31 research outputs found
Simultaneous cecal volvulus and gastric erosion secondary to laparoscopic adjustable gastric band
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Off-Pump Versus On-Pump: Should Graft Flow Confirmation at Time of Surgery Become Standard of Care?
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Preservation of aortic leaflets during rapid deployment valve implantation in patients with aortic insufficiency
No full textDevelopment of a new surgical technique for aortic valve replacement with the use of rapid deployment/sutureless valve: a leaflet preservation technique applying imbrication methods to pliable aortic leaflets. We aim to decrease the incidence of paravalvular leak by preserving aortic leaflets in patients with aortic insufficiency and large aortic annulus
Cardiac surgery for constrictive pericarditis
No full textThe pericardium is a protective cardiac biologic tissue. The pericardial structure consists of an avascular, double-walled sac containing two layers: the visceral pericardium, which is a thin layer comprising an inner serous monolayer and pericardial physiologic fluid, and the parietal pericardium, which consists of an outer fibroelastic layer. There are two pericardial sinuses: transverse and oblique. The pericardium serves important ligamentous, membranous, metabolic, reflexive, and mechanical functions that are described within the text of this chapter. Constrictive pericarditis is a serious cardiac pathologic process with profound clinical and hemodynamic implications. In constrictive pericarditis, chronic fibrous tight thickening of the pericardial tissue develops secondary to inflammation. As a result, the pericardial elasticity and compliance are adversely effected, in a process that severely impairs cardiac physiology. Clinically, constrictive pericarditis commonly presents with a picture of right-sided heart failure including symptoms of fatigue, exertional dyspnea, and peripheral edema. Associated left cardiac chambers dysfunction also presents as pulmonary congestive symptoms, chest pain, palpitations, abdominal symptoms, and frank anasarca. The unique physical examination findings when this pathology is encountered are delineated in this chapter. The diagnosis of constrictive pericarditis involves physical examination, electrocardiography, chest radiography, and echocardiography. Further evaluation and confirmation include cardiac imaging with computed tomography, magnetic resonance, and, when indicated, right and left heart catheterization.
Definitive surgical management is commonly performed through pericardiectomy. This operation remains technically challenging and its various approaches, challenges, and complications are described. Long-term survival after pericardiectomy is largely dependent on etiology and on patient comorbidities such as older age, New York Heart Association (NYHA) class, renal dysfunction, pulmonary hypertension, increased Child-Pugh liver disease, previous chest irradiation, and hyponatremia. Postoperatively, most patients exhibit improved hemodynamic condition, improved cardiac function, and become symptom free providing that accurate pre-op assessment, adequate patient selection, and timely surgical intervention are performed
Coronary calcifications: effect on coronary artery bypass graft surgery
No full textCoronary artery calcification (CAC) is a sex and age-dependent vascular pathology affecting normal coronary compliance and physiologic vasomotor response, as well as impairing adequate myocardial perfusion. CAC can be classified in two subtypes depending on the vascular layer affected: intimal or medial artery calcification. Denser deposits detected by imaging studies suggest the presence of advanced complicated lesions, which have shown to strongly correlate with atherosclerotic plaque burden. The diagnosis of coronary artery calcification is done by an electron-beam computed tomography scanner, and the degree of calcification is quantified using the Agatston score. Interventional treatment of calcified coronary arteries remains challenging. Focal coronary calcification is a well-known predictor of poor prognosis in patients undergoing percutaneous coronary intervention. The 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults recommended coronary artery bypass graft surgery (CABG) for patients with class III to IV CAC seen on intravascular ultrasound, presence of thrombotic or ulcer lesions, serious angle lesions >60 degrees, intimal tear lesions, diffuse lesion length >25mm, severe left ventricular dysfunction, and in patients where a coronary guidewire cannot pass the calcified lesion. The most commonly used grafts for coronary artery bypass are the left internal mammary artery and the greater saphenous vein. Graft choice for CABG depends on patient comorbidities and life expectancy, the location and number of coronary targets, and the availability of graft material. The preoperative assessment and operative steps for CABG are elucidated. Lastly, the evolution of coronary endarterectomy from a standalone intervention to an adjunct technique to CABG surgery is introduced
Off-pump CABG with lower sternotomy in a patient with dialysis access graft crossing the sternum
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