RESUMO
A 70-year-old Indian woman presented with an acute anterior wall myocardial infarction and a large multinodular goiter causing tracheal compression and dyspnea. Coronary artery angiography revealed severe triple-vessel disease, with an 80% occlusion of the left main stem, necessitating early coronary artery bypass grafting combined with total thyroidectomy. The procedure was performed successfully. At the 1-year follow-up, the patient remains euthyroid and in New York Heart Association functional class I. This case provides further evidence that combined coronary artery bypass grafting and total thyroidectomy is both feasible and safe.
Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Bócio Nodular/epidemiologia , Infarto do Miocárdio/epidemiologia , Tireoidectomia , Idoso , Comorbidade , Feminino , Bócio Nodular/complicações , Bócio Nodular/diagnóstico por imagem , Bócio Nodular/cirurgia , Humanos , Infarto do Miocárdio/cirurgia , Tomografia Computadorizada por Raios X , Doenças da Traqueia/diagnóstico por imagem , Doenças da Traqueia/etiologiaRESUMO
This project looked at the potential of five different membrane oxygenators to allow passage of catastrophic quantities of air in a clinically simulated environment. All the oxygenators were set up in an identical circuit using heparinized human blood as the perfusate. The study was carried out at flow rates ranging from 1.0 to 6.0 l/min. The clinical situation of obstructed venous drainage was simulated by clamping the venous return line at each respective flow rate, while the initial level of blood in the open system hard shell venous reservoir was maintained at 600 ml. The time interval between the application of the clamp on the venous line and the first appearance of macroscopic air in the arterial line was recorded at each level of flow rate. A graph of time versus flow rate was plotted for each oxygenator type. At a flow rate of 6 l/min, the Safe II oxygenator took 20 seconds to allow passage of air after the venous line was clamped, while it took the Bentley Univox Oxygenator only 10 seconds. The Dideco oxygenator, which has a valve incorporated in its reservoir, did not, however, allow any air to be pumped forward at all. At low rates, some of the oxygenators offered protection against passage of air into the arterial line. Thus the Cobe oxygenator offered protection at flow rates of less than 2 l/min, the Safe II oxygenator at flow rates of up to 2.5 l/min and the Bard oxygenator at flow rates up to 3 l/min.(ABSTRACT TRUNCATED AT 250 WORDS)
