Asunto(s)
Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/métodos , Síndrome de Marfan/complicaciones , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/cirugía , Angiografía/métodos , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/etiología , Aneurisma de la Aorta Torácica/cirugía , Biopsia con Aguja , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Humanos , Inmunohistoquímica , Cuidados Intraoperatorios/métodos , Masculino , Síndrome de Marfan/diagnóstico , Medición de Riesgo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodos , Adulto JovenRESUMEN
BACKGROUND AND AIM OF THE STUDY: The study aim was to assess the surgical options and advantages of beating-heart aortic valve replacement (AVR) in patients with patent coronary artery bypasses. METHODS: In this prospective study, conducted between January and August 2006, four consecutive patients (mean age 77.5 +/- 6.6 years) each with patent coronary artery bypasses, underwent beating-heart AVR using two specific methods of myocardial perfusion based on the origin and status of the grafts, as assessed by preoperative angiography. Pre-operatively, all patients were in NYHA functional class III, and each received an aortic valve bioprosthesis. RESULTS: There were no hospital deaths. The mean duration of ICU stay was 3.2 +/- 1.3 days. One patient presented with transitory atrial fibrillation. At discharge, echocardiography confirmed normally functioning bioprostheses, with no significant transprosthetic gradient. CONCLUSION: Beating-heart AVR with patent coronary artery bypasses using continuous myocardial perfusion is a reliable, simple and effective technique to reduce the risks of graft and myocardial injuries, and to achieve optimal preservation of the hypertrophic myocardium with coronary artery disease.
Asunto(s)
Válvula Aórtica/trasplante , Bioprótesis , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/cirugía , Puente de Arteria Coronaria , Circulación Coronaria , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Reperfusión Miocárdica/métodos , Estudios Prospectivos , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Heparin-induced thrombocytopenia and thrombosis syndrome (type II) is associated with thromboembolic complications and a mortality rate up to 30%. We describe a patient who developed intracardiac and aortic Dacron prosthesis heparin-induced thrombosis after aortic root conservative surgery. Successive transoesophageal echocardiographies demonstrated a progressive regression of intracardiac thrombosis with oral anticoagulation by warfarin and antiplatelet therapy combining aspirin and clopidogrel.