ABSTRACT
BACKGROUND: High thoracic epidural techniques are increasingly being used in patients scheduled for cardiothoracic surgery, including coronary artery bypass grafting. In the present study, we evaluated the acute effects of the epidural blockade on myocardial oxygen availability by means of tissue oxygen pressure monitoring in patients submitted for surgical revascularization. METHODS: Fifty adult patients were included in a prospective, randomized, double-blind study. After placement of an epidural catheter in thoracic space T1-T2, and under general anesthesia, 5-10 ml of either normal saline or 0.3% ropivacaine was injected through the epidural catheter. Hemodynamic parameters and the intramyocardial oxygen partial pressure were recorded before and 20 min after the epidural injection. RESULTS: There were no demographic or hemodynamic differences between the groups before intervention. A significant increase in intramyocardial partial oxygen pressure was observed in the ropivacaine group (14.6 mmHg vs. 25.1 mmHg, P < 0.0005). CONCLUSION: High thoracic epidural blockade with 5-10 ml of 0.3% ropivacaine increases myocardial oxygen availability in coronary diseased patients prior to surgical revascularization without deleterious hemodynamic disturbances.
Subject(s)
Analgesia, Epidural , Coronary Artery Bypass , Myocardium/metabolism , Oxygen/metabolism , Aged , Amides , Anesthesia, Epidural , Anesthetics, Local , Double-Blind Method , Female , Humans , Male , Middle Aged , Partial Pressure , RopivacaineABSTRACT
We report four cases of subacute left ventricular free wall rupture after myocardial infarction successfully treated with emergency surgery. Some aspects dealing with clinical presentation, diagnosis and treatment are discussed.
Subject(s)
Heart Rupture/etiology , Myocardial Infarction/complications , Aged , Heart Rupture/surgery , Heart Ventricles , Humans , Male , Middle AgedSubject(s)
Anticoagulants/administration & dosage , Biocompatible Materials , Heart Valve Prosthesis Implantation/instrumentation , Mitral Valve , Thromboembolism/prevention & control , Anticoagulants/therapeutic use , Follow-Up Studies , Heart Valve Diseases/surgery , Humans , Middle Aged , Postoperative Complications/prevention & control , Treatment OutcomeSubject(s)
Extracorporeal Circulation , Hypothermia/therapy , Adult , Combined Modality Therapy , Electric Countershock , Emergencies , Extracorporeal Circulation/methods , Humans , Hypothermia/complications , Male , Resuscitation , Ventricular Fibrillation/etiology , Ventricular Fibrillation/therapyABSTRACT
The Labcor-Santiago pericardial valve has been designed to minimize mechanical stress and to avoid abrasion wear, at the same time preserving the concept of mounting the pericardium outside the posts for full orifice opening. The new design has preserved the traditional superior hemodynamic performance of pericardial valves, avoiding abrasion by careful padding of the stents and introducing a new concept of cusp attachment in order to increase mechanical durability. Since June 1990, 40 patients received 46 Labcor-Santiago valves: 29 in the aortic position and 17 in the mitral position. Mean age was 65.6 years. Eighty percent of the patients were women. New York Heart Association Functional Class III-IV was present in 76% of patients. Hospital mortality has been 12.5%, with 31% undergoing concomitant procedures. No anticoagulation was administered and there has been one thromboembolic event. Echo-Doppler assessment yielded the following in the aortic position: effective orifice area for 19-mm size = 1 cm2; for 21-mm size = 1.2 cm2. Mean systolic gradient for 19-mm size = 14.7 mmHg; for 21-mm size = 11.2 mmHg. In the mitral position: effective orifice area for 27-mm size = 2 cm2; for 29-mm size = 2.3 cm2. Mean diastolic gradients for 27-mm size = 4.6 mmHg; for 29-mm size = 3.3 mmHg. The low-profile flexible stent, the streamlined shape without outside prosthetic material, and the anatomical sewing rim allow a comfortable implantation of the Labcor-Santiago valve, particularly in the small aortic annulus. It is hoped that this new design will contribute to an increase in in vivo mechanical durability.
Subject(s)
Bioprosthesis , Heart Valve Prosthesis , Adult , Aged , Aortic Valve/diagnostic imaging , Echocardiography, Doppler , Female , Follow-Up Studies , Humans , Intraoperative Period , Male , Middle Aged , Mitral Valve/diagnostic imaging , Pericardium , Regional Blood FlowABSTRACT
The diagnosis and management of lumbar disc disease has undergone significant changes in recent years. This is especially true for diagnostic imaging studies (MRI and CT). Currently, CT/myelography or unenhanced MRI may be used to confirm the diagnosis and the level of involvement of lumbar disc disease. The indications for lumbar disc surgery include patients with neurologic deficits and/or those in whom intractable pain does not respond to conservative measures. Conventional disc surgery and/or microdiscectomy are both good operative procedures for lumbar disc disease, and each yields excellent results when criteria for diagnosis and surgery are strictly followed.
Subject(s)
Intervertebral Disc Displacement/diagnosis , Intervertebral Disc Displacement/therapy , Lumbar Vertebrae , Diagnosis, Differential , Diagnostic Imaging , Humans , Intervertebral Disc/surgery , Intervertebral Disc ChemolysisSubject(s)
Heart Septal Defects, Atrial/surgery , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications , PrognosisABSTRACT
The following case involved duplication of the right atrioventricular valve in a patient with a common atrium. The accessory orifice, formed by two fine leaflets, connected the right atrium with the right ventricular outflow tract and had no subvalvular apparatus. Successful surgical correction was accomplished under standard cardiopulmonary bypass.
Subject(s)
Electrocardiography , Pericarditis, Constrictive/physiopathology , Adult , Aged , Chronic Disease , Female , Humans , Male , Middle AgedSubject(s)
Bioprosthesis , Heart Valve Prosthesis , Mitral Valve , Thromboembolism/physiopathology , Humans , Male , Middle AgedABSTRACT
We describe two cases of traumatic rupture of the pericardium with unusual features. The first patient had isolated pericardial rupture with extrapericardial luxation of the heart, and the sound patient had a combined rupture of the pericardium and diaphragm, with prolapsing bowel into the pericardial cavity. After emergency operation, both patients recovered uneventfully.
