ABSTRACT
Cardiovascular diseases are the most common disorder in the developed countries. Invasive cardiological and cardiosurgical techniques are known therapies. Yet, patients with severe hereditary haemorrhagical diseases (haemophilia, rare deficiencies of coagulation factors) have an increased bleeding risk by the use of anticoagulants. Therefore, the treatment of these patients requires a concomitant therapy. This article shows eight patients with a severe bleeding diathesis and cardiosurgical interventions in the years 2006 to 2011. This case report shall demonstrate that an adequate therapy can be accomplished with the help of a good cooperation between haemostaseologists and colleagues of the cardioinvasive/cardiosurgical disciplines.
Subject(s)
Blood Coagulation Disorders/complications , Blood Coagulation Disorders/therapy , Cardiac Surgical Procedures/adverse effects , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/prevention & control , Adult , Female , Humans , Male , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: In an effort to minimize access in coronary artery bypass (CAB) surgery, a total endoscopic approach using computer enhanced technology was developed. METHODS: By July 1999 the da Vinci telemanipulation system (Intuitive Surgical, Mountain View, CA) was used in 66 patients with coronary artery disease. In 12 patients undergoing routine coronary artery bypass grafting (CABG) (group 1) the internal thoracic artery (ITA) to left anterior descending artery (LAD) anastomosis was performed remotely using the system. In 32 patients (group 2) endoscopic dissection of the ITA was performed followed by a conventional minimally invasive direct coronary artery bypass (MIDCAB) operation. In 22 patients (group 3) the complete operation was performed endoscopically through 4 ports (total endoscopic coronary artery bypass, TECAB). Port-Access cardiopulmonary bypass with cardioplegic arrest was used for TECAB. RESULTS: In group 1 the time for performing the ITA to LAD anastomosis was 17 +/- 10 min. Mean graft flow was 38 +/- 25 ml/min. One anastomosis leaked and was repaired manually. In group 2 in 31/32 patients (96%) the ITA harvest was successfully performed with the system at mean of 61 +/- 27 min. There was a substantial learning curve associated with ITA take-down. In one patient a dissection caused insufficient free ITA graft flow which necessated additional vein grafting. Postoperative angiography demonstrated graft patency in all cases. In the TECAB group, the operation could be completed through four ports in 18 of the 22 patients (82%) with operating times in the range 220-507 min. In four patients, elective conversion to a minithoracotomy was required due to failure to identify the LAD (1), bleeding from the anastomosis (1), grafting of a diagonal branch (1) and torsion of the pedicle (1). One patient required reoperation for bleeding from an ITA side-branch. Median intubation time was 13 h and stay on ICU and hospitalization were 20 h and 7 days, respectively. A 3-month follow-up angiography revealed patent grafts in all TECAB patients. CONCLUSION: Endoscopic ITA harvesting and performing of arterial anastomoses can be safely performed with the da Vinci system. TECAB is possible on the arrested heart with good functional results. However, a substantial learning curve has to be overcome which is reflected in long operation times and an initial significant conversion rate.
Subject(s)
Coronary Artery Bypass/methods , Coronary Disease/surgery , Endoscopy , Image Processing, Computer-Assisted , Video Recording , Cardiopulmonary Bypass , Coronary Angiography , Coronary Disease/diagnostic imaging , Echocardiography , Equipment Design , Female , Heart Arrest, Induced , Humans , Male , Middle Aged , Monitoring, Intraoperative , Treatment OutcomeABSTRACT
Changes in the distribution patterns of chondrocytes in the embryonic transitory hyaline cartilage of the tarsus were studied using 56 sagittal section of tarsi from 28 human embryos, with a vertex-foot length from 7.0 to 44.0 cm. The os naviculare and os cuboideum were not sliced in all sections. A total of 93,931 cells were transferred via a mirror to paper, and the resulting patterns were analyzed. Determinations included the numerical surface and volume density of the chondrocytes and the cell distribution patterns using the dispersion index. In the case of the calcaneus, talus, os naviculare and os cuboideum, the number of sliced cells found over a constant area decreases at a continuous linear rate in the course of the embryonic period. In all tarsal primordia the distribution pattern developed from regular to random. Particular conditions prevail immediately below the perichondrium and near the ossification centers which can be found in the calcaneus from the 6th month onwards.
