RESUMO
AIM: We evauated the outcome of patients with left ventricular pseudoaneurysms, focusing on those treated surgically. METHODS: Between June 1990 and March 2007, 7 patients underwent surgery because of left ventricular pseudoaneursym following myocardial infarction, at our institution. The median time interval between myocardial infarction and the diagnosis of left ventricular psedoaneursym was 2.6 months (range: 15 days to 8 months). The aneursym was resected and the defect was closed with a Teflon patch or direct sutures. RESULTS: The location of the pseudoaneursym was posterior in 3 patients, inferolateral in 3 patients and anterolateral in 1 patient. The aneursym was resected and the defect was closed with a Teflon patch in 6 patients. In 1 patient with chronic pseudoaneurysm, the defect was closed with direct sutures reinforced with Teflon felt. In addition, 5 patients underwent coronary artery bypass grafting. The patients have been followed-up for a mean period of 45 months (range: 24 to 109 months). CONCLUSION: There was no intraoperative death. However, 2 patients died due to multiple organ failure, one 17 days and the other 1 month after the surgical operation. There was 1 late death due to the cancer. Currently, 1 patient is free of any cardiac symptoms, 2 patients have New York Heart Association (NYHA) Class II heart failure, and 1 patient with moderate mitral regurgitation is in class III.
Assuntos
Falso Aneurisma/cirurgia , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração , Infarto do Miocárdio/complicações , Idoso , Falso Aneurisma/etiologia , Aneurisma Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Continuous-flow left ventricular assist devices (CF-LVADs) such as the HeartMate II and HeartWare left ventricular assist device are important alternatives to heart transplantation. Thrombosis is a serious complication in both devices and we present our approach to treating thrombosis and analysis of predisposition factors. METHODS: Our center's CF-LVADs database was retrospectively reviewed for pump thrombosis between January 2011 and January 2015. The patients were grouped for pump thrombosis (n = 13) and nonpump thrombosis (n = 85). Patients with pump thrombosis were further divided by device type (n = 5 HeartMate II and n = 8 HeartWare left ventricular assist device). Predisposition factors for pump thrombosis, our treatment approach, and patient outcomes were evaluated. RESULTS: Pump thrombosis was diagnosed in 13 of 98 patients. The rate of pump thrombosis did not differ between the 37 HeartMate II and 61 HeartWare left ventricular assist device patients. High mean arterial blood pressure (P < .01) and noncompliance with the anticoagulation regimen (P = .04) were associated significantly with thrombosis. Twelve patients with stable hemodynamics were treated initially with intravenous tissue plasminogen activator and 1 patient who had end-organ damage underwent pump exchange. Two patients failed to respond to medical treatment and underwent pump exchange. Two patients with recurrent thrombosis were administered intracardiac tissue plasminogen activator. Five patients died after medical treatment and 4 deaths were due to cerebral hemorrhage. CONCLUSIONS: Avoiding increased mean arterial blood pressures and ensuring optimal anticoagulation may help to decrease pump thrombosis. In patients with pump thrombosis, thrombolytic therapy is an alternative that is less invasive than pump exchange, but carries the risk of hemorrhage and thromboembolism.
Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Complicações Pós-Operatórias/etiologia , Implantação de Prótese/instrumentação , Trombose/etiologia , Adulto , Anticoagulantes/uso terapêutico , Feminino , Hemodinâmica , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Trombose/fisiopatologia , Trombose/terapia , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do TratamentoRESUMO
INTRODUCTION: Donor organ shortage is still a problem for heart transplantation. Only 10% of patients in waiting list undergo heart transplantation. Over the last 5 years, 2 different continuous flow pumps, the HeartMate II and the HeartWare, have been successful clinically in the alternative treatment of patients with end-stage heart disease. METHODS: Fifty-five patients underwent left ventricular assist device implantation between 2011 and 2014. Patients were followed on pump support for complications and intraoperative outcomes. Potential device-related complications include infections, bleeding liver dysfunction, renal dysfunction, right ventricular failure, stroke, thromboembolism, gastrointestinal bleeding, and wound infection. RESULTS: The only preoperative significant difference between groups in the study was age; the Heartmate II group were significantly older than Heartware group. There were no differences in gender, body mass index, or body surface area. The Heartware has a better 1-year survival rate, although the difference was not significant. Patients with Heartmate II had a higher incidence of gastrointestinal bleeding and driveline infection. The Heartware group had a higher incidence of stroke and pump thrombosis. CONCLUSIONS: The Heartmate II and Heartware are comparable in most respects such as survival, intraoperative features, and major complications.
Assuntos
Coração Auxiliar/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Implantação de Prótese/instrumentação , Listas de Espera , Adulto , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Insuficiência Cardíaca/etiologia , Transplante de Coração , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Implantação de Prótese/métodos , Implantação de Prótese/mortalidade , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Taxa de Sobrevida , Tromboembolia/etiologia , Trombose/epidemiologia , Trombose/etiologia , Disfunção Ventricular Direita/etiologiaRESUMO
BACKGROUND: Because commercial minimally invasive harvesting equipments significantly increase operation costs, they are not always available in all clinics worldwide. The aim of this study was to investigate whether minimally invasive saphenous vein harvesting using a laryngoscope can be applied efficiently and successfully. METHODS: Thirty patients were prospectively randomized into two groups. One group underwent a minimally invasive technique using a laryngoscope; the other, open saphenous vein harvest. A modified bridging technique, in which tissue retraction and illumination is achieved with a sterilized laryngoscope, was used for minimally invasive harvesting. Smooth muscle contractile and endothelial functions were tested in vitro using an organ chamber. Morphology was examined with light microscopy. RESULTS: There was no statistically significant difference in harvest times or length of the vein harvested by either of the above mentioned techniques. Total length of the incision in the minimally invasive group was significantly shorter than that in the open group. In follow-ups, no significant complications occurred in either group. Pain and leg edema were significantly less in the minimally invasive group compared to those of the open group. There was no significant difference in response to acetylcholine and 80 mM KCl between veins taken with the laryngoscope compared to veins taken with the traditional open technique. Similarly, histological data was unable to show any significant damage to the vessel wall. CONCLUSIONS: Because the laryngoscopic saphenectomy does not harm the harvested graft, it can be applied, instead of other minimally invasive saphenous vein harvesting systems, with a zero cost, efficiently, successfully, and with satisfactory speed and significant reduction of postoperative leg pain and wound complications.
Assuntos
Ponte de Artéria Coronária/métodos , Laringoscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Veia Safena/citologia , Veia Safena/transplante , Coleta de Tecidos e Órgãos/métodos , Idoso , Ponte de Artéria Coronária/instrumentação , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
In order to investigate the possible relationship between atherosclerosis and chronic Pseudomonas aeruginosa infection, 66 Wistar rats were given five separate intratracheal inoculations of either P. aeruginosa or sterile saline at 4-week intervals. The rats were divided into four groups: group 1 was infected with P. aeruginosa and fed a diet containing cholesterol 1% w/v; group 2 was infected with P. aeruginosa and fed a normal diet; group 3 was not infected and was fed a diet containing cholesterol 1% w/v; and group 4 (the control group) was not infected and was fed a normal diet. One month after the final inoculation, the rats were killed humanely; computerised image analysis was used to evaluate sections of the aorta and heart, and the maximal wall thickness of the aorta and coronary artery. The aortic wall thickness was significantly greater for group 1 (329.53 +/- 58.06 microm) compared to groups 2 (190.59 +/- 27.81 microm; p < 0.0001), 3 (262.90 +/- 61.12 microm; p < 0.0004) and 4 (158.00 +/- 30.30 microm; p < 0.0001). Similarly, the coronary artery wall thickness was significantly greater for group 1 (72.96 +/- 10.67 microm) compared to groups 2 (35.07 +/- 8.53 microm; p < 0.0001), 3 (41.45 +/- 10.22 microm; p < 0.0001) and 4 (32.30 +/- 5.27 microm; p < 0.0001). These findings strengthen the hypothesis that chronic infection plays a role in the pathogenesis of atherosclerosis.
Assuntos
Arteriosclerose/etiologia , Modelos Animais de Doenças , Infecções por Pseudomonas/complicações , Animais , Arteriosclerose/microbiologia , Arteriosclerose/patologia , Colesterol na Dieta/administração & dosagem , Doença Crônica , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Ratos , Ratos WistarRESUMO
Cardiac hydatid cyst is rarely encountered. In this article, a case of hydatid cyst localized in multiple organs including the ventricular septum and causing pulmonary emboli is reported.
Assuntos
Cardiomiopatias/cirurgia , Equinococose/cirurgia , Septos Cardíacos , Embolia Pulmonar/etiologia , Adulto , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Equinococose/complicações , Equinococose/diagnóstico , Equinococose Hepática/diagnóstico por imagem , Feminino , Septos Cardíacos/cirurgia , Humanos , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Radiografia , Cintilografia , UltrassonografiaRESUMO
The insufficiency of the tricuspid valve developed due to blunt chest trauma is a rare and an insidiously progressing clinical incident. In this article we present a case which showed tricuspid insufficiency because of the rupture of the anterior papillary muscle due to trauma and which was treated surgically.
Assuntos
Traumatismos Cardíacos/etiologia , Traumatismos Torácicos/complicações , Insuficiência da Valva Tricúspide/etiologia , Ferimentos não Penetrantes/complicações , Adulto , Cordas Tendinosas/lesões , Próteses Valvulares Cardíacas , Humanos , Masculino , Insuficiência da Valva Tricúspide/cirurgiaRESUMO
This is the case report of a forty-five-year-old woman who manifested clinical findings characteristic of arrhythmogenic right ventricular dysplasia (ARVD) except for fluorescent antinuclear antibody (FANA) positiveness. To the authors' knowledge, this is the first report of FANA positiveness associated with ARVD.
Assuntos
Anticorpos Antinucleares/análise , Cardiomegalia/complicações , Taquicardia/etiologia , Cardiomegalia/imunologia , Feminino , Imunofluorescência , Humanos , Pessoa de Meia-Idade , Função Ventricular Direita/fisiologiaRESUMO
We performed coronary artery bypass grafting on a 58-year-old man who only 9 months earlier had undergone right pneumonectomy for bronchial carcinoma. Although his preoperative pulmonary function had been poor, coronary artery bypass surgery was successful, and the patient was discharged on the 9th postoperative day Two years after surgery, he remained in New York Heart Association functional class I. We attribute this success to special management before, during, and after the operation. On the 32nd postoperative month, this patient died of multiple tumor metastases.
Assuntos
Angina Instável/cirurgia , Ponte de Artéria Coronária , Pneumonectomia , Complicações Pós-Operatórias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Between 1 March 1992 and 31 June 1996, we enrolled 72 patients with left ventricular aneurysms in a prospective, nonrandomized study to compare--by study of cardiac indices, single-plane ejection fractions, and nuclear ventriculograms--the effects of classical aneurysmectomy (group 1, n = 36) with those of endoaneurysmorrhaphy (group 2, n = 36). Preoperative and postoperative cardiac index measurements were, respectively, 1.96 +/- 0.6 and 3.51 +/- 0.53 for group 1, and 1.96 +/- 0.31 and 3.43 +/- 0.41 for group 2. In this regard, there was not any significant difference between the groups preoperatively or postoperatively. Preoperative and postoperative multiple-gated acquisition measurements, were, respectively, 34.3 +/- 7.76 and 43.1 +/- 11.1 for group 1, and 37 +/- 3.88 and 66.5 +/- 5.2 for group 2. Although there was not any significant preoperative difference between the groups (P = 0.34), group 2 had significant postoperative improvement in left ventricular ejection fractions (P < 0.001). Preoperative and postoperative single-plane contrast ventriculographic ejection fractions were, respectively, 43.4 +/- 8.7 and 48.6 +/- 11.2 for group 1, and 43.8 +/- 5.5 and 60.8 +/- 15.1 for group 2. Again, there was not any significant difference between the 2 groups in preoperative left ventricular ejection fractions (P = 0.87), but the postoperative left ventricular ejection fractions of group 2 were significantly better than those of group 1 (P = 0.022). We conclude that left ventricular functional improvement with endoaneurysmorrhaphy is superior to that with classical aneurysmectomy.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Aneurisma Cardíaco/cirurgia , Débito Cardíaco , Feminino , Seguimentos , Coração/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cintilografia , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/fisiologiaRESUMO
A mechanical prosthetic heart valve can become acutely obstructed despite anticoagulation therapy. This can be a life-threatening complication. We report the case of a 38-year-old woman who survived obstruction of her Sorin prosthetic mitral valve. She was admitted to the hospital because of severe pulmonary edema. On auscultation, mechanical valve sounds were absent. Transthoracic echocardiography showed an immobile mechanical valve. The patient suffered a cardiac arrest while being prepared for surgery, but she underwent successful mitral valve replacement after cardiopulmonary resuscitation. When patients with prosthetic mitral valves present with acute dyspnea, the possibility of an obstructed prosthetic valve must be considered in the differential diagnosis.
Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Estenose da Valva Mitral/etiologia , Adulto , Ecocardiografia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Falha de PróteseAssuntos
Aneurisma Coronário/etiologia , Aneurisma Coronário/cirurgia , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/complicações , Idoso , Angina Pectoris/etiologia , Ponte Cardiopulmonar , Aneurisma Coronário/diagnóstico por imagem , Angiografia Coronária , Progressão da Doença , Humanos , Ligadura/métodos , Masculino , Veia Safena/transplante , Fatores de Tempo , Resultado do TratamentoAssuntos
Cardiomiopatias , Equinococose , Adolescente , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Cardiomiopatias/patologia , Cardiomiopatias/cirurgia , Equinococose/diagnóstico , Equinococose/patologia , Equinococose/cirurgia , Equinococose Pulmonar/complicações , Feminino , Átrios do Coração , Humanos , Nefropatias/complicaçõesRESUMO
In our study, we aimed to present our cases with heart wounds and to determine the factors influencing mortality. We retrospectively evaluated 23 cases with cardiac injuries who were treated among years 1986-99 in our clinic. There were 4 female and 19 male cases, and the average age was 32 years (range 12-52). Heart wounds were caused by blunt trauma in 6 cases, and penetrating trauma in 17 cases. Penetrating heart wounds was caused by gunshot wounds in four patients and stab wounds in 13 patients. Our cases were underwent to rapid resuscitation and emergency surgery. Mortality rate was 17% with 3 cases. Blunt cardiac wounds was caused by motor vehicle accidents in all cases. Diagnosis with immediate echocardiography and efficient treatment was performed. Mortality rate was 33% with 2 cases. We think that emergent resuscitation and immediately surgical exploration in patients with penetrating heart wounds and immediate diagnosis by echocardiography and prompt treatment in patients with blunt heart injuries may improve overall survival.