RESUMEN
Examination of totally or partially obstructed human aortocoronary vein grafts, obtained at different time intervals after the bypass operation, has shown that the initial occlusive process is due to thrombosis and may appear a few hours or days after surgery. The cellular phase of intimal proliferation affecting most of the grafts becomes apparent about 4 weeks after the operation. After 1 year the intimal hyperplasia acquires a cell-poor, fibrotic character; the graft usually remains patent. About one-half of the vein grafts obtained 3 or more years after the operation show complicated atherosclerotic lesions. These findings indicate that most of the vein grafts undergo extensive structural changes and some may show similar degenerative lesions as they develop in the coronary arteries.
Asunto(s)
Puente de Arteria Coronaria , Vena Safena/ultraestructura , Supervivencia de Injerto , Humanos , Microscopía Electrónica de Rastreo , Persona de Mediana Edad , Vena Safena/trasplante , Trasplante AutólogoRESUMEN
Scanning electron microscope study of two vein grafts which were removed after 50 months of implantation as aorta-coronary artery vein grafts showed considerable subendothelial thickening, which consisted of relatively cell-poor fibrous layer. In one of the grafts the endothelial surface was intact; the second graft showed focal loss of endothelial cells. Sections of two fresh human veins, studied prior to their insertion as aorta-coronary artery vein grafts, have shown that they retained an intact endothelial layer. A third fresh vein, however, showed focal damage with missing endothelial cells and adherent fibrin.
Asunto(s)
Puente de Arteria Coronaria , Vasos Coronarios/ultraestructura , Vena Safena/ultraestructura , Autopsia , Vasos Coronarios/patología , Humanos , Masculino , Microscopía Electrónica de Rastreo , Persona de Mediana Edad , Vena Safena/patologíaRESUMEN
A total of 205 adults with a variety of congenital heart lesions underwent operation for total correction of their defects. Operative and long-term mortality were 3 and 4 percent, respectively. There has been only one operative death in the past five years (85 patients). While most defects were repaired with good hemodynamic and symptomatic improvement, the three lesions associated with the worst results were cyanotic tetralogy of Fallot, severe pulmonic stenosis complicated by atrial septal defect, and ostium primum atrial septal defect. Myocardial failure due to end-stage myocardial fibrosis was the major cause of operative mortality. Myocardial fibrosis and irreversible pulmonary changes seemed to be the two factors limiting operative correctio
Asunto(s)
Cardiopatías Congénitas/cirugía , Adolescente , Adulto , Anciano , Femenino , Defectos de los Tabiques Cardíacos/cirugía , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interventricular/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estenosis de la Válvula Pulmonar/cirugía , Tetralogía de Fallot/cirugíaRESUMEN
Aorta-coronary artery vein grafts, obtained from 2 patients 37 and 59 months after an aorta-coronary bypass operation, showed extensive mural changes characterized by degenerative tissue lesions, loss of normal morphological features of the intima, and extracellular accumulation of lipids. Both patients had increased plasma triglyceride levels.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria/epidemiología , Venas/trasplante , Insuficiencia Venosa/etiología , Adulto , Arteriosclerosis/patología , Ésteres del Colesterol , Enfermedad Coronaria/patología , Endotelio/ultraestructura , Estudios de Seguimiento , Humanos , Masculino , Microscopía Electrónica de Rastreo , Necrosis , Vena Safena/ultraestructura , Insuficiencia Venosa/patologíaRESUMEN
Until changes of ureteric or vascular compromise are noted, retroperitoneal fibrosis usually goes unnoticed. When symptomatic retroperitoneal fibrosis has been associated with abdominal aortic aneurysm, ureteral involvement has uniformly been present. Three cases demonstrate a new ultrasonographic picture that can aid in early identification of retroperitoneal fibrosis before complications are manifest. In patients with abdominal aortic aneurysms, routine sonography may identify unsuspected retroperitoneal fibrosis, a factor that may be important in preoperative planning for safe surgical intervention.
Asunto(s)
Aneurisma de la Aorta/diagnóstico , Fibrosis Retroperitoneal/diagnóstico , Ultrasonografía , Aorta Abdominal/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/cirugía , Humanos , Masculino , Persona de Mediana Edad , Fibrosis Retroperitoneal/complicaciones , Fibrosis Retroperitoneal/cirugía , Enfermedades Ureterales/etiología , Enfermedades Ureterales/prevención & control , Obstrucción Ureteral/etiologíaRESUMEN
Pathological changes in aortocoronary vein grafts were investigated in 17 patients who had a second revascularization procedure 1 to 53 1/2 months after their initial operation. Subendothelial proliferation was present in all grafts and had resulted in total occlusion of 7. With increasing duration of implantation the proliferative lesions tended to show hyalinization and to affect the media. Advanced atherosclerosis had developed in 2 grafts.
Asunto(s)
Arteriosclerosis/patología , Puente de Arteria Coronaria , Vena Safena/patología , Venas/trasplante , Adulto , Puente de Arteria Coronaria/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Trasplante AutólogoRESUMEN
To better evaluate the incidence of atherosclerosis in the internal mammary artery (IMA), 215 IMA segments from routine postmortem examinations were evaluated microscopically. Significant atherosclerotic narrowing was seen in 9 patients (4.2%). No patient had more than a 50% reduction in lumen diameter. The degree of incipient atherosclerosis correlated well with age, hypertension, diabetes, and peripheral vascular disease.