Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Síndrome de Marfan/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia/métodos , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/cirurgia , Biópsia por Agulha , Seguimentos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Humanos , Imuno-Histoquímica , Cuidados Intraoperatórios/métodos , Masculino , Síndrome de Marfan/diagnóstico , Medição de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos , Adulto JovemRESUMO
BACKGROUND AND AIM OF THE STUDY: The study aim was to assess the surgical options and advantages of beating-heart aortic valve replacement (AVR) in patients with patent coronary artery bypasses. METHODS: In this prospective study, conducted between January and August 2006, four consecutive patients (mean age 77.5 +/- 6.6 years) each with patent coronary artery bypasses, underwent beating-heart AVR using two specific methods of myocardial perfusion based on the origin and status of the grafts, as assessed by preoperative angiography. Pre-operatively, all patients were in NYHA functional class III, and each received an aortic valve bioprosthesis. RESULTS: There were no hospital deaths. The mean duration of ICU stay was 3.2 +/- 1.3 days. One patient presented with transitory atrial fibrillation. At discharge, echocardiography confirmed normally functioning bioprostheses, with no significant transprosthetic gradient. CONCLUSION: Beating-heart AVR with patent coronary artery bypasses using continuous myocardial perfusion is a reliable, simple and effective technique to reduce the risks of graft and myocardial injuries, and to achieve optimal preservation of the hypertrophic myocardium with coronary artery disease.
Assuntos
Valva Aórtica/transplante , Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/cirurgia , Ponte de Artéria Coronária , Circulação Coronária , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Reperfusão Miocárdica/métodos , Estudos Prospectivos , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
Heparin-induced thrombocytopenia and thrombosis syndrome (type II) is associated with thromboembolic complications and a mortality rate up to 30%. We describe a patient who developed intracardiac and aortic Dacron prosthesis heparin-induced thrombosis after aortic root conservative surgery. Successive transoesophageal echocardiographies demonstrated a progressive regression of intracardiac thrombosis with oral anticoagulation by warfarin and antiplatelet therapy combining aspirin and clopidogrel.
