RESUMEN
Calcific constrictive pericarditis is a very rare complication of systemic sclerosis. This is the first report of surgically treated calcific constrictive pericarditis in systemic sclerosis. A 53 years-old woman, affected by limited systemic sclerosis, had a diagnosis of calcific constrictive pericarditis. She had a medical history of congestive heart failure since 2022. The patient was treated with pericardiectomy. Via a median sternotomy, the pericardium was dissected and removed from the midline to the left phrenic nerve, thus freeing the heart. Three months after the pericardiectomy, there was a significant clinical improvement. The calcific evolution of chronic pericarditis is a rare complication of systemic sclerosis. This case represents, at best of our knowledge, the first report of calcific constrictive pericarditis, in systemic sclerosis, treated with pericardiectomy.
Asunto(s)
Pericarditis Constrictiva , Pericarditis , Esclerodermia Sistémica , Femenino , Humanos , Persona de Mediana Edad , Pericarditis Constrictiva/cirugía , Pericarditis Constrictiva/complicaciones , Pericardiectomía/efectos adversos , Pericardio/cirugía , Esclerodermia Sistémica/complicacionesRESUMEN
INTRODUCTION: Carotid atherosclerotic disease is a known independent risk factor of post operative stroke after coronary artery bypass grafting (CABG). The best management of concomitant coronary artery disease and carotid artery disease remains debated. Current strategies include simultaneous carotid endoarterectomy (CEA) and CABG, staged CEA followed by CABG, staged CABG followed by CEA, staged transfemoral carotid artery stenting (TF-CAS) followed by CABG, simultaneous TF-CAS and CABG and transcarotid artery stenting. METHODS: We report our experience based on a cohort of 222 patients undergoing combined CEA and CABG surgery who come to our observation from 2004 to 2020. All patients with >70% carotid stenosis and severe multivessel or common truncal coronary artery disease underwent combined CEA and CABG surgery at our instituion. 30% of patients had previously remote neurological symptoms or a cerebral CT-scan with ischemic lesions. Patients with carotid stenosis >70%, either asymptomatic or symptomatic, underwent CT-scan without contrast media to assess ischemic brain injury, and in some cases, if necessary, CT-angiography of the neck and intracranial vessels. RESULTS: The overall perioperative mortality rate was 4.1% (9/222 patients). Two patients (.9%) had periprocedural ipsilateral transient ischemic attack (TIA) which completely resolved by the second postoperative day. Two patients (.9%) had an ipsilateral stroke, while 7 patients (3.2%) had a stroke of the controlateral brain hemisphere. Two patients (.9%) patients were affected by periprocedural coma caused by cerebral hypoperfusion due to perioperative heart failure. There were no statistically significant differences between patients in Extracorporeal Circulation (ECC) and Off-pump patients in the onset of perioperative stroke. CONCLUSION: Our experience reported that combined surgical treatment of CEA and CABG, possibly Off-Pump, is a feasible treatment procedure, able to minimize the risk of post-operative stroke and cognitive deficits.
Asunto(s)
Enfermedades de las Arterias Carótidas , Estenosis Carotídea , Enfermedad de la Arteria Coronaria , Endarterectomía Carotidea , Accidente Cerebrovascular , Enfermedades de las Arterias Carótidas/complicaciones , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Puente de Arteria Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Endarterectomía Carotidea/efectos adversos , Humanos , Stents/efectos adversos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/etiología , Resultado del TratamientoRESUMEN
BACKGROUND AND AIM: Second-order chord tethering of the anterior leaflet is a risk factor for failure of posterior leaflet prolapse repair. MATERIALS AND METHODS: We describe two cases of second-order chord tethering of the anterior leaflet associated with severe mitral regurgitation due to prolapse or chordal rupture of the anterior leaflet, causing early and late failure of repair. RESULTS: We described two cases where this phenomenon happened. CONCLUSIONS: Our cases demonstrate that the second-order chords of the prolapsing AL can be tethered and that this aspect should be carefully evaluated before surgery, as it can progress over time, affecting the results of surgical repair.
Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas/métodos , Anuloplastia de la Válvula Mitral/métodos , Insuficiencia de la Válvula Mitral/cirugía , Prolapso de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Insuficiencia del Tratamiento , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/patología , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/diagnóstico por imagen , Recurrencia , Factores de Riesgo , Rotura Espontánea/diagnóstico por imagen , Rotura Espontánea/cirugía , Factores de Tiempo , Resultado del TratamientoRESUMEN
El uno de enero de 2016 entrará en vigor la Ley 35/2015, de 22 de septiembre, de reforma del sistema para la valoración de los daños y perjuicios causados a las personas en accidentes de circulación, el querido «Baremo de accidentes de tráfico». Este artículo describe el capítulo referido a la urología, el aparato genitourinario y el aparato genital masculino. El autor expresa su criterio sobre los diferentes «ítems» que se contemplan en el «baremo» y lo que considera que podría ser recogido en el mismo (AU)
On January 1st of 2016 on the reform of scale by Law 35/2015 shall come into force, the beloved Scale of accidents. The article focused on the chapter on Urology, genitourinary system and male genital tract. The author expresses his opinion on different items that are contemplated in the scale and what he considers could be collected in the chapter (AU)
Asunto(s)
Humanos , Masculino , Sistema Urogenital/lesiones , Enfermedades Urogenitales Masculinas/complicaciones , Accidentes de Tránsito/legislación & jurisprudencia , Medicina Legal/legislación & jurisprudencia , Evaluación de Daños/legislación & jurisprudencia , 51727/legislación & jurisprudencia , 51727/métodos , Jurisprudencia/legislación & jurisprudencia , Medicina Legal/normas , Medicina Legal/tendencias , Estadísticas de Secuelas y Discapacidad , Uréter/patología , Enfermedades Ureterales/complicacionesRESUMEN
Mitral valve repair for ischaemic mitral incompetence has a 10% rate of failure at ten year follow-up. Progressive annular dilation could play an important role. We have implanted the enCor(SQ)(TM) mitral valve repair system. This system can be downsized during follow-up with the appropriate activation via the lead passed through the left atrium suture line, in order to restore mitral leaflet coaptation.
Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Anuloplastia de la Válvula Mitral/instrumentación , Insuficiencia de la Válvula Mitral/cirugía , Humanos , Diseño de Prótesis , Técnicas de Sutura , Resultado del TratamientoRESUMEN
The purpose of this report is to present the case of a 59-year-old man affected by multivessel coronary artery disease and sterile pseudoaneurysm of the right carotid bifurcation presenting as a pulsating neck mass 1 month after patch-free carotid endarterectomy. The surgical approach included median sternotomy and incision parallel to the anterior margin of the right sternocleidomastoid muscle. The pseudoaneurysm was excised after control of the brachiocefalic trunk and insertion of a Pruit-Inahara shunt, and the carotid vessels were directly sutured without using any prosthetic or autologous material. Concomitant coronary bypass grafting was performed. The postoperative course was uneventful and there was no evidence of recurrence of pseudoaneurysm at 6-month follow-up. On the basis of this experience and of pertinent literature, the options for the management of such rare entities are discussed.
Asunto(s)
Traumatismos de las Arterias Carótidas/etiología , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/efectos adversos , Anastomosis Quirúrgica , Traumatismos de las Arterias Carótidas/complicaciones , Traumatismos de las Arterias Carótidas/patología , Traumatismos de las Arterias Carótidas/cirugía , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/cirugía , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Técnicas de Sutura , Resultado del TratamientoRESUMEN
BACKGROUND: Diabetes mellitus is an established risk factor for leg wound healing complications after great saphenous vein harvest. Leg healing complications occur in 1-25% of coronary artery bypass graft patients, and are often underestimated. PATIENTS AND METHODS: The records of 230 patients enrolled in a prospective trial to evaluate a minimally invasive approach compared with conventional longitudinal harvest were reviewed. Of 100 patients with diabetes, 49 had undergone minimally invasive harvest (group A). Forty-nine patients from the pool without diabetes who underwent minimally invasive harvest were selected using propensity scoring analysis (group B), and 46 diabetic patients operated using a conventional technique (group C) were matched to group A patients. Ninety-five patients with and 49 without diabetes finally entered the study. The quality of leg wound healing was quantified by ASEPSIS score by two independent surgeons in a blinded manner. The occurrence of complications was compared between groups. RESULTS: Fewer leg wound healing complications occurred in diabetic patients in the minimally invasive compared with the conventional group (P < 0.0001). Rates of complications were comparable among diabetic and non-diabetic patients operated using the minimally invasive technique. The intraoperative flow of vein grafts obtained by the minimally invasive technique was comparable to that of veins harvested using the conventional technique. CONCLUSION: These data suggest that postoperative leg wound morbidity can be significantly attenuated by the adoption of a less invasive approach, even in high-risk patients with diabetes. The advantages are not offset by the co-existence of other cardiovascular risk factors or by a long history of diabetes.
Asunto(s)
Diabetes Mellitus Tipo 2/fisiopatología , Complicaciones Posoperatorias/prevención & control , Vena Safena/trasplante , Recolección de Tejidos y Órganos/métodos , Cicatrización de Heridas/fisiología , Anciano , Velocidad del Flujo Sanguíneo/fisiología , Puente de Arteria Coronaria , Femenino , Humanos , Pierna/fisiología , Pierna/cirugía , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Complicaciones Posoperatorias/fisiopatología , Estudios Prospectivos , Vena Safena/fisiología , Infección de la Herida Quirúrgica/microbiologíaRESUMEN
BACKGROUND: The Ultracision Harmonic Scalpel is associated with several advantages in radial artery (RA) harvesting. It allows fewer hemostatic clips to close the collateral branches, less thermal injury of the conduit, and reduced time of harvesting in comparison with the conventional RA harvesting technique with electrocautery and hemostatic clips. We recently started open RA harvesting with the harmonic shears (HSH). In this study, we aimed at evaluating the feasibility of this simplified ultrasonically activated harvesting technique, and report the results of RA harvesting with HSH. METHODS: The RA harvesting with HSH was performed in 20 patients operated on for myocardial revascularization from July 2004 to December 2005. RESULTS: The harvest of the RA was completed in little time, without any complication. Neither bleeding from the collateral branches nor spasm alongside the entire length of the RA was observed. No bleeding occurred from the muscles of the forearm. CONCLUSION: This technique of RA harvesting with HSH is impressive in terms of short time of harvest, complete absence of clips for the collateral branches, and no thermal injury of the conduit.