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1.
Int J Cardiol ; 291: 36-41, 2019 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-30929973

RESUMO

BACKGROUND: The STICH trial showed superiority of coronary artery bypass plus medical treatment (CABG) over medical treatment alone (MED) in patients with left ventricular ejection fraction (LVEF) ≤35%. In previous publications, percutaneous coronary intervention (PCI) prior to CABG was associated with worse prognosis. OBJECTIVES: The main purpose of this study was to analyse if prior PCI influenced outcomes in STICH. METHODS AND RESULTS: Patients in the STICH trial (n = 1212), followed for a median time of 9.8 years, were included in the present analyses. In the total population, 156 had a prior PCI (74 and 82, respectively, in the MED and CABG groups). In those with vs. without prior PCI, the adjusted hazard-ratios (aHRs) were 0.92 (95% CI = 0.74-1.15) for all-cause mortality, 0.85 (95% CI = 0.64-1.11) for CV mortality, and 1.43 (95% CI = 1.15-1.77) for CV hospitalization. In the group randomized to CABG without prior PCI, the aHRs were 0.82 (95% CI = 0.70-0.95) for all-cause mortality, 0.75 (95% CI = 0.62-0.90) for CV mortality and 0.67 (95% CI = 0.56-0.80) for CV hospitalization. In the group randomized to CABG with prior PCI, the aHRs were 0.76 (95% CI = 0.50-1.15) for all-cause mortality, 0.81 (95% CI = 0.49-1.36) for CV mortality and 0.61 (95% CI = 0.41-0.90) for CV hospitalization. There was no evidence of interaction between randomized treatment and prior PCI for any endpoint (all adjusted p > 0.05). CONCLUSION: In the STICH trial, prior PCI did not affect the outcomes of patients whether they were treated medically or surgically, and the superiority of CABG over MED remained unchanged regardless of prior PCI. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov; Identifier: NCT00023595.

2.
PLoS One ; 13(7): e0199277, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29979692

RESUMO

BACKGROUND: Mortality prediction after cardiac procedures is an essential tool in clinical decision making. Although rheumatic cardiac disease remains a major cause of heart surgery in the world no previous study validated risk scores in a sample exclusively with this condition. OBJECTIVES: Develop a novel predictive model focused on mortality prediction among patients undergoing cardiac surgery secondary to rheumatic valve conditions. METHODS: We conducted prospective consecutive all-comers patients with rheumatic heart disease (RHD) referred for surgical treatment of valve disease between May 2010 and July of 2015. Risk scores for hospital mortality were calculated using the 2000 Bernstein-Parsonnet, EuroSCORE II, InsCor, AmblerSCORE, GuaragnaSCORE, and the New York SCORE. In addition, we developed the rheumatic heart valve surgery score (RheSCORE). RESULTS: A total of 2,919 RHD patients underwent heart valve surgery. After evaluating 13 different models, the top performing areas under the curve were achieved using Random Forest (0.982) and Neural Network (0.952). Most influential predictors across all models included left atrium size, high creatinine values, a tricuspid procedure, reoperation and pulmonary hypertension. Areas under the curve for previously developed scores were all below the performance for the RheSCORE model: 2000 Bernstein-Parsonnet (0.876), EuroSCORE II (0.857), InsCor (0.835), Ambler (0.831), Guaragna (0.816) and the New York score (0.834). A web application is presented where researchers and providers can calculate predicted mortality based on the RheSCORE. CONCLUSIONS: The RheSCORE model outperformed pre-existing scores in a sample of patients with rheumatic cardiac disease.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doenças das Valvas Cardíacas/mortalidade , Febre Reumática/mortalidade , Cardiopatia Reumática/mortalidade , Idoso , Feminino , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/cirurgia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Febre Reumática/fisiopatologia , Febre Reumática/cirurgia , Cardiopatia Reumática/fisiopatologia , Cardiopatia Reumática/cirurgia , Medição de Risco , Fatores de Risco
3.
Arq. bras. cardiol ; 109(4): 290-298, Oct. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-887952

RESUMO

Abstract Background: Renal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary. Objective: To objectively evaluate whether CC is a better risk predictor than serum creatinine (SC) in patients undergoing cardiac surgery. Methods: Analysis of 3,285 patients registered in a prospective, consecutive and mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) between November 2013 and January 2015. Values of SC, CC (Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC and CC with morbidity and mortality was performed by calibration and discrimination tests. Independent multivariate models with SC and CC were generated by multiple logistic regression to predict morbidity and mortality following cardiac surgery. Results: Despite the association between SC and mortality, it did not calibrate properly the risk groups. There was an association between CC and mortality with good calibration of risk groups. In mortality risk prediction, SC was uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve showed that CC is better than SC in predicting both morbidity and mortality risk. In the multivariate model without CC, SC was the only predictor of morbidity, whereas in the model without SC, CC was not only a mortality predictor, but also the only morbidity predictor. Conclusion: Compared with SC, CC is a better parameter of renal function in risk stratification of patients undergoing cardiac surgery.


Resumo Fundamentos: Disfunção renal é preditor independente de morbimortalidade após cirurgia cardíaca. Para uma melhor avaliação da função renal, o cálculo do clearance de creatinina (CC) pode ser necessário. Objetivo: Avaliar objetivamente se o CC é melhor que a creatinina sérica (CS) para predizer risco nos pacientes submetidos à cirurgia cardíaca. Métodos: Análise em 3285 pacientes do Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) incluídos de forma prospectiva, consecutiva e mandatória entre novembro de 2013 e janeiro de 2015. Foram obtidos valores de CS, CC (Cockcroft-Gault) e do EuroSCORE II. Análise de associações da CS e do CC com morbimortalidade foi realizada mediante testes de calibração e discriminação. Por regressão logística múltipla, foram criados modelos multivariados independentes com CS e com CC para predição de risco de morbimortalidade após cirurgia cardíaca. Resultados: Apesar da associação entre a CS e morbimortalidade, essa não calibrou adequadamente os grupos de risco. Houve associação entre o CC e morbimortalidade com boa calibração dos grupos de risco. Na predição do risco de mortalidade, a CS ficou descalibrada com valores >1,35 mg/dL (p < 0,001). A curva ROC revelou que o CC é superior à CS na predição de risco de morbimortalidade. No modelo multivariado sem CC, a CS foi a única preditora de morbidade, enquanto que no modelo sem a CS, o CC foi preditor de mortalidade e o único preditor de morbidade. Conclusão: Para avaliação da função renal, o CC é superior que a CS na estratificação de risco dos pacientes submetidos a cirurgia cardíaca.

4.
Arq Bras Cardiol ; 109(4): 290-298, 2017 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28876374

RESUMO

BACKGROUND: Renal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary. OBJECTIVE: To objectively evaluate whether CC is a better risk predictor than serum creatinine (SC) in patients undergoing cardiac surgery. METHODS: Analysis of 3,285 patients registered in a prospective, consecutive and mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) between November 2013 and January 2015. Values of SC, CC (Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC and CC with morbidity and mortality was performed by calibration and discrimination tests. Independent multivariate models with SC and CC were generated by multiple logistic regression to predict morbidity and mortality following cardiac surgery. RESULTS: Despite the association between SC and mortality, it did not calibrate properly the risk groups. There was an association between CC and mortality with good calibration of risk groups. In mortality risk prediction, SC was uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve showed that CC is better than SC in predicting both morbidity and mortality risk. In the multivariate model without CC, SC was the only predictor of morbidity, whereas in the model without SC, CC was not only a mortality predictor, but also the only morbidity predictor. CONCLUSION: Compared with SC, CC is a better parameter of renal function in risk stratification of patients undergoing cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Creatinina/sangue , Taxa de Filtração Glomerular/fisiologia , Insuficiência Renal/sangue , Insuficiência Renal/mortalidade , Medição de Risco/métodos , Idoso , Calibragem , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos Prospectivos , Padrões de Referência , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade
5.
Lipids ; 49(7): 677-84, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24719245

RESUMO

Metabolic syndrome (MetS) refers to states of insulin resistance that predispose to development of cardiovascular disease and type 2 diabetes (T2DM). The aim was to investigate whether plasma lipids and lipid metabolism differ in MetS patients compared to those with T2DM with poor glycemic control (glycated hemoglobin > 7.0). Eighteen patients with T2DM, 18 with MetS and 14 controls, paired for age (40-70 years) and body mass index (BMI), were studied. Plasma lipids and the kinetics of a triacylglycerol-rich emulsion labeled with [(3)H]-triolein ([(3)H]-TAG) and [(14)C]-cholesteryl esters ([(14)C]-CE) injected intravenously followed by one-hour blood sampling were determined. Lipid transfers from an artificial nanoemulsion donor to high-density lipoprotien (HDL) were assayed in vitro. Low-density lipoprotein (LDL) and HDL cholesterol (mg/dl) were not different in T2DM (128 ± 7; 42 ± 7) and MetS (142 ± 6; 39 ± 3), but triacylglycerols were even higher in MetS (215 ± 13) than in T2DM (161 ±11, p < 0.05). Fractional clearance rate (FCR, in min(1)) of [(3)H]-TAG and [(14)C]-CE were equal in T2DM (0.008 ± 0.018; 0.005 ± 0.024) and MetS (0.010 ± 0.016; 0.006 ± 0.013), and both were reduced compared to controls. The transfer of non-esterified cholesterol, phospholipids and triacylglycerols to HDL was higher in MetS and T2DM than in controls (p < 0.01). Cholesteryl ester transfer and HDL size were equal in all groups. Results imply that MetS is equal to poorly controlled T2DM concerning the disturbances of plasma lipid metabolism examined here, and suggest that there are different thresholds for the insulin action on glucose and lipids. These findings highlight the magnitude of the lipid disturbances in MetS, and may have implications in the prevention of cardiovascular diseases.


Assuntos
Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/metabolismo , Metabolismo dos Lipídeos , Lipídeos/sangue , Lipoproteínas HDL/metabolismo , Lipoproteínas/metabolismo , Síndrome Metabólica/sangue , Síndrome Metabólica/metabolismo , Adulto , Idoso , Índice de Massa Corporal , Humanos , Masculino , Pessoa de Meia-Idade
6.
Arq Bras Cardiol ; 100(3): 246-54, 2013 Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23598578

RESUMO

BACKGROUND: Risk scores show difficulties to attain the same performance in different populations. OBJECTIVE: To create a simple and accurate risk assessment model for patients submitted to surgery due to coronary and/or valvular disease at Instituto do Coração da Universidade de São Paulo (InCor-HCFMUSP). METHODS: Between 2007 and 2009, 3,000 patients were submitted to surgical procedure due to coronary artery and/or valvular disease at InCor-HCFMUSP. From this record, data of 2/3 of the patients were used for model development (bootstrap technique), and 1/3 for internal validation of the model. The performance of the model (InsCor) was compared to the 2000 Bernstein-Parsonnet (2000BP) and EuroSCORE (ES) complexes. RESULTS: Only 10 variables were selected: age > 70 years, female sex; coronary revascularization + valve, myocardial infarction < 90 days; reoperation; surgical treatment of aortic valve; surgical treatment of tricuspid valve; creatinine < 2mg/dL; ejection fraction < 30%, and events. The Hosmer Lemeshow test for the InsCor was 0.184, indicating excellent calibration. The area under the ROC curve was 0.79 for the InsCor, 0.81 for the ES and 0.82 for 2000BP, confirming that the models are good and have similar discrimination. CONCLUSIONS: The InsCor and ES performed better than 2000BP at all stages of validation, but the new model, in addition to showing identification with the local risk factors, is simpler and more objective for mortality prediction in patients undergoing surgery due to coronary and/or valvular disease at InCor-HCFMUSP.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Doença da Artéria Coronariana/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Idoso , Calibragem/normas , Feminino , Humanos , Modelos Estatísticos , Curva ROC , Reprodutibilidade dos Testes , Medição de Risco/métodos , Medição de Risco/normas
7.
Arq. bras. cardiol ; 100(3): 246-254, mar. 2013. ilus, tab
Artigo em Português | LILACS | ID: lil-670865

RESUMO

FUNDAMENTO: Escores de risco apresentam dificuldades para obter o mesmo desempenho em diferentes populações. OBJETIVO: Criar um modelo simples e acurado para avaliação do risco nos pacientes operados de doença coronariana e/ou valvar no Instituto do Coração da Universidade de São Paulo (InCor-HCFMUSP). MÉTODOS: Entre 2007 e 2009, 3.000 pacientes foram operados consecutivamente de doença coronariana e/ou valvar no InCor-HCFMUSP. Desse registro, dados de 2/3 dos pacientes foram utilizados para desenvolvimento do modelo (técnica de bootstrap) e de 1/3 para validação interna do modelo. O desempenho do modelo (InsCor) foi comparado aos complexos 2000 Bernstein-Parsonnet (2000BP) e EuroSCORE (ES). RESULTADOS: Apenas 10 variáveis foram selecionadas: Idade > 70 anos; sexo feminino; cirurgia de revascularização coronariana + valva; infarto de miocárdio < 90 dias; reoperação; tratamento cirúrgico da valva aórtica; tratamento cirúrgico da valva tricúspide; creatinina < 2mg/dL; fração de ejeção < 30%; e eventos. O teste de Hosmer Lemeshow para o InsCor foi de 0,184, indicando uma excelente calibração. A área abaixo da curva ROC foi de 0,79 para o InsCor, 0,81 para o ES e 0,82 para o 2000BP, confirmando que os modelos são bons e similares na discriminação. CONCLUSÕES: O InsCor e o ES tiveram melhor desempenho que o 2000BP em todas as fases da validação; pórem o novo modelo, além de se identificar com os fatores de risco locais, é mais simples e objetivo para a predição de mortalidade nos pacientes operados de doença coronariana e/ou valvar no InCor-HCFMUSP.


BACKGROUND: Risk scores show difficulties to attain the same performance in different populations. OBJECTIVE: To create a simple and accurate risk assessment model for patients submitted to surgery due to coronary and/or valvular disease at Instituto do Coração da Universidade de São Paulo (InCor-HCFMUSP). METHODS: Between 2007 and 2009, 3,000 patients were submitted to surgical procedure due to coronary artery and/or valvular disease at InCor-HCFMUSP. From this record, data of 2/3 of the patients were used for model development (bootstrap technique), and 1/3 for internal validation of the model. The performance of the model (InsCor) was compared to the 2000 Bernstein-Parsonnet (2000BP) and EuroSCORE (ES) complexes. RESULTS: Only 10 variables were selected: age > 70 years, female sex; coronary revascularization + valve, myocardial infarction < 90 days; reoperation; surgical treatment of aortic valve; surgical treatment of tricuspid valve; creatinine < 2mg/dL; ejection fraction < 30%, and events. The Hosmer Lemeshow test for the InsCor was 0.184, indicating excellent calibration. The area under the ROC curve was 0.79 for the InsCor, 0.81 for the ES and 0.82 for 2000BP, confirming that the models are good and have similar discrimination. CONCLUSIONS: The InsCor and ES performed better than 2000BP at all stages of validation, but the new model, in addition to showing identification with the local risk factors, is simpler and more objective for mortality prediction in patients undergoing surgery due to coronary and/or valvular disease at InCor-HCFMUSP.


Assuntos
Idoso , Feminino , Humanos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Doença da Artéria Coronariana/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Calibragem/normas , Modelos Estatísticos , Reprodutibilidade dos Testes , Curva ROC , Medição de Risco/métodos , Medição de Risco/normas
8.
Rev Bras Cir Cardiovasc ; 27(2): 203-10, 2012.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22996970

RESUMO

BACKGROUND: Longitudinal median sternotomy is the most common surgical approach for access to heart disease treatment. The deep wound infections in postoperative period of cardiovascular surgery are a serious complication requiring high costs during treatment. Different studies have indicated some risk factors for the development of mediastinitis and preoperative variables are currently under investigation. OBJECTIVE: The aim of this study is to identify the preoperative risk factors for postoperative development of mediastinitis in patients undergoing coronary artery bypass grafting and valve replacement. METHODS: This observational study represents a cohort of 2768 consecutive operated patients. The period considered for analysis was from May 2007 to May 2009 and there were no exclusion criteria. Analysis was performed by univariate and multivariate logistic regression model of 38 preoperative variables. RESULTS: Thirty-five (1.3%) patients developed mediastinitis and 19 (0.7%) associated with osteomyelitis. The patient age average was 59.9 ± 13.5 years and the EuroSCORE of 4.5 ± 3.6. Hospital mortality was 42.8%. The multivariate analysis identified three variables as independent predictors of postoperative mediastinitis: intra-aortic balloon pump (OR 5.41, 95% CI [1.83 -16.01], P = 0.002), hemodialysis (OR 4.87, 95% CI [1.41 to 16.86], P = 0.012) and extracardiac vascular intervention (OR 4.39, 95% CI [1.64 to 11.76], P = 0.003). CONCLUSION: This study showed that necessity of preoperative hemodynamic support with intra-aortic balloon, hemodialysis, and extracardiac vascular intervention were risk factors for development of mediastinitis after cardiac surgery.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Valvas Cardíacas/cirurgia , Mediastinite/etiologia , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Idoso , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Fatores de Risco , Distribuição por Sexo
9.
BMC Cardiovasc Disord ; 12: 65, 2012 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-22898311

RESUMO

BACKGROUND: Although the release of cardiac biomarkers after percutaneous (PCI) or surgical revascularization (CABG) is common, its prognostic significance is not known. Questions remain about the mechanisms and degree of correlation between the release, the volume of myocardial tissue loss, and the long-term significance. Delayed-enhancement of cardiac magnetic resonance (CMR) consistently quantifies areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac biomarkers, we will evaluate the extent of irreversible injury in patients undergoing PCI and CABG and relate it to postprocedural modifications in cardiac biomarkers and long-term prognosis. METHODS/DESIGN: The study will include 150 patients with multivessel coronary artery disease (CAD) with left ventricle ejection fraction (LVEF) and a formal indication for CABG; 50 patients will undergo CABG with cardiopulmonary bypass (CPB); 50 patients with the same arterial and ventricular condition indicated for myocardial revascularization will undergo CABG without CPB; and another 50 patients with CAD and preserved ventricular function will undergo PCI using stents. All patients will undergo CMR before and after surgery or PCI. We will also evaluate the release of cardiac markers of necrosis immediately before and after each procedure. Primary outcome considered is overall death in a 5-year follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin in association with presence of myocardial fibrosis and systolic left ventricle dysfunction assessed by CMR. DISCUSSION: The MASS-V Trial aims to establish reliable values for parameters of enzyme markers of myocardial necrosis in the absence of manifest myocardial infarction after mechanical interventions. The establishments of these indices have diagnostic value and clinical prognosis and therefore require relevant and different therapeutic measures. In daily practice, the inappropriate use of these necrosis markers has led to misdiagnosis and therefore wrong treatment. The appearance of a more sensitive tool such as CMR provides an unprecedented diagnostic accuracy of myocardial damage when correlated with necrosis enzyme markers. We aim to correlate laboratory data with imaging, thereby establishing more refined data on the presence or absence of irreversible myocardial injury after the procedure, either percutaneous or surgical, and this, with or without the use of cardiopulmonary bypass.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/terapia , Creatina Quinase Forma MB/sangue , Cardiopatias/diagnóstico , Imagem Cinética por Ressonância Magnética , Miocárdio , Intervenção Coronária Percutânea/efeitos adversos , Projetos de Pesquisa , Troponina I/sangue , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/cirurgia , Fibrose , Cardiopatias/sangue , Cardiopatias/patologia , Cardiopatias/fisiopatologia , Humanos , Modelos Logísticos , Análise Multivariada , Miocárdio/metabolismo , Miocárdio/patologia , Necrose , Intervenção Coronária Percutânea/instrumentação , Valor Preditivo dos Testes , Estudos Prospectivos , Stents , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
10.
Rev. bras. cir. cardiovasc ; 27(2): 203-210, abr.-jun. 2012. tab
Artigo em Português | LILACS | ID: lil-649595

RESUMO

INTRODUÇÃO: A esternotomia mediana longitudinal é a via de acesso mais utilizada no tratamento das doenças cardíacas. As infecções profundas da ferida operatória no pós-operatório das cirurgias cardiovasculares são uma complicação séria, com alto custo durante o tratamento. Diferentes estudos têm encontrado fatores de risco para o desenvolvimento de mediastinite e as variáveis pré-operatórias têm tido especial destaque. OBJETIVO: O objetivo deste estudo é identificar fatores de risco pré-operatórios para o desenvolvimento de mediastinite em pacientes submetidos a revascularização do miocárdio e a substituição valvar. MÉTODOS: Este estudo observacional representa uma coorte de 2768 pacientes operados consecutivamente. O período considerado para análise foi de maio de 2007 a maio de 2009 e não houve critérios de exclusão. Foi realizada análise univariada e multivariada pelo modelo de regressão logística das 38 variáveis pré-operatórias eleitas. RESULTADOS: Nesta série, 35 (1,3%) pacientes evoluíram com mediastinite e 19 (0,7%) com osteomielite associada. A idade média dos pacientes foi de 59,9 ± 13,5 anos e o EuroSCORE de 4,5 ± 3,6. A mortalidade hospitalar foi de 42,8%. Na análise multivariada, foram identificadas três variáveis como preditoras independentes de mediastinite: balão intra-aórtico (OR 5,41, 95% IC [1,83 -16,01], P=0,002), hemodiálise (OR 4,87, 95% IC [1,41 - 16,86], P=0,012) e intervenção vascular extracardíaca (OR 4,39, 95% IC [1,64 - 11,76], P=0,003). CONCLUSÃO: O presente estudo demonstrou que necessidade do suporte hemodinâmico pré-operatório com balão intra-aórtico, hemodiálise e intervenção vascular extracardíaca são fatores de risco para o desenvolvimento de mediastinite após cirurgia cardíaca.


BACKGROUND: Longitudinal median sternotomy is the most common surgical approach for access to heart disease treatment. The deep wound infections in postoperative period of cardiovascular surgery are a serious complication requiring high costs during treatment. Different studies have indicated some risk factors for the development of mediastinitis and preoperative variables are currently under investigation. OBJECTIVE: The aim of this study is to identify the preoperative risk factors for postoperative development of mediastinitis in patients undergoing coronary artery bypass grafting and valve replacement. METHODS: This observational study represents a cohort of 2768 consecutive operated patients. The period considered for analysis was from May 2007 to May 2009 and there were no exclusion criteria. Analysis was performed by univariate and multivariate logistic regression model of 38 preoperative variables. RESULTS: Thirty-five (1.3%) patients developed mediastinitis and 19 (0.7%) associated with osteomyelitis. The patient age average was 59.9 ± 13.5 years and the EuroSCORE of 4.5 ± 3.6. Hospital mortality was 42.8%. The multivariate analysis identified three variables as independent predictors of postoperative mediastinitis: intra-aortic balloon pump (OR 5.41, 95% CI [1.83 -16.01], P = 0.002), hemodialysis (OR 4.87, 95% CI [1.41 to 16.86], P = 0.012) and extracardiac vascular intervention (OR 4.39, 95% CI [1.64 to 11.76], P = 0.003). CONCLUSION: This study showed that necessity of preoperative hemodynamic support with intra-aortic balloon, hemodialysis, and extracardiac vascular intervention were risk factors for development of mediastinitis after cardiac surgery.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte de Artéria Coronária/efeitos adversos , Valvas Cardíacas/cirurgia , Mediastinite/etiologia , Período Pré-Operatório , Complicações Pós-Operatórias/etiologia , Métodos Epidemiológicos , Osteomielite/etiologia , Fatores de Risco , Distribuição por Sexo
11.
Eur J Cardiothorac Surg ; 35(2): 313-8, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19008115

RESUMO

BACKGROUND: Several methods have been utilized to prevent pericardial and retrosternal adhesions, but none of them evaluated the mesothelial regenerative hypothesis. There are evidences that the mesothelial trauma reduces pericardial fibrinolytic capability and induces an adhesion process. Keratinocyte growth factor (KGF) has proven to improve mesothelial cells proliferation. This study investigated the influence of keratinocyte growth factor in reducing post-surgical adhesions. METHODS: Twelve pigs were operated and an adhesion protocol was employed. Following a stratified randomization, the animals received a topical application of KGF or saline. At 8 weeks, intrapericardial adhesions were evaluated and a severity score was established. The time spent to dissect the adhesions and the amount of sharp dissection used, were recorded. Histological sections were stained with sirius red and morphometric analyses were assessed with a computer-assisted image analysis system. RESULTS: The severity score was lower in the KGF group than in the control group (11.5 vs 17, p=0.005). The dissection time was lower in the KGF group (9.2+/-1.4 min vs 33.9+/-9.2 min, p=0.004) and presented a significant correlation with the severity score (r=0.83, p=0.001). A significantly less sharp dissection was also required in the KGF group. Also, adhesion area and adhesion collagen were significantly lower in the KGF group than in the control group. CONCLUSION: The stimulation of pericardial cells with KGF reduced the intensity of postoperative adhesions and facilitated the re-operation. This study suggests that the mesothelial regeneration is the new horizon in anti-adhesion therapies.


Assuntos
Fator 7 de Crescimento de Fibroblastos/uso terapêutico , Cardiopatias/prevenção & controle , Pericárdio/cirurgia , Animais , Modelos Animais de Doenças , Dissecação , Avaliação Pré-Clínica de Medicamentos/métodos , Células Epiteliais/efeitos dos fármacos , Cardiopatias/patologia , Cardiopatias/cirurgia , Masculino , Pericárdio/patologia , Proteínas Recombinantes/uso terapêutico , Reoperação , Sus scrofa , Aderências Teciduais/patologia , Aderências Teciduais/prevenção & controle , Aderências Teciduais/cirurgia
12.
Rev Bras Cir Cardiovasc ; 22(1): 68-74, 2007.
Artigo em Inglês, Português | MEDLINE | ID: mdl-17992306

RESUMO

OBJECTIVE: This study aimed at evaluating results of mitral valve replacement using a new technique of complete chordae tendineae adjustment for left ventricular remodeling. METHODS: Twenty end-stage idiopathic dilated cardiomyopathy patients with severe functional mitral valve regurgitation underwent mitral valve replacement. Seventeen (85%) were in functional class IV. Both anterior and posterior leaflets of the mitral valve were divided to obtain 4 pillars of chordae tendineae. These were displaced with traction toward the left atrium and anchored between the mitral annulus and a valvular prosthesis. To evaluate the left ventricular remodeling, Doppler echocardiography was performed. For statistical analysis, variance analysis and the Friedman's test were employed. RESULTS: Two (10%) early deaths occurred. Kaplan-Meyer showed survival at one year post-operative was 85%, 2 years it was 44%, at 3 years 44%, at 4 years 44% and at 5 years it was 44%. In the 48- and 54-month follow-ups, the McNemar test showed improvement in the functional class (p<0.001). In the third month of follow-up, variance analysis showed improvement in the ejection fraction (p=0.008) and reductions of the end diastolic diameter (p=0.038), end systolic diameter (p=0.008), end systolic volume (p=0.029) and end diastolic volume (p=0.009). No statistical differences were noted in the systolic volume. Comparing pre-operative and third- and six-month follow-ups, the Friedman test showed no statistical differences for all studied variables. Variance analyses between pre, three-month and final evaluations showed no significant differences. CONCLUSION: This technique of mitral valve replacement improved the left ventricle ejection fraction and decreased the end diastolic and systolic diameters and the end systolic diastolic volumes up to the third month of follow-up. From then on the variables stabilized.


Assuntos
Bioprótese , Cardiomiopatia Dilatada/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular/fisiologia , Análise de Variância , Animais , Cardiomiopatia Dilatada/complicações , Bovinos , Cordas Tendinosas/cirurgia , Diástole , Ecocardiografia , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Índice de Gravidade de Doença , Volume Sistólico , Sístole
13.
Lipids ; 42(5): 411-8, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17443358

RESUMO

A cholesterol-rich nanoemulsion (LDE) that mimics the composition of low-density lipoprotein (LDL) acquires apoE in the plasma and is taken-up by the cells by LDL receptors. In this study, to verify whether free cholesterol (FC) and the cholesteryl ester (CE) components of LDL are taken-up differently by the vessels. LDE labeled with (3)H-cholesterol and (14)C-cholesteryl oleate was injected into 20 coronary artery disease patients 24 h before a scheduled myocardial coronary artery bypass grafting. The plasma kinetics of both radiolabels was determined from plasma samples collected over 24 h, and fragments of vessels discarded during surgery were collected and analyzed for radioactivity. LDE FC was removed faster than CE. The radioactive counting of LDE CE was greater than that of LDE FC in the blood, but the uptake of FC was markedly greater than that of CE in all fragments: fivefold greater in the aorta (p = 0.04), fourfold greater in the internal thoracic artery (p = 0.03), tenfold greater in the saphenous vein (p = 0.01) and threefold in the radial artery (p = 0.05). In conclusion, the greater removal from plasma of FC compared with CE and the remarkably greater vessel tissue uptake of FC compared with CE suggests that, in the plasma, FC dissociates from the nanoemulsion particles and precipitates in the vessels. Considering LDE as an artificial nanoemulsion model for LDL, our results suggest that dissociation of FC from lipoprotein particles and deposition in the vessel wall may play a role as an independent mechanism in atherogenesis.


Assuntos
Aterosclerose/etiologia , Colesterol/sangue , Doença da Artéria Coronariana/sangue , Adulto , Idoso , Aterosclerose/metabolismo , Ésteres do Colesterol/sangue , Doença da Artéria Coronariana/metabolismo , Emulsões , Feminino , Humanos , Cinética , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Nanopartículas/administração & dosagem , Nanopartículas/química
14.
Rev. bras. cir. cardiovasc ; 22(1): 68-74, jan.-mar. 2007. tab, ilus, graf
Artigo em Português | LILACS | ID: lil-454629

RESUMO

OBJETIVO: Avaliar a geometria e a função do ventrículo esquerdo (VE) após a troca mitral com tração e fixação dos papilares, em portadores de insuficiência cardíaca terminal com insuficiência mitral secundária. MÉTODO: Dos 20 pacientes avaliados, 70 por cento eram homens, com idade média de 50,2 anos e 55 por cento recebiam inotrópicos. A fração de ejeção (FEVE) foi menor que 30 por cento em todos; 85 por cento estavam em classe funcional (CF) IV. Dezoito receberam próteses de pericárdio bovino e dois, mecânicas. Os períodos considerados foram: 3, 6, 12 e 18 meses. As variáveis consideradas: volume sistólico do VE (VS), a FEVE, os diâmetros sistólico e diastólico finais (DSF e DDF) e os volumes sistólico e diastólico finais (VSF e VDF). No estudo estatístico, empregou-se da análise de variância (AV) e o teste de Friedmann (F). A sobrevida foi aferida pelo método de Kaplan-Meyer. RESULTADOS: Dois (10 por cento) faleceram no período imediato. A sobrevida no primeiro ano foi de 85 por cento, no segundo, 44 por cento, no terceiro, 44 por cento, no quarto, 44 por cento e no quinto, 44 por cento. A comparação entre pré e 3 meses, empregando-se a AV, não revelou alteração significativa para o VS (p=0,086). Houve acréscimo da FEVE (p=0,008) e decréscimo do DDF (p=0,038); do DSF (p=0,008); do VDF (p=0,029) e do VSF (p=0,009). Os momentos pré, 3 e 6 meses, com o teste F, não revelaram alterações. Entre os momentos pré, 3 meses e final, empregando-se a AV, não houve significância. CONCLUSÃO: Há melhora da FEVE, dos VDF, VSF, DDF e DSF; até o terceiro mês. A partir de então, as variáveis permanecem estáveis.


OBJECTIVE: This study aimed at evaluating results of mitral valve replacement using a new technique of complete chordae tendineae adjustment for left ventricular remodeling. METHODS: Twenty end-stage idiopathic dilated cardiomyopathy patients with severe functional mitral valve regurgitation underwent mitral valve replacement. Seventeen (85 percent) were in functional class IV. Both anterior and posterior leaflets of the mitral valve were divided to obtain 4 pillars of chordae tendineae. These were displaced with traction toward the left atrium and anchored between the mitral annulus and a valvular prosthesis. To evaluate the left ventricular remodeling, Doppler echocardiography was performed. For statistical analysis, variance analysis and the Friedman's test were employed. RESULTS: Two (10 percent) early deaths occurred. Kaplan-Meyer showed survival at one year post-operative was 85 percent, 2 years it was 44 percent, at 3 years 44 percent, at 4 years 44 percent and at 5 years it was 44 percent. In the 48- and 54-month follow-ups, the McNemar test showed improvement in the functional class (p<0.001). In the third month of follow-up, variance analysis showed improvement in the ejection fraction (p=0.008) and reductions of the end diastolic diameter (p=0.038), end systolic diameter (p=0.008), end systolic volume (p=0.029) and end diastolic volume (p=0.009). No statistical differences were noted in the systolic volume. Comparing pre-operative and third- and six-month follow-ups, the Friedman test showed no statistical differences for all studied variables. Variance analyses between pre, three-month and final evaluations showed no significant differences. CONCLUSION: This technique of mitral valve replacement improved the left ventricle ejection fraction and decreased the end diastolic and systolic diameters and the end systolic diastolic volumes up to the third month of follow-up. From then on the variables stabilized.


Assuntos
Humanos , Cardiomiopatia Dilatada , Insuficiência Cardíaca , Valva Mitral , Próteses Valvulares Cardíacas
15.
Clinics (Sao Paulo) ; 62(6): 725-30, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18209915

RESUMO

BACKGROUND: Left internal thoracic artery to left anterior descending artery (LITA-LADA) grafting has become a fundamental part of the coronary artery bypass graft procedure (CABG). This grafting in turn has led to an increased use of other arterial conduits, of which the radial artery (RA) is most popular. Whether RA grafting can be used in the emergency patient is controversial. METHODS: 47 patients with critical stenosis (>70%) in all target vessels underwent CABG with LITA and RA grafts from 1996 to 2003. Patients were divided into elective (23 patients) and non-elective groups (24 patients) with LITA and RA grafts per patient being similar in both groups. Of these 47 patients, 5 died from non-cardiac complications and 12 were unavailable. Thus, 30 patients (71% of survivors) were studied by multidetector computed tomography. A total of 36 LITA and 64 RA grafts were studied. RESULTS: The RA patency rate for elective and non-elective grafts were 82% (31/38) and 85% (22/26), respectively (p=0.75). The RA had a similar patency rate for all target vessels ranging from 73% to 100%. Only one patient had a redo CABG and 29 (97%) are free from angina or re-intervention. LITA-LADA had a 92% (11/12) and 100% (10/10) patency rate for elective and non-elective groups, respectively (p=0.37). The sequential LITA-diagonal-LADA in the elective group had a 50% (03/06) patency rate, which was significantly lower than the 100% (08/08) patency rate of the non-elective group (p=0.02). CONCLUSION: Radial Artery grafts can be used in both elective and non-elective patients with excellent results.


Assuntos
Ponte de Artéria Coronária/métodos , Doença das Coronárias/cirurgia , Artéria Radial/transplante , Artérias Torácicas/transplante , Adulto , Idoso , Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária/normas , Doença das Coronárias/diagnóstico por imagem , Procedimentos Cirúrgicos Eletivos , Tratamento de Emergência , Métodos Epidemiológicos , Feminino , Humanos , Anastomose de Artéria Torácica Interna-Coronária , Masculino , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artérias Torácicas/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Grau de Desobstrução Vascular
16.
Clinics ; 62(6): 725-730, 2007. ilus, tab
Artigo em Inglês | LILACS | ID: lil-471792

RESUMO

BACKGROUND: Left internal thoracic artery to left anterior descending artery (LITA-LADA) grafting has become a fundamental part of the coronary artery bypass graft procedure (CABG). This grafting in turn has led to an increased use of other arterial conduits, of which the radial artery (RA) is most popular. Whether RA grafting can be used in the emergency patient is controversial. METHODS: 47 patients with critical stenosis (>70 percent) in all target vessels underwent CABG with LITA and RA grafts from 1996 to 2003. Patients were divided into elective (23 patients) and non-elective groups (24 patients) with LITA and RA grafts per patient being similar in both groups. Of these 47 patients, 5 died from non-cardiac complications and 12 were unavailable. Thus, 30 patients (71 percent of survivors) were studied by multidetector computed tomography. A total of 36 LITA and 64 RA grafts were studied. RESULTS: The RA patency rate for elective and non-elective grafts were 82 percent (31/38) and 85 percent (22/26), respectively (p=0.75). The RA had a similar patency rate for all target vessels ranging from 73 percent to 100 percent. Only one patient had a redo CABG and 29 (97 percent) are free from angina or re-intervention. LITA-LADA had a 92 percent (11/12) and 100 percent (10/10) patency rate for elective and non-elective groups, respectively (p=0.37). The sequential LITA-diagonal-LADA in the elective group had a 50 percent (03/06) patency rate, which was significantly lower than the 100 percent (08/08) patency rate of the non-elective group (p=0.02). CONCLUSION: Radial Artery grafts can be used in both elective and non-elective patients with excellent results.


INTRODUÇÃO: A anastomose da artéria torácica interna esquerda com a artéria descendente anterior (ATIE-DA) se tornou parte fundamental da cirurgia de revascularização do miocárdio (RM). Esta técnica levou ao aumento de utilização de outros enxertos arteriais, entre os quais, a artéria radial (AR) é muito usasa. Na literatura há controvérsia se a AR pode ser usada em pacientes em RM de emergência. MÉTODOS: 47 pacientes com lesões críticas (>70 por cento) em todas as artérias alvo foram submetidos à RM com ATIE e a AR entre 1996 e 2003. Os pacientes foram agrupados em eletivos (23 pacientes) e não eletivos (24 pacientes) sendo similares para número de enxertos de ATIE e AR por paciente. Dos 47 pacientes, 5 morreram de complicações não cardíacas e 12 não estavam disponíveis. Portanto, 30 pacientes (71 por cento dos sobreviventes) foram estudados com tomografia computadorizada. Um total de 36 ATIE e 64 AR foram analisadas. RESULTADOS: a perviabilidade da AR nos grupos eletivo e não eletivo foram respectivamente 82 por cento (31/38) e 85 por cento (22/26) (p=0,75). A AR teve perviabilidade semelhante para todas as artérias alvo variando de 73 por cento a 100 por cento. Apenas um paciente foi submetido à nova RM e 29 (97 por cento) estão livres de angina ou nova re-intervenção. ATIE-DA teve perviabilidade de 92 por cento (11/12) e 100 por cento (10/10) respectivamente nos grupos eletivo e não-eletivo (p=0,37). ATIE-Diagonal-DA seqüencial obteve perviabilidade de 50 por cento (03/06) no grupo eletivo que foi significativamente menor que a perviabilidade de 100 por cento (08/08) do não-eletivo (p=0,02). CONCLUSÃO: A AR pode ser utilizada nos pacientes eletivos e não eletivos com excelentes resultados.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte de Artéria Coronária/métodos , Doença das Coronárias/cirurgia , Artéria Radial/transplante , Artérias Torácicas/transplante , Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária/normas , Doença das Coronárias , Procedimentos Cirúrgicos Eletivos , Tratamento de Emergência , Métodos Epidemiológicos , Anastomose de Artéria Torácica Interna-Coronária , Artéria Radial , Fatores de Tempo , Resultado do Tratamento , Artérias Torácicas , Tomografia Computadorizada por Raios X/métodos , Grau de Desobstrução Vascular
17.
Circulation ; 112(9 Suppl): I20-5, 2005 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-16159816

RESUMO

BACKGROUND: Although the Cox-Maze III procedure is effective for treating permanent atrial fibrillation (AF), its high complexity limits its use. The Saline-Irrigated Cooled-tip Radiofrequency Ablation (SICTRA) System is an alternative source of energy used to ablate AF. The aim of this study was to evaluate the effectiveness of the SICTRA for the treatment of permanent AF in patients with rheumatic mitral valve (MV) disease. METHODS AND RESULTS: Between February 2002 and April 2003, 70 patients with permanent AF and rheumatic MV disease were randomly assigned to undergo a modified Maze III procedure using SICTRA associated with MV surgery (group A) or MV surgery alone (group B). Groups A and B were similar in terms of baseline characteristics. The in-hospital mortality rate was 2.3% (1 death) in group A versus 0% (no deaths) in group B (P>0.99). The additional time required for the left-sided radiofrequency ablation in group A was 14.2+/-5.1 minutes and for right-sided ablation was 12.3+/-4.2 minutes. The mean postoperative follow-up periods were 13.8+/-3.4 and 11.5+/-7.3 months, respectively, in groups A and B. The overall mid-term survival rate was 95.1% in group A and 92.8% in group B (P>0.99). The cumulative rates of sinus rhythm were 79.4% in group A and 26.9% in group B (P=0.001). Doppler echocardiography documented biatrial transport function in 90.3% of group A patients in sinus rhythm. CONCLUSIONS: The SICTRA is effective for treating permanent AF associated with rheumatic MV disease.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/instrumentação , Insuficiência da Valva Mitral/cirurgia , Cardiopatia Reumática/cirurgia , Adulto , Idoso , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/etiologia , Ablação por Cateter/métodos , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Cardiopatia Reumática/complicações , Resultado do Tratamento
18.
Rev. bras. cir. cardiovasc ; 20(2): 111-116, abr.-jun. 2005. ilus, tab, graf
Artigo em Português | LILACS | ID: lil-413754

RESUMO

INTRODUÇAO: A veia safena é um enxerto coronário eficiente. Porém, sua patência pode ser limitada por desenvolvimento de aterosclerose. Estudos experimentais "ex vivo", por nós realizados anteriormente, demonstraram apoptose (ensaio de TUNEL) em veias safenas humanas cultivadas sob pressão arterial por 24 horas. Nessas veias safenas, a expressão gênica da Interleucina-1ß avaliada por RT-PCR em tempo real, também mostrou-se elevada. Não há ainda consenso sobre a ação moduladora das citocinas sobre proliferação/apoptose das células musculares lisas das veias safenas. OBJETIVO: Avaliar a influência da Interleucina -1ß na proliferação inicial de cultura de células primárias de músculo liso de veia safena humana. MÉTODO: Foram cultivadas células primárias de músculo liso de seis diferentes veias safenas humanas (em triplicata). O meio de cultura foi o DMEM, suplementado com 10 por cento de soro fetal bovino. O grupo controle não recebeu Interleucina - 1ß. Nos demais grupos, as células cultivadas receberam, respectivamente, 0,1; 1; 10 e 100 ng/mL de Interleucina - 1ß. A proliferação celular foi avaliada através da quantificação de timidina triciada [ H], incorporada às células recém-proliferadas. RESULTADOS: O tratamento com Interleucina - 1ß diminuiu a proliferação celular, a saber: Grupo controle (sem Interleucina - 1ß): definiu-se esse grupo como apresentando 100±4,5 por cento de proliferação celular. Nos demais grupos, a quantidade de Interleucina - 1ß administrada e a proliferação celular aferida foram, respectivamente, 0,1 ng/mL:112±0,7 por cento; 1 ng/mL:83,8±4,7 por cento; 10 ng/mL:69,1±3,8 por cento; 100 ng/mL:67,3±10,9 por cento; (p<0,01). CONCLUSÕES: Estes resultados indicam que a administração de quantidade crescente de Interleucina - 1ß inibe a proliferação de células primárias de músculo liso, cultivadas a partir de veias safenas humanas. Isso sugere que o processo de apoptose, observado já em fase precoce (um dia) de exposição do enxerto venoso a regime pressórico arterial, pode estar relacionado à ação dessa citocina.


Assuntos
Humanos , Experimentação Humana , Técnicas In Vitro , Revascularização Miocárdica , Veia Safena , Técnicas de Cultura de Células , Expressão Gênica/genética , Fatores de Tempo
19.
Ann Thorac Surg ; 77(3): 1072-4, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-14992932

RESUMO

A 64-year-old man with left main coronary artery disease underwent myocardial revascularization. The left internal thoracic artery (LITA) was sutured to the left anterior descending artery, and the right internal thoracic artery (RITA) was sutured to the obtuse marginal artery. Eighteen years later, angina reoccurred. Catheterization revealed that both the coronary and the left subclavian arteries were occluded and that a patent RITA graft was maintaining the cardiac blood supply. The RITA graft evaluation revealed increased lumen diameters, suggestive of remodeling. The LITA was subsequently disconnected and sutured to the aorta as a free graft in order to restore appropriate myocardial blood flow. This case emphasizes the benefits of using a live graft for left coronary system grafting, which include long-term patency and flow-dependent remodeling.


Assuntos
Artéria Torácica Interna/fisiologia , Revascularização Miocárdica , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
20.
Arq. bras. cardiol ; 66(6): 357-360, Jun. 1996.
Artigo em Português | LILACS | ID: lil-319267

RESUMO

The authors describe a rare case of circumflex coronary artery perforation during rotational coronary atherectomy complicated with cardiac tamponade and good outcome. The possible causes of perforation are discussed and the burr oversize (burr/artery ratio was 0.58) was refused. Shortening and artery plicature (accordeon effect) might have been the cause of this event. Quantitative measurement was made in order to strengthen this hypothesis. It is emphasized the importance of selecting lesions that should be submitted to rotational coronary atherectomy.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Aterectomia Coronária/efeitos adversos , Doença das Coronárias , Vasos Coronários , Tamponamento Cardíaco/etiologia , Aterectomia Coronária/instrumentação , Cineangiografia
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