RESUMEN
Cardiac resynchronization therapy is not commonly used in the early postoperative period in patients undergoing cardiac surgery who have left ventricular (LV) dysfunction and a history of heart failure. We performed a prospective randomized clinical trial to compare atrial synchronous right ventricular (DDD RV) and biventricular (DDD BIV) pacing within 72 hours after cardiac surgery in patients with an EF ≤35 %, a QRS interval longer than 120 msec and who had LV dyssynchrony detected by real-time three-dimensional echocardiography (RT3DE). Epicardial pacing was provided by a modified Medtronic INSYNC III pacemaker. An LV epicardial pacing lead was implanted on the latest activated segment of the LV based on RT3DE. The study included 18 patients with ischemic heart disease, with or without valvular heart disease (14 men, 4 women, average age 71 years). Patients undergoing DDD BIV pacing had a statistically significant greater CO and CI (CO 6.7±1.8 l/min, CI 3.4±0.7 l/min/m(2)) than patients undergoing DDD RV pacing (CO 5.5±1.4 l/min, CI 2.8±0.7 l/min/m(2)), p<0.001. DDD BIV pacing in the early postoperative period after cardiac surgery corrects LV dyssynchrony and has better hemodynamic results than DDD RV pacing.
Asunto(s)
Terapia de Resincronización Cardíaca/métodos , Enfermedades de las Válvulas Cardíacas/fisiopatología , Isquemia Miocárdica/fisiopatología , Cirugía Torácica , Anciano , Ecocardiografía Tridimensional , Femenino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/cirugía , Periodo Posoperatorio , Estudios ProspectivosRESUMEN
Currently-used mechanical and biological heart valve prostheses have several disadvantages. Mechanical prostheses, based on carbon, metallic and polymeric components, require permanent anticoagulation treatment, and their usage often leads to adverse reactions, e.g. thromboembolic complications and endocarditis. Xenogenous and allogenous biological prostheses are associated with immune reaction, thrombosis and degeneration, and thus they have a high rate of reoperation. Biological prostheses of autologous origin, such as pulmonary autografts, often burden the patient with a complicated surgery and the risk of reoperation. Therefore, efforts are being made to prepare bioartificial heart valves with an autologous biological component by methods of tissue engineering. They should be biocompatible, durable, endowed with appropriate mechanical properties and able to grow with a child. For this purpose, scaffolds composed of synthetic materials, such as poly(lactic acid), poly(caprolactone), poly(4-hydroxybutyrate), hydrogels or natural polymers, e.g. collagen, elastin, fibrin or hyaluronic acid, have been seeded with autologous differentiated, progenitor or stem cells. Promising results have been obtained with nanostructured scaffolds, and also with cultivation in special dynamic bioreactors prior to implantation of the bioartificial grafts into an animal organism.
Asunto(s)
Bioprótesis , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Ingeniería de Tejidos , Animales , Materiales Biocompatibles , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Diseño de Prótesis , Técnicas de Cultivo de TejidosRESUMEN
Coronary artery lesions are evaluated in a group of 43 patients surviving for more than 3 months after heart transplantation. An angiographic finding was obtained from 35 patients, autopsy findings were available in eight cases. Angiography demonstrated coronary artery lesions in 12 out of the 35 patients whereas autopsy findings were positive in five out of the eight post mortem examinations. Overall, lesions were found in 40% of patients at a mean follow-up interval of 3.5 years. While the finding of a coronary artery lesion was not related to the classic risk factors for atherosclerosis, an association to a previous cytomegalovirus or Epstein-Barr virus infection was demonstrated. The data suggest that infection caused by the two above viruses is an important factor in the development of vascular lesions in the heart transplant.
Asunto(s)
Enfermedad Coronaria/etiología , Trasplante de Corazón , Adulto , Enfermedad Coronaria/diagnóstico , Femenino , Trasplante de Corazón/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
During the period from 1984-1991 in the Institute of Clinical and Experimental Medicine 72 orthotopic transplantations of the heart were performed in 71 patients with irreversible cardiac failure. Indication for transplantation in 39 patients was IHD, in 28 cardiomyopathy, in 3 RHD and in one instance a tumour. The mean age of the patients was 41 years, the youngest patient was 17 and the oldest 62 years old. Immunosuppression involved a combination of three preparations Azathioprine, corticoids and Cyclosporine A. Nineteen patients died within one month after operation. The most frequent cause of death was cardiac failure. As to postoperative complications, renal failure was most frequent. Fifty patients were followed-up on a long-term basis. The longest survival period was 8 years and 2 months. The most frequent cause of death in the long-term follow-up was sudden death caused in the majority most probably by rapid development of coronary disease.