RESUMO
BACKGROUND: Y- graft (Y-G) is a graft formed by the Left Internal Mammary Artery (LIMA) connected to the Left Anterior Descending Artery (LAD) and by a free Right Internal Mammary Artery (RIMA) connected to LIMA and to a Marginal artery of Left Circumflex Artery (LCx). Aim of the work was to study the flow of this graft during a six months follow-up to assess whether the graft was able to meet the request of all the left coronary circulation, and to assess whether it could be done by evaluation of coronary flow reserve (CFR). METHODS: In 13 consecutive patients submitted to Y-G (13 men), CFR was measured in distal LAD and in distal LCx from 1 week after , every two months, up to six months after operation (a total of 8 tests for each patient) by means of transthoracic echocardiography (TTE) and Adenosine infusion (140 mcg/kg/min for 3-6 min). A Sequoia 256, Acuson-Siemens, was used. Contrast was used when necessary (Levovist 300 mg/ml solution at a rate of 0,5-1 ml/min). Max coronary flow diastolic velocity post-/pre-test > or =2 was considered normal CFR. RESULTS: Coronary arteriography revealed patency of both branches of Y-G after six months. Accuracy of TTE was 100% for LAD and 85% for LCx. Feasibility was 100% for LAD and 85% for LCx. CFR improved from baseline in LAD (2.21 +/- 0.5 to 2.6 +/- 0.5, p = 0.03) and in LCx (1.7 +/- 1 to 2.12 +/- 1, p = 0.05). CFR was under normal at baseline in 30% of patients vs 8% after six months in LAD (p = 0.027), and in 69% of patients vs 30% after six months in LCx (p = 0.066). CONCLUSION: CFR in Y-G is sometimes reduced in both left territories postoperatively but it improves at six months follow-up. A follow-up can be done non-invasively by TTE and CFR evaluation.
Assuntos
Ponte de Artéria Coronária/métodos , Circulação Coronária/fisiologia , Vasos Coronários/fisiopatologia , Ecocardiografia/métodos , Infarto do Miocárdio/fisiopatologia , Recuperação de Função Fisiológica , Angiografia Coronária , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of this study was to assess the efficacy of preoperative and postoperative treatment with n-3 polyunsaturated fatty acids (PUFAs) in preventing the occurrence of atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG). BACKGROUND: Postoperative AF is a common complication of CABG. There is growing clinical evidence that PUFAs have cardiac antiarrhythmic effects. METHODS: A total of 160 patients were prospectively randomized to a control group (81 patients, 13 female, 64.9 +/- 9.1 years) or PUFAs 2 g/day (79 patients, 11 female, 66.2 +/- 8.0 years) for at least 5 days before elective CABG and until the day of discharge from the hospital. The primary end point was the development of AF in the postoperative period. The secondary end point was the hospital length of stay after surgery. All end points were independently adjudicated by two cardiologists blinded to treatment assignment. RESULTS: The clinical and surgical characteristics of the patients in the two groups were similar. Postoperative AF developed in 27 patients of the control group (33.3%) and in 12 patients of the PUFA group (15.2%) (p = 0.013). There was no significant difference in the incidence of nonfatal postoperative complications, and postoperative mortality was similar in the PUFA-treated patients (1.3%) versus controls (2.5%). After CABG, the PUFA patients were hospitalized for significantly fewer days than controls (7.3 +/- 2.1 days vs. 8.2 +/- 2.6 days, p = 0.017). CONCLUSIONS: This study first demonstrates that PUFA administration during hospitalization in patients undergoing CABG substantially reduced the incidence of postoperative AF (54.4%) and was associated with a shorter hospital stay.
Assuntos
Fibrilação Atrial/prevenção & controle , Ponte de Artéria Coronária , Ácidos Graxos Ômega-3/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Idoso , Fibrilação Atrial/mortalidade , Estudos de Coortes , Eletrocardiografia/efeitos dos fármacos , Feminino , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/mortalidade , Pré-Medicação , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Recent studies have shown that autologous bone marrow mononuclear cell (aBM-MNC) transplantation can be effectively performed in human beings either by the coronary route or by endoventricular injections. However, scanty data are available for patients undergoing coronary artery bypass grafting (CABG). Accordingly, the aim of this study was to evaluate the feasibility and safety of aBM-MNC transplantation in patients with recent myocardial infarction undergoing CABG. METHODS AND RESULTS: The study population included 36 consecutive patients with recent myocardial infarction (< 6 months) undergoing CABG. Eighteen patients (17 men, mean age 64 years) underwent CABG plus aBM-MNC transplantation, whereas 18 subjects undergoing conventional CABG (17 men, mean age 67 years) served as control subjects. Cell transplantation was performed by direct injections in the border zone of the recently infarcted area. An average number of 292 +/- 232 x 10(6) aBM-MNCs was injected in each patient. When compared with control subjects, transplanted patients showed higher values of troponin I peak after CABG (median values of 1.65 ng/mL vs 0.64 ng/mL, P < .001). No major transplant-related adverse event could be detected. During follow-up, transplanted patients had an improvement in left ventricular ejection fraction (from 0.46 to 0.51, P < .05) and wall motion score index (from 1.71 to 1.42, P < .01). The incidence of arrhythmias immediately after CABG and during follow-up was similar in the 2 groups. CONCLUSIONS: Our data support the idea that direct injection of aBM-MNCs in the myocardium during CABG is feasible and safe. Larger studies are needed to assess the efficacy of such an approach in patients undergoing CABG.
Assuntos
Transplante de Medula Óssea , Ponte de Artéria Coronária , Infarto do Miocárdio/cirurgia , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The development of a left ventricular rupture after myocardial infarction is not a rare complication. We report a case of 70-year-old male patient with clinical and instrumental signs of cardiac tamponade after left ventricular rupture. We repaired this lesion with pericardial patch and biological Glue without extracorporeal circulation and sutureless.
Assuntos
Pericárdio/transplante , Ruptura do Septo Ventricular/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , MasculinoRESUMO
The devolpment of a left ventricular rupture after myocardial infarction is not a rare complication. We report a case of 70-year-old male patient with clinical and instrumental signs of cardiac tamponade after left ventricular rupture. We repaired this lesion with pericardial patch and biological Glue without extracorporeal circulation and sutureless.
Assuntos
Ruptura Cardíaca Pós-Infarto/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , Masculino , Pericárdio , Adesivos TeciduaisRESUMO
We report 2 clinical cases of cardiac tumors, myxoma and papillary fibroelastoma, with unusual ventricular location. The clinical manifestations of these entities are not well described. Usually the patients are asymptomatic even if they have a high risk for cardiac and systemic embolic events so that these neoplasms are recognized during life more often in patients evaluated for embolic events of unclear pathology. The routine use of echocardiography has increased the detection of these tumors in living patients. In the surgical treatment, the approach should allow minimal manipulation of the tumors, inspection of all four cardiac chambers to overlook if tumors are multifocal and provide adequate exposure for complete resection. In our experience, we used two surgical approaches, via the left ventricle and via the aortic valve.