RESUMEN
Modified Blalock-Taussig shunt (MBTS) is a palliative operation for cyanotic congenital heart disease (CCHD) in patients for whom total correction is not appropriate. Many synthetic or biologic grafts have been proposed as alternative shunt materials. The use of a bovine mesenteric venous graft (BMVG) as a systemic-to-pulmonary artery shunt conduit without the administration of antiaggregant and anticoagulant has been proposed as a treatment for neonates with CCHD, but few reports address the importance of thrombophilic risk factors in MBTS and bovine venous graft as a shunt material. We used BMVG as a shunt material without any antiaggregant or antiplatelet regimen in 13 patients with CCHD, all of whom were candidates for MBTS and had thrombophilic risk factors assessed in our initial study. Early shunt failure occurred in the first 3 patients and was attributed to less surgical experience with this graft. No complications were attributable to graft material or surgery itself. In all cases functioning MBTSs were observed on follow-up. Our study results show that thrombophilic factors should be evaluated before the MBTS procedure. BMVG could be the choice of graft for use without the administration of antiaggregant and anticoagulants in patients with thrombophilic risk factors.
Asunto(s)
Derivación Arteriovenosa Quirúrgica , Cianosis/cirugía , Supervivencia de Injerto , Cardiopatías Congénitas/cirugía , Venas Mesentéricas/trasplante , Politetrafluoroetileno , Trombofilia/etiología , Grado de Desobstrucción Vascular , Animales , Factores de Coagulación Sanguínea , Bovinos , Femenino , Humanos , Masculino , Estudios Prospectivos , Factores de Riesgo , Trasplante Heterólogo , Trasplantes , Insuficiencia del TratamientoRESUMEN
We present a patient suffering from homozygous familial hypercholesterolemia, who developed coronary artery disease in the age of 15 treated with three vessels coronary artery bypass grafting (CABG) operation. 7 years after CABG surgery symptomatic bilateral carotid artery stenoses were observed. Both internal carotid arteries were stented. The combination of pharmacologic therapy with life-long LDL-apheresis is the current treatment of choice.
Asunto(s)
Implantación de Prótesis Vascular/instrumentación , Arteria Carótida Interna/cirugía , Estenosis Carotídea/cirugía , Puente de Arteria Coronaria , Estenosis Coronaria/cirugía , Hiperlipoproteinemia Tipo II/complicaciones , Hiperlipoproteinemia Tipo II/terapia , Stents , Adulto , Angiografía de Substracción Digital , Anticolesterolemiantes/uso terapéutico , Eliminación de Componentes Sanguíneos , Arteria Carótida Interna/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/tratamiento farmacológico , Estenosis Coronaria/tratamiento farmacológico , Estenosis Coronaria/etiología , Humanos , Hiperlipoproteinemia Tipo II/tratamiento farmacológico , Hiperlipoproteinemia Tipo II/cirugía , Masculino , Inhibidores de Agregación Plaquetaria/uso terapéutico , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
A pseudoaneurysm is defined as an aneurysmatic sac surrounded byfibrous tissue instead of other vascular layers such as the muscular one. It is a rare incident in infants especially in the brachial artery. Blunt trauma and vascular access attempts are the most common etiologic factors. We present two infants with brachial artery pseudoaneurysm in the antecubital region following accidental arterial puncture.
Asunto(s)
Aneurisma Falso/diagnóstico , Aneurisma Falso/etiología , Arteria Braquial/cirugía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Heridas Penetrantes/complicaciones , Heridas Penetrantes/diagnóstico , Aneurisma Falso/cirugía , Humanos , Lactante , Masculino , Heridas Penetrantes/cirugíaRESUMEN
This report describes a patient who had dizziness and loss of balance. During routine investigation, a mass located on the anterior mitral valve leaflet was detected on transthoracic echocardiography. The patient underwent surgery for a mass located on the mitral valve, and histopathologic examination determined the mass was a myxoma.
Asunto(s)
Infarto Encefálico/diagnóstico , Cerebelo/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico por imagen , Válvula Mitral , Mixoma/diagnóstico por imagen , Adulto , Arterias , Neoplasias Cardíacas/cirugía , Humanos , Masculino , Mixoma/cirugía , UltrasonografíaRESUMEN
BACKGROUND: Clinical procedures involving extracorporeal blood circulation are potentially complicated by the interaction of various blood systems with foreign surfaces. In cardiopulmonary bypass, exposure of blood to synthetic surfaces generally leads to activation of cellular and humoral blood systems with activation of complement cascade. This reaction can be associated with a variety of postoperation clinical complications such as increased pulmonary capillary permeability, anaphylactic reactions and various degrees of organ failure which contributes to mortality in routine cardiac operations. Application of biocompatible materials in an extracorporeal circuit modifies the normal pattern of blood activation, and therefore potentially may reduce clinical complications in routine cardiac surgery. METHODS: To evaluate whether the use of heparin coated extracorporeal circuits could reduce this activation process we performed a study on forty coronary artery bypass graft patients perfused randomly with heparin-coated circuits (Duraflo II, n = 20) or with non-coated circuits (De Bakey roller pump, control n = 20). Standardized heparinization was maintained for both groups of patients during cardiopulmonary bypass. RESULTS: The use of heparin-coated circuits resulted in reduction of systemic leukocyte activation of cardiopulmonary bypass reflected by reduced leukocyte and neutrophil counts 24 hours after operation (p < 0.05). Furthermore, blood samples taken from both the right and left atrium after reperfusion revealed that the differences in neutrophil counts between the right and left atrium occur less in the heparin-coated circuit in contrast to the control group (p < 0.05). The pattern of complement activation, probably initiating this inflammatory reaction, was modified by heparin coating in two different aspects. There was a significant reduction of C3 during and after cardiopulmonary bypass in patients perfused with heparin coated circuits as compared with the control group, also there was reduction of C4 after protamine administration in the same groups (p < 0.05). The reductions in blood and complement activation with heparin-coated circuit indicate a substantial improvement in biocompatibility, and consequently reducing clinical complications associated with cardiopulmonary bypass. CONCLUSIONS: In conclusions using the Duraflo II heparin-coated circuit in open heart surgery can reduce the complement activation and inflammatory response to cardiopulmonary bypass.
Asunto(s)
Anticoagulantes/farmacología , Puente Cardiopulmonar/efectos adversos , Activación de Complemento/efectos de los fármacos , Circulación Extracorporea , Heparina/farmacología , Inflamación/prevención & control , Anciano , Humanos , Persona de Mediana EdadRESUMEN
Extension of Wilms' tumor through inferior vena cava into the heart two years after the completion of therapy, is a very rare clinical aspect. We successfully operated on a 7 year old girl who had a huge right atrial mass which filled the right ventricle and right ventricular out flow tract, on an emergency basis using cardiopulmonary bypass.
Asunto(s)
Neoplasias Cardíacas/cirugía , Neoplasias Renales/patología , Tumor de Wilms/cirugía , Puente Cardiopulmonar , Niño , Tratamiento de Urgencia , Femenino , Neoplasias Cardíacas/secundario , Ventrículos Cardíacos/cirugía , Humanos , Invasividad Neoplásica , Tumor de Wilms/secundarioRESUMEN
Aortic root abscess, aneurysm of sinus Valsalva, severe aortic valve insufficiency, and a fragile aortic wall caused by infective endocarditis were found in a 10-year-old child. Aortic valve replacement was intended as a preoperative strategy, but one of modifications of Cabrol had to be used urgently because of aortic root rupture between right atrial and aortic connection just after pericardiotomy.
Asunto(s)
Aorta/cirugía , Aneurisma de la Aorta , Endocarditis Bacteriana Subaguda/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Complicaciones Intraoperatorias , Aneurisma de la Aorta/cirugía , Válvula Aórtica , Niño , Endocarditis Bacteriana Subaguda/complicaciones , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas , Humanos , Masculino , Pericardiectomía , Diseño de Prótesis , Rotura Espontánea , Seno AórticoRESUMEN
Varicose vein abnormalities involving the lesser saphenous vein of a 7-year-old boy are presented. The histopathology of the vein wall revealed a vacuolar degeneration without mucoid deposits of the muscle cells, which has not been described previously in the literature in congenital varices.
Asunto(s)
Músculo Liso Vascular/patología , Miopatías Estructurales Congénitas/patología , Vacuolas/patología , Várices/congénito , Niño , Diagnóstico Diferencial , Humanos , Masculino , Várices/patologíaRESUMEN
Vascular hamartoma of the mediastinum is a rare benign vascular tumor. A 13-year-old girl presented with back pain, persistent coughing, palpitation, and angina pectoris. Preoperative investigations demonstrated an enlarging mass involving the superior mediastinum extending posteriorly (T6-T8). An encapsulated, 6x5x3 cm dark purplish mass adherent to the aortic wall was found. The main mediastinal mass was totally excised but limited resection was carried out in the paravertebral region. Microscopic examination revealed a vascular hamartoma.
Asunto(s)
Hemangioma/diagnóstico , Neoplasias del Mediastino/diagnóstico , Adolescente , Angina de Pecho/etiología , Dolor de Espalda/etiología , Tos/etiología , Femenino , Hemangioma/complicaciones , Hemangioma/cirugía , Humanos , Imagen por Resonancia Magnética , Neoplasias del Mediastino/complicaciones , Neoplasias del Mediastino/cirugíaRESUMEN
Increments of lipoprotein (a) (Lp (a)) concentration during cardiopulmonary bypass (CPB) have not been justified in the literature yet. We have investigated whether Lp (a) levels remain constant or increase during CPB and if high plasma levels of low density lipoprotein (LDL; containing apolipoprotein (apo) B) in hypercholesterolemic patients affect the assembly of Lp (a) (containing apoB: Apo (a)). In this study, the change in plasma lipid and lipoprotein levels of 40 patients with hypercholesterolemia and 40 patients who have normal cholesterol values were determined and compared during CPB, and in the postoperative early stage. In our study, lipid and lipoproteins, except Lp (a), showed a falling trend and paradoxically, Lp (a) statistically showed a significant rising trend, like the acute phase reactant in two groups (p=0.011 for LDL, p=0.016 for high density lipoprotein (HDL) and p<0.001 for the others, in 80 patients). Concentrations of Lp (a) in plasma increased more sharply in the hypercholesterolemic group than the normocholesterolemic group during CPB. This difference was significant at the 60th minute of cardiopulmonary bypass with a nonparametric test (p<0.05 Mann-Whitney U test). High density lipoprotein values showed more decline in the hypercholesterolemic group patients than in the normocholesterolemic group patients (p<0.05). In conclusion, lipoprotein (a) levels increased more pronounced in patients with hypercholesterolemia during CPB. On the other hand, high LDL levels in hypercholesterolemic patients accelerated Lp(a)formation in the acute phase.
Asunto(s)
Puente Cardiopulmonar , Hipercolesterolemia/sangre , Lipoproteína(a)/sangre , Proteínas de Fase Aguda/metabolismo , Estudios de Casos y Controles , Puente de Arteria Coronaria , Humanos , Lípidos/sangre , Lipoproteínas/sangre , Factores de Tiempo , Triglicéridos/sangreRESUMEN
The aim of the study is to determine the impact of Chlamydial seropositivity on atherosclerosis in a group of patient requiring coronary and/or carotid revascularization. A population of 30 diabetic patients (group 3) and 26 nondiabetic patients (group 2) with angiographically documented coronary and/or carotid artery disease were enrolled for the study. Volunteers from the relatives of hospital staff with no known disease (n=29; group 1) were included as the control group. Serum samples from the participants were assayed for cardiovascular risk factors including total serum cholesterol, triglyceride and lipoprotein levels, fibrinogen, Hb A1c levels and IgG titers for Chlamydia pneumonia (C. pneumonia). Chlamydial seropositivity was analysed further to determine a possible impact on atherogenesis. Serum LDL cholesterol levels revealed statistically significant difference between groups 1 and 2 (p=0.001). There was no difference between groups 2 and 3 regarding LDL cholesterol levels. There was no significant difference among the groups with respect to C. pneumonia seropositivity and the other atherosclerotic risk factors. Chlamydial seropositivity was found to be more frequent in males than in females (p=0.008). In the C. pneumonia seropositive group, serum fibrinogen and lipoprotein a levels were found to be significantly higher than the seronegative group (p=0.0001 and p=0.001, respectively). Other atherogenic risk factors were similar in the seropositive and negative groups. The causal role of Chlamydial infections in atherosclerotic plaque formation might be due to their influence on the serum fibrinogen and lipoprotein a levels.