Radial artery harvesting technique for use in coronary bypass surgery

Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași, România Institutul de Boli Cardiovasculare „Prof. Gr. George I.M. Georgescu”, Iași, RomâniaThe radial artery (RA) was introduced in coronary artery bypass grafting (CABG) as an alternative to the use of the great saphenous vein at the beginning of the 1970s (Carpentier, 1973). The authors describe the anatomical characteristisc of the radial artery, the main procedures used in harvesting the vessel, underlying the most risky anatomical area that should be avoided during the surgical procedures. Compared with the internal mammary artery (IMA), the radial artery is characterized by an increased prevalence of intimal alterations of fibrointimal hyperplasia or atherosclerosis type. Rigurous knowledge of brachi-antebrahial anatomical structures and gentle manipulation of the RA prevents CABG complications such as arterial spasm, injury to the endothelium, dysesthesia, ischemia, and compartment syndrome. The strategy of the graft procedure (graft type, method of harvesting) depends on the clinico-anamnestic specificities of the case, on the surgeon's choice and his surgical expertise.Artera radială (AR) a fost introdusă în chirurgia cardiacă la începutul anilor 1970 ca alternativă a utilizării venelor în chirurgia de bypass aorto-coronarian (BAC) (Carpentier, 1973). Autorii descriu caracteristicile anatomice ale AR și metoda de recoltare chirurgicală insistând asupra zonelor anatomice riscante care trebuie abordate cu atenție pe parcursul intervenției. Datorită introducerii în practica medicală a blocanţilor de calciu, a perfecţionării tehnicilor de recoltare şi preparare a AR, a crescut durata patenţei graftului arterial, AR redevenind graft de elecţie în chirurgia arterelor coronare. Comparativ cu artera mamară internă (AMI), AR este caracterizată de o prevalență crescută a leziunilor intimale de tip hiperplazie fibrointimală sau ateroscleroză. Cunoaşterea morfologiei și anatomiei topografice a structurilor brahiantibrahiale precum și manevrarea delicată a AR previne apariţia complicațiilor secundare bypass-ului de tipul spasmului arterial, lezarea endarterei, disesteziilor, ischemiei, sindromului de compartiment. Tehnica BAC (alegerea tipului de graft, metoda de recoltare) depinde de particularitățile clinoc-anamnestice ale cazului, opțiunea și experiența chirurgului

Takayasu Arteritis: new trends in surgical approach – case presentation

Takayasu arteritis (TA) is defined as a rare chronic granulomatous panarteritis that classically involves segments of large arteries such as the aortic arch. The aim of this report is to present our recent experience in diagnosis and treatment of TA and to provide aspects of surgical strategy for inflammatory aneurysms caused by TA. We present the case of a 36-year-old Caucasian female admitted to our clinic with low effort dyspnea, fatigability, palpitations, sweats, malaise and light-headedness. The medical history revealed a history of treated tuberculosis, anemia, arterial hypertension, chronic inflammatory syndrome, aortic insufficiency, and anterior mitral valve prolapse. Echocardiography revealed grade III-IV aortic regurgitation, grade I-II mitral regurgitation, a dilated ascending aorta and mild systolic dysfunction. CT angiography revealed an aneurysmal dilatation of the ascending aorta. Surgical treatment was mandatory, and intraoperative, the surgeon noted a diffuse thickening of the aortic wall and suspected TA, further confirmed by histopathological examination. The tricuspid aortic valve was excised and a composite graft with a biological valve and an aortic conduit were implanted on patient’s request. Postoperative course was uneventful and the patient was discharged from the hospital on the 10th postoperative day, and directed towards Rheumatology Clinic for medical treatment. A multidisciplinary approach to the diagnosis and management of TA patients is essential to a satisfactory outcome

Some features of materials for oseous regeneration used in implantology

Rezumat. Evoluţia progresivă înregistrată în ultimii ani de către utilizarea materialelor şi tehnicilor restaurative create a făcut ca potenţialul medicinii stomatologice contemporane de a reface în condiţiile optime toate funcţiile sistemului stomatognat prin utilizarea de substitute artificiale — implanturi orale — să se găsească într-o continuă ascensiune.Summary. The registered progressive evolution in the latest years by using of materials and restaurative equipment created made the potential of the modern dentistry to remake all the functions of the stomatological system by using of artificial substituents — of oral implants in a continuous ascendance

Coronary sinus reconstruction - 2 cases report

University of Medicine and Pharmacy "Gr. T. Popa”, Iasi, Cardiovascular Disease Institute, Iasi (IBCV Iasi)Introduction: Coronary sinus and ostium primum (unique atrium type) atrial septal defects (ASD) represent rare congenital malformations (less than 1% o f total ASDs) and are frequently associated with persistent left superior vena cava (LSVC). The shunt is caused in the first case by the incomplete development of the wall between the coronary sinus and the left atrium and in the second case, the coronary sinus drains into the single atrial cavity. Case description: Two patients (I. P., 15 years, B. G., 12 years) were operated in 2013 in our clinic. In the first case, although enlargement of the coronary sinus was not identified during echography, angio-CT showed fenestration of the coronary sinus wall and cardiac catheterization documented the bidirectional shunt as well as the persistent LSVC. Moreover, the ASD was associated with patent ductus arteriosis and cor triatriatum. In the second case the ostium primum ASD and the persistent LSVC as well as an anterior mitral valve cleft were diagnosed by echography and CT. Both patients underwent elective surgery. The coronaiy sinus was reconstructed in both cases using autologous pericardial patches. Moreover, in the first patient the ductus arteriosis was ligated and the intraatrial trabeculum was excised. In the second case the interatrial septum was reconstructed with autologous pericardium. Both cases had an unremarkable postoperatory recovery. Conclusions: Both cases showed that although the diagnosis for these malformations requires multiple investigations, a surgical correction with good long term results is feasible if the mechanism of the shunt is well documented

Experimental use of titan implants with nanocluster layer in animals from the laboratory (preventive data)

Rezumat. Acest studiu are ca obiectiv evaluarea biocompatibilităţii şi osteointegrării titanului cu suprafaţa nanostructurată. Pe un lot de 12 şobolani (Linia Vistar) sa introdus în unghiul mandibulei implante din titan cu suprafaţa nanostructurată. Suprafeţele au fost supuse la diferite proceduri de temperatură prin care se urmăreşte îmbunătăţirea rezistenţei oxidului de titan prin modificarea proprietăţilor de suprafaţă a filmului. Astfel prin suprafaţa creată de noi nanostructurată de oxid de titan sa obţinut o interfaţă favorabilă între implantul metalic şi ţesut care induce un înalt grad de osteointegrare.Summary. Experimental Use of Titan Implants with Nanocluster Layer In Ani‑ mals from the Laboratory (preventive data) * The aim if this research is to evaluate the biocompatibility and titan oss‑ teointegration which has a nanocluster layer. Titan implants with nanoclus‑ ter layer were introduced to 12 mice in the maxilla area. These areas were supposed to different temperatures procedures in order to see the resistancy of titan oxid during modification of the film propreties. Thus due to the layer which we created — titan oxyd nanoclustral, we obtained a favourable interface between the tissue and metallic implant, which induces a high le‑ vel of osteointegration

Some aspects concerning the materials of the osteogenesis substitution and simulation

Rezumat În stomatologia practică se întrebuinţează materiale pentru regenerarea tisulară ghidată în componenţa cărora intră, colagen, hidroxiapatită, tri‑ calciu fosfat ş.a. În 18 cazuri de implantare dentară am utilizat materialul sub denumirea de „LitAr“, la care pacienţii au fost puşi la evidenţă timp de 6 ani.Summary In the dentystry practice are used materials to guide tissual regeneration which consist of collagenum, hydroxiapatique, tricalcium phosphate etc. In 18 cases of dental implantation we used the material called „LitAr“ where patients were followed during 6 years

Applying of the nanocomposit material ,,LitAr“ in experimental implantology by using of titan implants with nanostructured surface of titan oxide

Rezumat. Există o gamă variată de materiale pentru restabilirea defectului osos şi remodelarea osoasă. Am utilizat în implantologia experimentală un material compozit biodegradabil „LitAr“. Pe 6 animale de laborator (iepuri) s-a efectuat regenerarea şi remodelarea osoasă cu implantarea mostrelor din titan cu o suprafaţă nanotubulară de oxid de titan (ТЮ2) uniform repartizată pe toată suprafaţa, obţinută de noi.Summary. There is a various spectrum of materials to restore the bone’s defect and the oseos remodeling. I used experimental in implantology a biodebasing composit material ,,LitAr“. 6 experimental animals (rabbits) were used to regenerate the oseos remodeling with patterns implanting from titan with a nanotubular surface of titan oxide (Ti02) distributed plainly on the whole surface obtained by us

Preoperative Arrhythmias Such as Atrial Fibrillation: Cardiovascular Surgery Risk Factor

Atrial fibrillation is still the most common arrhythmia that occurs in heart surgery. However, there is few literature data on the manner in which preoperative atrial fibrillation may influence the postoperative outcome of various heart surgery procedures. The purpose of our research is to assess the effects of preoperative atrial fibrillation on patients having undergone different heart surgery procedures. The results of our research are a review of clinical data which were collected prospectively, over a 10-year period, from all the patients who had undergone heart surgery in our Institute. The study group included 1119 heart surgery patients, who were divided as follows: the preoperative AFib group (n=226, 20.19%) and the sinus rhythm group (n=893, 79.80%). Major postoperative complications and hospital mortality rates were analyzed. According to our statistical analysis, preoperative atrial fibrillation significantly increased the mortality risk (P=0.001), the patients’ mechanical ventilation needs (P=0.022), the rate of occurrence of infectious complications (P<0.5), the rate of occurrence of complications such as acute kidney failure (P=0.012), and the time spent by the patients in the intensive care ward (P<0.01). In conclusion, preoperative atrial fibrillation in heart surgery patients increases the mortality and major complication risk further to heart surgery

A Meta-Analysis on Prophylactic Donor Heart Tricuspid Annuloplasty in Orthotopic Heart Transplantation: High Hopes from a Small Intervention

(1) Background: Tricuspid regurgitation (TR) is the most frequent valvulopathy in heart transplant recipients (HTX). We aimed to assess the influence of prophylactic donor heart tricuspid annuloplasty (TA) in orthotopic HTX (HTX-A), comparing the outcomes with those of HTX patients. (2) Methods: Electronic databases of PubMed, EMBASE, and SCOPUS were searched. The endpoints were as follows: the overall rate of postprocedural TR (immediate, one week, six months, and one year after the procedure), postoperative complications (permanent pacemaker implantation rate, bleeding), redo surgery for TR, and mortality. (3) Results: This meta-analysis included seven studies. Immediate postprocedural, one-week, six-month and one-year tricuspid insufficiency rates were significantly lower in the HTX-A group. There was no difference in permanent pacemaker implantation rate between the groups. The incidence of postoperative bleeding was similar in both arms. The rate of redo surgery for severe TR was reported only by two authors. In both publications, the total number of events was higher in the HTX cohort, meanwhile pooled effect analysis showed no difference among the intervention and control groups. Mortality at one year was similar in both arms. (4) Conclusion: Our study showed that donor heart TA reduces TR incidence in the first year after orthotopic heart transplantation without increasing the surgical complexity. This is a potentially important issue, given the demand for heart transplants and the need to optimize outcomes when this resource is scarce