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1.
Thorac Cardiovasc Surg ; 50(6): 325-8, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12457306

RESUMO

BACKGROUND: Despite a negative Allen test, some patients develop hand ischemia after radial artery harvesting. The presence of large interosseous collaterals may reduce the sensitivity of Allen test. To evaluate the combination of ulnar flow measurements and the Allen test as an effective screening technique, we performed Doppler ultrasonography during Allen's maneuver. METHODS: The Allen test was used to select candidates for harvesting radial artery from 80 patients undergoing coronary bypass surgery. RESULTS: Of 71 patients with a negative Allen test, one patient developed hand ischemia. This patient was one of six (7.5 %) possessing low ulnar flow levels (less than 40 ml/min/m(2) during compression of the radial artery). This low-flow group had a higher risk for ischemia of the 71 patients with a negative Allen test. The post-operative flow differed greatly from the pre-operative flow in eight patients (11.3 %), which was likely due to large sacrificed interosseous collaterals. CONCLUSION: Combined use of ulnar flow measurement with the Allen test appears to increase the sensitivity of the Allen test. Neither test, however, is sufficient for a group of patients with large interosseous collaterals.


Assuntos
Mãos/irrigação sanguínea , Mãos/diagnóstico por imagem , Isquemia/diagnóstico , Artéria Radial/transplante , Ponte de Artéria Coronária , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Fluxo Sanguíneo Regional , Ultrassonografia
2.
Jpn J Thorac Cardiovasc Surg ; 49(4): 264-6, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11355264

RESUMO

We report 2 cases in which the double patch technique was used to repair an anterior postinfarction ventricular septal defect. To do this, we modified infarct exclusion as follows: In addition to a conventional patch excluding the infarcted muscle, another small patch is used to directly close the septal defect. Gelatin-resorcin-formal glue is applied between the double patches, which prevent the glue from being washed away and enhance it to polymerize stably, thereby rapidly stabilizing the infarcted myocardium with the endocardial patch. Echocardiography immediately after operation showed the infarcted septum had completely adhered to the endocardial patch. Both patients demonstrated satisfactory postoperative hemodynamics. Although 1 patient did well, the other died 6 months postoperatively due to complications of pneumonia and gastrointestinal bleeding secondary to colon carcinoma. This double patch technique appears useful, although further experience is needed to verify its safety and efficacy.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Comunicação Interventricular/cirurgia , Infarto do Miocárdio/complicações , Próteses e Implantes , Idoso , Idoso de 80 Anos ou mais , Combinação de Medicamentos , Evolução Fatal , Formaldeído/uso terapêutico , Gelatina/uso terapêutico , Comunicação Interventricular/etiologia , Humanos , Masculino , Resorcinóis/uso terapêutico , Adesivos Teciduais/uso terapêutico
3.
Ann Thorac Surg ; 70(5): 1565-70, 2000 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11093488

RESUMO

BACKGROUND: Perioperative stroke is one of the most serious complications of cardiac surgery. METHODS: Using transesophageal echocardiography, we estimated the intimal thickness of the thoracic aorta as an index of the severity of aortic atherosclerosis to determine the risk of stroke in coronary artery bypass grafting (CABG) patients. The study population comprised 315 consecutive patients who underwent isolated CABG with cardiopulmonary bypass. RESULTS: Five patients (1.6%) had perioperative cerebral stroke or systemic emboli. We compared the mean intimal thicknesses of the ascending aorta, aortic arch, and descending aorta. Mean thicknesses in patients without stroke were 2.07 +/- 0.76, 2.78 +/- 1.15, and 2.32 +/- 1.21 mm, respectively, and mean thicknesses in the stroke patients were 1.94 +/- 0.55, 6.94 +/- 3.79, and 3.39 +/- 1.85 mm, respectively. The patients with an intima of more than 5 mm at the aortic arch had a significantly greater incidence of perioperative stroke (p = 0.007). CONCLUSIONS: These results suggest that patients who have an aortic arch intima thickened to more than 5 mm are at a significantly high risk for perioperative stroke, and thus, the CABG procedure should be carefully evaluated to prevent such complications.


Assuntos
Aorta Torácica/patologia , Ponte de Artéria Coronária , Acidente Vascular Cerebral/etiologia , Idoso , Aorta/patologia , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/patologia , Arteriosclerose/patologia , Ecocardiografia Transesofagiana , Embolia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Fatores de Risco , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/patologia
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