1,721,100 research outputs found
Myocardial protection in adult patients. In: “Raja S., Cardiac Surgery: A Complete Guide”.
No full textAortic 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.The 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. © Copyright by ICR Publishers 2009
Early switch from vancomycin to oral linezolid for treatment of gram-positive heart valve endocarditis.
No full textPatients 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
Coronary artery bypass grafting with arterial conduits in the elderly: Where do we stand?
No full textAlthough improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization
in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated
in the overall population, the efficacy of this newer technique in the elderly is difficult to prove because
their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. Moreover,
more widespread use of this technique is limited by the concerns on the potential morbidity, particularly
the longer time required to perform the operation and the possibility of deep sternal wound infection in case of
bilateral internal thoracic artery harvesting due to the decreased blood supply to the sternum and surrounding
tissues.
The review of the recent literature indicates that the use of bilateral internal thoracic arteries in very elderly
patients should not be considered routinely. It seems reasonable to avoid it in octogenarians in the presence of
well-known predictors of sternal complications such as diabetes, morbid obesity, and severe chronic lung disease.
There is also still controversy about the superiority of the radial artery over the saphenous vein graft as a
second or third conduit for surgical myocardial revascularization, although the majority of recent studies seem
to support more liberal use of the radial artery as second arterial conduit in the elderly. Although a clinical
benefit of arterial graft revascularization cannot be formally excluded for elderly patients, the increased complexity
of this technique suggests that careful clinical judgment is necessary to select grafts for individual patients
Anticoagulation or antiplatelet therapy of bioprosthetic heart valves recipients: an unresolved issue.
No full textImprovements in the performance and longevity of biological valve prostheses have steadily increased their rates of implantation in recent years. Aortic bioprostheses, which are commonly used in the elderly or when the risks of anticoagulating are high, have generally been associated with low rates of long-term complications. Freedom from anticoagulation, therefore, represents the main theoretical advantage of biological, compared with mechanical, aortic prostheses. While a variety of anticoagulant and antiplatelet drug regimens have been described, a precise antithrombotic protocol for the early postoperative period after bioprosthetic aortic valve replacement has not been developed. There are also important differences between the international guidelines published. This review examines the clinical evidence concerning the use of vitamin K antagonist and antiplatelet therapy in the early management of the antithrombotic complications after bioprosthetic aortic valve replacement
Endovascular treatment of traumatic aortic dissection and innominate artery pseudoaneurysm.
No full textAortic valve replacement with right thoracotomy in a patient with sternal metastasis from renal carcinoma.
No full textWe present a clinical case of severe aortic stenosis in a 73-year-old patient symptomatic for dispnoea class NYHA III-IV. At the physical examination the patient presented a single sternal metastasis of renal carcinoma involving the sternum. Oncological stability prompted us to perform aortic valve replacement. In order to avoid median sternotomy and its complications due to the presence of sternal metastasis we successfully performed aortic valve replacement through a right minithoracotomy
Comparing warfarin to aspirin (WoA) after aortic valve replacement with the St. Jude Medical Epic heart valve bioprosthesis: results of the WoA Epic pilot trial.
No full textPatients with bioprosthetic heart valves have a higher risk of developing peripheral arterial embolic phenomena than the normal population. Antithrombotic therapy during the early postoperative period after bioprosthetic aortic valve replacement (BAVR) is controversial. This prospective pilot study sought to investigate the feasibility of a larger trial and the efficacy of postoperative warfarin compared to acetyl salicylic acid (aspirin; ASA) in patients after AVR with the St. Jude Epic porcine bioprosthesis (SJEP), and the feasibility of conducting a larger trial.
METHODS:
Patients undergoing isolated BAVR were allocated at random to two groups, each of which received different antithrombotic therapies: (i) warfarin (INR; range 2-3) for the first three months, followed by ASA (100 mg/day); or (ii) ASA alone (100 mg/day).
RESULTS:
During 2003 and 2004, a total of 75 patients underwent isolated BAVR with the SJEP. Six patients who developed postoperative de-novo atrial fibrillation that did not revert to sinus rhythm were excluded from the analysis, but included in the follow up. One postoperative cerebral ischemic event occurred in each group between 24 h and three months (2.8% versus 2.9%, p = NS). The rates of major bleeding, stroke-free survival and overall survival were similar in both groups.
CONCLUSION:
The early results of this WoA Epic pilot trial did not support the suggestion that patients receiving the SJEP, and tissue valves in general, should be administered warfarin to prevent valve thrombosis and peripheral arterial embolic phenomena
A Case of Type I Debranching Complicated by Anastomotic Pseudoaneurysm: Do Not Ask Too Much of the Ascending Aorta.
No full textTreatment of aortic arch aneurysm with standard open surgery is technically demanding, and associated morbidity and mortality are not insignificant. In high-risk patients, hybrid procedures with debranching and reimplantation or bypass of the aortic arch vessel followed by thoracic endovascular aortic repair (TEVAR) in the aortic arch represent a valid alternative to open surgery. However, when the ascending aorta is mildly dilated, the risk of retrograde dissection increases sharply. Here,we report a case of thoracic aortic aneurysm, with normal ascending aorta diameter, treated with Type I debranching and anterograde TEVAR complicated by anastomotic pseudoaneurysm and acute endocarditis, treated ultimately with ascending aortic repair and aortic valve replacement
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