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1.
Kyobu Geka ; 68(9): 777-9, 2015 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-26329712

RESUMO

A 53-year-old woman was developed congestive heart failure. She was diagnosed as having aortic coarctation, incompetent bicuspid aortic valve and an aberrant right subclavian artery by using echocardiography and enhanced computed tomography. Ankle brachial pressure index(ABI)in the right was 0.71 and 0.69 in the left. Blood pressure of the right arm was 60 mmHg lower than that of the left arm. To avoid perioperative adverse cardiac events due to a 2-staged operation, we performed ascending-descending aortic bypass and aortic valve replacement simultaneously through a median sternotomy. The heart was retracted cranially, and a vascular prosthesis was anastomosed to the descending aorta just above the diaphragm in an end-to-side manner. Then the graft was placed curvilinearly around the right atrium and was anastomosed to the ascending aorta. After the operation, the right and left ABI increased to 0.90 and 0.98 respectively. There was no pressure difference between the arms. The postoperative course was uneventful.

2.
J Card Surg ; 30(5): 433-5, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25783563

RESUMO

A 65-year-old male was diagnosed with purulent pericarditis, caused by Staphylococcus aureus five weeks after bare metal stenting for a 90% stenosis of the right coronary artery ostium. Subsequently, he developed a pseudoaneurysm in the right coronary sinus of Valsalva (CSV) requiring surgical intervention during the treatment of the pericarditis. Bacteremia after percutaneous coronary intervention (PCI) occurs in < 1% of patients and usually has insignificant clinical sequelae. We present an infected coronary bare metal stent of the proximal right coronary artery after PCI that resulted in a purulent pericardial effusion and mycotic pseudoaneurysm of the right coronary sinus of Valsalva (CSV). The patient successfully underwent surgical treatment.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Aneurisma Aórtico/etiologia , Derrame Pericárdico/etiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Estafilocócicas/etiologia , Stents/efeitos adversos , Idoso , Falso Aneurisma/diagnóstico , Aneurisma Infectado/diagnóstico , Aneurisma Aórtico/diagnóstico , Humanos , Masculino , Intervenção Coronária Percutânea/instrumentação , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/microbiologia , Pericardite/diagnóstico , Pericardite/etiologia , Infecções Relacionadas à Prótese/diagnóstico , Seio Aórtico , Infecções Estafilocócicas/diagnóstico
3.
Surg Case Rep ; 1(1): 24, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26943392

RESUMO

The anomalous origin of the left coronary artery from the pulmonary artery - known as Bland-White-Garland syndrome - is a rare congenital malformation that affects 1 in 300,000 live births. Most patients die in infancy without any surgical treatment. Some patients who survive past childhood often have varying symptoms such as myocardial ischemia, impaired left ventricular function, mitral regurgitation, and progressive heart failure, depending on the development collateral circulation. In the present report, we describe a procedure wherein the left coronary artery ostium was translocated through the transverse sinus of the pericardium in a 43-year-old mother with Bland-White-Garland syndrome and concomitant mitral regurgitation and report on the associated midterm results.

4.
Gen Thorac Cardiovasc Surg ; 60(9): 569-71, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22945860

RESUMO

Persistent left superior vena cava without a right superior vena cava is an extremely rare condition. We report the case of a 65-year-old woman with this condition who underwent mitral valve plasty. During cardiac catheterization, the asymptomatic patient with mitral valve prolapse syndrome was found to have a persistent left superior vena cava without a right superior vena cava. During mitral valve plasty, cardiopulmonary bypass was established using bicaval drainage through the persistent left superior vena cava and the right atrium. A cannula was inserted into the persistent left superior vena cava to provide a large surgical field in the left atrium. We selected a technique that involved direct insertion of an L-shaped cannula into the persistent left superior vena cava and obtained a clear view of the surgical field. Proper assessment of the right superior vena cava is necessary when a persistent left superior vena cava is suspected.


Assuntos
Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Prolapso da Valva Mitral/cirurgia , Malformações Vasculares/complicações , Veia Cava Superior/anormalidades , Idoso , Cateterismo Cardíaco , Ponte Cardiopulmonar , Feminino , Humanos , Achados Incidentais , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico , Esternotomia , Resultado do Tratamento , Malformações Vasculares/diagnóstico
5.
Surg Today ; 42(12): 1195-200, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22797961

RESUMO

PURPOSE: To achieve early recovery and early discharge from the hospital by applying an enhanced recovery after surgery (ERAS) protocol, which is mainly used with colonic surgery, for the perioperative management of open AAA surgery. METHOD: One hundred twenty-seven open AAA surgery cases successfully carried out between 2003 and 2011 were included in this study. The ERAS protocol was used for the cases from April 2008 onward, and we performed a comparison of the conventionally treated cases with ERAS cases regarding the start of postoperative oral consumption, the postoperative hospital stay, and hospitalization medical costs. RESULTS: The time to restarting oral consumption and the postoperative hospital stay were significantly shorter for the ERAS group (n = 52) compared to the conventionally managed group (n = 75); with values of 59 ± 15 and 93 ± 25 h (p = 0.021), 9 ± 3 and 16 ± 5 days (p = 0.001), respectively. The medical costs for the ERAS group were 92 % of the costs of the conventionally managed group. CONCLUSION: Use of the ERAS protocol for the perioperative management of open AAA surgery shortened the time before recommencing oral consumption, the postoperative hospital stay, and reduced the medical costs compared to the conventional approach.


Assuntos
Aneurisma da Aorta Abdominal/economia , Aneurisma da Aorta Abdominal/cirurgia , Tempo de Internação/economia , Idoso , Aneurisma da Aorta Abdominal/reabilitação , Protocolos Clínicos , Deambulação Precoce/economia , Medicina Baseada em Evidências/métodos , Feminino , Custos Hospitalares , Humanos , Masculino , Estudos Prospectivos , Tóquio , Resultado do Tratamento
6.
Ann Thorac Surg ; 93(6): 2065-7, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22632509

RESUMO

The patency rate of saphenous vein grafts (SVGs) for children with Kawasaki disease (KD) tends to decline during the early years after coronary artery bypass grafting (CABG). Although degenerative changes have been considered the main cause of SVG occlusion, there have been no reports on the histopathologic features of the SVG in patients with KD. We herein describe a redo off-pump total arterial revascularization in a 43-year-old man with KD, 34 years after the first CABG using SVG. The histopathologic examination of the longest-lived SVG demonstrated that graft occlusion was mainly caused by the diffuse intimal hyperplasia.


Assuntos
Ponte de Artéria Coronária , Oclusão de Enxerto Vascular/patologia , Oclusão de Enxerto Vascular/cirurgia , Sobrevivência de Enxerto/fisiologia , Síndrome de Linfonodos Mucocutâneos/patologia , Síndrome de Linfonodos Mucocutâneos/cirurgia , Veias/patologia , Veias/transplante , Adolescente , Adulto , Atrofia , Criança , Angiografia Coronária , Humanos , Hiperplasia , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Músculo Liso Vascular/patologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Reoperação , Tomografia Computadorizada por Raios X , Túnica Íntima/patologia
9.
Surg Today ; 40(9): 871-3, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20740352

RESUMO

A 70-year-old male patient had a tumor in the left ventricular apex that was detected by transthoracic echocardiography. He had no clinical manifestations. A diagnosis of benign lipoma was made using the noninvasive fat suppression technique of cardiac magnetic resonance imaging (MRI). Video-assisted surgery was performed to resect the tumor, and the histopathological examination confirmed the diagnosis of lipoma. A small part of the tumor was not resected. The postoperative course was uneventful. No signs of recurrence were detected on transthoracic echocardiography or MRI during a 22-month post surgical follow-up period.


Assuntos
Lipoma/diagnóstico , Imageamento por Ressonância Magnética , Idoso , Ecocardiografia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Humanos , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Masculino , Cirurgia Vídeoassistida
10.
Circ J ; 74(4): 735-40, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20154407

RESUMO

BACKGROUND: In the present study the effective dose and image quality at distal anastomoses were retrospectively compared between prospective electrocardiogram (ECG)-gated axial and retrospective ECG-gated helical techniques on 64-detector computed tomographic (CT) angiography following coronary artery bypass graft surgery. METHODS AND RESULTS: Following bypass surgery, 52 patients with a heart rate <65 beats/min underwent CT angiography: 26 patients each with prospective and retrospective ECG gating techniques. The effective dose was compared between the 2 groups using a 4-point scale (4, excellent; 1, poor) to grade the quality of curved multiplanar reformation images at distal anastomoses. Patient characteristics of the 2 groups were well matched, and the same CT scan parameters were used for both, except for the interval between surgery and CT examination, tube current, and image noise index. Image quality scores did not differ significantly (3.26+/-0.95 vs 3.35+/-0.87; P=0.63), but the effective dose was significantly lower in the prospective (7.3+/-1.8 mSv) than in the retrospective gating group (23.6+/-4.5 mSv) (P<0.0001). CONCLUSIONS: Following bypass surgery, 64-detector CT angiography using prospective ECG gating is superior to retrospective gating in limiting the radiation dose and maintaining the image quality of distal anastomoses.


Assuntos
Angiografia Coronária/métodos , Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Eletrocardiografia , Tomografia Computadorizada por Raios X/métodos , Idoso , Anastomose Cirúrgica , Diagnóstico por Imagem/normas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Estudos Retrospectivos , Sensibilidade e Especificidade
11.
Surg Today ; 39(8): 717-20, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19639442

RESUMO

There are many difficulties for young women with a Starr-Edwards ball valve who want to attempt pregnancy. There is no consensus regarding whether they should maintain anticoagulation therapy throughout pregnancy with the risk of a thromboembolism or to undergo a reoperation with bioprosthetic heart valves, followed by a third operation when the valve deteriorates. This report presents two cases of young women who underwent mitral valve replacement (MVR) with Starr-Edwards ball valves (model 6120: 1M) during their childhood. Although they did not have any cardiac symptoms, transthoracic echocardiography and cardiac catheterization data demonstrated that both the patients had asymptomatic mild relative mitral stenosis. They both wished to bear a child. After the patients and their family provided thorough informed consent, redo MVRs were preformed safely with biological prostheses. The presence of significant pannus formation along the strut and sewing ring of the excised valves could also have a positive impact on the decision to undergo reoperation.


Assuntos
Bioprótese , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/cirurgia , Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia/prevenção & controle , Adulto , Remoção de Dispositivo , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico , Gravidez , Reoperação , Ultrassonografia
12.
J Artif Organs ; 10(4): 218-22, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18071851

RESUMO

The purpose of this study was to compare the intubation time using Smart Care, a knowledge-based system for automated weaning, with that of conventional physician-controlled weaning after off-pump coronary artery bypass (OPCAB) and to determine the efficacy of Smart Care. During 2004, 53 sequential patients were scheduled for isolated coronary artery bypass grafting without cardiopulmonary bypass. Patients were divided into two groups: the Smart Care group (n = 10) and the control group (n = 35). Eight patients requiring hemodialysis and patients undergoing the awake OPCAB method were excluded. The intubation times were 172.6 +/- 51.6 min in the Smart Care group compared with 342.0 +/- 239.0 min in the control group (P = 0.032). No specific complications occurred with this computer-driven expert weaning system. In conclusion, the Smart Care system reduced the duration of mechanical ventilation and the respiratory care workload. This system was effective in the care of patients without complications requiring mechanical ventilation after OPCAB.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Desmame do Respirador/métodos , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Cuidados Pós-Operatórios/métodos , Respiração Artificial/métodos , Fatores de Tempo , Resultado do Tratamento
13.
Can J Surg ; 49(3): 193-6, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16749980

RESUMO

BACKGROUND: Investigation into the surgical application of robot technology continues to expand. We report on the first case series of robotic-assisted mitral valve (RAMV) repair in Canada with use of the da Vinci telemanipulation system (Intuitive Surgical, Sunnyvale, Calif.). METHODS: Between February 2004 and August 2004, 10 patients with normal left ventricular function and severe mitral valve regurgitation underwent RAMV repair with use of the da Vinci system. Peripheral cardiopulmonary bypass, transthoracic aortic cross-clamping and antegrade cardioplegia were used in all cases. A minithoracotomy in the fourth intercostal space and 2 ports in the third and fifth intercostal spaces allowed surgical access. All mitral valve valvuloplasties and band annuloplasties were done endoscopically with robotic assistance. RESULTS: Nine of 10 patients had successful valve repair, and 1 had conversion to mitral valve replacement due to persistent regurgitation. There were no deaths, strokes or need for sternotomy. One patient required re-exploration for bleeding. CONCLUSION: Minimally invasive RAMV repair is feasible and safe with promising early postoperative results when performed by experienced surgical personnel accomplished in both mitral valve procedures and robotic techniques.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Robótica/instrumentação , Cirurgia Assistida por Computador , Telemedicina/métodos , Adulto , Canadá , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
14.
Heart Surg Forum ; 7(1): 1-4, 2004 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-14980837

RESUMO

Abstract Background: Since the robot-assisted cardiac surgery program at this center was initiated in September 1998 the results have been regularly critically evaluated. We report a retrospective review of the first 100 robotic procedures and their evolution. Methods: Between September 1998 and May 2001, 146 patients underwent robot-assisted procedures. All procedures were performed using the Aesop robotically controlled camera or the Zeus robotic system. A harmonic scalpel was used for all internal thoracic artery (ITA) dissections whether the dissections were performed manually or with the Zeus robotic system. Results: There were 123 closed-heart and 23 open-heart procedures, which included 8 atrial-septal defect repairs, 11 mitral valve repairs, 4 mitral valve replacements, 57 Aesop ITA takedowns, 68 Zeus ITA takedowns, and 13 totally endoscopic coronary artery bypass grafts. Graft patency in Aesop and Zeus ITA takedown groups was 96%. All the patients were New York Heart Association class I after their procedures. Conclusion: With the development of surgical robots, it has been possible to perform endoscopic cardiac surgery for selected cases. Future directions will be demonstrated, including telementoring, telesurgery, and Zeus-assisted initiatives in cardiac surgery and other surgical disciplines.

15.
Ann Thorac Surg ; 76(3): 749-53, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12963192

RESUMO

BACKGROUND: Recent articles have commented on the "learning curve" in robotic-assisted coronary artery bypass grafting. We systematically studied this phenomenon using standard statistical and cumulative sum (CUSUM) failure methods. METHODS: Ninety patients underwent internal thoracic artery (ITA) takedown and an attempt at ITA to coronary bypass on the beating heart using the Zeus telerobotic system from September 1999 to December 2001. The rates of mortality and 11 predefined major complications were compared in five quintiles of 18 consecutive patients each and a CUSUM curve was generated for the entire cohort. RESULTS: All patients but one underwent successful endoscopic ITA takedown. Thirteen patients had a totally endoscopic anastomosis, whereas in 61 a small mini-thoracotomy or mini-sternotomy was used. Sixteen patients (17.8%) were converted electively to a sternotomy: 11 patients underwent off-pump and 5 patients on-pump surgery. There were no deaths; 13 patients (14.4%) incurred one or more of the 11 major complication(s), including 5, 1, 2, 3, and 2 in each of the five quintiles (p = 0.39). Standard statistical analyses identified a significant decrease in operating room time (p < 0.0001), as well as a decrease in the incidence of an occluded graft or wrong vessel grafted from quintiles 1 to 5 (p = 0.03). On CUSUM analysis, the failure curve was steep for the first 18 to 20 patients, before moderating its slope for the remainder of the experience. CONCLUSIONS: Robotic ITA to coronary bypass on the beating heart has a moderately steep learning curve, which is mitigated by further experience. CUSUM analysis complimented standard statistical methods in detecting a cluster of suboptimal results during the early experience with this procedure.


Assuntos
Competência Clínica , Ponte de Artéria Coronária/educação , Robótica/educação , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Surg Laparosc Endosc Percutan Tech ; 12(1): 52-7, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12008763

RESUMO

We sought to determine the efficacy of using robotic assistance to facilitate endoscopic harvesting of internal thoracic arteries (ITAs). A total of 104 patients had ITAs harvested endoscopically with use of both the AESOP 3000 system (Computer Motion, Goleta, CA, U.S.A.) and Zeus robotic telesurgical system (Computer Motion). All ITAs were harvested with a harmonic scalpel (Ethicon Endosurgery, Cincinnati, OH, U.S.A.). With the left lung collapsed, ITAs were harvested with CO2 insufflation through three 5-mm ports in the left chest. All patients tolerated insufflation without hemodynamic compromise. Average ITA harvest time was 61.3 +/- 20.9 minutes. Intraoperative graft flows averaged 36.3 +/- 22.4 mL/min. There were three distal ITA injuries; all other vessels were patent after harvesting and demonstrated no angiographic evidence of injury. This article demonstrates a technique by which ITA can be safely harvested totally endoscopically with use of computer-enhanced robotic systems and a harmonic scalpel, allowing complete pedicle dissection through 5-mm ports with minimal ITA manipulation.


Assuntos
Robótica/métodos , Artérias Torácicas/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Coleta de Tecidos e Órgãos/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artérias Torácicas/transplante , Cirurgia Torácica Vídeoassistida/instrumentação , Fatores de Tempo
17.
Semin Thorac Cardiovasc Surg ; 14(1): 101-9, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11977023

RESUMO

Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. This report describes a computer-assisted totally closed-chest coronary bypass operation, and preliminary results are discussed. The internal thoracic artery (ITA) was harvested through three 5-mm access ports and prepared and controlled endoscopically. A prototype sternal elevator was used to increase intrathoracic working space. A 10-mm endoscopic stabilizer was placed through the second intercostal space, and the left anterior descending coronary artery was controlled with silastic snares. Telerobotic anastomoses were completed end-to-side using custom-made, double-armed 8-0 polytetrafluroethylene sutures. To date, 84 patients have undergone successful myocardial revascularization with robotic assistance with a 0% surgical mortality rate. ITA harvest, anastomotic, and operating times for the entire group have been longer than for conventional surgery at 61.3 +/- 17.9 minutes, 28.5 +/- 28.2 minutes, and 368 +/- 129 minutes, respectively. Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology.


Assuntos
Ponte de Artéria Coronária/tendências , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Robótica/tendências , Cirurgia Assistida por Computador/tendências , Cirurgia Vídeoassistida/tendências , Ponte de Artéria Coronária/instrumentação , Ponte de Artéria Coronária/métodos , Previsões , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Robótica/instrumentação , Robótica/métodos , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Cirurgia Vídeoassistida/instrumentação , Cirurgia Vídeoassistida/métodos
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