RESUMO
Spontaneous coronary artery dissection is a rare condition that usually causes a coronary syndrome, but may also cause sudden death. It is more common in women and is associated with factors such as the peripartum period and oral contraceptive use. We report two cases. A 45-year-old woman with hepatitis C, presenting in the emergency room with angina. An intravascular ultrasound showed a dissecting hematoma involving the left, anterior descending and circumflex coronary arteries. She was initially managed with nitroglycerin, anticoagulation and anti-platelet drugs but due to persistence of symptoms, she required surgical revascularization. A 32-year-old woman presenting in the emergency room with angina. A coronary angiogram revealed a dissection of the anterior descending coronary artery. Eight days later an intravenous ultrasound showed a retrograde progression of the dissection and she was subjected to a surgical revascularization.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgiaRESUMO
Spontaneous coronary artery dissection is a rare condition that usually causes a coronary syndrome, but may also cause sudden death. It is more common in women and is associated with factors such as the peripartum period and oral contraceptive use. We report two cases. A 45-year-old woman with hepatitis C, presenting in the emergency room with angina. An intravascular ultrasound showed a dissecting hematoma involving the left, anterior descending and circumflex coronary arteries. She was initially managed with nitroglycerin, anticoagulation and anti-platelet drugs but due to persistence of symptoms, she required surgical revascularization. A 32-year-old woman presenting in the emergency room with angina. A coronary angiogram revealed a dissection of the anterior descending coronary artery. Eight days later an intravenous ultrasound showed a retrograde progression of the dissection and she was subjected to a surgical revascularization.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Doenças Vasculares/congênito , Anomalias dos Vasos Coronários/diagnóstico por imagem , Doenças Vasculares/cirurgia , Doenças Vasculares/diagnóstico por imagem , Angiografia Coronária , Anomalias dos Vasos Coronários/cirurgiaRESUMO
BACKGROUND: The 2014 Guidelines for the Management of Patients with Valvular Heart Disease require to know the probability of success and operative mortality of Mitral Valve Repair (MVR) for Degenerative Mitral Insufficiency (DMI) at a given institution. AIM: To assess the probability of success, operative mortality and long-term results of MVR for DMI. PATIENTS AND METHODS: The database of the Cardiovascular Surgery Service was reviewed for the period December 1991 to December 2013. Long-term survival information was obtained from death certificate records of the Chilean Identification Service. RESULTS: One hundred forty seven patients with DMI were identified, all operated by one author (RZ). In 28 (19%) the mitral valve was replaced, including three patients in whom a MVR was intended without success. A successful MVR was performed in 119 patients (81%). The probability of a successful MVR was 97.5% (119 of 122). Prolapsed posterior leaflet was present in 81% and annulus dilatation in 60% of cases. The most frequent surgical procedures were quadrilateral resection (83%) and chordal transfer (13%). A mitral annuloplasty was performed in 92% of cases. Operative mortality was 0.8%. At the end of a 9.9 (0 - 22.7) years follow-up, 87 patients (73%) were alive and mean survival was 16.9 years. Survival rates at 5, 10, 15 and 20 years were 91%, 78%, 71% and 50%, respectively. Six patients were re-operated, due to mitral valve dysfunction in three. Mean re-operation free survival was 21.4 years. Echocardiographic follow-up was 75% completed at an average of 64 months; 84% of cases had no or only 1+ mitral regurgitation. CONCLUSIONS: In our experience, MVR for DMI had an operative mortality below 1% and a probability of success greater than 95%, with excellent long-term results.
Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Background: The 2014 Guidelines for the Management of Patients with Valvular Heart Disease require to know the probability of success and operative mortality of Mitral Valve Repair (MVR) for Degenerative Mitral Insufficiency (DMI) at a given institution. Aim: To assess the probability of success, operative mortality and long-term results of MVR for DMI. Patients and Methods: The database of the Cardiovascular Surgery Service was reviewed for the period December 1991 to December 2013. Long-term survival information was obtained from death certificate records of the Chilean Identification Service. Results: One hundred forty seven patients with DMI were identified, all operated by one author (RZ). In 28 (19%) the mitral valve was replaced, including three patients in whom a MVR was intended without success. A successful MVR was performed in 119 patients (81%). The probability of a successful MVR was 97.5% (119 of 122). Prolapsed posterior leaflet was present in 81% and annulus dilatation in 60% of cases. The most frequent surgical procedures were quadrilateral resection (83%) and chordal transfer (13%). A mitral annuloplasty was performed in 92% of cases. Operative mortality was 0.8%. At the end of a 9.9 (0 - 22.7) years follow-up, 87 patients (73%) were alive and mean survival was 16.9 years. Survival rates at 5, 10, 15 and 20 years were 91%, 78%, 71% and 50%, respectively. Six patients were re-operated, due to mitral valve dysfunction in three. Mean re-operation free survival was 21.4 years. Echocardiographic follow-up was 75% completed at an average of 64 months; 84% of cases had no or only 1+ mitral regurgitation. Conclusions: In our experience, MVR for DMI had an operative mortality below 1% and a probability of success greater than 95%, with excellent long-term results.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/cirurgia , Seguimentos , Insuficiência da Valva Mitral/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Mitral valve repair is the preferred procedure for the surgical treatment of mitral valve insufficiency (MI), procedure that we initiated 20 years ago. AIM: To assess our experience and long-term results of mitral valve repair. PATIENTS AND METHODS: The database of the cardiology department was reviewed for the period between December 1991 and December 2012. A total of 322 patients aged 18 to 89 years (62% males) undergoing mitral valve repair were identified. Long-term survival information was obtained consulting death certificate records of the Chilean Identification Service. The latest echocardiogram available was analyzed. RESULTS: MI was degenerative in 144 patients (45%) and ischemic in 104 (32%). A prosthetic ring was used in all ischemic and in 92% of non-ischemic MI. Operative mortality was 7.5%, 13% in ischemic and 4.4% in non-ischemic MI (p < 0.01). Overall long-term survival was 14.1 years; 9.3 and 16 years for ischemic and non-ischemic MI, respectively (p < 0.001). Survival at 5, 10, 15 and 20 years was 79, 63, 54 and 42%, respectively. For degenerative MI survival at 5 and 10 years was 90 and 76% and for ischemic MI, it was 64 and 44%, respectively (p < 0.001). On a multivariate analysis the main predictors of late mortality were age, associated valvular disease and ischemic etiology. Echocardiographic follow-up was available for 223 patients; MI was absent in 53% and was mild in 29%. CONCLUSIONS: In a 20 years follow-up, mitral valve repair for MI had excellent long-term survival and echocardiographic results. The most common etiologies of MI were degenerative and ischemic diseases. The latter had a worst prognosis. The main predictors of long term mortality were age, associated valvular disease and ischemic etiology.
Assuntos
Insuficiência da Valva Mitral/cirurgia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Background: Mitral valve repair is the preferred procedure for the surgical treatment of mitral valve insufficiency (MI), procedure that we initiated 20 years ago. Aim: To assess our experience and long-term results of mitral valve repair. Patients and Methods: The database of the cardiology department was reviewed for the period between December 1991 and December 2012. A total of 322 patients aged 18 to 89 years (62% males) undergoing mitral valve repair were identified. Long-term survival information was obtained consulting death certificate records of the Chilean Identification Service. The latest echocardiogram available was analyzed. Results: MI was degenerative in 144 patients (45%) and ischemic in 104 (32%). A prosthetic ring was used in all ischemic and in 92% of non-ischemic MI. Operative mortality was 7.5%, 13% in ischemic and 4.4% in non-ischemic MI (p < 0.01). Overall long-term survival was 14.1 years; 9.3 and 16 years for ischemic and non-ischemic MI, respectively (p < 0.001). Survival at 5, 10, 15 and 20 years was 79, 63, 54 and 42%, respectively. For degenerative MI survival at 5 and 10 years was 90 and 76% and for ischemic MI, it was 64 and 44%, respectively (p < 0.001). On a multivariate analysis the main predictors of late mortality were age, associated valvular disease and ischemic etiology. Echocardiographic follow-up was available for 223 patients; MI was absent in 53% and was mild in 29%. Conclusions: In a 20 years follow-up, mitral valve repair for MI had excellent long-term survival and echocardiographic results. The most common etiologies of MI were degenerative and ischemic diseases. The latter had a worst prognosis. The main predictors of long term mortality were age, associated valvular disease and ischemic etiology.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Intervalo Livre de Doença , Seguimentos , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Background: An experimental model for ligation of the left anterior descending coronary artery (ADA) in rats has been commonly used in research into ischemic cardiopathy. However, this procedure is very difficult, with a high mortality rate. There is little information in the literature regarding its technical aspects. Our objective was to describe a surgical technique for ADA ligation in rats. Material and Method: Fifty-one Sprague-Dawley male rats weighting 230 +/- 20 gr were anaesthetized and connected to mechanical ventilation. Through a left-side thoracothomy we ligated the ADA 2 mm below the junction of the pulmonary artery and the left atrial appendage. The next day we performed transthoracic echocardiography to confirm our results. Results: The mortality rate was 7.8 percent (4 out of 51). The main cause of death was hemorrhage during surgery. The average time for the procedure was 45 +/- 5 min. We confirmed hypokinesia of the anterior lateral wall in 100 percent of the surviving rats. Discussion: This procedure was reproducible and safe, with less than 10 percent mortality.
Introducción: El modelo experimental de ligadura de la arteria coronaria descendente anterior izquierda (ADA) en ratas, ha sido de gran ayuda para el estudio de la cardiopatía isquémica. Sin embargo, es un procedimiento difícil de realizar y con alta mortalidad operatoria. Existe poca información de sus aspectos técnicos. El objetivo de nuestro trabajo fue describir en detalle la técnica quirúrgica de la ligadura de la ADA en ratas. Material y Método: Se utilizaron 51 ratas machos Sprague-Dawley 230 +/- 20 gr de peso anestesiadas y conectadas a ventilación mecánica. A través de una toracotomía izquierda se ligó la ADA, 2 mm debajo de la intersección entre la arteria pulmonar y la orejuela izquierda. Al día siguiente se realizó una ecocardiografía transtorácica para confirmar la presencia de hipocinesia. Resultados: La mortalidad operatoria fue de 7,8 por ciento (4 de 51). La principal causa de muerte fue la hemorragia en el intraoperatorio durante la curva de aprendizaje. El tiempo operatorio promedio fue de 45 +/- 5 min. Se confirmó la presencia de una hipocinesia de la pared anterolateral en el 100 por ciento de las ratas supervivientes. Discusión. Esta técnica es un procedimiento reproducible y seguro, con una mortalidad menor al 10 por ciento.