2,896 research outputs found
Degeneration of native and tissue prosthetic valve in aortic position: do statins play an effective role in prevention?
No full textDegenerative aortic valve stenosis is a common disease in western countries. When it becomes severe, it confers significant morbidity and mortality. Aortic stenosis has been recognized as a complex inflammatory and highly regulated process with histological and immunochemical similarities with the process of atherosclerosis. Hypertension, smoking and diabetes mellitus have consistently been linked to the development of aortic stenosis. Endothelial injury or other processes that contribute to coronary disease may play a role in calcific aortic stenosis. Several observational studies suggests that the key factors of aortic stenosis are lipoproteins and that medical therapies with cholesterol lowering drugs may retard its progression. Similarly, it has been suggested that the process of degeneration of the tissue heart valve has been associated with the same risk factors of atherosclerosis and shares many histological and molecular characteristics. Assuming all this concept, and evaluating the results of a retrospective study it has been suggested to use statin also as medical therapy able to prevent tissue valve degeneration. Randomized controlled clinical trials will be needed to demonstrate the role of lipid intervention to prevent the progression of aortic stenosis and the degeneration of tissue heart valves
Degeneration of native and tissue prosthetic valve in aortic position: Do statins play an effective role in prevention?
No full textThe ability of Salmonella to drill holes in the aorta.
No full textA 56-year-old male with fever and enlarged mediastinum
underwent examinations for lymphoma. He had back pain
and hypotension. Computed tomography showed a false
aneurysm of the aortic arch (Fig. 1a). Pathological aorta
was excised. Reconstruction of the large hole on the aortic
arch (Fig. 1b) with oval patch tailored from cryopreserved
thoracic aorta was performed under hypothermic circulatory
arrest. Blood and aortic cultures grew Salmonella. The
patient had uneventful recovery. One year later is free
from infection
Heart fatty acid biding protein in the diagnosis of myocardial infarction: where do we stand today?
No full textVideo-assisted cardioscopy for removal of primary left ventricular myxoma.
No full textLeft ventricular myxoma is a rare benign cardiac tumor. Surgical excision is the treatment of choice and completeness of removal is
mandatory to avoid late recurrence. A case is presented in which aortic transvalvular video-assisted cardioscopy was used to facilitate
removal
Port-Access cardiac surgery: from a learning process to the standard.
No full textBackground: Port-AccessTM surgery has been one of the
most innovative and controversial methods in the spectrum
of minimally invasive techniques for cardiac operations and
has been widely used for the treatment of several cardiac diseases.
The technique was introduced in our center to evaluate
its efficacy in reproducing standardized results without an
additional risk.
Methods: Endovascular cardiopulmonary bypass (CPB)
through femoral access and endoluminal aortic occlusion
were used in 129 patients for a variety of surgical procedures,
all of which were video-assisted. A minimal (4-6 cm) anterior
thoracotomy through the fourth intercostal space was used in
all cases as the surgical approach.
Results: More than 96% of the planned cases concluded
as true Port-AccessTM procedures. Mean CBP and crossclamp
times were 87.2 min. ± 51.2 (range of 10-457) and
54.9 min. ± 30.6 (range of 10-190), respectively. Hospital
mortality for the overall group was 1.5%, and mitral valve
surgery had a 2.2% hospital death rate. The incidence of early
neurological events was 0.7%. Mean extubation time, ICU
stay, and total length of hospital stay were 5 hours ± 6 hrs.
(range of 2-32), 12 hours ± 11.8 hrs. (range of 5-78), and
7 days ± 7.03 days (range of 1-72), respectively.
Conclusions: Our experience indicates that the Port-
AccessTM technique is safe and permits reproduction of standardized
results with the use of a very limited surgical
approach. We are convinced that this is a superior procedure
for certain types of surgery, including isolated primary or
redo mitral surgery, repair of a variety of atrial septal defects
(ASDs), and atrial tumors. It is especially useful in high-risk
patients, such as elderly patients or those requiring reoperation.
Simplification of the procedure is nevertheless desirable
in order to further reduce the time of operation and to
address other drawbacks
Fontes de nitrogênio e manejo de plantas espontâneas em pomar de macieira
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências Agrárias, Programa de Pós-Graduação em Agroecossistemas, Florianópolis, 2015.O Estado de Santa Catarina (SC) é o segundo maior produtor de maçãs do Brasil. Normalmente, o nitrogênio (N) é fornecido às maciei-ras na forma de ureia. Porém, outras fontes de N, como a ureia peletiza-da e a cama sobreposta de suínos podem liberar o nutriente mais lenta-mente no solo, potencializando a absorção pelas plantas, o que pode me-lhorar o estado nutricional e até afetar positivamente a produção, bem como reduzir a perda de N por lixiviação. Além disso, nos pomares de SC, as plantas espontâneas são dessecadas ou roçadas na linha de plan-tio, para diminuir a competição por água e nutrientes com as macieiras. Porém, é possível que em pomares adultos em produção não aconteça essa competição, não afetando negativamente o estado nutricional e produção das macieiras. Assim, pode não ser necessária nem a roçada ou dessecamento das plantas espontâneas. O crescimento das plantas es-pontâneas nos pomares pode diminuir a lixiviação de N e melhor os a-tributos químicos do solo. O trabalho objetivou (a) avaliar o teor de N total em folhas, a produção e o fluxo de N no solo e na solução, em po-mar de macieira com a aplicação de distintas fontes de N, (b) avaliar o estado nutricional, a produtividade de maçã, o fluxo de N no solo e na solução lixiviada, e os atributos químicos do solo, em pomar de maciei-ras com diferentes manejos de plantas espontâneas. O Estudo 1 foi inti-tulado produção e N no solo e na solução em pomar de macieira subme-tido à aplicação de fontes de nutrientes. O experimento foi instalado em Urubici (SC). As macieiras foram submetidas à aplicação de 33 kg de N ha-1 na forma de ureia, ureia peletizada e cama sobreposta de suínos; ha-vendo ainda um tratamento sem aplicação de N. O Estudo 2 foi intitula-do nutrição, produtividade e atributos químicos do solo, em pomar de macieira sob manejo de plantas espontâneas. O experimento foi implan-tado em um pomar em Urubici (SC). Os tratamentos foram manejos de plantas espontâneas: sem manejo das plantas espontâneas (SM), desse-camento das plantas espontâneas na linha de plantio (DL), roçada das plantas espontâneas na linha de plantio (RL) e roçada das plantas espon-tâneas na linha e entrelinha de plantio (RLE). No Estudo 1 e 2 foram a-valiados os teores de nutrientes nas folhas e mensurado o diâmetro do caule e a produção de frutos. Foram coletadas amostras de solo e de so-lução, e analisados os teores de N-NH4+ e N-NO3- ao longo de duas sa-fras no Estudo 1 e três safras no Estudo 2. Além disso, no Estudo 2 fo-ram abertas trincheiras e coletado nas camadas de 0-0,025, 0,025-0,05, 0,05-0,10, 0,10-0,15 0,15-0,20 e 0,20-0,4 m, após 24 meses da instala-ção do experimento. No Estudo 1 a aplicação de cama sobreposta de su-ínos, ureia e ureia peletizada em macieiras aumentou a produção de fru-tos na segunda safra avaliada, mas o teor de N total nas folhas não foi afetado. A aplicação de fontes de N no solo afetou o fluxo de formas do nutriente no solo e na solução ao longo do ciclo da macieira, com pe-quenos incrementos em períodos próximos às aplicações das diferentes fontes de N ao solo. No Estudo 2 observou-se que os diferentes manejos das plantas espontâneas não afetaram a produtividade, o crescimento das macieiras e pouco alteraram o teor de nutrientes nas folhas e nas cama-das de solo. Assim, as plantas espontâneas nas linhas de plantio e entre-linhas não necessitam ser manejadas nem com roçadas ou uso de herbi-cidas, para evitar a competição por água e nutrientes com as macieiras. Os maiores teores de N-NO3- e, por consequência, de N mineral tende-ram a ser observados na solução lixiviada no solo com dessecamento das plantas espontâneas na linha de plantio, o que pode potencializar a contaminação de águas sub-superficiais.Abstract : The state of Santa Catarina (SC) is the second largest producer of apples in Brazil. Typically, nitrogen (N) is supplied to the apple trees in urea form. However, other N sources such as pelletized urea and pig deep litter can slowly release the nutrient in the soil, enhancing the ab-sorption from the apple tree, which can improve the nutritional status and even affect positively the production and reduce the loss of N leach-ing. In addition, the SC orchards, the spontaneous plants are discarded or desiccation on row to reduce competition for water and nutrients to plants. However, it is possible that in adults orchards in production might not happen this competition, not adversely affecting the nutrition-al status and production of apple trees. So it may not be necessary mow-ing or desiccation of weeds. The growth of weeds in orchards can re-duce the leaching of N and better soil chemical attributes. Two studies were conducted. The study aimed to (a) evaluate the total N content in leaves, the production and the nitrogen flow in the soil and solution in apple orchard with the application of different sources of N, (b) evaluate the nutritional status, apple productivity, N flow in soil and leach solu-tion, and soil chemical properties in apple orchard with different man-agement of weeds. Study 1 corresponded: Production and nitrogen in soil and solution in apple orchard submitted to the application of nutri-ent sources. The experiment was in Urubici (SC). The apple trees were subjected to application of 33 kg N ha-1 as urea form, pelletized urea and pig deep litter; there was a treatment without application of N. Study 2 was titled: Nutrition, productivity and soil chemical attributes in apple orchard under management of weeds. The experiment was installed in an orchard in Urubici (SC). The treatments were different management of weeds: without management of weeds, desiccation of weeds in the rows, mowing of weeds in the row and mowing of weeds in the row and interrows. The study 1 and 2 was evaluated the levels of nutrients in the leaves and measured the diameter of the stem and fruit production. Soil and solution were collected and analyzed the content of NH4+-N and NO3--N over two seasons in Study 1 and three harvests in Study 2. In addition, in Study 2 were open trenches and collected in layers 0-0.025, 0.025-0.05, 0.05-0.10, 0.10-0.15, 0.15-0.20 e 0,20-0,4 m after 24 months of the experiment installation. The results obtained in Study 1 show that the pig deep litter application, urea and pelletized urea on ap-ples tree increased fruit production in the second season, but the total N content in leaves was not affected. The N sources in the soil affected the flow of the nutrient in the soil and solution over apple cycle, with smallincrements in near periods of the application of different nitrogen sources in the soil. The Study 2 showed that the different managements of weeds did not affect productivity, growth of apple tree and little changed the nutrient content in leaves and soil layers. Therefore, weeds in the rows and interrow need not be managed either with mowing or use of herbicides, to avoid competition for nutrients and water to the ap-ple trees. The highest levels of nitrate and, therefore, mineral C tended to be observed in the leach solution whit the desiccation of the weeds in the row, which can enhance the subsurface contamination of water
Heart fatty acid binding protein in the diagnosis of myocardial infarction: where do we stand today?
No full textHeart fatty acid binding protein (hFABP) is a novel small cytosolic protein that is abundant in the heart. It is highly cardiac-specific (i.e. expressed primarily in cardiac tissue), but is also expressed at low concentrations in tissues outside the heart. After myocardial ischemic damage, hFABP can be detected in the blood as early as 1-3 h after onset of chest pain, with peak values reached at 6-8 h and plasma levels returning to normal within 24-30 h. hFABP's clinical diagnostic value is very limited in the presence of renal failure and skeletal muscle diseases as it is completely renally eliminated. In these conditions, the diagnosis of acute myocardial infarction (AMI) may be overestimated. The combination of initial hFABP release after symptom onset, rapid kidney clearance from the circulation and high cardiac specificity suggests great potential for clinical use. Serial measurements of hFABP in the first 24 h after onset of symptoms in AMI patients can: (a) identify patients who are susceptible to reperfusion strategies, (b) detect perioperative AMIs, (c) distinguish patients who reperfuse their infarct-related artery from those who do not, as early as 30 min after starting thrombolytic treatment, (d) detect re-infarction if it occurs within 10 h after symptom onset, and (e) permit an accurate estimation of myocardial infarct size providing important prognosis information
Heart valve surgery in patients with the antiphospholipid syndrome: analysis of a series of nine cases.
No full textAntiphospholipid syndrome (APS) is a rare coagulation disorder associated with recurrent arterial and venous thrombotic events. Heart valve abnormalities are commonly found in patients with APS.
METHODS:
From March 1998 to March 2007, nine patients with APS underwent heart valve surgery using cardiopulmonary bypass. We retrospectively reviewed their clinical data, operative and postoperative courses and the long-term results.
RESULTS:
The mean age was 43.6+/-10.4 years, six were female and three male. Four patients underwent mitral valve replacement, three went through aortic valve replacement, one underwent combined mitral-aortic valve replacement and another aortic valve plasty. The syndrome was primary in seven patients and associated with systemic lupus erythematosus (SLE) in two. Follow-up was 8 days to 8 years (median 66 months). Two patients died in the early postoperative period: both due to an acute cerebrovascular accident. Four patients presented an uneventful late postoperative course. One patient experienced an ischaemic stroke 5 years after mitral valve replacement (MVR) and developed refractory congestive heart failure requiring heart transplantation three years postoperatively.
CONCLUSIONS:
Heart valve surgery in patients with antiphospholipid syndrome may carry considerable early and late mortality and morbidity. Thrombo-embolic complications are the most common complications. Mechanical prostheses have been used at our Institution in the previous years; however, today, after reviewing our historical results, we reconsider our general strategy and believe that tissue heart valve prostheses are the possible ideal substitutes, minimising the risks of morbidity and mortality due to the hypercoagulable state of AP
Is early antithrombotic therapy necessary after tissue mitral valve replacement?
No full textPatients with prosthetic heart valves have a higher risk of developing valve thrombosis and arterial thromboembolism. Antithrombotic therapy during the early postoperative period after biologic mitral valve replacement (MVR) is controversial. Hence, a retrospective study was conducted to investigate the efficacy of different antithrombotic therapies in patients after MVR with bioprostheses.
METHODS:
Between January 2000 and January 2006, a total of 99 patients presenting with preoperative sinus rhythm underwent isolated bioprosthetic MVR. Of these patients, 59 (58%) received a bovine pericardial xenograft, and 40 (42%) a porcine bioprosthesis. The postoperative antithrombotic therapy was prescribed according to the surgeon's preference.
RESULTS:
Fifty-one (51%) patients received acetylsalicylic acid (ASA group, 100 mg/day), 12 (13%) did not receive any specific antithrombotic therapy (NT group), and 36 (36%) received a vitamin K antagonist (VKA group, INR 2-3). The primary endpoints were the rate of cerebral ischemic events, bleeding events, and survival. The mean follow up was 23 months (range: 3-68 months). There were five early deaths (5%), and eight late deaths (8%). There were five episodes of cerebral ischemic events; these included three patients (8.3%) in the VKA group, one patient (2.0%) in ASA group, and one patient (8.3%) in the NT group (p = 0.351). Of these episodes, two occurred between 24 h and three months after surgery. Only one (2.8%) episode of major bleeding occurred (in the VKA group), due to poor anticoagulation management.
CONCLUSION:
Each of the antithrombotic therapies evaluated appeared to be safe. There was no evidence to suggest that any specific antithrombotic therapy would be superior in preventing valve thrombosis in patients undergoing bioprosthetic MVR
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