ABSTRACT
Retrograde type A aortic dissection is a severe and prognostically unfavourable complication of endovascular repair of the thoracic aorta. The aim of the present article is to describe a clinical case report concerning a hybrid operative intervention for retrograde type A aortic dissection in a patient having endured two-stage endovascular repair of the thoracic artery.
Subject(s)
Aortic Aneurysm, Thoracic , Aortic Dissection , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Hematoma , Postoperative Complications , Aortic Dissection/diagnosis , Aortic Dissection/physiopathology , Aortic Dissection/surgery , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/physiopathology , Aortic Aneurysm, Thoracic/surgery , Aortography/methods , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Hematoma/diagnosis , Hematoma/etiology , Hematoma/physiopathology , Hematoma/surgery , Humans , Male , Middle Aged , Multidetector Computed Tomography/methods , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Stents , Thoracic Arteries/diagnostic imaging , Thoracic Arteries/surgery , Time Factors , Treatment OutcomeABSTRACT
The results of plasty (124 patients) of postinfarction left ventricular aneurysm performed on the working heart are presented in this article. It is shown, that the upgrade of existing surgical techniques, which are directed to the creation of the optimal left ventricle shape, could improve the clinical results after plasty of postinfarction left ventricular aneurysm. It's important to arrange the conditions, which allow avoiding a negative influence on contractility function of the myocardium. The desired conditions could be obtained, if the plasty is performed on the working or fibrillating heart provided that the patient has a consistent aortic valve.
Subject(s)
Cardiac Surgical Procedures/methods , Heart Aneurysm , Heart Ventricles/surgery , Myocardial Infarction/complications , Echocardiography , Female , Heart Aneurysm/diagnosis , Heart Aneurysm/etiology , Heart Aneurysm/mortality , Heart Aneurysm/physiopathology , Heart Aneurysm/surgery , Heart Ventricles/physiopathology , Humans , Intraoperative Care/methods , Male , Middle Aged , Outcome Assessment, Health Care , Retrospective Studies , Russia , Treatment OutcomeABSTRACT
BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) can be associated with severe cardiovascular changes, thus requiring advanced haemodynamic monitoring. Our aim was to investigate the feasibility of transpulmonary single thermodilution (STD) combined with pulse-contour analysis, a newly introduced method for cardiovascular monitoring, for assessment of changes in haemodynamics during different anaesthetic techniques in OPCAB. METHODS: Thirty-six patients scheduled for elective OPCAB were randomized to receive anaesthesia either with midazolam, propofol or isoflurane, in addition to fentanyl and pipecuronium. After catheterization of the femoral artery, haemodynamic parameters were assessed using STD and pulse-contour analysis. The measurements were performed after induction of anaesthesia, during surgery and at 2, 4 and 6 h post-operatively. RESULTS: At the end of surgery, the global ejection fraction decreased by 29% and 19% in the midazolam and the propofol groups, respectively, (P < 0.05) but remained unchanged in the isoflurane group. Moreover, in the isoflurane group, the left ventricular contractility index was higher and the mean arterial pressure (MAP) and the systemic vascular resistance index (SVRI) decreased in comparison with pre-operative values. Post-operatively, the cardiac index (CI) and the cardiac function index (CFI) increased in all groups (P < 0.05). The peri-operative requirement for ephedrine and nitroglycerin increased in the propofol and the midazolam groups, respectively (P < 0.05). CONCLUSION: During OPCAB, STD and pulse-contour analysis displayed changes in preload, myocardial function and afterload that gave valuable guidance for the conduct of anaesthesia, fluid management, and the administration of vasoactive agents. As assessed using STD, isoflurane within the present dose range appears to maintain myocardial performance and vascular tone better than midazolam or propofol.
