocardial infarction (MI) (5.7%). The second vein graft proved to dramatically reduce the incidence of postoperative MI. Malignant refractory arrhythmias were recorded in 17 patients (48.6%). Twelve patients (34.3%) required inotropic support and seven patients (20%), all in Group II, required intra-aortic balloon pump (IABP) support. The average duration of IABP was 5 days +/- 1.8 days (range: 3 to 7). The necessity of IABP support was found to be statistically higher in the second group compared to the first one. CONCLUSIONS: Double supply to LAD using an additional saphenous vein graft is the treatment of choice for ITA malperfusion syndrome. The time interval between the first and the second grafts appears to be crucial for postoperative patient outcome.
Asunto(s)
Enfermedad de la Arteria Coronaria/cirugía , Vasos Coronarios/cirugía , Oclusión de Injerto Vascular/cirugía , Arterias Mamarias/patología , Arterias Mamarias/cirugía , Vena Safena/trasplante , Adulto , Anciano , Anastomosis Quirúrgica , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/mortalidad , Humanos , Unidades de Cuidados Intensivos , Contrapulsador Intraaórtico , Tiempo de Internación , Masculino , Persona de Mediana Edad , Reoperación , Análisis de Supervivencia , Síndrome , Resultado del TratamientoRESUMEN
BACKGROUND: Behcet's disease is a chronic inflammatory disease with a relapsing course. Behcet's disease affects many systems and causes hypercoagulability, and detection of an intracardiac mass in a Behcet patient should raise the question of an intracardiac thrombus. We analyzed our patients with Behcet's disease operated for valvular disease. METHODS: We operated three patients (one male and two females) who had been diagnosed as having Behcet's disease previously. Using mechanical bileaflet valves, aortic valve replacement in two and mitral valve replacement in the other patient were performed. Mechanical valve replacement was performed using pledgetted-interrupted sutures in the mitral procedure. Patients' steroid therapies were not interrupted and in the postoperative course, steroid was continued. No reoperations were needed. Anticoagulation with warfarin was instituted after the operation with the target of an international normalized ratio (INR) between 3 and 3.5. RESULTS: There was no mortality either early or late follow-up. Intraoperative and postoperative courses were uneventful. Two had ventricular arrhythmias. Total follow-up was 23.3 patient/years with a mean of 93.3 +/- 64.7 months. In the late follow-up, patient with the mechanical mitral valve experienced a cerebrovascular accident 40 months after the operation. Her echocardiographic examination gave a functional valve without any pathology. CONCLUSIONS: Surgeons should remember the hypercoagulable state in Behcet patients and strict anticoagulation protocols should be utilized. In the operations, bileaflet prostheses should be used.
Asunto(s)
Síndrome de Behçet/complicaciones , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Adulto , Anticoagulantes/uso terapéutico , Síndrome de Behçet/tratamiento farmacológico , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Glucocorticoides/uso terapéutico , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Humanos , Masculino , Complicaciones Posoperatorias/prevención & control , Trombosis/prevención & control , Resultado del TratamientoRESUMEN
BACKGROUND: The effects of exogenous L-aspartate and L-glutamate-enriched cardioplegia on postoperative left ventricular functions after coronary artery bypass surgery in patients with moderate left ventricular dysfunction (left ventricular ejection fraction [LVEF]= 30-40%) were studied. METHODS: In this prospective randomized study, 22 patients with moderate left ventricular dysfunction (mean LVEF = 37.27%+/- 3.43%), who underwent elective coronary artery bypass surgery, were examined. Isothermic substrate-enriched [L-aspartate and L-glutamate (13 mmol/L)] blood cardioplegia was used in 11 patients (Group AG), and cardioplegia including only potassium and sodium bicarbonate was used in 11 patients (Group C). All hemodynamic parameters for left and right heart were studied in both groups. Total perfusion time was 126.63 +/- 44.91 minutes versus 114.81 +/- 43.66 minutes (p = 0.54). The aortic cross-clamp time was 77.09 +/- 28.02 minutes versus 67.81 +/- 22.77 minutes (p = 0.4), respectively. The amount of cardioplegic solutions were 7218.2 +/- 3043.6 mL versus 5454.5 +/- 3048.1 mL (p = 0.167). Mean number of distal anastomosis were 3 +/- 0.89 versus 2.9 +/- 0.7 (p = 0.793). RESULTS: There was no difference between both groups in intra- and postoperative periods. In coronary sinus blood gas measures, myocardial acidosis caused by the aortic cross-clamp was found to be more severe in the Group C, but delta pH (0.12 +/- 0.14 vs. 0.092 +/- 0.058; p = 0.613) and delta lactate (1.39 +/- 1.03 vs. 1.62 +/- 0.85; p = 0.579) were similar in both groups. Free oxygen radical production caused by aortic cross-clamp was significant in the Group C. Not all myocardial enzymes, but Troponin-T levels were found higher in control group than the study group (0.6 +/- 0.36 vs. 0.36 +/- 0.25; p = 0.1). CONCLUSIONS: Although L-aspartate and L-glutamate favor myocardial metabolic functions, they do not have any affect on myocardial functional recovery in patients with moderate left ventricular dysfunction.
Asunto(s)
Ácido Aspártico/uso terapéutico , Puente de Arteria Coronaria , Ácido Glutámico/uso terapéutico , Paro Cardíaco Inducido/métodos , Disfunción Ventricular Izquierda/tratamiento farmacológico , Ácido Aspártico/farmacología , Estudios de Casos y Controles , Femenino , Ácido Glutámico/farmacología , Humanos , Masculino , Persona de Mediana Edad , Miocardio/metabolismo , Periodo PosoperatorioRESUMEN
BACKGROUND AND AIM OF THE STUDY: We present our experience on patients with renal artery stenosis undergoing myocardial revascularization procedures. METHODS: Eighteen patients with varying degrees of renal artery stenosis were operated for coronary artery bypass grafting between 1996 and 2003. The overall incidence was 0.15%. There were nine male and nine female patients with a mean age of 62 +/- 8.2 (40-72 years). Four had bilateral and eight had significant unilateral (>50%) renal artery stenoses. Preoperatively, three patients had renal arterial intervention (stenting), and one patient was on hemodialysis. The mean preoperative creatinine value was 2.6 +/- 2.7 mg/dL (range 0.7 to 9.3). The patients were followed medically: two patients underwent off-pump coronary bypass grafting and the others were operated on-pump. RESULTS: There was only one mortality and two patients required hemodialysis postoperatively. The postoperative mean creatinine values were 3.4 +/- 4.9 mg/dL (range 1.0 to 12.5). No electrolyte imbalances were noted except that one case revealed a transient metabolic acidosis. Five patients required inotropic support with dopamine and two needed diuretic infusions. Only five patients demonstrated a refractory hyper tensive period postoperatively. CONCLUSIONS: The concomitant correction of renal artery stenosis with CABG is usually not necessary, but the principles for renovascular diseases must be kept in mind and individually oriented strategies must be planned.