Cirugia Cardiovascular最新文献

Pleural effusions are frequent complications in the postoperative period of patients undergoing cardiac surgery. Different drainage systems have been developed, and those based on the Seldinger method demonstrate greater safety and less invasiveness. Thoracentesis with a central venous catheter maximizes these aspects, providing effective evacuation of pleural effusions in the postoperative period of cardiac surgery. We describe our experience adding technical modifications based on puncture with 18 G Tuohy needles.

The occurrence of a mechanical complication following an acute myocardial infarction with ST-segment elevation is currently uncommon, with the most common being papillary muscle rupture, free wall rupture of the ventricle, ventricular septal rupture, or the development of an aneurysmal dilation of the ventricle. We present a 63-year-old male patient with acute myocardial infarction with ST-segment elevation who developed two concomitant mechanical complications, both of which underwent surgical correction. The patient had a history of hypertension and smoking, and presented with clinical symptoms of precordial pain along with an electrocardiogram showing ST-segment elevation. Transthoracic echocardiogram revealed a ventricular septal defect and an ejection fraction of 51%. Cardiac catheterization indicated two-vessel coronary disease. Surgical management was decided for closure of the ventricular septal defect and revascularization. During the surgical procedure, an aneurysmal dilation of the left ventricle was observed and repaired using a pericardial patch. Finally, after compensating for heart failure secondary to septic shock from a urinary tract infection, the patient was discharged. Mechanical complications following an acute myocardial infarction remain a significant concern as they can occur days or weeks after the coronary event and may lead to death. Therefore, continuous monitoring of patients is crucial. The decision to surgically intervene for correction should weigh the risk-benefit ratio.

Infective endocarditis (IE) is a systemic disease with multiorgan involvement. It is a severe disease, which frequently requires surgical treatment, despite which mortality rates can be high due to complications related to an uncontrolled systemic inflammatory response and/or sepsis. Hemadsorption systems such as Cytosorb® allow the removal of proinflammatory cytokines and endotoxins to improve the prognosis of these patients. We performed a systematic review in Pubmed and Cochrane to identify controlled comparative studies of the perioperative use of Cytosorb® in patients undergoing cardiac surgery for IE. A meta-analysis was performed comparing different clinical outcomes. 9 studies were finally included in the meta-analysis. The use of hemadsorption therapy did not reduce mortality in the early postoperative period (RR = 0.75; p = 0.05). Both, the duration of mechanical ventilation (mean difference = -6.91 hours; p = 0.01) and the duration of support with vasopressor drugs (mean difference = -34.47 hours; p = 0.03) were significantly shorter in the case of patients treated with hemadsorption. However, postoperative stays, the incidence of postoperative renal failure or the need for surgical revision due to bleeding did not show differences between groups. To conclude, the use of the Cytosorb® hemadsorption filter in cardiac surgery for IE allowed better control of postoperative inflammatory activity, with lower requirements for vasopressor support and duration of mechanical ventilation, but without impact on perioperative mortality or other related complications.

Saphenous vein grafts (SVI) are the most common conduits used in revascularization surgery. However, its failure rate is 35-50% at 5-10 years, partially due to intimal hyperplasia secondary to shear wall stress. Different exostents have been developed in order to amend this effect. A systematic review was performed in Pubmed with different combinations of keywords to identify all studies about the use of exostents. Two meta-analyses were performed, one based on the patency of the grafts and another focused on the development of pathological intimal hyperplasia, corresponding to grades II-III of the Fitzgibbon classification. An update of the evidence was carried out regarding the 5 exostents already available. Ten controlled comparative studies were selected for the meta-analyses. The use of exostents was detrimental in terms of patency (RR: 1.67; P = .03). However, in the subgroup analysis, the VEST® devices did not show significant differences compared to the control group (RR: 1.11; P = .59). Furthermore, these devices allowed maintaining more grafts in grade I of intimal hyperplasia, compared to unsupported grafts (RR: 0.53; P = .02). To conclude, exostents, globally considered, do not improve IVS patency in the mid-short term follow-up. However, some devices such as VEST®, have shown to limit the development of intimal hyperplasia, which may improve graft patency in the extension of the follow-up of ongoing studies.

Right atrial thrombus with superior vena cava obstruction as the initial manifestation of metastatic carcinoma of unknown primary origin is not a frequent event. Evidence-based guidelines for the clinical management of patients with thrombus are still limited. We present an 82-year-old patient with a history of COPD, diabetes mellitus and an ex-smoker, who was admitted due to frequent syncope and limiting dyspnea. The echocardiographic study revealed a large mass in the right atrium at the entrance of the superior vena cava. Surgical resection of the same was performed, which turned out to be a thrombus, a lymph node in the anterior mediastinum was also resected, which was positive for metastatic undifferentiated large cell carcinoma. The primary lesion was not found in the studies carried out. The patient remains stable clinically with mild dyspnea four months after surgery. However, the prognosis for a patient with such a diagnosis is poor. In the operation of an obstructive intracardiac thrombus, the possibility of an adjacent paraneoplastic syndrome should be suspected, so it should be taken into account in clinical practice and a good collection of samples should be made in the surgical act for the anatomopathological study. Surgery, despite being risky, is an option in patients with an intracardiac mass with hemodynamic compromise

Acute aortic syndrome involves 3 entities (penetrating aortic ulcer, aortic dissection, and intramural hematoma) that, if not treated promptly cause the death of the patient in most cases. Timely treatment (surgical in most cases) requires an efficient transfer system, immediate availability of resources, trained doctors, etc. The hospitals of the Ministry of Health of Peru usually have limited resources that do not allow timely treatment of highly complex cardiovascular pathology. In this context, we present our initial experience in the management of 2 patients with type A aortic dissection and one patient with a penetrating aortic ulcer complicated by aortic pseudoaneurysm.

The common iliac artery aneurysm is relatively rare, has been observed in only 2-7% of all intra-abdominal aneurysms. It is a life-threatening condition when rupture and massive bleeding occur. We report the case of a 38-year-old patient who presented to the emergency room due to abdominal pain in the right hypochondrium, jaundice in the sclera, and a positive Murphy sign, compatible with acute cholecystitis. Computerized axial tomography was performed due to an insidious clinical picture that incidentally revealed a giant aneurysm (>10 cm) in the right common iliac artery and mural thrombus. An open emergency surgical procedure was performed due to the size of the aneurysm and infection by free fluid in the cavity and repair with autologous aorto-femoral graft with a good outcome for the patient. Giant AAIC with significant renal and hepatic involvement may present atypically in clinical practice and mimic other surgical pathologies. Common iliac artery aneurysm is a disease with high morbidity and mortality since it can threaten the patient's life when the aneurysm ruptures. It should be taken into account within the differential diagnoses when the clinical manifestations are insidious.