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1.
J Cardiothorac Surg ; 5: 66, 2010 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-20727201

RESUMO

BACKGROUND: Cogan's syndrome is a rare disorder of unknown origin characterized by inflammatory ocular disease and vestibuloauditory symptoms. Systemic vasculitis is found in about 10% of cases. CASE PRESENTATION: A 46-year-old female with Cogans's syndrome and a history of arterial hypertension presented with severe chest pain caused by an aneurysm of the ascending aorta with a dissection membrane located a few centimeters distal from the aortic root. After surgery, histopathological analysis revealed that vascular matrix integrity and expression of the major matrix molecules was characterized by elastolysis and collagenolysis and thus a dramatic loss of structural integrity. Remarkably, exceeding matrix deterioration was associated with massively increased levels of granulocyte macrophage colony stimulating factor (GM-CSF). CONCLUSION: Our data suggest that the persistently increased secretion of the inflammatory mediator GM-CSF by resident inflammatory cells but also by SMC may be the trigger of aortic wall structural deterioration.


Assuntos
Aorta/fisiopatologia , Aneurisma Aórtico/fisiopatologia , Dissecção Aórtica/fisiopatologia , Síndrome de Cogan/complicações , Fator Estimulador de Colônias de Granulócitos e Macrófagos/imunologia , Miócitos de Músculo Liso/imunologia , Dissecção Aórtica/etiologia , Dissecção Aórtica/imunologia , Dissecção Aórtica/cirurgia , Aorta/imunologia , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/imunologia , Aneurisma Aórtico/cirurgia , Vasos Sanguíneos/imunologia , Vasos Sanguíneos/fisiopatologia , Feminino , Humanos , Metaloproteinases da Matriz/imunologia , Pessoa de Meia-Idade
2.
J Thorac Cardiovasc Surg ; 137(4): 840-5, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19327506

RESUMO

OBJECTIVES: Do prior percutaneous coronary interventions adversely affect the outcome of subsequent coronary artery bypass grafting? We investigated this effect on a multicenter basis. METHODS: Eight cardiac surgical centers provided outcome data of 37,140 consecutive patients who underwent isolated first-time coronary bypass grafting between January 2000 and December 2005. Twenty-two patient characteristics and outcome variables were retrieved. Three groups of patients were analysed for in-hospital mortality and in-hospital major adverse cardiac events: patients without a previous percutaneous coronary intervention, with 1 previous intervention, and with 2 or more previous percutaneous coronary interventions before bypass grafting. A total of 29,928 patients with complete information for prior percutaneous coronary intervention underwent final analysis. Unadjusted univariate and risk-adjusted multivariate logistic regression analysis as well as computed propensity score matching were performed, based on 14 major risk factors to correct for and minimize selection bias. RESULTS: A total of 10.3% of patients had 1 previous percutaneous coronary intervention, and 3.7% of patients had 2 or more previous interventions. Risk-adjusted multivariate logistic regression analysis revealed a significant association of 2 or more previous percutaneous coronary interventions with in-hospital mortality (odds ratio [OR], 2.0; confidence interval [CI], 1.4-3.0; P = .0005) and major adverse cardiac events (OR, 1.5; CI, 1.2-1.9; P = .0013). After propensity score matching, conditional logistic regression analysis confirmed the results of adjusted analysis. A history of 2 or more previous percutaneous coronary interventions was significantly associated with in-hospital mortality (OR, 1.9; CI, 1.3-2.7; P = .0016) and major adverse cardiac events (OR, 1.5; CI, 1.2-1.9; P = .0019). CONCLUSIONS: Multicenter analysis confirms that a history of multiple previous percutaneous coronary interventions increases in-hospital mortality and the incidence of major adverse cardiac events after subsequent coronary artery bypass grafting. Critical discussion of the treatment strategy in these patients is warranted.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/cirurgia , Idoso , Estudos de Coortes , Ponte de Artéria Coronária/efeitos adversos , Feminino , Alemanha , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação/mortalidade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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