Cardiovascular surgery (London, England)最新文献

We report the case of a 35-year-old female with acute massive right pulmonary embolism, successfully treated by a minimally invasive off-pump pulmonary embolectomy—the first case in the literature implemented via the J-ministernotomy.

Pancreaticoduodenal arcade aneurysms are rare. Untreated, these lesions enlarge progressively and have the potential for spontaneous rupture. Aneurysmal degeneration of pancreaticoduodenal arcade vessels is known to be associated with celiac artery occlusion, vasculitis, and certain connective tissue disorders. Given their precarious location, surgical expiration is a challenging endeavor. Innovations in endovascular techniques offer a possible alternative.

We report a case of a 55-year-old gentleman with a 2.2×2.1-cm aneurysm of one of the inferior pancreaticoduodenal arteries and a concomitant finding of occlusion of the celiac artery trunk. Percutaneous coil embolization of the aneurysm was employed as the treatment in this case with the successful exclusion of the aneurysm sac, while maintaining continuity of the native circulation.

This case report demonstrates that, due to the success rate of aneurysm exclusion and the relatively low morbidity and mortality rates seen with endovascular repair as compared to surgical intervention, endovascular treatment has become the treatment of choice for pancreaticoduodenal artery aneurysms.

Objective: α₁-adrenoceptor activation confers myocardial protection from ischemic injury. We tested whether norepinephrine mediates delayed cardioprotection against stunning and whether this alters postischemic arrhythmias.

Methods: New Zealand White rabbits were assigned to three groups: Control-group (n=7): no drugs. Norepinephrine-group (n=7): 75 μg norepinephrine/kg bodyweight (bw). Norepinephrine/prazosin-group (n=7):75 μg norepinephrine and 15 μg prazosin/kg bw. After 24 h, hearts were excised, perfused with buffer and subjected to 20 min of ischemia followed by 120 min of reperfusion.

Results: (a) Developed pressures (dP) (P_syst−P_diast) at the end of reperfusion: C: 51.2±5.0%, NE: 71.7±5.1% (p<0.05 vs. C), NEP: 50.7±5.0%. (b) Ventricular extra beats (vebs) were detected throughout the experiments. C: 0.41±0.15 vebs/min, NE: 1.06±0.18 vebs/min (p<0.05 vs. C), NEP: 1.17±0.3 vebs/min.

Conclusion: Norepinephrine confers delayed preconditioning against myocardial stunning via an α₁-adrenoceptor mediated pathway. Norepinephrine-mediated preconditioning involves a beneficial effect towards stunning, but at the expense of a higher rate of postischemic ventricular arrhythmia.

Objective: Three myocardial protection techniques were evaluated in a prospective, randomised trial during coronary artery bypass grafts in 69 patients.

Material and method: Twenty seven patients received intermittent hyperkalaemic undiluted warm blood anterograde cardioplegia (AC), 21 received continuous hyperkalaemic undiluted warm blood retrograde cardioplegia (RC) and 21 received intermittent, hyperkalaemic, diluted cold blood (15 °C), anterograde cardioplegia (CC). Assessment criteria were clinical, laboratory and haemodynamic.

Results: Groups were homogeneous in terms of age, sex, cardiovascular risk factors, severity of coronary disease, preoperative ejection fraction, and number of bypass grafts performed. The oxygen extraction coefficient, and lactate and troponin production in the coronary sinus on aortic unclamping was not significantly different between the three groups. The base excess was −0.19±0.13 in the RC group, −0.18±0.52 in the AC group and −2.67±0.59 in the CC group (P<0.01 CC vs. AC and CC vs. RC). The priming volume was 1485±64 ml (CC), 1317±44 ml (RC) and 1318±30 ml (AC) (P<0.05 CC vs. AC and CC vs. RC). The haematocrit during CPB was 28.9±0.9 (CC), 32.5±0.8 (RC) and 32±0.7 (AC) (P<0.05 CC vs. AC and CC vs. RC). The volume of crystalloid delivered was 735±85 ml (CC), 362±67 ml (RC) and 357±105 ml (AC) (P<0.05 CC vs. AC and CC vs. RC). The incidence of ventricular fibrillation on aortic unclamping was 61.9% (CC), 9.5% (RC) and 0% (AC) (P<0.01 CC vs. AC and CC vs. RC). The transfusion rate, duration of intubation, postoperative troponin level, complication rate and mortality were not significantly different between the three groups. Haemodynamic parameters at H2, H4, H8 did not vary significantly between the three groups.

Conclusion: These three techniques appear to be comparable in terms of myocardial protection. Anterograde cardioplegia ensures an identical degree of security to retrograde cardioplegia regardless of the coronary lesions, apart from redo lesions. CC requires greater haemodilution of the patients during CPB.

Background: The development of a saphenous vein graft aneurysm (SVGA) after coronary artery bypass graft surgery is a rare occurrence. There are approximately 60 cases reported in the literature, the majority being single case reports. There is no consensus on the treatment of SVGA.

Methods: Retrospective analysis of the patients treated with SVGA was performed at our institution. Demographic and co-morbidity data were acquired on the patients. Patients who underwent surgical treatment were compared to those treated conservatively with the primary outcome being survival time from diagnosis of the SVGA.

Results: Thirteen patients with 15 SVGA were identified. The average age at the time of the most recent coronary artery bypass grafting (CABG) was similar in the conservative and the surgically treated groups (55 vs. 56.5 years, respectively). The average number of grafts per patient at the most recent CABG was similar (3.83 vs. 4.0, respectively). The average time from CABG to diagnosis was similar in both the groups (12.6 vs. 15 years, respectively). The average survival from diagnosis was similar in both the groups (2.3 vs. 1.5 years, respectively, p>0.05).

Conclusions: Early surgical treatment of SVGA does not provide longer short-term survival compared with conservative management. A treatment algorithm for SVGA based upon patient co-morbidities and aneurysm characteristics is proposed.

The purpose of this study is to determine the diagnosis means, the surgical management and the prognosis of patients with intracavitary cardiac hydatid cyst.

We report a series of seven patients. The diagnosis was orientated by coexisting pulmonary locations in all patients. The cyst was located in the right cardiac chambers. Cardiopulmonary bypass with aortic cross clamping and cardioplegia was necessary in all cases.

The postoperative course was satisfactory for all patients. There was a recurrence of pulmonary cysts in all patients after a mean duration of 42 months. Medical treatment (Albendazole) was instituted. One late death occurred at 3 years of follow-up due to chronic right heart failure.

In conclusion, cardiac hydatid cysts with intracavitary location must be suspected in patients with pulmonary or systemic embolization. Early surgical treatment is necessary and medical treatment must be instituted after surgery.