ABSTRACT
BACKGROUND: There is increasing evidence that programmed cell death can be triggered during cardiopulmonary bypass (CPB) and may be involved in postoperative complications. The purpose of this study was to investigate whether apoptosis occurs during aortic valve surgery and whether modifying temperature during CPB has any influence on cardiomyocyte apoptotic death rate. METHODS: 20 patients undergoing elective aortic valve replacement for aortic stenosis were randomly assigned to either moderate hypothermic (ModHT group, n = 10, 28 degrees C) or mild hypothermic (MiHT group, n = 10, 34 degrees C) CPB. Myocardial samples were obtained from the right atrium before and after weaning from CPB. Specimens were examined for apoptosis by flow cytometry analysis of annexin V-propidium iodide (PI) and Fas death receptor staining. RESULTS: In the ModHT group, non apoptotic non necrotic cells (annexin negative, PI negative) decreased after CPB, while early apoptotic (annexin positive, PI negative) and late apoptotic or necrotic (PI positive) cells increased. In contrast, no change in the different cell populations was observed over time in the MiHT group. Fas expression rose after reperfusion in the ModHT group but not in MiHT patients, in which there was even a trend for a lower Fas staining after CPB (p = 0.08). In ModHT patients, a prolonged ischemic time tended to induce a higher increase of Fas (p = 0.061). CONCLUSION: Our data suggest that apoptosis signal cascade is activated at early stages during aortic valve replacement under ModHT CPB. This apoptosis induction can effectively be attenuated by a more normothermic procedure.
Subject(s)
Aortic Valve Stenosis/surgery , Apoptosis/physiology , Cardiopulmonary Bypass/methods , Heart Valve Prosthesis Implantation/adverse effects , Hypothermia, Induced , Myocytes, Cardiac/physiology , Aged , Aged, 80 and over , Aortic Valve Stenosis/pathology , Aortic Valve Stenosis/physiopathology , Cardiopulmonary Bypass/adverse effects , Female , Heart Atria/pathology , Humans , Male , Middle Aged , Receptors, Death Domain/metabolism , Stroke Volume , Treatment Outcome , fas Receptor/metabolismABSTRACT
Valve repair is the best surgical treatment for mitral regurgitation. In the present article we describe the results of mitral valve repair in patients with chronic mitral regurgitation treated at our center during the last eight years. The degree of correction of valve insufficiency, functional benefit, in-hospital morbidity and mortality, postoperative outcome of ventricular function, and middle-term overall and reoperation-free survival are analyzed.
Subject(s)
Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Cardiac Surgical Procedures , Chronic Disease , Echocardiography, Transesophageal , Female , Follow-Up Studies , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/mortality , Mitral Valve Insufficiency/physiopathology , Stroke Volume , Survival Analysis , Treatment OutcomeABSTRACT
La reparación valvular es el tratamiento quirúrgico ideal de la insuficiencia mitral. En este trabajo presentamos los resultados de la reparación valvular en pacientes con insuficiencia mitral crónica operados en nuestro centro durante los últimos 8 años. Analizamos el grado de corrección de la insuficiencia, el beneficio funcional, la morbimortalidad hospitalaria, la evolución posquirúrgica de la función ventricular y la supervivencia global y libre de reoperación a medio plazo
Valve repair is the best surgical treatment for mitral regurgitation. In the present article we describe the results of mitral valve repair in patients with chronic mitral regurgitation treated at our center during the last eight years. The degree of correction of valve insufficiency, functional benefit, in-hospital morbidity and mortality, postoperative outcome of ventricular function, and middle-term overall and reoperation-free survival are analyzed
Subject(s)
Adult , Aged , Aged, 80 and over , Humans , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/physiopathology , Mitral Valve Insufficiency/surgery , Cardiac Surgical Procedures , Echocardiography, Transesophageal , Mitral Valve Insufficiency/mortality , Mitral Valve Insufficiency , Stroke Volume , Survival Analysis , Treatment OutcomeABSTRACT
INTRODUCTION AND OBJECTIVES: Five percent of the patients with hypertrophic obstructive cardiomyopathy (HOCM) have symptoms unresponsive to medical treatment and are candidates for invasive therapy. The objective of this study was to analyze our results with surgical treatment of HOCM during the last 10 years. PATIENTS AND METHOD: Between July 1993 and January 2004 26 patients with HOCM refractory to drug therapy were operated on. An extended septal myectomy was performed, in combination with anterior mitral leaflet plication in 19 cases (73%) and with mitral valve replacement in 5 (19%). Evolution of the grade of dyspnea, left ventricle outflow tract gradient (LVOTG), mitral regurgitation, and systolic anterior motion after surgery was analyzed. RESULTS: Mean follow-up was 63 (37) months. After surgery, a significant reduction in LVOTG (from 96.5 to 19.5 mmHg; P<.001), grade of mitral regurgitation (from 2.54 to 0.69; P<.001) and systolic anterior motion (from 2.92 to 0.23; P<.001) was achieved, which led to improvement in functional class. Hospital mortality and need for pacemaker implantation due to complete heart block after surgery was 3.8% (n=1). There were no cases of iatrogenic ventricular septal defect or mitro-aortic valve injury. Actuarial survival at 5 years was 96% (4%). CONCLUSIONS: Surgery in patients with HOCM yields great clinical improvements with low morbidity and mortality. Simultaneous intervention for both myocardial and valvular components of the disease allows not only reduction in the LVOTG but also correction of mitral regurgitation and abolition of systolic anterior motion.
Subject(s)
Cardiomyopathy, Hypertrophic/surgery , Heart Septum/surgery , Adult , Aged , Cardiac Surgical Procedures/methods , Cardiomyopathy, Hypertrophic/diagnosis , Cardiomyopathy, Hypertrophic/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Mitral Valve/pathology , Mitral Valve/surgery , Ventricular Outflow Obstruction/physiopathologyABSTRACT
Pheochromocytoma is a catecholamine-producing tumor and a rare cause of hypertension. Most cases are intra-adrenal and intrapericardial pheochromocytomas are extremely uncommon. We report the case of a 46-year-old woman with a 1-year history of hypertension, in which a right atrial pheochromocytoma was detected after a hypertensive crisis. 131I-metaiodobenzylguanidine scintigraphy and magnetic resonance imaging established the diagnosis. The tumor was successfully resected using cardiopulmonary bypass and the right atrium was reconstructed using bovine pericardium.
Subject(s)
Cardiomyopathies/chemically induced , Cocaine-Related Disorders/pathology , Cocaine/pharmacokinetics , Nasal Mucosa/metabolism , Adult , Cardiomyopathies/diagnostic imaging , Cardiomyopathies/physiopathology , Female , Humans , Myocardial Contraction , UltrasonographyABSTRACT
El feocromocitoma es un tumor productor de catecolaminas y una causa infrecuente de hipertensión arterial. La mayoría están localizados en la glándula suprarrenal, siendo la localización intrapericárdica una rareza. Describimos el caso de una paciente de 46 años, hipertensa de un año de evolución, a la que tras una crisis hipertensiva se le diagnosticó un feocromocitoma de aurícula derecha mediante gammagrafía con 131 I-metaiodobencilguanidina y resonancia magnética. El tumor fue resecado con éxito mediante circulación extracorpórea y la pared auricular, reconstruida con un parche de pericardio bovino (AU)
