Maria Elaine Floriano - Academia.edu (original) (raw)
Uploads
Papers by Maria Elaine Floriano
Interactive CardioVascular and Thoracic Surgery, 2010
Objective: The patient with a diagnosis of heparin-induced thrombocytopenia and thrombosis who re... more Objective: The patient with a diagnosis of heparin-induced thrombocytopenia and thrombosis who requires urgent cardiac surgery represents a formidable challenge. Among the alternatives to heparin, argatroban has gained widespread use in non-cardiac surgery patients. The object of this communication is to report our recent experience with this agent during cardiopulmonary bypass (CPB) and to review the cases previously published in order to better define indications, dosage, monitoring and limitations in cardiac surgery patients. Methods: A case of mitral valve replacement where argatroban was used for anticoagulation during CPB is described. The literature on the subject is reviewed and the relationship between argatroban dosage and activated clotting time (ACT) is studied by regression analysis. Results: Clotting of the oxygenator requiring prompt replacement occurred after release of cross-clamp. Upon termination of the drug, ACT remained elevated beyond the expected half-life. A significative (P-0.05) relationship was disclosed between increasing dosage and ACT, while the same relationship was absent on decreasing dosage. Conclusions: Because of unresolved issues like the possibility of clotting in the extracorporeal circuit and prolonged anticoagulation after discontinuing the drug, at present, the use of argatroban as a substitute of heparin during CPB should be restricted to those cases where the other thrombin inhibitors are contraindicated.
Interactive CardioVascular and Thoracic Surgery, 2010
Objective: Thoracic endovascular aortic repair (TEVAR) is particularly indicated in a patient wit... more Objective: Thoracic endovascular aortic repair (TEVAR) is particularly indicated in a patient with complicated type B dissection. The object of this communication is to report a case of deployment of the endograft in the false lumen, to propose a protocol in order to prevent it and discuss the possible surgical options when this complication has occurred. Methods: A case of complicated acute type B dissection is described where the endovascular prosthesis was positioned in the false lumen. The literature on the subject is briefly reviewed for the insertion techniques and conversion to surgery. Results: The occurrence was recognized and treated with replacement of the entire aorta from the sinotubular junction to a level of the eighth thoracic vertebra under deep circulatory arrest with selective antegrade cerebral perfusion. Conclusions: TEVAR for complicated type B dissection should be carried out according to a precise and stepwise protocol in institutions familiar with all the different options of conversion to open repair.
Interactive CardioVascular and Thoracic Surgery, 2010
Objective: The patient with a diagnosis of heparin-induced thrombocytopenia and thrombosis who re... more Objective: The patient with a diagnosis of heparin-induced thrombocytopenia and thrombosis who requires urgent cardiac surgery represents a formidable challenge. Among the alternatives to heparin, argatroban has gained widespread use in non-cardiac surgery patients. The object of this communication is to report our recent experience with this agent during cardiopulmonary bypass (CPB) and to review the cases previously published in order to better define indications, dosage, monitoring and limitations in cardiac surgery patients. Methods: A case of mitral valve replacement where argatroban was used for anticoagulation during CPB is described. The literature on the subject is reviewed and the relationship between argatroban dosage and activated clotting time (ACT) is studied by regression analysis. Results: Clotting of the oxygenator requiring prompt replacement occurred after release of cross-clamp. Upon termination of the drug, ACT remained elevated beyond the expected half-life. A significative (P-0.05) relationship was disclosed between increasing dosage and ACT, while the same relationship was absent on decreasing dosage. Conclusions: Because of unresolved issues like the possibility of clotting in the extracorporeal circuit and prolonged anticoagulation after discontinuing the drug, at present, the use of argatroban as a substitute of heparin during CPB should be restricted to those cases where the other thrombin inhibitors are contraindicated.
Interactive CardioVascular and Thoracic Surgery, 2010
Objective: Thoracic endovascular aortic repair (TEVAR) is particularly indicated in a patient wit... more Objective: Thoracic endovascular aortic repair (TEVAR) is particularly indicated in a patient with complicated type B dissection. The object of this communication is to report a case of deployment of the endograft in the false lumen, to propose a protocol in order to prevent it and discuss the possible surgical options when this complication has occurred. Methods: A case of complicated acute type B dissection is described where the endovascular prosthesis was positioned in the false lumen. The literature on the subject is briefly reviewed for the insertion techniques and conversion to surgery. Results: The occurrence was recognized and treated with replacement of the entire aorta from the sinotubular junction to a level of the eighth thoracic vertebra under deep circulatory arrest with selective antegrade cerebral perfusion. Conclusions: TEVAR for complicated type B dissection should be carried out according to a precise and stepwise protocol in institutions familiar with all the different options of conversion to open repair.