RESUMEN
Renal vein aneurysm (RVA) is extremely rare and often asymptomatic, disclosed only incidentally on diagnostic imaging modalities such as computed tomography and ultrasonography. Management is often just watchful follow-up, but some patients require intervention. We present the case of a 74-year-old man complaining of lower back pain in whom a 53-mm RVA was identified. He underwent successful endovascular repair using Amplatzer vascular plugs. The aneurysm had completely resolved by 12 months. Endovascular treatment of a primary RVA does not seem to have been reported previously. This is a milestone case in the management of RVA.
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Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Neumonías Intersticiales Idiopáticas/cirugía , Donadores Vivos , Trasplante de Pulmón/métodos , Anciano , Comorbilidad , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/epidemiología , Ecocardiografía , Femenino , Humanos , Neumonías Intersticiales Idiopáticas/diagnóstico , Neumonías Intersticiales Idiopáticas/epidemiología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Valve-sparing root replacement is increasingly used to overcome drawbacks associated with valvular prostheses. In our institution, 7 patients underwent valve-sparing root replacement from August 2016 to July 2017. The mean age was 45 years (range, 14~69 years). Three patients had Marfan syndrome and 1 had Loeys-Dietz syndrome with acute aortic dissection. All patients underwent surgery with reimplantation technique using a Valsalva graft. Two patients required repair of aortic valve leaflet prolapse. All patients had an excellent clinical course, with mild or no aortic regurgitation and a decrease in end-diastolic volume on echocardiography. These results support the continued use of valve-sparing root replacement in selected patients.
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Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/cirugía , Implantación de Prótesis Vascular , Adolescente , Adulto , Anciano , Femenino , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
OBJECTIVE: To elucidate the factors associated with high left ventricular mass index (LVMI) and to test the hypothesis that high LVMI is associated with worse outcome in severe aortic stenosis (AS). METHODS: We analysed 3282 patients with LVMI data in a retrospective multicentre registry enrolling consecutive patients with severe AS in Japan. The management strategy, conservative or initial aortic valve replacement (AVR), was decided by the attending physician. High LVMI was defined as LVMI >115 g/m2 for males and >95 g/m2 for females. We compared the risk between normal and high LVMI in the primary outcome measures compromising aortic valve-related death and heart failure hospitalisation. RESULTS: Age was mean 77 (SD 9.6) years and peak aortic jet velocity (Vmax) was 4.1 (0.9) m/s. The factors associated with high LVMI (n=2374) included female, body mass index ≥22, absence of dyslipidemia, left ventricular ejection fraction <50%, Vmax ≥4 m/s, regurgitant valvular disease, hypertension, anaemia and end-stage renal disease. In the conservative management cohort (normal LVMI: n=691, high LVMI: n=1480), the excess adjusted 5-year risk of high LVMI was significant (HR: 1.53, 95% CI 1.26 to 1.85, p<0.001). In the initial AVR cohort (normal LVMI: n=217, high LVMI: n=894), the risk did not differ significantly between the two groups (HR: 0.96, 95% CI 0.60 to 1.55, p=0.88). There was a significant interaction between the initial treatment strategy and the risk of high LVMI (p=0.016). CONCLUSIONS: The deleterious impact of high LVMI on outcome was observed in patients managed conservatively, but not observed in patients managed with initial AVR. TRIAL REGISTRATION NUMBER: UMIN000012140; Post-results.
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Estenosis de la Válvula Aórtica/terapia , Implantación de Prótesis de Válvulas Cardíacas , Función Ventricular Izquierda , Remodelación Ventricular , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Distribución de Chi-Cuadrado , Bases de Datos Factuales , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/radioterapia , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Japón , Masculino , Análisis Multivariante , Oportunidad Relativa , Readmisión del Paciente , Modelos de Riesgos Proporcionales , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Volumen Sistólico , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: There is discordance regarding the effect of symptom status before aortic valve replacement (AVR) on long-term outcome after AVR in severe aortic stenosis (AS).MethodsâandâResults:The CURRENT AS registry is a multicenter retrospective registry enrolling 3,815 consecutive patients with severe AS. Among 1,196 patients managed with the initial AVR strategy, long-term clinical outcomes were compared between the symptomatic patients (n=905), and asymptomatic patients (n=291). Median follow-up interval was 1337 days with a 91% follow-up rate at 2 years. AVR was performed in 886 patients (98%) in the symptomatic group and in 287 patients (99%) in the asymptomatic group. Symptomatic patients were older and more often had comorbidities than asymptomatic patients with similar echocardiographic AS severity. The cumulative 5-year incidences of all-cause death and heart failure (HF) hospitalization were significantly higher in symptomatic patients than in asymptomatic patients (25.6% vs. 15.4%, P=0.001, and 14.2% vs. 3.8%, P<0.001, respectively). On landmark analysis at 30 days after AVR, the differences in mortality and HF hospitalization between the 2 groups were mainly observed beyond 30 days. CONCLUSIONS: When managed with the initial AVR strategy, the long-term outcomes of symptomatic severe AS were worse than those of asymptomatic severe AS. Early AVR strategy might be recommended in some selected asymptomatic severe AS patients with reasonable operative risk.
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Estenosis de la Válvula Aórtica/etiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Evaluación de Síntomas/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Válvula Aórtica/cirugía , Comorbilidad , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Introduction. The aim of this study was to examine the incidence and risk factors of catheterization-related CI in the contemporary era, using diffusion-weighted magnetic resonance imaging. Methods. We retrospectively analyzed consecutive 84 patients who underwent MRI (magnetic resonance imaging) after 2.81 ± 2.4 days (mean ± SD) of catheterization via aortic arch. We categorized the patients by the presence or absence of acute CI determined by diffusion-weighted MRI and analyzed the incidence and predictors. Results. Of 84 patients that underwent MRI after catheterization, acute CI was determined in 27 (32.1%) patients. In univariate analysis, dyslipidemia, age, coronary artery disease, antiplatelet agents, number of catheters used, urgent settings, and interventional procedures were significantly different. Multivariate analysis revealed dyslipidemia (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.41-16.03; p = 0.01), higher age (OR, 1.09; 95% CI, 1.007-1.19; p = 0.03), and the number of catheters used (OR, 2.21; 95% CI, 1.21-4.36; p = 0.01) as independent predictors of the incidence of catheterization-related acute CI. Conclusions. Dyslipidemia, higher age, and number of catheters used were independent predictors for acute CI after catheterization. These findings imply that managing dyslipidemia and comprehensive planning to minimize the numbers of catheters are important.
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Cateterismo Cardíaco/estadística & datos numéricos , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/epidemiología , Imagen de Difusión por Resonancia Magnética/estadística & datos numéricos , Dislipidemias/mortalidad , Anciano , Causalidad , Comorbilidad , Imagen de Difusión por Resonancia Magnética/métodos , Dislipidemias/diagnóstico , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Pronóstico , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: To determine which patients effectively respond to ventilatory assistance (VA) and to examine the factors influencing patient response in patients who underwent cardiovascular (CV) surgery. METHODS: We conducted the first walking session after surgery either with or without VA in a randomized order. The patients walked with 3cmH2O of inspiratory pressure support. We measured dyspnea and leg fatigue during initial walking either with or without VA by using a modified Borg scale. Ventilatory parameters were measured by mechanical ventilation before and immediately after walking. Lung function and maximal inspiratory pressure (MIP) were measured and chest radiographs were analyzed by the same cardiac surgeon on the same day as walking. RESULTS: From the total of 74 patients who underwent CV surgery, 56 patients were successively enrolled in the study. Thirty-five out of 56 patients had dyspnea and 18 patients (30% of the total patients) effectively responded to VA (responders). Minute ventilation/estimated maximum voluntary ventilation immediately after walking significantly decreased with VA, and MIP was lower in responders than in non-responders after surgery. The responders revealed greater pulmonary edema scores than non-responders. CONCLUSIONS: The findings of the present study suggest that VA may possibly facilitate successful mobilization early after CV surgery, especially in patients with impaired cardiopulmonary function.
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Procedimientos Quirúrgicos Cardiovasculares/efectos adversos , Disnea/terapia , Complicaciones Posoperatorias/terapia , Respiración Artificial/métodos , Caminata/fisiología , Anciano , Disnea/etiología , Disnea/fisiopatología , Prueba de Esfuerzo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Respiración con Presión Positiva/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Estudios ProspectivosRESUMEN
BACKGROUND: Recently, it has been reported that specific microRNA (miRNA) levels are elevated in serum and can be used as biomarkers in patients with cardiovascular diseases. However, miRNAs expression profiles and their sources in pericardial fluid (PF) are unclear. METHODS AND RESULTS: The purpose of this study was to identify the levels of miRNAs in PF in relation to those in the serum in patients undergoing cardiac surgery. Serum (S) and PF from patients undergoing coronary artery bypass graft (CABG) due to stable angina pectoris (sAP) and unstable AP (uAP) and aortic valve replacement due to aortic stenosis (AS) were analyzed for the detection of miRNAs. We named these samples S-sAP, S-uAP, S-AS, PF-sAP, PF-uAP, and PF-AS, respectively. We first measured the levels of miR-423-5p, which was recognized previously as a biomarker for heart failure. miR-423-5p levels were significantly higher in PF than serum. Although there was no difference in miR-423-5p levels among the PF-AS, PF-sAP, and PF-uAP, its levels were significantly elevated in S-uAP compared with those in S-AS and S-sAP. In order to clarify the source of miR-423-5p in PF, we measured the levels of muscle-enriched miR-133a and vascular-enriched miR-126 and miR-92a in the same samples. miR-133a levels were significantly higher in serum than in PF, and it was elevated in S-uAP compared with S-AS. miR-126 level was significantly increased in serum compared with PF, and the level of miR-92a the similar tendency. miR-423-5p is located in the first intron of NSRP1. There is another miRNA, miR-3184, encoded in the opposite direction in the same region. In vitro experiments indicated that the duplex of miR-423-5p and miR-3184-3p was more resistant to RNase than the duplex of miR-423-5p and miR-133-3p, which may help to stabilize miR-423-5p in the PF. CONCLUSIONS: Our results suggested that miR-423-5p is enriched in PF, and serum miR-423-5p may be associate with uAP. Its expression pattern was different to that of muscle- and vascular-enriched miRNAs, miR-133a, miR-126, and miR-92a.
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Angina de Pecho/genética , Estenosis de la Válvula Aórtica/genética , MicroARNs/sangre , MicroARNs/genética , Líquido Pericárdico/metabolismo , Anciano , Anciano de 80 o más Años , Angina de Pecho/sangre , Angina de Pecho/cirugía , Estenosis de la Válvula Aórtica/sangre , Estenosis de la Válvula Aórtica/cirugía , Secuencia de Bases , Puente de Arteria Coronaria , Femenino , Perfilación de la Expresión Génica , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Intrones , Masculino , MicroARNs/análisis , Persona de Mediana EdadRESUMEN
INTRODUCTION: We previously reported that the prevalence of abdominal aortic aneurysms (AAAs) was higher in patients undergoing scheduled transthoracic echocardiography (TTE) than in patients undergoing abdominal ultrasonography (AUS); however, intergroup patient backgrounds differed significantly in that report. PURPOSE: We tested the hypothesis that TTE could detect AAA as effectively as AUS. DESIGN: A propensity score-matching analysis of a cross-sectional study was adopted as the design for this study. METHODS: We enrolled 7,619 and 15,433 patients scheduled to undergo TTE with additional evaluation of abdominal aorta at the end of the routine study and AUS, respectively, from 2009 to 2010 in our hospital, as reported. A propensity score for profiles of patients who underwent TTE or AUS was developed to adjust for potential confounding bias. Consequently, 4,388 patients in each group were matched for analyses. RESULTS: In propensity-matched patients, AAA was detected in 59 patients of the TTE group and in 48 patients of the AUS group; the prevalence of AAA detection did not differ significantly between TTE and AUS groups (P = 0.331). Positive associations were observed between AAA detection and male sex (adjusted odds ratio [OR]: 3.25; 95% confidence interval [CI], 2.05-5.15; P < 0.001), older age (adjusted OR: 1.029; 95% CI: 1.01-1.04; P < 0.001), and the presence of ischemic heart disease (adjusted OR: 1.78; 95% CI: 1.04-3.03; P = 0.033) and hypertension (adjusted OR: 2.16; 95% CI: 1.38-3.37; P = 001). CONCLUSION: TTE detected AAA with comparable efficacy as AUS in propensity-matched groups who underwent scheduled TTE and AUS.
RESUMEN
We report an extremely rare case of a successful treatment of the intracranial hemorrhage after the cardiac surgery for infective endocarditis(IE). A 34-year-old woman was admitted to our hospital with a diagnosis of active IE due to Staphylococcus aureus, complicated with cerebral infarctions. Preoperative echocardiography showed mobile vegetations on both leaflets of the mitral valve with 15 and 6 mm diameters. Mitral valve repair was performed on hospital day 10. There were mobile vegetations on the A2 and P3. Five days after the cardiac surgery, brain magnetic resonance imaging(MRI) and angiography demonstrated intracranial hemorrhage due to the rupture of the intracranial aneurysm, which was urgently clipped. No neurological sequel has been noted since the successful treatment.
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Hemorragia Cerebral/cirugía , Endocarditis Bacteriana/cirugía , Infecciones Estafilocócicas/cirugía , Adulto , Hemorragia Cerebral/etiología , Endocarditis Bacteriana/complicaciones , Femenino , Humanos , Aneurisma Intracraneal/complicacionesAsunto(s)
Calcinosis/diagnóstico , Cardiomiopatías/diagnóstico , Enfermedades de las Válvulas Cardíacas/diagnóstico , Válvula Mitral , Anciano , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Ecocardiografía Transesofágica , Femenino , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patología , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/patología , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/patologíaRESUMEN
Whole-body periodic acceleration (WBPA) has been developed as a passive exercise device capable of improving endothelial function by applying pulsatile shear stress to vascular endothelium. We hypothesized that treatment with WBPA improves exercise capacity, myocardial ischemia, and left ventricular (LV) function because of increased coronary and peripheral vasodilatory reserves in patients with angina. Twenty-six patients with angina who were not indicated for percutaneous coronary intervention and/or coronary artery bypass grafting were randomly assigned to remain sedentary (sedentary group) or undergo 20 sessions of WBPA with the motion platform for 4 weeks (WBPA group) in addition to conventional medical treatment. WBPA was applied at 2 to 3 Hz and approximately ±2.2 m/s² for 45 minutes. We repeated the symptom-limited treadmill exercise test and adenosine sestamibi myocardial scintigraphy. In the WBPA group, the exercise time until 0.1-mV ST-segment depression increased by 53% (p <0.01) and the double product at 0.1-mV ST-segment depression by 23% (p <0.001). Severity score of myocardial scintigraphy during adenosine infusion decreased from 20 ± 10 to 14 ± 8 (p <0.001) and severity score at rest also decreased from 13 ± 10 to 8 ± 10 (p <0.01). On scintigraphic images at rest, LV end-diastolic volume index decreased by 18% (p <0.01) with an augmentation of LV ejection fraction from 50 ± 16% to 55 ± 16% (p <0.01). In contrast, all studied parameters remained unchanged in the sedentary group. In conclusion, treatment with WBPA for patients with angina ameliorates exercise capacity, myocardial ischemia, and LV function.
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Angina de Pecho/rehabilitación , Circulación Coronaria/fisiología , Terapia por Ejercicio/métodos , Tolerancia al Ejercicio , Heparina/uso terapéutico , Disfunción Ventricular Izquierda/rehabilitación , Función Ventricular Izquierda/fisiología , Aceleración , Anciano , Anciano de 80 o más Años , Angina de Pecho/complicaciones , Angina de Pecho/fisiopatología , Anticoagulantes/uso terapéutico , Progresión de la Enfermedad , Electrocardiografía , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Índice de Severidad de la Enfermedad , Tomografía Computarizada de Emisión de Fotón Único , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
A 71-year-old man on hemodialysis and with a history of right lobectomy was referred for aortic valve replacement. Chest computed tomography revealed counterclockwise rotation of the heart through its longitudinal axis.We approached the aortic valve through median sternotomy. Accordingly, we transected the sternum at the level of the 3rd intercostal space and extended the skin incision approximately 2 inches perpendicular to the midline. After partial transection of the sternum, 3 spreaders were placed: the 1st, in the upper sternum; the 2nd, in the lower sternum; and the 3rd, between the ribs. These devices yielded excellent exposure of the ascending aorta. In addition, the relatively central shift of the ascending aorta contributed to the exposure of the right atrium and the right upper pulmonary vein. Subsequently, aortic valve replacement was performed in the usual fashion, and the patient experienced no postoperative respiratory complications. Aortic valve surgery with T-shaped sternotomy and without thoracotomy is an alternative technique in a patient who has a secondary deviation after lobectomy.
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Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Neoplasias Pulmonares/cirugía , Mediastino/cirugía , Neumonectomía , Esternotomía , Anciano , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Masculino , Mediastino/diagnóstico por imagen , Toracotomía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Atrial fibrillation following cardiac surgery remains as a most common complication. Tachycardia with atrial fibrillation just after the operation could lead to cardiac deterioration. Although we have to control tachycardia, we often have great difficulties in managing these arrhythmias. Many reports have showed landiolol, ultra short-acting beta1 blocker, and amiodarone were effective against postoperative atrial fibrillation. However there has been no report on comparison between these 2 drugs. As excessively sympathetic activity might cause atrial fibrillation, landiolol was introduced into our therapy concomitant with the sedative. Our investigation confirmed that both landiolol and amiodarone were effective in preventing atrial fibrillation, and that the timing of transition from intravenous administration to oral intake was acceptable. When landiolol was administered, enough attention should be paid to the patients whose left ventricular function was low. The patients in whom atrial fibrillation occurred under landiolol therapy showed tendency of lower heart rate in comparison with the patients under amiodarone therapy.
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Antagonistas Adrenérgicos beta/uso terapéutico , Amiodarona/uso terapéutico , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/prevención & control , Procedimientos Quirúrgicos Cardíacos , Morfolinas/uso terapéutico , Urea/análogos & derivados , Anciano , Femenino , Humanos , Masculino , Complicaciones Posoperatorias , Urea/uso terapéuticoRESUMEN
Recently we have developed new sustained release system of basic fibroblast growth factor (bFGF) using gelatin hydrogel as a carrier. Using this system, we examined the effect of topical sustained release of bFGF on angiogenesis and tissue blood perfusion in a rabbit model of hind limb ischemia. Thirty-two rabbits underwent excision of right femoral artery under general anesthesia. Two weeks later the rabbits were randomized into four groups (n = 8 each): no treatment, intramuscular injection of gelatin hydrogel alone, and intramuscular injection of gelatin hydrogel incorporating 30 microg and 100 microg of bFGF. Four weeks after each treatment, selective angiography, tissue blood flowmetry using laser Doppler perfusion imaging, and histological examination of thigh muscle were performed. In groups treated with bFGF incorporating gelatin hydrogel, tissue blood flow, number of arterioles, and vascular density were significantly increased in a dose-dependent manner 4 weeks after the treatment. Serum concentrations of bFGF and vascular endothelial growth factor were not elevated 4 weeks after the treatment. In conclusion, sustained release of bFGF using gelatin hydrogel augmented angiogenesis and improved tissue blood flow after excision of the femoral artery.
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Factor 2 de Crecimiento de Fibroblastos/farmacología , Miembro Posterior/irrigación sanguínea , Neovascularización Fisiológica/efectos de los fármacos , Animales , Modelos Animales de Enfermedad , Portadores de Fármacos , Arteria Femoral , Factor 2 de Crecimiento de Fibroblastos/administración & dosificación , Factor 2 de Crecimiento de Fibroblastos/sangre , Gelatina , Miembro Posterior/anatomía & histología , Miembro Posterior/diagnóstico por imagen , Hidrogeles , Inyecciones Intramusculares , Isquemia , Flujometría por Láser-Doppler , Conejos , Radiografía , Flujo Sanguíneo Regional/efectos de los fármacos , Factores de Crecimiento Endotelial Vascular/sangreRESUMEN
We report 2 cases of calcified amorphous tumor (CAT) in hemodialysis patients. Case 1 is a 68-year-old man who had received hemodialysis for 11 years due to diabetic nephropathy with renal failure. He was admitted because of shortness of breath. After appropriate diagnostic testing, we found a 7 mm movable tumor on the side of the left atrium causing stenosis at the base of the left anterior descending artery (LAD). We suspected this to be a myxoma. We performed a myxomectomy and coronary artery bypass grafting (CABG). The tumor had a stalk and hemogenesis on the surface. Case 2 is a 63-year-old man who had received continuous ambulatory peritoneal hemodialysis for 18 months due to diabetic nephropathy with renal failure. He was admitted because of subjective complaints of chest compression and shortness of breath. Ultrasound cardiography revealed 16 mm tumor on the posterior mitral valve leaflet with mild mitral regurgitation. We removed the tumor and placed a mitral valve prosthesis. Grossly the tumor was encapsulated with endocardium. On pathological examination, both tumors were CATs. CAT is a lesion characterized by calcified fibrin deposits. Preoperative diagnosis of these tumors is difficult. While many surgeons elect to conservatively watch these tumors among dialysis patients, when they are movable, there is a risk of embolism and we should remove the tumor early.
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Calcinosis/diagnóstico , Cardiomiopatías/diagnóstico , Diálisis Renal , Anciano , Diagnóstico Diferencial , Neoplasias Cardíacas/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Delayed saphenous vein graft (SVG) rupture following coronary artery bypass graft (CABG) is an unusual but potentially fatal complication. Herein we report a case of SVG rupture 18 years after CABG. A 75-year-old man had undergone a CABG with SVG in 1987 at another institution. In 2004 the patient developed angina and underwent re-CABG with arterial conduits in our hospital. On the preoperative cineangiogram, the SVG to the right coronary artery (RCA) was irregularly dilated, yet still providing flow to the distal RCA. In 2005 he was readmitted to our hospital for abdominal pain. Chest computed tomography revealed a huge round mass adjacent to the heart. Cineangiogram showed leakage of the contrast in the midportion of the SVG. At operation, graft rupture was evident and repaired under cardiopulmonary bypass. Although cardiac function was well maintained, after the surgery he developed ischemic colitis and died of multiple organ failure on the 17th postoperative day.
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Puente de Arteria Coronaria , Vena Safena/patología , Vena Safena/cirugía , Anciano , Puente Cardiopulmonar , Cineangiografía , Colitis Isquémica/etiología , Resultado Fatal , Humanos , Masculino , Insuficiencia Multiorgánica/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación , Rotura Espontánea/diagnóstico por imagen , Rotura Espontánea/etiología , Rotura Espontánea/cirugía , Vena Safena/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
There have been few reports of surgical repair of acute aortic dissection in renal transplant recipients. The incidence, operative risk, or perioperative management of aortic dissection with functioning allografts remains unknown. Herein we report our experience in successful treatment of type I dissecting aortic aneurysm in a renal transplant patient. A 35-year-old man was admitted to our hospital complaining of severe chest pain. He had undergone a living renal transplant from his mother for chronic renal failure caused by immunoglobulin A nephropathy 11 years prior to admission. An immunosuppressive regimen had been maintained continuously. Preoperative chest computed tomography demonstrated a thoracic dissecting aortic aneurysm (DeBakey classification type I). An emergent graft replacement for the ascending aorta was placed under circulatory arrest. Although continuous hemodiafiltration was required postoperatively because of deteriorated renal function, he recovered uneventfully and his renal function returned to preoperative values. He was discharged on postoperative day 26 without any complications.
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Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Trasplante de Riñón , Adulto , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Humanos , Masculino , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: After cavopulmonary shunt in which the superior vena cava is anastomosed to the right pulmonary artery, the right lung is in a unique condition without flow pulsatility and hepatic venous effluent. In a previous study, we reported that hypoxic pulmonary vasoconstriction disappeared in the pulmonary circulation after cavopulmonary shunt. In this study, however, to investigate the influence of pulsatility and hepatic venous effluent on hypoxic pulmonary vasoconstriction in the pulmonary circulation, we developed an alternative cavopulmonary shunt rabbit model that included hepatic venous effluent in the pulmonary circulation and reduced the pulsatility of the pulmonary arterial blood flow. We then observed the physiologic characteristics of the peripheral pulmonary artery after cavopulmonary shunt, specifically the disappearance of hypoxic pulmonary vasoconstriction. METHODS: Sixteen Japanese white rabbits (12-16 weeks old) were used in this study. With general anesthesia, a cavopulmonary shunt was established by anastomosing the right superior vena cava to the right pulmonary artery in an end-to-side fashion. Of the 16 rabbits for the study, the proximal right pulmonary artery was completely ligated in 5 (atresia group) and partially ligated in 6 (stenosis group). Sham operation was performed in the remaining 5 rabbits. Two weeks later, we analyzed the response of the pulmonary artery (which was divided into three categories: segmental, lobular, and acinar level artery) to hypoxia (8% oxygen inhalation) with a specially designed video radiographic system. Morphometric analysis of the resistance pulmonary artery was done in each group after angiography. RESULTS: Mean pressure and pulse pressure in the right pulmonary artery were not significantly different between the atresia and stenosis groups. The mean pulmonary artery pressures in the atresia and stenosis groups were 8 and 11 mm Hg, respectively. However, the pulse pressure was less than 2 mm Hg in both groups. The baseline internal diameter of the resistance pulmonary artery of the atresia group was significantly different from those of the stenosis and sham groups. In the atresia group, the resistance pulmonary arteries did not respond to hypoxia. In contrast, significant constriction (as assessed by percentage change of internal diameter of the resistance pulmonary arteries in the acinar and lobular level arteries) was observed in the pulmonary arteries of the sham and stenosis groups (atresia vs stenosis vs sham 0.4% vs - 19.0% vs - 18.8%, P = .01). In our morphometric study, we observed vasodilation of the resistance pulmonary artery with a thinner medial layer in the atresia group, consistent with the result of microangiography. CONCLUSION: We developed a cavopulmonary shunt rabbit model in which the inferior vena caval blood was derived from the right ventricle. Hypoxic pulmonary vasoconstriction was maintained in the model with the blood flow from the right ventricle. When the blood flow was not maintained, however, hypoxic pulmonary vasoconstriction disappeared. This phenomenon strongly suggests that a substance in hepatic venous effluent partially regulates the physiological pulmonary vascular function in the rabbit lung.