RESUMEN
BACKGROUND: Aortopulmonary fistula is an uncommon but usually fatal condition if not treated surgically. The most frequent cause is erosion of a false aneurysm of the descending thoracic aorta into the left lung. METHODS: Review of charts of all patients who had had resection of a thoracic aortic aneurysm at the MidAmerica Heart Institute (1971 to 1997) revealed three cases in which the presentation was hemoptysis resulting from an aortopulmonary fistula. The clinical features and course of each patient are summarized in this report. RESULTS: The three patients with hemoptysis due to an aortopulmonary fistula had emergency surgical intervention with no major complication. CONCLUSIONS: Any patient who has an otherwise unexplained hemoptysis and a history of a previous thoracic aortic surgical procedure or is known to have a thoracic aortic aneurysm should have appropriate clinical evaluation to exclude the presence of an aortopulmonary fistula. If an aortopulmonary fistula cannot be excluded, emergency operation should be done.
Asunto(s)
Enfermedades de la Aorta/cirugía , Hemoptisis/etiología , Enfermedades Pulmonares/cirugía , Fístula del Sistema Respiratorio/cirugía , Fístula Vascular/cirugía , Anciano , Aneurisma Falso/complicaciones , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/complicaciones , Enfermedades de la Aorta/etiología , Aortografía , Femenino , Humanos , Enfermedades Pulmonares/etiología , Masculino , Fístula del Sistema Respiratorio/etiología , Tomografía Computarizada por Rayos X , Fístula Vascular/etiologíaRESUMEN
BACKGROUND: Single-vessel coronary artery disease is usually treated with PTCA; however, this approach when applied to the left anterior descending coronary artery (LAD) is hampered by high restenosis rates, often approaching 50%. Coronary stenting (STENT) and left internal mammary artery bypass grafting of the LAD (LIMA-LAD) are other options that have been successfully used for single-vessel LAD disease. The optimal mode of revascularization for patients with isolated single-vessel LAD disease is unclear. The purpose of the present study was to examine PTCA versus STENT versus LIMA-LAD with respect to short- and intermediate-term outcomes. METHODS AND RESULTS: This was an observational retrospective cohort study comparing in-hospital and intermediate-term outcomes and functional class among patients with isolated single-vessel LAD disease revascularization. Consecutive eligible patients were grouped according to their initial revascularization procedure and systematically followed up. A total of 704 patients qualified for the study: 469 in the PTCA group, 137 in the STENT group, and 98 in the LIMA-LAD group. Follow-up data were complete for 97% of patients and averaged 27+/-13 months. In-hospital mortality for the PTCA, STENT, and LIMA-LAD groups was 1.1%, 0%, and 0% (P=0.51), respectively. Median hospital stays after the procedure for the respective treatment groups were 1, 1, and 5 days (P<0.001), and occurrences of in-hospital myocardial infarction were 0.9%, 1.5%, and 1.0% (P=NS). Repeat revascularization procedures were performed in 30%, 24%, and 5% of the PTCA, STENT, and LIMA-LAD groups (P=<0. 001 for LIMA-LAD versus other groups, P=0.11 for PTCA versus STENT). Actuarial 2-year mortality was 3.9%, 2.6%, and 1% in the PTCA, STENT, and LIMA-LAD groups (P=0.33). CONCLUSIONS: Revascularization for isolated LAD disease using PTCA, STENT, or LIMA-LAD results in low in-hospital adverse event rates and good long-term results. Repeat procedures are required less often after LIMA-LAD than after either PTCA or STENT. Long-term mortality was not statistically different, but the trend was for the lowest mortality with LIMA-LAD, a somewhat higher mortality with STENT, and the highest mortality with PTCA.
Asunto(s)
Angioplastia Coronaria con Balón , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Enfermedad Coronaria/terapia , Stents , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Arterias Mamarias/cirugía , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
All patients with an abdominal aortic aneurysm treated during a 27-year period by one surgical group at the MidAmerica Heart Institute were included in this study. A prospective routine postaneurysmectomy hemodynamic assessment of the inferior mesenteric artery (IMA) circulation was performed in a test group of consecutive patients operated on by one surgeon. When a mean IMA stump pressure
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Arteria Mesentérica Inferior/fisiopatología , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Rotura de la Aorta/cirugía , Presión Sanguínea/fisiología , Causas de Muerte , Colitis Isquémica/diagnóstico , Colitis Isquémica/etiología , Colitis Isquémica/patología , Colonoscopía , Femenino , Hemodinámica/fisiología , Humanos , Incidencia , Laparoscopía , Masculino , Arteria Mesentérica Inferior/cirugía , Complicaciones Posoperatorias , Estudios Prospectivos , Flujo Sanguíneo Regional/fisiología , Reimplantación , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Advances in immunosuppression and reports of improved survival after cardiac transplantation have led to a liberalization of traditional recipient eligibility criteria, especially age. While age alone is not a contraindication to transplantation, conflicting data exists regarding long-term survival of the older transplant recipient. METHODS: One hundred-fifty three patients undergoing consecutive first time cardiac transplantation from June 7, 1985 through February 1, 1997 were studied. For purposes of analysis, patients were stratified according to age (<55 years vs. >55 years) and hospital and late outcomes determined. RESULTS: The incidence of early and late acute cellular rejection was not different based up on age. The freedom from infection at 12 months was 54+/-5% for patients < or =55 compared to 32+/-8% for patients >55 years old (p = .04). Five year estimated survival for patients >55 years old was only 56+/-9% compared to 78+/-5% for patients < or =55 years old (p = .005). The hazard for death was highest within the first post-transplant year for older patients and was most commonly due to infection. Both advanced age and pre-transplant diagnosis of ischemic cardiomyopathy were found to be independently and additively predictive of reduced late survival. CONCLUSIONS: In the present study, late survival was adversely influenced by advanced age. Older patients (>55 years) with pre-transplant diagnosis of ischemic cardiomyopathy were particularly at high risk (risk ratio 4.6:1) for death. Given little prospect of expanding the number of donor hearts, careful selection of patients over the age of 55 with pre-transplant ischemic cardiomyopathy is warranted.