Behavior of inflammatory markers of myocardial injury in cardiac surgery: laboratory correlation with the clinical picture of postpericardiotomy syndrome.
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OBJECTIVE: To verify the association of serum markers of myocardial injury, such as troponin I, creatinine kinase, and creatinine kinase isoenzyme MB, and inflammatory markers, such as tumor necrosis factor alpha (TNF-alpha), C-reactive protein, and the erythrocyte sedimentation rate in the perioperative period of cardiac surgery, with the occurrence of possible postpericardiotomy syndrome. METHODS: This was a cohort study with 96 patients undergoing cardiac surgery assessed at the following 4 different time periods: the day before surgery (D0); the 3rd postoperative day (D3); between the 7th and 10th postoperative days (D7-10); and the 30th postoperative day (D30). During each period, we evaluated demographic variables (sex and age), surgical variables (type and duration, extracorporeal circulation), and serum dosages of the markers of myocardial injury and inflammatory response. RESULTS: Of all patients, 12 (12.5%) met the clinical criteria for a diagnosis of postpericardiotomy syndrome, and their mean age was 10.3 years lower than the age of the others (P=0.02). The results of the serum markers for tissue injury and inflammatory response were not significantly different between the 2 assessed groups. No significant difference existed regarding either surgery duration or extracorporeal circulation. CONCLUSION: The patients who met the clinical criteria for postpericardiotomy syndrome were significantly younger than the others were. Serum markers for tissue injury and inflammatory response were not different in the clinically affected group, and did not correlate with the different types and duration of surgery or with extracorporeal circulation. (+info)
Three unusual cases where cardiopulmonary bypass was used in thoracic surgery.
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Cardiopulmonary bypass (CPB) is a technique which is commonly performed without any problem in cardiac surgery. CPB can also be used in patients with a tumoral mass adherent to the great vessels, in patients with critically narrowed airway, if cross-table intubation of the distal trachea is not feasible and in patients necessitating re-do surgery with extensive adhesions because it allows extensive mobilization of the heart and great vessels without compromising their function. It also allowed the central pulmonary artery to be controlled without comprising oxygenation and complete resection of a tumor localized in the A-P window. Herein we report such patients operated with CPB without any problem. (+info)
Prophylactic respiratory physiotherapy after cardiac surgery: systematic review.
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OBJECTIVE: To assess whether respiratory physiotherapy prevents pulmonary complications after cardiac surgery. DATA SOURCES: Searches through Medline, Embase, Cinahl, the Cochrane library, and bibliographies, for randomised trials comparing any type of prophylactic respiratory physiotherapy with another type or no intervention after cardiac surgery, with a follow up of at least two days, and reporting on respiratory outcomes. REVIEW METHODS: Investigators assessed trial validity independently. Information on study design, population, interventions, and end points was abstracted by one investigator and checked by the others. RESULTS: 18 trials (1457 patients) were identified. Most were of low quality. They tested physical therapy (13 trials), incentive spirometry (eight), continuous positive airway pressure (five), and intermittent positive pressure breathing (three). The maximum follow up was six days. Four trials only had a no intervention control; none showed any significant benefit of physiotherapy. Across all trials and interventions, average values postoperatively were: incidence of atelectasis, 15-98%; incidence of pneumonia, 0-20%; partial pressure of arterial oxygen per inspired oxygen fraction, 212-329 mm Hg; vital capacity, 37-72% of preoperative values; and forced expiratory volume in one second, 34-72%. No intervention showed superiority for any end point. For the most labour intensive intervention, continuous positive airway pressure, the average cost of labour for each patient day was 27 euro (pound 19; 32 dollars). CONCLUSIONS: The usefulness of respiratory physiotherapy for the prevention of pulmonary complications after cardiac surgery remains unproved. Large randomised trials are needed with no intervention controls, clinically relevant end points, and reasonable follow up periods. (+info)
Double lumen tube location predicts tube malposition and hypoxaemia during one lung ventilation.
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BACKGROUND: Poor positioning of an endobronchial double lumen tube (DLT) could affect oxygenation during one lung ventilation (OLV). We set out to relate DLT position to hypoxaemia and DLT misplacement during OLV. METHODS: We recruited 152 ASA physical status I-II patients about to have elective thoracic surgery. The trachea was intubated with a left-sided DLT. Tube position was assessed by fibre-optic scope and correction was made after patient positioning and during OLV. If Pa(O(2)) was less than 10.7 kPa, the DLT position was checked and then PEEP, continuous positive airway pressure (CPAP), oxygen insufflation, or two lung ventilation (TLV) were tried. RESULTS: The DLT was found to be misplaced in 49 patients (32%) after patient positioning, and in 38 patients (25%) during OLV. PEEP to the dependent lung, CPAP or apneic oxygen insufflation to the non-dependent lung, or brief periods of TLV, were applied in 46 patients (30%). Patients who had DLT malposition after placing the patient in the lateral position had a greater incidence of DLT malposition during OLV (59 vs 9%) and also required each intervention more frequently (57 vs 10%). Patients with DLT malposition during OLV also required interventions more often (84 vs 12%). CONCLUSIONS: Patients who have DLT malposition after placing the patient in the lateral position had more DLT malposition during OLV and hypoxaemia during OLV. (+info)
Quantification of mitochondrial sublimons in human fibrillating atria.
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Supraventricular tachycardias, including AF (atrial fibrillation), and mtDNA (mitochondrial DNA) deletions may lead to dilated cardiomyopathy. It is unknown whether mtDNA function is impaired in the human atrium in AF. In the present study, we investigated the role of rearranged mtDNA 'sublimons' in the pathogenesis of AF. Right atrial biopsies were collected from 38 patients in AF and 35 patients with SR (sinus rhythm) undergoing elective cardiac surgery. Total DNA was extracted by standard methods. The break-point regions of the two most prevalent classes of sublimon were amplified by PCR using fluorescent oligonucleotides for the 3.75 kb partial duplication and the 2.83 kb deletion. Multiplex reactions included additional primers to amplify an internal genomic standard for semi-quantitative analysis. Reaction products were quantified as peak areas in the electrophoretogram and ratios computed of the sublimon abundance relative to the genomic standard. There was no difference in SCN (sublimon copy number) between AF and SR patients [19.09+/-28.29 compared with 10.25+/-24.68, the difference was 0.28 (95% confidence interval, -0.04 and +0.61; P =0.08)]. SCN did not increase with age ( P =0.207) and was unrelated to AF duration ( P =0.661), left atrial diameter ( P =0.560), post-operative AF ( P =0.52), underlying disease ( P =0.94), medication and gender (2.84+/-0.72 in females vs 2.97+/-0.67 in males; P =0.431). In conclusion, our findings do not indicate any role of mtDNA in the pathophysiology of AF. (+info)
The use of human fibrin glue in the surgical operations.
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Human Fibrin Glue (HFG) is made of two components contained in separate vials: a freeze dried concentrate of clotting proteins, mainly fibrinogen, Factor XIII and fibronectin (the sealant) and freeze dried thrombin (the catalyst). The first component is reconstituted with an aprotinin solution that inhibits tissue fibrinolysis. The second component (thrombin), available in 500 I.U. concentration, is dissolved with calcium chloride. It is so a set of substances involved in the hemostatic process and in the wound healing, conferring to the product the following important properties: hemostatic and sealing action, through the strengthening of the last step of the physiological coagulation; biostimulation, which favors the formation of new tissue matrix. The indications for the use of human fibrin sealant are numerous and present in all the surgical branches. A randomized controlled trial of 50 patients undergoing hernia repair according to Lichtenstein's technique under local anesthesia was performed. Patients had concurrent coagulopathies as a consequence of liver disease or long-term treatment with anticoagulants for ischemic heart disease or cardiac rhythm disturbances. Coagulopathies were defined according to the following criteria: prothrombin time < 10.5 seconds, activated partial thromboplastin time < 21 seconds, and fibrinogen < 230 mg/dL. Patients were randomized in a 1:1 ratio with (group A) or without (control group B) use of human fibrin glue: Postoperative hemorrhagic complications were significantly reduced in group A (4%) compared with group B (24%). This study showed that human fibrin glue is effective in preventing local hemorrhagic complications after inguinal hernia repair in patients with concurrent coagulation disorders. (+info)
Primary giant hydatid cyst of the diaphragm.
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We report a case of an hydatid cyst of diaphragma in a 34-year-old female who was admitted to our clinic for right basithoracic pain. Magnetic resonance imaging (MRI) reported a giant hydatid cyst including multiple vesicles at the right lower thoracic cavity. Surgical exploration revealed an independent giant diaphragmatic hydatid cyst. We performed cystotomy and more than 200 daughter vesicles were removed from the cyst. The rest of the giant cyst cavity was excised. (+info)
Pulmonary artery stenosis due to external compression by a calcified pericardial band.
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A 60-year-old male with exertional dyspnea was referred to our hospital. Right pulmonary artery stenosis due to external compression by a calcified band was diagnosed by echocardiography, computed tomography, and magnetic resonance imaging. Percutaneous transluminal angioplasty was conducted in vain due to vascular recoil and failure of stent delivery. Pulmonary bypass grafting was performed successfully. The surgery indicated a probable etiology of chronic pericarditis. This is an extremely rare case of adult pulmonary artery stenosis without a known history of congenital disease, constrictive pericarditis, tuberculosis, or surgery. (+info)