Takayasu's or tuberculous arteritis?

Takayasu's arteritis (TA) is a large vessel vasculitis of unknown aetiology characterised by involvement of the aorta and its major branches. Tuberculous arteritis of the aorta is an uncommon condition usually secondary to the dissemination of Mycobacterium tuberculosis infection from the mediastinum and/or lung to the adjacent aorta; this may mimic TA. We report a case of a 23-year-old woman with cutaneous granulomatous vasculitis and saccular aneurysmal dilation of the aorta and large vessels, and highlight the findings shared by TA and tuberculous arteritis.

Cirugía de bypass en la enfermedad coronaria multivasos: tratamiento antiguo con vigencia actual / Bypass surgery in multivessel coronary disease: old and contemporary relevance treatment

Objetivo: Evaluar nuestros resultados a corto y largo plazo en la cirugía de bypass para el grupo de enfermedad coronaria multivasos (3 vasos y/o tronco izquierdo). Analizar recientes estudios que comparan stent liberador de drogas (DES del inglés Drug eluting stents) versus cirugía. Actualizar recomendaciones. Métodos: Se analiza retrospectivamente 121 pacientes consecutivos tratados con cirugía de revascularización miocárdica por enfermedad coronaria multivasos entre diciembre de 1998 y febrero de 2008 y se comparan con los resultados de la literatura. Además se evaluó la presencia de factores de riesgo preoperatorios que influenciarían los resultados. Resultados: La mortalidad hospitalaria (30 días) fue de 2.5%. A un seguimiento de 4.4 años, en 100 pacientes se observa una sobrevida de 93.21% y una necesidad de repetir revascularización de 3.3%. Conclusión: Se observa un aumento de los factores de riesgo (edad y procedimientos coronarios previos, sean quirúrgicos o intervencionistas) en la población que acude a cirugía, a pesar de lo cual la morbi-mortalidad continúa baja, incluso en el seguimiento a largo plazo. Nuestros resultados concuerdan con los de las publicaciones internacionales de centros avanzados. Estudios randomizados y observacionales de estos centros muestran, en la enfermedad coronaria multivasos, que la cirugía tiene menos eventos adversos cardiacos y cerebro vasculares que el stent y ventaja en la sobrevida a largo plazo. La cirugía se mantiene como la opción preferida para la enfermedad coronaria multivasos no aguda, en especial cuando las lesiones coronarias son anatómicamente complejas.

Objective: With this study we have assessed our early and late surgical outcomes in patients with Multivessel Coronary Artery Disease (CAD) (defined as 3 coronary vessels or Left Main Coronary Disease) treated with Coronary Artery Bypass Grafting (CABG) Surgery. We have analyzed studies comparing Drug Eluting Stent (DES) versus CABG Surgery to treat Multivessel CAD. We have reviewed all up to date guidelines and recommendations. Methods: We have retrospectively analyzed 121 consecutive patients with multivessel CAD treated with CABG surgery. Results: In-hospital mortality (30 days) was 2,5 %. A subsequent follow up of 100 patients after 4,4 years showed a rate of survival of 93.21 % and the need for repeat myocardial revascularization procedures in 3,3%. Conclusion: CABG surgery to treat Multivessel CAD has low morbidity and mortality even with increase in the risk factors of the population.We have similar results to other published Randomized Controlled and Observational Trials. These studies show that CABG surgery has lower rates of Mayor Adverse Cardiac and Cerebrovascular Events (MACCE) and higher survival rates than DES. Surgery is still the treatment of choice for non-acute multivessel CAD, especially when there is a complex anatomy.

Surgical repair of coarctation of aorta in adults under left heart bypass.

OBJECTIVE: To describe our experience with repair of coarctation of the aorta in adults using left heart bypass. METHODS: From November 2007 to October 2009, eight adult patients with coarctation of the aorta underwent surgical repair under circulatory support using a left atrium to femoral artery bypass circuit, with graft interposition tube through left posterolateral thoracotomy. Five patients were female, with mean age of 31.5 ± 13.1 years. All patients had hypertension and others associated cardiovascular diseases. RESULTS: There were no deaths or neurological complications. The mean surgical time was 308 minutes with mean left heart bypass and distal aortic clamping time of 73 and 65 minutes respectively. Postoperative bleeding was 696 ml in average. Six patients developed severe hypertension postoperatively requiring intravenous vasodilators. The mean length of stay was 9 days. A significant reduction of gradient blood pressure occurred. Echocardiographic follow-up up to two months postoperatively showed mean aortic / graft gradient of 20.3 mmHg. CONCLUSION: In this series the use of left heart bypass showed to be a safe option in the surgical correction of coarctation of the aorta in adults, especially in patients with abnormal aortic wall. There was no spinal cord ischemia in the cases studied.

Correção cirúrgica da coarctação da aorta em adultos sob assistência circulatória extracorpórea esquerda / Surgical repair of coarctation of aorta in adults under left heart bypass

OBJETIVO: Descrever a experiência do serviço com a correção da coarctação da aorta em adultos utilizando assistência circulatória esquerda. MÉTODOS: De novembro de 2007 a outubro de 2009, oito pacientes adultos com coarctação da aorta foram submetidos a correção cirúrgica com interposição de enxerto tubular através de toracotomia póstero-lateral esquerda e uso de assistência circulatória com uso de circuito átrio esquerdo e artéria femoral. Cinco pacientes eram do sexo feminino e tinham idade média de 31,5 ± 13,1 anos. Todos tinham hipertensão arterial sistêmica (HAS) e apresentavam doenças cardiovasculares associadas. RESULTADOS: Não houve óbitos ou complicações neurológicas. O tempo médio cirúrgico foi de 308 minutos, o tempo médio de assistência circulatória de 73 minutos e o de pinçamento aórtico médio de 65 minutos. O sangramento médio no pós-operatório foi de 696 ml. Seis pacientes evoluíram com HAS grave no pós-operatório, sendo necessário uso de vasodilatadores endovenosos. As altas hospitalares ocorreram em média no 9º dia pós-operatório. Houve redução significativa do gradiente médio da pressão arterial sistêmica. O seguimento ambulatorial com ecocardiograma até dois meses de pós-operatório demonstrou gradiente aorta/enxerto médio de 20,3 mmHg. CONCLUSÃO: O uso da assistência circulatória esquerda pode ser uma opção na correção cirúrgica da coarctação da aorta em adultos, principalmente em pacientes com alterações parede da aorta, não sendo observada isquemia medular nos casos estudados.

OBJECTIVE: To describe our experience with repair of coarctation of the aorta in adults using left heart bypass. METHODS: From November 2007 to October 2009, eight adult patients with coarctation of the aorta underwent surgical repair under circulatory support using a left atrium to femoral artery bypass circuit, with graft interposition tube through left posterolateral thoracotomy. Five patients were female, with mean age of 31.5 ± 13.1 years. All patients had hypertension and others associated cardiovascular diseases. RESULTS: There were no deaths or neurological complications. The mean surgical time was 308 minutes with mean left heart bypass and distal aortic clamping time of 73 and 65 minutes respectively. Postoperative bleeding was 696 ml in average. Six patients developed severe hypertension postoperatively requiring intravenous vasodilators. The mean length of stay was 9 days. A significant reduction of gradient blood pressure occurred. Echocardiographic follow-up up to two months postoperatively showed mean aortic / graft gradient of 20.3 mmHg. CONCLUSION: In this series the use of left heart bypass showed to be a safe option in the surgical correction of coarctation of the aorta in adults, especially in patients with abnormal aortic wall. There was no spinal cord ischemia in the cases studied.

Extracorporeal circulation with autogenous oxygenation: hemodynamic and gasometric parameters.

Ten experimental perfusions with autogenous oxygenation were performed in mongrel dogs to evaluate the efficacy of the procedure in maintaining normal hemodynamic the efficacy of the procedure in maintaining normal hemodynamic conditions and adequate blood gases for 1 h. Blood was drained from the right and left atria and pumped to the pulmonary artery and aorta, respectively. Two closed circuits containing compliant chambers and roller pumps were utilized. Artificial ventilation with an FiO2 of 50% were used in 5 animals and with an FiO2 level of 30% in the other 5. EKG, cardiac output, aortic, pulmonary artery, and left atrium pressures were registered. Pulmonary tissue was biopsied after perfusion. The heart was electrically fibrillated after perfusion was established and defibrillated at the end of the bypass. The procedure was able to maintain blood gases and pulmonary, aortic, and left atrial pressures within normal ranges during the perfusion. The mobility of the heart and the access to all coronary arteries was excellent. Clinical central nervous system evaluation, EKG tracings, and pulmonary histological exams showed no adverse effects of perfusion. We conclude that the technique employed may present a suitable proceeding for extracorporeal circulation in closed heart surgeries, and its clinical application should be evaluated as a safe and economical alternative.