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1.
Ann Vasc Surg ; 100: 138-147, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38141967

RESUMEN

BACKGROUND: Prophylactic embolization of the inferior mesenteric artery (IMA) during endovascular aneurysm repair (EVAR) is recommended to prevent type 2 endoleak (T2EL). However, the impact of patent lumbar arteries (LAs) on T2ELs and aneurysm diameter has not been elucidated. METHODS: Fifty-seven consecutive patients who underwent EVAR at our institution between January 2013 and September 2022 and whose IMA had been occluded preoperatively or newly occluded postoperatively were included in the study. Predictive factors for aneurysm sac enlargement, sac shrinkage, and T2EL were investigated. RESULTS: T2ELs occurred in 22.8% of the patients. The 4-year cumulative incidence rates of sac enlargement and shrinkage were 6.7% and 64.6%, respectively. The number of postoperative patent LAs was identified as a risk factor for T2ELs (95% confidence interval [CI]: 1.54-12.7, P = 0.0065). The number of postoperative patent LAs was found to be a significant predictor of sac enlargement (adjusted hazard ratio [AHR] 3.15, 95% CI: 1.43-6.96, P = 0.0045) and shrinkage (AHR 0.63, 95% CI: 0.43-0.91, P = 0.014). CONCLUSIONS: The current study demonstrated that the number of postoperative patent LAs had a significant impact on the development of T2ELs and the change in aneurysm diameter in patients in whom the IMA was occluded after EVAR.


Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Embolización Terapéutica , Procedimientos Endovasculares , Humanos , Endofuga/diagnóstico por imagen , Endofuga/etiología , Endofuga/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Reparación Endovascular de Aneurismas , Resultado del Tratamiento , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Aorta Abdominal/cirugía , Factores de Riesgo , Estudios Retrospectivos , Embolización Terapéutica/efectos adversos
2.
Gen Thorac Cardiovasc Surg ; 69(12): 1519-1526, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34033007

RESUMEN

OBJECTIVES: Pulmonary hypertension during cardiac surgery is associated with increased morbidity and mortality. Inhaled nitric oxide serves as a selective pulmonary vasodilator and has other potential extrapulmonary protective roles. Its effects on pulmonary hypertension and organ functions after adult valve surgeries were evaluated. METHODS: From April 2017 to March 2000, 30 patients received inhaled nitric oxide therapy for pulmonary hypertension during weaning from cardiopulmonary bypass in valvular surgery (iNO group). The group was compared with a control group of 65 patients who developed pulmonary hypertension during weaning from cardiopulmonary bypass in valvular surgery and received conventional therapy from April 2014 to March 2017. Intraoperative hemodynamic changes and postoperative Sequential Organ Failure Assessment (SOFA) score were evaluated. RESULTS: The inhalation of nitric oxide lowered the pulmonary-to-systemic pressure ratio (Pp/Ps) (p < 0.0001) in the iNO group, and this ratio after the inhalation was significantly lower than that in the control group (p = 0.015). Moreover, norepinephrine requirement was lower in the iNO group than in the control group (p = 0.0060). The SOFA total scores, respiratory scores, coagulation scores, and the increase of renal scores within postoperative 2 days were lower in the iNO group than in the control group (p < 0.0001, p = 0.0002, p = 0.0013, and p = 0.037). CONCLUSIONS: Inhaled nitric oxide therapy ameliorated pulmonary hypertension and improved postoperative respiratory, coagulation, and renal functions in adult valve surgeries.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Hipertensión Pulmonar , Administración por Inhalación , Adulto , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Válvulas Cardíacas/cirugía , Humanos , Hipertensión Pulmonar/tratamiento farmacológico , Hipertensión Pulmonar/etiología , Óxido Nítrico , Vasodilatadores/uso terapéutico
3.
Kyobu Geka ; 73(12): 1011-1014, 2020 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-33268752

RESUMEN

Transcatheter aortic valve replacement(TAVR) in the treatment of patients with severe aortic valve stenosis (AS) has evolved on the basis of evidence from clinical trials. A 84-year-old woman with a complaint of dyspnea was diagnosed with severe AS. A preoperative computed tomography (CT) revealed huge mural thrombus at descending aorta, therefore we planned direct aortic access for TAVR to avoid embolism. Transesophageal echocardiography revealed fluttering echogram at left ventricular outflow tract. After TAVR the fluttering echogram disappeared. A postoperative CT revealed spleen infarction. In such cases, we should keep in mind that surgical AVR can be a treatment option.


Asunto(s)
Estenosis de la Válvula Aórtica , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Femenino , Humanos , Infarto , Índice de Severidad de la Enfermedad , Bazo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del Tratamiento
4.
Kyobu Geka ; 71(1): 19-24, 2018 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-29483476

RESUMEN

Valve-sparing root replacement is increasingly used to overcome drawbacks associated with valvular prostheses. In our institution, 7 patients underwent valve-sparing root replacement from August 2016 to July 2017. The mean age was 45 years (range, 14~69 years). Three patients had Marfan syndrome and 1 had Loeys-Dietz syndrome with acute aortic dissection. All patients underwent surgery with reimplantation technique using a Valsalva graft. Two patients required repair of aortic valve leaflet prolapse. All patients had an excellent clinical course, with mild or no aortic regurgitation and a decrease in end-diastolic volume on echocardiography. These results support the continued use of valve-sparing root replacement in selected patients.


Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/cirugía , Implantación de Prótesis Vascular , Adolescente , Adulto , Anciano , Femenino , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Adulto Joven
5.
BMJ Case Rep ; 20172017 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-28536236

RESUMEN

Massive haemoptysis is associated with high mortality. Among various diseases presenting with massive haemoptysis, a ruptured bronchial artery aneurysm (BAA) is a rare entity. We report the case of a ruptured BAA as small as 3 mm in diameter associated with massive haemoptysis in a previously healthy 77-year-old woman. She had suddenly developed massive haemoptysis and was intubated and admitted to the intensive care unit. A CT scan and repeated bronchoscopy could not reveal the cause. Because haemorrhage continued, she underwent bronchial arteriography (BAG) twice. We finally detected a BAA with a bleb that led to the diagnosis of a ruptured BAA only 3 mm in diameter. After bronchial artery embolisation, the haemoptysis ceased. Although rare, a ruptured BAA should be considered as a cause of massive haemoptysis. Because a small BAA may get overlooked, close observation is important in BAG.


Asunto(s)
Aneurisma Roto/complicaciones , Arterias Bronquiales , Hemoptisis/etiología , Anciano , Femenino , Humanos , Índice de Severidad de la Enfermedad
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