Pub Date : 2022-05-02DOI: 10.21470/1678-9741-2021-0024
Y. Tekin, G. Tekin, İ. Korkmaz, Sefa Yurtbay
We carefully read the comments of dear colleagues Cengiz Beyan and Esin Beyan[1]. about our article titled “Mean Platelet Volume and Related Parameters May not Contribute to the Diagnosis in Patients with Ascending Thoracic Aortic Aneurysm”[2]. Beyan et al.[1] commented that “The control group did not consist of healthy volunteers, and it was made up of individuals who applied in the hospital at the same time. The fact that the control group is not composed of healthy volunteers and does not represent the society makes it difficult to interpret the results obtained.”. Our study results have a statistically significant value, and while we have excluded the patients previously diagnosed with hematological malignancy, chronic obstructive pulmonary disease (or COPD), autoimmune liver disease, cirrhosis, metastatic bone marrow infiltration, acute or chronic inflammatory disease — such as physical trauma, tonsillitis, asthma, rheumatoid arthritis, and active hepatitis —, and current or recent treatment (in the past three months) with oral or intravenous steroids or other medications that might cause pancytopenia from the control group according to their background, it is possible that all the exclusion criteria cannot be made in a retrospective study and that there can be pre-analytical and analytical errors, but this does not change the statistical difference. Additionally, Beyan et al.[1] tried to draw attention that mean platelet volume (MPV) is a complete blood count parameter whose measurement has not been standardized to date and, therefore, it has been reported to have no role in diagnosis and prognosis of acquired diseases according to a study, but there are many studies about the prognostic value of MPV in many clinical diseases. Vardon-Bounes et al.[3] reported that MPV was an independent predictive factor of 90-day mortality. They suggested that continuous monitoring of MPV may be a useful parameter to stratify mortality risk in septic shock. Ma et al.[4] reported that high MPV can be considered as an independent biomarker for predicting three-month mortality in patients with hepatitis B virus-related decompensated cirrhosis. Lee Response to the Letter: Mean Platelet Volume and Related Parameters May Not Contribute to the Diagnosis in Patients with Ascending Thoracic Aortic Aneurysm
{"title":"Response to the Letter: Mean Platelet Volume and Related Parameters May Not Contribute to the Diagnosis in Patients with Ascending Thoracic Aortic Aneurysm","authors":"Y. Tekin, G. Tekin, İ. Korkmaz, Sefa Yurtbay","doi":"10.21470/1678-9741-2021-0024","DOIUrl":"https://doi.org/10.21470/1678-9741-2021-0024","url":null,"abstract":"We carefully read the comments of dear colleagues Cengiz Beyan and Esin Beyan[1]. about our article titled “Mean Platelet Volume and Related Parameters May not Contribute to the Diagnosis in Patients with Ascending Thoracic Aortic Aneurysm”[2]. Beyan et al.[1] commented that “The control group did not consist of healthy volunteers, and it was made up of individuals who applied in the hospital at the same time. The fact that the control group is not composed of healthy volunteers and does not represent the society makes it difficult to interpret the results obtained.”. Our study results have a statistically significant value, and while we have excluded the patients previously diagnosed with hematological malignancy, chronic obstructive pulmonary disease (or COPD), autoimmune liver disease, cirrhosis, metastatic bone marrow infiltration, acute or chronic inflammatory disease — such as physical trauma, tonsillitis, asthma, rheumatoid arthritis, and active hepatitis —, and current or recent treatment (in the past three months) with oral or intravenous steroids or other medications that might cause pancytopenia from the control group according to their background, it is possible that all the exclusion criteria cannot be made in a retrospective study and that there can be pre-analytical and analytical errors, but this does not change the statistical difference. Additionally, Beyan et al.[1] tried to draw attention that mean platelet volume (MPV) is a complete blood count parameter whose measurement has not been standardized to date and, therefore, it has been reported to have no role in diagnosis and prognosis of acquired diseases according to a study, but there are many studies about the prognostic value of MPV in many clinical diseases. Vardon-Bounes et al.[3] reported that MPV was an independent predictive factor of 90-day mortality. They suggested that continuous monitoring of MPV may be a useful parameter to stratify mortality risk in septic shock. Ma et al.[4] reported that high MPV can be considered as an independent biomarker for predicting three-month mortality in patients with hepatitis B virus-related decompensated cirrhosis. Lee Response to the Letter: Mean Platelet Volume and Related Parameters May Not Contribute to the Diagnosis in Patients with Ascending Thoracic Aortic Aneurysm","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"37 1","pages":"279 - 280"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48049413","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 : 2022-05-02DOI: 10.21470/1678-9741-2020-0649
L. Cardoso, R. Dias, L. Demarchi, Lucas Molinari Veloso da Silveira, C. Mady, F. Jatene
We present an unusual case of a 67-year-old woman with an incidental finding of a cardiac mass on a chest computed tomography. Coronary angiotomography confirmed the diagnosis of right coronary artery aneurysm, with 5.7×5.7 cm. The patient underwent aneurysm resection and coronary bypass surgery, with subsequent histologic study suggestive of arteritis sequelae. Giant coronary artery aneurysms have a high risk of complications and aneurysm exclusion must be beneficial. This is a rare condition that can also be part of a systemic inflammatory disease.
{"title":"Nonatherosclerotic Giant Right Coronary Artery Aneurysm","authors":"L. Cardoso, R. Dias, L. Demarchi, Lucas Molinari Veloso da Silveira, C. Mady, F. Jatene","doi":"10.21470/1678-9741-2020-0649","DOIUrl":"https://doi.org/10.21470/1678-9741-2020-0649","url":null,"abstract":"We present an unusual case of a 67-year-old woman with an incidental finding of a cardiac mass on a chest computed tomography. Coronary angiotomography confirmed the diagnosis of right coronary artery aneurysm, with 5.7×5.7 cm. The patient underwent aneurysm resection and coronary bypass surgery, with subsequent histologic study suggestive of arteritis sequelae. Giant coronary artery aneurysms have a high risk of complications and aneurysm exclusion must be beneficial. This is a rare condition that can also be part of a systemic inflammatory disease.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"37 1","pages":"271 - 272"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43135429","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 : 2022-05-02DOI: 10.21470/1678-9741-2022-0129
O. García-Villarreal
The usefulness of percutaneous approaches in structural heart disease could be limited if they have been defined in terms of often unrealistic scenarios. Thus, the long-term outcomes and consequences need to be painstakingly analyzed. Much attention needs to be paid to the global magnitude of this issue. One such example, is the transcatheter edge-to-edge mitral valve repair (TEER) and considerations of pivotal importance that arise from using this therapy to treat functional mitral regurgitation (FMR). Traditionally, surgical treatment has been the best option for mitral valve (MV) repair. When comparing TEER to surgical MV repair, details to be considered. One of the drawbacks of the that
{"title":"Transcatheter Edge-to-Edge Mitral Valve Repair in Functional Mitral Regurgitation. Does it Pass Muster? Still Leaving Plenty to Be Desired","authors":"O. García-Villarreal","doi":"10.21470/1678-9741-2022-0129","DOIUrl":"https://doi.org/10.21470/1678-9741-2022-0129","url":null,"abstract":"The usefulness of percutaneous approaches in structural heart disease could be limited if they have been defined in terms of often unrealistic scenarios. Thus, the long-term outcomes and consequences need to be painstakingly analyzed. Much attention needs to be paid to the global magnitude of this issue. One such example, is the transcatheter edge-to-edge mitral valve repair (TEER) and considerations of pivotal importance that arise from using this therapy to treat functional mitral regurgitation (FMR). Traditionally, surgical treatment has been the best option for mitral valve (MV) repair. When comparing TEER to surgical MV repair, details to be considered. One of the drawbacks of the that","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"37 1","pages":"I - IV"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42098847","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 : 2022-05-02DOI: 10.21470/1678-9741-2021-0140
Mayara Gabrielle Barbosa Borges, Daniel Lago Borges, Mariane Oliveira Ribeiro, Lara Susan Silva Lima, Karolina Carneiro Morais Macedo, Vinicius José da Silva Nina
Introduction: Early mobilization of patients in the postoperative period of cardiac surgery who are hospitalized in the intensive care unit (ICU) is a practice that has a positive impact.
Methods: This is a systematic review of studies published until September 2020 in the Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase, Physiotherapy Evidence Database (or PEDro), Scientific Electronic Library Online (or SciELO), and Latin American and Caribbean Health Sciences Literature (or LILACS) databases. Randomized clinical trials describing mobilization protocols performed early in ICU patients after cardiac surgery were included.
Results: According to the eligibility criteria, only 14 of the 1,128 articles found were included in the analysis. Early mobilization protocols were initiated in the immediate postoperative period or first postoperative day. The resources and technics used were progressive mobilization, cycle ergometer, early bed activities, walking protocols, resistance exercise, and virtual reality. Intensity of the mobilization activities was determined using the Borg scale and heart rate.
Conclusion: Early mobilization protocols are generalist (not individual), and low-intensity exercises are used, through progressive mobilization, with two daily physical therapy sessions, during 10 to 30 minutes.
{"title":"Early Mobilization Prescription in Patients Undergoing Cardiac Surgery: Systematic Review.","authors":"Mayara Gabrielle Barbosa Borges, Daniel Lago Borges, Mariane Oliveira Ribeiro, Lara Susan Silva Lima, Karolina Carneiro Morais Macedo, Vinicius José da Silva Nina","doi":"10.21470/1678-9741-2021-0140","DOIUrl":"10.21470/1678-9741-2021-0140","url":null,"abstract":"<p><strong>Introduction: </strong>Early mobilization of patients in the postoperative period of cardiac surgery who are hospitalized in the intensive care unit (ICU) is a practice that has a positive impact.</p><p><strong>Methods: </strong>This is a systematic review of studies published until September 2020 in the Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase, Physiotherapy Evidence Database (or PEDro), Scientific Electronic Library Online (or SciELO), and Latin American and Caribbean Health Sciences Literature (or LILACS) databases. Randomized clinical trials describing mobilization protocols performed early in ICU patients after cardiac surgery were included.</p><p><strong>Results: </strong>According to the eligibility criteria, only 14 of the 1,128 articles found were included in the analysis. Early mobilization protocols were initiated in the immediate postoperative period or first postoperative day. The resources and technics used were progressive mobilization, cycle ergometer, early bed activities, walking protocols, resistance exercise, and virtual reality. Intensity of the mobilization activities was determined using the Borg scale and heart rate.</p><p><strong>Conclusion: </strong>Early mobilization protocols are generalist (not individual), and low-intensity exercises are used, through progressive mobilization, with two daily physical therapy sessions, during 10 to 30 minutes.</p>","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"37 1","pages":"227-238"},"PeriodicalIF":1.1,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9054150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47335235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-02DOI: 10.21470/1678-9741-2021-0139
N. Vitale, T. Acquaviva, Teresa A P Quagliara, N. Bari, G. Capone, N. Marraudino, A. Milano
Introduction Left ventricular assist devices are an established therapy for end-stage heart failure. Follow-up of these patients showed complications, such as thrombosis. Our objective was to evaluate the contribution of echocardiography — in association with HeartWare HVAD online logfiles reviews and lactate dehydrogenase titration — for diagnosis and treatment of thrombosis. Methods Seventeen episodes of thrombosis were diagnosed in 8/20 patients with HVAD. Diagnosis was made by trans-thoracic echocardiographic blood flow velocities, logfiles review of power consumption and pump flows, and titration of lactate dehydrogenase. Data were collected at baseline routine control (Group A), during thrombosis (Group B), after thrombolysis (Group C). Results Thrombolysis was successful in all cases; one patient died of cerebral haemorrhage. Echocardiographic maximal blood flow velocity near the inflow cannula was 598±42 cm/sec (Group B), 379.41±21 cm/sec (Group C), and 378.24±28 cm/sec (Group A) (P<0.00001). In eight (47%) cases, thrombi were visualized in the left ventricle by three-dimensional modality. Logfiles recordings of blood flows were 9.52±0.9 L/min (Group B), 4.02±0.4 L/min (Group C), and 4.04±0.4 L/min (Group A) (P<00001). Power consumption was 5.01±0.7 W (Group B), 3.45±0.2 W (Group C), and 3.46±0.2 W (Group A) (P<0.00001). Lactate dehydrogenase was 756±54 IU (Group B), 234±22 IU (Group A), and 257±36 IU (Group C) (P<0.00001). Conclusions Echocardiography of increased maximal velocity near the inflow cannula is a sign of HVAD obstruction. Logfile reviews provide a clear picture of HVAD obstruction. Combination of echocardiographic data and review of logfiles detects signs of left ventricular assist devices thrombosis leading to a successful treatment.
左心室辅助装置是终末期心力衰竭的常用治疗方法。随访发现患者出现血栓形成等并发症。我们的目的是评估超声心动图的贡献-与HeartWare HVAD在线日志文件回顾和乳酸脱氢酶滴定-诊断和治疗血栓形成。方法20例HVAD患者中有8例有血栓形成。通过经胸超声心动图血流速度、功率消耗和泵流量日志回顾、乳酸脱氢酶滴定进行诊断。收集基线常规对照(A组)、血栓形成时(B组)、溶栓后(C组)的数据。结果所有病例溶栓均成功;1例患者死于脑溢血。B组、C组和A组的超声心动图最大血流速度分别为598±42 cm/sec、379.41±21 cm/sec和378.24±28 cm/sec (P<0.00001)。在8例(47%)病例中，血栓在左心室通过三维模式可见。血流量日志记录分别为9.52±0.9 L/min (B组)、4.02±0.4 L/min (C组)、4.04±0.4 L/min (A组)(P<00001)。功耗分别为5.01±0.7 W (B组)、3.45±0.2 W (C组)和3.46±0.2 W (A组)(P<0.00001)。乳酸脱氢酶分别为756±54 IU (B组)、234±22 IU (A组)和257±36 IU (C组)(P<0.00001)。结论超声心动图显示流入管附近最大流速增高是HVAD梗阻的标志。日志文件检查提供了HVAD阻塞的清晰图像。结合超声心动图数据和回顾日志文件检测左心室辅助装置血栓形成的迹象，导致成功的治疗。
{"title":"Left Ventricular Assist Device Thrombosis: Combined Approach by Echocardiography and Logfiles Review for Diagnosis and Management","authors":"N. Vitale, T. Acquaviva, Teresa A P Quagliara, N. Bari, G. Capone, N. Marraudino, A. Milano","doi":"10.21470/1678-9741-2021-0139","DOIUrl":"https://doi.org/10.21470/1678-9741-2021-0139","url":null,"abstract":"Introduction Left ventricular assist devices are an established therapy for end-stage heart failure. Follow-up of these patients showed complications, such as thrombosis. Our objective was to evaluate the contribution of echocardiography — in association with HeartWare HVAD online logfiles reviews and lactate dehydrogenase titration — for diagnosis and treatment of thrombosis. Methods Seventeen episodes of thrombosis were diagnosed in 8/20 patients with HVAD. Diagnosis was made by trans-thoracic echocardiographic blood flow velocities, logfiles review of power consumption and pump flows, and titration of lactate dehydrogenase. Data were collected at baseline routine control (Group A), during thrombosis (Group B), after thrombolysis (Group C). Results Thrombolysis was successful in all cases; one patient died of cerebral haemorrhage. Echocardiographic maximal blood flow velocity near the inflow cannula was 598±42 cm/sec (Group B), 379.41±21 cm/sec (Group C), and 378.24±28 cm/sec (Group A) (P<0.00001). In eight (47%) cases, thrombi were visualized in the left ventricle by three-dimensional modality. Logfiles recordings of blood flows were 9.52±0.9 L/min (Group B), 4.02±0.4 L/min (Group C), and 4.04±0.4 L/min (Group A) (P<00001). Power consumption was 5.01±0.7 W (Group B), 3.45±0.2 W (Group C), and 3.46±0.2 W (Group A) (P<0.00001). Lactate dehydrogenase was 756±54 IU (Group B), 234±22 IU (Group A), and 257±36 IU (Group C) (P<0.00001). Conclusions Echocardiography of increased maximal velocity near the inflow cannula is a sign of HVAD obstruction. Logfile reviews provide a clear picture of HVAD obstruction. Combination of echocardiographic data and review of logfiles detects signs of left ventricular assist devices thrombosis leading to a successful treatment.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"37 1","pages":"145 - 152"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42963640","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 : 2022-05-02DOI: 10.21470/1678-9741-2020-0616
Joanna Stanisz-Kempa, Z. Gąsior, A. Kułach
Introduction A potentially new marker of cardiovascular diseases — proadrenomedullin is the precursor of adrenomedullin, which is a multifunctional peptide hormone, produced in most of the tissues in response to cellular stress, ischemia, and hypoxia. Methods Ninety-three people, aged 51-79 years, were included in the study. Exclusion criteria were severe or corrected valvular disease, acute coronary syndrome, age ≥ 80 years, glomerular filtration rate < 45 ml/min, active infectious diseases, and cancer. The subjects were observed for adverse events, including reduced left ventricular ejection fraction (LVEF) by ≥ 10%, first incidence of atrial fibrillation (AF), and the necessity of using dopamine during hospitalization. Results Use of pressure amines, occurrence of the first AF episode, and left ventricular dysfunction defined by a decrease in LVEF by at least 10% compared to the value before surgery were reported in the perioperative period. No death, sudden cardiac arrest with effective resuscitation, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, or heart failure were observed. Significantly higher proadrenomedullin concentration was observed in the group with reduced postoperative LVEF (1.68 vs. 0.77 nmol/l, P=0.005). The relative risk of a decrease in ejection fraction in the group of patients with proadrenomedullin concentration ≥ 0.77 nmol/l was more than twelve-fold higher (95% confidence interval 1.69-888.33; P=0.013) than in the group of patients with a concentration of proadrenomedullin < 0.77 nmol/l. Conclusion The higher baseline concentration of proadrenomedullin has a predominantly predictive value of postoperative left ventricular systolic dysfunction.
{"title":"Proadrenomedullin in Patients with Preserved Left Ventricular Systolic Function Undergoing Coronary Artery Bypass Grafting","authors":"Joanna Stanisz-Kempa, Z. Gąsior, A. Kułach","doi":"10.21470/1678-9741-2020-0616","DOIUrl":"https://doi.org/10.21470/1678-9741-2020-0616","url":null,"abstract":"Introduction A potentially new marker of cardiovascular diseases — proadrenomedullin is the precursor of adrenomedullin, which is a multifunctional peptide hormone, produced in most of the tissues in response to cellular stress, ischemia, and hypoxia. Methods Ninety-three people, aged 51-79 years, were included in the study. Exclusion criteria were severe or corrected valvular disease, acute coronary syndrome, age ≥ 80 years, glomerular filtration rate < 45 ml/min, active infectious diseases, and cancer. The subjects were observed for adverse events, including reduced left ventricular ejection fraction (LVEF) by ≥ 10%, first incidence of atrial fibrillation (AF), and the necessity of using dopamine during hospitalization. Results Use of pressure amines, occurrence of the first AF episode, and left ventricular dysfunction defined by a decrease in LVEF by at least 10% compared to the value before surgery were reported in the perioperative period. No death, sudden cardiac arrest with effective resuscitation, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, or heart failure were observed. Significantly higher proadrenomedullin concentration was observed in the group with reduced postoperative LVEF (1.68 vs. 0.77 nmol/l, P=0.005). The relative risk of a decrease in ejection fraction in the group of patients with proadrenomedullin concentration ≥ 0.77 nmol/l was more than twelve-fold higher (95% confidence interval 1.69-888.33; P=0.013) than in the group of patients with a concentration of proadrenomedullin < 0.77 nmol/l. Conclusion The higher baseline concentration of proadrenomedullin has a predominantly predictive value of postoperative left ventricular systolic dysfunction.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"37 1","pages":"219 - 226"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44289679","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 : 2022-05-02DOI: 10.21470/1678-9741-2020-0720
F. Atik, Carolina de Castro Borges, M. Ulhoa, R. Chaves, Vitor Barzilai, R. Biondi, Tiago Martins de Almeida, Isabela Medeiros, H. Cardoso
Introduction Combined solid organ transplantation is infrequently performed in Brazil. The objective of this article is to present our initial experience with combined heart and kidney transplantation. Methods From January 2007 to December 2019, four patients were submitted to combined heart and kidney transplantation. Their mean age was 55.7±4.4 years, and three (75%) patients were males. All patients had Chagas cardiomyopathy, two were hospitalized and inotrope dependent, and all patients were on preoperative dialysis (median of 12 months prior to transplant). Results All patients survived and were in New York Heart Association functional class I at the latest follow-up (mean 34.7±17.5 months). Mean retarded kidney graft function was 22.9±9.7 days. One patient lost the kidney graft two years after the transplant due to Polyomavirus infection. Conclusion Our initial experience of combined heart and kidney transplantation was favorable in selected patients with advanced heart failure and end-stage kidney disease. It requires involvement of a dedicated multispecialty team throughout all the diagnostics and treatment steps.
{"title":"Combined Heart and Kidney Transplantation: Initial Clinical Experience","authors":"F. Atik, Carolina de Castro Borges, M. Ulhoa, R. Chaves, Vitor Barzilai, R. Biondi, Tiago Martins de Almeida, Isabela Medeiros, H. Cardoso","doi":"10.21470/1678-9741-2020-0720","DOIUrl":"https://doi.org/10.21470/1678-9741-2020-0720","url":null,"abstract":"Introduction Combined solid organ transplantation is infrequently performed in Brazil. The objective of this article is to present our initial experience with combined heart and kidney transplantation. Methods From January 2007 to December 2019, four patients were submitted to combined heart and kidney transplantation. Their mean age was 55.7±4.4 years, and three (75%) patients were males. All patients had Chagas cardiomyopathy, two were hospitalized and inotrope dependent, and all patients were on preoperative dialysis (median of 12 months prior to transplant). Results All patients survived and were in New York Heart Association functional class I at the latest follow-up (mean 34.7±17.5 months). Mean retarded kidney graft function was 22.9±9.7 days. One patient lost the kidney graft two years after the transplant due to Polyomavirus infection. Conclusion Our initial experience of combined heart and kidney transplantation was favorable in selected patients with advanced heart failure and end-stage kidney disease. It requires involvement of a dedicated multispecialty team throughout all the diagnostics and treatment steps.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"37 1","pages":"263 - 267"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42092760","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 : 2022-04-18DOI: 10.21470/1678-9741-2020-0705
D. Oztas, M. Uğurlucan, O. Sayin, F. Ekiz, Yilmaz Onal, M. O. Beyaz, M. Umutlu, Mert Meriç, B. Acunaş, U. Alpagut
Introduction The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. Methods Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. Results Patients’ mean age was 65.3±19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. Conclusion Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.
{"title":"Follow-up Results of Endovascular Aneurysm Repair Following Abdominal Visceral Debranching","authors":"D. Oztas, M. Uğurlucan, O. Sayin, F. Ekiz, Yilmaz Onal, M. O. Beyaz, M. Umutlu, Mert Meriç, B. Acunaş, U. Alpagut","doi":"10.21470/1678-9741-2020-0705","DOIUrl":"https://doi.org/10.21470/1678-9741-2020-0705","url":null,"abstract":"Introduction The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. Methods Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. Results Patients’ mean age was 65.3±19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. Conclusion Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"37 1","pages":"883 - 892"},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44424791","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 : 2022-04-18DOI: 10.21470/1678-9741-2021-0350
D. Zdravković, Igor S Zivkovic, V. Kovacevic, P. Milačić, M. Miličić
Accidental detachment of mechanical valve leaflet during implantation is a rare and potentially serious complication. When the lost leaflet cannot be found by direct visualisation, additional diagnostic procedures are necessary to detect it. Computer tomography is the best detection method, but the patient needs reoperation. We presented a patient in whom the detached leaflet migrated and became trapped into the left inferior pulmonary vein. The computed tomography (CT) scan was used to reveal leaflets, and successful extirpation was performed in the second operation.
{"title":"Surgical Removal of The Mechanical Valve Leaflet Dislocated into The Pulmonary Vein","authors":"D. Zdravković, Igor S Zivkovic, V. Kovacevic, P. Milačić, M. Miličić","doi":"10.21470/1678-9741-2021-0350","DOIUrl":"https://doi.org/10.21470/1678-9741-2021-0350","url":null,"abstract":"Accidental detachment of mechanical valve leaflet during implantation is a rare and potentially serious complication. When the lost leaflet cannot be found by direct visualisation, additional diagnostic procedures are necessary to detect it. Computer tomography is the best detection method, but the patient needs reoperation. We presented a patient in whom the detached leaflet migrated and became trapped into the left inferior pulmonary vein. The computed tomography (CT) scan was used to reveal leaflets, and successful extirpation was performed in the second operation.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"37 1","pages":"409 - 411"},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47656365","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 : 2022-04-18DOI: 10.21470/1678-9741-2021-0112
M. Kuyumcu, M. Uzun, Y. Ozen, F. Aksoy, B. A. Uysal, E. Varol
Introduction The benefit of implantable cardioverter-defibrillator (ICD) in patients with non-ischemic dilated cardiomyopathy (DCM) is still an issue under discussion. Studies examining the relationship between ventricular scar tissue and ICD shock with cardiac magnetic resonance (CMR) are promising. CMR studies have shown that ventricular scar tissue size and Selvester score show a correlation. In the light of this information, this study aimed to investigate the potential relationship between Selvester score and ICD therapies. Methods The study included 48 patients who had undergone ICD implantation with a diagnosis of DCM and who had undergone routine 6-month ICD control in outpatient clinic controls between December 2018 and October 2019. Selvester score and other data were compared between patients who received ICD therapy (n=10) and those who did not (n=38). Results Selvester score (P<0.001) was higher in ICD therapy group. Positive correlation was found between ICD shock therapy and Selvester score (P=0.002, r=0.843). Selvester score was detected as an independent predictor for ICD therapy after multiple linear regression analysis (P=0.004). Receiver operating characteristic curve analysis showed that Selvester score (P<0.001) was a significant predictor of ICD therapy. Selvester score cutoff points of 5 for were calculated to estimate ICD therapy, with a sensitivity of 100% and specifity of 81%. Conclusion In our study, it was found that a high Selvester score may be a predictor for ICD therapies in patients with DCM. As an inexpensive and non-invasive method, Selvester score can help in the decision-making in these patients.
{"title":"Selvester Score May Be a Predictor of ICD Therapies in Patients with Non-Ischemic Dilated Cardiomyopathy","authors":"M. Kuyumcu, M. Uzun, Y. Ozen, F. Aksoy, B. A. Uysal, E. Varol","doi":"10.21470/1678-9741-2021-0112","DOIUrl":"https://doi.org/10.21470/1678-9741-2021-0112","url":null,"abstract":"Introduction The benefit of implantable cardioverter-defibrillator (ICD) in patients with non-ischemic dilated cardiomyopathy (DCM) is still an issue under discussion. Studies examining the relationship between ventricular scar tissue and ICD shock with cardiac magnetic resonance (CMR) are promising. CMR studies have shown that ventricular scar tissue size and Selvester score show a correlation. In the light of this information, this study aimed to investigate the potential relationship between Selvester score and ICD therapies. Methods The study included 48 patients who had undergone ICD implantation with a diagnosis of DCM and who had undergone routine 6-month ICD control in outpatient clinic controls between December 2018 and October 2019. Selvester score and other data were compared between patients who received ICD therapy (n=10) and those who did not (n=38). Results Selvester score (P<0.001) was higher in ICD therapy group. Positive correlation was found between ICD shock therapy and Selvester score (P=0.002, r=0.843). Selvester score was detected as an independent predictor for ICD therapy after multiple linear regression analysis (P=0.004). Receiver operating characteristic curve analysis showed that Selvester score (P<0.001) was a significant predictor of ICD therapy. Selvester score cutoff points of 5 for were calculated to estimate ICD therapy, with a sensitivity of 100% and specifity of 81%. Conclusion In our study, it was found that a high Selvester score may be a predictor for ICD therapies in patients with DCM. As an inexpensive and non-invasive method, Selvester score can help in the decision-making in these patients.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"37 1","pages":"900 - 907"},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46638338","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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