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1.
Kyobu Geka ; 72(11): 931-934, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31588112

RESUMO

A 51-year-old man complaining of exertional dyspnea and syncope was admitted to our hospital. Computed tomography(CT) and transesophageal echocardiography demonstrated a mobile tumor-like lesion in the right atrium. Surgical resection was performed under cardioplegic arrest, which revealed an organized thrombus. Pathological examination revealed amyloid deposition in the myocardium, and bone marrow biopsy revealed CD138 (+) stem cells. Therefore, the patient was diagnosed with amyloid light-chain (AL) amyloidosis associated with multiple myeloma. Although he required percutaneous cardiopulmonary support for postoperative right heart failure for 3 days, he recovered well and was discharged from the hospital on day 44, in a good condition. He was treated with bortezomib for multiple myeloma after surgery. Thus, despite the maintenance of sinus rhythm, intra-cardiac thrombus could be formed with amyloidosis.


Assuntos
Amiloidose , Cardiopatias , Trombose , Átrios do Coração , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina , Masculino , Pessoa de Meia-Idade
2.
Kyobu Geka ; 72(3): 224-227, 2019 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-30923300

RESUMO

The incidences of hip fracture and aortic valve stenosis are increasing in the aging population. Operative repair for hip fracture contributes to excellent clinical results. Transcatheter aortic valve implantation, which does not require cardiopulmonary bypass, represents a new era for the treatment of aortic valve stenosis. We herein describe a patient with both hip fracture and severe aortic valve stenosis. A 93-year-old woman underwent transcatheter aortic valve implantation for the valve stenosis immediately followed by open repair surgery for the fracture. She fully recovered without heart failure during the postoperative rehabilitation period. The performance of concomitant surgeries for hip fracture and aortic valve stenosis might increase in the future.


Assuntos
Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Fraturas do Quadril/cirurgia , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Feminino , Fraturas do Quadril/complicações , Humanos , Resultado do Tratamento
3.
Gen Thorac Cardiovasc Surg ; 67(7): 594-601, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30729379

RESUMO

BACKGROUND: Although outcomes of acute type A aortic dissection (ATAAD) have improved, malperfusion remains associated with high morbidity and mortality rates, and its optimal therapeutic treatment is unknown. Emergency central repair has been performed as our first-line approach for malperfusion. Here, we analyzed outcomes of ATAAD with malperfusion and reassessed emergency central repair. METHODS: In total, 1026 ATAAD patients underwent emergency surgery within 48 h of symptom onset, of whom 318 (30.9%) patients complicated with any preoperative malperfusion were included. Pathophysiology of malperfusion and surgical outcomes were analyzed. RESULTS: The in-hospital mortality rate was 12.9% for patients with malperfusion and 4.8% for patients without malperfusion (p < 0.0001). Coronary malperfusion was complicated in 7.5% of patients (% dead per group, 19.5%), mesenteric malperfusion in 3.6% (24.3%), renal malperfusion in 8.8% (14.4%), lower leg malperfusion in 12.6% (13.7%), brain malperfusion in 9.7% (12.0%), and spinal malperfusion in 1.1% (18.2%). Mortality rates varied substantially according to the number of affected organ systems (none, 4.8%; one system, 10.4%; two systems, 14.5%; three systems, 30.0%, and four systems; 30.3%; p < 0.0001). In malperfused patients, logistic regression analysis revealed that obesity (body mass index > 30 kg/m2), preoperative shock (systolic blood pressure < 80 mmHg), and visceral ischemia were independent predictors for hospital death. CONCLUSIONS: Malperfusion of more organ systems and mesenteric malperfusion resulted in unfavorable prognosis, and effects of central repair were limited in such severe/complex malperfusion. To further improve outcomes of ATAAD with malperfusion, emergency reperfusion of affected organs followed by central repair might be considered.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Mortalidade Hospitalar , Doença Aguda , Idoso , Aneurisma Dissecante/fisiopatologia , Aneurisma Aórtico/fisiopatologia , Isquemia Encefálica/etiologia , Emergências , Feminino , Humanos , Isquemia/etiologia , Perna (Membro)/irrigação sanguínea , Masculino , Isquemia Mesentérica/etiologia , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , Obesidade/complicações , Período Pré-Operatório , Circulação Renal , Choque/complicações , Isquemia do Cordão Espinal/etiologia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
4.
Gen Thorac Cardiovasc Surg ; 67(6): 501-509, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30552649

RESUMO

BACKGROUND: Acute type A aortic dissection (ATAAD) is relatively uncommon in dialysis patients, and characteristics and repair outcomes are not fully understood. PATIENTS AND METHODS: Patients with ATAAD (n = 960) were divided into a dialysis group (n = 19) and non-dialysis group (n = 941), depending on whether they required dialysis for preoperative end-stage renal disease (ESRD). Hospital charts and imaging data were reviewed, and characteristics and outcomes were compared between the groups. Segmental aortic wall or intima/media flap calcification in the thoracic and abdominal aorta was assessed in the dialysis patients. RESULTS: The leading primary causes of ESRD were polycystic kidney disease (n = 5) and chronic glomerulonephritis (n = 5). There were no significant differences (dialysis group vs. non-dialysis group) in age (60.5 vs. 64.5 years), preoperative hemodynamics, or organ ischemia. Dialysis patients were more likely to have an entry tear in the aortic arch (42% vs. 15%, p = 0.003). These patients showed moderate-to-severe calcification (multiple focal or single focal calcification > 10 mm) in the ascending aorta (17%), aortic arch (61%), descending aorta (67%), and abdominal aorta (83%). Arch replacement was common in this group (37% vs. 18%, p = 0.030). Although in-hospital mortality was increased in this group (21% vs. 7%, p = 0.059), morbidities did not differ significantly. Six-year survival was 60.3 ± 13.4% and 78.8 ± 1.6%, respectively (p = 0.01). CONCLUSIONS: Dialysis patients tend to have aortic calcification and a primary tear in the aortic arch. Outcomes are acceptable.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aorta/cirurgia , Diálise Renal , Idoso , Aneurisma da Aorta Torácica/cirurgia , Calcificação Fisiológica , Feminino , Mortalidade Hospitalar , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Túnica Íntima/cirurgia
5.
Circ J ; 83(2): 285-294, 2019 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-30584230

RESUMO

BACKGROUND: Outcomes of early-onset acute type A aortic dissection (ATAAD) associated with Marfan syndrome (MFS) are known, but not with other etiologies. Methods and Results: ATAAD patients from 2 centers (n=1,001) were divided into 2 groups: age ≤45 years (n=93) and age >45 years (n=908). Although in-hospital death and 10-year survival were similar (12% vs. 7% and 62.6% vs. 67.3%), the 10-year aortic event-free survival differed (50.0% vs. 80.2%; P<0.01). ATAAD patients from 3 centers (n=132), all aged ≤45 years, were divided into 5 groups: lone hypertension (HTN, n=71), MFS (n=23), non-syndromic familial thoracic aortic aneurysm and dissection (NS-FTAAD, n=16), bicuspid aortic valve (BAV, n=11), and no known etiologic factor (n=11). The incidence of severe aortic insufficiency varied between groups (HTN: 11%, MFS: 39%, NS-FTAAD: 38%, BAV: 55%, no known factor: 46%; P<0.01), whereas in-hospital death did not (14%, 22%, 0%, 0%, and 9%; P=0.061). The 10-year survival was 52.2%, 64.7%, 83.6%, 100%, and 90.9%, respectively, and 10-year aortic event-free survival was 55.6%, 36.3%, 77.5%, 90.0%, and 30.0%. Median descending aorta growth (mm/year) was 1.1 (0.1-3.4), 2.3 (0.3-5.3), 1.9 (1.3-2.7), 0.9 (-0.1-2.0), and 1.0 (-0.2-2.9) (P=0.15), respectively. CONCLUSIONS: Late aortic events are common in young ATAAD patients. Known etiologic factors, though not BAV, negatively influence late outcomes in these patients.

6.
Kyobu Geka ; 71(13): 1088-1091, 2018 12.
Artigo em Japonês | MEDLINE | ID: mdl-30587748

RESUMO

Pulmonary artery aneurysm (PAA) is usually associated with congenital heart disease, pulmonary artery hypertension, and connective tissue abnormalities, but idiopathic PAA is a rare clinical entity. We experienced a surgical case of idiopathic PAA measuring 60 mm in diameter. A 72-year-old man had been admitted to a nearby hospital 5 years before because of an abnormal shadow on chest X-ray, and was diagnosed with an idiopathic PAA measuring 37 mm in diameter. The PAA gradually expanded during follow-up and surgery was scheduled. Aneurysmal resection and reconstruction with a 24 mm expanded polytetrafluoroethylene graft were performed. The postoperative course was uneventful and the patient was discharged on the 11th postoperative day.


Assuntos
Aneurisma/cirurgia , Artéria Pulmonar/cirurgia , Idoso , Aneurisma/diagnóstico por imagem , Implante de Prótese Vascular , Humanos , Hipertensão Pulmonar/complicações , Masculino , Politetrafluoretileno , Artéria Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
Ann Vasc Dis ; 11(2): 196-201, 2018 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-30116411

RESUMO

Objective: This study was performed to determine whether open surgical decompression (OSD) decreased the mortality associated with abdominal compartment syndrome (ACS) following open repair (OR) of ruptured abdominal aortic aneurysm and iliac aneurysm (rAAA), and to investigate the risk factors associated with OSD. Material and Methods: Total 113 consecutive patients with rAAA underwent OR in our institution. Ninety patients underwent primary abdominal closure; however, three of them developed ACS and required OSD. Prophylactic OSD was performed at the initial OR in 23 patients. Results: The in-hospital mortality rate was higher in those who underwent OSD than in those who did not undergo OSD [27.0% (7/26) vs. 6.9% (6/87), respectively; p=0.01]. However, no ACS-related death occurred in the OSD group. Multivariate analyses revealed that a preoperative/intraoperative base excess (BE)<-11 [p=0.045; odds ratio (OR), 3.33; 95% confidence interval (CI), 1.021-10.850], performance of left thoracotomy (p=0.038; OR, 5.17; 95%CI, 1.098-24.357), and intraoperative blood transfusion >1,800 mL (p=0.012; OR, 4.30; 95%CI, 1.386-13.322) were associated with OSD. Conclusion: The prevalence and mortality rates of ACS were low at our institution. OSD is considered to be useful for the prevention and treatment of ACS after repair of rAAA. OSD should be considered in patients with the above-mentioned factors.

8.
Kyobu Geka ; 71(5): 376-379, 2018 May.
Artigo em Japonês | MEDLINE | ID: mdl-29755092

RESUMO

Intravenous leiomyomatosis is a rare neoplastic condition characterized by the benign intravascular proliferation of smooth muscle cells originating from either the uterine venous wall or a uterine leiomyoma. In the present report, we describe the case of a 36-year-old woman, who was referred to our institution due to abdominal pain. Computed tomography indicated the presence of a giant intravenous leiomyoma originating from the uterus and extending to the right ventricle with complex pathways. The patient was successfully treated by tumor resection under circulatory arrest in two-stage operations in conjunction with gonadotrophin-releasing hormone agonists therapy. She continued to recover and did not exhibit any recurrence at the 8-month follow-up.


Assuntos
Neoplasias Cardíacas/cirurgia , Leiomiomatose/cirurgia , Neoplasias Uterinas/cirurgia , Dor Abdominal/etiologia , Adulto , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Neoplasias Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Leiomiomatose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias Uterinas/patologia
9.
Ann Thorac Surg ; 105(1): 137-143, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29054307

RESUMO

BACKGROUND: Although surgical outcomes of acute type A aortic dissection (ATAAD) have improved, it is still a high-risk procedure for octogenarians. This study analyzed early and late outcomes of surgical repair of ATAAD among octogenarians. METHODS: From 1990 through 2016, 1,260 consecutive patients with ATAAD were emergently admitted to Jichi Medical University Hospitals. Of them, 1,026 patients who underwent emergency surgery for ATAAD within 48 hours of symptom onset were included in this retrospective study. Of these, 112 were aged 80 years or more (mean, 83.1 ± 2.7) and formed the octogenarian group; and 914 were aged less than 80 years (mean, 62.0 ± 11.4) and formed the control group. Early and late outcomes were compared. RESULTS: The inhospital mortality rate was 6.3% for the octogenarian group and 7.4% for the control group (p = 0.85). No significant difference was observed in the causes of hospital death. Although the overall postoperative complication rate was not different (24.1% versus 23.0%), pneumonia was more frequent among octogenarians (p = 0.03). Multivariate analysis of hospital mortality did not indicate age 80 years or more as a risk factor. Overall postoperative survival for the octogenarian group was 84.6%, 70.5%, and 57.1% at 1, 3, and 5 years, respectively. For the control group, the rates were 89.1%, 85.6%, and 82.1%, respectively. Pneumonia and decrepitude were the major causes of remote death for the octogenarian group. CONCLUSIONS: No significant difference in the hospital mortality rate or the complication rate was observed between the groups. Emergency surgery for ATAAD in octogenarians could be performed with the same low risk observed for younger patients.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Doença Aguda , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/classificação , Aneurisma da Aorta Torácica/classificação , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
Kyobu Geka ; 70(13): 1121-1124, 2017 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-29249793

RESUMO

Stent perforation of a coronary artery during percutaneous coronary intervention (PCI) is a rare but life-threatening complication. A 70-year-old man was admitted to our hospital for management of acute coronary syndrome. PCI was attempted for the left circumflex artery(LCX);however, catheterization was complicated by perforation of the LCX by the stent. He developed cardiac tamponade and was resuscitated using percutaneous cardiopulmonary support. Emergency surgery( ligation of the LCX and aorto-coronary bypass grafting for the distal LCX) was performed. His postoperative course was uneventful, and the patient was discharged on the 20th postoperative day. Collaboration between cardiologists and surgeons is essential to salvage such a critical patient.


Assuntos
Doença da Artéria Coronariana/cirurgia , Vasos Coronários/lesões , Intervenção Coronária Percutânea , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Masculino , Resultado do Tratamento
11.
Kyobu Geka ; 70(9): 731-736, 2017 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-28790237

RESUMO

Vacuum-assisted closure(VAC) therapy is mainly used for tissue defects. VAC therapy can remove exudate that could impair the healing process. We applied VAC therapy in patients considered at high risk of surgical site infection who underwent cardiovascular surgery via standard median sternotomy. Risk factors included advanced heart failure, obesity, diabetes mellitus, steroid administration, immunosuppressant administration, and chronic renal failure, etc. VAC therapy was used in 134 patients. Only 3 of these patients (2.2%) developed surgical site infection caused by Staphylococcus epidermidis;2 patients fully recovered after prolonged VAC therapy for 2 weeks, and the other required an additional sternal fixation after the sternal wires were removed for wound infection control. No patient developed infective mediastinitis. Prophylactic VAC therapy can reduce postoperative wound infection in high risk patients undergoing open heart surgery via full sternotomy.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Feminino , Humanos , Masculino , Mediastinite/prevenção & controle , Fatores de Risco , Esternotomia
12.
Kyobu Geka ; 70(7): 514-517, 2017 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-28698420

RESUMO

Symptomatic intravascular hemolysis after prosthetic aortic graft replacement is rare. It is primarily attributed to mechanical injury of red blood cells caused by stenosis of the vascular graft. A 50-year-old man presented with hemolytic anemia, 5 years after total arch replacement with an elephant trunk for type A aortic dissection. The hemolysis was caused by graft stenosis of the elephant trunk. Endovascular treatment for the stenotic elephant trunk was successfully performed. The postoperative course was uneventful, and the hemolysis was resolved immediately after operation.


Assuntos
Anemia Hemolítica/etiologia , Constrição Patológica/cirurgia , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Constrição Patológica/complicações , Procedimentos Endovasculares , Humanos , Masculino , Pessoa de Meia-Idade
13.
Kyobu Geka ; 70(7): 536-539, 2017 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-28698424

RESUMO

A 77-year-old man presented with exertional dyspnea. The patient had a history of ankylosing skeletal hyperostosis and sleep apnea syndrome. Echocardiographic examination revealed severe aortic valve regurgitation. The patient underwent a prophylactic tracheostomy 2 weeks before cardiac surgery to decrease his risk of perioperative respiratory failure. He successfully underwent aortic valve replacement through a lower partial sternotomy. His postoperative course was uneventful, and the tracheostoma was closed 6 months after the cardiac surgery.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Hiperostose Esquelética Difusa Idiopática/cirurgia , Idoso , Insuficiência da Valva Aórtica/etiologia , Implante de Prótese de Valva Cardíaca , Humanos , Hiperostose Esquelética Difusa Idiopática/complicações , Masculino , Traqueostomia
14.
Cardiovasc Interv Ther ; 32(2): 190-195, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27090810

RESUMO

A 79-year-old man developed severe bilateral ischemic symptoms in the lower limbs. Chest-abdominal-pelvic contrast computed tomography (CT) showed acute occlusion involving the abdominal aorta, and endovascular therapy (EVT) was used as emergency treatment. Two self-expandable stents placed in the thrombus area resulted in restoration of blood flow to the lower limbs, despite limited stent expansion, and movement of these limbs. Follow-up CT showed good stent expansion. The patient had a favorable recovery without additional surgery. This case suggests that EVT might be an additional option for acute abdominal aortic occlusion if surgery or thrombolytic therapies are not possible.


Assuntos
Aorta Abdominal , Doenças da Aorta/cirurgia , Procedimentos Endovasculares/métodos , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Stents Metálicos Autoexpansíveis , Doença Aguda , Idoso , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico , Aortografia , Constrição Patológica , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Masculino , Desenho de Prótese , Tomografia Computadorizada por Raios X
16.
Gen Thorac Cardiovasc Surg ; 64(7): 403-8, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27059841

RESUMO

BACKGROUND: Extended arch repair for acute type A aortic dissection remains controversial. Our strategy for acute type A aortic dissection was primary entry resection and tear-oriented ascending/hemiarch replacement for patients with the intimal tear in the ascending aorta or is not found in the ascending/aortic arch. Extended total/partial arch replacement was performed for patients with the tear located in the aortic arch. Here, we investigated the validity of our strategy from the viewpoints of long-term survival and reoperation. PATIENTS AND METHODS: Between 2003 and 2014, 267 acute type A aortic dissection patients (mean age; 65.2 ± 12.9 years, 134 men and 133 women) underwent emergent surgical repair. Ascending/hemiarch replacements were performed in 225 patients (ascending/hemiarch group) and total/partial arch replacements in 42 patients (arch group). Early and late outcomes of both groups were compared. RESULTS: The hospital mortality rates in the ascending/hemiarch and the arch groups were 4.4 and 9.5 %, respectively (p = 0.25). For ascending/hemiarch and arch groups, the actuarial survival rates were 80.7 vs. 84.3 % after 5 years, and 66.4 vs. 74.6 %, respectively, after 10 years (p = 0.94). For ascending/hemiarch and arch groups, reoperation-free survival rates were 72.1 vs. 77.1 % after 5 years, and 62.0 vs. 67.1 %, respectively, after 10 years (p = 0.85). CONCLUSIONS: We observed no significant differences in the actuarial survival or reoperation-free survival rates between the groups. These findings suggest that tear-oriented ascending/hemiarch replacement for acute type A aortic dissection does not increase the risk of long-term mortality or reoperation.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Doença Aguda , Adulto , Idoso , Aneurisma Dissecante/mortalidade , Aorta/cirurgia , Aorta Torácica/cirurgia , Implante de Prótese Vascular/mortalidade , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
17.
J Artif Organs ; 19(2): 134-40, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26749145

RESUMO

Valve surgery in hemodialysis-dependent patients is associated with postoperative complications and a high mortality rate, and such patients frequently suffer cachexia. This study aimed to determine pre- and intraoperative risk factors associated with in-hospital mortality and long-term survival in hemodialysis-dependent patients undergoing heart valve surgery from the viewpoint of nutrition status. Eighty-seven hemodialysis-dependent patients who underwent valve surgery between January 1998 and October 2015 were retrospectively reviewed. Thirty-seven potential perioperative risk factors were evaluated. The in-hospital mortality rate was 12.6 % (11 patients). Univariate analysis identified New York Heart Association Functional Classification III or IV, emaciation (body mass index <17.6 kg/m(2)), total cholesterol <120 mg/dl, serum albumin <3.0 mg/dl, emergent/urgent surgery, and intraoperative blood transfusion >3000 ml as predictors of in-hospital death. Multivariate logistic regression analysis confirmed low serum albumin <3.0 mg/dl (hazard ratio 7.22; p = 0.032) and emergent/urgent operation (hazard ratio 43.57; p = 0.035) as independent predictors of in-hospital death. The 1- and 3-year actuarial survival rates were 64.9 ± 5.4 and 51.8 ± 5.8 %, respectively. Long-term survival estimated by log-rank test was negatively impacted by anemia (hemoglobin <10 mg/dl), low serum albumin, emergent/urgent operation, and infective endocarditis. Multivariate analysis using Cox proportional hazards modeling indicated low serum albumin (hazard ratio 2.12; p = 0.047) and emergent/urgent operation (hazard ratio 8.97; p = 0.0002) as independent predictors of remote death. Hypoalbuminemia and emergent/urgent operation are strong predictors of in-hospital and remote death. Malnutrition before surgery should be considered for operative risk estimation, and adequate preoperative nutrition management may improve surgical outcomes for hemodialysis-dependent patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Valvas Cardíacas/cirurgia , Estado Nutricional , Complicações Pós-Operatórias/mortalidade , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Endocardite Bacteriana , Feminino , Implante de Prótese de Valva Cardíaca , Mortalidade Hospitalar , Humanos , Japão/epidemiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
18.
Kyobu Geka ; 68(12): 1019-22, 2015 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-26555919

RESUMO

A 67-year-old man experienced acute inferior myocardial infarction. Echocardiography and computed tomography showed massive pericardial effusion. He underwent emergency operation for ischemic ventricular free wall rupture. During the operation, an oozing type rupture was found on the inferior wall and the bleeding was completely controlled by applying fibrin glue sheets. On the 5th day after the operation, ventricular tachycardia appeared with hemodynamic deterioration. Echocardiography showed a ruptured posteromedial papillary muscle with massive mitral regurgitation. Intra-aortic balloon pumping was introduced and emergency repair operation was performed. The mitral valve was replaced with a bioprosthetic valve. The postoperative course was uneventful.


Assuntos
Ruptura Cardíaca/cirurgia , Isquemia Miocárdica/cirurgia , Músculos Papilares/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos , Eletrocardiografia , Serviços Médicos de Emergência , Ruptura Cardíaca/etiologia , Ruptura Cardíaca/fisiopatologia , Humanos , Masculino , Isquemia Miocárdica/complicações , Tomografia Computadorizada por Raios X
19.
Kyobu Geka ; 68(11): 907-11, 2015 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-26469256

RESUMO

Between 2003 and 2014, at Jichi Medical University Hospital, 11 patients with prosthetic valve endocarditis (PVE) underwent re-operation. There was 1 in-hospital death and 2 late deaths. The cause of death was cirrhosis, heart failure and sepsis, respectively. Emergency surgery, previous double valve replacement (DVR) and Staphylococcus infection were common risk factors for all 3 cases. Two cases of patients that survived who underwent mitral valve replacement (MVR) and DVR for PVE after DVR were treated with multiple antibiotic courses for bacteremia associated with hemodialysis and colon cancer. One patient who underwent DVR after mitral valve plasty which was complicated with cerebral hemorrhage, had survived and was discharged. Of the aortic PVE patients, 2 cases of aortic valve replacement (AVR) using a mechanical valve, 1 case of aortic root replacement (ARR) using a mechanical valve, and 1 ARR using the homograft, were considered cured and never relapsed. A patient with aortic PVE, who underwent AVR after cesarean section for heart failure in birth period, has received ARR twice with the mechanical valve for recurrent pseudo-aneurysm of the left ventricular outflow tract. Since hemodialysis and colon cancer is a risk factor for recurrent PVE, it is necessary to consider the long-term administration of antibiotics after surgery.


Assuntos
Endocardite Bacteriana/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Adulto , Idoso , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , Resultado do Tratamento
20.
Kyobu Geka ; 68(7): 528-31, 2015 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-26197829

RESUMO

A 77-year-old man presented with exertional dyspnea. He had undergone aortic and mitral valve replacement with tissue valves 6-years earlier. The patient's hemoglobin level was 9.8 g/dl and serum aspartate aminotransferase (70 mU/ml) and lactate dehydrogenase (1,112 mU/ml) were elevated. Echocardiography revealed stenosis of the prosthetic valve in the aortic position with peak flow velocity of 3.8 m/second and massive mitral regurgitation. The patient underwent repeat valve replacement. Pannus formation around both implanted valves was observed. The aortic valve orifice was narrowed by the pannus, and one cusp of the prosthesis in the mitral position was fixed and caused the regurgitation, but they were free from cusp laceration or calcification. The patient's postoperative course was uneventful, and he continues to do well 14 months after surgery.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Constrição Patológica/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Humanos , Masculino , Falha de Prótese , Fatores de Tempo
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