RESUMO
OBJECTIVES: The present study aimed to evaluate the prognostic value of preoperative carbohydrate antigen 125 (CA125) levels for clinical outcomes after off-pump coronary artery bypass grafting (OPCAB). METHODS: A total of 314 consecutive patients who underwent OPCAB were enrolled in this study and divided into three groups corresponding to baseline CA125 level tertiles. Clinical outcomes of these patients were followed up after 1 year. The primary endpoint was the incidence of combined major adverse cardiac events (MACE). RESULTS: Event-free survival was significantly associated with the CA125 tertile (log-rank P=0.021); specifically, hazard ratios (HRs) increased progressively from CA125 tertile 1 to tertile 3 [vs. tertile 1: tertile 2 h=1.8; 95% confidence interval (CI): 1.1-2.8, P=0.040; tertile 3 h=2.9; 95% CI: 1.1-8.1, P=0.018]. In the first multivariate Cox regression analytical model (all variables except EuroSCORE), CA125 was an independent predictor of MACE (HR=1.1, 95% CI: 1.0-2.4, P=0.016). In a second model (CA125 levels and EuroSCORE only), CA125 remained an independent predictor of MACE (HR=1.1, 95% CI: 1.0-1.3, P=0.036). CONCLUSION: An increased preoperative CA125 level is an independent predictor of worse clinical outcomes after OPCAB during a 1-year follow-up.
Assuntos
Antígeno Ca-125/sangue , Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Proteínas de Membrana/sangue , Idoso , Biomarcadores/sangue , Distribuição de Qui-Quadrado , China , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Creatina Quinase Forma MB/sangue , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/etiologia , Modelos de Riscos Proporcionais , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento , Troponina I/sangueRESUMO
OBJECTIVE: This study demonstrated left atrial endocardial dysfunction and platelet activation in patients with atrial fibrillation and mitral stenosis. METHODS: Study included 80 patients with mitral stenosis and atrial fibrillation (40 each with and without left atrial thrombosis), 15 healthy volunteers, and 10 left atrial appendage (LAA) specimens from donor hearts. Blood samples were collected through peripheral vein and left atrium, with peripheral blood samples of volunteers as controls. LAA specimens were collected during operations. LAA expressions of von Willebrand factor (vWF) and P-selectin were determined immunohistochemically; plasma concentrations were measured by enzyme-linked immunosorbent assay. LAA expressions of vWF and P-selectin genes in were quantitated with real-time fluorescent quantitative polymerase chain reaction. RESULTS: The difference in vWF and P-selectin plasma levels between left atrial and peripheral venous blood was not significant; however, peripheral plasma levels of vWF and P-selectin were significantly higher in those with thrombosis than without thrombosis, which in turn were higher than in healthy subjects. Both vWF and P-selectin proteins were stained in both left atrial endocardium and cardiomyocytes. The normalized vWF gene expression relative to control was 3.04 in patients with thrombosis and 2.16 in those without thrombosis (P<.01). The difference in P-selectin gene expressions among the groups was not significant. CONCLUSIONS: No differences were observed in plasma levels of vWF and P-selectin between left atrial and peripheral venous blood. Over expression of vWF gene in LAA may contribute to increased plasma vWF levels. P-selectin and vWF together may play a role in thrombosis.
Assuntos
Fibrilação Atrial/complicações , Função do Átrio Esquerdo , Endocárdio/fisiopatologia , Estenose da Valva Mitral/complicações , Ativação Plaquetária , Trombose/etiologia , Adulto , Apêndice Atrial/química , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/genética , Fibrilação Atrial/fisiopatologia , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/sangue , Estenose da Valva Mitral/diagnóstico , Estenose da Valva Mitral/genética , Estenose da Valva Mitral/fisiopatologia , Selectina-P/sangue , Selectina-P/genética , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Trombose/sangue , Trombose/diagnóstico , Trombose/genética , Trombose/fisiopatologia , Fator de von Willebrand/análise , Fator de von Willebrand/genéticaRESUMO
A case of persistent left with absent right superior vena cava accompanied with atrial septal defect in a six-year-old girl is presented. This rare venous malformation was diagnosed incidentally during surgery when the pericardium was incised. An L-shape cannula was directly inserted into the left superior vena cava for cardiopulmonary bypass. The atrial septal defect was closed with a fresh autologous pericardial patch. The surgical management of this rare anomaly is the subject of this review.
Assuntos
Anormalidades Múltiplas/cirurgia , Comunicação Interatrial/cirurgia , Malformações Vasculares/cirurgia , Veia Cava Superior/anormalidades , Ponte Cardiopulmonar , Criança , Feminino , Humanos , Esternotomia , Veia Cava Superior/cirurgiaRESUMO
Intercostal artery aneurysms associated with coarctation of aorta (CoA) are rare and their natural histories are poorly understood. This report describes the surgical correction of this anomaly in an adult without performing extracorporeal circulation. The coarctated segment of aorta and intercostal artery aneurysm were resected, and the continuity of the descending aorta was reestablished with an interposed vascular graft.
