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1.
Tex Heart Inst J ; 51(1)2024 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-38711341

RESUMEN

A 62-year-old woman who had undergone mitral valve replacement 24 years ago was admitted to the hospital with congestive heart failure. She needed heart transplantation for stage D heart failure. Preoperative cardiac computed tomographic scans showed a severely calcified left atrium and a large right atrium. Given that the left atrium's calcification was too severe to suture, the calcified left atrial wall was broadly resected, and the resected left atrial wall was reconstructed with a bovine pericardial patch for anastomosis with the donor's left atrial wall. The operation was completed without heavy bleeding, and the patient was discharged from the hospital with no complications.


Asunto(s)
Calcinosis , Atrios Cardíacos , Insuficiencia Cardíaca , Trasplante de Corazón , Cardiopatía Reumática , Tomografía Computarizada por Rayos X , Humanos , Femenino , Cardiopatía Reumática/cirugía , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/diagnóstico , Trasplante de Corazón/métodos , Persona de Mediana Edad , Calcinosis/cirugía , Calcinosis/diagnóstico , Calcinosis/complicaciones , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Insuficiencia Cardíaca/cirugía , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/diagnóstico , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Implantación de Prótesis de Válvulas Cardíacas/métodos , Pericardio/trasplante , Pericardio/cirugía
2.
Neurol India ; 72(2): 292-296, 2024 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-38691472

RESUMEN

INTRODUCTION: Dural closure is an important part of neurosurgery, failure which may lead to wound infection, pseudomeningoceles, meningitis, severe morbidity to a patient, and even mortality. In cases where primary dura closure is not possible, a bovine pericardial patch is a good alternative with the benefits of suturability and the ability to provide watertight closure, hence preventing Cerebrospinal Fluid (CSF) leak. The present study demonstrates the use of the bovine pericardial patch in both cranial and spinal disorders for dural closure as well as for transposition technique in microvascular decompression. OBJECTIVES: The aim of our study is to understand the advantages and feasibility of a bovine pericardial patch in various neurosurgical procedures. MATERIAL METHODS: Fifty-one patients were analyzed prospectively and followed up in which glutaraldehyde-free bovine pericardial patch was used in various cranial and spinal disorders. RESULTS: The most common indications where a bovine pericardial patch was used, in decreasing order of frequency, were meningioma excision surgery (47%), followed by Chiari malformation operated for foramen magnum decompression (17.6%), meningomyelocele (7.8%), spinal dural defects (7.8%), trigeminal neuralgia (5.8%), traumatic decompression with lax duraplasty (4%), glioma (4%), encephalocele (4%), and skull base defects (2%). Two patients had complications, one with CSF leak and the other had superficial wound infection, which were managed appropriately. CONCLUSIONS: The use of a bovine pericardial patch as a dural substitute in various cranial and spinal disorders is feasible with good outcomes, and it can be considered an ideal dural substitute.


Asunto(s)
Procedimientos Neuroquirúrgicos , Pericardio , Humanos , Pericardio/cirugía , Bovinos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Animales , Duramadre/cirugía , Anciano , Adolescente , Adulto Joven , Estudios Prospectivos , Niño
3.
Europace ; 26(5)2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38587311

RESUMEN

AIMS: Pericardiocentesis is usually completed under fluoroscopy. The electroanatomic mapping (EAM) system allows visualizing puncture needle tip (NT) while displaying the electrogram recorded from NT, making it possible to obtain epicardial access (EA) independent of fluoroscopy. This study was designed to establish and validate a technique by which EA is obtained under guidance of three-dimensional (3D) EAM combined with NT electrogram. METHODS AND RESULTS: 3D shell of the heart was generated, and the NT was made trackable in the EAM system. Unipolar NT electrogram was continuously monitored. Penetration into pericardial sac was determined by an increase in NT potential amplitude and an injury current. A long guidewire of which the tip was also visible in the EAM system was advanced to confirm EA. Epicardial access was successfully obtained without complication in 13 pigs and 22 patients. In the animals, NT potential amplitude was 3.2 ± 1.0 mV when it was located in mediastinum, 5.2 ± 1.6 mV when in contact with fibrous pericardium, and 9.8 ± 2.8 mV after penetrating into pericardial sac (all P ≤ 0.001). In human subjects, it measured 1.54 ± 0.40 mV, 3.61 ± 1.08 mV, and 7.15 ± 2.88 mV, respectively (all P < 0.001). Fluoroscopy time decreased in every 4-5 cases (64 ± 15, 23 ± 17, and 0 s for animals 1-4, 5-8, 9-13, respectively, P = 0.01; 44 ± 23, 31 ± 18, 4±7 s for patients 1-7, 8-14, 15-22, respectively, P < 0.001). In five pigs and seven patients, EA was obtained without X-ray exposure. CONCLUSION: By tracking NT in the 3D EAM system and continuously monitoring the NT electrogram, it is feasible and safe to obtain EA with minimum or no fluoroscopic guidance.


Asunto(s)
Técnicas Electrofisiológicas Cardíacas , Mapeo Epicárdico , Imagenología Tridimensional , Agujas , Pericardio , Humanos , Masculino , Femenino , Animales , Pericardio/diagnóstico por imagen , Pericardio/cirugía , Persona de Mediana Edad , Imagenología Tridimensional/métodos , Anciano , Técnicas Electrofisiológicas Cardíacas/instrumentación , Técnicas Electrofisiológicas Cardíacas/métodos , Mapeo Epicárdico/métodos , Pericardiocentesis/métodos , Punciones , Valor Predictivo de las Pruebas , Adulto , Porcinos , Modelos Animales , Potenciales de Acción , Sus scrofa , Fluoroscopía
5.
J Am Heart Assoc ; 13(9): e034004, 2024 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-38639381

RESUMEN

BACKGROUND: An epicardial connection (EC) through the intercaval bundle (EC-ICB) between the right pulmonary vein (RPV) and right atrium (RA) is one of the reasons for the need for carina ablation for PV isolation and may reduce the acute and chronic success of PV isolation. We evaluated the intra-atrial activation sequence during RPV pacing after failure of ipsilateral RPV isolation and sought to identify specific conduction patterns in the presence of EC-ICB. METHODS AND RESULTS: This study included 223 consecutive patients who underwent initial catheter ablation of atrial fibrillation. If the RPV was not isolated using circumferential ablation or reconnected during the waiting period, an exit map was created during mid-RPV carina pacing. If the earliest site on the exit map was the RA, the patient was classified into the EC-ICB group. The exit map, intra-atrial activation sequence, and RPV-high RA time were evaluated. First-pass isolation of the RPV was not achieved in 36 patients (16.1%), and 22 patients (9.9%) showed reconnection. Twelve and 28 patients were classified into the EC-ICB and non-EC-ICB groups, respectively, after excluding those with multiple ablation lesion sets or incomplete mapping. The intra-atrial activation sequence showed different patterns between the 2 groups. The RPV-high RA time was significantly shorter in the EC-ICB than in the non-EC-ICB group (69.2±15.2 versus 148.6±51.2 ms; P<0.001), and RPV-high RA time<89.0 ms was highly predictive of the existence of an EC-ICB (sensitivity, 91.7%; specificity, 89.3%). CONCLUSIONS: An EC-ICB can be effectively detected by intra-atrial sequencing during RPV pacing, and an RPV-high RA time of <89.0 ms was highly predictive.


Asunto(s)
Fibrilación Atrial , Estimulación Cardíaca Artificial , Ablación por Catéter , Atrios Cardíacos , Venas Pulmonares , Humanos , Venas Pulmonares/cirugía , Venas Pulmonares/fisiopatología , Femenino , Masculino , Ablación por Catéter/métodos , Persona de Mediana Edad , Fibrilación Atrial/cirugía , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Estimulación Cardíaca Artificial/métodos , Anciano , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/cirugía , Resultado del Tratamiento , Estudios Retrospectivos , Pericardio/cirugía , Pericardio/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Potenciales de Acción , Técnicas Electrofisiológicas Cardíacas , Frecuencia Cardíaca/fisiología
6.
BMC Surg ; 24(1): 106, 2024 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-38614997

RESUMEN

BACKGROUND: Pericardial defect that occurs after intrapericardial pneumonectomy can cause many fatal complications, and closing the defect with mesh is a widely used surgical method to prevent these complications. METHODS: Data of patients who underwent intrapericardial pneumonectomy and pericardial resection in our clinic between October 2010 and June 2022 were retrospectively reviewed. Patients were divided into two groups, those who had prolene mesh used to close the pericardial defect and those who underwent the "Rug Weave" technique we proposed as an alternative, and the results were compared. RESULTS: The study included 23 patients, one of whom was female. All patients underwent surgery due to malignancy. The vast majority of the patients had a diagnosis of squamous cell lung carcinoma (86.9%). Atrium was added to three patients and rib resection was added to one patient during intrapericardial pneumonectomy and pericardial resection. There was no significant difference between the two groups in terms of average age, gender, and length of hospital stay. There was no significant difference between the two groups in terms of complications, including atrial fibrillation, which is commonly seen in these patients (p = 0.795). The Rug Weave group had an average defect width of 23.96 cm2 and was found to be advantageous in terms of overall survival compared to the mesh group (p = 0.017). CONCLUSIONS: The "Rug Weave" technique we proposed for closing pericardial defects after pneumonectomy can be used as a cheaper method safely and effectively that reduces complications as much as the traditional method of using mesh.


Asunto(s)
Cardiopatías , Neoplasias Pulmonares , Humanos , Femenino , Estudios Retrospectivos , Neumonectomía , Pericardio/cirugía , Neoplasias Pulmonares/cirugía
7.
Sci Prog ; 107(1): 368504231221686, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38196177

RESUMEN

PURPOSE.: The treatment of infectious aortic disease is still challenging with open surgical debridement and reconstruction using biological, preferably autologous material, being the treatment of choice. However, these procedures are associated with high morbidity and mortality. Endovascular therapy is often considered a bridging method only, since the biologically inactive fabric of the covered stent grafts usually cannot be treated sufficiently with anti-infective agents in the event of a (obligate) consecutive secondary graft infection. This study aims to prove the feasibility of a physician-made pericardium stent graft ex-vivo. TECHNIQUE.: A state-of-the-art TEVAR was modified by separating the fabric from the z-stents and suturing a hand-sewn bovine pericardium tube to the bare metal. Feasibility of preparation, re-sheathing, and delivery is demonstrated in an ex-vivo model. CONCLUSION.: This first xenogeneic stent graft could be manufactured and deployed successfully. In the future this may provide a bridging alternative for high-risk patients with infected native aortic aneurysm or aortic fistulas, eventually followed by surgical or thoracoscopic/laparoscopic debridement. Further studies on simulators or animal models are needed to test the technique and investigate its long-term durability. Additionally, this study prompts reflection on whether materials currently used should be further developed to prevent graft infections.


Asunto(s)
Enfermedades de la Aorta , Médicos , Humanos , Animales , Bovinos , Stents , Comercio , Pericardio/cirugía
8.
BMC Cardiovasc Disord ; 24(1): 49, 2024 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-38218764

RESUMEN

BACKGROUND: Uterine leiomyosarcoma is a rare and aggressive tumour with a poor prognosis. Its metastases to the heart are even rarer, especially to the epicardium. The majority of reported cardiac metastases of uterine leiomyosarcoma were in the cardiac chambers or intramyocardial. Surgical resection of the uterine leiomyosarcoma in the early stages is the only definitive treatment for this disease. However, in the cases of cardiac metastasis, surgery is recommended only in emergencies and patients with expected beneficial outcomes. CASE PRESENTATION: Our patient was a 49-year-old female referred to the Department of Cardiac Surgery for scheduled surgery of pericardial neoplasia. The patient underwent a hysterectomy and adnexectomy three years prior owing to the uterine leiomyosarcoma. A regular follow-up magnetic resonance imaging of the abdomen and pelvis discovered neoplasia in the diaphragmic portion of the pericardium. No other signs of primary disease relapse or metastases were found. The patient was asymptomatic. The multidisciplinary team concluded that the patient is a candidate for surgery. Surgery included diastolic cardiac arrest achievement and resection of the tumour. Macroscopically, a parietal layer of the pericardium was completely free from the tumour that invaded only the apical myocardium of the left ventricle. Completed histopathology confirmed the diagnosis of leiomyosarcoma of the uterine origin. Three months after surgery, the patient received adjuvant chemotherapy with doxorubicin and dacarbazine. One year after surgery, there are no signs of new metastases. CONCLUSIONS: Strict surveillance of patients with uterine leiomyosarcoma after successful treatment of the early stage of the disease is of utmost importance to reveal metastatic disease to the heart in a timely manner and to treat it with beneficial outcomes. Surgery with adjuvant chemotherapy might be a good approach in patients with a beneficial prognosis. From a surgical point of view, it is challenging to assess the appropriate width of the resection edges to be radical enough and, at the same time, sufficiently conservative to ensure the satisfactory postoperative function of the remaining myocardium and avoid repetitive tumour growth. Therefore, intraoperative histopathology should always be performed.


Asunto(s)
Leiomiosarcoma , Neoplasias Uterinas , Femenino , Humanos , Persona de Mediana Edad , Leiomiosarcoma/diagnóstico por imagen , Leiomiosarcoma/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/cirugía , Histerectomía , Pericardio/diagnóstico por imagen , Pericardio/cirugía , Pericardio/patología
9.
BMC Cardiovasc Disord ; 24(1): 44, 2024 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-38218797

RESUMEN

BACKGROUND: Although chest trauma happens very often, accompanying tricuspid valve injuries occur rarely and may be manifested by scarce symptoms and signs. Pericardial rupture with cardiac herniation is even a bigger rarity. Transthoracic echocardiography plays a key role in the diagnosis of valve injuries but is of limited value in cardiac herniation. CASE PRESENTATION: We present the case of 58-year-old man who experienced severe chest trauma in a car accident. Symptoms of right heart failure occurred 10 years after the injury, due to the loss of tricuspid leaflet support caused by the rupture of tendinous chords with significant tricuspid regurgitation. Intraoperatively, old posttraumatic pericardial rupture into left pleura was also found, with partial cardiac herniation and pressure of the edge of pericardium on all left-sided coronary arteries simultaneously. The patient was successfully operated and is free of symptoms 4 years later. CONCLUSIONS: This case emphasizes the importance of timely diagnosis and underlines a mechanism that leads to delayed rupture of the tricuspid valve apparatus. Repeated echocardiography in all patients who experienced chest trauma could be of great importance. Also, given the limited value of echocardiography in posttraumatic pericardial rupture and cardiac herniation, cardiac computed tomography should be performed.


Asunto(s)
Lesiones Cardíacas , Traumatismos Torácicos , Insuficiencia de la Válvula Tricúspide , Heridas no Penetrantes , Masculino , Humanos , Persona de Mediana Edad , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/cirugía , Ecocardiografía/efectos adversos , Traumatismos Torácicos/diagnóstico , Pericardio/diagnóstico por imagen , Pericardio/cirugía , Rotura/complicaciones , Lesiones Cardíacas/complicaciones , Lesiones Cardíacas/diagnóstico por imagen
11.
World J Pediatr Congenit Heart Surg ; 15(1): 44-51, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37525504

RESUMEN

Objectives: An ideal Fontan pathway should be capable of adapting to changes in circulatory demands. The external pericardial lateral tunnel Fontan (EPLTF) is constructed of viable, autologous tissue and may be capable of changing in size. We investigated the ability of the EPLTF to enlarge with increasing physiologic demands of somatic growth. Methods: Retrospective review of echocardiographic images for patients with a minimum of five years follow-up after EPLTF. Serial echocardiographic measurements of the EPLTF pathway were obtained at three distinct locations: the inferior vena cava junction with the EPLTF, midsection of the EPLTF, and cross-sectional area of the EPLTF visualized in a four-chamber view. Body surface area (BSA) was calculated at the time of each echocardiographic measurement. Changes in echocardiographic measurements over time were analyzed and compared with changes in BSA. Results: A total of 332 echocardiographic studies from 38 patients were reviewed. Significant enlargement of the EPLTF pathway is observed at the inferior vena caval junction (P < .001), midsection (P < .01), and cross-sectional area (P < .001). Repeated measures correlation between pathway measurements and BSA is highly significant (P < .001). Conclusions: The EPLTF pathway enlarges over time in correlation with increasing BSA. Further research is needed to define ideal pathway size, differentiate normal physiologic growth from pathologic enlargement, and correlate changes with clinical outcomes.


Asunto(s)
Procedimiento de Fontan , Cardiopatías Congénitas , Humanos , Procedimiento de Fontan/métodos , Pericardio/cirugía , Ecocardiografía , Estudios Retrospectivos , Vena Cava Superior/cirugía , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía
12.
Surg Today ; 54(2): 162-167, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37340140

RESUMEN

PURPOSE: Preoperative investigations to detect invasion to neighboring organs are important for deciding on the most appropriate surgical approach for thymoma. We evaluated preoperative computed tomography (CT) findings in thymoma patients to identify the CT features associated with tumor invasion. METHODS: Clinicopathologic information on 193 patients who underwent surgical resection for thymoma at Chiba University Hospital between 2002 and 2016 was collected retrospectively. The surgical pathology identified invasion of thymoma in 35 patients: in the lung (n = 18), pericardium (n = 11), or both (n = 6). Contact lengths between the tumor contour and lung (CLTL) or pericardium (CLTP) were measured at the maximum section of the tumor on axial CT. Univariate and multivariate analyses were performed to analyze the relationship between pathological invasion of the lung or pericardium and the clinicopathologic features. RESULTS: The mean CLTL and CLTP were significantly longer in patients with invasion of the neighboring organs than in those without invasion. A lobulated tumor contour was identified in 95.6% of the patients with invasion of the neighboring organs. A multivariate analysis revealed that a lobulated tumor contour was significantly associated with both lung and pericardial invasion. CONCLUSIONS: A lobulated tumor contour was significantly associated with lung and/or pericardial invasion in thymoma patients.


Asunto(s)
Timoma , Neoplasias del Timo , Humanos , Timoma/diagnóstico por imagen , Timoma/cirugía , Estudios Retrospectivos , Neoplasias del Timo/diagnóstico por imagen , Neoplasias del Timo/cirugía , Pericardio/diagnóstico por imagen , Pericardio/cirugía , Pulmón/patología
14.
Fetal Diagn Ther ; 51(1): 92-100, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-37725930

RESUMEN

INTRODUCTION: Fetal intrapericardial teratoma is a rare tumor that can be diagnosed by antenatal ultrasonography early in pregnancy. CASE PRESENTATION: A fetal intrapericardial teratoma was detected on routine ultrasonography in the second trimester of pregnancy. At 31 weeks gestation, a marked increase in tumor size, fetal ascites, and pericardial effusion were observed, indicating that preterm delivery would be inevitable. Corticosteroid prophylaxis (24 mg of betamethasone in two doses of 12 mg 24 h apart) initiated for prophylaxis of respiratory distress syndrome led to a reduction in fetal ascites and pericardial effusion. Betamethasone therapy (4 mg/per day) was continued with the aim to postpone the expected date of delivery. Gestation was extended for more than 2 weeks. At 33 weeks and 5 days gestation, the neonate was delivered by elective cesarean section with ex utero intrapartum treatment and immediately submitted to fetal cardiac surgery. The infant was discharged from the hospital in good health about 4 months later. CONCLUSION: The present report draws attention to improvement in fetal status and extension of gestation achieved with maternal low-dose corticosteroid therapy on antenatal ultrasound finding of fetal ascites and pericardial effusion due to intrapericardial teratoma.


Asunto(s)
Neoplasias Cardíacas , Derrame Pericárdico , Teratoma , Recién Nacido , Embarazo , Humanos , Femenino , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/terapia , Derrame Pericárdico/etiología , Cesárea , Ascitis , Pericardio/diagnóstico por imagen , Pericardio/patología , Pericardio/cirugía , Ultrasonografía Prenatal/efectos adversos , Teratoma/diagnóstico por imagen , Teratoma/tratamiento farmacológico , Teratoma/cirugía , Corticoesteroides , Betametasona/uso terapéutico , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/tratamiento farmacológico , Neoplasias Cardíacas/cirugía
16.
Braz J Biol ; 83: e276220, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38126640

RESUMEN

Bovine pericardium (BP) has been used as a biomaterial for several decades in many medical applications particularly due to its mechanical properties and the high collagen content. In the acellular form it favors faster tissue repair, providing a three-dimensional support for cellular and vascular events observed during tissue repair and due, to a low elastin content, may favor its use as a breast implant cover, resulting in a low possibility of contracture of the biomaterial, preventing the appearance of irregularities during the reconstruction process. Thus, the aim of this study was to evaluate, histomorphologically, the behavior of acellularized bovine pericardium (ABP) as a mammary implant cover in rats. For this purpose, 16 animals were divided into two groups, with eight animals at each biological point: 7 and 15 days after surgery. Of the 16 animals, 32 specimens were obtained: 16 in the experimental group (EG) and 16 in the control group (CG). Throughout this study, none of the studied groups had postoperative complications. Results: The histomorphological results showed, in the two biological points, both in the EG and in the CG, chronic inflammatory infiltrate, leukocyte fibrin exudate, formation of granulation tissue and deposition of collagen fibers, more evident in the EG, regressive along the biological points. At 15 days, the implanted ABP showed initial biointegration with the fibrous capsule and surrounding tissues of the recipient bed. Conclusion: These results indicate that the due to the observed favorable tissue response ABP may be of potential use as a breast implant cover.


Asunto(s)
Implantes de Mama , Ratas , Animales , Bovinos , Materiales Biocompatibles , Colágeno , Cicatrización de Heridas , Pericardio/cirugía , Pericardio/fisiología
18.
J Cardiothorac Surg ; 18(1): 338, 2023 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-37990270

RESUMEN

BACKGROUND: Re-opening the chest is an unwanted and potentially morbid complication after open heart surgery, most commonly required for refractory bleeding or tamponade. In this report, we present a unique case of a postoperative coronary artery bypass patient, demonstrating clinical features of cardiac tamponade of the right atrium and ventricle with inconclusive findings on imaging. CASE PRESENTATION: A 62 year-old male presented to hospital with exertional angina and a coronary angiogram found severe three-vessel coronary artery disease with preserved left ventricular function. He underwent an uncomplicated triple coronary artery bypass surgery. Over the following hours in the cardiac intensive care unit, the patient had a climbing serum lactate level and increasing vasopressor requirements. On investigations, there was evidence of compression of the right heart. The patient was taken back to the operating room where very little clot or bleeding was identified, rather there was significant amounts of mediastinal fat surrounding the heart which was subsequently resected with wide margins. The patient had complete resolution of their symptoms and an uncomplicated postoperative course thereafter. CONCLUSIONS: To our knowledge, this case is the first reported occurrence of cardiac constriction from excessive mediastinal fat after open heart surgery. Identifying patients at high-risk for excessive pericardial fat, as well as considering alternative modalities of imaging appear to be the main stay in diagnosis at this point. Current treatment is a mediastinal lipectomy with wide margins, avoiding injury to surrounding structures such as the phrenic nerve and innominate vein. Future study might consider the value of prophylactic mediastinal lipectomy at time of surgery, and methods to improve detection with current and future imaging modalities.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Taponamiento Cardíaco , Lipectomía , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Puente de Arteria Coronaria/efectos adversos , Pericardio/cirugía
19.
Curr Cardiol Rep ; 25(12): 1705-1713, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37938424

RESUMEN

PURPOSE OF REVIEW: The purpose of this review is to discuss the evolving techniques and approaches for pericardiectomy, with a focus on the use of cardiopulmonary bypass (CPB) and the extent of radical pericardial resection. The review aims to highlight the benefits and considerations associated with these modifications in radical pericardiectomy. RECENT FINDINGS: Recent studies have demonstrated that the use of CPB during pericardiectomy does not increase procedural risk or negatively impact survival. In fact, it has been shown to contribute to a more radical resection and improve postoperative outcomes, which is associated with less recurrence and better survival. The review emphasizes the importance of radical pericardiectomy and the use of CPB in achieving successful outcomes. Radical resection of the pericardium, facilitated by CPB, helps minimize the risk of recurrent constrictions and the need for reinterventions. The findings highlight the correlation between postoperative outcomes and survival, further supporting the use of CPB.


Asunto(s)
Cardiopatías , Pericarditis Constrictiva , Humanos , Pericarditis Constrictiva/cirugía , Pericardio/cirugía , Pericardiectomía/métodos , Cardiopatías/complicaciones
20.
JACC Clin Electrophysiol ; 9(11): 2315-2328, 2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-37676203

RESUMEN

BACKGROUND: The subxiphoid pericardial access is technically difficult and has a considerable rate of complications, thus transatrial access may be an alternative. OBJECTIVES: This study sought to assess the feasibility and safety of this strategy regarding periprocedural period and after 1-week follow-up. METHODS: The investigators performed epicardial mapping through transatrial puncture in 20 swine. Animals were divided into group A, in which aspiration of the sheath was performed to maintain negative pressure after the withdraw of the catheters, and group B, in which a device (Konar-MF VSD Occluder) was delivered to occlude the right atrial appendage perforation. Bleeding was investigated immediately and 1 week after. RESULTS: Access was safe in 19 of 20 animals (95%) with small amount of bleeding (6.4 ± 6 mL). In group A (n = 10), 1 animal presented hemopericardium right after the puncture. In the other 9, epicardial ablation was performed and 60.0 ± 28.0 mL of blood was aspirated without events. After 1 week, fibrin-hemorrhagic pericarditis was identified in 3 animals. In group B (n = 10), reaching the epicardial surface was possible in all animals. An adequate position of the prosthesis was obtained in 90% (9 of 10). One death occurred in the immediate postoperative period, secondary to pneumothorax. After 1 week, postmortem analysis showed absence of pericardial bleeding and a normal-appearing pericardium in the 8 animals with adequate prosthesis position. CONCLUSIONS: Transatrial access allows epicardial mapping and ablation. Sheath removal after negative pressure contributes to achieving acute bleeding control but does not prevent its occurrence. The use of the device prevents bleeding and hemorrhagic pericarditis.


Asunto(s)
Mapeo Epicárdico , Pericarditis , Animales , Porcinos , Estudios de Factibilidad , Mapeo Epicárdico/métodos , Pericardio/cirugía , Hemorragia/etiología
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