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1.
Asian Cardiovasc Thorac Ann ; 22(6): 737-8, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24887818

ABSTRACT

Although drug-eluting stents are increasingly used to treat coronary disease, restenosis remains the major limitation of these devices. We report a case of complete metal jacket using 17 stents for triple-vessel coronary disease in a 73-year-old man, for whom surgery would have been the best choice.


Subject(s)
Coronary Artery Disease/therapy , Coronary Restenosis/therapy , Metals , Percutaneous Coronary Intervention/instrumentation , Stents , Aged , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease/diagnostic imaging , Coronary Restenosis/diagnostic imaging , Coronary Restenosis/etiology , Drug-Eluting Stents , Fatal Outcome , Humans , Male , Patient Selection , Percutaneous Coronary Intervention/adverse effects , Prosthesis Design , Retreatment , Risk Factors , Time Factors , Treatment Outcome
2.
Tex Heart Inst J ; 40(1): 42-9, 2013.
Article in English | MEDLINE | ID: mdl-23466655

ABSTRACT

We sought to determine whether preoperative statin treatment is more effective in reducing, after cardiac surgery with cardiopulmonary bypass, systemic inflammatory response and myocardial damage markers in patients who have elevated preoperative interleukin-6 levels than in patients who have normal preoperative interleukin-6 levels. The study involved a prospective cohort of 164 patients who underwent coronary and valvular surgery with cardiopulmonary bypass. There were 2 study groups: group A (n = 60), patients with elevated preoperative interleukin-6 levels; and group B (n = 104), patients with normal preoperative interleukin-6 levels. Each group was subdivided according to whether patients were (group 1) or were not (group 2) treated preoperatively with statins. Accordingly, the subdivided study groups were A1 (n = 40), A2 (n = 20), B1 (n = 56), and B2 (n = 48). The plasma levels of proinflammatory interleukin-6 were measured 1, 6, 24, and >72 hours after surgery. The baseline, operative, and postoperative morbidity and mortality characteristics were similar in all groups. Group A1 had significantly lower levels of interleukin-6 and troponin I than did group A2 at all postoperative time points. Group B1 had significantly lower levels of interleukin-6 than did group B2 postoperatively. There were no significant differences in troponin I levels between groups B1 and B2. We conclude that, in patients with preoperative activation of the inflammatory system, preoperative treatment with statins is associated with lower postoperative interleukin-6 and troponin I levels after cardiac surgery with cardiopulmonary bypass.


Subject(s)
Coronary Artery Bypass/adverse effects , Coronary Artery Disease/surgery , Heart Valve Diseases/surgery , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Inflammation Mediators/blood , Systemic Inflammatory Response Syndrome/prevention & control , Aged , Biomarkers/blood , Cardiopulmonary Bypass/adverse effects , Chi-Square Distribution , Coronary Artery Bypass/mortality , Coronary Artery Disease/blood , Coronary Artery Disease/immunology , Coronary Artery Disease/mortality , Female , Heart Valve Diseases/blood , Heart Valve Diseases/immunology , Heart Valve Diseases/mortality , Humans , Interleukin-6/blood , Male , Middle Aged , Prospective Studies , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/immunology , Systemic Inflammatory Response Syndrome/mortality , Time Factors , Treatment Outcome , Troponin I/blood , Up-Regulation
3.
Asian Cardiovasc Thorac Ann ; 20(4): 493-4, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22879570

ABSTRACT

To decrease the risk of traumatic injury or dissection of the aorta in patients with diffuse atherosclerotic disease or calcification of the ascending aorta, we have devised a simple method that uses an Embol-X aortic cannula with a Fogarty occlusion catheter.


Subject(s)
Balloon Occlusion/instrumentation , Balloon Occlusion/methods , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis Implantation/methods , Aortic Diseases/complications , Atherosclerosis/complications , Constriction , Equipment Design , Heart Valve Diseases/complications , Humans
4.
J Cardiothorac Surg ; 6: 55, 2011 Apr 17.
Article in English | MEDLINE | ID: mdl-21496323

ABSTRACT

The ideal surgical approach is unclear in adult patients with coarctation of the aorta that is associated with other cardiovascular pathologies that require intervention. Standard median sternotomy allows simultaneous, coronary revascularization surgery, valve replacement and repair of aortic coarctation. However the collateral circulation and the anatomy of the mammary arteries must be determined, to avoid possible complications. We report a case of a 69 year-old man with aortic coarctation, aortic stenosis, coronary artery disease and internal mammary artery dilatation who underwent concomitant surgical procedures through a median sternotomy.


Subject(s)
Aortic Coarctation/surgery , Aortic Valve Stenosis/surgery , Coronary Artery Disease/surgery , Dilatation, Pathologic/surgery , Mammary Arteries/surgery , Aged , Aortic Coarctation/diagnostic imaging , Aortic Valve Stenosis/diagnosis , Coronary Artery Disease/diagnostic imaging , Dilatation, Pathologic/diagnostic imaging , Humans , Male , Sternotomy , Tomography, X-Ray Computed
6.
J Cardiothorac Surg ; 5: 77, 2010 Oct 07.
Article in English | MEDLINE | ID: mdl-20929577

ABSTRACT

BACKGROUND: As the population ages, bioprosthesis are increasingly being used in cardiac valve replacement. Pericardial bioprosthesis combine an excellent hemodynamic performance with low thrombogenicity, but valve failure associated with calcification remains a concern with these valves. We describe distortion of the bioprosthesis ring as a risk factor for early calcification. METHODS: A total of 510 patients over the age of 70 years underwent isolated aortic valve replacement with the Mitroflow (A12) pericardial bioprosthesis. Thirty two patients (6,2%) have undergone a second aortic valve replacement due to structural valve dysfunction resulting from valve calcification. In all patients a chest radiography and coronary angiography was performed before reoperation. A 64 Multidetector Computed Tomography (MDCT) with retrospective ECG gating study was performed in four patients to evaluate the aortic bioprosthesis. RESULTS: Chest radiography showed in all patients an irregular bioprosthesis ring. At preoperative coronary angiography a distorted bioprosthesis ring was detected in all patients. Macroscopic findings of the explanted bioprostheses included extensive calcification in all specimens. CONCLUSION: There was a possible relationship between early bioprosthetic calcification and radiologic distortion of the bioprosthesis ring.


Subject(s)
Aortic Valve/surgery , Bioprosthesis/adverse effects , Calcinosis/etiology , Heart Valve Prosthesis/adverse effects , Aged , Aged, 80 and over , Device Removal , Female , Heart Valve Prosthesis Implantation/adverse effects , Humans , Male , Radiography, Thoracic , Reoperation , Risk Factors
7.
Interact Cardiovasc Thorac Surg ; 11(4): 488-9, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20634274

ABSTRACT

Absorbable topical hemostatic agents are commonly used in cardiac surgery. In this study, we report an unusual case of an acute ischemic event after coronary revascularization produced by interaction between oxidized cellulose and epsilon aminocaproic acid (EACA). An in vitro study was also performed to test the interaction between oxidized cellulose and EACA.


Subject(s)
Cellulose, Oxidized/adverse effects , Coronary Artery Disease/surgery , Graft Occlusion, Vascular/etiology , Hemostatics/adverse effects , Myocardial Ischemia/etiology , Administration, Topical , Aged , Cellulose, Oxidized/administration & dosage , Coronary Artery Bypass , Hemostatics/administration & dosage , Humans , Male
9.
Cases J ; 2: 6741, 2009 Jun 18.
Article in English | MEDLINE | ID: mdl-19829855

ABSTRACT

This report describes a 41-year-old man who had atypical angina resulting from coronary steal by left atrial myxoma. The tumor was completely excised and the patient was symptoms free after operation.

10.
Interact Cardiovasc Thorac Surg ; 9(5): 842-6, 2009 Nov.
Article in English | MEDLINE | ID: mdl-19679611

ABSTRACT

BACKGROUND: We report our experience in the elderly with aortic valve replacement using the Mitroflow A12 pericardial bioprosthesis. METHODS: From January 1993 to January 2006, 491 patients over the age of 70 years received an aortic Mitroflow A12 bioprosthesis implantation. Concomitant procedures included coronary artery bypass grafting in 20% of patients. All patients had routine postoperative Echo-Doppler studies at discharge, one month and a mean of 11.1 months after surgery and annually thereafter. RESULTS: Twenty (4%) patients underwent a second aortic valve replacement due to bioprosthetic valve dysfunction (Group 2). Calcified stenosis was the most common finding at reoperation (98%). Median time to valve reoperation was 76 months. Of patients requiring reoperation, median age at first and second implantation was 73 (70-78) and 79 (76-83) years, respectively. For all patients, freedom from structural valve dysfunction (SVD) was 95+/-3% at 5 years and 55.8+/-2% at 10 years. Bioprosthetic valve deterioration was identified in 27 patients (Group 1). Median age of these patients at first operation and at diagnosis of deterioration by echo was 75 (70-84) and 77 (70-82) years, respectively. The median interval between operation and detection of bioprosthesis valve deterioration was 46 months. Among the total patient population, freedom from bioprosthetic deterioration was 85.7+/-2% at 5 years and 33.5+/-4% at 10 years. CONCLUSION: The Mitroflow A12 pericardial bioprosthesis provides less than optimal performance in elderly patients.


Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Bioprosthesis , Calcinosis/etiology , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Pericardium/transplantation , Age Factors , Aged , Aged, 80 and over , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/mortality , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/mortality , Calcinosis/diagnostic imaging , Calcinosis/mortality , Calcinosis/surgery , Echocardiography, Doppler , Female , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/mortality , Humans , Kaplan-Meier Estimate , Male , Patient Selection , Proportional Hazards Models , Prosthesis Design , Prosthesis Failure , Reoperation , Risk Assessment , Risk Factors , Treatment Outcome
11.
Eur J Cardiothorac Surg ; 36(6): 998-1005, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19581104

ABSTRACT

OBJECTIVE: To determine if preoperative statin treatment is associated with a reduction in systemic inflammatory response (SIR) and myocardial damage markers following cardiac surgery with cardiopulmonary bypass (CPB). METHODS: We study a prospective cohort of 138 patients who underwent coronary and valvular surgery with CPB. We differentiate two study groups: patients with (group A, n=72) or without (group B, n=66) statins. Plasma levels of pro-inflammatory interleukins (tumour necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, IL-8 and IL-2R), creatine phosphokinase (CPK), CPK-MB and troponin I were measured before and 1, 6, 24 and >72 h after surgery. RESULTS: The baseline, operative and postoperative morbidity and mortality characteristics were similar for both the groups. Group A had significantly lower postoperative levels of IL-6 than group B at 6h (68.8+/-5 pg ml(-1) vs 108.9+/-108 pg ml(-1), p=0.01), 24h (71.7+/-7 pg ml(-1) vs 110.4+/-106 pg ml(-1), p=0.01) and before hospital discharge (21.6+/-12 pg ml(-1) vs 32.8+/-27 pg ml(-1), p=0.005), as well as significantly lower average IL-6 levels in the first 24h following surgery (71.8+/-5 pgml(-1) vs 112.8+/-82 pg ml(-1), p=0.002). The postoperative CPK-MB at 24h (19.7+/-23 ng ml(-1) vs 33.1+/-32 ng ml(-1), p=0.02) and troponin I levels at the end of the intervention (2.2+/-2.2 ng ml(-1) vs 3.3+/-3.1 ng ml(-1), p=0.03) and at 24h (4.1+/-3.5 ng ml(-1) vs 6.6+/-8 ng ml(-1), p=0.04) were also significantly lower in the group treated with statins prior to surgery. CONCLUSIONS: Preoperative treatment with statins is associated with a lower biochemical parameters of SIR and myocardial damage following cardiac surgery with CPB, regardless of it being coronary bypass grafting (CABG) or valvular surgery.


Subject(s)
Cardiac Surgical Procedures/adverse effects , Cardiopulmonary Bypass/adverse effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Systemic Inflammatory Response Syndrome/prevention & control , Aged , Biomarkers/metabolism , Blood Specimen Collection/methods , Drug Administration Schedule , Female , Heart Valves/surgery , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Inflammation Mediators/blood , Interleukin-6/blood , Male , Middle Aged , Postoperative Care/methods , Preanesthetic Medication/methods , Prospective Studies , Systemic Inflammatory Response Syndrome/etiology
12.
J Cardiothorac Surg ; 3: 43, 2008 Jul 09.
Article in English | MEDLINE | ID: mdl-18613969

ABSTRACT

We report a 72 year-old man with dysphagia and dizziness. Aortography and Computed tomographic scans revealed the aberrant right subclavian artery arising from a calcified aneurysm of the Kommerell's diverticulum and bilateral carotid artery disease with atherosclerotic narrowing. Surgical relief was accomplished by excluding the aneurysm from circulation through the aortic arch and a 10 mm graft was interposed between the aberrant artery and the ascending aorta.


Subject(s)
Aortic Aneurysm, Thoracic/complications , Calcinosis/complications , Diverticulum/complications , Subclavian Artery/abnormalities , Vascular Malformations/complications , Aged , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortography , Calcinosis/diagnostic imaging , Calcinosis/surgery , Diagnosis, Differential , Diverticulum/diagnostic imaging , Diverticulum/surgery , Humans , Male , Tomography, X-Ray Computed , Vascular Malformations/diagnostic imaging , Vascular Malformations/surgery , Vascular Surgical Procedures/methods
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