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1.
Am J Case Rep ; 24: e939200, 2023 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-37143323

RESUMO

BACKGROUND Coronary artery pseudoaneurysm is an extremely rare condition. In this report, we describe an 85-year-old hemodialysis male patient who developed a coronary artery pseudoaneurysm due to physical damage associated with coronary artery calcification. CASE REPORT An 85-year-old man on hemodialysis had undergone emergency percutaneous coronary intervention of the left anterior descending artery for acute coronary syndrome 9 years ago. He presented to the emergency room with a fever and chest pain and was admitted to the cardiology department with a urinary tract infection and acute coronary syndrome. On day 21 after admission, when the urinary tract infection had resolved, coronary angiography was performed, which revealed a pseudoaneurysm proximal to the left anterior descending artery stent. The patient was scheduled to undergo surgery due to the pseudoaneurysm's risk of rupture. Surgical manipulation was performed under cardiac arrest using the median sternotomy approach. A highly calcified coronary intima was found inside the pseudoaneurysm, which was completely ruptured on the proximal side of the pseudoaneurysm. The pseudoaneurysm was closed after endarterectomy. A coronary artery bypass graft was also performed in the great saphenous vein graft of the left anterior descending artery. Histopathological examination showed no obvious signs of infection, and a diagnosis of pseudoaneurysm was established. Postoperative contrast-enhanced computed tomography showed patency of the coronary artery bypass graft and no pseudoaneurysm recurrence. CONCLUSIONS Coronary artery pseudoaneurysms are extremely rare, but this case demonstrates that atherosclerotic changes can lead to the formation of a pseudoaneurysm in an elderly hemodialysis patient.


Assuntos
Síndrome Coronariana Aguda , Falso Aneurisma , Doença da Artéria Coronariana , Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Diálise Renal/efeitos adversos , Ruptura
2.
Ann Vasc Dis ; 14(2): 168-172, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34239644

RESUMO

Neurofibromatosis type 1 (NF-1) is a rare disease known to cause vascular fragility. A case of a 59-year-old man with NF who had ruptures in three different arteries within a month is presented. The first rupture occurred in the right renal artery and was treated using a stent graft and embolization coils. The second and third ruptures occurred in an artery that had been compressed by a hematoma formed during the first bleed; both were embolized. In patients with NF-1, blood vessel fragility must be considered in treatment selection, especially when performing surgery or other invasive procedures near the great vessels.

3.
Asian Cardiovasc Thorac Ann ; 28(5): 276-278, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32479110

RESUMO

An 86-year-old female with severe aortic valve stenosis underwent transcatheter aortic valve replacement. A balloon-expandable valve was used, guided by a double-stiff guidewire that successfully straightened the aorta. During valve placement, the balloon shifted. After placement of the prosthetic valve, intraoperative transesophageal echocardiography revealed severe mitral regurgitation from the anterior mitral leaflet. Open conversion was performed immediately. A 5-mm hole was identified in the anterior leaflet, and direct closure was chosen for mitral valve repair. While transcatheter aortic valve replacement has gained popularity for patients with severe aortic stenosis and high operative risk, reports of mitral valve perforation are rare.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valvuloplastia com Balão/efeitos adversos , Traumatismos Cardíacos/etiologia , Insuficiência da Valva Mitral/etiologia , Valva Mitral/lesões , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento
4.
J Cardiovasc Surg (Torino) ; 61(6): 784-789, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32186170

RESUMO

BACKGROUND: This study aimed to identify differences in prognosis, causes of death, and outcomes between open and endovascular repair for aortic arch aneurysms. METHODS: We retrospectively analyzed the survival status and causes of death determined from the medical records of 124 consecutive elderly patients (age>70 years) with aortic arch aneurysms that were treated between 2010 and 2018 at our hospital. Forty patients (male, N.=30; mean age, 76 years) underwent open repair and 84 (male, N.=68; mean age, 78 years) underwent endovascular repair. RESULTS: Early postoperative complications (10.0% vs. 6.3%; P=0.4) and rates of in-hospital death (2.5% vs. 6.3%; P=0.2) did not significantly differ between open and endovascular repair. Cumulative long-term and event free survival rates at eight years were similar in both groups (78.7% vs. 66.3%, P=0.1 and 66.6% vs. 58.4%; P=0.4, respectively). The causes of death at follow-up after endovascular repair comprised malignancies in 11 (52.4%) patients and cardiopulmonary and cerebral events unrelated to aortic aneurysms in 10 (47.6%). CONCLUSIONS: Early and late outcomes did not statistically differ after both procedures. However, the prevalence of cancer-related death occurring late after arch repair was significantly higher after endovascular repair. The most important observation from this series was that significantly more patients died of malignant disease during follow-up after endovascular repair than open repair.


Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Causas de Morte , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Neoplasias/mortalidade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
J Cardiovasc Surg (Torino) ; 60(6): 749-754, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31640318

RESUMO

BACKGROUND: In descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) surgery, though proximal anastomosis using deep hypothermic circulatory arrest (DHCA) is often selected, there are issues surrounding brain and heart protection. In this study, the usefulness of concomitant upper body perfusion via transapical aortic cannulation during deep hypothermic surgery was examined. METHODS: Between October 2014 and May 2019, 5 patients (Crawford extent II chronic dissection, N.=3; extent IV aneurysms, N.=1; DTAA, N.=1) underwent DTAA/TAAA repair under deep hypothermia using transapical aortic perfusion. A proximal anastomosis and artery of Adamkiewicz (AKA) reconstruction were performed under continuous perfusion of the upper and lower body at 20 °C. RESULTS: The time from aortic cross-clamping to proximal anastomosis was 69±33 minutes, and it took 86±47 minutes to AKA reperfusion. There was no spinal cord ischemic injury or brain or heart complications. One patient required tracheostomy, and the average postoperative intubation time for the other patients was 57±52 hours. All patients were discharged, and the average postoperative hospital stay was 25.6±8.1 days. CONCLUSIONS: Concomitant upper body perfusion by the transapical aortic approach contributes to avoidance of brain and heart complications and maintaining spinal cord circulation under deep hypothermic DTAA/TAAA surgery.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular , Parada Circulatória Induzida por Hipotermia Profunda , Perfusão/métodos , Adulto , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/fisiopatologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Doença Crônica , Parada Circulatória Induzida por Hipotermia Profunda/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Perfusão/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Fluxo Sanguíneo Regional , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
Ann Vasc Dis ; 12(4): 537-540, 2019 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-31942215

RESUMO

Deep hypothermia in thoracoabdominal aortic aneurysm operations is considered extremely useful for ensuring sufficient time to reconstruct the segmental arteries feeding the spinal cord. However, because the amplitude of motor evoked potentials (MEPs) decrease or disappear during deep hypothermia, feasible methods for assessing spinal cord circulation have not yet been reported. Performing additional segmental arterial reconstructions that rely on MEPs is also impractical. In the present case, to ascertain spinal cord circulation under deep hypothermia, we intraoperatively measured the reconstructed segmental arterial pressure in real time and investigated whether sufficient spinal cord blood flow had been attained.

7.
Gen Thorac Cardiovasc Surg ; 66(1): 27-32, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28828590

RESUMO

OBJECTIVE: A total of 69 patients with Budd-Chiari syndrome (BCS) were operated by direct approach under cardiopulmonary bypass (CPB). To assess the operative procedure, the perioperative course of esophageal varices (EVs) was evaluated. PATIENTS AND METHODS: Of the 69 patients, 59 (22 females) were enrolled in this study because they had complete follow-up data for endoscopic evaluation of EVs. Their mean age was 46.3 ± 13.0 years (range 21-73.3 years). EVs were found in 52 patients. Under partial cardiopulmonary bypass, the inferior vena cava (IVC) was incised. The obstruction of the IVC was excised, and the occluded hepatic veins were reopened. The incised IVC was reconstructed with an auto-pericardial patch. RESULTS: Postoperatively, the repaired IVC was patent in all patients. The average number of patent hepatic veins (HVs) increased from 1.23 ± 0.81 to 2.21 ± 0.97/patient. The pressure gradient between the IVC and right atrium (RA) decreased from 12.4 ± 5.52 to 4.46 ± 3.21 mmHg. The indocyanine green clearance test (ICG) at 15 min decreased from 31.57 ± 17.44 to 22.27 ± 15.23%. EVs had disappeared in 13 patients at discharge and in 6 patients at late postoperative follow-up. CONCLUSION: Our operative procedure for BCS is useful for decreasing portal pressure, which is reflected by disappearance of EVs. Therefore, the high risk of EV rupture could be avoided by reopening the occluded HVs.


Assuntos
Síndrome de Budd-Chiari/cirurgia , Adolescente , Adulto , Idoso , Síndrome de Budd-Chiari/fisiopatologia , Ponte Cardiopulmonar , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Humanos , Fígado/fisiopatologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Veia Cava Inferior/cirurgia , Adulto Jovem
8.
Ann Thorac Cardiovasc Surg ; 24(1): 32-39, 2018 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-29118307

RESUMO

PURPOSE: Unilateral re-expansion pulmonary edema (RPE) is a rare but one of the most critical complications that may occur after re-expansion of a collapsed lung after minimally invasive cardiac surgery (MICS) with mini-thoracotomy. METHODS: We performed a total of 40 consecutive patients with MICS by right mini-thoracotomy with single-lung ventilation between January 2013 and June 2016. We divided the patients into control group (n = 13) and neutrophil elastase inhibitor group (n = 27). Neutrophil elastase inhibitor group received continuous intravenous infusion of neutrophil elastase inhibitor at 0.2-0.25 mg/kg per hour from the start of anesthesia until extubation during the perioperative period. RESULTS: There were no relations with operative time, cardiopulmonary bypass (CPB) time, aortic clamp time, and intraoperative water valances for postoperative mechanical ventilation support time. Compared with the neutrophil elastase inhibitor group, the control group had significantly higher initial alveolar-arterial oxygen gradient and significantly lower initial ratio of partial pressure of arterial oxygen to fraction of inspired oxygen at the intensive care unit (ICU). The control group had significantly longer postoperative mechanical ventilation support time and hospital stay compared with the neutrophil elastase inhibitor group. CONCLUSIONS: Neutrophil elastase inhibitor may have beneficial effects against RPE after MICS with mini-thoracotomy.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Glicina/análogos & derivados , Elastase de Leucócito/antagonistas & inibidores , Edema Pulmonar/prevenção & controle , Inibidores de Serina Proteinase/administração & dosagem , Sulfonamidas/administração & dosagem , Toracotomia , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Glicina/administração & dosagem , Glicina/efeitos adversos , Humanos , Infusões Intravenosas , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Estudos Retrospectivos , Fatores de Risco , Inibidores de Serina Proteinase/efeitos adversos , Sulfonamidas/efeitos adversos , Toracotomia/efeitos adversos , Toracotomia/métodos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
J Cardiothorac Surg ; 12(1): 32, 2017 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-28526092

RESUMO

BACKGROUND: Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery. CASE PRESENTATION: A 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis. The deep hypothermia was induced with bilateral infusion of cardiopulmonary bypass by femoral artery cannulation for the lower body and by transapical cannulation for the upper body because of easy access. There was no hemorrhagic tendency after deep hypothermic bypass. The patient was discharged uneventfully. CONCLUSIONS: For upper body perfusion, transapical aortic cannulation was a simple and effective procedure during left thoracotomy.


Assuntos
Lesão Pulmonar Aguda/prevenção & controle , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Hipotermia Induzida/métodos , Perfusão/métodos , Dissecção Aórtica/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Angiografia por Tomografia Computadorizada , Humanos , Imageamento Tridimensional , Período Intraoperatório , Masculino , Pessoa de Meia-Idade
10.
J Artif Organs ; 19(2): 192-5, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26740211

RESUMO

We present a case of paracorporeal left ventricular assist device (p-LVAD)-related infection, caused by multi-drug resistant Pseudomonas aeruginosae (MDRP), and successfully treated by p-LVAD re-implantation with omental covering. A 59-year-old man underwent p-LVAD implantation and coronary artery bypass grafting after percutaneous cardiopulmonary support and intra-aortic balloon pumping for cardiogenic shock due to acute myocardial infarction. Then, he was registered for heart transplantation. He suffered from blood stream infection causative organism of Pseudomonas aeruginosa, 2 months after that operation. He underwent re-median sternotomy and open drainage, 15 months after the p-LVAD implantation. However, he suffered from septic shock due to MDRP. He underwent p-LVAD re-implantation under hypothermic circulatory arrest and iodine gauze packing, followed by omental covering of the all artificial materials in his body 10 days after that operation. Soon after that, the infection was well controlled and the intravenous antibiotics could be discontinued 2 months after that operation. He successfully underwent heart transplantation, 17 months after that procedure. We concluded that p-LVAD re-implantation with omental covering is seemed to be useful in the treatment of massive device infection. This procedure might be a novel treatment for severe VAD-related infection until heart transplantation.


Assuntos
Coração Auxiliar/efeitos adversos , Implantação de Prótese , Infecções por Pseudomonas/etiologia , Reoperação , Resistência a Múltiplos Medicamentos , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Humanos , Balão Intra-Aórtico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Omento/transplante , Pseudomonas aeruginosa/isolamento & purificação , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Resultado do Tratamento
11.
Interact Cardiovasc Thorac Surg ; 21(3): 346-51, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26078384

RESUMO

OBJECTIVES: The extent of visceral malperfusion due to acute type A aortic dissection remains difficult to assess in view of the clinical signs that typically present at a late stage. We suspected that visceral malperfusion can persist after proximal aortic graft replacement despite redirecting blood flow into the true lumen. We therefore evaluated the operative outcomes of visceral malperfusion complicated with acute type A aortic dissection. METHODS: Among 121 patients with acute type A aortic dissection treated at our hospital between January 2000 and December 2014, 10 (8.2%) were preoperatively complicated with visceral malperfusion. Eight of them had been treated by visceral arterial branch bypass followed by central repair, and 2 with circulatory instability had undergone central repair followed by laparotomy. RESULTS: The 2 patients who underwent initial central repair required extensive intestinal resection due to necrosis and died of multiple organ failure related to visceral necrosis in hospital (hospital mortality rate, 20.0%). The ischaemic time (interval between the onset of dissection and visceral arterial revascularization) was significantly longer for patients who initially underwent central repair compared with those who were initially treated by visceral arterial revascularization. However, base excess and lactate levels did not significantly differ between the two groups. CONCLUSIONS: We believe that if visceral ischaemia is severe and extensive in patients with type A aortic dissection, abdominal surgery should proceed before the aorta is surgically approached to avoid further irreversible ischaemic damage caused by circulatory arrest in organs with compromised perfusion.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Isquemia/cirurgia , Laparotomia/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Vísceras/irrigação sanguínea , Doença Aguda , Adulto , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Feminino , Mortalidade Hospitalar/tendências , Humanos , Isquemia/etiologia , Isquemia/mortalidade , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
12.
J Thorac Cardiovasc Surg ; 149(1): 360-6, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25524689

RESUMO

OBJECTIVE: During thoracoabdominal surgery in which segmental arteries are sacrificed over a large area, blood supply routes from collateral networks have received attention as a means of avoiding spinal cord injury. The aim of this study was to investigate spinal cord blood supply through a collateral network by directly measuring spinal cord blood flow and spinal cord perfusion pressure experimentally. METHODS: In beagle dogs (n = 8), the thoracoabdominal aorta and segmental arteries L1-L7 were exposed, and a temporary bypass was created for distal perfusion. Next, a laser blood flow meter was placed on the spinal dura mater in the L5 region to measure the spinal cord blood flow. The following were measured simultaneously when the direct blood supply from segmental arteries L2-L7 to the spinal cord was stopped: mean systemic blood pressure, spinal cord perfusion pressure (blood pressure within the aortic clamp site), and spinal cord blood flow supplied via the collateral network. These variables were then investigated for evidence of correlations. RESULTS: Positive correlations were observed between mean systemic blood pressure and spinal cord blood flow during interruption of segmental artery flow both with (r = 0.844, P < .01) and without (r = 0.834, P < .01) distal aortic perfusion. In addition, we observed significant correlations between spinal cord perfusion pressure and spinal cord blood flow with and without distal perfusion (r = 0.803, P < .001 and r = 0.832, P < .01, respectively), and between mean systemic blood pressure and spinal cord perfusion pressure with and without distal perfusion (r = 0.898, P < .001 and r = 0.837, P < .001, respectively). The spinal cord was perfused from the collateral network from outside the interrupted segmental arteries, and high systemic blood pressure (∼1.33-fold higher) was needed to obtain the preclamping spinal cord blood flow, whereas 1.68-fold higher systemic blood pressure was needed when distal perfusion was halted. CONCLUSIONS: Spinal cord blood flow is positively correlated with mean systemic blood pressure and spinal cord perfusion pressure under spinal cord ischemia caused by clamping a wide range of segmental arteries. In open and endovascular thoracic and thoracoabdominal surgery, elevating mean systemic blood pressure is a simple and effective means of increasing spinal cord blood flow, and measuring spinal cord perfusion pressure seems to be useful for monitoring perioperative spinal cord blood flow.


Assuntos
Aorta Abdominal/fisiopatologia , Aorta Torácica/fisiopatologia , Pressão Arterial , Determinação da Pressão Arterial/métodos , Circulação Colateral , Vértebras Lombares/irrigação sanguínea , Isquemia do Cordão Espinal/diagnóstico , Animais , Velocidade do Fluxo Sanguíneo , Modelos Animais de Doenças , Cães , Feminino , Fluxo Sanguíneo Regional , Isquemia do Cordão Espinal/fisiopatologia , Fatores de Tempo
13.
BMC Res Notes ; 7: 683, 2014 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-25270542

RESUMO

BACKGROUND: Renal cell carcinoma with tumor thrombus extension into the inferior vena cava occurs in approximately 5% of cases. Despite such situations, an aggressive surgical approach is recommended. However, intraoperative prevention of pulmonary embolism by a fragmended tumor thrombus is necessary. To prevent pulmonary embolism, placement of a temporary suprarenal filter has been attempted, however, the precise placement of a temporary filter between the level of the hepatic vein and right atrium is not always easy because of its migration, tilting, and strut fracture. Here we report a method for early occlusion control of the intrapericardial inferior vena cava to prevent pulmonary embolism during nephrectomy in level II or III renal cell carcinoma tumor thrombus. CASE PRESENTATION: Our first case was a 37-year-old Japanese man with left renal cell carcinoma extending into the inferior vena cava below the main hepatic vein (level II) and our second was a 75-year-old Japanese man with right renal cell carcinoma extending into the retrohepatic inferior vena cava at the main hepatic vein (level III). En block resection of the kidney and the tumor thrombus was performed with the aid of partial extracorporeal circulation; the postoperative course of both patients was uneventful. CONCLUSION: Control of intrapericardial inferior vena cava is a feasible method to prevent pulmonary embolism.


Assuntos
Carcinoma de Células Renais/cirurgia , Circulação Extracorpórea/métodos , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos , Embolia Pulmonar/prevenção & controle , Trombose/complicações , Veia Cava Inferior , Adulto , Idoso , Carcinoma de Células Renais/complicações , Humanos , Neoplasias Renais/complicações , Masculino , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Asian Cardiovasc Thorac Ann ; 22(2): 208-11, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24585797

RESUMO

A 68-year-old man lost consciousness while speaking. Computed tomography of the head revealed no hemorrhage or areas of hypodensity. Recombinant tissue plasminogen activator was administered. Neck duplex scanning showed dissecting intima of the right common carotid artery. Chest computed tomography disclosed Stanford type A aortic dissection. We performed emergency surgery because the right common carotid artery was severely stenosed. Despite 8 h of surgery due to coagulopathy, the patient was discharged without neurological deficits.


Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular , Isquemia Encefálica/etiologia , Artéria Carótida Primitiva/cirurgia , Estenose das Carótidas/cirurgia , Acidente Vascular Cerebral/etiologia , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Aortografia/métodos , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Artéria Carótida Primitiva/diagnóstico por imagem , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Emergências , Fibrinolíticos/administração & dosagem , Humanos , Masculino , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler Dupla
16.
World J Gastrointest Endosc ; 5(3): 138-40, 2013 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-23515703

RESUMO

Gastric antral vascular ectasia (GAVE) has been recognized as one of the important causes of occult and obscure gastrointestinal bleeding. The diagnosis is typically made based on the characteristic endoscopic features, including longitudinal row of flat, reddish stripes radiating from the pylorus into the antrum that resemble the stripes on a watermelon. These appearances, however, can easily be misinterpreted as moderate to severe gastritis. Although it is believed that capsule endoscopy (CE) is not helpful for the study of the stomach with its large lumen, GAVE can be more likely to be detected at CE rather than conventional endoscopy. CE can be regarded as "physiologic" endoscopy, without the need for gastric inflation and subsequent compression of the vasculature. The blood flow of the ecstatic vessels may be diminished in an inflated stomach. Therefore, GAVE may be prominent in CE. We herein describe a case of active bleeding from GAVE detected by CE and would like to emphasize a possibility that CE can improve diagnostic yields for GAVE.

17.
Ann Thorac Cardiovasc Surg ; 19(3): 186-94, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22971810

RESUMO

BACKGROUND: Oxidative stress due to reactive oxygen species (ROS) is thought to play a considerable role in ischemia/reperfusion (I/R) injury that impairs cardiac function. The present study examined oxidative damage in I/R injury and investigated the correlation between oxidative stress and impaired cardiac function after I/R injury of the isolated rat heart. METHODS: Hearts isolated from male Sprague-Dawley rats were mounted on a Langendorff apparatus. Hearts arrested using St. Thomas cardioplegic solution and then they were reperfused. The hearts were divided into three groups depending on the frequency (0-2) of I/R. After I/R, left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), positive maximum left ventricular developing pressure (max LV dP/dt) and coronary flow (CF) were measured. Creatine kinase (CK) was measured in the coronary effluent and 8-hydroxy-2'deoxyguanosine (8OHdG), a marker of oxidative DNA damage, was measured. Adenosine triphosphate (ATP) was measured from frozen myocardial tissue after experiment. RESULTS: We immunohistochemically demonstrated and quantified levels of 8-OHdG after I/R injury of the heart. The frequency of I/R injury and cardiac dysfunction significantly and negatively correlated. The ATP products were similar among the three groups. The incidence of ventricular arrhythmias was not by affected oxidative stress. CONCLUSION: The frequency of I/R injury had more of an effect on 8-OHdG products and on impaired cardiac function with less myocyte damage than ischemic duration within 30 minutes of ischemia.


Assuntos
Traumatismo por Reperfusão Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Miocárdio/metabolismo , Estresse Oxidativo , Função Ventricular Esquerda , 8-Hidroxi-2'-Desoxiguanosina , Trifosfato de Adenosina/metabolismo , Animais , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/metabolismo , Arritmias Cardíacas/fisiopatologia , Biomarcadores/metabolismo , Circulação Coronária , Creatina Quinase/metabolismo , Dano ao DNA , Desoxiguanosina/análogos & derivados , Desoxiguanosina/metabolismo , Metabolismo Energético , Imuno-Histoquímica , Técnicas In Vitro , Masculino , Traumatismo por Reperfusão Miocárdica/etiologia , Perfusão , Ratos , Ratos Sprague-Dawley , Fatores de Tempo , Pressão Ventricular
18.
Eur J Cardiothorac Surg ; 43(6): 1177-82, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23233070

RESUMO

OBJECTIVES: Postoperative infection control is one of the most important issues for infected aortic aneurysms, and the methods of preventing recurrent infection remain controversial. We previously reported that omental flaps could prevent or reduce the occurrence of infection after implanting an artificial aortic graft. However, the long-term outcomes of this strategy are unknown. We used imaging modalities to evaluate whether wrapping prosthetic grafts with omentum prevents postoperative graft infection over the long-term. METHODS: We surgically treated 521 patients with thoracic aortic aneurysm (TAA) at our hospital between July 1995 and May 2012. Of these, 22 (3.9%) (male, n = 17; mean age, 68.2 ± 11.4 years) had infectious TAA. All infectious aneurysms were resected, all patients received in-situ grafts and 16 grafts were wrapped with omentum. We followed up all survivors annually using computed tomography. We also used angiography to investigate blood circulation in omental flaps over the long-term. RESULTS: Five patients died in-hospital (operative mortality, 26.3%). The operative mortality rates of patients with and without omental wrapping were 12.5 and 50.0%, respectively (P = 0.06, NS), and the 5-year event-free survival rates were 84.6 and 33.3% (P = 0.025), respectively. Omental flaps around prosthetic grafts and their blood circulation were well-preserved over the long-term. CONCLUSIONS: Wrapping implanted artificial aortic grafts with omental flaps could prevent or reduce the occurrence of subsequent infection. Furthermore, blood circulation in the flaps must be well-preserved to improve the long-term outcomes.


Assuntos
Implante de Prótese Vascular/métodos , Prótese Vascular , Omento/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Asian Cardiovasc Thorac Ann ; 20(5): 587-90, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23087307

RESUMO

A right-sided aortic arch associated with an aberrant subclavian artery is a rare anomaly. Regardless, this condition is clinically relevant because mortality is associated with rupture, morbidity results from compression of mediastinal structures, and the surgery is complex. We describe the successful surgical repair of this vascular anomaly by totally debranching the neck vessels and placing an endovascular stent-graft to exclude the ruptured Kommerell's diverticulum.


Assuntos
Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Divertículo/cirurgia , Procedimentos Endovasculares , Artéria Subclávia/cirurgia , Malformações Vasculares/cirurgia , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Divertículo/complicações , Divertículo/diagnóstico por imagem , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Stents , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagem
20.
Interact Cardiovasc Thorac Surg ; 15(4): 794-6, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22778143

RESUMO

Rapid restoration of flow into the true lumen and obliteration of a false lumen is considered the optimal approach to treating malperfusion syndrome due to acute aortic dissection. However, organ malperfusion can occasionally persist after proximal aortic graft replacement despite redirecting blood flow into the true lumen. A 35-year old man underwent the modified Bentall procedure for Stanford type A acute aortic dissection without organ malperfusion. Ischaemia of the visceral and lower extremities developed on postoperative day 8. Enhanced computed tomography (CT) revealed a thrombus in the false lumen interfering with the true lumen above the celiac trunk. We immediately performed a left axillary-to-bilateral femoral artery bypass. The patient recovered uneventfully and was discharged on postoperative day 28. Although organ malperfusion persisting after proximal aortic graft replacement despite redirecting blood flow into the true lumen is rare, close observation remains imperative after central repair of type A dissection.


Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Arteriopatias Oclusivas/etiologia , Implante de Prótese Vascular/efeitos adversos , Isquemia/etiologia , Trombose/etiologia , Vísceras/irrigação sanguínea , Doença Aguda , Adulto , Dissecção Aórtica/fisiopatologia , Aneurisma Aórtico/fisiopatologia , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/cirurgia , Artéria Axilar/fisiopatologia , Artéria Axilar/cirurgia , Artéria Femoral/fisiopatologia , Artéria Femoral/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Masculino , Fluxo Sanguíneo Regional , Reoperação , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Trombose/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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