RESUMO
BACKGROUND: Alpha-gal syndrome is an allergic condition in which individuals develop an immune-mediated hypersensitivity response when consuming red meat and its derived products. Its diagnosis is important in individuals undergoing cardiac surgery, as patients frequently require large doses of unfractionated heparin or the insertion of surgical implants, both of which are porcine or bovine in origin. There are currently no guidelines for heparin administration in alpha-gal patients, with even less knowledge regarding the long-term clinical implications of these patients after receiving bioprosthetic valve replacements or other prostheses. CASE PRESENTATION: We present the case of a 31-year-old male who underwent cardiac surgery in the setting of alpha-gal syndrome for a large atrial septal defect (ASD) and mitral valve prolapse (MVP). The patient continues to do well one year after undergoing a mitral valve repair, tricuspid valve repair and an ASD closure using bovine pericardium. He sustained no adverse reaction to the use of heparin products or the presence of a bovine pericardial patch. This rare case was managed by a multidisciplinary team consisting of cardiothoracic surgery, cardiac anesthesiology, and allergy/immunology that led to an optimal outcome despite the patient's pertinent allergic history. CONCLUSIONS: This case highlights that the use of bovine pericardium and porcine heparin to close septal defects in patients with milder forms of alpha-gal allergy can be considered if other options are not available. Further studies are warranted to investigate the long-term outcomes of such potential alpha-gal containing prostheses and heparin exposure and establish the optimal decision making algorithm and prophylactic regimen.
Assuntos
Hipersensibilidade Alimentar , Comunicação Interatrial , Masculino , Humanos , Bovinos , Animais , Suínos , Adulto , Heparina/uso terapêutico , Pericárdio , Comunicação Interatrial/cirurgia , ContraindicaçõesAssuntos
Permeabilidade do Canal Arterial , Comunicação Interventricular , Hipertensão Pulmonar , Adulto , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/cirurgia , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Hipertensão Pulmonar/complicaçõesAssuntos
Aorta Torácica/patologia , Aorta Torácica/cirurgia , Doenças da Aorta/patologia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/métodos , Hematoma/patologia , Hematoma/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Doença Aguda , Idoso de 80 Anos ou mais , Aorta/diagnóstico por imagem , Aorta/patologia , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Seguimentos , Hematoma/diagnóstico por imagem , Humanos , Resultado do TratamentoAssuntos
Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Doenças da Aorta/etiologia , Vasos Coronários/lesões , Vasos Coronários/cirurgia , Fístula/etiologia , Cardiopatias/etiologia , Ventrículos do Coração , Doença Iatrogênica , Intervenção Coronária Percutânea/efeitos adversos , Ruptura/etiologia , Stents/efeitos adversos , Falso Aneurisma/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Angiografia por Tomografia Computadorizada , Vasos Coronários/diagnóstico por imagem , Fístula/cirurgia , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura/cirurgia , Resultado do TratamentoAssuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Embolia/prevenção & controle , Filtração/instrumentação , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco , Idoso , Aorta , Embolia/epidemiologia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: We developed a technique for open heart surgery through a small (5 cm) right-anterolateral thoracotomy without aortic cross-clamp. METHODS: One hundred and ninety-five consecutive patients (103 male and 92 female), age 69 +/- 8 years, underwent surgery between January 2006 and July 2007. Mean preoperative New York Heart Association function class was 2.2 +/- 0.7. Thirty-five patients (18%) had an ejection fraction 0.35 or less. Cardiopulmonary bypass was instituted through femoral (176 of 195, 90%), axillary (18 of 195, 9%), or direct aortic (1 of 195, 0.5%) cannulation. Under cold fibrillatory arrest (mean temperature 28.2 degrees C) without aortic cross-clamp, mitral valve repair (72 of 195, 37%), mitral valve replacement (117 of 195, 60%), or other (6 of 195, 3%) procedures were performed. Concomitant procedures included maze (45 of 195, 23%), patent foramen ovale closure (42 of 195, 22%) and tricuspid valve repair (16 of 195, 8%), or replacement (4 of 195, 2%). RESULTS: Thirty-day mortality was 3% (6 of 195). Duration of fibrillatory arrest, cardiopulmonary bypass, and "skin to skin" surgery were 88 +/- 32, 118 +/- 52, and 280 +/- 78 minutes, respectively. Ten patients (5%) underwent reexploration for bleeding and 44% did not receive any blood transfusions. Six patients (3%) sustained a postoperative stroke, eight (4%) developed low cardiac output syndrome, and two (1%) developed renal failure requiring hemodialysis. Mean length of hospital stay was 7 +/- 4.8 days. CONCLUSIONS: This simplified technique of minimally invasive open heart surgery is safe and easily reproducible. Fibrillatory arrest without aortic cross-clamping, with coronary perfusion against an intact aortic valve, does not increase the risk of stroke or low cardiac output. It may be particularly useful in higher risk patients in whom sternotomy with aortic clamping is less desirable.