1,721,181 research outputs found
Alternatives to transplantation in the surgical therapy for heart failure.
No full textDespite considerable improvements in the medical treatment of heart failure (HF), the gold standard for the treatment of these patients remains heart transplantation. Nevertheless, in consideration of the shortage of organ donors, this procedure can be offered only to a small percentage of patients who could benefit from a new heart. A number of innovative approaches are being investigated in terms of improved survival and quality of life in patients refractory to medical therapy and excluded from cardiac transplantation lists. These procedures include the optimization of medical therapy, coronary artery bypass surgery and valve surgery in high-risk patients, ventricular restoration techniques, and the implantation of ventricular assist devices as destination therapy. Future therapies for HF could include stem cell therapy, associated with standard revascularization techniques or with other procedures such as ventricular assist devices implantation or ventricular restoration techniques, allowing the potential differentiation of implanted stem cells in a resting and unloaded heart. The modern approach to surgical treatment of HF is multidisciplinary, given that the number of alternative available options to heart transplantation requires a close collaboration between both cardiologists and cardiac surgeons in treating patients with end-stage HF who are not candidates for transplant. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Images in cardiovascular medicine. Periaortic valve abscess presenting as unstable angina.
No full text
Early switch from vancomycin to oral linezolid for treatment of gram-positive heart valve endocarditis.
No full textBackground. Patients with complicated gram-positive endocarditis are usually treated with a combination of surgical procedure and long-term antibiotic therapy with intravenous vancomycin. However, oral linezolid offers the potential for an early switch from intravenous vancomycin to oral linezolid therapy.
Methods. We conducted a retrospective study from February 2002 to August 2005 to determine the potential for early switch from intravenous vancomycin to oral linezolid in patients surgically treated for a left-sided active gram-positive endocarditis.
Results. Fourteen patients were identified; average age was 52 +/- 16 years. There were 10 (85%) and 2 (15%) cases of native and prosthetic valve endocarditis, respectively. Patients were operated on 3 to 10 days after diagnosis. There were no cases of operative mortality. Mean follow-up was 20.8 +/- 7.0 months. Two (14%) patients died of noncardiac causes during follow-up. The mean intensive care unit length of stay was 3.1 +/- 2.3 days, and mean hospital length of stay was 10.5 +/- 3.4 days. No cases of recurrent endocarditis or periprosthetic leakage were observed.
Conclusions. The combination of aggressive surgical treatment and the early switch from intravenous vancomycin to oral linezolid for treatment of active gram-positive heart valve endocarditis is safe and effective, and reduces infection relapses, vancomycin use, hospital length of stay, and economic costs
Aortic valve regurgitation in a patient affected by KBG sindrome.
No full textThe KBG syndrome is a very rare condition characterized by developmental delay, short stature, distinct facial dysmorphism, macrodontia of the upper central incisors and skeletal abnormalities. Associated congenital heart defects have been described in 9% of patients. Herein is described a case of aortic root dilatation with significant regurgitation in a young patient affected by KBG syndrome. Surgical inspection showed a dilated aortic annulus, slightly dilated aortic sinuses, a tricuspid valve with slightly thickened cuspal margins and central regurgitation. Histological examination showed a fibrous hyaline involution of the valvular leaflets. To the authors' knowledge, this is the first reported case of KBG syndrome affected by aortic root dilatation with severe regurgitation. Morphology of the aortic valve leaflets was relatively normal, but the annulus was dilated in the absence of any history of rheumatic fever, hypertension, connective tissue or rheumatic systemic diseases. The unusual findings in this young patient raised questions regarding the as-yet unexplained etiopathogenesis of the KBG syndrome
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
A KALLIKREIN-LIKE ENZYME IN HUMAN VASCULAR TISSUE
No full textWe attempted to identify the presence of kallikrein in human vascular tissue obtained from patients undergoing surgery. Sections of thoracic (n = 9) and abdominal aorta (n = 6), renal artery (n = 6), and saphenous vein (n = 17) were rinsed with 0.01 mol/L Tris-HCl buffer, cleaned, minced, and homogenized at 4 degrees C. The homogenates were centrifuged and supernatants were assayed for protein content and for active and total (trypsin activation) enzymatic activity on the peptide H-D-Val-Leu-Arg-paranitroanilide (S2266), a synthetic substrate for glandular kallikrein. Enzymatic activity was inhibited by aprotinin and polyclonal antibodies against human glandular kallikrein. Kallikrein was resistant to soybean trypsin inhibitor and had an optimum pH of 8.2. A significant correlation was found between the amidolytic and kininogenase activities measured on S2266 and dog kininogen, respectively (r = 0.83, P < .01). The kallikrein-like enzyme was present mainly in the inactive form. Higher levels were found in the homogenates of renal artery (active: 190 +/- 36, total: 5036 +/- 908 pkat/g protein) than in those of thoracic (active: 38 +/- 9, total: 973 +/- 350 pkat/g protein) and abdominal aorta (active: 44 +/- 10, total: 3031 +/- 709 pkat/g protein). In the homogenates of saphenous vein, active and total enzymatic activities averaged 188 +/- 90 and 2003 +/- 450 pkat/g protein, respectively. A significant inverse correlation was found between the levels of total enzymatic activity in saphenous vein homogenates and mean blood pressure values (r = 0.78, P < .005). These results suggest that a kallikrein-like enzyme is present in human vasculatur
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