RESUMEN
Extracorporeal circulation (ECC) is not only used for open heart surgery. There are also other surgical and medical applications. ECC can be used for encephalic arteries surgery to induce hypothermia and maximally protect the brain. Femoro-femoral ECC may be needful for urgent traumatologic surgery of the supra-aortic trunci. Intracranial aneurysm repair can occasionally necessitate deep hypothermia and circulatory arrest with ECC. Renal cell carcinomas may metastasize to the right atrium and surgery with ECC is mandatory for complete excision. Some reports in the literature mention use of ECC for hepatic surgery of intra-hepatic aneurysms. With acute peripheral ischemia, metabolites in the affected limb can be washed out with good results. Medical indications for ECC are numerous with pulmonary assistance as one of the foremost when mechanical ventilation failed. Homogeneous and rapid rewarming of hypothermic patients can be achieved with ECC. Finally, some groups have reported the use of ECC to administer chemotherapy in limb melanoma.
Asunto(s)
Circulación Extracorporea/métodos , Procedimientos Quirúrgicos Cardíacos , Circulación Extracorporea/instrumentación , Humanos , Enfermedades Renales/cirugía , Hepatopatías/cirugía , Oncología Médica , Procedimientos Neuroquirúrgicos , Selección de Paciente , Recalentamiento , Procedimientos Quirúrgicos Torácicos , Procedimientos Quirúrgicos VascularesRESUMEN
The influence of anxiety and depression on the development and prognosis of coronary disease seems to be well established but there are few studies of the effects of these disturbances on the postoperative outcome of coronary surgery. The object of this review of the literature was to present recent data on this subject and to suggest therapeutic strategies for patients referred for coronary bypass surgery to improve their quality of life and even cardiovascular prognosis.
Asunto(s)
Trastornos de Ansiedad/complicaciones , Puente de Arteria Coronaria/psicología , Depresión/complicaciones , Humanos , Selección de Paciente , Pronóstico , Calidad de Vida , Resultado del TratamientoRESUMEN
To prevent direct secondary aortoenteric fistulas, a devastating complication of abdominal aortic surgery, we describe here a rapid, very easy to perform and no cost operating technique. A part about 4 cm long of the vascular prosthesis was cut to obtain a partial tailored ring which was passed through the prosthesis. After the anastomosis was realized, the tailored ring was hitched up to totally cover proximal anastomosis and prevent direct contact between aorto-prosthetic anastomosis and the bowel.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Enfermedades de la Aorta/prevención & control , Implantación de Prótesis Vascular/métodos , Fístula/prevención & control , Enfermedades Intestinales/prevención & control , Intestino Delgado/cirugía , HumanosRESUMEN
Over an 11 year period from January 1990 to December 2000, 3282 patients underwent isolated or combined surgical myocardial revascularisation. In this group, 42 were aged 80 or over (maximum 87 years), 1.3% of the total patient population. The mean age of this subgroup was 81.8 +/- 1.75 years) with a male predominance (61.9%). All patients were autonomous and considered to be in good general and psychological health. Preoperative coronary angiography showed 33.3% of left main stem lesions either alone or associated with a right coronary lesion. The ejection fraction was over 50% in 78.6% of cases. Saphenous vein grafts were used in all but 5 patients who also had left internal mammary artery grafts. Thirteen patients (31%) underwent combined valvular surgery (11 aortic and 2 mitral valve) and 2 patients underwent combined vascular surgery. Three patients were operated as an emergency. A total of 5 patients died in the first 30 postoperative days, a hospital mortality of 11.9%. There were 2 postoperative hemiplegias and 2 cases of renal failure which were aggravated in the postoperative period. The other patients were discharged from hospital with a satisfactory cardiac and functional status. The global mortality was 14% at 3 years and 18% at 5 years. The main bad prognostic factor for survival was the association of aortic valve surgery. In selected octogenarians in good general and psychological health without severe co-morbid conditions, surgical myocardial revascularisation may be considered with an acceptable operative risk.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Anciano , Anciano de 80 o más Años , Angiografía Coronaria , Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Anastomosis Interna Mamario-Coronaria/mortalidad , Masculino , Estudios Retrospectivos , Tasa de Supervivencia , Factores de TiempoAsunto(s)
Recuperación del Miembro/efectos adversos , Infecciones por Proteus/terapia , Proteus mirabilis , Succión/métodos , Infección de la Herida Quirúrgica/terapia , Cicatrización de Heridas , Anciano , Arteriopatías Oclusivas/patología , Arteriopatías Oclusivas/cirugía , Enfermedad Crónica , Femenino , Humanos , Necrosis , Arteria Poplítea , Cuidados Posoperatorios/métodos , Infecciones por Proteus/diagnóstico , Infecciones por Proteus/etiología , Vena Safena/trasplante , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/etiología , Resultado del TratamientoRESUMEN
The chronic constrictive pericarditis is a rare affection, with multiple etiologies and concerning especially the adult. We report a case of chronic constrictive pericarditis in an African child in whom no etiology was found. A review of the literature raises the characteristics of chronic constrictive pericarditis for a better therapeutic management.
Asunto(s)
Pericarditis Constrictiva/diagnóstico , África Oriental , Niño , Enfermedad Crónica , Humanos , MasculinoRESUMEN
A 16-year-old male with bone marrow failure due to chemotherapy for recurrent acute lymphoblastic leukemia developed an abscess in the lower lobe of the left lung draining through a bronchogastric fistula, as well as mitral valve endocarditis with large vegetations. After a course of antifungal therapy, the left lobe was removed and the fistula closed. The mitral valve was then replaced, after a failed attempt at valve repair, by a mechanical, double-leaflet prosthesis. Microscopy of the lung and heart specimens disclosed hyphae. Cultures of both specimens on Sabouraud's medium recovered a fungus, which was identified by culturing on Czapek's medium as Aspergillus flavus. Despite further antifungal therapy, fatal embolism developed. The emboli contained the same A. flavus as the valve and lung specimens. This case confirms the grim prognosis of primary Aspergillus endocarditis in immunocompromised patients, and suggests that delayed surgical treatment and the presence of another focus of Aspergillus infection may increase the risk of death.
Asunto(s)
Aspergilosis , Aspergillus flavus , Endocarditis/microbiología , Absceso Pulmonar/microbiología , Válvula Mitral , Adolescente , Aspergilosis/diagnóstico , Aspergilosis/cirugía , Endocarditis/complicaciones , Endocarditis/diagnóstico , Endocarditis/cirugía , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/microbiología , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Absceso Pulmonar/complicaciones , Absceso Pulmonar/diagnóstico , Masculino , Válvula Mitral/cirugía , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológicoRESUMEN
OBJECTIVES: The objective of this study was to determine whether a small-size valve prosthesis contributes to exercise intolerance, as assessed by VO2 measurement during an exhaustive cycle ergometer exercise. BACKGROUND: The determinants of exercise capacity after mechanical aortic replacement are not well known. The selection of small valve sizes has, however, been described as an independent predictor of exercise intolerance as assessed by exercise duration. Maximal oxygen uptake (VO2max) is a good index of exercise tolerance. METHODS: Fourteen patients were eligible, with a mean age of 62 +/- 6 years. Before surgery, the mean left ventricular ejection fraction (LVEF) was 73 +/- 8%. Two valve types with small diameter (19 to 21 mm) were used: Medtronic Hall and St Jude Medical. A healthy sedentary control group (n = 14) paired for age, weight and size was constituted. After one year of follow-up, cardiorespiratory tests were performed. In addition, the gradients through the prostheses were determined by continuous pulse Doppler at rest and immediately after the cardiorespiratory test. RESULTS The exercise tolerance was not significantly different between the control group and patient group: VO2 peak (21.7 vs. 20.4 ml/kg/min; p = 0.42), workloads (115 vs. 93 W; p = 0.13) and ventilatory parameters were similar. The mean and peak gradients at rest and during exercise were not correlated with VO2max. CONCLUSIONS: Valve replacement by small aortic prosthesis does not seem to be a factor of exercise intolerance as assessed by VO2max in patients without LVEF dysfunction before surgery.
Asunto(s)
Válvula Aórtica/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Resistencia Física , Anciano , Antropometría , Ecocardiografía Doppler , Diseño de Equipo , Prueba de Esfuerzo , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , EspirometríaRESUMEN
Deep hypothermia was proposed to prevent neuronal ischemia and stroke during surgical procedures on arteries that supply the brain, especially with extended occlusive lesions on both internal carotid arteries. The interest of this therapeutic option is still under discussion, even in the case of combined cardiac and cerebrovascular surgery. We report the case of a 53-year-old male who was admitted to our institution for symptomatic vertebrobasilar insufficiency. Angiography showed a thrombosis of both internal carotid arteries, stenosis of both external carotid arteries, and a tight proximal stenosis of a dominant right vertebral artery. Endarterectomy and angioplasty of the origin of the right external carotid artery was done first to increase the blood supply to the brain via collateral arteries connecting the extra- and intracranial networks. Six weeks after this, a right-sided vertebral-to-carotid artery anastomosis was performed during cardiopulmonary bypass (CPB)-induced deep hypothermia for optimal neuronal protection, with good results. However, early thrombosis of the right vertebral artery requiring reintervention in normothermia, without any stroke, indicate that deep hypothermia was unnecessary in this case, probably because of the previous natural and surgical development of collateral circulation. However, there was no means of predicting this in a reliable manner before the procedure and deep hypothermia appeared a safe technique for neuronal protection without any specific postoperative complications.
Asunto(s)
Arteriopatías Oclusivas/cirugía , Puente Cardiopulmonar , Arteria Carótida Externa/cirugía , Hipotermia Inducida , Arteria Vertebral/cirugía , Insuficiencia Vertebrobasilar/cirugía , Anastomosis Quirúrgica/métodos , Angiografía , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/diagnóstico , Arteria Carótida Externa/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Ultrasonografía Doppler , Arteria Vertebral/diagnóstico por imagen , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/etiologíaRESUMEN
We report two cases of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), revealed by malignant ventricular arrhythmias in adult patients. A two coronary system was re-established in both patients, and cryotherapy was performed on one of the patients who, in addition, presented ventricular aneurysm triggering ventricular tachycardia.
Asunto(s)
Arritmias Cardíacas/etiología , Anomalías de los Vasos Coronarios/complicaciones , Arteria Pulmonar/anomalías , Adulto , Procedimientos Quirúrgicos Cardíacos , Anomalías de los Vasos Coronarios/cirugía , Crioterapia , Femenino , Humanos , Persona de Mediana Edad , Taquicardia Ventricular/terapiaRESUMEN
BACKGROUND: Allograft coronary artery disease (CAD) is a major long-term complication in heart transplant recipients. Unfortunately, methods for early estimation of the likelihood of development of the disease are not currently available. Lactate dehydrogenase (LDH) is composed of heart and muscle subunits. The prevalence of these subunits in LDH isoenzymes (LDH1 through LDH5) is an accurate indicator of myocardial metabolism and allows indirect estimation of oxygen availability to cardiocytes. This study investigated the prognostic value of myocardial LDH composition for the occurrence of morbid events in patients with severe allograft CAD. METHODS: Eighty-eight heart transplant recipients were followed up for a median of 4.3 years. The isoenzymes of LDH and the ratio of the heart and muscle subunits (H/M) were determined in 526 endomyocardial biopsy samples. RESULTS: Eleven patients (12%) died from allograft CAD during follow-up. They had significantly lower H/M ratios compared with event-free patients, with clear differences as early as 6 months after operation. A threshold value of 2.75 was derived from receiver operating characteristic curve analysis. Patients showing H/M values < or =2.75 had a significantly higher mortality rate than did those with higher values (p=.0003). Importantly, the H/M ratio emerged as the most powerful independent prognostic factor of death by allograft CAD (p=.001) in a multivariate model. CONCLUSIONS: Poor myocardial aerobic metabolism estimated through low H/M values was highly predictive of cardiac death resulting from severe allograft CAD. Analysis of LDH isoenzyme profile in routine endomyocardial biopsies might be of clinical value.
Asunto(s)
Rechazo de Injerto/diagnóstico , Trasplante de Corazón/patología , L-Lactato Deshidrogenasa/análisis , Adolescente , Adulto , Anciano , Biopsia , Endocardio/enzimología , Endocardio/patología , Femenino , Rechazo de Injerto/enzimología , Rechazo de Injerto/patología , Humanos , Isoenzimas , Masculino , Persona de Mediana Edad , Daño por Reperfusión Miocárdica/diagnóstico , Daño por Reperfusión Miocárdica/enzimología , Daño por Reperfusión Miocárdica/patología , Miocardio/enzimología , Miocardio/patología , Pronóstico , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Severe accidental hypothermia with central temperature below 28 degrees C can result from prolonged cold exposure and lead to a fatal outcome by spontaneous or provoked ventricular fibrillation. CASE REPORT: Three patients were referred for central temperature below 24 degrees C. At admission, the patients had major ventricular rythm disorders (two were in a state of circulatory arrest and the third had auricular fibrillation and circulatory collapse). Emergency care associated internal warning using extracorporeal circulation via the femoro-femoral route with a centrifuge pump. Outcome was favorable in 2 cases. DISCUSSION: Prognosis is very poor in patients who experience severe accidental hypothermia (< 28 degrees C) with circulatory collapse. Death often results from major rhythm disorders. Optimal emergency rewarming and oxygenation using extracorporeal circulatory assistance can be successful.
Asunto(s)
Circulación Extracorporea , Hipotermia/etiología , Adulto , Anciano , Urgencias Médicas , Femenino , Humanos , Hipotermia/terapia , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVE: Map-guided procedures have been the accepted standard for ventricular tachycardia surgery. However, promising results of visually guided resections without mapping have been reported. The goal of this study was to evaluate the efficacy of large encircling cryoablation without mapping for ventricular tachycardia after anterior myocardial infarction. METHODS: Between 1985 and 1996, this procedure, along with aneurysmectomy, was performed on 38 patients for malignant ventricular tachycardia. The mean interval between the operation and myocardial infarction was 59.2 months; 7 patients (18.4%) were operated on within 1 month of myocardial infarction. The mean patient age was 62.1 +/-7.3 years and the mean left ventricular ejection fraction was 29.0% +/-7.2%. RESULTS: Hospital mortality was 2.6% (1 patient). The electrical success rate based on postoperative electrophysiologic studies was 94.5%. Overall electrical success rate was 89.1%. Freedom from ventricular tachycardia was 77% (95% CI 61%-94%) at both 5 and 7 years. Freedom from sudden cardiac death was 91% (95% CI 80%-100%) at both 5 and 7 years, with overall actuarial survivals at 5 and 7 years of 63% (95% CI 47%-80%) and 42% (95% CI 22%-63%), respectively. The main cause of late death was congestive heart failure in 62.6% of these patients. CONCLUSIONS: One can achieve good results without intraoperative mapping in the treatment of patients with ventricular tachycardia after anterior myocardial infarction by using large encircling cryoablation.
Asunto(s)
Criocirugía , Electrocardiografía , Infarto del Miocardio/cirugía , Taquicardia Ventricular/cirugía , Análisis Actuarial , Adulto , Anciano , Causas de Muerte , Muerte Súbita Cardíaca/epidemiología , Femenino , Estudios de Seguimiento , Aneurisma Cardíaco/mortalidad , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/cirugía , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/fisiopatología , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Factores de Riesgo , Volumen Sistólico/fisiología , Tasa de Supervivencia , Taquicardia Ventricular/mortalidad , Taquicardia Ventricular/fisiopatología , Resultado del Tratamiento , Función Ventricular Izquierda/fisiologíaRESUMEN
The aim of this study was to assess the perioperative mortality and long-term outcome of Type I dissection of the aorta operated in patients over 70 years age. Of the 87 dissections of the aorta operated between 1988 and 1995, 19 concerned patients aged 71 to 79 (average 74.1 +/- 2.4 years). The procedure was replacement of the ascending aorta with gluing of the false lumen in call ases. Two patients also underwent aortic valve replacement and three also had replacement or repair of the aortic arch. Eleven patients (56%) had circulatory arrests lasting an average of 33 minutes (10-86 minutes). The mortality rate at 30 days was 31.5% (6/19): 3 deaths were due to bleeding, 1 to mesenteric infarction, 1 to cardiac arrhythmia and 1 to a cerebrovascular accident. The morbidity was 53%, mainly due to neurological complications, chest infection and renal failure. After an average period of 36.8 months (range: 3 to 75 months) with no patient lost to follow-up, the late mortality was 23% (3/13), giving actuarial survival rates at 1.5 and 6 years of 63%, 47.5% and 32%, respectively (including the operative mortality). Or the survivors, 9 were in NYHA Classes I-II and 1 in class III. One patient developed a hemiparesis. The authors conclude that, despite high mortality and morbidity at 30 days, long-term survival and its quality are arguments in favour of surgical management, even in elderly patients.
Asunto(s)
Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Factores de Edad , Anciano , Humanos , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND AND AIM OF THE STUDY: A multicenter study was designed to evaluate the Pericarbon pericardial bioprosthesis for up 10 years after implantation in the aortic position. METHODS: Between January 1986 and November 1996, 321 patients (mean age 75.8 +/- 7.3 years) received 325 Pericarbon pericardial valves in the aortic position. Four patients underwent redo surgery and each received a second Pericarbon prosthesis. Associated cardiac procedures in 80 patients were mainly coronary bypass (n = 66). Follow up extended up to 10 years (cumulative follow up of 931.0 patient-years; mean follow up 3.1 +/- 2.2 years). RESULTS: There were 19 late deaths, with seven valve-related. Twelve patients suffered an embolic complication (transient cerebral attack in four, peripheral in six and induction of a myocardial infarction in two). Of these complications, five occurred within 30 days of surgery and seven beyond the first year. Ten patients were reoperated on, six for primary tissue failure, two for prosthetic endocarditis and two for paraprosthetic leak. Primary failure was due in all cases to leaflet mineralization. No primary tear of the leaflet was reported. Actuarial freedom after 10 years from primary tissue failure was 83.9 +/- 7.4% and from major embolic events 97.6 +/- 1.0%. Freedom from valve-related mortality at 10 years was 92.1 +/- 4.9%. CONCLUSIONS: These results indicate that, over a period of up to 10 years, the Pericarbon pericardial bioprosthesis compares favorably with other replacement valves.
Asunto(s)
Bioprótesis , Prótesis Valvulares Cardíacas , Anciano , Válvula Aórtica , Bioprótesis/efectos adversos , Bioprótesis/estadística & datos numéricos , Puente de Arteria Coronaria , Ecocardiografía , Estudios de Seguimiento , Prótesis Valvulares Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/estadística & datos numéricos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Diseño de Prótesis , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
This report describes a case involving mycotic aneurysm of the extracranial internal carotid artery occurring as a complication of staphylococcal endocarditis in a patient with systemic lupus erythematosus. Three main points are emphasized: (1) this complication occurred in an immunodepressed patient; (2) surgical treatment consisted of aneurysmorraphy using absorbable suture; (3) the outcome was successful with a follow-up of 24 months.