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BACKGROUND: The aim of our study was to compare the outcome of patients who underwent mitral valve anterior leaflet repair with and without chordal replacement for degenerative mitral valve insufficiency. METHODS: This study was conducted at our center between May 2006 and May 2013. The study included 125 patients with degenerative mitral valve insufficiency (64 males, 61 females; mean age 47 years, age range 16-78 years) who underwent mitral valve repair with anterior leaflet procedures. The patients were divided into 2 groups. Group A consisted of 56 patients with chordal replacement, and group B consisted of 69 patients with other repair techniques performed. RESULTS: No significant difference was determined between the 2 groups in mortality, recurrence, and reoperation rates. The mortality rate was 3.6% in group A and 1.4% in group B. During the follow-up period, 3 patients were reoperated on (mitral valve replacement) because of severe mitral valve insufficiency. Two of these patients were from group A (3.6%), and the other was from group B (1.4%). One patient in group A underwent intraoperative mitral valve replacement after unsuccessful chordal replacement. Fifty patients (89.3%) in group A and 65 patients (94.2%) in group B exhibited no or mild recurrence of mitral valve insufficiency. CONCLUSION: Mitral valve repair in patients with degenerative mitral valve insufficiency resulting from anterior leaflet pathology is a safe procedure because of its durability and good long-term results. Despite the difficulty of the chordal replacement procedure, it may be used as an alternative technique for anterior mitral valve leaflet repair.
Assuntos
Implante de Prótese de Valva Cardíaca/efeitos adversos , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação , Taxa de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: This study aims to compare three different tricuspid annuloplasty techniques using suture, ring, and band. METHODS: Between January 2010 and December 2015, a total of 231 consecutive patients (78 males, 153 females; mean age 50.3±15.9 years; range, 34 to 66 years) who underwent tricuspid valve annuloplasty using three different techniques were retrospectively analyzed. Tricuspid valve r epair w as p erformed w ith d e Vega a nnuloplasty t echnique (n=62, 26.8%), flexible ring (n=76, 32.9%) or Teflon strip (n=93, 40.3%). Postoperative data including vital signs, echocardiographic reports, functional status, and the rate of re-do surgeries were recorded. RESULTS: Cardiopulmonary bypass times were statistically significantly shorter in the de Vega annuloplasty group (p<0.001). There was no significant difference among the groups in terms of the in-hospital mortality. Late postoperative tricuspid regurgitation grades, systolic pulmonary artery pressure, and right atrial diameters showed significant improvements, compared to baseline, in ring and strip annuloplasty groups. CONCLUSION: Our study results demonstrate that suture-based approaches should be avoided. Instead of performing routine tricuspid ring annuloplasty, Teflon strip annuloplasty may be considered an alternative method in most cases, particularly due to controversy in selection of true ring size and high cost of this surgical material in the real-life setting.
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The surgical treatment of diffuse thoracic aortic pathologies remains a challenge in aortic surgery for surgeons. Traditionally, these aortic diseases are treated with a 2-step approach known as the "elephant trunk procedure." This technique gives us an opportunity for the construction of the distal anastomosis during the initial operation. However, this staged approach is associated with a substantial overall mortality and morbidity. In order to improve the outcomes, few single-stage repair methods have been tried. Most of them are performed through a clamshell incision, and for this reason, it is potentially associated with a high incidence of pulmonary complications. Repair techniques of diffuse thoracic aortic pathologies have changed substantially over the last decade; these techniques appear to have a significant lower operative risk for patients. "Frozen elephant trunk" (FET) technique was developed for combined lesions of the thoracic aorta as a single-stage procedure which is a combination of endovascular treatment and conventional surgery. However, experiences are limited in the field of FET and endovascular techniques that is why traditional 2-staged approach still remains as a first choice in our clinic like many centers. In eligible patients, we use a handmade skirted tube graft for conventional technique in 2-staged repair for diffuse thoracic aortic aneurysm. In this report, we aim to explain the possible advantages of this graft and how we do it.
Assuntos
Doenças da Aorta/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Doenças da Aorta/diagnóstico por imagem , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Humanos , Polietilenotereftalatos , Desenho de Prótese , Técnicas de Sutura , Resultado do TratamentoRESUMO
AIM: To determine the association of monocyte count-to-high-density lipoprotein (HDL)-cholesterol ratio, a recently emerged inflammatory marker, with abdominal aortic aneurysm (AAA) size. PATIENTS & METHODS: A total of 120 asymptomatic AAA subjects (99 male, mean age: 67.1 ± 10.2 years) were enrolled into the study. All data were compared between patients with low and high admission monocyte/HDL ratio. Multivariate linear regression analysis was performed to study the relationship between different variables and AAA size. RESULTS: Compared to patients with below-median monocyte/HDL ratio, aneurysm diameter was significantly higher in above-median monocyte/HDL ratio group (54.3 ± 10.6 mm vs 62.0 ± 12.4 mm, p < 0.001, respectively). Hypertension, coronary artery disease, monocyte/HDL ratio and C-reactive protein were independently associated with AAA diameter. CONCLUSION: Monocyte/HDL ratio is independently associated with AAA size.
Assuntos
Aneurisma da Aorta Abdominal/diagnóstico , Lipoproteínas HDL/sangue , Monócitos/citologia , Idoso , Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/etiologia , Biomarcadores/sangue , Proteína C-Reativa/análise , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Hipertensão/complicações , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise MultivariadaRESUMO
OBJECTIVE: To compare the nerve injury and vessel disruption complicaitons in patients undergoing saphenous vein stripping using olive heads of different sizes. METHODS: Big olive heads were used in group A (n=50) and small olive heads were used in group B (n=50) from the ankle to the groin; in group C (n=50), the vein was stripped in two sections; in an upward fashion by stripping the distal portion from the ankle to the level of the knee using small olive heads and by stripping the proximal portion from the knee to the level of the groin using big olive heads. RESULTS: Six months after the operation, nerve injury symptoms were identified in 26%, 4%, 6% of patients in groups A, B, and C respectively. Vessel disruption occurred 2% in group A, 32% in group B, and 4% in group C. Both vessel disruption and nerve injury complications of group C were significantly lower than group A and B (p<0.001). CONCLUSION: Saphenous stripping using big olive heads for the proximal portion from the groin down to the level of the knee and using small olive heads for the distal portion from the knee to the level of the ankle is the alternative method which results in minimal nerve injury and vessel disruption.
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Background This pilot study aimed to evaluate the effectiveness of posterior left atrial wall plication (T-plasty) in patients with persistent atrial fibrillation (AF) (> 7 days) undergoing mitral valve surgery. Materials and Methods A total of 60 patients who were scheduled for mitral valve replacement were randomly allocated into two groups: one would receive (Group 1; n = 32, mean age; 49.37 ± 9.00) and one would not receive (Group 2; n = 28; mean age 48.64 ± 8.6) left atrial size reduction using T-plasty technique. Patients with a clear indication for combined procedures other than tricuspid valve disease, aortic valve disease, and coronary artery stenosis were not included. Follow-up was performed at 6th, 12th, and 18th months after the operation. Results After the operation, 21 patients (65.6%) in Group 1 and 13 patients (46.4%) in Group 2 regained sinus rhythm (p = 0.13). Mortality did not occur. AF recurrence rates were not significantly different between the groups in three follow-ups. Restoration of sinus rhythm was significantly more common in Group 1 patients than in Group 2 patients during follow-up. Patients in Group 1 had lower left atrial volume indexes than those in Group 2 at the 6th and 12th months, whereas the difference at the 18th month was at the limit of significance. Conclusion We achieved satisfactory results using the T-plasty technique for left atrial size reduction in terms of mid-term restoration and preservation of normal sinus rhythm in patients undergoing mitral valve surgery. Further study may be justified to reveal the prognostic importance of the technique described herein.
Assuntos
Fibrilação Atrial/cirurgia , Função do Átrio Esquerdo , Átrios do Coração/cirurgia , Frequência Cardíaca , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Adulto , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Projetos Piloto , Estudos Prospectivos , Recuperação de Função Fisiológica , Recidiva , Fatores de Tempo , Resultado do Tratamento , TurquiaRESUMO
BACKGROUND: To determine predictors of mortality after surgical management of post-infarction ventricular septal rupture repair. METHODS: A total of 63 patients (73.2%, mean age 67.22±7.71 years, male:female ratio; 35:28) underwent open heart surgery for post-infarction ventricular septal rupture repair. Patient demographics, operative data and postoperative parameters were analysed to reveal predictors of early mortality and long-term survival. RESULTS: In-hospital mortality was 54.0% (34/63). Time from myocardial infarction to operation ≤ 14 days (OR: 4.10, 95% CI 1.16-14.46, p=0.02), systolic pulmonary artery pressure > 45 mmHg (OR: 4.14, 95% CI 1.110-15.496, p=0.03) and age (years) (OR: 1.09, 95% CI 1.002-1.194, p=0.04) were found to be independent predictors of in-hospital mortality. In multivariate Cox regression analysis, presence of pulmonary oedema on admission (HR: 4.95, 95% CI 1.58-15.54, p=0.006), age (years) (HR: 1.09, 95% CI 1.009-1.180, p= 0.02) and cross-clamp time <60 min (HR: 3.93, 95% CI 1.13-13.64, p=0.03) were found to be independent predictors of long-term survival. Within a follow-up of a median of 60.0 months, five-year survival rate was 67±9.0%. CONCLUSION: In line with the previous studies, our study demonstrated the benefits of delaying the repair for post-infarction ventricular septal rupture to allow adequate myocardial healing if haemodynamic status of the patient allows.
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Mortalidade Hospitalar , Infarto do Miocárdio , Ruptura do Septo Ventricular , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia , Taxa de Sobrevida , Fatores de Tempo , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/mortalidade , Ruptura do Septo Ventricular/fisiopatologiaRESUMO
In graft-replacement surgery of the ascending aorta and aortic arch, 2 separate grafts are frequently needed in order to construct a more physiologically configured aorta. We describe a new cutting method for accurate performance of graft-to-graft anastomosis.
Assuntos
Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Prótese Vascular , Adulto , Idoso , Anastomose Cirúrgica , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/cirurgia , Desenho de Prótese , Reoperação , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
We describe a novel suture technique of distal anastomosis between the graft and the aorta in ascending aortic aneurysm repair surgery. In this technique, the aortic graft is positioned inside the distal aortic lumen with an overlapping segment and circumferential or back wall part only diagonal basting stitches are performed without use of Teflon pledgets, strips, or bioadhesives. This new technique establishes a secure anastomosis line, shortens anastomosis time, and avoids the use of foreign materials.
Assuntos
Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Técnicas de Sutura , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Humanos , Desenho de Prótese , Técnicas de Sutura/efeitos adversos , Resultado do TratamentoRESUMO
We have investigated the effects of ketamine-based and remifentanil-based anesthetic protocol on perioperative serum cystatin-C levels, and creatinine and/or cystatin-C-based eGFR equations in terms of acute kidney injury in coronary artery bypass graft (CABG) surgery. Using a simple randomization method (coin tossing), patients were divided into the two groups and not-blinded to the anesthetist. Remifentanil-midazolam-propofol or ketamine-midazolam-propofol-based anesthetic regimen was chosen. Different eGFR formulas using creatinine (MDRD, CKD-EPI, Cockrauft Gault); cystatin-C (eGFR1, eGFR2) or a combination of creatinine and cystatin-C (eGFR 3) were used to calculate estimated glomerular filtration rates (eGFRs). High-sensitive troponin T was used to determine if ketamine use in coronary surgery contributed to myocardial cell damage. Thirty-seven patients were included in the study (remifentanil group = 19, ketamine Group = 18). Urea, creatinine, cystatin-C levels were comparable between the groups in all the measurement times and also postoperative day 2 samples showed statistically higher results compared to baseline (p < 0.001). Effects of ketamine and remifentanil on renal functions were found similar. Creatinine and cystatin-C-based eGFR equations resulted similar in our study. Reversible stage 1 acute kidney injury (AKI) was observed on postoperative day 2 in seven patients from the remifentanil group and six patients from the ketamine group. Hs-troponin T was found to be higher in postoperative day 1 samples; there were no significant difference between the groups. Our results indicated that patients who have normal renal functions undergoing on-pump coronary bypass surgery, effects of ketamine and remifentanil on renal functions in terms of AKI were found to be similar.
Assuntos
Injúria Renal Aguda/sangue , Anestésicos/administração & dosagem , Taxa de Filtração Glomerular/efeitos dos fármacos , Ketamina/administração & dosagem , Piperidinas/administração & dosagem , Complicações Pós-Operatórias , Idoso , Ponte de Artéria Coronária/métodos , Creatinina/sangue , Cistatina C/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Remifentanil , Troponina T/sangueRESUMO
AIM: Acute aortic dissection is a life-threatening cardiovascular emergency. Neutrophil-to-lymphocyte ratio is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. The aim of the present study was to evaluate the relationship between admission neutrophil-to-lymphocyte ratio and in-hospital mortality in acute type I aortic dissection. MATERIALS AND METHODS: We retrospectively evaluated 123 consecutive patients who had undergone emergent surgery for acute type I aortic dissection. Patients were divided into 2 groups as patients dying in the hospital (Group 1) and those discharged alive (Group 2). All parameters, including neutrophil-to-lymphocyte ratio, were compared between the 2 groups and predictors of mortality was estimated by using multivariate analysis. RESULTS: A total of 104 patients (79 males, mean age: 55.2 + 14 years) were included in the final analysis. In multivariate analyses, cross- clamp time, cardiopulmonary bypass time, intensive care-unit duration, platelet count, and neutrophil-to-lymphocyte ratio were found to be independent predictors of mortality. Patients with higher neutrophil-to-lymphocyte ratios had a significantly higher mortality rate (hazard ratio: 1.05; 95% CI: 1.01-1.10; P = 0.033). Receiver operating characteristic analysis revealed that using a cut-off point of 8, neutrophil-to-lymphocyte ratio predicts mortality with a sensitivity of 70% and specificity of 53%. CONCLUSION: This study suggests that admission neutrophil-to-lymphocyte ratio is a potential predictive parameter for determining the in-hospital mortality of acute type I aortic dissection.
Assuntos
Aneurisma Aórtico/mortalidade , Dissecção Aórtica/mortalidade , Mortalidade Hospitalar , Linfócitos/citologia , Neutrófilos/citologia , Dissecção Aórtica/cirurgia , Aneurisma Aórtico/cirurgia , Biomarcadores/metabolismo , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Contagem de Plaquetas , Estudos Retrospectivos , Sensibilidade e Especificidade , Turquia/epidemiologiaRESUMO
OBJECTIVE: Prosthetic vascular access is the other choice when the superficial venous system is inadequate to perform a simple radio-cephalic and brachio-cephalic fistula. METHODS: This paper reports the outcomes of a prospective cohort study of 54 patients who underwent either saphenous vein (SVI Group, n=29) or PTFE graft (PTFE Group, n=25) interposition surgery for prosthetic hemodialysis access. All patients were evaluated via color Doppler ultrasonography during preoperative course and superficial venous systems of these patients were found inadequate to perform simple radial/brachial artery-cephalic vein anastomosis. Follow-up was performed for every 6-months period. Kaplan-Meier analysis and Log Rank test was used for estimation and comparison of the patency. RESULTS: In SVI group access failure was observed in 5 of 29 patients (17.2%). In PTFE group, access failure was observed in 13 of the 25 patients (52%). Primary patency rate was 93% in 12th month and 82% in 24th month in SVI group while it was 88% in 12th month and 56% in 24th month in PTFE group. According to the Kaplan-Meier method, mean time of primary patency was significantly higher in SVI group when compared to PTFE group (33.03±1.32 months vs. 28.16±1.91 months, Log Rank chi-square value: 7.01, df:1, p=0.008). Secondary patency rate was 96% in 12th month and 93% in 24th month for SVI group while 96% in 12th month and 84% in 24th month for PTFE group. According to the Kaplan-Meier method, mean time of secondary patency was significantly higher in SVI group when compared to PTFE group (34.27±0.95 months vs. 31.16±1.40 months, Log Rank chi-square value: 7.33, df:1, p=0.007). CONCLUSION: Autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due its higher primary and secondary patency, lower complication rate and cost when compared with PTFE grafts.
Assuntos
Derivação Arteriovenosa Cirúrgica , Implante de Prótese Vascular , Artéria Braquial/fisiologia , Antebraço/irrigação sanguínea , Falência Renal Crônica/terapia , Veia Safena/fisiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Diálise Renal , Ultrassonografia Doppler , Grau de Desobstrução VascularRESUMO
BACKGROUND: Ischemic heart disease is a significant complication of atherosclerosis. Myocardial infarction after the development of coronary artery disease can lead to a number of serious complications, including ischemic mitral regurgitation (IMR). Currently there is no consensus regarding the preferred therapeutic modality for moderately severe IMR. In this study, the postoperative outcome of concomitant coronary artery bypass (CABG) and mitral valve repair was compared with that of CABG alone in two groups of patients with moderately severe IMR. METHODS: A total of 84 patients who underwent operations for coronary artery disease and moderately severe IMR were included in the study. Preoperative demographic and clinical characteristics were recorded at the time of admission. The severity of mitral regurgitation was graded using transthoracic echocardiography and left ventriculography. RESULTS: Significant postoperative improvements were observed in ejection fraction and systolic diameter compared to preoperative values (P = .006 and P = .020 respectively, in the intervention group, P = .001 and P = .001 respectively, in the control group). The decrease in pulmonary artery pressure (PAP) was significant only in the intervention group (P = .001). There was a significantly marked reduction in the severity of IMR in the intervention group compared to control. CONCLUSION: Surgical repair of the mitral valve in conjunction with CABG for moderately severe IMR appears to be more effective than isolated CABG for certain outcome parameters, including decreased severity of mitral regurgitation and decreased pulmonary artery pressure.
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Algoritmos , Anuloplastia da Valva Cardíaca/métodos , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/complicações , Isquemia Miocárdica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Isquemia Miocárdica/diagnóstico , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Left ventricular pseudo-aneurysms develop when cardiac rupture is contained by pericardial adhesions or scar tissue due to myocardial infarction, surgery, trauma or infection. Left ventricular pseudo-aneurysms are uncommon, difficult to diagnose and prone to cardiac rupture. Urgent surgical repair is recommended. Here we report on a case of a large left ventricular pseudo-aneurysm on the anterolateral wall due to a previous anterior myocardial infarction, and its successful repair using the on-pump beating-heart technique.
Assuntos
Falso Aneurisma/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ventrículos do Coração/cirurgia , Infarto do Miocárdio/complicações , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Radiografia , UltrassonografiaRESUMO
Reverse T-plasty is an alternative "no resection" technique for posterior mitral leaflet prolapse repair that is inspired by butterfly resection. It combines mediolateral and anteroposterior plane foldings of the posterior leaflet without any resection and shortens cardiopulmonary bypass and cross-clamping time.
Assuntos
Prolapso da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , HumanosRESUMO
A median sternotomy is the most common approach for cardiac and great vessel surgery. After a median sternotomy, healing complications such as instability, nonunion, and infection, are rare but devastating. Predisposing factors for sternal complications are old age, diabetes, steroid treatment, postmenopause state, obesity, reoperation, and the use of bilateral internal mammary arteries. Patients with sternal dehiscence frequently require reoperation to maintain optimum sternal stability. The technique chosen for sternal closure must provide excellent sternal approximation. We describe a modified Robicsek procedure reinforced with figure-of-8 sternal wires. We named this technique "double-check".
Assuntos
Esternotomia/efeitos adversos , Esterno/cirurgia , Deiscência da Ferida Operatória/cirurgia , Técnicas de Fechamento de Ferimentos , Idoso , Fios Ortopédicos , Humanos , Masculino , Reoperação , Esterno/diagnóstico por imagem , Deiscência da Ferida Operatória/diagnóstico por imagem , Deiscência da Ferida Operatória/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/instrumentação , CicatrizaçãoRESUMO
Transventricular mitral valve surgery combined with left ventricular restoration avoids atriotomy and provides a larger operative field. We describe a series of 5 patients in whom we performed transventricular mitral valve repair by various techniques, such as band annuloplasty, papillary muscle reattachment, chordal cutting, and edge-to-edge repair. The more acute forms of ischemic mitral regurgitation, as found in our patients, can coexist with post-myocardial infarction contained rupture or post-myocardial infarction ventricular septal rupture. Because these patients already have an indication for ventriculotomy, concomitant transventricular repair of the mitral valve can render a separate atriotomy unnecessary and thereby shorten the duration of cardiopulmonary bypass. Moreover, in patients with acute presentations, the absence of atrial dilation (this last associated with chronic cases) might make transventricular repair a better choice than the more difficult atrial approach.
Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Infarto do Miocárdio/complicações , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Doppler em Cores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Resultado do TratamentoRESUMO
Subvalvular apparatus preservation is an important concept in mitral valve replacement (MVR) surgery that is performed to remedy mitral regurgitation. In this study, we sought to determine the effects of papillary muscle repositioning (PMR) on clinical outcomes and echocardiographic left ventricular function in rheumatic mitral stenosis patients who had normal left ventricular systolic function. We prospectively assigned 115 patients who were scheduled for MVR surgery with mechanical prosthesis to either PMR or MVR-only groups. Functional class and echocardiographic variables were evaluated at baseline and at early and late postoperative follow-up examinations. All values were compared between the 2 groups. The PMR group consisted of 48 patients and the MVR-only group of 67 patients. The 2 groups' baseline characteristics and surgery-related factors (including perioperative mortality) were similar. During the 18-month follow-up, all echocardiographic variables showed a consistent improvement in the PMR group; the mean left ventricular ejection fraction deteriorated significantly in the MVR-only group. Comparison during follow-up of the magnitude of longitudinal changes revealed that decreases in left ventricular end-diastolic and end-systolic diameters and in left ventricular sphericity indices, and increases in left ventricular ejection fractions, were significantly higher in the PMR group than in the MVR-only group. This study suggests that, in patients with rheumatic mitral stenosis and preserved left ventricular systolic function, the addition of papillary muscle repositioning to valve replacement with a mechanical prosthesis improves left ventricular dimensions, ejection fraction, and sphericity index at the 18-month follow-up with no substantial undesirable effect on the surgery-related factors.
Assuntos
Implante de Prótese de Valva Cardíaca , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Músculos Papilares/cirurgia , Cardiopatia Reumática/cirurgia , Sístole , Função Ventricular Esquerda , Adulto , Idoso , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico , Estenose da Valva Mitral/mortalidade , Estenose da Valva Mitral/fisiopatologia , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/mortalidade , Cardiopatia Reumática/fisiopatologia , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: The aim of this study was to examine the predictive ability of admission neutrophil/lymphocyte ratio (NLR) for predicting amputation in patients with acute limb ischemia who underwent embolectomy. METHODS: We retrospectively analyzed the clinical, hematologic, and amputation data of 254 patients who had undergone embolectomy for acute limb ischemia. There were 152 (52%) men and 93 (48%) women, with a mean age of 66.04 ± 13.30 years. The admission NLR was determined by dividing the absolute neutrophil count by the absolute lymphocyte count. The primary end point was determined as amputation and death. RESULTS: The mean duration of follow-up was 26 months. During the follow-up period, there were 18 (7%) amputations within 30 days of surgery and 36 (15%) amputations over a mean follow-up of 26 months. Based on multivariate logistic regression modeling, no arterial back bleeding and preoperative NLR were observed to be independent risk factors for amputation within 30 days of surgery, and no arterial back bleeding and preoperative NLR were observed to be independent risk factors for midterm amputation for the same time period. A NLR of ≥5.2 was taken as the cutoff based upon the receiver operating characteristic. In receiver operating characteristic curve analysis, a NLR ≥5.2 had 83% sensitivity and 63% specificity in predicting amputation within 30 days of surgery and 63% sensitivity and 63% specificity in predicting midterm amputation. CONCLUSIONS: An elevated NLR is associated with a poorer limb survival after embolectomy. This simple, inexpensive test may therefore be added to risk stratification of these high-risk patients.
Assuntos
Amputação Cirúrgica , Embolectomia/efeitos adversos , Extremidades/irrigação sanguínea , Isquemia/cirurgia , Linfócitos , Neutrófilos , Doença Aguda , Idoso , Amputação Cirúrgica/efeitos adversos , Amputação Cirúrgica/mortalidade , Área Sob a Curva , Distribuição de Qui-Quadrado , Embolectomia/mortalidade , Feminino , Humanos , Isquemia/sangue , Isquemia/diagnóstico , Isquemia/mortalidade , Estimativa de Kaplan-Meier , Salvamento de Membro , Modelos Logísticos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Admissão do Paciente , Valor Preditivo dos Testes , Curva ROC , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
Angiosarcoma, the most common primary malignant neoplasm of the heart in adults, usually presents as pericardial effusion or right-sided heart failure. Rupture of an angiosarcoma-infiltrated cardiac chamber as a cause of hemothorax is very rare in the literature. In this report, we describe a 34-year-old male patient, who presented to emergency service with sudden chest pain and dyspnea. The diagnostic work-up revealed spontaneous right-sided hemothorax and a large right atrial (RA) mass with suspicious atrial perforation. An urgent surgery showed a vascularized irregular RA mass invading the parietal pericardium and pleura and a perforation of the RA free wall. Histopathologic examination confirmed the diagnosis of angiosarcoma, and the patient was subsequently referred for radiotherapy and chemotherapy.