Disfunção aguda devido a uma trombose da prótese da válvula mitral mecânica

Um homem de 64 anos recebeu uma prótese mecânica CarboMedics de 31 mm para refluxo mitral grave. Após quatro dias, o paciente apresentou-se com fadiga e dispnéia em repouso. Estudos do Doppler ecocardiografia transtorácica e transesofágica confirmaram uma disfunção na mobilidade do folheto da válvula protética devido à trombose e uma operação de emergência foi feita. O pós-operatório transcorreu sem intercorrências. Este é um caso incomum de disfunção grave devido à trombose de uma prótese mitral mecânica em um paciente tomando anticoagulantes orais e calciparinaAn 64-year-old man received a 31-mm CarboMedics mechanical prosthesis for severe mitral regurgitation. After four days the patient presented fatigue and dyspnoea with rest; transthoracic and transesophageal Doppler echocardiographic study confirmed a failing mobility of prosthetic valve leaflet from thrombosis and an emergency operation was done. The postoperative course was uneventful. This is an unusual case of acute dysfunction from thrombosis of a mechanical mitral valve prosthesis in a patient on oral anticoagulant therapy and calciheparin

Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery: A meta-analysis of 5100 patients

ObjectiveOur objective was to determine whether the use of unilateral (u-ACP) or bilateral antegrade cerebral perfusion (b-ACP) results in different mortality and neurologic outcomes after complex aortic surgery.MethodsPubMed, Embase, and the Cochrane Library were searched for studies reporting on postoperative mortality and permanent (PND) and temporary neurologic dysfunction (TND) in complex aortic surgery requiring circulatory arrest with antegrade cerebral protection. Analysis of heterogeneity was performed with the Cochrane Q statistic.ResultsTwenty-eight studies were analyzed for a total of 1894 patients receiving u-ACP versus 3206 receiving b-ACP. Pooled analysis showed similar rates of 30-day mortality (8.6% vs 9.2% for u-ACP and b-ACP, respectively; P = .78), PND (6.1% vs 6.5%; P = .80), and TND (7.1% vs 8.8%; P = .46). Age, sex, and cardiopulmonary bypass time did not influence effect size estimates. Higher rates of postoperative mortality and PND were among nonelective operations and for highest temperatures and duration of the circulatory arrest. The Egger test excluded publication bias for the outcomes investigated.ConclusionsThis meta-analysis shows that b-ACP and u-ACP have similar postoperative mortality and both PND and TND rates after circulatory arrest for complex aortic surgery

Intensive hyperglycemia control reduces postoperative infections after open heart surgery

Background: Diabetes mellitus increases the risk of infections in patients undergoing cardiac surgery. We hypothesized that intensive perioperative hyperglycemia control by intravenous insulin infusion reduces postoperative infections in all patients undergoing open heart surgical procedures. Methods: Sixty diabetics patients who underwent CABG operation (Group 1) were compared with fifty-five patients who underwent other cardiac surgery (Group 2) between January 2004 and March 2005. A continuous infusion of insulin was used in all these patients. Results: There were no 30-day mortalities in either group. There was no difference in the incidence of infections between the two groups: in Group 1, 3 (5%) patients were diagnosed to have postoperative infection (superficial sternal wound infections in 1 (1.66%) and lung infection in 2 (3.33%) patients); postoperative infection occurred in only 2 patients (3.63%) in Group 2, 1 superficial sternal wound infections (1.81%) and 1 lung infection (1.81%). Conclusions: Our analysis indicates that continuous intravenous insulin infusion improves outcome and reduces postoperative infections in patients undergoing CABG as well as those undergoing other cardiac surgery procedures.

How to ensure a good flow to the arm during direct axillary artery cannulation

We herein describe a simple and safe technique to avoid compartment syndrome/arm ischemia during direct right axillary artery cannulation, especially in patients who require long-term extracorporeal membrane oxygenation support. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Percutaneous transluminal coronary angioplasty hardware entrapment: guidewire entrapment

Entrapment and fracture of coronary angioplasty hardware are rare complications of percutaneous coronary interventions for which cardiac surgery is sometimes required. We report a case of guidewire entrapment during stenting of the left anterior descending coronary artery (LAD) that required surgical removal. Although a piece of guidewire remained entrapped inside the stent, in the proximal tract of the LAD, a single bypass using the left mammary artery was performed. No perioperative complications were observed. There were no signs of perioperative or postoperative myocardial infarction, as indicated by clinical biomarkers or by electrocardiographic changes. The patient had an uneventful recovery and was discharged from the hospital on the sixth postoperative day. J Cardiovasc Med 9:1140-1141 (C) 2008 Italian Federation of Cardiology

Emergency repair of coronary perforation following percutaneous transluminal coronary angioplasty failure: a high-risk choice?

Coronary perforation is a recognized hazard following cardiac catheterization and may lead to a catastrophic outcome. Prompt decision-making following diagnosis is of key importance. Whether to perform prolonged attempts at percutaneous repair or to promptly refer the patient for emergency surgery soon after diagnosis still remains a matter of debate. We report the case of a 78-year-old woman suffering from coronary artery perforation during left anterior descending coronary artery percutaneous transluminal coronary angioplasty-stenting, who underwent unsuccessful multiple prolonged attempts at percutaneous repair followed by subsequent successful emergency surgery. J Cardiovasc Med 7: 365-367 (C) 2006 Italian Federation of Cardiology

Mild and moderate renal dysfunction: impact on short-term outcome

Background: Preoperative renal dysfunction is an important risk factor in cardiac surgery. Thus, the association between creatinine clearance (ClCr) and mechanical ventilation time and ICU length of stay, independent of other established preoperative risk indicators, was analyzed. Methods: In our study, 156 consecutive patients underwent open-heart surgery at the Department of Cardiac Surgery, University Hospital St. Andrea, Rome, and were prospectively studied for the relation between the ClCr, using the formula develop by Cockroft and Gault, and ICU length of stay and mechanical ventilation time. The 156 patients were divided into two groups in relation of ClCr: group A (n = 78) ClCr 70 ml/min. Results: In multivariate analysis, ICU length of stay was influenced by ClCr < 70 ml/min, hypertension and COPD. ICU stay was median 48 h (range 24-72) in group A versus 24 h (range 20.7-44) in group B (p = 0.0001). In multivariate analysis, only ClCr < 70 ml/min and EuroScore were associated with increasing VAM. VAM was median 8 h (range 5.7-13.2) in group A versus 6 h (range 4-10) in group B (p = 0.001). Conclusions: Our study demonstrates that after short-term outcome follow-up, preoperative mild renal dysfunction is an independent predictor of ICU length of stay and mechanical ventilation time. © 2007 European Association for Cardio-Thoracic Surgery

Clinical utility of tissue Doppler imaging in prediction of atrial fibrillation after coronary artery bypass grafting

Background. Atrial systolic dysfunction in patients with coronary artery disease might influence the development of atrial fibrillation after coronary artery bypass grafting (CABG). Tissue Doppler imaging of the mitral annulus during atrial systole has proved to quantify, accurately, left atrial contractile function. Therefore, the aim of the present study was to investigate the correlation between preoperative left atrial dysfunction assessed by tissue Doppler and postoperative atrial fibrillation after CABG. Methods. We studied a total of 96 patients (mean age 67 +/- 6 years; range, 55 to 81) undergoing CABG who were preoperatively in sinus rhythm. All patients underwent a preoperative transthoracic echocardiography with tissue Doppler evaluation. Until the day of discharge, all patients were monitored with continuous electrocardiographic telemetry. Results. There were no hospital deaths. Postoperative atrial fibrillation was recorded in 24 of 96 patients (25%). Patients with postoperative atrial fibrillation were significantly older (70 +/- 6 vs 65 +/- 8 years; p = 0.006), had a preoperative larger left atrium diameter (38 +/- 5 vs 36 +/- 4 mm; p = 0.045), a larger left atrium area (13.2 +/- 3.4 vs 11.5 +/- 2.3 cm(2); p = 0.007), and a lower peak atrial systolic mitral annular tissue Doppler velocity (10 +/- 3 vs 13 +/- 5 cm/second; p = 0.01). Stepwise logistic regression analysis showed that age 70 years or greater (p = 0.02; odds ratio [OR] 2.0), preoperative medication with ss-blockers (p = 0.04; OR 0.7), left atrium area 13 cm(2) or greater (p = 0.02; OR 2.5), and peak atrial systolic mitral annular tissue Doppler velocity 9 cm/second or less (p = 0.03; OR 1.8) were independently related with the incidence of postoperative atrial fibrillation. Conclusions. Tissue Doppler is useful for assessing preoperative atrial dysfunction and predicting atrial fibrillation after CABG. Further studies are needed to confirm this finding