RESUMEN
BACKGROUND: We aimed to give an overview of the contemporary status of aortic valve replacement. MATERIALS AND METHODS: This single-center prospective study was initiated in January 2003. From this date on, every patient with aortic valve disease admitted to our hospital was reviewed by a cardiologist and a surgeon to determine eligibility for replacement. In no instance was the operation denied in the absence of surgical consultation. All operations were performed using a median sternotomy, with cardiopulmonary bypass and cardioplegic arrest. RESULTS: A total of 873 cases were screened until the end of the study. We identified three groups of patients: Group 1 (inoperable cases) consisted of 15 patients (1 %); Group 2 (high-risk cases) included 99 patients with an additive EuroSCORE ≥ 10 or an expected mortality > 20 % (logistic model); Group 3 (moderate- to low-risk cases) consisted of 759 patients with an additive EuroSCORE < 10 or an expected mortality < 20 %. In-hospital mortality was 6.0 % (6/99) for Group 2 and 0.3 % (3/759) for Group 3. Major complications occurred in 5 patients of Group 2 (5 %) and in 9 patients of Group 3 (1.1 %). At predischarge echocardiography, 99.3 % of the implanted valves were perfect. At a follow-up of 28.9 ± 12.3 months 798/849 patients were alive; 89 % of them (711) were in NYHA 1-2. CONCLUSIONS: Surgical aortic valve replacement provides excellent results and has a low operative mortality even in high-risk patients. Surgical consultation for every aortic patient resulted in an extremely low rate of surgery refusals. Our data should be regarded as a benchmark for transcatheter techniques.
Asunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Puente Cardiopulmonar , Distribución de Chi-Cuadrado , Femenino , Paro Cardíaco Inducido , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Mortalidad Hospitalaria , Humanos , Italia , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Esternotomía , Factores de Tiempo , Resultado del Tratamiento , UltrasonografíaRESUMEN
OBJECTIVE: To test the hypothesis that impaired coronary and myocardial blood flow are linked with increased myocyte apoptosis, thus establishing a link between pressure overload and left ventricular (LV) remodelling. METHODS AND RESULTS: Peak diastolic coronary blood flow velocity (CBFV) was evaluated at transthoracic Doppler echocardiography, and signal intensity (SI) and the rate of SI rise (beta) were measured at myocardial contrast echocardiography in 11 patients with severe aortic stenosis and LV hypertrophy. In the same patients, biopsies were obtained from the anterolateral LV free wall during surgery and analysed for cardiomyocyte apoptosis. LV mass corrected CBFV (CBFVI) was significantly lower in patients than in controls (median 0.100 cm.g/s (interquartile range 0.07-0.115) v 0.130 cm.g/s (0.130-0.160), p = 0.002). Similarly, SI*beta was significantly lower in patients than in controls (11 1/s (8-66) v 83 1/s (73-95), p = 0.001). Apoptotic rate was increased in aortic stenosis more than 100-fold versus controls (1.2% (0.8-1.4) v 0.01% (0.01-0.01), p < 0.001) and inversely correlated with lower CBFVI and SI*beta (r = -0.77, p = 0.001 for both). CONCLUSIONS: Patients with severe aortic stenosis and LV hypertrophy have impaired myocardial perfusion, which is associated with enhanced cardiomyocyte apoptosis. Impaired myocardial perfusion and the ensuing oxygen demand-supply imbalance may, at least partially, be responsible for increased apoptosis and possible transition to heart failure, thus establishing a link between pressure overload, LV remodelling, and heart failure.
Asunto(s)
Estenosis de la Válvula Aórtica/fisiopatología , Apoptosis/fisiología , Circulación Coronaria/fisiología , Anciano , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/patología , Velocidad del Flujo Sanguíneo/fisiología , Ecocardiografía/métodos , Ecocardiografía Doppler/métodos , Femenino , Humanos , Masculino , Microcirculación/fisiología , Miocitos Cardíacos/patologíaRESUMEN
Thoraco-abdominal blunt trauma can lead to multiple injuries of several organs. We report a case of a patient in whom, 10 years after a trauma, a chest X-ray showed visceral herniation into the left thorax. Angio computed tomographic scan (CTS) and magnetic resonance imaging (MRI) confirmed these lesions and also showed a saccular thoracic aortic aneurysm. During the surgical procedure a giant post-traumatic emphysema bulla of the left lower pulmonary lobe was discovered and repaired. In the presence of diaphragmatic injuries, CTS and MRI are mandatory for excluding other organ involvement, and during the surgical procedure, careful inspection of left thorax and abdomen should always be done to repair other possible injuries not seen before.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Hernia Diafragmática/cirugía , Traumatismo Múltiple/cirugía , Enfisema Pulmonar/cirugía , Accidentes de Tránsito , Adulto , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Enfermedad Crónica , Hernia Diafragmática/complicaciones , Humanos , Masculino , Enfisema Pulmonar/complicaciones , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
141 patients who had a hysteroscopic septum resection of a partial uterine septum (class Vb, American Society for Reproductive Medicine, ASRM) were divided into two groups: Group I (69 patients) presented with infertility and Group II (72 patients) with recurrent abortion. The mean+/-SD post-operative follow up period was 36+/-19.5 months. Thiry-six Group I patients (52.1%) and 38 Group II patients (52.7%) achieved pregnancy, with respective abortion rates of 20% and 25%.
Asunto(s)
Aborto Habitual/cirugía , Histeroscopía/métodos , Infertilidad Femenina/cirugía , Enfermedades Uterinas/cirugía , Adulto , Femenino , Humanos , Embarazo , Resultado del Embarazo , Resultado del TratamientoRESUMEN
Interleukin (IL)-6 plasma levels are predictive of major cardiovascular events. The -174 G/C promoter polymorphism of the IL-6 gene affects basal levels in vivo and transcription rates in vitro, but its association with IL-6 acute phase levels among patients with coronary artery disease has not been investigated. In 111 patients with multivessel coronary artery disease undergoing elective coronary artery bypass graft surgery, we prospectively assessed genotype at position -174 and serial blood levels of IL-6 and other inflammatory indexes. Clinical and surgical characteristics did not differ among genotypic groups. IL-6 levels--measured daily up to 72 hours before surgery, after surgery, and at discharge--showed a mean 17-fold increase, peaking at 24 hours (p <0.0001). IL-6 levels (but not fibrinogen, white-blood cell count, and C-reactive protein values) differed significantly according to the -174 genotype (p = 0.042 for difference between areas under the curve), the 62 GG homozygotes exhibiting higher concentrations than the 49 carriers of the C allele (widest difference at 48 hours, p = 0.015 in multivariate analysis). GG homozygosity was associated with longer stays in the intensive care unit (2.5 +/- 3.4 vs 1.4 +/- 0.9 days, p = 0.02) and in the hospital (6.7 +/- 4.0 vs 5.3 +/- 1.4 days, p = 0.02) than C carriership. Rates of postoperative death, myocardial infarction, and stroke were 8% in GG homozygotes and 2% in C-carriers (p = 0.16). The IL-6-174 GG genotype is associated with higher acute phase levels of IL-6 and with longer stays in the hospital and in the intensive care unit than C allele carriership after surgical coronary revascularization.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria/terapia , Interleucina-6/genética , Polimorfismo Genético , Proteína C-Reactiva/metabolismo , Femenino , Genotipo , Humanos , Interleucina-6/sangre , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVES: The goal of this study was to assess the presence of systemic inflammation in degenerative aortic valvular stenosis. BACKGROUND: Local inflammatory changes, resembling those observed in atherosclerosis, have been recently reported in degenerative aortic valvular stenosis. It is presently unknown whether systemic signs of inflammation, similar to those observed in atherosclerosis, may be present in this disorder. METHODS: C-reactive protein (CRP) was measured by enzyme immunoassay in 141 subjects: 62 with trileaflet degenerative valvular aortic stenosis and 79 volunteers with similar demographic and clinical characteristics. IgG antibodies against Helicobacter pylori (enzyme-linked immunosorbant assay) and Chlamydia pneumoniae (microimmunofluorescence assay) were also measured. RESULTS: C-reactive protein levels (mg/dl, mean +/- SD) were 0.848 +/- 1.42 in patients and 0.394 +/- 0.50 in controls (p = 0.0001, Mann-Whitney U test). Seroprevalence of H. pylori was 68.7% in patients and 79.7% in controls (p = NS), whereas seroprevalence of C. pneumoniae infection was higher in patients than it was in controls (59.7% vs. 33%, p = 0.003; chi-square test). After adjustment for various covariates in multiple logistic regression, the odds ratio for degenerative aortic stenosis was 3.41 for C. pneumoniae infection (95% confidence intervals [CI]: 1.60 to 7.30) and 2.76 for CRP (95% CI: 1.08 to 7.05). There was no significant difference in patients or controls in CRP levels according to the serostatus for C. pneumoniae. CONCLUSIONS: Systemic signs of inflammation, similar to those found in atherosclerosis, are present in patients with degenerative aortic valve stenosis. They do not seem to be linked to C. pneumoniae or H. pylori infection.
Asunto(s)
Estenosis de la Válvula Aórtica/sangre , Proteína C-Reactiva/análisis , Anciano , Estenosis de la Válvula Aórtica/fisiopatología , Chlamydophila pneumoniae/inmunología , Femenino , Helicobacter pylori/inmunología , Humanos , Técnicas para Inmunoenzimas , Modelos Logísticos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: This study was conceived to elucidate the clinical and angiographic effects of chronic calcium channel blocker therapy (CCCBT) continued after the first postoperative year in patients in whom the radial artery (RA) was used for myocardial revascularization. METHODS AND RESULTS: Patients who received RA grafts at our institution and who at 1 year had no scintigraphic evidence of ischemia in the RA territory or angiographic evidence of RA malfunction (n=120) were randomly assigned to continue (n=63) or suspend (n=57) the CCCBT with diltiazem (120 mg/d). After 5 years, all patients were reassessed clinically and by stress myocardial scintigraphy, and 87 of them (45 from the continued group that continued CCCBT and 42 from the group that suspended CCCBT) were restudied angiographically. No differences regarding either the clinical and scintigraphic results or the RA angiographic status were demonstrated between the 2 groups. CONCLUSIONS: After the first postoperative year, the continuation of CCCBT does not affect RA graft patency or clinical and scintigraphic results.
Asunto(s)
Bloqueadores de los Canales de Calcio/administración & dosificación , Puente de Arteria Coronaria , Enfermedad Coronaria/tratamiento farmacológico , Diltiazem/administración & dosificación , Arteria Radial/trasplante , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/cirugía , Vasoespasmo Coronario/prevención & control , Esquema de Medicación , Femenino , Corazón/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Arteria Radial/diagnóstico por imagen , Arteria Radial/efectos de los fármacos , Cintigrafía , Serotonina/farmacología , Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular/efectos de los fármacosRESUMEN
Intra-abdominal hemorrhage occurring while on cardio-pulmonary bypass (CPB) is a rare and potentially lethal event during coronary artery bypass procedures. We herein report an unusual case in which massive intra-abdominal bleeding during CPB originated from a previously undiagnosed ovarian tumor, leading to acute anemization and hemodynamic instability and requiring emergency gynecologic surgery.
Asunto(s)
Puente Cardiopulmonar , Hemorragia Gastrointestinal/etiología , Complicaciones Intraoperatorias/etiología , Neoplasias Ováricas/complicaciones , Anciano , Enfermedad Coronaria/cirugía , Femenino , Hemorragia Gastrointestinal/terapia , Humanos , Complicaciones Intraoperatorias/terapia , Neoplasias Ováricas/cirugíaRESUMEN
A 57-year-old patient underwent prosthetic replacement of a previously implanted ascending aorta graft and developed a periprosthetic purulent collection 1 month later. He was successfully treated by debridement of infected tissues, antiseptic irrigation and transposition of an omental flap. The postoperative course was uneventful. A chest computed tomography scan performed 15 months later showed no signs of perigraft infection. Prompt conservative surgical treatment including omental transposition can be effective in the treatment of mediastinitis following graft replacement of the ascending aorta.
Asunto(s)
Implantación de Prótesis Vascular/efectos adversos , Mediastinitis/etiología , Epiplón/trasplante , Disección Aórtica/cirugía , Aneurisma de la Aorta/cirugía , Desbridamiento , Humanos , Masculino , Mediastinitis/diagnóstico por imagen , Persona de Mediana Edad , Irrigación Terapéutica , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The optimal treatment of severe monolateral asymptomatic carotid artery stenosis (SMACS) in patients undergoing coronary artery bypass grafting (CABG) is still controversial. MATERIALS AND METHODS: This study is based on the in-hospital and mid-term (>5 years) clinical results of a cohort of 139 consecutive CABG patients with SMACS operated at our Institution between January 1989 and December 1995. In the first 73 patients (no carotid surgery group), the SMACS was left untouched at the time of coronary surgery, whereas in the remaining 66 (carotid endoarterectomy group), the carotid stenosis was treated either immediately before or concomitantly with the CABG procedure (depending on the severity of the anginal symptoms). RESULTS: The overall preoperative characteristics of the patients were comparable. The in-hospital results were similar between the two groups with regard to mortality, stroke and major postoperative complications. However, at mid-term follow-up, significantly more patients of the no carotid surgery group suffered cerebral events (transient or permanent) ipsilateral to the SMACS or the lesion had to be operated on. CONCLUSIONS: The concomitant treatment (either staged or simultaneous) of SMACS at the time of CABG does not influence the in-hospital results, but confers significant neurological protection during the years after the operation.
Asunto(s)
Estenosis Carotídea/complicaciones , Estenosis Carotídea/cirugía , Puente de Arteria Coronaria , Enfermedad Coronaria/complicaciones , Endarterectomía Carotidea , Anciano , Enfermedad Coronaria/cirugía , Femenino , Humanos , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/prevención & control , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & controlAsunto(s)
Puente de Arteria Coronaria/métodos , Arteria Radial/trasplante , Angiografía Coronaria , Puente de Arteria Coronaria/efectos adversos , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/cirugía , Humanos , Arteria Radial/anatomía & histología , Arteria Radial/diagnóstico por imagen , Arteria Radial/fisiología , Grado de Desobstrucción Vascular , VasodilataciónRESUMEN
BACKGROUND: The unclampable ascending aorta (UAA) is a condition increasingly encountered during CABG procedures. We report our experience with CABG patients with UAA and place particular emphasis on the preoperative diagnosis and surgical management. METHODS AND RESULTS: UAA was diagnosed in 211 of 4812 consecutive CABG patients (4.3%). On the basis of the chest radiograph, echocardiogram, and coronary angiograph, a preoperative diagnosis was achieved in only 58 patients (27.4%). An age of >70 years, diabetes, smoking, unstable angina, diffuse coronaropathy, and peripheral vasculopathy were all predictors of UAA. Patients were treated with hypothermic ventricular fibrillation (no-touch technique n=129) or beating heart revascularization (no-pump technique n=82) depending on the possibility of founding an arterial cannulation site. The overall in-hospital mortality rate was 2.8% (6 of 211) with no differences between the 2 surgical strategies. The no-touch technique was associated with a greater incidence of neurological complications (stroke and transient ischemic attack), renal insufficiency, and stay in the intensive care unit and hospital. However, at midterm follow-up, more patients of the no-pump group had ischemia recurrence. CONCLUSIONS: A preoperative diagnosis of UAA is achievable only in a minority of patients, which highlights the necessity revising the current diagnostic protocols. The use of the no-touch technique is associated with an high perioperative risk but a superior possibility of complete revascularization, whereas adoption of the no-pump strategy ensures a smoother postoperative course at the expense of an higher incidence of ischemia recurrence.
Asunto(s)
Aorta/cirugía , Enfermedades Cardiovasculares/cirugía , Puente de Arteria Coronaria , Anciano , Enfermedades Cardiovasculares/mortalidad , Puente de Arteria Coronaria/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: The purpose of this study was to elucidate the midterm endothelium-dependent vasodilatory capacity of radial artery grafts anastomosed to the aorta, as well as their morphometric evolution with the time. METHODS: Five years after surgery we evaluated the response of aorta-anastomosed radial artery grafts to the endovascular infusion of acetylcholine in 11 of the first 61 patients operated on at our institution, and we compared it to the response with that of internal thoracic artery grafts. Moreover, the first 20 patients who had a perfect radial artery graft on angiography at 1 year were restudied at 5 years and subjected to a comparative analysis of the diameters of the radial artery graft and the grafted coronary arteries. RESULTS: At midterm angiography, dilation of the 2 types of grafts was similar in response to acetylcholine administration (radial artery, from 2.61 +/- 0.39 to 2. 90 +/- 0.34 mm; internal thoracic artery, from 2.68 +/- 0.21 to 2.93 +/- 0.27 mm; P =.01 for both). The diameters of aorta-anastomosed radial artery grafts and grafted coronary arteries increased between both 1 and 5 years according to angiographic studies (radial artery grafts, from 2.08 +/- 0.45 to 2.54 +/- 0.53 mm; grafted coronary arteries, from 1.92 +/- 0.47 to 2.18 +/- 0.41 mm; P <.001 for both), but the increase was greater for the radial artery grafts (P <.001). CONCLUSIONS: Aorta-anastomosed radial artery grafts maintain an appreciable capacity for endothelium-dependent vasodilatation 5 years after implantation and undergo a progressive increase in luminal diameter with time. These observations contradict the presumed tendency for progressive fibrous intimal hyperplasia to develop in radial artery grafts.
Asunto(s)
Anastomosis Quirúrgica , Aorta/cirugía , Puente de Arteria Coronaria , Endotelio Vascular/fisiología , Arteria Radial/trasplante , Acetilcolina/administración & dosificación , Análisis de Varianza , Aorta/efectos de los fármacos , Angiografía Coronaria , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Arteria Radial/efectos de los fármacos , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Vasodilatadores/administración & dosificaciónRESUMEN
OBJECTIVES: We sought to investigate the effect of topical application of tranexamic acid into the pericardial cavity in reducing postoperative blood loss in coronary artery surgery. METHODS: A prospective, randomized, double-blind investigation with parallel groups was performed. Forty consecutive patients undergoing primary coronary surgery were randomly assigned to group 1 (tranexamic acid group) or group 2 (placebo group). Tranexamic acid (1 g in 100 mL of saline solution) or placebo was poured into the pericardial cavity and over the mediastinal tissues before sternal closure. The drainage of mediastinal blood was measured hourly. RESULTS: Chest tube drainage in the first 24 hours was 485 +/- 166 mL in the tranexamic acid group and 641 +/- 184 mL in the placebo group (P =.01). Total postoperative blood loss was 573 +/- 164 mL and 739 +/- 228 mL, respectively (P =.01). The use of banked donor blood products was not significantly different between the two groups. Tranexamic acid could not be detected in any of the blood samples blindly collected from 24 patients to verify whether any systemic absorption of the drug occurred. There were no deaths in either group. None of the patients required reoperation for bleeding. CONCLUSIONS: Topical application of tranexamic acid into the pericardial cavity after cardiopulmonary bypass in patients undergoing primary coronary bypass operations significantly reduces postoperative bleeding. Further studies must be carried out to clarify whether a more pronounced effect on both bleeding and blood products requirement might be seen in procedures with a higher risk of bleeding.
Asunto(s)
Antifibrinolíticos/administración & dosificación , Pérdida de Sangre Quirúrgica/prevención & control , Puente de Arteria Coronaria/efectos adversos , Ácido Tranexámico/administración & dosificación , Administración Tópica , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
The authors found an increase of endothelin-1 (ET-1) plasma levels in patients with pseudoexfoliatio syndrome (PXS): 2.730 +/- 0.224 pg/ml vs 1.420 +/- 0.30S pg/ml. With Color Doppler Imaging (CDI) they found in PXS patients a decrease of peak systolic velocity values in the posterior ciliary arteries that were 12.725 +/- 2.536 cm/sec vs 15.450 +/- 3.173 cm/sec (p < 0.049) while the resistance values were increased 0.640 +/- 0.051 vs 0.548 +/- 0.058 (p < 0.001). The increase of ET-1 plasma levels may assess the vasospasm and uveal tissue hypoxia.
Asunto(s)
Endotelina-1/sangre , Síndrome de Exfoliación/sangre , Anciano , Velocidad del Flujo Sanguíneo , Arterias Ciliares/diagnóstico por imagen , Arterias Ciliares/fisiopatología , Síndrome de Exfoliación/diagnóstico por imagen , Síndrome de Exfoliación/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Arteria Oftálmica/fisiopatología , Ultrasonografía Doppler en ColorRESUMEN
Five years after surgery the echo-Doppler characteristics of the forearm circulation and the transcutaneous oxygen and carbon dioxide pressures of the operated and control arm were determined at rest and under conditions of hand exercise in 34 patients who received a radial artery graft for myocardial revascularization. Doppler measurements showed the ulnar compensation to radial artery removal, and transcutaneous measurements demonstrated a moderate degree of exercise-induced hand ischemia on the operated site.
Asunto(s)
Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/cirugía , Antebrazo/irrigación sanguínea , Hemodinámica , Arteria Radial/trasplante , Recolección de Tejidos y Órganos , Monitoreo de Gas Sanguíneo Transcutáneo , Circulación Colateral , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Antebrazo/diagnóstico por imagen , Antebrazo/fisiopatología , Humanos , Isquemia/fisiopatología , Isquemia/prevención & control , Estudios Prospectivos , Arteria Radial/diagnóstico por imagen , Arteria Radial/fisiopatología , Ventriculografía con Radionúclidos , Arteria Cubital/diagnóstico por imagen , Arteria Cubital/fisiopatología , Ultrasonografía DopplerRESUMEN
BACKGROUND: This study was conceived to evaluate the effect of internal thoracic artery (ITA) skeletonization on vessel wall integrity. METHODS: Forty consecutive patients undergoing coronary artery bypass were randomized to receive a skeletonized (n = 22) or a pedicled (n = 18) ITA graft. ITA harvesting was performed by 2 experienced surgeons using the same instrumentation and technique. Specimens were examined by light and electron microscope in order to assess vascular wall integrity. A specific immunohistochemical staining and a computerized method were used to quantify the degree of endothelial integrity after surgical preparation. RESULTS: Morphologic analysis revealed 2 cases of limited subadventitial hemorrhage (one for each group) and no case of major arterial damage. Immunohistochemical staining demonstrated an extremely high degree of maintenance of the endothelial integrity in both groups (97.2% +/- 1.9% in the skeletonized and 96.8% +/- 2.1% in the pedicled one; p = 0.53). CONCLUSIONS: Skeletonization does not affect ITA wall integrity in humans submitted to coronary artery bypass procedures.
Asunto(s)
Enfermedad Coronaria/cirugía , Arterias Mamarias/patología , Revascularización Miocárdica/métodos , Anciano , Enfermedad Coronaria/patología , Endotelio Vascular/patología , Femenino , Supervivencia de Injerto/fisiología , Humanos , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Complicaciones Posoperatorias/patologíaRESUMEN
Cardiac rupture represents a fatal complication of acute myocardial infarction within the first two weeks. In exceptional cases, the postinfarction rupture of the myocardium is not transmural but remains circumscribed within the wall itself as a cavity joined to the left ventricle through a narrow neck. This finding is usually defined as pseudo-pseudoaneurysm. We report a rare case of postinfarction posterior pseudo-pseudoaneurysm of the left ventricle, perforated into the right ventricle. This unusual anatomy resulted, over a period of several years, by progressive intramural dissection of the surrounding necrotic myocardium with late formation of a large, partially fibrotic chamber, communicating either with left and right ventricles. Despite correct preoperative diagnosis was not achieved by 2D echocardiography, pulsed Doppler and contrast ventriculography, a successful surgical treatment was possible with a really good outcome.
Asunto(s)
Aneurisma Falso/cirugía , Disección Aórtica/cirugía , Aneurisma Cardíaco/cirugía , Rotura Cardíaca Posinfarto/cirugía , Anciano , Disección Aórtica/diagnóstico , Aneurisma Falso/diagnóstico , Diagnóstico por Imagen , Aneurisma Cardíaco/diagnóstico , Rotura Cardíaca Posinfarto/diagnóstico , Tabiques Cardíacos/patología , Tabiques Cardíacos/cirugía , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Sensibilidad y EspecificidadRESUMEN
We report one case in which chronic native competitive flow from an almost normal target coronary artery did not influence IMA graft patency. This patient underwent control postoperative angiography 11 months after surgery and the mammary artery-left anterior descending graft was found to be normofunctioning despite the fact that the coronary artery showed no residual stenosis.