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1.
Brain Inj ; 38(8): 668-674, 2024 Jul 02.
Article in English | MEDLINE | ID: mdl-38555515

ABSTRACT

INTRODUCTION: Low-velocity penetrating brain injury (LVPBI) is a class of brain injury where a foreign object violates the skull and damages the brain. Such injuries are rare and consequently understudied. CASE: As such, we report an illustrative case of a 29-year-old female with a dense, plastic spike penetrating her right orbit and into her midbrain. After assessment with a CT scan and angiography, the object was removed with careful attention to possible vascular injury. The patient had an uncomplicated post-operative course and received antibiotic and antiepileptic prophylaxis. She was discharged on post-operative day 5, experiencing only mild left-sided weakness. DISCUSSION: Common concerns regarding LVPBI include infection, post-traumatic epilepsy, and vascular injury. A review of published LVPBI cases over the past 20 years demonstrated that most cases (55.2%) are due to accidents. Of patients undergoing surgery, 43.4% underwent a craniotomy, and 22.8% underwent a craniectomy. Despite the grave nature of LVPBI, only 13.5% of the patients died. Additionally, 6.5% of patients developed an infection over their clinical course. CONCLUSION: In all, more reported cases further paint a picture of the current state of management and outcomes regarding LVPBI, paving the way for more cohesive guidelines to ensure the best possible patient outcomes.


Subject(s)
Head Injuries, Penetrating , Humans , Female , Adult , Head Injuries, Penetrating/diagnostic imaging , Head Injuries, Penetrating/surgery , Head Injuries, Penetrating/complications , Tomography, X-Ray Computed , Foreign Bodies/surgery , Craniotomy
2.
Semin Thorac Cardiovasc Surg ; 34(3): 870-877, 2022.
Article in English | MEDLINE | ID: mdl-34380081

ABSTRACT

Evaluate outcomes of the Freestyle stentless aortic bioprosthesis in patients 60 years old and younger. All patients, 60 years old and younger, between January 1, 1998 to December 31, 2015 who underwent implantation of a Freestyle aortic valve at a single institution were reviewed. Medical records and telephone interviews were utilized for data collection. 515 patients were identified with an average age of 51.3 years. Mean follow up was 11.1 years. 225 full root replacements and 290 subcoronary implants were performed. Overall survival, including patients with concomitant procedures, at 15 years was 63.7% (95% CI 58.3-68.5). Isolated subcoronary implants (58%,167/290) had a 15-year survival of 71.6% (95% CI 62.6-78.7) vs 78.4% (95% CI 69.7, 84.9) for isolated root replacements (63%,141/225) which was not statistically significant (P = 0.397). No significant difference in operative SVD at 15 years occurred between full root replacements 37.6% (95% CI 27.2-50.2) vs subcoronary implants 39.4% (95% CI31.1, 49.0). 110 patients required reoperation solely for intrinsic SVD. 93% (102/110) failed due to aortic insufficiency. Of reoperative interventions for SVD, 37% (41/110) of patients required urgent reoperation and 4.5% (5/110) required emergent reoperation. Pseudoaneurysms developed in six of the full root replacements. Freestyle aortic valves have a high rate of acute failure requiring urgent or emergent reintervention in patients 60 years old and younger. This has led our group to shift practice away from their implantation.


Subject(s)
Bioprosthesis , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Follow-Up Studies , Humans , Middle Aged , Prosthesis Design , Treatment Outcome
3.
Interact Cardiovasc Thorac Surg ; 32(6): 839-845, 2021 05 27.
Article in English | MEDLINE | ID: mdl-33570145

ABSTRACT

OBJECTIVES: The Magna Ease aortic valve (Edwards Lifesciences, Irvine, CA) is a third-generation bioprosthetic valve developed as a modification of the well-studied Perimount and Magna valve designs. This study's objective is to evaluate a large, single-centre experience with Magna Ease aortic valve replacement (AVR) focusing on clinical outcomes and haemodynamic performance. METHODS: All patients undergoing AVR between 8/2010 and 10/2018 at our institution implanted with the Magna Ease valve were included except those undergoing ventricular assist device or congenital aortic surgery. Primary outcomes were overall survival and freedom from reoperation. Mean transprosthetic gradient (mTPG) and structural valve deterioration (SVD) served as secondary outcomes. RESULTS: Totally 1126 consecutive implantations of Magna Ease valves were included. Concomitant procedures were performed in 56.5% (n = 636). No severe patient-prosthesis mismatch (PPM) was present at implantation. Overall survival at 30 days, 1 year, 5 years and 9 years was 97.2%, 95.0%, 86.1% and 78.2%, respectively, with improved survival for isolated AVR. Total of 2.4% (n = 27) of patients required reoperation with 0.3% (n = 4) for SVD. Echocardiographic follow-up data revealed low mTPG throughout the study period. SVD occurred in 28.7% of patients at a mean of 3.9 years post implantation. CONCLUSIONS: Magna Ease AVR maintained low mean transprosthetic gradients throughout mid-term evaluation and was associated with excellent overall survival and freedom from reoperation at nine years post implantation.


Subject(s)
Aortic Valve Stenosis , Bioprosthesis , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Heart Valve Prosthesis Implantation/adverse effects , Hemodynamics , Humans , Prosthesis Design , Retrospective Studies , Treatment Outcome
4.
World J Pediatr Congenit Heart Surg ; 11(4): 518-519, 2020 07.
Article in English | MEDLINE | ID: mdl-32645770

ABSTRACT

Extremely low birth weight neonates with complex congenital heart disease have increased mortality risk. Multi-organ dysfunction, pulmonary disease, fluctuating pulmonary vascular resistance, and complex cardiovascular anatomy create a challenge for effective management. We present the case of a 760-g neonate with dextro-transposition of the great arteries, ventricular septal defect, patent ductus arteriosus, and single coronary artery with proximal intramural segment of the right coronary artery branch. We describe features of preoperative care, surgical intervention, and postoperative course that enabled this infant to survive.


Subject(s)
Cardiac Surgical Procedures/methods , Infant, Extremely Premature , Transposition of Great Vessels/surgery , Cardiac Catheterization/methods , Extracorporeal Membrane Oxygenation/methods , Humans , Infant, Newborn
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