RESUMO
UNLABELLED: The mortality of cardiogenic shock (CS) after an acute myocardial infarction (AMI) still remains high. Thrombolysis, PTCA or CABG, when possible, can improve the results, but when all the treatments fail death is almost certain. OBJECTIVE: We investigate the use of the mechanical circulatory assistance (MCA) and heart transplantation (HT) to improve the adverse results in this irreversible situation. METHODS: Among 11 patients with irreversible CS after an AMI we used a MCA (Abiomed BVS-5000). After improvement and hemodynamic stabilization, we performed heart transplantation in 7 patients of mean age 52 years (35-60) including two women. The MCA was univentricular in 7 patients and biventricular in 4. Mean duration of the MCA was 5 days (1-12). RESULTS: Three patients died during the MCA: two due to cerebrovascular accidents and one multiorgan failure. Weaning was possible in one patient. Among Seven transplanted patients one died due to sepsis. Seven (64%) patients are long-term survivors. CONCLUSION: When all the treatments have failed for CS after an AMI, MCA may be used as a bridge to heart transplantation in a select group of patients where the procedure is not contraindicated. The long-term results of 64% survivors in our experience is satisfactory.
Assuntos
Transplante de Coração/fisiologia , Coração Auxiliar , Infarto do Miocárdio/complicações , Choque Cardiogênico/terapia , Adulto , Feminino , Transplante de Coração/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/cirurgia , Análise de SobrevidaAssuntos
Transplante de Coração/mortalidade , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Emergências , Feminino , Humanos , Hipertensão Pulmonar/cirurgia , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Fatores de Risco , Doadores de TecidosRESUMO
We report two cases of constrictive pericarditis after heart transplantation. It is noteworthy that constriction developed after a healed intrathoracic infection in the two patients. Unlike previous reported experiences, pericardiectomy was uneventful and successfully performed, although incomplete improvement was achieved in one case.
Assuntos
Transplante de Coração/efeitos adversos , Pericardite Constritiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pericardiectomia , Pericardite Constritiva/diagnóstico , Pericardite Constritiva/cirurgiaAssuntos
Transplante de Coração , Análise Atuarial , Adolescente , Adulto , Feminino , Seguimentos , Transplante de Coração/métodos , Transplante de Coração/mortalidade , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Taxa de Sobrevida , Fatores de Tempo , Doadores de Tecidos/provisão & distribuiçãoRESUMO
Long-term results of the surgical treatment of cardiac myxomas are not completely understood due to its recurrence. We review our experience in 27 operated cases with a follow-up to 22 years (mean 6.5 years), in order to throw light on results and review the problem of recurrence. One patient had a previous recurrent myxoma. At surgery we resect all the tumors and their attachment bases. We prefer a biatrial approach, ample resection and exploration of all cardiac chambers. Hospital mortality was 3.7% (1 case of associated aortic valve replacement) and late mortality 7%. Long-term results were satisfactory, without recurrences. The postoperative life expectancy of these patients seems similar to that of the normal population, except in cases of recurrence or associated valve replacement. Recurrence is very low (4.7% in 526 cases reported in the literature), except in the case of young patients and recurrent, familial, multiple or complex myxomas. The multigrowth potential of the tumor seems more important than an inadequate surgical resection.
