Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Defectos del Tabique Interatrial , Insuficiencia de la Válvula Tricúspide , Humanos , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Resultado del Tratamiento , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/cirugía , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Oxígeno , Defectos del Tabique Interatrial/complicacionesAsunto(s)
Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Complicaciones Posoperatorias , Falla de Prótesis/etiología , Reoperación/métodos , Anciano , Ecocardiografía Tridimensional/métodos , Femenino , Fluoroscopía/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Complicaciones Posoperatorias/diagnóstico por imagen , Resultado del TratamientoAsunto(s)
Aneurisma de la Aorta/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Enfermedad Aguda , Anciano , Disección Aórtica/fisiopatología , Disección Aórtica/cirugía , Aneurisma de la Aorta/fisiopatología , Aneurisma de la Aorta/cirugía , Humanos , Masculino , Valor Predictivo de las PruebasAsunto(s)
Trombosis Coronaria/etiología , Heparina/efectos adversos , Trombocitopenia/inducido químicamente , Anciano , Antitrombinas/uso terapéutico , Estenosis de la Válvula Aórtica/tratamiento farmacológico , Estenosis de la Válvula Aórtica/cirugía , Angiografía Coronaria , Trombosis Coronaria/diagnóstico , Trombosis Coronaria/tratamiento farmacológico , Ecocardiografía , Ensayo de Inmunoadsorción Enzimática , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Heparina/uso terapéutico , Hirudinas , Humanos , Contrapulsador Intraaórtico , Proteínas Recombinantes/uso terapéutico , Trombocitopenia/diagnósticoAsunto(s)
Implantación de Prótesis Vascular/métodos , Seno Coronario , Ecocardiografía/métodos , Defectos del Tabique Interatrial , Imagen por Resonancia Magnética/métodos , Anciano , Seno Coronario/anomalías , Seno Coronario/diagnóstico por imagen , Seno Coronario/cirugía , Atrios Cardíacos/anomalías , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/cirugía , Humanos , Cuidados Intraoperatorios , Masculino , Resultado del TratamientoRESUMEN
INTRODUCTION: The incidence of percutaneous closure of secundum atrial septal defects (ASD) and patent foramen ovale (PFO), which has become an established therapy, is constantly increasing. In this study, which is the first in the Greek literature, we present the immediate and mid-term results from this intervention in our center. METHODS: From April 2004 to April 2008, 103 patients underwent percutaneous closure of an ASD or PFO using Amplatzer closure devices. Thirty were male, the mean age was 37 +/- 15.5 years, and the mean follow-up period 21.7 +/- 14.8 months. The procedure was successful in 102 of the above patients; 69 (mean age 36.3 years +/- 17.1, 81% female) underwent secundum ASD closure, while 33 patients (mean age 39.1 +/- 10.5 years, 16 female and 17 male) underwent percutaneous closure of a PFO due to cryptogenic stroke. RESULTS: There were no major complications during the procedure (death, device embolization or need for immediate cardiac surgery). There were minor complications in 8 (7.7%) patients (bleeding at the puncture site, transient ST elevation in the inferior leads, multiple atrial and ventricular ectopics). The transient ST elevation in the inferior leads appeared in 5 patients (5%) and was probably due to air embolization. This transient complication completely resolved within 3 minutes. During the follow-up period, no patient had a major complication (cardiac rupture, device embolization, thrombus formation, thromboembolism or infective endocarditis). Most importantly, in the patients who underwent PFO closure there were no recurrences of cryptogenic stroke during the follow-up period (24.3 +/- 14.5 months). CONCLUSIONS: This study shows that using Amplatzer closure devices for atrial septal communications is both safe and effective, with sustained results over a maximum follow-up period of four years. Appropriate patient selection, as well as accurate device sizing fitting the dimensions of the defect, are important factors for the success and the safety of the method.
Asunto(s)
Foramen Oval Permeable/cirugía , Defectos del Tabique Interatrial/cirugía , Complicaciones Posoperatorias/prevención & control , Dispositivo Oclusor Septal , Adulto , Ecocardiografía Transesofágica , Femenino , Estudios de Seguimiento , Foramen Oval Permeable/diagnóstico por imagen , Grecia , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Incidencia , Masculino , Diseño de Prótesis , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Bioprótesis , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Cateterismo Cardíaco , Ecocardiografía Transesofágica , Humanos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Falla de Prótesis , ReoperaciónRESUMEN
INTRODUCTION: The purpose of the current study was to examine the effect of surgical ventricular restoration in left atrial (LA) performance and left ventricular (LV) diastolic function in patients with congestive heart failure after extensive anterior myocardial infarction. METHODS: Seventeen consecutive patients (age 63 +/- 9 years, 14 male, 4 with diabetes) were studied prospectively. All patients underwent surgical ventricular restoration and concomitant coronary artery bypass surgery. LA volumes were calculated, as were peak LA kinetic energy (LAKE) and LA ejection fraction (LAEF). LV diastolic filling patterns were also assessed. RESULTS: Follow-up period was 1 year. LA size and volumes did not change significantly during the follow-up period. Two distinct groups of patients were identified: group A, in which LAEF and peak LAKE increased, and group B, in which LAEF and peak LAKE decreased. In both groups, the LAEF and peak LAKE appeared to increase or decrease simultaneously and this became evident from the first month after the surgery. However, 1 year after the operation, diastolic filling pattern was significantly different between the two groups. LA function showed improvement only in patients who demonstrated an improvement in indices of diastolic filling pattern. CONCLUSIONS: Despite improvement in clinical status and indices of LV systolic function in all patients who underwent surgical ventricular restoration for treatment of congestive heart failure as a result of LV dilatation secondary to large myocardial infarction, improvement of LA function occurs in patients with improved LV diastolic function.
Asunto(s)
Función del Atrio Izquierdo/fisiología , Procedimientos Quirúrgicos Cardíacos/métodos , Ecocardiografía Doppler en Color/métodos , Atrios Cardíacos/fisiopatología , Insuficiencia Cardíaca/cirugía , Ventrículos Cardíacos/cirugía , Infarto del Miocardio/complicaciones , Diástole , Femenino , Estudios de Seguimiento , Atrios Cardíacos/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Infarto del Miocardio/fisiopatología , Periodo Posoperatorio , Pronóstico , Índice de Severidad de la Enfermedad , Función Ventricular Izquierda/fisiologíaRESUMEN
Congenital left ventricular (LV) diverticula are rare findings, particularly when first diagnosed in adulthood. We describe successful surgical repair of an isolated congenital apical LV diverticulum associated with an abnormal submitral apparatus in a young adult who received his diagnosis following a peripheral embolism. We intraoperatively identified an abnormally originating belly of the posteromedial papillary muscle, which arose from the interventricular septum, causing partition of the LV cavity and forming an apical aneurysmal communicating chamber. This anatomy of abnormal papillary muscle bifurcation was possibly the mechanism for the development of the apical diverticulum and to the best of our knowledge has not previously been described. Reattachment of the abnormal belly to its normal position preserved mitral valve competence, and an endoventricular patch repair restored LV volume and geometry.
Asunto(s)
Procedimientos Quirúrgicos Cardiovasculares/métodos , Divertículo/congénito , Divertículo/cirugía , Aneurisma Cardíaco/congénito , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos/anomalías , Ventrículos Cardíacos/cirugía , Anomalías Múltiples/cirugía , Adulto , Procedimientos Quirúrgicos Cardiovasculares/instrumentación , Humanos , Masculino , Músculos Papilares/anomalías , Músculos Papilares/cirugía , Resultado del TratamientoRESUMEN
Surgical treatment of heart failure is emerging as one of the most challenging clinical dilemmas for patients with end-stage cardiac failure not amenable to medical treatment. One of the most intriguing techniques is the use of implantable left ventricular assist devices (LVADs) as a bridge to recovery. The early experience from our centre has shown that even short term post-cardiotomy mechanical assistance, after heart failure surgery, improves patient outcome; thus, a clinical feasibility study was designed. The hypothesis of the study is that reparative heart failure surgery combined with postoperative mechanical support, ventricular resynchronisation where indicated, and pharmacological treatment can maximise myocardial recovery. In the study a new, implantable, magnetically levitated, rotary pump will be used as a bridge to recovery. In this manuscript the first worldwide human implantation of a new, continuous-flow LVAD, the WorldHeart Rotary Pump (Levacor, WorldHeart Inc., Oakland CA), is reported. The design and the rationale of the feasibility study, the inclusion and exclusion criteria, and the primary and secondary end points of the clinical investigation, are delineated. In addition, the design of the new rotary pump, its general principles of operation, and the implantation technique are described.