ABSTRACT
We report a case of a large aneurysm of the inferior mesenteric artery that extended from its origin to bifurcation in the left colic and sigmoidal arteries, and was associated with occlusion of the celiac and superior mesenteric arteries in a 64-year-old patient. The diagnosis was made by arteriography. The patient underwent angioplasty and stenting of the superior mesenteric artery before the operation, which consisted of resection of the aneurysm and reimplantation of the left colic and the sigmoidal arteries separately in the aorta. We believe that this is the first reported case managed by angioplasty in combination with surgery, as well as reimplantation of the branches of the inferior mesenteric artery.
Subject(s)
Aneurysm/complications , Arterial Occlusive Diseases/complications , Celiac Artery , Mesenteric Artery, Inferior , Mesenteric Artery, Superior , Humans , Male , Mesenteric Vascular Occlusion/complications , Middle AgedABSTRACT
OBJECTIVE: Fifteen collaborating centers in eight countries present their pooled experience with the new Bicarbon bileaflet valve. METHODS: Between 4/90 and 4/96, 1351 patients, 806 males and 545 females, aged 10 to 83, mean 58.4 +/- 12.4, underwent valve implantation. OPERATIONS: aortic valve replacement (AVR), 726; mitral valve replacement (MVR), 475; double valve replacement (DVR), 150. Additional procedures: CABG, 211; TV repair, 64; other, 152. RESULTS: Mortality: 67 early (seven valve related) and 56 late (40 valve related). Valve thrombosis: six obstructive, three non-obstructive; embolism: nine major cerebral, 37 other. Major bleeding: 29. Hemolysis: two clinically significant. Non-structural dysfunction: 24 paravalvular leaks, one leaflet interference. No structural failure! Endocarditis: 24. Reoperation 48: 22 non-structural dysfunctions, 14 endocarditis, seven thrombosis and embolism, five other. Estimated 5-year freedom from valve-related deaths is 97.2% for AVR and 92.4% for MVR; 4-year freedom from valve related deaths for DVR is 90.5%. Mean calculated NYHA improvement is 1.24. CONCLUSIONS: The Bicarbon mechanical prosthesis is well designed, durable, has good hemodynamic features and an acceptably low incidence of complications.
Subject(s)
Heart Valve Diseases/surgery , Heart Valve Prosthesis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Embolism/etiology , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Postoperative Complications , Prosthesis Design , Retrospective Studies , Thrombosis/etiology , Time Factors , Treatment OutcomeABSTRACT
The indication of coronary revascularization surgery in elderly people confronts the clinician and the surgeon with a particular question, in which quality of life is at least as important as prolonging life. Although age is not an intrinsic contraindication for surgery, a number of surgical risk factors are more frequent among elderly people, such as diabetes or pulmonary disease. These factors, together with the concomitant presence of aortic valvular stenosis or disease of the carotid or the peripheral arteries, must be taken into account before planning surgery. The new emerging techniques, such as transmyocardial laser revascularization can also be applied to this segment of the population.
Subject(s)
Myocardial Revascularization , Age Factors , Aged , Humans , Myocardial Revascularization/methods , Patient Selection , Quality of Life , Risk FactorsABSTRACT
Sixteen patients with angina refractory to medical therapy who were not considered suitable for standard revascularization underwent transmyocardial revascularization with holmium laser. The average age of the patients was 63.2 +/- 10.5 years. All of them had angina class 3 or 4, and 9 (56%) had previously undergone an aortocoronary bypass grafting. Four patients died during the 6-month follow-up period (25%). Among the survivors, anginal class decreased to class 2 or 1 at the 6th month (p = 0.002). Ejection fraction did not change. The ischemic burden by Holter decreased from 85.3 +/- 656 to 5.5 +/- 9.7 min (p = 0.046). Myocardial perfusion with 201Tl single photon emission computed tomography (SPECT) images at rest and after dipyridamole showed a significant improvement among the ischemic treated segments (p = 0.015). Baseline ejection fraction was somehow lower in nonresponsive than in responsive patients (33 +/- 13 vs. 49 +/- 10, p = 0.052). We conclude that transmyocardial laser revascularization with holmium laser is effective in treatment in ischemic patients not amenable to surgery or percutaneous procedures, as previously reported with CO2 laser. Further investigation is needed to determine which clinical profiles identify the patients for whom this therapy is suitable.
Subject(s)
Angina, Unstable/surgery , Laser Therapy , Myocardial Revascularization/methods , Aged , Aged, 80 and over , Angina, Unstable/diagnosis , Angina, Unstable/physiopathology , Cardiac Output , Coronary Artery Bypass , Echocardiography , Electrocardiography, Ambulatory , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Revascularization/mortality , Retrospective Studies , Survival Rate , Tomography, Emission-Computed, Single-Photon , Treatment OutcomeABSTRACT
Valve replacement with an Angell-Shiley bioprosthesis was accomplished in 449 patients. To evaluate the bioprostheses from this total series, 344 patients who did not undergo associated operation, had no previous operations, or had no other valve substitutes were selected. Hospital mortality was 2.6% for aortic (4 out of 156), 7.2% for mitral (9 out of 125), and 12.7% for multiple-valve replacements (8 out of 63). The 323 patients discharged from the hospital were followed for 6 to 36 months. There were 15 late deaths. Hepatitis, bleeding, thromboembolism, endocarditis, and residual valvular incompetence, always periprosthetic, were the major complications. Forty-five patients with single-valve replacement (16 mitral and 29 aortic) without clinical valve dysfunction were electively recatheterized to assess hemodynamic performance. Measurements were recorded at rest and during exercise on a bicycle ergometer. Functional aortic valve orifice averaged 1.23 +/- 0.33 cm2 and the mean systolic gradient was 21.51 +/- 6.68 mm Hg at rest. During exercise, aortic gradient increased to 26.60 +/- 7.54 mm Hg and mean functional area to 1.51 +/- 0.34 cm2. In the mitral position, the mean diastolic gradient at rest was 8.44 +/- 3.17 mm Hg and the functional orifice area averaged 1.67 +/- 0.51 cm2. Exercise increased the mean gradient to 11.92 +/- 3.8 mm Hg and the mean orifice area to 2.05 +/- 0.57 cm2.
Subject(s)
Bioprosthesis , Heart Valve Prosthesis/methods , Adolescent , Adult , Aged , Aortic Valve/surgery , Aortic Valve/transplantation , Cardiac Output , Female , Follow-Up Studies , Heart Rate , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis/rehabilitation , Humans , Male , Middle Aged , Mitral Valve/surgery , Mitral Valve/transplantation , Postoperative Complications/epidemiology , Tricuspid Valve/surgery , Tricuspid Valve/transplantationABSTRACT
A case of successful surgical treatment of double outlet left ventricle is reported. In a 7 year-old patient with this rare congenital cardiac malformation, situs solitus of the viscera and atria and concordant connexion of atria and ventricles, d-malformation of the great arteries with the aorta to the right and slightly posterior to the pulmonary artery, large doubly committed ventricular septal defect and neither a subpulmonary nor subaortic infundibulum, the repair was achieved performing intraventricular rerouting of the blood from the right ventricle to the pulmonary artery and closing the interventricular communication with a synthetic patch.
