6 research outputs found
Az ischaemiás eredetű balkamra-aneurysma sebészi rekonstrukciója. Két sebészi technika korai és középtávú eredményei = Surgical ventricular reconstruction for ischemic left ventricular aneurysm. Early and medium-term outcomes for two surgical techniques
Absztrakt:
Bevezetés: A balkamra-aneurysma az akut myocardialis infarctus
súlyos szövődménye; jelentősen növeli a morbiditást, mortalitást. A sebészi
korrekciós technikák fejlődése ellenére számtalan kérdőjel van e kórkép
kezelésének optimális megközelítésével kapcsolatban.
Célkitűzés: Tanulmányunk célja az ischaemiás eredetű
balkamra-aneurysma két különböző sebészi technikával (endoventriculoplastica és
lineáris varrat) végzett műtéti rekonstrukciója rövid és középtávú eredményeinek
vizsgálata annak érdekében, hogy meghatározzuk, melyik eljárás előnyösebb.
Módszer: A vizsgálatba 117 beteget vontunk be, 48 esetben
(41%) endoventriculoplasticával (1. csoport), 69 betegnél (59%) lineáris
varrattal (2. csoport) végeztük a balkamra-rekonstrukciót. 113 betegnél (96,5%)
egy időben más eljárás is szükséges volt: 108 esetben műtéti myocardialis
revascularisatio, 8 betegnél kamrai septumsutura, 18 esetben
mitralisbillentyű-plastica történt. A rövid és középtávú morbiditást és
mortalitást, az ejekciós frakció változásait és a szívelégtelenség súlyosságát
(NYHA) elemeztük. Eredmények: A perioperatív mortalitás 11,11%
volt, 4,2% az endoventriculoplasticás csoportban, 15,9% a
lineárisvarrat-csoportban (p = 0,03). Az 5 éves túlélés 78,5% volt (88,7% az 1.
csoportban és 71,2% a 2. csoportban). Mindkét csoportban javult a bal kamra
ejekciós frakciója, a szív funkcionális osztályba sorolása (NYHA); az eredmények
szignifikánsan jobbak voltak az endoventriculoplasticával műtött betegek
csoportjában. Következtetések: A bal kamra műtéti
rekonstrukciója jó korai és középtávú eredményeket mutató eljárás az ischaemiás
balkamra-aneurysma korrigálására; az endoventriculoplastica jobb eredményeket
biztosít a korai és középtávú mortalitás, az ejekciós frakció és a NYHA
funkcionális osztály szempontjából. Orv Hetil. 2018; 159(51): 2167–2174.
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Abstract:
Introduction: Left ventricular aneurysm is a severe complication
of acute myocardial infarction, which contributes significantly to mortality and
morbidity associated with this pathology. Despite the progress of correction
techniques, there are still controversies about the optimal approach addressing
this pathology. Aim: The aim of this study was to analyse short
and medium term outcomes of left ventricular reconstruction for ischemic left
ventricular aneurysm using two surgical techniques (endoventricular patch plasty
and liniar suture) in order to determine if one of these techniques has
supperior results. Method: 117 patients were included in the
study, 48 patients (41%) underwent left ventricular reconstruction with
endoventricular patch (Group 1), 69 patients (59%; Group 2) had linear
reconstruction. 113 patients (96.5%) required associated procedures: 108
surgical myocardial revascularization, 18 mitral valvuloplasty and 8 ventricular
septal defect closure. Short and medium term morbidity, mortality, alteration of
ejection fraction and NYHA class were analysed. Results:
Perioperative mortality was 11.11%, 4.2% in the endoventricular patch group, and
15.9% in the linear suture group (p = 0.03). The overall 5-year survival was
78.5% (88.7% in Group 1 and 71.2% in Group 2). The left ventricular ejection
fraction and NYHA functional class improved in both groups, with greater
improvement in the endoventricular patch group. Conclusions:
Surgical ventricular reconstruction is a procedure performed for the correction
of ischemic left ventricular aneurysm with good early and medium-term results,
but with better results with the endoventricular patch technique regarding early
and medium-term mortality, ejection fraction and NYHA functional class
improvement. Orv Hetil. 2018; 159(51): 2167–2174
Implantation of Covered Stent for Coarctation of the Aorta and Secondary Hypertension in Adolescents—Case Report
Introduction: Coarctation of the aorta represents a narrowing of the thoracic aorta. Hypertensive patients with blood pressure differences ≥20 millimetres of mercury have an indication for surgical or interventional treatment. Implantation of a covered stent became the preferred therapy for the management of this pathology in adolescents/adults. Case report: We report the case of a 14-year-old male sportsman, who presented in the emergency room with headache, dizziness, and tinnitus. The clinical exam revealed blood pressure differences between the upper and lower limbs of up to 50 mmHg. Based on the clinical and paraclinical data, we established the diagnosis of coarctation of the aorta and severe secondary arterial hypertension. The case was discussed by a multidisciplinary team and accepted for covered stent implantation. The 24 h blood pressure Holter monitoring after the procedure indicated the persistence of stage I arterial hypertension. Conclusions: Coarctation of the aorta is a congenital cardiovascular anomaly with high morbidity and mortality rates. Arterial hypertension, heart failure, and aortic dissection are complications of this pathology, some of them being sometimes direct consequences of secondary hypertension. Periodic cardiology follow up after the procedure is mandatory to assess the hemodynamic response, to identify potential complications, and to stratify the cardiovascular risk
Evaluation of Perioperative Beta-Blockers and Factors Associated with Postoperative Atrial Fibrillation in Cardiac Surgery: A Single Center Experience
Background: Postoperative atrial fibrillation (AF) has a complex etiology, and beta-blockers are commonly recommended for its pharmacological prevention. This study aims to assess the impact of beta-blocker therapy on postoperative AF occurrence in patients undergoing aortic valve replacement, mitral valve replacement, surgical revascularization of the myocardium, or a combination of these procedures. Methods: The study encompassed 472 patients who received aortic valve replacement, mitral valve replacement, surgical revascularization, or their combination. We evaluated the efficacy of preoperative and one-month postoperative beta-blocker administration in preventing postoperative AF, and the associated risk factors involved in the development of postoperative AF. Results: Of the total patient population, 36% experienced postoperative AF. Our study demonstrated a significant reduction in postoperative AF incidence among patients receiving beta-blocker treatment (all p-values < 0.05). Additionally, one-month post-surgery, beta-blocker treatment exerted a protective effect by maintaining the sinus rhythm (p = 0.0001). Regarding the risk factors involved in the development of postoperative AF, both age and left atrium (LA) sizeassessed pre-and postoperatively—were positively correlated with the occurrence of postoperative AF (p = 0.006). No relationship was found between leukocyte counts and AF incidence. Notably, C-reactive protein (CRP) levels were significantly elevated on the fifth postoperative day in patients with AF (p < 0.007). The duration of ischemia was significantly longer in patients with AF (p = 0.009). Conclusions: This study establishes the efficacy of perioperative beta-blocker treatment in mitigating postoperative AF. One month post-surgery, most patients under beta-blocker therapy maintained sinus rhythm, suggesting a potential long-term protective effect of beta-blockers against late-onset AF
A Rare Case of Undifferentiated Pleomorphic Cardiac Sarcoma with Inflammatory Pattern
Cardiac undifferentiated pleomorphic sarcoma (UPS) associated with fever and inflammatory response is an extremely rare condition. Herein, we report a rare case of cardiac UPS with unusual clinical presentation and inflammatory response. A 67-year-old male complaining of progressive dyspnea and intermittent fever of unknown cause was referred to our hospital for surgical resection of a left atrial mass. Laboratory analysis showed leukocytosis (26 × 103/μL) and high C-reactive protein (CRP) levels (155.4 mg/L). Hemoculture tests and urine analysis were negative for infection. A contrast chest computed tomography revealed a mass measuring 5.5 × 4.5 cm, occupying the left atrium cavity. The patient underwent surgical excision of the mass, however, surgical margin of the resected tumor could not be evaluated, due to the multifragmented nature of the resection specimen. Postoperative CRP and leukocyte levels normalized, highlighting the relationship between the tumor and the inflammatory status. Early diagnosis is crucial for a proper management and favorable outcome, enabling patients to undergo chemotherapy and achieve complete surgical resection