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Ascending aortic graft thrombosis from an endoluminal candida albicans infection
No full textA 71-year old male who had undergone ascending aortic replacement
because of intramural haematoma was referred with abdominal
pain and fever. Computed tomography scan showed
thrombosis circumferentially adhering to the Dacron graft .
After graft excision, cultures were positive for Candida albicans,
a life-threatening condition rarely described in the literature
Total arterial myocardial revascularization: surgical technique and mid-term results
No full textThe purpose of this study is to evaluate perioperative and mid-term results of total arterial coronary revascularization in our experience and to establish its safety. One-hundred and ninety-one patients underwent total arterial coronary revascularization at our Institution from February 1997 to August 2000. The mean age was 60.1 years. Of the patients, 45% had three coronary vessels disease, 12% a left main coronary artery disease and 2.6% of them were classified urgent. Mean ejection fraction was 59.6%. Three hundred and thirty-four comprehensive anastomoses were performed; mean grafts per patient was 1.8. A Y or T graft with the left internal thoracic artery was used in 21 patients. The in-hospital mortality rate was 1% (2 patients). Complications included low cardiac output syndrome in 2.8% of patients, acute myocardial infarction in 0.9% and acute renal insufficiency in 3.1%. Intraaortic balloon pump was used in 1.8% of patients. At a mean follow-up of 899 days the first 81 patients contacted are all free of angina but two (one experienced an acute myocardial infarction and another one died for a pulmonary neoplasia). We conclude that total arterial coronary revascularization is a safe surgical technique, providing excellent perioperative and mid-term results
Midterm clinical results in myocardial revascularization using the radial artery
No full textStudy objectives: The aim of this study was to evaluate the immediate and midterm results of coronary artery bypass grafting with the radial artery (RA) as a conduit. Patients: Two hundred forty-one patients underwent myocardial revascularization using the RA. In 78.5% of patients, three coronary vessels were involved, and in 25% of patients, the left main coronary artery was involved. The mean (± SD) preoperative ejection fraction was 58 ± 13%. Interventions: The RA was implanted on branches of the circumflex artery in 81% of the cases, and the left internal mammary artery was implanted on the left anterior descending artery in 94% of patients. Total arterial myocardial revascularization was performed in 58% of patients. Measurements and results: The in-hospital mortality rate was 0.8%. Two patients had acute myocardial infarction, and three patients experienced a transient low-cardiac output syndrome. We reviewed the records of all 171 patients who had undergone at least 6 months of follow-up after surgery. The late mortality rate in this group was 0.6% (one patient died 2 months after surgery because of cardiocirculatory arrest due to untreatable ventricular fibrillation). At a mean follow-up time of 545 ± 253 days, two patients showed class 3 residual angina according to the Canadian Cardiovascular Society (CCS) guidelines. One patient required another hospital admission 6 months after undergoing surgery for PTCA/stenting on a circumflex artery that had not previously undergone bypass. The second patient, 8 months after undergoing coronary artery bypass grafting, underwent angiography and stenting on a stenosed anastomosis of a posterolateral branch of the circumflex artery that previously had been bypassed with the right internal mammary artery. Conclusions: The routine use of the RA for coronary bypass grafting is a safe surgical technique, providing excellent clinical mid-term results in terms of cardiac event-free expectancy
Ischaemic mitral valve regurgitation: a surgical approach
No full textThe aim of this study IS to determine surgical results after surgical mitral valve repair in ischaemic mitral regurgitation. Materials and methods: Between January 1999 and June 2000, 64 patients (5.1% of overall patients) underwent myocardial revascularization and mitral valve surgery. A Cosgrove-Edwards mitral annuloplasty ring was used in 59 cases (92.2%). Average patient age was 64.3±12.4 years (38 males, 21 females). Average degree of mitral regurgitation was 2.8±0.6. Average NYHA class was 3.5±0.5. Average ejection fraction (EF) was 40±12.5 percent. Results: Post-operative 30-day mortality was 3.4% (2 patients). The follow-up was complete for 95 percent (mean 20.4±4.8 months for patients)and data showed an improvement of NYHA class (mean value 1.8±0.2) (p=0.01) and ejection fraction (mean value 51.7±10.2) (p=0.05) with residual mitral regurgitation value of 0.6±0.7. Conclusions: Mitral valve repair in coronary artery disease improves left ventricular function, quality of life and survival rate with low operative risk. Perioperative transesophageal echocardiography has a central role in surgical decision making
The basic protome of human left ventricle: a novel approach for the study of the molecular changes associated with aortic stenosis
No full textAbout the treatment of acute type A aortic dissection: a step forward? Abstracts of Aortic Surgery
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