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1.
Rev. bras. cir. cardiovasc ; 35(5): 821-823, Sept.-Oct. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137350

ABSTRACT

Abstract In this case report, I describe a new technique for total reconstruction of the aortic valve with autologous pericardium. The parameters of the cusps were calculated using very simple formulas after measurement of the aortic root intercommissural distances. Glutaraldehyde-treated pericardium was trimmed along the marked line, leaving 2 mm of tissue along the fibrous annulus attachment margin for the suture and small wings on both commissural margins to secure the commissural coaptation between right and noncoronary cusps. The annular margin of each pericardial cusp was sutured to the corresponding fibrous annulus with running 4/0 polypropylene suture. The commissures of pericardial patch and the commissural coaptation between right and noncoronary cusps were secured with mattress 4/0 polypropylene sutures. The coaptation of the three cusps was checked with negative pressure on the left ventricular vent before closure of the aortotomy. Intraoperative transesophageal echocardiogram revealed a peak pressure gradient of 10 mmHg and trivial aortic regurgitation.


Subject(s)
Humans , Animals , Aortic Valve Insufficiency , Aortic Valve Stenosis , Cardiovascular Surgical Procedures/methods , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Pericardium/transplantation , Glutaral
2.
Rev. bras. cir. cardiovasc ; 34(6): 775-778, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057498

ABSTRACT

Abstract Ventricular free wall rupture is a fatal mechanical complication of acute myocardial infarction. In some cases it can be represented as subacute clinic and may not cause death in a few minutes. Acute pseudo-aneurysms are extremely unstable and bound to fatal rupture. Herein we report a male patient who suffered dyspnea and mild chest pain, 4 weeks after acute ST-segment elevation myocardial infarction.


Subject(s)
Humans , Male , Middle Aged , Cardiovascular Surgical Procedures/methods , Heart Rupture, Post-Infarction/surgery , Myocardial Infarction/surgery , Heart Rupture, Post-Infarction/diagnostic imaging , Echocardiography , Suture Techniques , Coronary Angiography , Heart Ventricles/surgery , Myocardial Infarction/physiopathology , Myocardial Infarction/diagnostic imaging
3.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3 (supl)): 345-352, jul.-set. 2018. tab
Article in English, Portuguese | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-964372

ABSTRACT

As emergências cardiológicas podem causar rápidas e profundas alterações na resposta metabólica e sistêmica. Essas alterações contribuem acentuadamente para a mobilização das reservas corporais que repercutirão no estado nutricional. A avaliação nutricional, ainda que não seja realizada na fase crítica da assistência interdisciplinar, deverá ser realizada o quanto antes, visando a adoção da alimentação adequada e reposição hídrica e de eletrólitos. O uso de ferramentas subjetivas capazes de estimar o risco nutricional global é de fácil aplicação devido a sua praticidade e rapidez. Entre essas destaca-se o Nutritional Risk Score ­ NRS 2002. Sempre que possível, a avaliação nutricional global deve ser complementada pela avaliação nutricional objetiva e pelo uso de marcadores nutricionais bioquímicos, os quais auxiliarão na avaliação mais precisa do estado nutricional do paciente crítico. Essas ferramentas devem ser utilizadas por nutricionistas treinados e os resultados devem ser discutidos pela equipe multidisciplinar de terapia nutricional que decidirá as estratégias mais adequadas para o início da terapia nutricional precoce nos quadros de emergências cardiológicas


Cardiac emergencies can cause rapid and profound changes in the metabolic and systemic response. These changes contribute significantly to the mobilization of body reserves, which will affect nutritional status. Nutritional evaluation, although not performed in the critical phase of interdisciplinary care, should be carried out as early as possible in order to ensure an adequate diet, and water and electrolyte replacement. The use of subjective tools capable of estimating the global nutritional risk is easy to apply due to its effective and rapid application. One such tool is the Nutritional Risk Score ­ NRS 2002. Whenever possible, the global nutritional assessment should be complemented with objective nutritional assessment and the use of biochemical nutritional markers, which will help obtain a more accurate evaluation of the nutritional status of the critically ill patient. These tools should be applied by trained nutritionists, and the results should be discussed by the multidisciplinary nutritional therapy team, which will decide on the most appropriate strategies for the initiation of early nutritional therapy in cardiac emergency situations


Subject(s)
Humans , Male , Female , Adult , Cardiology , Nutrition Assessment , Emergencies , Prognosis , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , Cardiovascular Surgical Procedures/adverse effects , Cardiovascular Surgical Procedures/methods , Ultrasonics/methods , Body Mass Index , Anthropometry/methods , Guidelines as Topic/standards , Heart Diseases/surgery , Hospitalization
4.
Rev. bras. cir. plást ; 31(3): 391-397, 2016. ilus
Article in English, Portuguese | LILACS | ID: biblio-2308

ABSTRACT

INTRODUÇÃO: A mediastinite pós-operatória é uma condição grave, com altas taxas de mortalidade. O retalho de omento maior é usado com êxito no tratamento de mediastinites pós-operatórias decorrentes de cirurgia cardíaca. O uso dessa abordagem não foi relatado em lactentes, provavelmente porque nessa idade o omento maior é membranáceo, pouco volumoso e possui tecido adiposo escasso. MÉTODOS: Entre julho de 2010 e agosto de 2014, foram tratados quatro lactentes com mediastinite pós-operatória decorrentes de cirurgia cardíaca, realizada por esternotomia. O tratamento cirúrgico consistiu em remoção dos fios de aço da osteossíntese esternal, desbridamento e lavagem do mediastino, seguidos da transposição de todo o omento maior para a cavidade mediastinal. O tratamento cirúrgico foi feito em um só tempo. Não foi feita nova síntese do esterno com fios de aço. RESULTADOS: Os quatro pacientes sobreviveram ao tratamento e obtiveram alta da unidade de tratamento intensivo sem infecção. CONCLUSÕES: Embora membranáceo e apresentando pequeno volume, o retalho de omento maior se mostrou um excelente método de abordagem da mediastinite pós-operatória do lactente.


INTRODUCTION: Postoperative mediastinitis is a serious condition that presents high mortality rates. The greater omentum flap has been used with good results in postoperative mediastinitis after cardiac surgery. The use of this approach has not been reported in infants probably because at this age, the greater omentum is membranous, not bulky, and has little amount of fatty tissue. METHOD: Between July 2010 and August 2014, four infants who presented with mediastinitis after a cardiac surgery via sternotomy were treated. The surgical treatment consisted of steel wire removal, debridement, and wound washing, followed by transposition of the entire greater omentum to the mediastinal cavity. Surgical treatment was performed in a single step. No rewiring of the sternum was performed. RESULTS: All four patients survived the treatment and were discharged from the intensive care unit without infection. CONCLUSIONS: Although membranous and not bulky, the use of a greater omentum flap proved to be an excellent approach in infant postoperative mediastinitis.


Subject(s)
Humans , Male , Female , Infant , History, 21st Century , Omentum , Postoperative Complications , Cardiovascular Surgical Procedures , Therapeutics , Review , Sternotomy , Infant , Mediastinitis , Mediastinum , Omentum/surgery , Omentum/pathology , Postoperative Complications/surgery , Cardiovascular Surgical Procedures/adverse effects , Cardiovascular Surgical Procedures/methods , Therapeutics/adverse effects , Therapeutics/methods , Sternotomy/adverse effects , Sternotomy/methods , Mediastinitis/surgery , Mediastinitis/complications , Mediastinitis/mortality , Mediastinum/surgery , Mediastinum/injuries
5.
Rev. bras. cir. cardiovasc ; 29(3): 374-378, Jul-Sep/2014. tab
Article in Portuguese | LILACS | ID: lil-727154

ABSTRACT

Objetivo: Avaliar se o uso de recuperadores de hemácias está indicado nos pacientes submetidos à cirurgia cardiovascular com o uso de circulação extracorpórea. Métodos: Foram estudados 77 pacientes submetidos a cirurgias cardíacas com uso de recuperadores de hemácias e circulação extracorpórea de novembro de 2010 a junho de 2012. A amostra foi subdividida em três grupos, conforme o tempo de circulação extracorpórea. No grupo A ,o tempo de circulação extracorpórea foi menor que 45, no grupo B, de 45 a 90 e, no grupo C, maior que 90 minutos. Analisou-se o volume recuperado e infundido de hemácias, a hemoglobina de pré, trans e pós-operatório, número de unidades de concentrado de hemácias transfundidas, volume globular e hemoglobina do sangue infundido. Resultados: A idade média, dos pacientes, foi de 60,44±12,09 anos, sendo 71,43% do sexo masculino. O grupo A é formado por 5,19%, o B por 81,82% e o C por 12,99% dos pacientes. O volume recuperado e infundido foi, respectivamente, de 1.360,50±511,37 ml e 339,75±87,71 ml no grupo A, 1.436,63±516,06 ml e 518,83±183,0 ml no B e 2.137,00±925,04 ml e 526,20±227,15 ml no C. Em relação às transfusões de concentrado de hemácias, no grupo A foram transfundidas 1,00±2,00 concentrado de hemácias, no B 1,27±1,85 concentrado de hemácias e no C 2,56±2,01 concentrado de hemácias. O sangue infundido tinha um volume globular de 50,97±12,06% e hemoglobina de 19,57±8,35 g/dl. Conclusão: O recuperadores de hemácias podem ser usados em pacientes submetidos à cirurgia cardiovascular com circulação extracorpórea, mas somente em cirurgias com tempo de circulação extracorpórea acima de 45 minutos o reaproveitamento de sangue ...


Objective: To show if blood salvage is indicated in all patients submitted to cardiovascular surgery with cardiopulmonary bypass. Methods: We studied 77 consecutive patients submitted to cardiac surgery with use of blood salvage and cardiopulmonary bypass from November 2010 to June 2012. The sample was divided in three groups, depending on the time of cardiopulmonary bypass. In group A, the time of cardiopulmonary bypass was smaller than 45, in group B from 45 to 90 and in group C greater than 90 minutes. We analyzed the volume of red cells recovered and infused, the pre, intra and post-operative hemoglobin, the number of packed red cells units which were transfused and hematocrit and hemoglobin blood infused. Results: The average group age was 60.44±12.09 years old, of whom 71.43% were males. The group A was formed by 5.19% of the patients, B by 81.82% and C by 12.99%. The volume of erythrocytes recovered and infused was respectively 1,360.50±511.37 ml and 339.75±87.71 ml in group A, 1,436.63±516.06 ml and 518.83±183.0 ml in B and 2,137.00±925.04 ml and 526.20±227.15 ml in C. About packed red cells transfusions, in group A 1,00±2,00 packed red cells were transfused, in B 1.27±1.85 packed red cells and in C 2.56±2.01 packed red cells. The infused blood had a hematocrit of 50.97±12.06% and hemoglobin of 19.57±8.35 g/dl. Conclusion: That blood salvage can be used in patients submitted to cardiovascular surgery with cardiopulmonary bypass. However, it is only cost-effective in surgeries in which the time of cardiopulmonary bypass is greater than 45 minutes. .


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cardiopulmonary Bypass/methods , Cardiovascular Surgical Procedures/methods , Erythrocyte Transfusion/methods , Operative Blood Salvage/methods , Erythrocyte Volume , Hematocrit , Postoperative Period , Prospective Studies , Reproducibility of Results , Time Factors , Treatment Outcome
6.
Arq. bras. cardiol ; 100(4): 347-354, abr. 2013. tab
Article in Portuguese | LILACS | ID: lil-674202

ABSTRACT

FUNDAMENTO: Há uma paucidade de dados comparando o método percutâneo e o cirúrgico para tratamento da comunicação interatrial tipo ostium secundum. OBJETIVOS: Análise de segurança e eficácia comparando ambos os métodos tratamento em um hospital excelência com vínculo o Ministério de Saúde. MÉTODOS: Estudo observacional, prospectivo, não randomizado de duas coortes de crianças e adolescentes < 14 anos tratadas por meio do cateterismo intervencionista (grupo A) ou da cirurgia cardíaca convencional (grupo B). A coleta dos dados foi prospectiva no grupo A e retrospectiva no B. RESULTADOS: De abr/2009 a out/2011 foram alocados 75 pts no grupo A e entre jan/2006 e jan/2011foram tratados 105 pts no grupo B. A idade e o peso dos pacientes foram maiores no grupo B e o diâmetro da comunicação interatrial do tipo ostium secundum foi semelhante entre os grupos. Sucesso técnico foi observado em todos os procedimentos e não houve óbitos. Complicações (a maioria menores) foram encontradas em 68% no grupo B e em 4% do grupo A (p < 0,001). As taxas de fluxo residual não significativo ou de oclusão total do defeito foram semelhantes nos dois grupos. A mediana de internação foi de 1,2 dias após o procedimento percutâneo e 8,4 dias após a correção cirúrgica (p < 0,001). CONCLUSÃO: Ambos os tratamentos são seguros e eficazes com ótimos desfechos, porém o tratamento percutâneo apresenta menor morbidade e tempo de internação. Tais observações embasam a visão que essa forma de tratamento deve ser, hoje em dia, o método de escolha para pacientes selecionados com CIA do tipo ostium secundum.


BACKGROUND: There is a scarcity of data comparing percutaneous and surgical closure of the secundum atrial septal defect (ASD). OBJECTIVES: Assessment of safety and efficacy of both methods of treatment in a referral center affiliated with the Ministry of Health. METHODS: Observational, prospective, non-randomized study of two cohorts of children and adolescents younger than 14 years, treated by catheterization or surgery. Data was collected prospectively in the percutaneous group (A) and retrospectively in the surgical group (B). RESULTS: A total of 75 patients (pts) were enrolled in group A from April 2009 to October 2011 and 105 pts were treated in group B from January 2006 to January 2011. Age was older and weight was higher in group B and the ASD diameter was similar in both groups. Technical success was achieved in all procedures and there were no deaths. Complications (most minor) occurred in 68% of group B and 4% of A (p < 0.001). Rates of total occlusion or non-significant residual shunts were similar in both groups. Median hospitalization time was 1.2 days in group A and 8.4 days in group B (p < 0.001). CONCLUSION: Both treatment modalities are safe and effective, showing excellent outcomes. However, the percutaneous treatment has lower morbidity and shorter in-hospital stay length. These observations support the concept that percutaneous treatment of atrial septal defects should be regarded as the method of choice to manage selected patients with this condition.


Subject(s)
Adolescent , Child , Female , Humans , Male , Heart Septal Defects, Atrial/surgery , Cardiac Catheterization/adverse effects , Cardiac Catheterization/methods , Cardiovascular Surgical Procedures/adverse effects , Cardiovascular Surgical Procedures/methods , Epidemiologic Methods , Length of Stay/statistics & numerical data , Prosthesis Implantation/adverse effects , Prosthesis Implantation/methods , Treatment Outcome
7.
Dolor ; 20(55): 54-58, jul. 2011. tab
Article in Portuguese | LILACS | ID: lil-682516

ABSTRACT

Justificativa e objetivos: A bomba de analgesia controlada pelo paciente (ACP) permite que sejam administrados opioides de forma segura e em diferentes programações. O objetivo deste estudo foi avaliar a analgesia, efeitos colaterais e o consumo analgésico de pacientes em pós operatório de cirurgia cardíaca que utilizaram ACP na programação contínua mais bolus com morfina, por via venosa. Método: Estudo prospectivo unicêntrico. O acompanhamento foi realizado a partir da extubação dos pacientes a cada 6h,até 30h. Foram analisadas as seguintes variáveis: intensidade de dor, o consumo de analgésico, número de solicitações de analgésicos e ocorrência de efeitos colaterais.Resultados: A ausência da dor foi verificada em 86 por cento dospacientes, os efeitos colaterais predominantes foram náuseas e vômitos, houve diminuição significante no consumo e nasolicitação de morfina. Conclusão: A programação contínua mais bolus foi segura e eficaz no controle da dor.


Background and objectives: Patient-controlled analgesia pump (PCA) allows for the safe administration of opioids in different schedules. This study aimed at evaluating analgesia, side-effects and analgesic consumption of patients in the postoperative period of heart surgery using intravenous PCA incontinuous infusion plus morphine bolus. Method: Prospective study carried out in a hospital of São Paulo. Patients were followed-up as from extubation every 6 h,until 30h. The following variables were evaluated: pain intensity, analgesic consumption, lumber of analgesic requests and side effects. Results: There has been no pain in 86 per cent of patients. Predominant side-effects were nausea and vomiting with significant decrease in morphine consumption and request. Conclusion: Continuous infusion plus bolus is safe and effective to control pain.


Subject(s)
Humans , Male , Female , Analgesia, Patient-Controlled/methods , Pain, Postoperative/drug therapy , Morphine/administration & dosage , Cardiovascular Surgical Procedures/methods , Analgesia, Patient-Controlled/adverse effects , Analgesics, Opioid/administration & dosage , Dose-Response Relationship, Drug , Morphine/adverse effects , Pain Measurement , Prospective Studies , Receptors, Opioid/administration & dosage
10.
Av. cardiol ; 31(4): 301-307, 2011. tab, graf
Article in Spanish | LILACS | ID: lil-640663

ABSTRACT

La tetralogía de Fallot es una de las cardiopatías congénitas cianógenas más frecuentes. A pesar de ello no existen en Venezuela reportes actualizados de los resultados de su corrección quirúrgica. Describir los resultados obtenidos en la reparación quirúrgica de pacientes con tetralogía de Fallot y evaluar los factores de riesgo de mortalidad operatoria relacionados así como describir la sobrevida actuarial y la libertad de reoperación del tracto de salida del ventrículo derecho. Se incluyeron en forma restrospectiva a todos aquellos pacientes intervenidos de corrección total de tetralogía de Fallot entre octubre 2006 a mayo 2010. Se evaluó el tiempo de by-pass cardiopulmonar, tiempo de pinzamiento aórtico, edad, peso, talla, relación de presiones entre el ventrículo derecho e izquierdo después de la corrección. Adicionalmente se trazaron las curvas actuariales para sobrevida y libertad de reoperación para el tracto de salida derecho. Solo el tiempo de circulación extracorporea mayor a 100 minutos estuvo relacionado a mortalidad operatoria. La mortalidad operatoria global fue de 5,8%. La sobrevida actuarial a los 4 años fue de 92,5%, y la libertad de reoperación por obstrucción del tracto de salida derecho fue de 98,4%. Los resultados obtenidos son similares a los observados en la literatura mundial en relación con la mortalidad operatoria y libertad de reoperación del tracto de salida derecho. Los tiempos de circulación extracorporea mayores a 100 minutos podrían estar relacionados a una mayor dificultad técnica de la corrección y esto a su vez estar relacionado a mortalidad.


Tetralogy of Fallot is one of the most common cyanotic congenital heart defects. However, in Venezuela there are no current reports of results of its surgical correction. To describe the results of surgical repair of Tetralogy of Fallot patients and evaluate the risk factors related to operative mortality and to describe the actuarial survival curves and freedom from reoperation for the right ventricule outflow tract obstruction. We included retrospectively all patients undergoing total correction of tetralogy of Fallot from October 2006 to May 2010. We evaluated time of cardiopulmonary bypass, aortic cross-clamp time, age, weight, height, and pressure ratio between right and left ventricle after correction. Additionally actuarial curves were plotted for survival and freedom from reoperation for right outflow tract obstruction. Cardiopulmonary by-pass times longer than 100 minutes was related to operative mortality. The overall operative mortality was 5.8%. The actuarial survival at 4 years was 92.5%, and freedom from reoperation for right outflow tract obstruction was 98.4%. These results are similar to those observed in the literature regarding the operative mortality and freedom from reoperation for right outflow tract obstruction. Cardiopulmonary by-pass times longer than 100 minutes could be related to increased technical difficulties during correction and this in turn be related to mortality.


Subject(s)
Humans , Cardiovascular Surgical Procedures/methods , Risk Factors , Tetralogy of Fallot/surgery , Tetralogy of Fallot/diagnosis , Tetralogy of Fallot/mortality
11.
Article in English | IMSEAR | ID: sea-135627

ABSTRACT

Cardiovascular disease has become the leading cause of morbidity and mortality in India during the last 3 decades. The genetic predisposition and acquisition of traditional risk factors at a rapid rate as a result of urbanization seems to be the major cause. While efforts are being made to contain this epidemic by educating public and applying preventive measures, the ever increasing burden of patients with symptomatic and life threatening manifestations of the disease is posing a major challenge. This requires a concerted effort to develop modern facilities to treat these patients. The healthcare facilities to manage these high risk patients by contemporary methods like percutaneous coronary revascularization and surgical methods have shown a very promising trend during the last decade. The facilities of modern diagnostic methods and new proven techniques to offer symptomatic relief and improve their prognosis are available in most parts of the country. The lack of social security and health insurance for the large majority of the population, however, is a serious limitation. Unregulated availability of some of the newer devices for these techniques had become a very concerning issue. However, in the last few years serious efforts have been made to streamline these procedures. Indigenous research and scientific data acquisition in relation to the modern technology for achieving coronary revascularization has also started on a promising note.


Subject(s)
Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/surgery , Cardiovascular Surgical Procedures/methods , Cardiovascular Surgical Procedures/trends , Delivery of Health Care/methods , Delivery of Health Care/trends , Health Services Accessibility/statistics & numerical data , Health Services Accessibility/trends , India/epidemiology
12.
Rev. bras. cardiol. (Impr.) ; 23(5): 263-269, set.-out. 2010. tab, graf
Article in Portuguese | LILACS | ID: lil-568754

ABSTRACT

Fundamentos: A cirurgia cardíaca é uma forma de tratamento que, apesar de trazer melhora para o paciente, acarreta alterações no organismo. Objetivo: Avaliar a influência da dor, na primeira cirurgia e na reoperação com uso de circulação extracorpórea (CEC), na medida de independência funcional (MIF). Métodos: Foram estudados 22 pacientes cardiopatas, internados na Fundação de Beneficência Hospital de Cirurgia, submetidos à cirurgia cardíaca eletiva por toracotomia médio-esternal (TME) com uso de circulação extracorpórea (CEC) no período de março a abril 2010. Utilizou-se o questionário da medida de independência funcional (MIF) e a escala de dor pela escala visual analógica (EVA) no pré-operatório, 2º/3º dias pós-operatórios (DPO) e 5º/6º DPO. Resultado: Houve uma redução da dor do 2º/3º DPO para o 5º/6º DPO; uma perda de desempenho funcional do pré-operatório para o 2º/3ºDPO e um ganho deste do 2º/3º DPO para 5º/6º DPO com p<0,001. Não se obteve uma correlação significante entre a dor e o quantitativo cirúrgico com o desempenho funcional, apenas deste com o tempo de CEC, que se mostrou inversamente proporcional. Conclusão: A dor, na primeira cirurgia e na reoperação, não influenciou a medida de independência funcional, sendo apenas influenciada pelo tempo de CEC.


Background: Cardiac surgery is a form of treatment that causes changes in the body, although offering improvement for the patient. Objective: To evaluate the influence of pain during the initial surgery and reoperation with the use ofcardiopulmonary bypass (CPB) on the functional independence measure (FIM).Methods: This study focused on 22 cardiac patients in the Fundação de Beneficência Hospital de Cirurgia(FBHC) hospitalized for elective heart surgery through mid-sternal thoracotomy (MST) with cardiopulmonary bypass (CPB) between March and April 2010, using thefunctional independence measure (FIM) questionnaire and the Visual Analog Scale (VAS) for pain in the preoperative, 2/3 and 5/6 PODs. Results: Pain reduction was noted between 2/3 and 5/6 PODs; a loss of functional performance between the preoperativeperiod and the 2/3 PODs; and a gain between the 2/3 and 5/6 PODs with p<0.001. No statistically significant correlation was found between pain and the amount of surgery with functional performance, but only between the latter and the duration of the CPB, whichwas inversely proportional. Conclusion: Pain caused by the first surgery andreoperation did not affect the functional independence measure, which was influenced only by the CPB.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Thoracic Surgery/methods , Pain, Postoperative/surgery , Cardiovascular Surgical Procedures/methods , Cardiovascular Surgical Procedures/rehabilitation , Extracorporeal Circulation/methods , Extracorporeal Circulation
13.
Journal of the Saudi Heart Association. 2010; 22 (4): 187-194
in English | IMEMR | ID: emr-145007

ABSTRACT

Patients referred for aortic valve replacement are often elderly and may have increased surgical risk associated with ascending aortic calcification, left ventricular dysfunction, presence of coronary artery disease, previous surgery, and/or presence of several co-morbidities. Some of these patients may not be considered candidates for conventional surgery because of their high risk profile. While transcatheter aortic valve replacement constitutes a widely accepted alternative, some patients may not be eligible for this modality due to anatomic factors. Apico-Aortic Conduit [AAC] insertion [aortic valve bypass surgery] constitutes a possible option in those patients. Apico-Aortic Conduit is not a new technique, as it has been used for decades in both pediatric and adult populations. However, there is a resurging interest in this technique due to the expanding scope of elderly patients being considered for the treatment of aortic stenosis. Herein, we describe our surgical technique and provide a systematic review of recent publications on AAC insertion, reporting that there is continued use and several modifications of this technique, such as performing it through a small thoracotomy without the use of the cardiopulmonary bypass


Subject(s)
Humans , Adult , Middle Aged , Aged , Cardiovascular Surgical Procedures/methods , Treatment Outcome , Postoperative Complications
14.
Pakistan Journal of Medical Sciences. 2010; 26 (2): 267-270
in English | IMEMR | ID: emr-97963

ABSTRACT

The mortality rate after surgeries for congenital heart disorders is the most important factor for determination of the quality of these operations. A study that evaluate the mortality rate of these surgeries has not been done till now in Iran. Therefore, the purpose of this study was to determine the prevalence and risk factors of mortality after surgery for correction of congenital heart disease. In a retrospective study, 120 children who expired after cardiac surgery and also 150 children who survived after surgery were evaluated between 2005 and 2009. Personal and Social parameters and some risk factors were analyzed. Analysis of results was performed using SPSS version 14 and descriptive and inferential statistics. It showed that 12.64% of children died after surgery. Important risk factors of death were age, weight, height, body surface, preoperative Blood Urea Nitrogen, preoperative Prothrombin Time, preoperative cyanosis and postoperative bleeding. The results of this study indicate that the death rate of children after heart surgery in cardiovascular center of Tabriz Medical University seems to be high. Because of the lack of studies in this field more trials are advised


Subject(s)
Humans , Infant , Child, Preschool , Male , Female , Cardiovascular Surgical Procedures/methods , Prevalence , Risk Factors , Retrospective Studies , Mortality
15.
Cuad. cir ; 24(1): 34-39, 2010. tab
Article in Spanish | LILACS | ID: lil-645018

ABSTRACT

La enfermedad tromboembólica es un término que incluye a la trombosis venosa profunda y el tromboembolismo pulmonar, complicación más temida. Dentro de los factores de riesgo para desarrollar estas patologías destacan los períodos de inmovilización, pacientes sometidos a grandes cirugías y pacientes cursando una patología oncológica. Estas condiciones son parte del perfil común del paciente hospitalizado en los servicios quirúrgicos, situación que es similar en nuestro subdepartamento. En la siguiente revisión presentamos la norma creada por el Equipo de Vascular del Subdepartamento de Cirugía del Hospital Base Valdivia abordando la estratificación del paciente quirúrgico hospitalizado, las alternativas no farmacológicas, farmacológicas, destacando el uso de heparinas de bajo peso molecular, los nuevos anticoagulantes orales, y cuál es la recomendación actual en cada situación.


Subject(s)
Humans , Anticoagulants/therapeutic use , Heparin/therapeutic use , Antibiotic Prophylaxis/methods , Thromboembolism/prevention & control , Perioperative Care/methods , Pulmonary Embolism/prevention & control , Hospitalization , Cardiovascular Surgical Procedures/methods , Risk Assessment , Risk Factors , Venous Thrombosis/prevention & control
16.
Article in English | WPRIM | ID: wpr-77808

ABSTRACT

Maze operation could alter P wave morphology in electrocardiogram (ECG), which might prevent exact diagnosis of the cardiac rhythm of patients. However, characteristics of P wave in patients with sinus rhythm after the operation have not been elucidated systematically. Consecutive patients who underwent the modified Cox Maze operation from January to December 2007 were enrolled. The standard 12-lead ECG and echocardiography were evaluated in patients who had sinus rhythm at 6 months after the operation. The average axis of P wave was 65+/-30 degrees. The average amplitude of P wave was less than 0.1 mV in all 12-leads, with highest amplitude in V1. The most common morphology of P wave was monophasic with positive polarity (49%), except aVR lead, which was different from those in patients with enlarged left atrium, characterized by large P-terminal force in the lead V1. There were no significant differences in P-wave characteristics and echocardiographic parameters between patients with LA activity (30.6%) versus without LA activity (69.4%) at 6 months after the operation. In conclusion, the morphology of P wave in patients after Maze operation shows loss of typical ECG pattern of P mitrale: P wave morphology is small in amplitude, monophasic and with positive polarity.


Subject(s)
Atrial Fibrillation/physiopathology , Cardiovascular Surgical Procedures/methods , Electrocardiography/methods , Female , Heart Conduction System/physiopathology , Heart Rate , Humans , Male , Middle Aged , Treatment Outcome
17.
Rev. bras. cir. cardiovasc ; 24(4): 567-569, out.-dez. 2009. ilus
Article in English, Portuguese | LILACS | ID: lil-540760

ABSTRACT

Objetivo: Descrever a experiência com a técnica de ampliação do folheto posterior em crianças com insuficiência mitral reumática. Métodos: Entre abril de 2002 e outubro de 2007, 30 crianças com idade média de 11,3 anos, foram submetidas à correção de insuficiência mitral pela técnica de ampliação do folheto posterior com enxerto de pericárdio. Em oito pacientes, utilizou-se o anel de Carpentier. Seis crianças apresentavam doença da valva aórtica: cinco, foram submetidas à operação de Ross e, uma, a substituição da valva aórtica por homoenxerto. Todas estavam em classe funcional III ou IV (classificação da New York Heart Association). Resultados: Houve um óbito hospitalar. Uma criança exibiu acentuada hemólise no pós-operatório e foi submetida à substituição da valva mitral. Os demais pacientes tiveram evolução favorável. Conclusão: A técnica de ampliação do folheto posterior com enxerto de pericárdio é efetiva na correção da insuficiência mitral reumática em crianças.


Objective: To describe the experience with the technique of posterior leaflet extension in children suffering of rheumatic mitral regurgitation. Methods: Between April 2002, and October 2007, 30 children, mean age 11.3 years, underwent correction of mitral insufficiency with the technique of posterior leaflet extension with a pericardial patch. Eight also received a Carpentier ring. Six children had aortic valve disease and were submitted to Ross operation (five cases) or valve replacement with an aortic homograft. All were in functional class III or IV (NYHA classification). Results: There was one death. One child presented severe hemolysis in the postoperative period and was submitted to mitral valve replacement. Clinical evolution in the remaining patients was good. Conclusions: Posterior leaflet extension of the mitral valve seems to be an effective surgical technique for correction of rheumatic mitral insufficiency in children.


Subject(s)
Adolescent , Child , Female , Humans , Male , Cardiovascular Surgical Procedures/methods , Mitral Valve Insufficiency/surgery , Pericardium/transplantation , Rheumatic Heart Disease/surgery , Mitral Valve/surgery , Treatment Outcome
18.
Rev. bras. cir. cardiovasc ; 24(3): 327-333, jul.-set. 2009. ilus, tab
Article in Portuguese | LILACS | ID: lil-533261

ABSTRACT

OBJETIVO: A bandagem da artéria pulmonar (BAP) é um procedimento tecnicamente simples, mas envolto em várias peculiaridades que o fazem apresentar elevadas taxas de morbidade e mortalidade. O objetivo deste estudo é analisar a experiência de um hospital de referência na bandagem da artéria pulmonar, avaliando e correlacionando diversas variáveis relacionadas ao procedimento. MÉTODOS: Entre janeiro de 2000 e dezembro de 2008, 61 pacientes submetidos a BAP por cardiopatia congênita de hiperfluxo no Hospital do Coração de Messejana-Fortaleza/CE foram avaliados quanto a mortalidade, complicações, permanência em ventilação mecânica (VM) e terapia intensiva (UTI), uso de drogas vasoativas, dificuldade de ajustes transoperatórios e reoperações para reajuste. Análise estatística foi realizada para comparações entre subgrupos. RESULTADOS: Em 46,8 por cento dos pacientes, não se conseguiu o ajuste pressórico pretendido e 6,5 por cento precisaram ser reoperados para reajustes. O tempo médio UTI e VM foi 14,16 ± 10,92 dias e 14,1 ± 49,6 dias, respectivamente. Em 82,6 por cento dos pacientes foram administradas drogas vasoativas por 10,30 ± 12,79 dias. Complicações graves incidiram em 49,15 por cento dos pacientes, com predominância da insuficiência cardíaca (44 por cento). A taxa de mortalidade foi de 8,2 por cento, não influenciada por peso, procedimentos associados ou cardiopatia univentricular ou biventricular. CONCLUSÃO: Neste estudo, a BAP foi realizada com taxas de mortalidade aceitáveis, compatíveis com a literatura mundial. No entanto, os ajustes transoperatórios são de difícil análise, tornando o procedimento complexo e justificando elevados índices de complicações, resultando em longa permanência em UTI. Nenhuma variável isolada representou significante fator de risco, dentre as quais, fisiologia uni ou biventricular


OBJECTIVE: Although pulmonary artery banding (PAB) seems to be a technically simple procedure it presents several peculiarities and is related to a significant morbidity and mortality. The aim of this study is to analyze the experience of a tertiary hospital on the PAB by assessing and correlating many aspects related to the procedure. METHODS: Between January 2000 and December 2008, 61 patients undergone PAB due to congenital heart disease with increased pulmonary blood flow at Messejana Heart Hospital were assessed as for mortality, complications, stay in mechanical ventilation and need for intensive care unit (ICU), use of vasoactive drugs, difficulties in the adjustment on the banding and reoperations. Some statistical analyzes were performed to compare the subgroups. RESULTS: In 46.8 percent of the patients the intended pressoric adjustment was not achieved and in 6.5 percent it was necessary another surgery to readjust the banding. The mean time of mechanical ventilation was 14.1±49.6 days and ICU 14.16±10.92 days. In 82.6 percent of the patients vasoactives drugs were administrated for 10.3±12.79 days. Severe complications were noted in 49.15 percent of patients and cardiac insufficiency was the most common one with an incidence of 44 percent. The mortality rate was 8.2 percent and it was not influenced by weight or associated procedures with the PAB neither if univentricular or biventricular heart disease. CONCLUSION: The PAB can be performed with acceptable mortality rates compatible with the ones of the world literature. Nevertheless, the adjustment of the banding is difficult to be assessed during the surgery by making the procedure complex and justifying the high incidence of complications and long stay in ICU. It wasn't found any specific risk factor significant to mortality neither uni- or biventricular heart disease


Subject(s)
Humans , Infant , Male , Cardiovascular Surgical Procedures/methods , Heart Defects, Congenital/surgery , Pulmonary Artery/surgery , Chi-Square Distribution , Cardiovascular Surgical Procedures/adverse effects
20.
Rev. bras. cardiol. invasiva ; 17(2): 190-195, abr.-jun. 2009. tab
Article in Portuguese | LILACS | ID: lil-527891

ABSTRACT

Lesões carotídeas estão presentes em 8 por cento a 14 por cento dos candidatos a cirurgia cardiovascular e aumentam o risco de acidente vascular cerebral perioperatório. Esse problema é particulamente importante em pacientes com doença coronária e/ou valvar grave que não são candidatos a procedimentos de revascularização em momentos diferentes. Avaliamos os resultados de uma estratégia híbrida de tratamento, na qual angioplastia carotídea e cirurgia cardiovascular foram realizadas de forma sequencial, com intervalo de algumas horas...


Subject(s)
Humans , Male , Female , Aged , Carotid Artery, Common/surgery , Carotid Artery, Common/pathology , Cardiovascular Surgical Procedures/methods , Cardiovascular Surgical Procedures , Stents
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