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1.
Anatol J Cardiol ; 18(4): 261-265, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29076814

RESUMO

OBJECTIVE: This study aimed to assess the effect of new generation oral, direct factor Xa inhibitor rivaroxaban on intimal hyperplasia and smooth muscle cell proliferation at the carotid artery anastomosis site of rabbits. METHODS: In total, 14 New Zealand male rabbits weighing 3-3.5 kg were randomized into two groups. Group A (7 rabbits) served as the control group and received no medication. Rivaroxaban was perorally administered to group B (7 rabbits) mg/kg/day for 28 days. Following anesthesia induction, carotid arteries were dissected through a right neck incision. following heparinization at 100 IU/kg, vertical full thickness arteriotomy was performed, then was repaired continuously with 8-0 polypropylene. At day 28, all rabbits were sacrificed and the anastomosed carotid artery segments were analyzed using light microcopy. Hematoxylin-eosin and Masson's trichrome stained images were analyzed using a digital image analysis program, and lumen diameter, lumen area, intimal and medial thickness, and media areas were measured and results were compared. RESULTS: In the serial sections, the average lumen diameter of group B was higher than that of group A (p=0.001). The lumen areas of group B were also higher than those of group A (p=0.004). The intimal thickness of group B was lower than that of group A (p=0.001). When the section series were evaluated for media thickness, the thickness of group B was lesser than that of group A; the difference was statistically significant (p=0.002). CONCLUSION: This study may imply a potential midterm benefit of rivaroxaban following arterial anastomosis by reducing intimal proliferation and restenosis.


Assuntos
Artérias Carótidas/patologia , Proliferação de Células/efeitos dos fármacos , Inibidores do Fator Xa/farmacologia , Hiperplasia/prevenção & controle , Rivaroxabana/farmacologia , Anastomose Cirúrgica , Animais , Modelos Animais de Doenças , Inibidores do Fator Xa/administração & dosagem , Masculino , Miócitos de Músculo Liso/efeitos dos fármacos , Coelhos , Rivaroxabana/administração & dosagem , Túnica Íntima/efeitos dos fármacos
2.
J Clin Ultrasound ; 44(2): 85-91, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26178614

RESUMO

PURPOSE: To investigate if duplex ultrasonography findings change according to the menstrual cycle phases in women with early symptoms of lower extremity chronic venous disease. METHODS: Thirty women (60 extremities) aged 18-50 years with regular menstrual cycles who presented with complaints of telangiectasia and/or trunk varices with accompanying leg pain were evaluated prospectively by duplex ultrasonography at three different times of a single menstrual cycle. Previous DVT or menstrual irregularities were exclusion criteria. All exams were performed by the same radiologist, under the same conditions. Reflux was provoked in the deep veins, great saphenous vein (GSV), and small saphenous vein (SSV) using the Valsalva maneuver. Reflux times in each vein and average diameters of the GSV and SSV were recorded. RESULTS: Reflux times showed no significant differences in any of the vein segments and the diameters of GSV and SSV were similar in the different menstrual phases (p > 0.05). Reflux was not predominant at any specific phase, and its presence was independent of menstrual phase. CONCLUSIONS: Reflux was not specific to a particular phase of menstrual cycle in women with early symptoms of chronic venous disease.


Assuntos
Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Ciclo Menstrual , Varizes/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Extremidade Inferior/patologia , Pessoa de Meia-Idade
3.
Pak J Med Sci ; 31(1): 131-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25878629

RESUMO

OBJECTIVE: We have utilized subclavian flap angioplasty (SFA) frequently in infants with coarctation particularly in patients with arch hypoplasia which is quite frequent. We have followed these patients with serial echocardiography and have analyzed our results in this study to determine recoartation rates, recurrent hypertension and left arm development. METHODS: Thirty eight infants less than 3 months age (22 boys and 16 girls, mean age was 28±22.6 days) operated at Dokuz Eylul University Hospital between August 2007 - December 2013. Twelve (32%) patients with pulmonary banding due to accompanying VSD or AVSD were included to the study, those infants with complex pathologies such as transposition of great arteries or single ventricle, while the patients less than 1000 gram in weight were excluded. RESULTS: The mean follow-up time was 21 months (1-76 months). Twelve (32%) patients had aortic arch hypoplasia proximal to the left subclavian artery. Operative mortality was found 7.7% for isolated coarctation, 16% for coarctation repair with pulmonary banding. In 5 patients, a residual gradient was detected and re intervention was required in 7.8% patients with balloon angioplasty. CONCLUSION: Subclavian flap angioplasty is a safe repair technique in small infants and neonates. High gradients and intervention more likely depends on the anatomy of the aortic arch rather than the subclavian flap angioplasty technique.

4.
J Cardiothorac Surg ; 8: 229, 2013 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-24330814

RESUMO

In this case, our patient was a heart transplant candidate connected to a respiratory system. An extracorporeal biventricular assist device (BIVAD) was the only option in order to bridge to transplantation. In routine procedures, it is recommended that Berlin Heart Excor cannulas be removed through the subfascial subcostal tunnel. As the severely dilated right ventricle compressed the apex of the left ventricle, which was also dilated to the mid-back zone of the left hemithorax, the whole length of the Extracorporeal BIVAD apical cannula had to remain within the thorax; however, the cannula was removed from the body by creating a tunnel at the 7th intercostal space. In the long-term follow-up, this compulsory modification has proven to be safe and effective.


Assuntos
Circulação Extracorpórea/instrumentação , Circulação Extracorpórea/métodos , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Coração Auxiliar , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade
5.
BMC Anesthesiol ; 13(1): 28, 2013 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-24088357

RESUMO

BACKGROUND: Accidental intravenous exposure to bupivacaine is highly cardiotoxic and may lead to death. Positive inotropic agents are usually utilized in resuscitative efforts. We have compared the efficacy of levosimendan, a novel inotropic agent, with dobutamine and their combination in a rat model of bupivacaine intoxication. METHODS: Twenty-eight male Wistar albino rats weighing between 250-300 g were divided into these four groups: control (C), levosimendan (L), dobutamine (D) and dobutamine+levosimendan (D+L). Bupivacaine was administered at a dose of 3 mg/kg/min until cardiac arrest occurred or for 120 min. ECG, heart rate, blood pressure, arterial blood gases, and end tidal CO2 levels were monitored. Levosimendan was administered as a bolus of 12 µg/kg for 10 min and continued as an infusion at 0.3 µg/kg/min. Dobutamine was infused at a dose of 3 µg/kg/min. The time required for a 50% and 75% decrease in heart rate and blood pressure with a total time to cardiac arrest and bupivacaine dose for obtaining cardiac arrest were analyzed. RESULTS: Time periods for heart rate reductions of 50% and 75% were significantly longer in groups L (903, 1198 s), D (984, 1542 s) and L+D (1705, 3152 s) compared with the control group (345, 538 s p < 0.001). Median times to mean blood pressure reductions of 50% and 75% were 399 - 504 s in the control group, 1005 -1204 s in group L, 685 - 1009 s in group D and 1544- 2982 s in group L+D, and the difference was significant compared with the control group. Median time duration to asystole was 703 s in the control group compared with 1385 s in group L, 1789 s in group D and 3557 s in group L+D. Time to cardiac arrest was significantly higher in all 3 study groups. It was also significantly higher in the L+D group compared with both groups L and D separately. CONCLUSION: A combination of dobutamine with levosimendan significantly increased survival times in this bupivacaine-induced toxicity rat model compared with the control, levosimendan, and dobutamine groups.

7.
J Cardiothorac Surg ; 7: 129, 2012 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-23234577

RESUMO

BACKGROUND: Patent ductus arteriosus is a common congenital cardiac condition. Its importance is mostly underestimated and accepted as an "easy" heart disease. Physiological consequences of pulmonary overflow may cause severe mortality in premature neonates. Accurate timing of surgical intervention is essential to decrease the mortality in very low birth weight premature infants. On-site surgery in the intensive care units (ICUs) results excellent surgical quality without jeopardizing the safety of the patients. METHODS: We have summarized the clinical and operative data of 26 premature neonates (<37 weeks of gestational age), which were operated for the diagnosis of PDA in the ICUs of Dokuz Eylül University. Thirteen low birth weight infants (<1000 gr) have been compared with remaining 13 neonates (>1000 gr). RESULTS: There was no surgical mortality in both groups. Co-existing problems were observed in both groups, which did not affect surgical mortality and morbidity. CONCLUSIONS: Surgery in the ICU is a safe method for premature neonates with physiologically significant PDA. This technique should be the method of choice in experienced centers.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/cirurgia , Doenças do Prematuro/cirurgia , Ligadura/métodos , Fatores Etários , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Estudos Retrospectivos , Resultado do Tratamento
9.
Pediatr Cardiol ; 33(4): 607-17, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22314366

RESUMO

This study aimed to evaluate the presenting symptoms, the effectiveness of imaging methods, and the surgical treatment of vascular rings. Data for 44 patients (32 enrolled prospectively, 12 reviewed retrospectively) over a 10-year period in a tertiary referral center were analyzed. These patients comprised 25 patients with a left aortic arch and an aberrant right subclavian artery, 13 patients with a right aortic arch and a left subclavian artery originating from Kommerell's diverticulum, 1 patient with a right aortic arch and an aberrant left subclavian artery, 3 patients with a double aortic arch, and 2 patients with a pulmonary sling. Respiratory symptoms were found in 25 patients and dysphagia in 6 patients. Atypical symptoms such as reflex apnea, cyanosis, syncope episodes, and exercise-induced wheezing were noted in five patients. Associated congenital heart defects were detected in 41% of the patients. The diagnostic yield was 95.23% for barium esophagography, 54.54% for echocardiography, and 66.66% for computed tomography. The anatomy could be correctly identified by magnetic resonance imaging (MRI) in 97.43% and by angiography in 90.5% of the patients. Of the 30 patients who underwent surgery, 80% were completely relieved of symptoms during a mean follow-up period of 25 ± 33.5 months. Vascular rings should not be overlooked in infants with atypical symptoms. The authors' diagnostic procedure of choice is MRI because it is superior to angiography for delineating the relationship between abnormal vascular structures, trachea, and esophagus.


Assuntos
Aneurisma/diagnóstico , Anormalidades Cardiovasculares/diagnóstico , Transtornos de Deglutição/etiologia , Diagnóstico por Imagem/normas , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Vasculares/normas , Adolescente , Aneurisma/cirurgia , Angiografia , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Anormalidades Cardiovasculares/cirurgia , Criança , Pré-Escolar , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/cirurgia , Diagnóstico por Imagem/métodos , Ecocardiografia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Estudos Prospectivos , Artéria Subclávia/anormalidades , Artéria Subclávia/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
10.
J Pediatr Surg ; 46(7): E23-5, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21763821

RESUMO

Cor triatriatum is a rare cardiac anomaly characterized by a membrane in the left atrium that separates the atrium into the proximal and distal chambers. Herein, we describe an unusual case of cor triatriatum combined with a ventricular septal defect in a newborn infant with a giant omphalocele and underwent a successful cardiac surgical repair. In this abnormality, there is a high incidence of associated congenital abnormalities; but to the best of our knowledge, this is the first time that a combination of cor triatriatum and omphalocele has been reported in the literature.


Assuntos
Anormalidades Múltiplas/cirurgia , Coração Triatriado/cirurgia , Comunicação Interventricular/cirurgia , Hérnia Umbilical/terapia , Doenças do Prematuro/cirurgia , Anormalidades Múltiplas/terapia , Ponte Cardiopulmonar , Cesárea , Permeabilidade do Canal Arterial , Humanos , Hipotermia Induzida , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Oxigenoterapia
11.
Tex Heart Inst J ; 36(3): 252-4, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19568400

RESUMO

Blunt thoracoabdominal trauma is most often caused by high-velocity motor-vehicle accidents or by falls from a height. The clinical spectrum of cardiac injuries arising from this type of trauma varies from myocardial contusion to valvular rupture. Intracardiac valvular rupture is rarely observed, and few cases have been reported. The youngest of the patients in cases reported to date was 6 years of age. Here we report the case of a 2(1/2)year-old child, who sustained mitral valve insufficiency due to isolated rupture of the posterior mitral papillary muscle, which developed after a domestic accident.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Traumatismos Cardíacos/cirurgia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Músculos Papilares/cirurgia , Ferimentos não Penetrantes/cirurgia , Pré-Escolar , Ecocardiografia Doppler em Cores , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/lesões , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/lesões , Pericárdio/transplante , Técnicas de Sutura , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologia
12.
Ann Trop Paediatr ; 28(2): 161-4, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18510828

RESUMO

Geleophysic dysplasia (GD) is a rare, recessively inherited lysosomal storage disorder of unknown origin with a progressive course. A 9-year-old Turkish boy born to consanguineous parents with findings typical of GD is reported. Cardiac abnormalities included mitral and aortic stenosis with aortic insufficiency. There was persistent hypo-uricacidaemia, severe pulmonary hypertension and tricuspid insufficiency. He required aortic and mitral valve replacement but, unfortunately, died of a severe pulmonary infection in the post-operative period. The condition has to be differentiated from lysosomal storage disorders such as mucopolysaccharidosis.


Assuntos
Doenças por Armazenamento dos Lisossomos/diagnóstico , Anormalidades Múltiplas/diagnóstico , Pré-Escolar , Fácies , Evolução Fatal , Cardiopatias Congênitas/diagnóstico , Humanos , Doenças por Armazenamento dos Lisossomos/genética , Masculino , Fenótipo
13.
Scand J Infect Dis ; 37(9): 694-6, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16126574

RESUMO

We present 3 patients, 2 with recent heart transplants, complicated with invasive pulmonary aspergillosis (IPA), treated successfully with surgical resection. These patients demonstrate the role of surgery in management of IPA, and 2 heart transplant patients are of particular interest as surgical treatment of IPA after solid organ transplantation is seldom reported.


Assuntos
Aspergilose/cirurgia , Transplante de Coração/efeitos adversos , Pneumopatias Fúngicas/cirurgia , Adulto , Aspergilose/microbiologia , Aspergillus/isolamento & purificação , Aspergillus fumigatus/isolamento & purificação , Feminino , Humanos , Pneumopatias Fúngicas/microbiologia , Masculino , Pessoa de Meia-Idade
14.
Ann Thorac Surg ; 73(5): 1638-40, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12022570

RESUMO

Plasa oozing through the graft after a modified Blalock-Taussig shunt is a troublesome complication. We encountered a massive leak following a modified Blalock-Taussig shunt in a 2 1/2 year-old-girl which required reexploration. The leak was treated by wrapping the polytetrafluoroethylene shunt with the parietal pleura flap harvested from the adjacent chest wall. The patient had an uneventful recovery. Covering of the polytetrafluoroethylene shunt with parietal pleura appears to stop plasma leak through the graft following a modified Blalock-Taussig shunt.


Assuntos
Implante de Prótese Vascular , Cardiopatias Congênitas/cirurgia , Politetrafluoretileno , Complicações Pós-Operatórias/cirurgia , Falha de Prótese , Retalhos Cirúrgicos , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Derrame Pleural/cirurgia , Reoperação
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