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1.
BMJ ; 367: l6395, 2019 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801725

RESUMO

OBJECTIVE: To investigate whether remote ischaemic preconditioning (RIPC) prevents myocardial injury in patients undergoing hip fracture surgery. DESIGN: Phase II, multicentre, randomised, observer blinded, clinical trial. SETTING: Three Danish university hospitals, 2015-17. PARTICIPANTS: 648 patients with cardiovascular risk factors undergoing hip fracture surgery. 286 patients were assigned to RIPC and 287 were assigned to standard practice (control group). INTERVENTION: The RIPC procedure was initiated before surgery with a tourniquet applied to the upper arm and consisted of four cycles of forearm ischaemia for five minutes followed by reperfusion for five minutes. MAIN OUTCOME MEASURES: The original primary outcome was myocardial injury within four days of surgery, defined as a peak plasma cardiac troponin I concentration of 45 ng/L or more caused by ischaemia. The revised primary outcome was myocardial injury within four days of surgery, defined as a peak plasma cardiac troponin I concentration of 45 ng/L or more or high sensitive troponin I greater than 24 ng/L (the primary outcome was changed owing to availability of testing). Secondary outcomes were peak plasma troponin I and total troponin I release during the first four days after surgery (cardiac and high sensitive troponin I), perioperative myocardial infarction, major adverse cardiovascular events, and all cause mortality within 30 days of surgery, length of postoperative stay, and length of stay in the intensive care unit. Several planned secondary outcomes will be reported elsewhere. RESULTS: 573 of the 648 randomised patients were included in the intention-to-treat analysis (mean age 79 (SD 10) years; 399 (70%) women). The primary outcome occurred in 25 of 168 (15%) patients in the RIPC group and 45 of 158 (28%) in the control group (odds ratio 0.44, 95% confidence interval 0.25 to 0.76; P=0.003). The revised primary outcome occurred in 57 of 286 patients (20%) in the RIPC group and 90 of 287 (31%) in the control group (0.55, 0.37 to 0.80; P=0.002). Myocardial infarction occurred in 10 patients (3%) in the RIPC group and 21 patients (7%) in the control group (0.46, 0.21 to 0.99; P=0.04). Statistical power was insufficient to draw firm conclusions on differences between groups for the other clinical secondary outcomes (major adverse cardiovascular events, 30 day all cause mortality, length of postoperative stay, and length of stay in the intensive care unit). CONCLUSIONS: RIPC reduced the risk of myocardial injury and infarction after emergency hip fracture surgery. It cannot be concluded that RIPC overall prevents major adverse cardiovascular events after surgery. The findings support larger scale clinical trials to assess longer term clinical outcomes and mortality. TRIAL REGISTRATION: ClinicalTrials.gov NCT02344797.


Assuntos
Fixação de Fratura/efeitos adversos , Traumatismos Cardíacos/prevenção & controle , Fraturas do Quadril/cirurgia , Precondicionamento Isquêmico Miocárdico/métodos , Complicações Pós-Operatórias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Tratamento de Emergência , Feminino , Traumatismos Cardíacos/etiologia , Humanos , Análise de Intenção de Tratamento , Masculino , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Complicações Pós-Operatórias/etiologia , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(43): e16989, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651833

RESUMO

Periprocedural myocardial injury (PMI) and contrast-induced nephropathy (CIN) are frequent complications of percutaneous coronary intervention (PCI) associated with early and late major adverse cardiovascular events. Both conditions are associated with similar risk factors, which could imply their possible association. The aim of our study was to assess the correlation of PMI and early postprocedural creatinine shift (ECS) as a marker of renal injury.A total of 209 hospitalized patients with stable coronary artery disease (CAD) were enrolled, who underwent an elective PCI in a period of 12 months. All patients had their serum high-sensitivity troponin I (hsTnI) measured at baseline and 16 hours after the PCI. PMI was defined according to the elevation of postprocedural hsTnI using criteria provided by both the most recent consensus documents as well as evidence-based data. Renal injury was evaluated using the ECS concept. Serum creatinine (SCr) was also measured at baseline and at 16 hours. ECS was defined as SCr >5% at 16 hours compared to baseline.Although incidence of both PMI (77.5%) and ECS (44.5%) were high, no association of these 2 conditions could be found. Further analyses of our data showed that diabetes is associated with a higher incidence of ECS, while patients on beta-blocker therapy had a lower incidence of ECS.In our study, no association between PMI and ECS was found. Additional studies with a larger number of patients and longer patient observation are needed to assess the correlation between PMI and CIN as well as to validate the attractive, but controversial, concept of ECS as an early marker of CIN.


Assuntos
Lesão Renal Aguda/epidemiologia , Meios de Contraste/efeitos adversos , Traumatismos Cardíacos/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/induzido quimicamente , Idoso , Biomarcadores/sangue , Doença da Artéria Coronariana/cirurgia , Creatinina/sangue , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Feminino , Traumatismos Cardíacos/sangue , Traumatismos Cardíacos/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Fatores de Risco , Troponina I/sangue
3.
Heart Surg Forum ; 22(5): E375-E379, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31596715

RESUMO

BACKGROUND: Coronary collateral circulation (CCC) is a small vascular formation that allows the connection between the different parts of an epicardial vessel or other vessels. The presence of collateral circulation contributes positively to the course of coronary artery disease (CAD). The aim of this study was to investigate the effect of collateral circulation on myocardial injury and clinical outcomes during coronary artery bypass grafting (CABG) in a high-risk patient group. METHODS: 386 patients who underwent isolated CABG under cardiopulmonary bypass (CPB) were included in the study. Patients were divided into two groups according to the Rentrop scores (n = 225 poor CCC group; and n = 161 good CCC group). Myocardial injury and postoperative clinical results were evaluated as endpoints. RESULTS: The mean age was 62.9 ± 7.5 years, and 61.6% of all patients were male. Postoperative 30-day mortality rate was significantly higher in poor CCC group (4 [1.7%] and 1 [0.6%], P < .001). The frequency of postoperative intraaortic balloon pump (IABP) use (5 [2.2%] and 1 [0.6%], P < .001), low cardiac output syndrome (LCOS) (28 [12.4%] and 10 [6.2%], P < .001) and postoperative atrial fibrillation (35 [15.6%] and 16 [9.9%], P = .038) were significantly higher in poor CCC group. 12th and 24th hour CK-MB and cTn-I values were found to be significantly lower in the good CCC group. CONCLUSION: It is inevitable that the CPB circuit and operation have devastating effects on myocardium in CABG operations. The presence of CCC reduces postoperative myocardial injury, low cardiac output syndrome, and mortality rates.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Circulação Colateral , Ponte de Artéria Coronária/efeitos adversos , Circulação Coronária , Traumatismos Cardíacos/etiologia , Complicações Pós-Operatórias/etiologia , Fibrilação Atrial/etiologia , Baixo Débito Cardíaco/etiologia , Ponte Cardiopulmonar/mortalidade , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/cirurgia , Feminino , Parada Cardíaca Induzida , Humanos , Balão Intra-Aórtico/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos
4.
BMC Complement Altern Med ; 19(1): 182, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337380

RESUMO

BACKGROUND: Increase oxidative trauma is the main cause behind Cisplatin (CP) induced cardiotoxicity which restricts its clinical application as anti-neoplastic prescription. Acacia hydaspica is a natural shrub with diverse bioactivities. Acacia hydaspica ethyl acetate extract (AHE) ameliorated drug-induced cardiotoxicity in animals with anti-oxidative mechanisms. Current study aimed to evaluate the protective potential of A. hydaspica against cisplatin-induced myocardial injury. METHODS: Rats were indiscriminately distributed into six groups (n = 6). Group 1: control; Groups 2: Injected with CP (7.5 mg/kg bw, i.p, single dose) on day 16; Group 3: Treated for 21 days with AHE (400 mg/kg b.w, oral); Group 4: Received CP injection on day 16 and treated with AHE for 5 days post injection; Group 5: Received AHE (400 mg/kg b.w/day, p.o.) for 21 days and CP (7.5 mg/kg b.w., i.p.) on day 16; Group 6: Treated with silymarin (100 mg/kg b.w., p.o.) after 1 day interval for 21 days and CP injection (7.5 mg/kg b.w., i.p.) on day 16. On 22nd day, the animals were sacrificed and their heart tissues were removed. Cisplatin induced cardiac toxicity and the influence of AHE were evaluated by examination of serum cardiac function markers, cardiac tissue antioxidant enzymes, oxidative stress markers and histology. RESULTS: CP inoculation considerably altered cardiac function biomarkers in serum and diminished the antioxidant enzymes levels, while increased oxidative stress biomarkers in cardiac tissues AHE treatment attenuated CP-induced deteriorations in creatine kinase (CK), Creatine kinase isoenzymes MB (CK-MB), cardiac Troponin I (cTNI) and lactate dehydrogenase (LDH) levels and ameliorated cardiac oxidative stress markers as evidenced by decreasing lipid peroxidation, H2O2 and NO content along with augmentation in phase I and phase II antioxidant enzymes. Additionally, CP inoculation also induced morphological alterations which were ameliorated by AHE. In pretreatment group more significant protection was observed compared to post-treatment group indicating preventive potential of AHE. The protective potency of AHE was comparable to silymarin. CONCLUSION: Results demonstrate that AHE attenuated CP induce cardiotoxicity. The polyphenolic metabolites and antioxidant properties of AHE might be responsible for its protective influence.


Assuntos
Antineoplásicos/efeitos adversos , Cisplatino/efeitos adversos , Traumatismos Cardíacos/prevenção & controle , Coração/efeitos dos fármacos , Extratos Vegetais/administração & dosagem , Substâncias Protetoras/administração & dosagem , Acacia , Animais , Antioxidantes/administração & dosagem , Traumatismos Cardíacos/etiologia , Humanos , Peróxido de Hidrogênio/metabolismo , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Estresse Oxidativo/efeitos dos fármacos , Extratos Vegetais/química , Folhas de Planta/química , Substâncias Protetoras/química , Ratos , Ratos Sprague-Dawley , Silimarina/administração & dosagem , Silimarina/análise
5.
Rev Bras Ter Intensiva ; 31(2): 262-265, 2019 May 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31166560

RESUMO

Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.


Assuntos
Forame Oval Patente/etiologia , Átrios do Coração/cirurgia , Músculos Papilares/lesões , Valva Tricúspide/lesões , Acidentes de Trânsito , Anuloplastia da Valva Cardíaca/métodos , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/cirurgia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Músculos Papilares/cirurgia , Valva Tricúspide/cirurgia
6.
Eur J Pharmacol ; 858: 172471, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31228455

RESUMO

Due to the potential benefits of curcumin in the ischemic heart disease, this study was performed to evaluate whether pretreatment with curcumin may reduce myocardial injury following elective percutaneous coronary intervention (PCI). A randomized clinical trial was performed on 110 patients undergoing elective PCI. The intervention group (n = 55) received a single dose of 480 mg nanomicelle curcumin orally and the standard treatment before PCI, while the control group (n = 55) received only the standard treatment., Serum concentrations of CK-MB and troponin I was measured before, 8 and 24 h after the procedure to assess myocardial damage during PCI. The results showed that the raise of CK-MB in curcumin group was half of the control group (4 vs. 8 cases) but was not significant. There were no significant differences in CK-MB levels at 8 (P = .24) and 24 h (P = .37) after PCI between the curcumin and the control group. No significant difference was also found in troponin I levels at 8 (P = 1.0) and 24 h (P = .35) after PCI between the groups. This study did not support the potential cardioprotective benefit of curcumin against pre-procedural myocardial injury in patients undergoing elective PCI.


Assuntos
Curcumina/farmacologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/prevenção & controle , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Feminino , Traumatismos Cardíacos/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de Tempo , Troponina I/metabolismo
7.
Fish Shellfish Immunol ; 89: 117-126, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30928664

RESUMO

Inflammation plays a crucial role in cardiac regeneration. Numerous advantages, including a robust regenerative ability, make the zebrafish a popular model to study cardiovascular diseases. The zebrafish breakdance (bre) mutant shares several key features with human long QT syndrome that predisposes to ventricular arrhythmias and sudden death. However, how inflammatory response and tissue regeneration following cardiac damage occur in bre mutant is unknown. Here, we have found that inflammatory response related genes were markedly expressed in the injured heart and excessive leukocyte accumulation occurred in the injured area of the bre mutant zebrafish. Furthermore, bre mutant zebrafish exhibited aberrant apoptosis and impaired heart regenerative ability after ventricular cryoinjury. Mild dosages of anti-inflammatory or prokinetic drugs protected regenerative cells from undergoing aberrant apoptosis and promoted heart regeneration in bre mutant zebrafish. We propose that immune or prokinetic therapy could be a potential therapeutic regimen for patients with genetic long QT syndrome who suffers from myocardial infarction.


Assuntos
Regulação para Baixo , Traumatismos Cardíacos/fisiopatologia , Inflamação/fisiopatologia , Regeneração , Peixe-Zebra/fisiologia , Animais , Temperatura Baixa/efeitos adversos , Modelos Animais de Doenças , Coração , Traumatismos Cardíacos/etiologia , Inflamação/etiologia
8.
BMJ Case Rep ; 12(2)2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30824470

RESUMO

Postcardiac injury syndrome (PCIS) is a rare condition that is considered to have a trauma-induced autoimmune mechanism triggered by damage to pericardial and/or pleural tissues. We report a case of PCIS accompanied by systemic oedema after thymectomy. A 73-year-old woman was referred to our hospital for dyspnoea and oedema, 9 months after thymectomy. Evaluation revealed the presence of pericardial effusion, pleural effusion and systemic oedema. Differential diagnosis included constrictive pericarditis (secondary to tuberculosis), serositis caused by collagen disease and malignancy. Detailed investigations led to the diagnosis of PCIS, which was successfully treated with prednisolone. This report focuses on the diagnostic approach to PCIS. Since it took time to make a final diagnosis in our patient, we analysed several past case reports and series to determine the cause of the delay in diagnosis.


Assuntos
Traumatismos Cardíacos/complicações , Traumatismos Cardíacos/diagnóstico , Timectomia/efeitos adversos , Idoso , Anti-Inflamatórios/uso terapêutico , Aspirina/uso terapêutico , Colchicina/uso terapêutico , Diagnóstico Tardio , Diagnóstico Diferencial , Ecocardiografia , Feminino , Traumatismos Cardíacos/tratamento farmacológico , Traumatismos Cardíacos/etiologia , Humanos , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/tratamento farmacológico , Derrame Pericárdico/etiologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/tratamento farmacológico , Derrame Pleural/etiologia , Prednisolona/uso terapêutico , Síndrome , Tomografia Computadorizada por Raios X , Moduladores de Tubulina/uso terapêutico
9.
Kyobu Geka ; 72(3): 228-231, 2019 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-30923301

RESUMO

Blunt chest trauma can cause life-threatening condition. We performed prompt drainage and operative repair for traumatic cardiac injury caused by striking at epigastric fossa. Close monitoring should be needed even for blunt chest trauma due to assault.


Assuntos
Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Drenagem , Humanos
10.
Blood Press ; 28(3): 173-183, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30836778

RESUMO

BACKGROUND: Arterial hypertension is associated with obstructive sleep apnoea, poor quality and duration of sleep, which might contribute to hypertension-mediated organ damage. METHODS: We investigated the presence of insomnia, restless legs syndrome, and obstructive sleep apnoea using validated questionnaires (Insomnia Severity Index, Restless Legs Syndrome Rating Scale, and STOP-Bang), and their relationship with hypertension-mediated organ damage, in hypertensive patients. RESULTS: In 159 consecutive consenting hypertensive patients [age 47(11) years, median and (interquartile range), body mass index 25.5(5.9) kg/m2, office systolic and diastolic blood pressure 144(23)/92(12) mmHg], the STOP-Bang, but not the other scores, predicted cardiac remodelling: compared to patients with a STOP-Bang score < 3, those at high risk of obstructive sleep apnoea showed higher left ventricular mass index [49.8(11.9) vs. 43.3(11.9) g/m2.7, p < 0.0001], left atrium volume [25.7(2.5) vs. 25.0(2.8) ml/m2, p = 0.003], and aortic root diameter [33.6(3.0) vs. 33.0(3.7) mm, p < 0.0001]. They did not differ for microalbuminuria and estimated glomerular filtration rate. At multivariate analysis, after adjustment for office systolic blood pressure values, the STOP-Bang score remained a predictor of left ventricular mass index; while the Insomnia Severity Index and restless legs syndrome risk score had no predictive value. However, a significant interaction between STOP-Bang and Restless Legs Syndrome Rating Scale scores in determining left ventricular remodelling was found. CONCLUSIONS: In consecutive hypertensive stage I patients the STOP-Bang questionnaire allowed identification of a high-risk cohort featuring a more prominent cardiac damage. Hence, this inexpensive tool can be useful for risk stratification purposes in municipalities with limited access to health care resources.


Assuntos
Traumatismos Cardíacos/etiologia , Hipertensão/complicações , Apneia Obstrutiva do Sono/complicações , Adulto , Feminino , Coração , Humanos , Rim/lesões , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/patologia , Apneia Obstrutiva do Sono/patologia , Inquéritos e Questionários
11.
Semin Thorac Cardiovasc Surg ; 31(3): 537-546, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30738149

RESUMO

We performed preclinical validation of intraoperative fiber-optic confocal microscopy (FCM) and assessed its safety and efficacy in an ovine model of the pediatric heart. Intraoperative imaging was performed using an FCM system (Cellvizio, Mauna Kea Technology, Paris, France) with specialized imaging miniprobe (GastroFlex UHD, Mauna Kea Technologies). Before imaging, we applied an extracellular fluorophore, sodium fluorescein, to fluorescently label extracellular space. We imaged arrested hearts of ovine (1-6 months) under cardiopulmonary bypass. Image sequences (1-10 seconds duration) were acquired from regions of the sinoatrial and atrioventricular node, as well as subepicardial and subendocardial working myocardium from atria and ventricle. The surgical process was evaluated for integration of the imaging protocol during the operative procedure. In addition, fluorescein cardiotoxicity studies (n = 3 animals) were conducted by comparing electrocardiogram (PR and QRS intervals) and ejection fraction at baseline and after topical application of fluorescein at 1:10, 1:100, and 1:1000 dilutions on a beating ovine heart. Our studies suggest that intraoperative FCM can be used to identify regions associated with specialized conducting tissue in ovine hearts in situ. The imaging protocol was integrated with conventional open heart surgical procedures with minimal changes to the operative process. Application of fluorescein in varying concentrations did not affect the normalized PR interval, QRS interval, and ejection fraction. These preclinical validation studies demonstrated both safety and efficacy of the proposed intraoperative imaging approach. The studies constitute an important step toward first-in-human clinical trials.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Tecnologia de Fibra Óptica , Sistema de Condução Cardíaco/diagnóstico por imagem , Cuidados Intraoperatórios/métodos , Microscopia Confocal , Potenciais de Ação , Animais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Fluoresceína/administração & dosagem , Corantes Fluorescentes/administração & dosagem , Parada Cardíaca Induzida , Sistema de Condução Cardíaco/lesões , Sistema de Condução Cardíaco/fisiopatologia , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/prevenção & controle , Frequência Cardíaca , Modelos Animais , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Carneiro Doméstico , Volume Sistólico
12.
Zhonghua Wai Ke Za Zhi ; 57(2): 134-138, 2019 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-30704218

RESUMO

Objective: To investigate the indication and midterm outcomes of surgical treatment of traumatic tricuspid insufficiency. Methods: Totally 19 patients with traumatic tricuspid insufficiency who underwent surgical treatment at Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2002 to January 2018 were included in this retrospective study. There were 12 male and 7 female patients, aged (43.1±12.9) years (range: 17-68 years). The main causes of traumatic tricuspid insufficiency included blunt chest trauma following high-speed vehicle accidents (17 patients) and high-fall trauma (2 patients). The preoperative New York Heart Association functional class was class Ⅱ in 5 patients, class Ⅲ in 12 patients, and class Ⅳ in 2 patients. The mechanism of tricuspid insufficiency included anterior chordal rupture in 9 patients, anterior papillary muscle rupture in 3 patients, anterior and posterior chordal or papillary muscle rupture in 4 patients, laceration of leaflet combined with chordal rupture in 2 patients and infection combined with anterior papillary muscle rupture in 1 patient. Anular dilation and enlargement of the right ventricle were observed in all the patients. Paired t test was used to evaluate the echocardiogratic results at preoperation, postoperation and follow-up. Independent sample rank sum test was used to evaluate the intervals between trauma and surgery in tricuspid valve repair group and tricuspid valve replacement group. Results: Tricuspid valve repair was successful in 8 patients, and 11 patients underwent valve replacement. Among the patients who underwent valve replacement, 6 patients received mechanical valve and 5 received bioprosthetic valve. The interval from trauma to surgery of the valve repair group and valve replacement group were 8.5(10.0) months (range: 0.1-13.0 months) and 72.0 (108.0) months (range: 2.0-228.0 months), respectively. Concomitant procedures included debridement in scalp trauma (1 patient), internal fixation of femoral fracture (1 patient). One patient died from liver failure 10 days after operation and the remaining patients survived. Eighteen patients were followed up for (94±50) months, 15 patients were in New York Heart Association functional class Ⅰ and 3 patients in class Ⅱ. One patient received redo-tricuspid valve replacement because of mechanical valve failure at the 11 years of follow-up. Conclusions: The midterm outcomes of surgical treatment of severe traumatic tricuspid insufficiency were satisfactory. Early diagnosis and surgical invention were recommended to achieve successful valve repair.


Assuntos
Traumatismos Cardíacos/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Ferimentos não Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Seguimentos , Traumatismos Cardíacos/etiologia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/lesões , Insuficiência da Valva Tricúspide/etiologia , Ferimentos não Penetrantes/complicações , Adulto Jovem
13.
J Cardiothorac Surg ; 14(1): 28, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717747

RESUMO

BACKGROUND: Isolated right atrial rupture (IRAR) from blunt chest trauma is rare. There are no physical exam findings and non-invasive testing specific to the condition, which result in diagnostic delays and poor outcomes. We present a case of IRAR along with a systematic review of similar cases in the literature. CASE REPORT: A 23-year-old male presented following a motor vehicle accident (MVA). He was bradycardic and hypotensive during transportation; and required intubation. There were contusions along the right chest wall with clear breath sounds, and no jugular venous distension, muffled heart sounds. Hemodynamic status progressively worsened, ultimately leading to his death. However, no external sources of bleeding or evidence of cardiac tamponade was found. METHODS: A search of PubMed, Ovid, and the Cochrane Library using: (Blunt OR Blunt trauma) AND (Laceration OR Rupture OR Tear) AND (Right Atrium OR Right Atrial). Articles were included if they were original articles describing cases of IRAR. RESULTS: Forty-five reports comprising seventy-five (n = 75) cases of IRAR. CONCLUSION: IRAR most commonly occurs following MVAs as the result of blunt chest trauma. Rupture occurs at four distinct sites and is most commonly at the right atrial appendage. IRAR is a diagnostic challenge and requires a high index of suspicion, as patients' hemodynamics can rapidly deteriorate. The presentations vary depending on multiple factors including rupture size, pericardial integrity, and concomitant injuries. Cardiac tamponade may have a protective effect by prompting the search for a bleeding source. A pericardial window can be diagnostic and therapeutic in IRAR. Outcomes are favourable with timely recognition and prompt surgical intervention.


Assuntos
Apêndice Atrial/lesões , Traumatismos Cardíacos/diagnóstico , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Evolução Fatal , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Masculino , Adulto Jovem
14.
Health Phys ; 116(3): 383-400, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30688698

RESUMO

Male rhesus macaques were subjected to partial-body irradiation at 10, 11, or 12 Gy with 5% bone marrow protection. Animals were euthanized when dictated by prospectively determined clinical parameters or at approximately 180 d following irradiation. Histological sections of lung and heart were stained with hematoxylin and eosin as well as a battery of histochemical and immunohistochemical stains. Histopathological alterations in the lung were centered on fibrosis, inflammation, and reactive/proliferative changes in pneumocytes. These changes were noted in animals necropsied after approximately 85-100 d postirradiation and extending through the observation period. Interstitial and pleural fibrosis demonstrated by Masson's trichrome staining were associated with increased alpha smooth muscle actin and collagen 1 immunohistochemical staining. Areas of interstitial fibrosis had reduced microvascular density with CD31 immunohistochemical staining. Accumulations of CD163- and CD206-positive alveolar macrophages were present in areas of interstitial fibrosis. Unidentified cells termed "myxoid" cells in alveolar walls had histochemical and immunohistochemical staining characteristics of epithelial-, endothelial-, or pericyte-mesenchymal transition states that were developing myofibroblast features. Distinctive focal or multifocal alveolar-bronchiolar hyperplasia had microscopic features of preneoplastic proliferation. Delayed radiation-associated changes in the heart consisted primarily of myocardial fibrosis, with rare histological evidence of myofiber degeneration.


Assuntos
Medula Óssea/efeitos da radiação , Traumatismos Cardíacos/etiologia , Lesão Pulmonar/etiologia , Lesões Experimentais por Radiação/patologia , Animais , Coração/efeitos da radiação , Traumatismos Cardíacos/patologia , Pulmão/patologia , Pulmão/efeitos da radiação , Lesão Pulmonar/patologia , Macaca mulatta , Masculino , Miocárdio/patologia , Lesões Experimentais por Radiação/etiologia
15.
Br J Anaesth ; 122(2): 180-187, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30686303

RESUMO

BACKGROUND: Systemic inflammation is pivotal in the pathogenesis of cardiovascular disease. As inflammation can directly cause cardiomyocyte injury, we hypothesised that established systemic inflammation, as reflected by elevated preoperative neutrophil-lymphocyte ratio (NLR) >4, predisposes patients to perioperative myocardial injury. METHODS: We prospectively recruited 1652 patients aged ≥45 yr who underwent non-cardiac surgery in two UK centres. Serum high sensitivity troponin T (hsTnT) concentrations were measured on the first three postoperative days. Clinicians and investigators were blinded to the troponin results. The primary outcome was perioperative myocardial injury, defined as hsTnT≥14 ng L-1 within 3 days after surgery. We assessed whether myocardial injury was associated with preoperative NLR>4, activated reactive oxygen species (ROS) generation in circulating monocytes, or both. Multivariable logistic regression analysis explored associations between age, sex, NLR, Revised Cardiac Risk Index, individual leukocyte subsets, and myocardial injury. Flow cytometric quantification of ROS was done in 21 patients. Data are presented as n (%) or odds ratio (OR) with 95% confidence intervals. RESULTS: Preoperative NLR>4 was present in 239/1652 (14.5%) patients. Myocardial injury occurred in 405/1652 (24.5%) patients and was more common in patients with preoperative NLR>4 [OR: 2.56 (1.92-3.41); P<0.0001]. Myocardial injury was independently associated with lower absolute preoperative lymphocyte count [OR 1.80 (1.50-2.17); P<0.0001] and higher absolute preoperative monocyte count [OR 1.93 (1.12-3.30); P=0.017]. Monocyte ROS generation correlated with NLR (r=0.47; P=0.03). CONCLUSIONS: Preoperative NLR>4 is associated with perioperative myocardial injury, independent of conventional risk factors. Systemic inflammation may contribute to the development of perioperative myocardial injury. CLINICAL TRIAL REGISTRATION: NCT01842568.


Assuntos
Traumatismos Cardíacos/etiologia , Procedimentos Cirúrgicos Operatórios/métodos , Síndrome de Resposta Inflamatória Sistêmica/complicações , Idoso , Estudos de Coortes , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Monócitos/metabolismo , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Espécies Reativas de Oxigênio/metabolismo , Fatores de Risco , Resultado do Tratamento , Troponina T/sangue
16.
J Surg Res ; 235: 322-328, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30691813

RESUMO

BACKGROUND: Little evidence exist associating displaced sternal fractures with blunt cardiac injury (BCI), especially regarding the depth and severity of sternal fracture displacement and risk of BCI. The purpose of this study was to quantify sternal fracture severity by the degree of displacement and to evaluate the association of fracture severity with BCI. MATERIALS AND METHODS: A single institution retrospective review was performed from 2011 to 2014. All adult patients with sternal fracture were identified from the trauma registry, and sternal fracture displacement was quantified as mild (>0 mm, <5 mm), moderate (≥5 mm, <10 mm), or severe (≥10 mm). BCI was diagnosed according to standard AAST grading. Analysis was performed to assess the association of sternal fracture displacement with BCI, which was the primary outcome of interest. RESULTS: Two hundred thirty-five patients with sternal fractures were included in the study. Forty-five percentage of patients suffered a displaced fracture, and 42.6% were diagnosed with BCI. There was no difference in mean fracture displacement when compared to patients without BCI (2.4 versus 1.6 mm, P = 0.07). There was no significant increase in BCI with sternal fracture displacement when compared to patients with nondisplaced fractures (44.3% versus 41.1%, P = 0.62). Neither fracture displacement (OR 1.10, CI 95% 0.65-1.88) nor severe displacement (OR 2.34, CI 95% 0.64-8.54) was associated with significantly increased risk of BCI. CONCLUSIONS: There is no significant association between the depth of sternal fracture displacement and BCI. Further evaluation and management for BCI should be reserved in the absence of additional symptoms or findings.


Assuntos
Fraturas Ósseas/complicações , Traumatismos Cardíacos/etiologia , Esterno/lesões , Traumatismos Torácicos/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Ann Thorac Surg ; 107(6): e381-e383, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30481520

RESUMO

This report describes a case of blunt cardiac injury and pericardial tamponade after video-assisted thoracoscopic surgery in a patient with lung cancer, hypertension, and cardiac hypertrophy. Anatomic findings included massive hemorrhage in the pericardium, cardiac hypertrophy, and a superficial contusion with a ruptured blood vessel on the epicardium at the lateral wall of the left ventricle. The patient died of pericardial tamponade secondary to blunt trauma from the tip of the thoracoscopic instrument. This case suggests that detailed assessment of the cardiovascular system, especially cardiac hypertrophy, careful preoperative preparation, and careful monitoring of postoperative conditions are important.


Assuntos
Tamponamento Cardíaco/etiologia , Traumatismos Cardíacos/etiologia , Complicações Intraoperatórias/etiologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Ferimentos não Penetrantes/etiologia , Evolução Fatal , Traumatismos Cardíacos/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos não Penetrantes/complicações
18.
J Forensic Sci ; 64(4): 1238-1240, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30462838

RESUMO

Cardiac rupture by blunt chest trauma is commonly seen after motor vehicle accidents and falls; however, it is rarely caused by a blow to the chest. We herein report an autopsy case of a high school boy who sustained severe right ventricular rupture by only one knee kick to the chest during a quarrel. He was hospitalized and developed cardiopulmonary arrest. Emergency surgery was performed, but the patient died. The autopsy revealed no external severe trauma or deformation, but the side wall of the right ventricle contained a large V-shaped laceration. The other thoracic organs had no injuries. This case illustrates that severe cardiac rupture can occur by only one blow to the chest. Blunt cardiac injuries can occur even if no severe injuries are present on the body surface. We should consider the possibility of severe cardiac injuries regardless of the presence of external injuries.


Assuntos
Traumatismos Cardíacos/patologia , Violência , Ferimentos não Penetrantes/complicações , Adolescente , Tamponamento Cardíaco/etiologia , Traumatismos Cardíacos/etiologia , Hemorragia/patologia , Humanos , Masculino , Fraturas das Costelas/patologia
19.
J Emerg Med ; 56(2): 197-200, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30389284

RESUMO

BACKGROUND: Injuries from nail guns are a unique type of penetrating trauma seen in emergency departments (EDs), rising in prevalence in the United States. These devices can lead to life-threatening injuries that require rapid diagnosis to help guide management. CASE REPORT: An elderly man was brought to the ED having sustained a nail gun injury to the chest. After loss of pulses, brief closed chest compressions and rapid blood product administration led to a return of spontaneous circulation. Using bedside ultrasound, a metallic foreign body was identified tracking through the right ventricle with associated pericardial fluid and pericardial clot. This rapid diagnosis with bedside ultrasound helped facilitate timely transport to the operating room for median sternotomy, foreign body removal, and pledgeted cardiac repair. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With continued developments in image quality and acquisition, and improvements of physician operator performance, ultrasonography has continued to make significant impacts in traumatically injured patients in new ways. We present this case report to highlight precordial nail gun injuries and to emphasize the diagnostic capabilities of bedside ultrasound for these patients.


Assuntos
Traumatismos Cardíacos/cirurgia , Coração/fisiopatologia , Testes Imediatos/normas , Ultrassonografia/métodos , Ferimentos Penetrantes/diagnóstico , Idoso , Serviço Hospitalar de Emergência/organização & administração , Armas de Fogo/estatística & dados numéricos , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Coração/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Humanos , Masculino , Testes Imediatos/tendências , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , Toracotomia/métodos , Ferimentos Penetrantes/cirurgia
20.
Eur Radiol ; 29(2): 963-974, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30019144

RESUMO

OBJECTIVES: Cardiac lead perforation is a rare but potentially life-threatening event. The purpose of this study was to investigate the diagnostic performances of chest radiography, transthoracic echocardiography (TTE) and electrocardiography (ECG)-gated contrast-enhanced cardiac CT in the assessment of cardiac lead perforation. METHODS: This retrospective study was approved by the ethics review board of Sun Yat-Sen Memorial Hospital at Sun Yat-Sen University (Guangzhou, China), and the need to obtain informed consent was waived. Between May 2010 and Oct 2017, 52 patients were clinically suspected to have a cardiac lead perforation and received chest radiography, TTE and ECG-gated contrast-enhanced cardiac CT. Among them, 13 patients were identified as having cardiac lead perforation. The diagnostic performances of these three modalities were evaluated by receiver-operating characteristic (ROC) curves using a composite reference standard of surgical and electrophysiological results and clinical follow-up. The areas under ROCs (AUROCs) were compared with the McNemar test. RESULTS: The accuracies of chest radiography, TTE and ECG-gated contrast-enhanced cardiac CT imaging for the diagnosis of cardiac lead perforation were 73.1%, 82.7% and 98.1%, respectively. ECG-gated contrast-enhanced cardiac CT had a higher AUROC than chest radiography (p < 0.001) and TTE (p < 0.001). CONCLUSIONS: ECG-gated contrast-enhanced cardiac CT is superior to both chest radiography and TTE imaging for the assessment of cardiac lead perforation. KEY POINTS: • ECG-gated contrast-enhanced cardiac CT has an accuracy of 98.1% in the diagnosis of cardiac lead perforation. • The AUROC of ECG-gated contrast-enhanced cardiac CT is higher than those of chest radiography and TTE imaging. • ECG-gated contrast-enhanced cardiac CT imaging has better diagnostic performance than both chest radiography and TTE imaging for the assessment of cardiac lead perforation.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Traumatismos Cardíacos/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Imagem de Sincronização Cardíaca/métodos , Ecocardiografia/métodos , Eletrocardiografia/métodos , Eletrodos Implantados/efeitos adversos , Análise de Falha de Equipamento/métodos , Feminino , Traumatismos Cardíacos/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Curva ROC , Radiografia Torácica/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Ferimentos Penetrantes/etiologia
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