RESUMEN
A routine pre-operative chest X-ray of a patient admitted to our institution for an elective coronary artery bypass operation revealed a mildly dilated mediastinal silhouette, which led the cardiovascular surgery resident to schedule emergency transthoracic echocardiography (TTE), with a special note asking for detailed evaluation of the ascending aorta and aortic arch. TTE revealed a mobile atheroma at the aortic arch, which obliged the cardiac surgery team to modify their strategy to combined hemi-arcus aortae replacement and coronary artery bypass grafting (CABG). Although with transoesophageal echocardiography (TEE) a small portion of the ascending aorta may be obscured by the trachea, TEE provides higher resolution images than TTE. Therefore one can conclude that TEE is the imaging modality of choice for detecting aortic atheromatous plaques but in patients with low risk for stroke and aortic atheromas, a detailed TTE may be sufficient for the pre-operative assessment.
Asunto(s)
Angina Estable/cirugía , Aorta Torácica/diagnóstico por imagen , Puente de Arteria Coronaria , Ecocardiografía/métodos , Placa Aterosclerótica/diagnóstico por imagen , Anciano , Angina Estable/complicaciones , Diagnóstico Diferencial , Humanos , Masculino , Placa Aterosclerótica/complicaciones , Periodo Preoperatorio , Radiografía TorácicaRESUMEN
Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of myocardial infarction. Although the incidence has decreased to less than 1% after the extensive use of reperfusion strategies, post-infarction VSD still carries a high mortality risk. Management is controversial, whether to wait for surgery after a stabilisation period or to perform emergency surgery when diagnosed. We report on a case of post-infarction VSD that was detected with severe haemodynamic instability, beginning immediately after the patient's Valsalva manoeuvre on the sixth day of a non-reperfused inferior myocardial infarction. In the early period, the post-infarction VSD was repaired via a trans-aneurismal approach.
Asunto(s)
Aneurisma Cardíaco/etiología , Infarto de la Pared Inferior del Miocardio/complicaciones , Maniobra de Valsalva , Rotura Septal Ventricular/etiología , Procedimientos Quirúrgicos Cardíacos , Angiografía Coronaria , Ecocardiografía Doppler en Color , Femenino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/cirugía , Hemodinámica , Humanos , Infarto de la Pared Inferior del Miocardio/diagnóstico , Infarto de la Pared Inferior del Miocardio/fisiopatología , Persona de Mediana Edad , Factores de Riesgo , Resultado del Tratamiento , Rotura Septal Ventricular/diagnóstico , Rotura Septal Ventricular/fisiopatología , Rotura Septal Ventricular/cirugíaRESUMEN
The biatrial approach has been the classic means of access for left atrial myxoma resection. Increased surgical experience led cardiac surgeons to favour the uniatrial approach to reduce incisions and achieve adequate exposure. In this study, two unilateral surgical approaches were compared in 18 consecutive left atrial myxoma cases. Patients were divided into two groups according to the surgical approach: left atriotomy (group 1, n = 9) and right atriotomy trans-septal approach (group 2, n = 9). Comparison criteria included pre- and post-operative functional capacity, cardiac rhythm, left ventricular ejection fraction, pulmonary artery pressure, left atrial dimensions, cardiopulmonary bypass time, aortic cross-clamp time, drainage over 48 h post-operatively, units of blood transfused, extubation time and length of stay in the intensive care unit and hospital. No significant between-group difference was observed in any criteria except aortic cross-clamp time, which was significantly longer in group 2 than in group 1. No recurrence of myxoma occurred in either group for the 15 patients followed up. Right atrial trans-septal incision appears to be as safe and effective as the left atriotomy approach for left atrial myxoma resection.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Mixoma/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
To investigate the relationship between anticoagulation treatment and drug resistance in chest pain, levels of factor Xa residual activity were determined in patients seen in intensive care with recurrent chest pain and compared with levels in patients who had no ischaemic events during hospitalization. A total of 122 patients aged 18 - 75 years who were admitted to hospital with acute coronary syndrome and treated with enoxaparin were included. Of these, 62 patients had recurrent chest pain while hospitalized (group A) and 60 patients had an uneventful follow-up period (group B). Patients requiring primary percutaneous transluminal coronary angioplasty and/or treatment with glycoprotein IIb/IIIa inhibitors, and those with renal failure, a high risk of bleeding or receiving anti-inflammatory drugs were excluded from the study. Median levels (+/- interquartile range) of factor Xa residual activity were significantly higher in group A compared with group B (0.68 +/- 0.29 IU/ml versus 0.34 +/- 0.33 IU/ml). It is concluded that enoxaparin resistance, resulting in high levels of factor Xa residual activity, should be considered in patients with recurrent ischaemia.
Asunto(s)
Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/tratamiento farmacológico , Anticoagulantes/uso terapéutico , Dolor en el Pecho/inducido químicamente , Resistencia a Medicamentos , Enoxaparina/uso terapéutico , Unidades de Cuidados Intensivos , Adolescente , Adulto , Anciano , Angioplastia Coronaria con Balón , Dolor en el Pecho/tratamiento farmacológico , Monitoreo de Drogas , Factor Xa/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Adulto JovenRESUMEN
OBJECTIVES: The objective of this study was to determine the quantitative influence of vitamin K epoxide reductase complex subunit 1 (VKORC1) and cytochrome P450 2C9 (CYP 2C9) polymorphisms on warfarin dose requirements in Turkish patients. METHODS: A total of 205 patients taking warfarin for >2 months were enrolled in the study. Deoxyribonucleic acid (DNA) samples from these patients were genotyped for polymorphisms in VKORC1 and CYP2C9 genes. A linear regression analysis was used to determine the independent effects of genetic and non-genetic factors on mean warfarin dose requirements. RESULTS: The VKORC1 promoter polymorphism (3673 G>A) was associated with differences in weekly mean varfarin dose: for GG genotype the dose was 43.18 mg/week, for GA genotype 33.78 mg/week and for AA genoype 25.83 mg/week (P < 0.0001). Patients who carried VKORC1 and CYP2C9 variants needed a 40% lower mean weekly warfarin dose compared to wild types. Variables associated with lower warfarin dose requirements were VKORC1 3673 AA or GA genotype (both P < 0.0001), one or two CYP2C9 variant alleles (both P < 0.0001), increasing age (P < 0.0001) and non-indication of venous thromboembolism for warfarin therapy (P = 0.002). CONCLUSION: Polymorphisms in VKORC1 and CYP2C9 genes were important determinants of warfarin dose requirements in Turkish patients.
Asunto(s)
Anticoagulantes/administración & dosificación , Hidrocarburo de Aril Hidroxilasas/genética , Oxigenasas de Función Mixta/genética , Polimorfismo Genético , Warfarina/administración & dosificación , Adulto , Anciano , Anticoagulantes/uso terapéutico , Citocromo P-450 CYP2C9 , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Relación Normalizada Internacional , Masculino , Persona de Mediana Edad , Turquía , Vitamina K Epóxido Reductasas , Warfarina/uso terapéuticoRESUMEN
In this study we examined a possible association between a 27 base pair (bp)-repeat polymorphism in intron 4 of the ecNOS gene and myocardial infarction (MI) in a subgroup of the Turkish population. We compared MI and control groups for the frequencies of the ecNOS alleles and their genotypes. The frequency of the ecNOS 4a/a and 4a/b genotypes was found to be significantly higher in the MI group than in the control group. Interestingly, the frequency of the ecNOS 4a/b polymorphism was found to be significantly higher in the selected MI group (patients with no known secondary risk factors) than in the control and non-selected MI group. We found that the patients with MI had the frequency of the a/a genotype 4.3%, of the a/b genotype 26.6% and the b/b genotype 69.1%. The controls, however, showed only 0.6% for a/a, 18.0% for a/b and 81.4% for the b/b genotype (P < 0.001; chi2 = 13.626). In this study, we show that myocardial infarction is associated with one subtype of ecNOS gene polymorphism.
Asunto(s)
Predisposición Genética a la Enfermedad/genética , Infarto del Miocardio/genética , Óxido Nítrico Sintasa/genética , Polimorfismo Genético/genética , Adulto , Femenino , Humanos , Intrones/genética , Isoenzimas/genética , Masculino , Persona de Mediana Edad , Infarto del Miocardio/enzimología , Óxido Nítrico Sintasa de Tipo III , Factores de Riesgo , TurquíaRESUMEN
Gangliosides have previously been considered to be possible antigenic sites in Type 1 diabetes. Lymphocytic infiltration of Langerhans islands is the pathologic hallmark of autoimmune diabetes and may also be observed in salivary glands in experimental diabetes. Diabetic complications of parotid and submaxillary glands may therefore be related with an autoimmune process against sialoglycoconjugates of salivary gland tissue.
Asunto(s)
Diabetes Mellitus Tipo 1/fisiopatología , Gangliósidos/fisiología , Glándulas Salivales/fisiopatología , Diabetes Mellitus Tipo 1/inmunología , Gangliósidos/metabolismo , Humanos , Glándulas Salivales/metabolismoRESUMEN
Left-ventricular hypertrophy (LVH), a bad prognostic sign, is a common finding in hemodialysis patients. The aim of the study was to analyze factors, including angiotensin-converting enzyme (ACE) genotype that may have an effect on the development of LVH in hemodialysis patients. Seventy-nine hemodialysis patients (42 males, 37 females, mean age 37.7 +/- 13.1 years) and 82 age- and sex-matched normotensive healthy controls (40 males, 42 females, mean age 35.6 +/- 5.7 years) were included. Left-ventricular mass index (LVMI) was higher in the hemodialysis group compared to controls (170.1 +/- 69.3 versus 84.9 +/- 15.7 g/m(2), p < 0.001). Fourty-three hypertensive patients in the hemodialysis group had an increased LVMI compared to 36 normotensive hemodialysis patients (194.2 +/- 75.5 versus 141.2 +/- 48.0 g/m(2), p < 0.001). On univariate analysis, LVMI was found to be correlated with blood pressure (r = 0.38, p < 0.001), time spent on dialysis (r = 0.22, p = 0.02) and hemoglobin levels (r = -0.21, p = 0.03). No correlation was found between LVMI and age (r = 0.09, p = 0.22), predialytic creatinine (r = 0.09, p = 0.21) and albumin (r = -0.10, p = 0.18). On multivariate analysis for the predictors of LVMI, blood pressure, time spent on dialysis and hemoglobin levels were also found to be significant. LVMI in DD, ID and II genotypes were 155.0 +/- 71.2, 181.6 +/- 60.6, and 163.6 +/- 83.4 g/m(2), respectively (p > 0.05). No association between LVMI and DD genotype was found. ACE genotype distribution was similar in hemodialysis patients and healthy controls. It was concluded that LVH in hemodialysis patients was mainly related to hypertension, anemia and time spent on dialysis and the DD genotype had no effect on LVMI in hemodialysis patients.