Assuntos
Malformações Arteriovenosas/complicações , Artéria Femoral/anormalidades , Hematoma/etiologia , Síndrome do Desconforto Respiratório/complicações , Angiografia/métodos , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Feminino , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Pessoa de Meia-Idade , Espaço Retroperitoneal , Tomografia Computadorizada por Raios XRESUMO
Endovascular stent-grafting of the aorta, as an alternative to open surgical techniques, is gaining in popularity everyday, especially in high-risk patients. Acute or chronic traumatic lesions of the descending aorta, especially after motor vehicle accidents, constitute such a group with a high-risk of morbidity and mortality. Here, we report the successful endovascular repair of acute and chronic traumatic thoracic aortic aneurysms after motor vehicle accidents in five patients.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Acidentes , Acidentes de Trânsito , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motocicletas , Radiografia , StentsRESUMO
Mycotic aneurysm of the aorta is a rare but highly fatal complication of coronary bypass surgery. A 49-year-old man developed mycotic pseudoaneurysm in the ascending aorta after coronary bypass in another hospital. Computed tomography showed the pseudoaneurysm originated from the previous aortic cannulation site. The defect was successfully repaired with pericardial-pledgeted sutures.
Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Aneurisma Aórtico/etiologia , Ponte de Artéria Coronária/efeitos adversos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Falso Aneurisma/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Aneurisma Aórtico/cirurgia , Aortografia/métodos , Desbridamento , Drenagem , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos VascularesRESUMO
Penetrating injuries to the neck have high morbidity and mortality rates because of the multiple vital structures present within this anatomic region. Endovascular treatment of an AV fistula of left common carotid artery and left subclavian vein subsequent to stab injury of the left supraclavicular region is presented in this case report.
Assuntos
Fístula Arteriovenosa/diagnóstico , Lesões das Artérias Carótidas/diagnóstico , Lesões do Ombro , Veia Subclávia/lesões , Ferimentos Perfurantes/complicações , Adulto , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/cirurgia , Lesões das Artérias Carótidas/complicações , Lesões das Artérias Carótidas/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Procedimentos Cirúrgicos VascularesRESUMO
Statins provide strong clinical benefits via reducing stroke deaths, and they are also considered for tumor reduction and chemo-sensitization. High dose atorvastatin in adults (80 mg daily, approx. 1 mg/kg) is proven to afford greater protection against cardiac deaths than does a standard lipid-lowering dose in coronary syndrome. For cancer trials, mega doses up to 30 mg/kg have been used for short term treatments but neither a high nor a mega-dose of atorvastatin has been tested for long term cardiac safety. This may be of special concern, since some animal studies showed deleterious effects of statins on cardiac tissue, which may be related with coenzymeQ (CoQ) depletion. We performed an electron microscopic analysis of rat hearts after low, high-or mega-dose atorvastatin therapy and with or without MNU (methyl-nitrosourea)-stress. MNU + daily high dose atorvastatin treatment for 13 months did not produce severe cardiac toxicity with CoQ. However, at mega doses (30 mg/kg) and with MNU, mitochondrial damage and myofibrillary disintegration was obvious. Strong proliferation of mitochondria under high dose atorvastatin therapy with CoQ may explain the lack of cardiotoxicity; and this finding seems to parallel recent data that statins induce HNF-4 and PPAR-alpha, both responsible for mitochondria-proliferation. Employment of statins for tumor chemo-sensitization at high-dosage and for long term treatments may require strategies to direct the mevalonate-entry differentially into cardiac and tumor cells and to develop a protocol analogous to folic acid salvage of methotrexate toxicity.
Assuntos
Antineoplásicos/efeitos adversos , Cardiomiopatias/induzido quimicamente , Ácidos Heptanoicos/efeitos adversos , Pirróis/efeitos adversos , Ubiquinona/análogos & derivados , Animais , Antineoplásicos/administração & dosagem , Atorvastatina , Coenzimas/administração & dosagem , Coenzimas/uso terapêutico , Feminino , Ácidos Heptanoicos/administração & dosagem , Humanos , Metilnitrosoureia/toxicidade , Microscopia Eletrônica de Transmissão , Mitocôndrias Cardíacas/efeitos dos fármacos , Pirróis/administração & dosagem , Ratos , Ratos Wistar , Ubiquinona/administração & dosagem , Ubiquinona/uso terapêuticoRESUMO
In this study, basal and thrombin-stimulated release of nitric oxide and endothelin-1 in the internal mammary artery and the radial artery were measured, together with superoxide radicals generated after anoxia and reoxygenation. Arterial segments were obtained from patients undergoing coronary bypass operations. Quantification of nitric oxide was performed by measuring the stable oxidation products of nitric oxide. Endothelin levels were measured by an enzyme immunoassay kit, and the superoxides were measured by lucigenin-enhanced chemiluminescence. Basal and stimulated release of nitric oxide from the internal mammary artery is significantly higher than that in the radial artery. On the other hand, basal release of endothelin-1 is less in the internal mammary artery than in the radial artery, but similar after stimulation. In our study, the quantity of superoxide radicals produced by the internal mammary artery was greater than that produced by the radial artery. Our results show that there are differences between these 2 arteries in regard to production of nitric oxide, endothelin-1, and superoxide radicals. These differences may have a role in the process of atherogenesis and may contribute to long-term patency of arterial bypass grafts. These results may also explain the mechanism of radial artery graft spasm in coronary artery surgery and may constitute a basis for future pharmacological and clinical improvements for successful surgical application.
Assuntos
Aterosclerose/metabolismo , Ponte de Artéria Coronária , Endotelina-1/biossíntese , Artéria Torácica Interna/metabolismo , Óxido Nítrico/biossíntese , Artéria Radial/metabolismo , Superóxidos/metabolismo , Vasoespasmo Coronário/fisiopatologia , Humanos , Luminescência , Artéria Torácica Interna/transplante , Artéria Radial/transplante , Grau de Desobstrução Vascular/fisiologiaRESUMO
Tuberculous pseudoaneurysm of the aorta is a rare disease that is uniformly fatal if not treated properly. The authors present a case of a recurrent tuberculous false aneurysm of the descending thoracic aorta that was treated surgically with excision and primary repair of the lesion. To their knowledge, this is the first reported case of recurrent disease after a successful surgical treatment.
Assuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Aneurisma da Aorta Torácica/microbiologia , Tuberculose Cardiovascular/microbiologia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Aorta Torácica/microbiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aortografia , Implante de Prótese Vascular , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Toracotomia , Tomografia Computadorizada por Raios X , Tuberculose Cardiovascular/diagnóstico por imagem , Tuberculose Cardiovascular/cirurgiaAssuntos
Angioplastia Coronária com Balão/efeitos adversos , Doença da Artéria Coronariana/terapia , Vasos Coronários , Corpos Estranhos , Angina Pectoris/etiologia , Doença da Artéria Coronariana/complicações , Remoção de Dispositivo , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Esterno/cirurgiaRESUMO
A 67-year-old man operated on 8 years previously for type B aortic dissection presented with two episodes of massive hemoptysis. An aortobronchial fistula was suspected with spiral computed tomography angiography, and showed a small pseudoaneurysm corresponding to the distal anastomotic site. The patient underwent endovascular stent-graft implantation and is asymptomatic 8 months after the procedure.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Fístula Artério-Arterial/cirurgia , Hemoptise/cirurgia , Idoso , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Fístula Artério-Arterial/diagnóstico por imagem , Implante de Prótese Vascular , Hemoptise/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Stents , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: Because the autonomic nervous system is an important determinant in the appearance of atrial fibrillation, we have assessed the role of ventral cardiac denervation for its prevention. METHODS: Patients undergoing low-risk coronary artery surgery were enrolled. No routine antiarrhythmic drugs were administered before or after the operation. Ventral cardiac denervation was performed in 207 patients, and 219 patients were used as control subjects. Denervation was performed before cardiopulmonary bypass. The groups were comparable regarding demographic, clinical, and operative variables. RESULTS: The additional time for the denervation was 5 +/- 2 minutes, and there were no associated complications. Postoperative atrial fibrillation was present in 15 (7%) patients undergoing ventral cardiac denervation (95% confidence interval, 4%-12%) and in 56 (27%) control subjects (95% confidence interval, 18%-35%). Patients submitted to ventral cardiac denervation had fewer and less severe episodes of atrial fibrillation, and no patient had atrial fibrillation after discharge. Ventral cardiac denervation was the most significant predictor of postoperative atrial fibrillation (odds ratio, 0.42; confidence interval, 0.23-0.78; P =.006). Age of greater than 65 years (odds ratio, 1.67; confidence interval, 0.96-2.9; P =.067) was a highly suggestive predictor. The analysis of the effect of ventral cardiac denervation correlated with the patient's age showed a more pronounced effect in patients younger than 70 years (odds ratio, 0.43; confidence interval, 0.22-0.86; P =.022) CONCLUSIONS: Ventral cardiac denervation is a fast and low-risk procedure. Its use significantly reduces the incidence and severity of atrial fibrillation after routine coronary artery bypass surgery. Patients younger than 70 years of age are expected to have a higher success rate than those older than 70 years.
Assuntos
Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Ponte de Artéria Coronária , Denervação , Coração/inervação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Antagonistas Adrenérgicos beta/uso terapêutico , Fatores Etários , Idoso , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/epidemiologia , Cardioversão Elétrica , Feminino , Sistema de Condução Cardíaco/efeitos dos fármacos , Sistema de Condução Cardíaco/patologia , Sistema de Condução Cardíaco/cirurgia , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Reoperação , Resultado do TratamentoRESUMO
OBJECTIVE: Intraoperative coronary angiography has always been favoured by cardiac surgeons. Thermal coronary angiography (TCA) is a useful method for intraoperative control of graft patency. It detects heat differences between tissues, provides easy-to-interpret angiographic images and even measures the flow of the grafts quantitatively. METHODS: Between January 2000 and January 2002, TCA has been used in scheduled coronary bypass operations. Upon completion of each distal anastomosis, the perfusion of the distal arterial tree from the graft was evaluated with a thermal camera. RESULTS: TCA was applied to 1401 patients, mean age 60.97+/-9.61 years, who underwent simple coronary artery bypass grafting (CABG) procedures. A total of 4105 thermal images were obtained including 2161 venous, 1355 single internal thoracic artery (ITA), 56 bilateral ITA and 477 radial artery grafts. Image quality was not sufficient in 34 grafts (1.57%) due to either deep intramyocardial vessels or excessive epicardial fat tissue. Technical failures in three ITA anastomoses were detected and revised before the cross-clamp was removed. Flow-restricting lesions distal to the anastomosis on the left anterior descending artery (LAD) in nine patients were managed with a secondary distal bypass graft (five patients) or plaque splitting and anastomotic revision (four patients). Endarterectomy was combined in seven patients since the graft flow and the distal visualization was not satisfactory, although the anastomoses were performed on a good lumen. Angiographically undetected diagonal arteries were revascularized in 11 patients with totally occluded LAD vessels. CONCLUSION: Thermal imaging provides decisive coronary angiographies, and detects the perfusion area and flow of the implanted graft. It allows real-time detection of technical failures, reveals unexpected occluding plaques or any kind of flow-restricting lesions, and gives the chance of refinement of the anastomosis during the arrest period. We believe that the thermal imaging technique is a safe, noninvasive and feasible method to document the quality of the myocardial revascularization intraoperatively.
Assuntos
Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Oclusão de Enxerto Vascular/diagnóstico , Cuidados Intraoperatórios/métodos , Termografia/métodos , Grau de Desobstrução Vascular , Idoso , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Endarterectomia/métodos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Termografia/instrumentaçãoAssuntos
Angioplastia Coronária com Balão , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/terapia , Stents , Doença Aguda , Idoso , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/patologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XAssuntos
Fibrilação Atrial/cirurgia , Bioprótese , Ablação por Cateter/efeitos adversos , Fístula Esofágica/etiologia , Átrios do Coração/fisiopatologia , Próteses Valvulares Cardíacas/efeitos adversos , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Ablação por Cateter/métodos , Fístula Esofágica/cirurgia , Evolução Fatal , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Humanos , Complicações Intraoperatórias/cirurgia , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Complicações Pós-Operatórias , Reoperação , Índice de Gravidade de DoençaRESUMO
PURPOSE: To assess the impact of gender, age, and other cardiovascular risk factors on the outcomes of patients undergoing coronary artery bypass grafting (CABG). METHODS: A total of 5067 consecutive patients undergoing isolated CABG between 1995 and 2000 were divided into the age groups: 25-49 years, 50-59 years, 60-69 years, and 70-84 years. Data on patient age, gender, smoking, serum cholesterol, blood pressure, body mass index, diabetes, family history, morbid obesity, and renal failure were retrospectively analyzed. RESULTS: The percentage of women aged > 60 years undergoing CABG was higher than the percentage of men aged > 60 years (45.6% vs 36.6%). Most of the cardiovascular risk factors, except for smoking, were favorable in women (P < 0.001). The in-hospital mortality was 2.0% in women and 1.7% in men (P = 0.409). CABG was performed on significantly more men than women, accounting for 80.7% and 19.3% of the 5067 patients, respectively (P < 0.001). However, the incidence increased remarkably in women aged > 60 years. CONCLUSIONS: The risks of CABG may vary to some degree in accordance with the major cardiovascular risk factors. The risk of operative mortality was independent of gender in this study.
Assuntos
Ponte de Artéria Coronária/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Lipídeos/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia , Resultado do TratamentoRESUMO
Treatment of chronic atrial fibrillation with intraoperative radiofrequency ablation is gaining more acceptance in patients with rheumatic valve disease. This article reports a case of fatal atrio-esophageal fistula after radiofrequency ablation in a patient with rheumatic mitral and aortic valve disease with chronic atrial fibrillation.
Assuntos
Estenose da Valva Aórtica/cirurgia , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Fístula Esofágica/etiologia , Próteses Valvulares Cardíacas , Estenose da Valva Mitral/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Ablação por Cateter/métodos , Doença Crônica , Terapia Combinada , Eletrocardiografia , Fístula Esofágica/diagnóstico , Esofagoscopia , Evolução Fatal , Feminino , Átrios do Coração/patologia , Humanos , Pessoa de Meia-Idade , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: Endovascular treatment of aortic aneurysms is getting popular in our country due to its less invasive nature and shortened hospital stay. The initial experience with endovascular stent-graft implantation procedures to treat abdominal aortic aneurysms and their results were evaluated retrospectively in this study. METHODS: Eight patients with abdominal aortic aneurysms were treated with endovascular stent grafts. Seven patients were male and 1 was female with the mean age of 63.13+/-9.23 (48-72) years. Six patients were considered not proper for conventional surgical treatment. RESULTS: The procedure was converted to conventional surgery in one patient due to traumatic rupture of the iliac artery during the intervention. Type I endoleak was detected in 1 patient in the first month and was treated successfully by balloon dilatation of the proximal neck. Type II endoleak in two patients resolved spontaneously in the postoperative follow-up. No mortality was occurred. The mean intensive care unit stay was 24.57+/-10.37 (20-48) hours, mean hospital stay was 4.00+/-1.83 (3-8) days, and mean use of blood and blood products was 456.25+/-722.81 ml, excluding the patient treated by conventional surgery. The mean follow-up period was 9.36+/-3.75 (4-15) months. CONCLUSION: Endovascular treatment of abdominal aortic aneurysms is a good therapeutic alternative with low morbidity even in complicated cases. More studies are needed to enlighten the safety, effectiveness and durability of this therapeutic modality.