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1.
Anaesthesia ; 76(1): 19-26, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32406071

RESUMO

Over 30,000 adult cardiac operations are carried out in the UK annually. A small number of these patients need to return to theatre in the first few days after the initial surgery, but the exact proportion is unknown. The majority of these resternotomies are for bleeding or cardiac tamponade. The Association of Cardiothoracic Anaesthesia and Critical Care carried out a 1-year national audit of resternotomy in 2018. Twenty-three of the 35 centres that were eligible participated. The overall resternotomy rate (95%CI) within the period of admission for the initial operation in these centres was 3.6% (3.37-3.85). The rate varied between centres from 0.69% to 7.6%. Of the 849 patients who required resternotomy, 127 subsequently died, giving a mortality rate (95%CI) of 15.0% (12.7-17.5). In patients who underwent resternotomy, the median (IQR [range]) length of stay on ICU was 5 (2-10 [0-335]) days, and time to tracheal extubation was 20 (12-48 [0-2880]) hours. A total of 89.3% of patients who underwent resternotomy were transfused red cells, with a median (IQR [range]) of 4 (2-7 [1-1144]) units of red blood cells. The rate (95%CI) of needing renal replacement therapy was 23.4% (20.6-26.5). This UK-wide audit has demonstrated that resternotomy after cardiac surgery is associated with prolonged intensive care stay, high rates of blood transfusion, renal replacement therapy and very high mortality. Further research into this area is required to try to improve patient care and outcomes in patients who require resternotomy in the first 24 h after cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Reoperação/mortalidade , Reoperação/estatística & dados numéricos , Esternotomia/mortalidade , Esternotomia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Extubação , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Cuidados Críticos/estatística & dados numéricos , Transfusão de Eritrócitos/mortalidade , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/cirurgia , Terapia de Substituição Renal/mortalidade , Terapia de Substituição Renal/estatística & dados numéricos , Reino Unido/epidemiologia
2.
Kyobu Geka ; 73(11): 955-957, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130723

RESUMO

Pericardial effusion due to malignancy often needs drainage, however, it is difficult to repeat pericardiocentesis. We report a case of malignant pericardial effusion in a 55-year-old female, who had been diagnosed with sigmoid colon cancer and treated with surgical resection and chemotherapy 2 years before. She developed multiple organ metastasis and suffered from dyspnea due to increasing pericardial effusion. We performed pericardiocentesis repeatedly, but the pericardial effusion continuously increased. Therefore, we inserted a drainage catheter into the pericardial space, which was connected to a subcutaneously placed port system. She was discharged from the hospital, but expired 12 days later. In the case of malignant pericardial effusion, subcutaneous placing of a port system may be safe and useful.


Assuntos
Tamponamento Cardíaco , Neoplasias , Derrame Pericárdico , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , Pericardiocentese , Pericárdio
3.
Am J Case Rep ; 21: e925554, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32606285

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness. However, with rising numbers of cases, multiple reports of cardiovascular manifestations have emerged. We present a case of COVID-19 infection complicated by myopericarditis and tamponade requiring drainage. CASE REPORT An 82-year-old woman with multiple comorbidities presented with five days of productive cough, fever with chills, and intermittent diarrhea. She tested positive for COVID-19. Index EKG revealed new diffuse T-wave inversions and a prolonged QT interval (>500 ms). Troponin was mildly elevated without any anginal symptoms. Hydroxychloroquine and azithromycin were not initiated due to concerns about QT prolongation. The echocardiogram revealed preserved left ventricular (LV) function, a small global pericardial effusion, and apical hypokinesis. Serial echocardiograms revealed an enlarging circumferential pericardial effusion with pacemaker wire reported as 'piercing' the right ventricular (RV) apex alongside early diastolic collapse of the right ventricle, suggesting echocardiographic tamponade. Chest CT revealed extension of the RV pacemaker lead into the pericardial fat. Interestingly, on comparison with a previous chest CT from 2019, similar lead positions were confirmed. Pericardiocentesis was performed with removal of 400 cc exudate. CONCLUSIONS Acute myopericarditis and pericardial effusion can occur in COVID-19 infection, even in the absence of severe pulmonary disease. This case highlights the importance of awareness of rare cardiac manifestations of COVID-19 in the form of acute myopericarditis and cardiac tamponade and their early diagnosis and management.


Assuntos
Betacoronavirus , Tamponamento Cardíaco/etiologia , Diagnóstico Precoce , Miocardite/complicações , Derrame Pericárdico/etiologia , Pericardiocentese/métodos , Pericardite/complicações , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/cirurgia , Ecocardiografia , Feminino , Humanos , Miocardite/diagnóstico , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/cirurgia , Pericardite/diagnóstico , Função Ventricular Esquerda/fisiologia
4.
J Cardiothorac Surg ; 15(1): 165, 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641086

RESUMO

BACKGROUND: We present an unusual case of pericardial tamponade occurring subsequent to a radical right nephrectomy performed entirely through a laparotomy. CASE PRESENTATION: A 43 year old gentleman who presented with large loculated posterior pericardial effusion compressing the left atrium, following a radical nephrectomy performed entirely through a laparotomy. He required an emergency sternotomy, pericardial and pleural drainage. CONCLUSION: Cardiac tamponade is an extremely rare complication of radical nephrectomy. However, any procedure that involves opening of the pericardium does carry a risk of bleeding and therefore cardiac tamponade, particularly in the context of post-operative full anticoagulation.


Assuntos
Tamponamento Cardíaco/cirurgia , Nefrectomia/efeitos adversos , Derrame Pericárdico/cirurgia , Adulto , Fibrilação Atrial/cirurgia , Tamponamento Cardíaco/etiologia , Drenagem , Humanos , Masculino , Nefrectomia/métodos , Derrame Pericárdico/etiologia , Esternotomia
5.
Medicine (Baltimore) ; 99(29): e21290, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702923

RESUMO

Pericardial effusions can either be drained by percutaneous pericardiocentesis (PCC) or by surgical pericardiotomy (SP), with limited evidence of superiority for the management of cardiac tamponade (CTa).This study uses the US Nationwide Emergency Department Sample database to investigate the effectiveness of SP and PCC in patients with CTa in terms of clinical outcomes and healthcare costs.Retrospective observational study conducted on the US Nationwide Emergency Department Sample 2014 dataset CTa patients. Descriptive and multivariate logistic regression analyses were done to assess the impact of different procedures (none, SP, PCC, SP, and PCC) on mortality.A total of 10,410 CTa patients were included, of which 28.9% underwent no procedure, 32.9% underwent SP, 30.2% underwent PCC and 8.0% underwent SP and PCC. Mortality rates were highest in patients undergoing no procedure (22.3%) followed by PCC (15.0%), SP and PCC (11.5%), and then SP (9.6%) (P < .001). SP patients had longer length of stay (11.65 vs 8.16 days, P < .001) and higher total charges ($162,889.1 vs $100,802, P < .001) compared to PCC patients. Undergoing any procedure for CTa reduced the rate of mortality compared to no procedure with SP being the most effective (OR = 0.323, 95%CI 0.244-0.429), followed by SP & PCC (OR = 0.387, 95% CI 0.239-0.626), and then PCC (OR = 0.582, 95% CI 0.446-0.760).Adult CTa patients treated with SP had lower mortality rates but longer length of stay and higher healthcare expenses. This SP associated benefit remained consistent across different subpopulations after stratifying by age and potential disease etiology.


Assuntos
Tamponamento Cardíaco/cirurgia , Pericardiectomia , Pericardiocentese , Tamponamento Cardíaco/mortalidade , Feminino , Custos de Cuidados de Saúde , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Pericardiectomia/mortalidade , Pericardiocentese/mortalidade , Estudos Retrospectivos , Resultado do Tratamento
6.
J Cardiothorac Surg ; 15(1): 138, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532284

RESUMO

BACKGROUND: Acute aortic dissection (AAD) is a rare, but a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A Acute aortic dissection (TAAAD) still remains high, and treatment for such patients remains controversial. CASE PRESENTATION: A new surgical approach which entails "stepwise external wrapping (SEW)" using a zero-porosity artificial graft was developed in extremely high-risk patients with TAAAD. Herein, we described its surgical details and showed two representative cases which was successfully done. CONCLUSIONS: Our SEW procedure is a feasible alternative to conventional graft replacement for TAAAD in extremely high-risk or aged patients, although the gold standard consists of surgical replacement of the dissected aorta. (129 words).


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Implante de Prótese Vascular/métodos , Tamponamento Cardíaco/cirurgia , Ponte Cardiopulmonar , Ecocardiografia , Feminino , Humanos , Masculino , Choque Cardiogênico/cirurgia , Esternotomia , Tomografia Computadorizada por Raios X
7.
Kyobu Geka ; 73(3): 220-222, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32393705

RESUMO

Coronary-pulmonary artery fistula( CPAF) is a relatively rare congenital malformation. We successfully treated a patient who presented with cardiac tamponade due to ruptured CPAF. A 58-year-old woman was admitted to our hospital due to consciousness disorder. Enhanced computed tomography revealed hemopericardium, and she was diagnosed with cardiac tamponade due to a ruptured coronary artery aneurysm with fistula arising from the right coronary and entering the main pulmonary artery. Therefore, emergency operation was performed. Under cardiopulmonary bypass, the aneurysm was opened and the ostium of the fistula was closed with pledgetted mattress sutures. After ligating the tortuous CPAF, the aneurysmal wall was sutured. Postoperative course was uneventful, and she was discharged on postoperative day 16.


Assuntos
Aneurisma Roto , Fístula Artério-Arterial , Tamponamento Cardíaco , Aneurisma Coronário , Fístula Artério-Arterial/complicações , Fístula Artério-Arterial/cirurgia , Tamponamento Cardíaco/complicações , Tamponamento Cardíaco/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Pulmonar
8.
Medicine (Baltimore) ; 99(15): e19778, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282740

RESUMO

RATIONALE: Therapeutic or diagnostic thoracentesis is widely used in different clinical settings. Cardiac injury, a rare complication, could lead to fatal consequences. We describe a case of cardiac tamponade complicating thoracentesis that was recognized and rescued in a timely manner. PATIENT CONCERNS: A 42-year-old woman underwent blind thoracentesis due to excessive left pleural effusion after left pneumonectomy surgery. She suddenly lost consciousness and was in a state of shock a few minutes after needle insertion and fluid drainage. DIAGNOSIS: Bedside transthoracic echocardiography revealed pericardial effusion at a depth of 20 mm, and cardiac tamponade complicating thoracentesis was diagnosed. INTERVENTIONS: After draining 250 mL of non-coagulated blood by pericardiocentesis under transthoracic echocardiography guidance, a tube was placed for continuous drainage over the subsequent 36 hours. OUTCOMES: The patient's hemodynamic condition was stabilized hours after pericardiocentesis. The patient was discharged in good condition a few days later. LESSONS: Imaging assessment and guidance in the process of thoracentesis was indispensable, especially in a patient with altered intra-thoracic anatomy. Cardiac damage, as a life-threatening complication, should be considered once hemodynamic instability occurs during the procedure.


Assuntos
Tamponamento Cardíaco/etiologia , Pneumonectomia/métodos , Toracentese/efeitos adversos , Adulto , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/cirurgia , Drenagem/efeitos adversos , Ecocardiografia/métodos , Feminino , Humanos , Pericardiocentese/instrumentação , Derrame Pleural/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Resultado do Tratamento
10.
Ann Thorac Surg ; 110(3): e153-e155, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32142816

RESUMO

Inferior vena cava filters are used for patients with pulmonary embolism or those with risk of embolization. Here we present a case of a 38-year-old man who underwent placement of an inferior vena cava filter because of deep vein thrombosis. The operating arm fractured and embolized to the posteromedial papillary muscle of mitral valve and the posterior inferior wall of the left ventricle through right atrium and atrioventricular septum, leading to large symptomatic mitral and tricuspid insufficiency and pericardial tamponade. Here we report a rare case where the filter migrated to the left ventricle and destroyed the mitral valve.


Assuntos
Migração de Corpo Estranho/diagnóstico , Ventrículos do Coração , Insuficiência da Valva Mitral/etiologia , Valva Mitral/lesões , Insuficiência da Valva Tricúspide/etiologia , Filtros de Veia Cava/efeitos adversos , Adulto , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/cirurgia , Veia Cava Inferior , Trombose Venosa/complicações
12.
Ann Thorac Surg ; 110(4): 1357-1363, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32151579

RESUMO

BACKGROUND: Cardiac tamponade with acute aortic dissection type A can cause fatal outcomes. We previously reported excellent outcomes using percutaneous pericardial drainage with controlled volumes of aspirated pericardial effusion (controlled pericardial drainage [CPD]) to stabilize patients with critical cardiac tamponade. This study evaluates the early and late outcomes using this approach. METHODS: Between September 2003 and July 2018, 308 patients with acute aortic dissection type A were treated surgically, including 76 patients who presented with cardiac tamponade on hospital arrival. Forty-nine patients who did not respond to intravenous volume resuscitation underwent CPD in the emergency room, including 14 patients (28.6%) who presented with cardiopulmonary arrest. After CPD 39 patients (79.6%) were transferred to the operating room to undergo immediate aortic repair. The remaining 10 patients (20.4%) received medical treatment on arrival, followed by aortic repair within several days. RESULTS: In 49 patients the mean systolic blood pressure before CPD was 64.4 ± 10.3 mm Hg. Blood pressure rose significantly in all patients after CPD. The total volume of aspirated pericardial effusion was 46.8 ± 56.2 mL, and 30 of 49 patients (61%) required only 30 mL or less of aspiration to improve their blood pressure. All patients underwent successful aortic repair. Early hospital mortality was 16%. However there was no mortality related to CPD. The mean follow-up period was 52.9 ± 54.3 months. The cumulative survival rate was 63.4% after 5 years. CONCLUSIONS: CPD for critical cardiac tamponade with acute type A aortic dissection produced satisfactory early and late outcomes.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Tamponamento Cardíaco/cirurgia , Drenagem , Derrame Pericárdico/cirurgia , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/complicações , Aneurisma Aórtico/mortalidade , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
14.
BMC Cardiovasc Disord ; 20(1): 67, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32028901

RESUMO

BACKGROUND: Cardiac tamponade is a rare but serious complication of Takotsubo cardiomyopathy (TC). Two cases of cardiac tamponade subsequent to TC have been reported. The pericardial effusion in these cases was hemorrhagic and caused by ventricular rupture. Cardiac tamponade induced by an inflammatory effusion complicated with TC has not been reported. This is the first case report of TC, which developed cardiac tamponade during the recovery phase with a large volume non-hemorrhagic inflammatory effusion. CASE PRESENTATION: We describe a case of an 81-year-old woman admitted to our hospital because of severe chest pain. Her symptoms began soon after her son's hospitalization. We diagnosed her with TC based on results of an electrocardiogram, echocardiogram, and emergent coronary angiography. Her symptoms and left ventricular dysfunction improved gradually. She developed newly confirmed chest pain and dyspnea on day 9 after admission. A large pericardial effusion developed, resulting in cardiac tamponade. Her symptoms and hemodynamic status improved immediately after the pericardiocentesis. The effusion was non-hemorrhagic and exudative. No specific signs of infection, collagen disease, or malignant tumors were observed, except for TC. CONCLUSIONS: We experienced a case of circulatory collapse induced by TC-related inflammatory pericardial effusion at recovery phase. This case emphasizes the importance of careful follow-up even after improved left ventricular dysfunction in a patient with TC.


Assuntos
Tamponamento Cardíaco/etiologia , Derrame Pericárdico/etiologia , Cardiomiopatia de Takotsubo/complicações , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/fisiopatologia , Tamponamento Cardíaco/cirurgia , Feminino , Hemodinâmica , Humanos , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/fisiopatologia , Derrame Pericárdico/cirurgia , Pericardiocentese , Recuperação de Função Fisiológica , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/fisiopatologia , Resultado do Tratamento , Função Ventricular Esquerda
19.
A A Pract ; 14(4): 116-118, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31876557

RESUMO

With the ongoing development of safer anesthesia, pregnant women with cardiac disease are presenting more frequently for cesarean delivery. We report the successful anesthetic management of a 31-year-old parturient, on long-term anticoagulant therapy, who presented with acute cardiac tamponade due to perforation of the left atrium from a dislodged atrial septum defect occluder. The cesarean delivery was followed by temporary repair of the perforation without extracorporeal circulation (EC) due to concerns about excessive postpartum bleeding. The definitive repair of the atrial defect and the perforation were successfully accomplished under (EC) 5 days after delivery.


Assuntos
Anestesia/métodos , Tamponamento Cardíaco/cirurgia , Traumatismos Cardíacos/cirurgia , Comunicação Interatrial/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Tamponamento Cardíaco/genética , Cesárea , Feminino , Traumatismos Cardíacos/complicações , Traumatismos Cardíacos/etiologia , Humanos , Gravidez , Falha de Prótese , Dispositivo para Oclusão Septal , Resultado do Tratamento
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