RESUMEN

AIM: To report the results of long-term (>5 years) computed tomography (CT) angiography follow-up after thoracic endovascular aortic repair in patients with traumatic thoracic aortic injury. MATERIALS AND METHODS: All follow-up CT angiographies performed in patients with traumatic thoracic aorta injury treated by endovascular stent-graft between 2002 and 2008 were reviewed. Of the 14 patients treated, seven patients had CT angiography follow-up examinations for more than 5 years. All patients were men with a mean age of 26 years. The Talent device was used in four patients and Gore TAG device in three patients. The mean device diameter and length were 24.6 mm and 103 mm, respectively. Follow-up included annual outpatient clinic surveillance and CT angiography examinations, which were reviewed for any device-related complications. The radiation effective dose was calculated from the CT dose report. RESULTS: Thirty-three CT examinations performed 64-110 months (mean 76) after stent-graft implementation were reviewed. The mean follow-up number of examinations per patient was 4.7 (range 2-8). Intra-graft circular mural tissue at the distal part of the stent-graft was seen in one patient. Stable lack of proximal device apposition was seen in all patients. No other radiological complications (e.g., aortic infection, dilatation, aneurysm or pseudoaneurysm, device struts breakage, migration, collapse, endoleak) were detected. None of the patients developed hypertension. The average effective dose was 77.01 mSv (range 34.11-128.84 mSv). CONCLUSION: CT angiography did not reveal any complications developing throughout the long-term follow-up. These results suggest that long-term CT angiography follow-up may not be required.

Asunto(s)

RESUMEN

The high prevalence of end-stage heart failure and its influence on the quality of life, force the medical community to seek effective therapeutic modalities. Heart transplantation is the accepted therapy for such patients, nevertheless, a significant percentage of patients do not reach transplantation due to the shortage of donors. Therefore, the establishment of surgical alternatives is very important. Dynamic cardiomyoplasty is accepted as an alternative to heart transplantation. In this technique skeletal muscle is wrapped around the heart and stimulated synchronously with the heart itself. We describe the present status of this procedure.

Asunto(s)

RESUMEN

A unique patient who developed pseudoaneurysm of the ascending aorta after coronary artery bypass grafting is presented. This case is peculiar due to the presenting symptom being fever of unknown origin. It is the first description of a patient on hemodialysis, who developed ascending aortic pseudoaneurysm.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: There are few guidelines for surgical intervention late after unoperated traumatic aortic rupture. We reviewed our experience and the literature to determine when and how to operate. METHODS: Between 1987 and 1997, we treated 9 patients aged 22 to 82 years with chronic traumatic aneurysm. Seven patients underwent aneurysm resection. Two patients have not been operated on. The injury-to-operation interval ranged from 8 weeks to 18 years (mean, 4.1 years). One patient underwent median sternotomy and patch repair during hypothermic circulatory arrest. Six patients underwent left thoracotomy: 2 were operated on with left atrio-femoral bypass, and 4 with hypothermic circulatory arrest and ascending aortic cannulation. RESULTS: There was no surgical mortality or morbidity. The 2 patients who were not operated on remained asymptomatic without radiologic change in the aneurysm after follow-up of 2 and 9 years. CONCLUSIONS: From this limited experience and literature review, we make the following subjective observations: (1) all patients with new symptoms should be operated on promptly, and (2) asymptomatic densely calcified aneurysms detected more than 2 years after the accident can be observed by repeated tomography unless new symptoms arise.

Asunto(s)

Asunto(s)

RESUMEN

We describe a patient with left atrial myxoma followed by a second lesion in the left ventricle. Previous reports of "recurrent" myxoma were studied, with the following conclusions: There is little evidence for the process of myxoma seeding, local recurrence can occur through inadequate resection or malignant change, and many alleged recurrences are at a different site and multifocal disease occurs frequently in the familial setting.

Asunto(s)

RESUMEN

We describe successful management of pulmonary hypertension with a reversible aorto-pulmonary (central) shunt and inhaled nitric oxide gas after truncus arteriosus repair. A temporary central shunt may provide a lifeline in those cases refractory to pharmacologic pulmonary vasodilation as long as marginal systemic oxygenation can be maintained.

Asunto(s)

RESUMEN

We used a Freestyle (Medtronic, Minneapolis, MN) porcine root to replace a regurgitant aortic valve and repair acute type A dissection. A Hemashield (Meadox Medicals, Oakland, NJ) graft was used to replace the ascending aorta with the "open anastomosis" technique. This method is a valuable alternative to conventional root replacement in acute type A dissection.

Asunto(s)

RESUMEN

Intravenous leiomyomatosis is a condition characterized by intravenous growth of histologically benign smooth muscle tumor, originating in the uterus. A case of intravenous leiomyomatosis with right atrial extension in a 64-year-old woman is described. The atrial tumor was successfully removed with a single-stage approach via sternolaparotomy and total circulatory arrest using cardiopulmonary bypass.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: Monitoring of end-tidal CO2 levels, performed routinely nowadays in most operating rooms, is obligatory in our hospital for all anesthesia patients. Levels are dependent on pulmonary blood flow, ventilation, and CO2 content of blood. When ventilation is kept constant, the end-tidal CO2 closely follows pulmonary blood flow. METHODS: Reduction of end-tidal CO2 in the expired air was used to adjust tightness of the pulmonary band in 10 patients with complex cardiac anomalies, all including ventricular septal defect, who underwent pulmonary artery banding. Other parameters were systemic blood pressures and distal pulmonary artery pressures. RESULTS: There were no operative deaths. Average reduction was 3.8 mm Hg (range, 2 to 10 mm Hg; p < 0.001 by paired t test), average increase in systolic blood pressure was 14 mm Hg (range, 4 to 20 mm Hg; p < 0.03 by Wilcoxon sign rank test), distal pulmonary artery pressure was reduced from 56 mm Hg (range, 37 to 79 mm Hg) to 29 mm Hg (range, 20 to 38 mm Hg; p < 0.03 by t test), and postoperative pulmonary artery to systemic pressure ratio averaged 0.36 mm Hg (range, 0.24 to 0.49 mm Hg, difference from preoperative value, p < 0.06). CONCLUSIONS: End-tidal CO2 tension is a simple and convenient, yet highly reliable parameter for adjusting pulmonary artery band tightness.

Asunto(s)

RESUMEN

Platelet transfusion and aprotinin administration improve platelet function and clinical hemostasis after extracorporeal circulation. To compare two methods of improving postoperative hemostasis, we preoperatively randomized 40 patients undergoing various open heart procedures into two groups. Group A included 20 patients who, immediately after bypass, received single-donor plateletpheresis concentrates collected from ABO-compatible donors (Baxter Autopheresis-C System). They were compared with 20 patients who received high-dose aprotinin (6 x 10(6) KIU) before and during cardiopulmonary bypass (group B). Group A patients showed significantly higher platelet count after single-donor plateletpheresis concentrate transfusion (157 +/- 36 x 10(9)/L compared with 118 +/- 42 x 10(9)/L (p < 0.05). However, platelet aggregation on extracellular matrix was better in group B (3.4 +/- 0.7 versus 2.8 +/- 0.9; p < 0.05). Total 24-hour blood loss and exposure to homologous blood products were significantly less in group B (396 +/- 125 mL and 1.1 +/- 1.6 units compared with 617 +/- 233 mL and 5.4 +/- 3.4 units; p < 0.01). Despite higher platelet count in patients after single-donor plateletpheresis concentrates transfusion, hemostasis in patients receiving aprotinin is better due to improved platelet function.

Asunto(s)

RESUMEN

Since our previous studies suggested that the transfusion of 1 unit fresh whole blood (FWB) after cardiopulmonary bypass (CPB) using a bubble oxygenator may provide hemostatic benefit equivalent to 8-10 units of platelet concentrates, we have routinely used FWB at the termination of CPB. Two patients who received FWB and developed transfusion-associated graft-versus-host disease (TA-GVHD) prompted us to investigate the effect of irradiation of FWB on platelet and clinical hemostasis. Twenty-four patients were randomized to receive either 1 unit FWB (12 patients), or 1 unit irradiated FWB (IrFWB, 1,500 cGy,12 patients) after CPB. Platelet aggregation on extracellular matrix, studied by a scanning electron microscope and graded from 1 to 4 (from poor to excellent aggregation), was similar in both groups preoperatively [3.3 +/- 0.9 (FWB) and 3.5 +/- 0.5 (Ir FWB)], and at the end of CPB [1.8 +/- 1.2 (FWB) and 1.9 +/- 0.9 (IrFWB)]. Platelet aggregation was similar after transfusion of FWB (3.0 +/- 1.0) and after IrFWB (3.2 +/- 0.8), as was the increase in platelet count. Twenty-four hours total postoperative bleeding was similar (560 +/- 420 and 523 +/- 236 ml for FWB and IrFWB, respectively). We conclude that irradiation of FWB for prevention of TA-GVHD does not impair platelet aggregating capacity, and can be used when blood is donated by the patient's next of kin.

Asunto(s)

RESUMEN

The authors describe a retroperitoneal liposarcoma with secondary involvement of the left ventricle. Therapy has been disappointing, and is guided by the nature of the primary tumor, previous therapy, extent of metastatic spread, and feasibility of cardiac resection. In selected patients whose primary tumor is well-controlled and progressing slowly, with no evidence of widespread disease, resection of the cardiac metastases can be performed when technically feasible.

Asunto(s)

RESUMEN

Septic emboli, giving rise to physical signs similar to those of subacute bacterial endocarditis, are extremely rare complications of radial artery catheterization. A case is reported with splinter hemorrhages and Janeway lesions, resulting from an infected radial artery catheter. Five other cases with these signs are collected from among 21 patients with localized septic complications described in the literature. The duration of radial artery catheterization was 4 days or longer in all cases, and Staphylococcus aureus was the offending agent in all. We conclude that arterial lines should be removed as early as possible, and in any case they should be pulled out at the earliest sign of a local complication. In the presence of signs of local infection, antistaphylococcal treatment should be given until results of cultures are available.

Asunto(s)

RESUMEN

Twenty units of fresh whole blood were separated into fresh packed red blood cells (PC) and platelet-rich plasma (PRP) and were transfused to 40 patients immediately after coronary bypass grafting. Patients were preoperatively randomized to receive either PRP (group A, 20 patients) or PC (group B, 20 patients). Platelet number in the PRP group was greater, but not significantly greater, than in the PC group (7.5 +/- 3 versus 5.9 +/- 2.2 x 10(10); p = not significant). However, mean platelet volume in the PC group was significantly greater (8.75 +/- 1.1 versus 6 +/- 0.7 fL). Postoperatively, group A patients bled more than group B (566 +/- 164 versus 327 +/- 41 mL; p less than 0.01) and received more red blood cell units (2.7 +/- 1.2 versus 1.6 +/- 0.7 U; p less than 0.05) and a larger number of blood products (5.9 +/- 3.7 versus 2.6 +/- 1.2 U; p less than 0.05). Transfusion of PRP to group A increased platelet count from 128 +/- 20 to 148 +/- 110 x 10(9)/L; however, platelet functions did not improve. Administration of PC to group B increased platelet count from 139 +/- 22 to 156 +/- 23 x 10(9)/L, improved platelet aggregation (with collagen from 33% +/- 20% to 53% +/- 23%, with epinephrine from 36% +/- 24% to 51% +/- 20%; p less than 0.05), and corrected the prolonged bleeding time. The results suggest that the improved hemostasis observed after fresh whole blood administration is related to the large, potent platelets that remained in the PC and were not separated to the PRP during standard platelet concentrate preparation.

Asunto(s)