RESUMO
OBJECTIVES: Liver cirrhosis is a well-known risk factor of mortality after cardiac surgery, but not considered in the widely used EuroSCOREII (ESII). The objective was to analyse the performance of the ESII, the Child-Pugh-Turcotte (CPT) and the Model of End-stage Liver Disease (MELD) scores to predict hospital mortality in cardiac surgery for cirrhotic patients and to analyse the survival according to the preoperative cirrhosis status. METHODS: Preoperative and cirrhosis characteristics and postoperative outcomes were compared according to hospital mortality. The performance of the 3 scores was analysed by the area under the receiver-operating characteristics (AUC-ROC) by DeLong's method. The survival of the patients who were discharged was analysed by Kaplan-Meier curves according to the preoperative cirrhosis status. RESULTS: Seventy-four patients were included. Observed hospital mortality was 12%, the predictive mortality by ESII was 3.9% ± 5.2%, and AUC-ROC was 0.67 [0.44-0.90]. Only the MELD score was discriminant (AUC-ROC 0.75 [0.57-0.93]). The observed hospital mortality increased by threefold over the ESII (12% versus 3.9%, p < 0.001), except the patients with MELD < 10 for whom hospital mortality was similar as ESII (3% versus 2.6%, p = 0.89). Long-term survival was higher for the MELD < 10 patients. CONCLUSIONS: The ESII did not predict hospital mortality after a cardiac surgery in cirrhotic patients and the MELD score should be considered for decision of cardiac intervention in cirrhotic patients.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Doença Hepática Terminal , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/cirurgia , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
We report the case of a 30-year-old male who had symptomatic bicuspid aortic valve stenosis. Operative findings unexpectedly revealed right juxtaposition of the atrial appendages. This is a rare association, as juxtaposition of atrial appendages is generally associated with more complex forms of congenital heart disease. The patient underwent successful surgery with uneventful postoperative course.
Assuntos
Anormalidades Múltiplas , Estenose da Valva Aórtica/diagnóstico , Valva Aórtica/anormalidades , Apêndice Atrial/anormalidades , Cardiopatias Congênitas/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Adulto , Doença da Válvula Aórtica Bicúspide , Feminino , Humanos , Imageamento Tridimensional , Recém-Nascido , Tomografia Computadorizada por Raios XRESUMO
We report the case of 24-year-old woman who presented with ductal aneurysm 7 years after a triple ligation of a patent ductus arteriosus. She underwent successful repair through median sternotomy and under moderate hypothermic circulatory arrest and selective cerebral perfusion.
Assuntos
Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Parada Cardíaca Induzida , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Aneurisma/etiologia , Artéria Axilar/cirurgia , Ponte Cardiopulmonar , Canal Arterial/cirurgia , Permeabilidade do Canal Arterial/cirurgia , Feminino , Humanos , Esternotomia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemAssuntos
Trombose Coronária/patologia , Pericardiectomia , Pericardite Constritiva/cirurgia , Complicações Pós-Operatórias/patologia , Anticoagulantes/uso terapêutico , Trombose Coronária/tratamento farmacológico , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológicoRESUMO
We report the case of 54 year-old man who presented with an injury of the brachiocephalic artery secondary to a violent blunt chest trauma. The patient underwent urgent open surgical repair. The procedure was achieved on on-pump beating heart approach. The subsequent course was uneventful.
Assuntos
Falso Aneurisma/cirurgia , Tronco Braquiocefálico/lesões , Ponte de Artéria Coronária/métodos , Ferimentos não Penetrantes/cirurgia , Falso Aneurisma/etiologia , Tronco Braquiocefálico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Esternotomia , Enxerto Vascular , Ferimentos não Penetrantes/complicaçõesRESUMO
A 57 year-old woman with a large right atrial myxoma underwent emergency surgical resection in our institute. It is known that surgical management of such tumours is difficult regarding venous cannulation and embolic risk, but in our patient, the surgery was more challenging because of the severe left ventricular dysfunction. Thus, we aim on the one hand, to discuss the association between the left ventricular dysfunction and the right atrial myxoma, and, on the other hand, to describe the on-pump beating heart technique we used to remove this mass.
Assuntos
Neoplasias Cardíacas , Mixoma , Disfunção Ventricular Esquerda , Feminino , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Pessoa de Meia-Idade , Mixoma/complicações , Mixoma/patologia , Mixoma/cirurgia , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/cirurgiaRESUMO
The left superior vena cava is the most common congenital venous anomaly in the chest; however, its drainage into the left atrium is exceptional. The aim of the paper is to describe our novel technique to connect the left superior vena cava to the right cavities using the left atrial appendage, without cardiopulmonary bypass.
Assuntos
Anormalidades Múltiplas/cirurgia , Apêndice Atrial/transplante , Procedimentos Cirúrgicos Cardíacos , Átrios do Coração/cirurgia , Defeitos dos Septos Cardíacos/cirurgia , Tetralogia de Fallot/cirurgia , Malformações Vasculares/cirurgia , Veia Cava Superior/cirurgia , Anormalidades Múltiplas/diagnóstico , Anastomose Cirúrgica , Ponte Cardiopulmonar , Criança , Átrios do Coração/anormalidades , Defeitos dos Septos Cardíacos/diagnóstico , Humanos , Tetralogia de Fallot/diagnóstico , Transplante Autólogo , Resultado do Tratamento , Malformações Vasculares/diagnóstico , Veia Cava Superior/anormalidadesRESUMO
Textiloma is unusual and uncommon diagnosis which is rarely considered. We report the case of a 13 year-old patient with Holt-Oram syndrome. He was operated on in 2006 for ostium secundum atrial septal defect. The postoperative course was uneventful until 2010 when the child presented paroxysmal dyspnoea. Investigations revealed para-cardiac mass which was thought to be a hydatid cyst, but operative findings showed textiloma.
