Pub Date : 2019-12-01DOI: 10.21470/1678-9741-2018-0125
Elinthon T Veronese, C. Brandão, S. Steffen, P. Pomerantzeff, F. Jatene
Quadricuspid aortic valve (QAV) is a rare cardiac malformation. Many cases are incidentally diagnosed in aortic surgeries or autopsies and it usually appears as an isolated anomaly. The most widely classification used is the one by Hurwitz and Roberts[1], which divides 7 alphabetical subtypes based on the cusps size. The aim of this report is to describe three different anatomic presentations of this rare aortic valve anomaly.
{"title":"Quadricuspid Aortic Valve: Three Cases Report and Literature Review","authors":"Elinthon T Veronese, C. Brandão, S. Steffen, P. Pomerantzeff, F. Jatene","doi":"10.21470/1678-9741-2018-0125","DOIUrl":"https://doi.org/10.21470/1678-9741-2018-0125","url":null,"abstract":"Quadricuspid aortic valve (QAV) is a rare cardiac malformation. Many cases are incidentally diagnosed in aortic surgeries or autopsies and it usually appears as an isolated anomaly. The most widely classification used is the one by Hurwitz and Roberts[1], which divides 7 alphabetical subtypes based on the cusps size. The aim of this report is to describe three different anatomic presentations of this rare aortic valve anomaly.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47036476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.21470/1678-9741-2018-0245
A. Saraçoğlu, Onur Ermerak, Esra Yaman Savci Sirzai, M. Yuksel, Z. Aykaç, B. Yıldızeli
Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperative anesthesia and surgical management of pulmonary endarterectomy which was successfully managed without Cardiopulmonary Bypass.
{"title":"Anesthesia Management for a Patient Undergoing Pulmonary Endarterctomy without Cardiopulmonary Bypass","authors":"A. Saraçoğlu, Onur Ermerak, Esra Yaman Savci Sirzai, M. Yuksel, Z. Aykaç, B. Yıldızeli","doi":"10.21470/1678-9741-2018-0245","DOIUrl":"https://doi.org/10.21470/1678-9741-2018-0245","url":null,"abstract":"Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperative anesthesia and surgical management of pulmonary endarterectomy which was successfully managed without Cardiopulmonary Bypass.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42984699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.21470/1678-9741-2018-0350
O. Gokalp, L. Yılık, Y. Beşir, H. Iner, Nihan KarakasYesilkaya, Erturk Karaagac, Yasar Gokkurt, S. Iscan, A. Gurbuz
Objective Treatment of acute diseases of the aorta is still associated with high mortality and morbidity. It is believed that interventions for these diseases on overtime hours (night shifts or weekend shifts) may increase mortality. In this study, we investigated the effect of performing acute type A aortic dissection surgery on overtime hours in terms of postoperative outcomes. Methods 206 patients who underwent emergency surgery for acute type A aortic dissection were retrospectively evaluated. Two groups were constituted: patients operated on daytime working hours (n=61), and patients operated on overtime hours (n=145), respectively. Results Chronic obstructive pulmonary disease and repeat surgery were higher in group 1. There was no statistically significant difference between the two groups in terms of operative and postoperative results. Mortality rates and postoperative neurological complications in group 1 were 9.8% and 13.1%, respectively. In group 2, these rates were 13.8% and 12.4%, respectively (P=0.485 - P=0.890). Multivariate analysis identified that cross-clamp time, amount of postoperative drainage, preoperative loss of consciousness and postoperative neurological complications are the independent predictors of mortality. Conclusions As the surgical experience of the clinics improves, treatment of acute type A aortic dissections can be successfully performed both overtime and daytime working hours.
{"title":"\"Overtime Hours Effect\" on Emergency Surgery of Acute Type A Aortic Dissection","authors":"O. Gokalp, L. Yılık, Y. Beşir, H. Iner, Nihan KarakasYesilkaya, Erturk Karaagac, Yasar Gokkurt, S. Iscan, A. Gurbuz","doi":"10.21470/1678-9741-2018-0350","DOIUrl":"https://doi.org/10.21470/1678-9741-2018-0350","url":null,"abstract":"Objective Treatment of acute diseases of the aorta is still associated with high mortality and morbidity. It is believed that interventions for these diseases on overtime hours (night shifts or weekend shifts) may increase mortality. In this study, we investigated the effect of performing acute type A aortic dissection surgery on overtime hours in terms of postoperative outcomes. Methods 206 patients who underwent emergency surgery for acute type A aortic dissection were retrospectively evaluated. Two groups were constituted: patients operated on daytime working hours (n=61), and patients operated on overtime hours (n=145), respectively. Results Chronic obstructive pulmonary disease and repeat surgery were higher in group 1. There was no statistically significant difference between the two groups in terms of operative and postoperative results. Mortality rates and postoperative neurological complications in group 1 were 9.8% and 13.1%, respectively. In group 2, these rates were 13.8% and 12.4%, respectively (P=0.485 - P=0.890). Multivariate analysis identified that cross-clamp time, amount of postoperative drainage, preoperative loss of consciousness and postoperative neurological complications are the independent predictors of mortality. Conclusions As the surgical experience of the clinics improves, treatment of acute type A aortic dissections can be successfully performed both overtime and daytime working hours.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47799663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.21470/1678-9741-2019-0309
A. Fatahian
Despite developing new standards and advances in anesthetic and surgical techniques, postoperative atrial fibrillation (POAF) is one of the most frequent complications and a significant unsolved clinical problem after cardiac surgery[1]. Occurrence of POAF is associated with significant increased risk of long-term mortality, morbidity, and long intensive care unit (ICU) and hospital stays, which consequently impose additional cost on both health system and patient[2]. Considering the potential significant adverse effects of POAF in patients undergoing cardiac surgery and the limited efficacy of current preventive strategies, concerted efforts to identify and implement new preventive strategies are necessary[1,2]. Recently, injection of botulinum toxin into epicardial fat pads in patients undergoing cardiac surgery has been suggested as a promising modality for prevention of POAF. In a study by Pokushalov et al.[3], it has been shown that 50 U botulinum toxin injection, at four major epicardial fat pads, during surgery in patients undergoing coronary artery bypass grafting (CABG) provided considerable atrial tachyarrhythmia suppression, in both early and one-year followups[3]. Also, a three-year follow-up of this study indicates a sustained and significant reduction in atrial fibrillation (AF) incidence and burden, along with reduction in patients' hospitalizations. Besides, no serious adverse events related to injection of botulinum toxin for prevention of POAF after CABG have been reported[4]. Suppression of atrial autonomic remodeling has been suggested as a potential mechanism of botulinum toxin injection for prevention of POAF[34]. Another study by Waldron et al.[5] showed that injection of 50 U of botulinum toxin into each five epicardial fat pads (immediately after beginning of cardiopulmonary bypass) in patients undergoing cardiac surgery reduced the incidence of POAF compared to placebo (36.5% and 47.8%, respectively), however this difference was not statistically significant. Also, no significant differences were seen between length of hospital stay and occurrence of adverse effects in patients who received botulinum toxin injection or placebo[5]. In this study, patients who underwent CABG or valve surgery or combined CABG and valve surgery were included; whereas in Pokushalov et al.[3] one-year and three-year follow-up studies[4], only CABG patients were included and evaluated. Additionally, the left atrial sizes, as a marker of atrial structural remodeling, which commonly is associated with increased risk for AF, were considerably different between these studies (3.9±0.6 and 3.9±0.7 cm vs. 4.7±0.8 and 4.8±0.6, respectively). These issues may be possible explanations for the inconsistent results between studies. In sum, it seems that botulinum toxin injection into epicardial fat pads may be considered as a potentially promising and safe modality for prevention of POAF after cardiac surgery. However, further well-designed studies will be
{"title":"Botulinum Toxin Injection into Epicardial Fat Pads: A Promising Potential Modality for Prevention of Postoperative Atrial Fibrillation After Cardiac Surgery","authors":"A. Fatahian","doi":"10.21470/1678-9741-2019-0309","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0309","url":null,"abstract":"Despite developing new standards and advances in anesthetic and surgical techniques, postoperative atrial fibrillation (POAF) is one of the most frequent complications and a significant unsolved clinical problem after cardiac surgery[1]. Occurrence of POAF is associated with significant increased risk of long-term mortality, morbidity, and long intensive care unit (ICU) and hospital stays, which consequently impose additional cost on both health system and patient[2]. Considering the potential significant adverse effects of POAF in patients undergoing cardiac surgery and the limited efficacy of current preventive strategies, concerted efforts to identify and implement new preventive strategies are necessary[1,2]. Recently, injection of botulinum toxin into epicardial fat pads in patients undergoing cardiac surgery has been suggested as a promising modality for prevention of POAF. In a study by Pokushalov et al.[3], it has been shown that 50 U botulinum toxin injection, at four major epicardial fat pads, during surgery in patients undergoing coronary artery bypass grafting (CABG) provided considerable atrial tachyarrhythmia suppression, in both early and one-year followups[3]. Also, a three-year follow-up of this study indicates a sustained and significant reduction in atrial fibrillation (AF) incidence and burden, along with reduction in patients' hospitalizations. Besides, no serious adverse events related to injection of botulinum toxin for prevention of POAF after CABG have been reported[4]. Suppression of atrial autonomic remodeling has been suggested as a potential mechanism of botulinum toxin injection for prevention of POAF[34]. Another study by Waldron et al.[5] showed that injection of 50 U of botulinum toxin into each five epicardial fat pads (immediately after beginning of cardiopulmonary bypass) in patients undergoing cardiac surgery reduced the incidence of POAF compared to placebo (36.5% and 47.8%, respectively), however this difference was not statistically significant. Also, no significant differences were seen between length of hospital stay and occurrence of adverse effects in patients who received botulinum toxin injection or placebo[5]. In this study, patients who underwent CABG or valve surgery or combined CABG and valve surgery were included; whereas in Pokushalov et al.[3] one-year and three-year follow-up studies[4], only CABG patients were included and evaluated. Additionally, the left atrial sizes, as a marker of atrial structural remodeling, which commonly is associated with increased risk for AF, were considerably different between these studies (3.9±0.6 and 3.9±0.7 cm vs. 4.7±0.8 and 4.8±0.6, respectively). These issues may be possible explanations for the inconsistent results between studies. In sum, it seems that botulinum toxin injection into epicardial fat pads may be considered as a potentially promising and safe modality for prevention of POAF after cardiac surgery. However, further well-designed studies will be","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49209640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.21470/1678-9741-2018-0205
U. S. Sanrı, K. K. Özsin, F. Toktaş, Ş. Yavuz
Ventricular free wall rupture is a fatal mechanical complication of acute myocardial infarction. In some cases it can be represented as subacute clinic and may not cause death in a few minutes. Acute pseudo-aneurysms are extremely unstable and bound to fatal rupture. Herein we report a male patient who suffered dyspnea and mild chest pain, 4 weeks after acute ST-segment elevation myocardial infarction.
{"title":"Appropriate Surgical Repair of Ventricular Free Wall Rupture after Infarction: a Case Report","authors":"U. S. Sanrı, K. K. Özsin, F. Toktaş, Ş. Yavuz","doi":"10.21470/1678-9741-2018-0205","DOIUrl":"https://doi.org/10.21470/1678-9741-2018-0205","url":null,"abstract":"Ventricular free wall rupture is a fatal mechanical complication of acute myocardial infarction. In some cases it can be represented as subacute clinic and may not cause death in a few minutes. Acute pseudo-aneurysms are extremely unstable and bound to fatal rupture. Herein we report a male patient who suffered dyspnea and mild chest pain, 4 weeks after acute ST-segment elevation myocardial infarction.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43450193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.21470/1678-9741-2018-0314
Rupesh Kumar, Javid Raja
The most common cardiac tumour in the pediatric age group is rhabdomyoma. These are usually located in the ventricles, either in the ventricular septum or free wall. Cardiac tumours in early infancy may lead to severely compromised blood flow due to inflow or outflow tract obstruction. The diagnosis of cardiac rhabdomyoma can be established by transthoracic echocardiography (TTE). Rhabdomyomas have a natural history of spontaneous regression; surgical intervention is reserved for patients with symptoms of severe obstruction or hemodynamic instability. In this study, a case of two-year old child who presented with failure to thrive and underwent excision of pedunculated mass from the right ventricular outflow tract was reported.
{"title":"A Mass Causing Right Ventricular Outflow Obstruction - A Dreadful Complication","authors":"Rupesh Kumar, Javid Raja","doi":"10.21470/1678-9741-2018-0314","DOIUrl":"https://doi.org/10.21470/1678-9741-2018-0314","url":null,"abstract":"The most common cardiac tumour in the pediatric age group is rhabdomyoma. These are usually located in the ventricles, either in the ventricular septum or free wall. Cardiac tumours in early infancy may lead to severely compromised blood flow due to inflow or outflow tract obstruction. The diagnosis of cardiac rhabdomyoma can be established by transthoracic echocardiography (TTE). Rhabdomyomas have a natural history of spontaneous regression; surgical intervention is reserved for patients with symptoms of severe obstruction or hemodynamic instability. In this study, a case of two-year old child who presented with failure to thrive and underwent excision of pedunculated mass from the right ventricular outflow tract was reported.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42157346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.21470/1678-9741-2019-0067
S. Ozturk, M. Şahin
Objective To evaluate the predictive accuracy of SYNTAX score (SS) I and II for detecting significant carotid artery stenosis (CAS) in patients with multivessel coronary artery disease undergoing coronary artery bypass grafting (CABG) surgery. Methods The study population consisted of 416 patients. Clinical, demographic, and radiological records were retrospectively reviewed. Characteristics of patients with CAS (n=66) and patients without CAS (n=350) were compared before and after propensity score matching analysis. Results Patients with significant CAS were older compared to those without significant CAS [(60 (53-65) vs. 63 (59-67); P=0.01]. However, atherosclerotic risk factors and SS I were similar between groups. SS II CABG and percutaneous coronary intervention (PCI) were significantly higher in patients with CAS [37.4 (30.9-43.5) vs. 33.8 (29.9-38.9); P=0.02]. After propensity score matching analysis (66 vs. 66), age, SS II PCI and CABG were significantly higher in patients with CAS than those without CAS [37.4 (30.9-43.5) vs. 33 (29.3-36.9); P=0.03]. Age, SS II PCI and CABG were associated with CAS in logistic regression analysis [OR=1.086, 95% CI (1.032-1.143), P<0.001; OR=1.054, 95% CI (1.010-1.101), P=0.02; OR=1.078, 95% CI (1.029-1.129), P<0.01]. In ROC curve analysis, SS II PCI >33.1 had 68.2% sensitivity and 54.6% specificity [AUC=0.624, P=0.01, 95% CI (0.536-0.707)] whereas SS II CABG >26.1 had 81.8% sensitivity and 54.6% specificity [AUC=0.670, P<0.01, 95% CI (0.583-0.749)] to predict CAS. Pairwise comparison of ROC curves revealed similar statistical accuracy for prediction of CAS (z statistic: 0.683, P=0.49) Conclusion SS II is useful to predict asymptomatic CAS in patients with multivessel coronary artery disease.
目的评价SYNTAX评分(SS) I和II对多支冠状动脉病变行冠状动脉搭桥术(CABG)患者颈动脉明显狭窄(CAS)的预测准确性。方法研究人群为416例。回顾性回顾临床、人口统计学和放射学记录。比较倾向评分匹配分析前后CAS患者(n=66)和非CAS患者(n=350)的特征。结果与无显著CAS的患者相比，显著CAS患者年龄较大[60(53-65)比63 (59-67);P = 0.01)。然而，两组之间的动脉粥样硬化危险因素和SS I相似。在CAS患者中，SS II CABG和经皮冠状动脉介入治疗(PCI)的评分明显更高[37.4(30.9-43.5)比33.8 (29.9-38.9);P = 0.02)。经倾向评分匹配分析(66比66)，有CAS患者的年龄、SS II PCI和CABG明显高于无CAS患者[37.4(30.9-43.5)比33 (29.3-36.9);P = 0.03)。logistic回归分析显示，年龄、SS II PCI和CABG与CAS相关[OR=1.086, 95% CI (1.032-1.143)， P33.1预测CAS的敏感性为68.2%，特异性为54.6% [AUC=0.624, P=0.01, 95% CI(0.536-0.707)]，而SS II CABG bbb26.1预测CAS的敏感性为81.8%，特异性为54.6% [AUC=0.670, P<0.01, 95% CI(0.583-0.749)]。ROC曲线两两比较显示，预测无症状冠状动脉综合征(CAS)的统计准确率相近(z统计量:0.683,P=0.49)。结论SSⅱ可用于预测多支冠状动脉病患者无症状CAS。
{"title":"Syntax Score I and II for Predicting Carotid Artery Stenosis in Patients with Multivessel Coronary Artery Disease: A Propensity Score Matching Analysis","authors":"S. Ozturk, M. Şahin","doi":"10.21470/1678-9741-2019-0067","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0067","url":null,"abstract":"Objective To evaluate the predictive accuracy of SYNTAX score (SS) I and II for detecting significant carotid artery stenosis (CAS) in patients with multivessel coronary artery disease undergoing coronary artery bypass grafting (CABG) surgery. Methods The study population consisted of 416 patients. Clinical, demographic, and radiological records were retrospectively reviewed. Characteristics of patients with CAS (n=66) and patients without CAS (n=350) were compared before and after propensity score matching analysis. Results Patients with significant CAS were older compared to those without significant CAS [(60 (53-65) vs. 63 (59-67); P=0.01]. However, atherosclerotic risk factors and SS I were similar between groups. SS II CABG and percutaneous coronary intervention (PCI) were significantly higher in patients with CAS [37.4 (30.9-43.5) vs. 33.8 (29.9-38.9); P=0.02]. After propensity score matching analysis (66 vs. 66), age, SS II PCI and CABG were significantly higher in patients with CAS than those without CAS [37.4 (30.9-43.5) vs. 33 (29.3-36.9); P=0.03]. Age, SS II PCI and CABG were associated with CAS in logistic regression analysis [OR=1.086, 95% CI (1.032-1.143), P<0.001; OR=1.054, 95% CI (1.010-1.101), P=0.02; OR=1.078, 95% CI (1.029-1.129), P<0.01]. In ROC curve analysis, SS II PCI >33.1 had 68.2% sensitivity and 54.6% specificity [AUC=0.624, P=0.01, 95% CI (0.536-0.707)] whereas SS II CABG >26.1 had 81.8% sensitivity and 54.6% specificity [AUC=0.670, P<0.01, 95% CI (0.583-0.749)] to predict CAS. Pairwise comparison of ROC curves revealed similar statistical accuracy for prediction of CAS (z statistic: 0.683, P=0.49) Conclusion SS II is useful to predict asymptomatic CAS in patients with multivessel coronary artery disease.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47827655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.21470/1678-9741-2018-0198
Beatriz J. S. Branco, Cesar Sanchez, C. Mendoza, M. Magarakis, Alejandro E. Macias, T. Salerno
Spontaneous coronary artery dissection (SCAD) is characterized by tear of the inner layer in the coronary artery, creating a false lumen between the inner and central layer. Its infrequent incidence often leads to delay in diagnosis posing challenges in management. There are currently no guidelines for the treatment of this condition. We describe an adult patient who presented with multiple episodes of ventricular fibrillation, in whom cardiac catheterization showed SCAD, treated by off-pump coronary artery bypass.
{"title":"Challenges in Diagnosis and Management of Spontaneous Coronary Artery Dissection in a Young Patient","authors":"Beatriz J. S. Branco, Cesar Sanchez, C. Mendoza, M. Magarakis, Alejandro E. Macias, T. Salerno","doi":"10.21470/1678-9741-2018-0198","DOIUrl":"https://doi.org/10.21470/1678-9741-2018-0198","url":null,"abstract":"Spontaneous coronary artery dissection (SCAD) is characterized by tear of the inner layer in the coronary artery, creating a false lumen between the inner and central layer. Its infrequent incidence often leads to delay in diagnosis posing challenges in management. There are currently no guidelines for the treatment of this condition. We describe an adult patient who presented with multiple episodes of ventricular fibrillation, in whom cardiac catheterization showed SCAD, treated by off-pump coronary artery bypass.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44974274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.21470/1678-9741-2018-0312
Nafiseh Emadi, M. Nemati, M. Ghorbani, E. Allahyari
Objective To evaluate the effect of high-dose vitamin C on cardiac reperfusion injury and plasma levels of creatine kinase-muscle/brain (CK-MB), troponin I, and lactate dehydrogenase (LDH) in patients undergoing coronary artery bypass grafting (CABG). Methods This is a double-blind randomized clinical trial study. Fifty patients (50-80 years old) who had CABG surgery were selected. The intervention group received 5 g of intravenous vitamin C before anesthesia induction and 5 g of vitamin C in cardioplegic solution. The control group received the same amount of placebo (normal saline). Arterial blood samples were taken to determine the serum levels of CK-MB, troponin I, and LDH enzymes. Left ventricular ejection fraction was measured and hemodynamic parameters were recorded at intervals. Results High doses of vitamin C in the treatment group led to improvement of ventricular function (ejection fraction [EF]) and low Intensive Care Unit (ICU) stay. The cardiac enzymes level in the vitamin C group was lower than in the control group. These changes were not significant between the groups in different time intervals (anesthesia induction, end of bypass, 6 h after surgery, and 24 h after surgery) for CK-MB, LDH, and troponin I. Hemodynamic parameters, hematocrit, potassium, urinary output, blood transfusion, arrhythmia, and inotropic support showed no significant difference between the groups. Conclusion Vitamin C has significantly improved the patients’ ventricular function (EF) 72 h after surgery and reduced the length of ICU stay. No significant changes in cardiac biomarkers, including CK-MB, troponin I, and LDH, were seen over time in each group. IRCT code IRCT2016053019470N33
{"title":"The Effect of High-Dose Vitamin C on Biochemical Markers of Myocardial Injury in Coronary Artery Bypass Surgery","authors":"Nafiseh Emadi, M. Nemati, M. Ghorbani, E. Allahyari","doi":"10.21470/1678-9741-2018-0312","DOIUrl":"https://doi.org/10.21470/1678-9741-2018-0312","url":null,"abstract":"Objective To evaluate the effect of high-dose vitamin C on cardiac reperfusion injury and plasma levels of creatine kinase-muscle/brain (CK-MB), troponin I, and lactate dehydrogenase (LDH) in patients undergoing coronary artery bypass grafting (CABG). Methods This is a double-blind randomized clinical trial study. Fifty patients (50-80 years old) who had CABG surgery were selected. The intervention group received 5 g of intravenous vitamin C before anesthesia induction and 5 g of vitamin C in cardioplegic solution. The control group received the same amount of placebo (normal saline). Arterial blood samples were taken to determine the serum levels of CK-MB, troponin I, and LDH enzymes. Left ventricular ejection fraction was measured and hemodynamic parameters were recorded at intervals. Results High doses of vitamin C in the treatment group led to improvement of ventricular function (ejection fraction [EF]) and low Intensive Care Unit (ICU) stay. The cardiac enzymes level in the vitamin C group was lower than in the control group. These changes were not significant between the groups in different time intervals (anesthesia induction, end of bypass, 6 h after surgery, and 24 h after surgery) for CK-MB, LDH, and troponin I. Hemodynamic parameters, hematocrit, potassium, urinary output, blood transfusion, arrhythmia, and inotropic support showed no significant difference between the groups. Conclusion Vitamin C has significantly improved the patients’ ventricular function (EF) 72 h after surgery and reduced the length of ICU stay. No significant changes in cardiac biomarkers, including CK-MB, troponin I, and LDH, were seen over time in each group. IRCT code IRCT2016053019470N33","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47469278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.21470/1678-9741-2019-0062
F. Aksoy, S. Guler, F. Kahraman, M. Kuyumcu, Ali Bağcı, H. Baş, Dinçer Uysal, E. Varol
Introduction Metabolic syndrome (MetS) is defined as an association between diabetes, hypertension, obesity and dyslipidemia and an increased risk of cardiovascular disease. Mitral annular calcification (MAC) is associated with several cardiovascular disorders, including coronary artery disease, atrial fibrillation (AF), heart failure, ischemic stroke and increased mortality. The CHA2DS2-VASc score is used to estimate thromboembolic risk in AF. However, the association among MAC, MetS and thromboembolic risk is unknown and was evaluated in the current study. Methods The study group consisted of 94 patients with MAC and 86 patients with MetS. Patients were divided into two groups: those with and those without MAC. Results Patients with MAC had a higher MetS rate (P<0.001). In patients with MAC, the CHA2DS2-VASc scores and the rate of cerebrovascular accident and AF were significantly higher compared to those without MAC (P<0.001, for both parameters). The results of the multivariate regression analysis showed that history of smoking, presence of MetS and high CHA2DS2-VASc scores were associated with the development of MAC. ROC curve analyses showed that CHA2DS2-VASc scores were significant predictors for MAC (C-statistic: 0.78; 95% CI: 0.706-0.855, P<0.001). Correlation analysis indicated that MAC was positively correlated with the presence of MetS and CHA2DS2-VASc score (P=0.001, r=0.264; P<0.001, r=0.490). Conclusion We have shown that CHA2DS2-VASc score and presence of MetS rates were significantly higher in patients with MAC compared without MAC. Presence of MAC was correlated with CHA2DS2-VASc score, presence of MetS, AF and left atrial diameter and negatively correlated with left ventricular ejection fraction.
代谢综合征(MetS)被定义为糖尿病、高血压、肥胖和血脂异常与心血管疾病风险增加之间的一种关联。二尖瓣环钙化(MAC)与几种心血管疾病有关，包括冠状动脉疾病、心房颤动(AF)、心力衰竭、缺血性中风和死亡率增加。CHA2DS2-VASc评分用于评估房颤的血栓栓塞风险。然而，MAC、MetS和血栓栓塞风险之间的关系尚不清楚，本研究对其进行了评估。方法研究组包括94例MAC患者和86例MetS患者。患者分为两组:有MAC组和无MAC组。结果有MAC的患者有较高的MetS率(P<0.001)。MAC患者CHA2DS2-VASc评分、脑血管意外和房颤发生率均显著高于无MAC患者(P<0.001)。多因素回归分析结果显示，吸烟史、有无MetS、CHA2DS2-VASc评分偏高与MAC的发生有关。ROC曲线分析显示，CHA2DS2-VASc评分是MAC的显著预测因子(C-statistic: 0.78;95% ci: 0.706-0.855, p <0.001)。相关性分析显示，MAC与MetS、CHA2DS2-VASc评分呈正相关(P=0.001, r=0.264;P < 0.001, r = 0.490)。结论MAC患者的CHA2DS2-VASc评分和MetS发生率明显高于无MAC患者。MAC的存在与CHA2DS2-VASc评分、MetS的存在、AF和左房内径相关，与左室射血分数负相关。
{"title":"The Relationship Between Mitral Annular Calcification, Metabolic Syndrome and Thromboembolic Risk","authors":"F. Aksoy, S. Guler, F. Kahraman, M. Kuyumcu, Ali Bağcı, H. Baş, Dinçer Uysal, E. Varol","doi":"10.21470/1678-9741-2019-0062","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0062","url":null,"abstract":"Introduction Metabolic syndrome (MetS) is defined as an association between diabetes, hypertension, obesity and dyslipidemia and an increased risk of cardiovascular disease. Mitral annular calcification (MAC) is associated with several cardiovascular disorders, including coronary artery disease, atrial fibrillation (AF), heart failure, ischemic stroke and increased mortality. The CHA2DS2-VASc score is used to estimate thromboembolic risk in AF. However, the association among MAC, MetS and thromboembolic risk is unknown and was evaluated in the current study. Methods The study group consisted of 94 patients with MAC and 86 patients with MetS. Patients were divided into two groups: those with and those without MAC. Results Patients with MAC had a higher MetS rate (P<0.001). In patients with MAC, the CHA2DS2-VASc scores and the rate of cerebrovascular accident and AF were significantly higher compared to those without MAC (P<0.001, for both parameters). The results of the multivariate regression analysis showed that history of smoking, presence of MetS and high CHA2DS2-VASc scores were associated with the development of MAC. ROC curve analyses showed that CHA2DS2-VASc scores were significant predictors for MAC (C-statistic: 0.78; 95% CI: 0.706-0.855, P<0.001). Correlation analysis indicated that MAC was positively correlated with the presence of MetS and CHA2DS2-VASc score (P=0.001, r=0.264; P<0.001, r=0.490). Conclusion We have shown that CHA2DS2-VASc score and presence of MetS rates were significantly higher in patients with MAC compared without MAC. Presence of MAC was correlated with CHA2DS2-VASc score, presence of MetS, AF and left atrial diameter and negatively correlated with left ventricular ejection fraction.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42669453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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