RESUMO
The case was a 65-year-old woman. She underwent graft replacement of ascending aorta because she developed Stanford type A acute aortic dissection in November 2016. After six months she had a fever, so she underwent contrast-enhanced computed tomography and echocardiography at the previous hospital. An abnormal shadow was found in the artificial blood vessel, and the blood culture test was positive. The abnormal shadow was suspected to be a vegetation and was referred to our department. Vegetation was highly mobile and emergency surgery was performed considering the risk of embolism. Intraoperative findings showed that vegetation was attached to the anastomotic site of the artificial blood vessel. She was transferred to a rehabilitation hospital 57 days after the operation and is currently rehabilitating.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Embolia , Idoso , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Feminino , HumanosRESUMO
From May 1976 to June 2001, 95 porcine heart valve bioprostheses (BPs) were explanted. Among them, 85 prostheses were available for an analysis of structural valve deterioration (SVD). There were 32 Hancock (H) BPs and 53 Carpentier-Edwards (CE) BPs, with a mean implantation duration of 12 +/- 3.5 and 11.0 +/- 4 years, respectively. There were two extraordinary complications. One was commissural dehiscence (CD) of the CEBPs in 10/53 cases (18.9%), with a mean duration of 12.7 +/- 2.7 years. This was not observed in the HBPs. The other was pannus formation in both BPs. In the mitral position, it was 25/32 (78.1%) in HBPs and 37/53 (69.8%) in CEBPs. In the aortic position, it was 4/32 (1.3%) in the HBPs and 11/53 (20.8%) in the CEBPs. We conclude that CD could not be diagnosed preoperatively and anticoagulation is therefore indicated to prevent pannus formation of such prostheses, particularly in those located in the mitral position.
Assuntos
Bioprótese , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias , Deiscência da Ferida Operatória , Animais , Calcinose , Feminino , Doenças das Valvas Cardíacas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , SuínosRESUMO
BACKGROUND: Coronary artery bypass grafting (CABG) for hemodialysis patients is high risk compared with other patient groups. The aim of this study was to analyze the potential benefits of off-pump CABG for hemodialysis patients. METHODS: From April 1994 through December 2000, 26 hemodialysis patients underwent CABG. The off-pump group consisted of 15 patients operated on without a pump and the on-pump group consisted of 11 patients operated on with a pump. RESULTS: There was no difference between the two groups with regard to mean age, mean number of diseased vessels and mean number of anastomoses per patient. No patient died in either group during hospitalization. The postoperative complication rate was low in both groups. The postoperative ventilation time was shorter in the off-pump group (8.5 vs 26.1 hours, p < 0.001, respectively [off-pump group vs on-pump group]). The length of ICU stay was shorter in the off-pump group (1.7 vs 3.5 days, p = 0.01, respectively [off-pump group vs on-pump group]). The medial cost was lower in the off-pump group (26,200.80 dollars versus 44,024.10 dollars p = 0.0001 respectively [off-pump group vs on-pump group]). CONCLUSIONS: Off-pump CABG provided excellent less-invasive cardiac surgical results for dialysis patients.
