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1.
Kardiochir Torakochirurgia Pol ; 16(2): 69-73, 2019 Jul.
Article in English | MEDLINE | ID: mdl-31410093

ABSTRACT

INTRODUCTION: Significant hemodynamic derangements can occur during off-pump coronary artery bypass graft (OPCAB) surgery resulting from the displacement of the beating heart, which may necessitate conversion to on-pump surgery. AIM: We proposed to evaluate the alterations in hemodynamic parameters in patients during the course of anastomosis in OPCAB surgery using the Octopus tissue stabilizer. MATERIAL AND METHODS: In 100 consecutive patients undergoing OPCAB surgery, hemodynamic variables including cardiac output (CO), heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were recorded at baseline, during each coronary artery anastomosis at 2 min, 10 min and after release of the Octopus tissue stabilizer. RESULTS: CO decreased significantly after target stabilization and during all coronary anastomoses (5.42 ±1.1 l/min at baseline, 4.26 ±1.02 l/min at 2 min and 3.92 ±0.98 l/min at 10 min; p < 0.001), with the greatest decrease noted during obtuse marginal (OM) branch of left circumflex artery anastomosis (3.67 ±0.86 l/min at 2 min and 3.38 ±0.78 l/min at 10 min). Inotropic drugs were required to maintain mean arterial pressure (MAP) > 60 mm Hg in 43 patients, which was most frequently noted during OM anastomosis (p < 0.001). The incidence of bradycardia requiring inotropes was noted to be the highest during left anterior descending (LAD) artery anastomosis (p = 0.002). CONCLUSIONS: During OPCAB surgery using the Octopus for coronary target stabilization, CO decreased the most during OM anastomosis requiring inotropes, while bradycardia was most frequent during LAD anastomosis. Careful monitoring and management of hemodynamic variables are therefore of utmost importance to avoid conversion to on-pump surgery.

2.
Int J Surg Case Rep ; 59: 217-219, 2019.
Article in English | MEDLINE | ID: mdl-30948268

ABSTRACT

INTRODUCTION: Partial anomalous pulmonary venous connection (PAPVC) is a rare entity. Only 10% of these are left sided. An intact atrial septum is further uncommon. PRESENTATION OF CASE: We present a case of left sided PAPVC with no atrial septal defect (ASD), who presented with effort intolerance and an unremarkable physical examination. Computed tomography pulmonary angiography (CTPA) confirmed the primary diagnosis as suggested by an initial 2-D echocardiography, and aided in better understanding of the anatomy. CONCLUSION: Patient underwent successful surgery through a simple & reproducible technique of anastomosis of vertical vein to left atrial appendage. Patient recovered uneventfully and was discharged on day 10.

3.
Braz J Cardiovasc Surg ; 32(4): 288-294, 2017.
Article in English | MEDLINE | ID: mdl-28977201

ABSTRACT

OBJECTIVE: Cardiac surgical operations involving extracorporeal circulation may develop severe inflammatory response. This severe inflammatory response syndrome (SIRS) is usually associated with poor outcome with no predictive marker. Red cell distribution width (RDW) is a routine hematological marker with a role in inflammation. We aim to determine the relationship between RDW and SIRS through our study. METHODS: A total of 1250 patients who underwent cardiac surgery with extracorporeal circulation were retrospectively analyzed out of which 26 fell into the SIRS criteria and 26 consecutive control patients were taken. RDW, preoperative clinical data, operative time and postoperative data were compared between SIRS and control groups. RESULTS: The demographic profile of the patients was similar. RDW was significantly higher in the SIRS versus control group (15.5±2.0 vs. 13.03±1.90), respectively with P value <0.0001. There was significant mortality in the SIRS group, 20 (76.92%) as compared to 2 (7.6%) in control group with a P value of <0.005. Multiple logistic regression analysis revealed that there was significant association with high RDW and development of SIRS after extracorporeal circulation (OR for RDW levels exceeding 13.5%; 95% CI 1.0-1.2; P<0.05). CONCLUSION: Increased RDW was significantly associated with increased risk of SIRS after extracorporeal circulation. Thus, RDW can act as a useful tool to predict SIRS in patients undergoing cardiac surgery with extracorporeal circulation. Hence, more aggressive measures can be taken in patients with high RDW to prevent postoperative morbidity and mortality.


Subject(s)
Erythrocyte Indices , Extracorporeal Circulation/adverse effects , Postoperative Complications/blood , Systemic Inflammatory Response Syndrome/blood , Aged , Biomarkers/blood , Blood Glucose/analysis , Cardiac Surgical Procedures , Female , Humans , Male , Middle Aged , Operative Time , Postoperative Complications/mortality , Predictive Value of Tests , Retrospective Studies , Systemic Inflammatory Response Syndrome/mortality
4.
Rev. bras. cir. cardiovasc ; 32(4): 288-294, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-897927

ABSTRACT

Abstract Objective: Cardiac surgical operations involving extracorporeal circulation may develop severe inflammatory response. This severe inflammatory response syndrome (SIRS) is usually associated with poor outcome with no predictive marker. Red cell distribution width (RDW) is a routine hematological marker with a role in inflammation. We aim to determine the relationship between RDW and SIRS through our study. Methods: A total of 1250 patients who underwent cardiac surgery with extracorporeal circulation were retrospectively analyzed out of which 26 fell into the SIRS criteria and 26 consecutive control patients were taken. RDW, preoperative clinical data, operative time and postoperative data were compared between SIRS and control groups. Results: The demographic profile of the patients was similar. RDW was significantly higher in the SIRS versus control group (15.5±2.0 vs. 13.03±1.90), respectively with P value <0.0001. There was significant mortality in the SIRS group, 20 (76.92%) as compared to 2 (7.6%) in control group with a P value of <0.005. Multiple logistic regression analysis revealed that there was significant association with high RDW and development of SIRS after extracorporeal circulation (OR for RDW levels exceeding 13.5%; 95% CI 1.0-1.2; P<0.05). Conclusion: Increased RDW was significantly associated with increased risk of SIRS after extracorporeal circulation. Thus, RDW can act as a useful tool to predict SIRS in patients undergoing cardiac surgery with extracorporeal circulation. Hence, more aggressive measures can be taken in patients with high RDW to prevent postoperative morbidity and mortality.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Postoperative Complications/blood , Systemic Inflammatory Response Syndrome/blood , Erythrocyte Indices , Extracorporeal Circulation/adverse effects , Postoperative Complications/mortality , Blood Glucose/analysis , Biomarkers/blood , Predictive Value of Tests , Retrospective Studies , Systemic Inflammatory Response Syndrome/mortality , Operative Time , Cardiac Surgical Procedures
5.
Eur J Cardiothorac Surg ; 52(6): 1168-1174, 2017 Dec 01.
Article in English | MEDLINE | ID: mdl-28591821

ABSTRACT

OBJECTIVES: Pulmonary arterial hypertension (PAH) is associated with poor outcome after mitral valve replacement (MVR). We proposed to evaluate the effect of valve prosthesis patient mismatch (PPM) on pulmonary arterial (PA) pressure following MVR. METHODS: Five hundred patients who have undergone MVR were studied retrospectively. Postoperative PA systolic pressure (PASP) measured 6 months postoperatively by Doppler echocardiography was compared with preoperative values. PASP ≥ 40 mmHg was defined as PAH. Mitral valve effective orifice area was calculated by the continuity equation and indexed for body surface area. PPM was defined as indexed effective orifice area ≤ 1.2 cm2/m2. A multivariate model was constructed to ascertain the independent determinants of systolic PA pressure. Also, a propensity score model was constructed to overcome the baseline differences between the PPM and no PPM groups. RESULTS: The incidence of PPM in this study was 37.2%. The average postoperative PASPs were 30.49 and 42.35 mmHg in the no PPM and PPM groups, respectively; (P < 0.001). Regression of PAH in the PPM and no PPM groups was 76.26% and 20.64%, respectively; (P < 0.001). The indexed effective orifice area correlated well with postoperative PASP (r = 0.71). The overall survival and freedom from cardiac death at 10 years were 79.8% and 85.3%; and at 20 years were 66.5% and 74.3%, respectively. Both, overall survival and the freedom from cardiac death were higher in the no PPM group than in the PPM group; (P < 0.001). Propensity score matching analysis yielded 112 pairs of the PPM and no PPM cohorts, which revealed higher overall survival and freedom from cardiac death in the no PPM group; (P = 0.028 and 0.012, respectively). CONCLUSIONS: Mitral PPM is an independent predictor of persistent PAH after MVR along with associated morbidity and reduced survival.


Subject(s)
Bioprosthesis/adverse effects , Forecasting , Heart Valve Prosthesis/adverse effects , Hypertension, Pulmonary/etiology , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Postoperative Complications , Adolescent , Adult , Aged , Echocardiography, Doppler , Female , Follow-Up Studies , Humans , Hypertension, Pulmonary/epidemiology , Hypertension, Pulmonary/physiopathology , Incidence , India/epidemiology , Male , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/physiopathology , Propensity Score , Retrospective Studies , Treatment Outcome , Young Adult
6.
Braz J Cardiovasc Surg ; 32(2): 138-140, 2017.
Article in English | MEDLINE | ID: mdl-28492796

ABSTRACT

Cardiac hydatid cyst is an uncommon but potentially fatal disease. In cystic Echinococcus humans are an accidental host. Liver and lungs are the most frequently involved organs. Herein a unique case of intramyocardial hydatid cyst of left ventricle along with pulmonary hydatid cyst in a 38-year-old lady is reported. Surgical removal of the cardiac hydatid cyst was done with the aid of cardiopulmonary bypass followed by removal of pulmonary hydatid cyst.


Subject(s)
Echinococcosis, Pulmonary/surgery , Echinococcosis/surgery , Heart Diseases/surgery , Adult , Echinococcosis/complications , Echinococcosis/diagnostic imaging , Echinococcosis, Pulmonary/complications , Echinococcosis, Pulmonary/diagnostic imaging , Echocardiography , Female , Heart Diseases/complications , Heart Diseases/diagnostic imaging , Heart Ventricles/diagnostic imaging , Heart Ventricles/surgery , Humans , Thoracotomy , Tomography, X-Ray Computed
7.
Rev. bras. cir. cardiovasc ; 32(2): 138-140, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-843470

ABSTRACT

Abstract Cardiac hydatid cyst is an uncommon but potentially fatal disease. In cystic Echinococcus humans are an accidental host. Liver and lungs are the most frequently involved organs. Herein a unique case of intramyocardial hydatid cyst of left ventricle along with pulmonary hydatid cyst in a 38-year-old lady is reported. Surgical removal of the cardiac hydatid cyst was done with the aid of cardiopulmonary bypass followed by removal of pulmonary hydatid cyst.


Subject(s)
Humans , Female , Adult , Echinococcosis/surgery , Echinococcosis, Pulmonary/surgery , Heart Diseases/surgery , Thoracotomy , Echocardiography , Tomography, X-Ray Computed , Echinococcosis/complications , Echinococcosis/diagnostic imaging , Echinococcosis, Pulmonary/complications , Echinococcosis, Pulmonary/diagnostic imaging , Heart Diseases/complications , Heart Diseases/diagnostic imaging , Heart Ventricles/surgery , Heart Ventricles/diagnostic imaging
8.
Ann Thorac Surg ; 95(6): e139-41, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23706464

ABSTRACT

A case of thymoma with extensive ossification in an 8-year-old female child is presented. The presence of extensive ossification in the stroma of the thymoma is an extremely rare feature. To date, there is a single report of ossifying thymoma in children. This report represents the second known case in a child in the worldwide literature.


Subject(s)
Calcinosis/pathology , Thymoma/pathology , Thymoma/surgery , Thymus Neoplasms/pathology , Thymus Neoplasms/surgery , Biopsy, Needle , Child , Female , Follow-Up Studies , Humans , Immunohistochemistry , Rare Diseases , Severity of Illness Index , Sternotomy/methods , Treatment Outcome
9.
Cardiovasc Pathol ; 18(2): 114-8, 2009.
Article in English | MEDLINE | ID: mdl-18402821

ABSTRACT

Localization of hydatid cysts in the heart is a rare phenomenon, with an incidence of 0.5-2%. In almost half these cases, the heart is the sole organ to be involved. We report a case of massive pericardial hydatidosis in a female patient who presented with features of congestive cardiac failure. Cysts in the endocardium of right side of the heart resulted in fatal pulmonary embolism.


Subject(s)
Echinococcosis/diagnosis , Heart Diseases/diagnosis , Heart Failure/diagnosis , Pericardium/pathology , Pulmonary Embolism/diagnosis , Adult , Diagnosis, Differential , Fatal Outcome , Female , Heart Diseases/parasitology , Humans , Pericardium/parasitology , Pulmonary Embolism/parasitology , Tomography, X-Ray Computed
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