RESUMEN
Lung infarction after intrathoracic surgery is a life-threatening complication that needs urgent intervention. Although the exact etiology is not known, pulmonary infarction may be suspected for patients presenting with consolidation of the lung after intrathoracic surgery. We report a very rare case of pulmonary infarction after successful surgical treatment of a type B aortic dissection. The pulmonary infarction was treated by intrapericardial pneumonectomy. This article discusses possible etiology and management of such patients. A high index of clinical suspicion and timely investigations may allow early detection of this unusual event and avoid fatal outcomes.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Complicaciones Posoperatorias/etiología , Infarto Pulmonar/etiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Infarto Pulmonar/cirugía , Tomografía Computarizada por Rayos XRESUMEN
We report the case of a patient who underwent a redo surgery for a leaflet escape from a Bjork-Shiley tilting disc mitral prosthesis inserted 18 years previously. The escaped disc remained lodged in the thoracic aorta without any complication. She ultimately died of terminal heart failure 13 years after the second operation. We believe this to be the longest survival with a dislodged leaflet from a mechanical valve. Removal of dislodged disc is recommended in literature but there may be a place for watchful observation in exceptional cases with no haemodynamic compromise.
Asunto(s)
Aorta Torácica , Embolia/etiología , Migración de Cuerpo Extraño/complicaciones , Prótesis Valvulares Cardíacas/efectos adversos , Estenosis de la Válvula Mitral/cirugía , Diagnóstico Diferencial , Supervivencia sin Enfermedad , Ecocardiografía Transesofágica , Embolia/diagnóstico por imagen , Embolia/cirugía , Resultado Fatal , Femenino , Estudios de Seguimiento , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Humanos , Persona de Mediana Edad , Falla de Prótesis , Reoperación , Factores de TiempoRESUMEN
OBJECTIVES: We aimed to evaluate the renoprotective role of renal-dose dopamine on cardiac surgical patients at high risk of postoperative renal dysfunction. The latter included older patients or those with pre-existing renal disease, elevated preoperative serum creatinine (Cr), poor ventricular function, hypertension, diabetes mellitus and unstable angina requiring intravenous therapy. METHODS: Fifty patients undergoing cardiopulmonary bypass (CPB) who fulfilled the entry criteria were prospectively randomized into two groups: Group 1 received a 'renal-dose' (3 microg kg(-1) min(-1)) dopamine infusion starting at anaesthetic induction for 48 h whilst saline infusion acted as placebo in Group 2. The anaesthetic and CPB regimes were standardized. Urinary excretion of retinol binding protein (RBP) indexed to Cr, an accurate and sensitive marker of early renal tubular damage, was assessed daily for 6 days. Additional outcome measures included daily fluid balance, blood urea and serum Cr. Statistical comparisons were made using ANOVA and Mann-Whitney U-test. RESULTS: No significant difference was found between the groups in their age, gender, preoperative NYHA class, ejection fraction, baseline serum Cr and duration of CPB and aortic cross-clamping. Renal replacement therapy was not required in any instance. Both groups demonstrated a similar and significant rise in urinary RBP throughout the study period. Dopamine-treated patients achieved more negative average fluid balance than those on placebo (5 vs. 229 ml, P<0.05). CONCLUSIONS: Renal-dose dopamine therapy failed to offer additional renoprotection to patients considered at increased risk of renal dysfunction after CPB.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Cardiotónicos/uso terapéutico , Dopamina/uso terapéutico , Enfermedades Renales/prevención & control , Anciano , Anciano de 80 o más Años , Puente Cardiopulmonar , Cardiotónicos/farmacología , Creatinina/sangre , Dopamina/farmacología , Femenino , Humanos , Riñón/irrigación sanguínea , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteínas de Unión al Retinol/orina , Vasodilatación/efectos de los fármacosRESUMEN
BACKGROUND: Surgical mobilization of the latissimus dorsi muscle produces regional ischemic damage that may compromise its function in clinical applications such as cardiomyoplasty. We compared the effectiveness of two procedures designed to maintain blood flow throughout the mobilized muscle. METHODS: Adult pigs were assigned to two experimental groups: an electrically prestimulated group (n = 10) and a vascular delay group (n = 10). In the prestimulated group the left latissimus dorsi muscle was activated in situ at 2 Hz for 24 h/d. In the vascular delay group, the intercostal perforating arteries to the left latissimus dorsi muscle were divided. Two weeks later, hyperemic blood flow was measured by means of fluorescent microspheres immediately before and after mobilizing the latissimus dorsi muscle and again after recovery for a further 2 days. RESULTS: In the prestimulated group, blood flow was not significantly depressed in any region of the muscle immediately after mobilization, and blood flow increased significantly in proximal (p = 0.01), middle (p = 0.02), and distal (p = 0.007) regions following recovery. In muscles subjected to vascular delay the proximal and middle regions showed no significant changes in blood flow after mobilization or recovery, but flow in the distal region was 50% lower after mobilization (p = 0.003), and it remained significantly depressed even after recovery (p = 0.008). CONCLUSIONS: Prestimulation was significantly more effective than vascular delay in preserving distal blood flow. Because it is also less invasive and initiates metabolic transformation before mobilization, this technique should allow cardiac assistance to be introduced at an earlier postoperative stage without compromising the viability of the grafted muscle.
Asunto(s)
Estimulación Eléctrica , Isquemia/prevención & control , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/trasplante , Complicaciones Posoperatorias/prevención & control , Animales , Flujo Sanguíneo Regional , Ventrículo de Músculo Esquelético , Porcinos , Factores de Tiempo , Procedimientos Quirúrgicos VascularesRESUMEN
Surgical mobilization of the latissimus dorsi muscle (LDM) produces fiber degeneration, particularly in the distal part of the graft, that may compromise its function in clinical applications such as dynamic cardiomyoplasty. In five rats, the left LDM was stimulated continuously at 10 HZ. After 5 weeks, vessels perforating the chest wall were divided and the left LDM was mobilized as a pedicle graft based on the thoracodorsal artery. Twenty-four hours later, animals were killed and left and right LDMs were incubated with the vital stain nitroblue tetrazolium. Five control rats underwent a similar procedure without prestimulation. Mobilization of the LDM resulted in a loss of viability in the distal third of the muscle graft. This was reduced significantly by prestimulation (P = 0.006). Blood flow to the distal LDM graft is known to be augmented by electrical stimulation in situ before mobilization; the present results show that there is an associated enhancement of viability. The clinical implications of this finding are discussed.