Vena Cava Filter Misplacement: A Killer Traveler

ABSTRACT Inferior vena cava filter embolization is not uncommon and can reach 11.8%. However, device migration to the heart is not frequent and occurs in cases after inferior vena cava filter fracture. We present the case of a young woman who was submitted to a routine inferior vena cava filter placement three days before and presented with hemodynamic instability. Since the device was not retrievable, the surgical team opted for an open cardiac surgery under cardiopulmonary bypass to remove the inferior vena cava filter and avoid other further complications.

Heyde syndrome treated by conventional aortic valve replacement

Abstract Heyde syndrome manifests as aortic stenosis associated with gastrointestinal bleeding. We describe the case of a 64-year-old man who came to the emergency room due to acute heart failure and intermittent gastrointestinal bleeding. Treatment involves initial correction of anemia and heart failure followed by aortic valve replacement. The prosthesis used depends on the characteristics of each patient and valve replacement allows the resolution of bleeding in most cases. Gastrointestinal bleeding in patients with aortic stenosis is associated with severity of the valve obstruction. A mechanical prosthesis was used with no recurrent bleeding even with the need for lifelong anticoagulation therapy.

Hemolysis and inflammatory response to extracorporeal circulation during on-pump cabg: comparison between roller and centrifugal pump systems

Abstract Objective: To compare the perioperative incidence rates of hemolysis and inflammatory response in patients undergoing coronary artery bypass grafting with the two main types of cardiopulmonary bypass, centrifugal and roller pumps, and establish correlations among hemolytic and inflammatory changes. Methods: This was a prospective, randomized trial of 60 patients assigned to either roller pump (G1, n=30) or centrifugal pump (G2, n=30) bypass. Markers of hemolysis (serum haptoglobin, lactate dehydrogenase [LDH]) and inflammation (interleukin [IL]1ß, IL-6, and TNF-α) were measured and analyzed. Results: There was no significant between-group difference in the variables of interest. In G1, there was a positive association with IL-6 and TNF-α (P<0.01 and P<0.05, respectively). In G2, there was a positive association with LDH in the postoperative period (P<0.5). At 24h post-cardiopulmonary bypass, there were positive associations between LDH and IL-1ß (P<0.05), LDH and TNF-α (P<0.01), haptoglobin and TNF-α (P<0.05), and LDH and TNF-α (P<0.01) in G1, and between LDH and IL-6 (P<0.01), LDH and TNF-α (P<0.01), and LDH and IL-6 (P<0.01) in G2. Conclusion: There were no significant between-group differences in markers of hemolysis or inflammation. IL-6 and TNF-α were positively associated with duration of cardiopulmonary bypass in G1, while LDH was positively associated with duration of cardiopulmonary bypass in G2. The rate of significant associations between markers of hemolysis and inflammation was higher in the roller pump group (G1). Registration number: ReBEC (RBR-92b9dg).

Cistatina C e taxa de filtração glomerular em cirurgia cardíaca com circulação extracorpórea / Cystatin C and glomerular filtration rate in the cardiac surgery with cardiopulmonary bypass

OBJETIVO: Avaliar a cistatina C como marcador de função renal em pacientes submetidos à cirurgia de cardíaca com circulação extracorpórea, comparando com a dosagem sérica de creatinina. MÉTODOS: Foram analisados 50 pacientes consecutivos submetidos à cirurgia de revascularização do miocárdio. A função renal foi avaliada com a dosagem sérica de cistatina C e de creatinina no pré-operatório, no primeiro e no quinto dia de pós-operatório. Foram utilizadas as fórmulas de Cockcroft-Gault (CG) e Modification of Diet in Renal Disease (MDRD) para calcular a taxa de filtração glomerular estimada (TFG) através da creatinina, e a fórmula de Larsson para a TFG estimada através da cistatina C (TFG-Cis). RESULTADOS: A creatinina e o TFG através das fórmulas de CG e MDRD não mostraram diferença significativa nos momentos estudados. Após a agressão renal pela cirurgia, houve um aumento da cistatina C no 1º e 5º pós-operatório, sendo que no 5º pós-operatório com diferença estatisticamente significativa (P < 0,01). Houve uma queda da TFG estimada pela cistatina C de 105,2 ± 41,0 ml/min, no pré-operatório, para 89,5 ± 31,5 ml/min no 5º dia pós-operatório (P < 0,012). CONCLUSÃO: A cistatina C e a TFG-Cis apresentaram mudanças significativas no pós-operatório de cirurgia de revascularização do miocárdio quando comparadas a creatinina e a respectiva TFG estimada pelas fórmulas de Cockcroft-Gault e MDRD

OBJECTIVE: The aim of this study was to compare cystatin C versus creatinine as a marker for acute kidney injury in patients submitted to cardiac surgery with cardiopulmonary bypass. METHODS: Fifty consecutive patients submitted to coronary artery bypass grafting were studied. Renal function was evaluated by serum cystatin C and creatinine. Blood samples were obtained from each patient at three time points: before operation, and on the first and fifth postoperative days. Glomerular filtration rate (GFR) was calculated by Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Larsson (Cys-GFR) formulas. RESULTS: Creatinine and GFR by CG and MDRD formulas did not show statistical difference between study times. After renal injury from surgery, there was an increase in cystatin C on the 1st and 5th day after surgery, being significantly different on the 5th postoperative (P<0.01). The GFR by Larson formula was higher in the preoperative time (105.2 ± 41.0 ml/min) than in the 5th postoperative day (89.5± 31.5 ml/min; P<0.012). CONCLUSION: The cystatin C and the Cys-GFR showed significant changes after cardiac surgery when compared with the creatinine and respective GFR calculated by the Cockcroft-Gault and MDRD formulas.

Ausência parcial de veia cava inferior associada à malformação intestinal / Partial absence of the inferior vena cava associated with bowel malformation

Criança de 6 anos de idade, sexo feminino, procurou serviço médico devido a mal-formação gastrointestinal. Durante o acompanhamento médico, foi diagnosticada ausência parcial de veia cava inferior, alteração congênita rara que envolve a drenagem vascular do segmento inferior do corpo. Realizados...

Cirurgia cardíaca no idoso / Cardiac surgery in elderly patients

Com o aumento da expectativa de vida da população brasileira cresce o número de pessoas com idade superior a 70 anos que necessitam de operação cardíaca. CASUÍSTICA E MÉTODOS: Foram avaliados, retrospectivamente, 75 pacientes com idade 3 a 70 anos submetidos a operação cardíaca no HC-UFPR, entre 1995 e 1999, com objetivo de analisarmos os resultados imediatos e tardios. A idade variou de 70 a 88 anos, sendo 34 (46,7 porcento) do sexo feminino e 41 (53,3 porcento) do masculino. Os principais sintomas foram angina (81,3 porcento), dispnéia (42,6 porcento) e síncope (16 porcento). Os pacientes encontravam-se em classe I (57,3 porcento), classe II (17,3 porcento), classe III (18,6 porcento) e classe IV (6,6 porcento) da NYHA, 61,3 porcento eram hipertensos, 48 porcento tabagistas, 28 porcento diabéticos e 9,3 porcento haviam sido submetidos a operação cardíaca prévia. Foram realizadas 50 (66,6 prcento) revascularizações do miocárdio, 9 (12 porcento) trocas de valva aórtica, 5 (6,6 porcento) operações de aorta, 4 (5,2 porcento) trocas valvares + revascularização miocárdica e outros procedimentos (7 porcento). As principais complicações pós-operatórias foram cardiovasculares: arritmias ventriculares (22,6 porcento), arritmias supraventriculares (21,3 porcento), baixo débito cardíaco (16 porcento); infecciosas (16 porcento) e pulmonares (9,3 poecento). O tempo médio de permanência na UTI foi de 5 dias. RESULTADOS: A mortalidade hospitalar foi de 13,3 poecento e houve 5 óbitos tardios. Dos sobreviventes, 78,4 porcento compareceram para seguimento ambulatorial. O tempo médio de seguimento foi de 20,7 meses e a sobrevida foi de 92 porcento; um dos óbitos tardios foi de origem cardiovascular. CONCLUSÃO: Apesar de serem pacientes de maior complexidade clínica pela maior incidência de doenças crônicas e acometimento de outros órgãos, os avanços na cirurgia cardíaca e terapia intensiva tornaram possível a intervenção com baixa morbi-mortalidade