Asunto(s)
Puente Cardiopulmonar , Factor XII , Pruebas de Coagulación Sanguínea , Transfusión Sanguínea , Heparina , HumanosRESUMEN
Thrombocytopenia is a recognized complication following aortic valve replacement (AVR). While post-operative thrombotic thrombocytopenic purpura (TTP) is less common than heparin-induced thrombocytopenia (HIT), it is associated with high mortality and morbidity and prompt diagnosis and treatment is vital. In this case report, we describe the first reported case of TTP after AVR using the trifecta bio-prosthesis. We recommend that patients with severe and progressive thrombocytopenia following biological AVR should have early screening for both HIT and TTP, to shorten the decision-making process and provide the appropriate therapy.
RESUMEN
'Sutureless' or rapid-deployment (RD) aortic valve replacement (AVR) is an emerging alternative to standard AVR in elderly high-risk surgical patients. Here, the authors describe their implantation technique for the newer-generation Edwards INTUITY-Elite® valve (Edwards Lifesciences, Irvine, CA, USA), a balloon-expandable stented trileaflet bovine pericardial bioprosthesis that received CE Mark European approval in April 2014.
Asunto(s)
Válvula Aórtica/cirugía , Bioprótesis , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Stents , Procedimientos Quirúrgicos sin Sutura , Válvula Aórtica/fisiopatología , Valvuloplastia con Balón , Calcinosis , Enfermedades de las Válvulas Cardíacas/fisiopatología , Humanos , Diseño de Prótesis , Resultado del TratamientoAsunto(s)
Cardiomiopatías/cirugía , Insuficiencia de la Válvula Mitral/complicaciones , Válvula Mitral/cirugía , Infarto del Miocardio/complicaciones , Músculos Papilares/cirugía , Cardiomiopatías/etiología , Reanimación Cardiopulmonar , Paro Cardíaco , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/cirugía , Rotura Espontánea/cirugía , Sepsis/complicacionesRESUMEN
Post-sternotomy pseudoaneurysms of the internal mammary arteries (IMAs) and their branches are rare and often present with rupture-associated haemothorax and haemodynamic instability. In those cases, urgent surgical correction or embolization can be the treatment of choice. Traumatic chest injuries might lead to IMA branch injury as well; after cardiac surgery, injuries to these branches during sternal closure can be an extremely rare cause of pseudoaneurysm. We describe the case of a 78-year old lady with a left IMA branch pseudoaneurysm, arising from left sternal edge a few weeks after redo-sternotomy for mitral valve surgery. We also describe its non-surgical successful repair.
Asunto(s)
Aneurisma Falso/etiología , Procedimientos Quirúrgicos Cardíacos , Arterias Mamarias/lesiones , Esternotomía/efectos adversos , Lesiones del Sistema Vascular/etiología , Anciano , Aneurisma Falso/diagnóstico , Aneurisma Falso/terapia , Embolización Terapéutica , Femenino , Humanos , Arterias Mamarias/diagnóstico por imagen , Reoperación , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/terapiaRESUMEN
Sinus of Valsalva aneurysms are very rare and are often asymptomatic. Clinical manifestations depend on associated complications, most commonly rupture or dissection. We describe the unusual case of a 46-year old presenting with exercise-induced ventricular fibrillation due to extrinsic compression of the left coronary artery. We also describe the surgical correction by valve-sparing aortic root replacement.
Asunto(s)
Aneurisma de la Aorta/complicaciones , Esfuerzo Físico , Seno Aórtico , Fibrilación Ventricular/etiología , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular , Angiografía Coronaria/métodos , Humanos , Masculino , Persona de Mediana Edad , Carrera , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Fibrilación Ventricular/diagnósticoRESUMEN
OBJECTIVE: We report the long-term results of left ventricular surgical restoration in which 2 different strategies were used, which had restoration of ventricular volume or ventricular shape as their target. METHODS: From 1988 to 2008, 308 patients with anterior scars underwent elective left ventricular surgical restoration. Before 2002, a Dor procedure was performed in 107 cases to reduce left ventricular volume (group V); from 1998 to 2001, a Guilmet procedure was performed in 32 patients to rebuild a left ventricular conical shape (group S). From 2002, 169 patients (group S) underwent left ventricular surgical restoration to reshape a conical left ventricle by means of the Dor procedure (n = 29, septoapical scars) or septal reshaping (n = 140, when the septum was more involved than the anterior wall). The 2 groups were similar for all features but age, mitral regurgitation grade, mitral valve surgery rate (higher in group S), and ejection fraction (higher in group V). RESULTS: Early mortality was 7.8% (11.2% in group V vs 6.0% in group S, P = .102). Logistic regression showed that volume reduction was significantly related to higher early mortality. Five-year cardiac survival, cardiac event-free survival, and event-free survival were higher in group S. Cox analysis showed that the choice of volume reduction provided lower survival (hazard ratio, 2.1), cardiac survival (hazard ratio, 3.0), cardiac event-free survival (hazard ratio, 2.7), and event-free survival (hazard ratio, 2.2). When 30-day events were excluded, volume reduction was still a risk factor for cardiac event-free survival (hazard ratio, 2.2). CONCLUSIONS: When the main target of left ventricular surgical restoration is left ventricular reshaping rather than left ventricular volume reduction, early and late outcomes seem to improve.
