Kateter yoluyla aort kapağı yerleştirilmesi sırasında hemodinamik bozukluk ve ST-segment yükselmesi gelişen bir olgu (original) (raw)
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Morbimortalidade em pacientes acima de 75 anos submetidos à cirurgia por estenose valvar aórtica
Arquivos Brasileiros de Cardiologia, 2010
Background: The greater longevity observed today has caused an increase in the number of elderly who need surgery. Aortic stenosis is a common condition in this age group. Objective: To evaluate morbidity and mortality in people aged 75 years or older who have undergone valvuloplasty or valve replacement surgery for aortic stenosis alone or associated with other injuries. Methods: We studied 230 consecutive cases between Jan/2002-Dec/2007. Patients were 79.5 ± 3.7 years (75-94), and 53.9% were men. In the sample, 68.7% had hypertension, 17.9% had atrial fibrillation, 15.9% were obese, and 14.4% had undergone previous heart surgery. At surgery, 87.4% underwent aortic stent placement, and 12.6% underwent aortic valvuloplasty. Results: The mortality rate was 13.9% (9.4% with isolated aortic stenosis versus 20.9% with an associated procedure, p = 0.023) and the morbidity rate was 30.0% (25.2% with aortic stenosis alone versus 37.4% with an associated procedure, p = 0.068). The most common complications were: low cardiac output (20.2%), renal dysfunction (9.7%), and prolonged ventilatory support (7.9%). In the bivariate analysis, the main predictors of mortality were low cardiac output (RR 10.
Cukurova Medical Journal, 2020
Öz Purpose: The aim of this study was to determine the difference between patients undergoing coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) (with new generation drug-eluting stents) who had diabetes mellitus during the course of an acute coronary syndrome (ACS). Materials and Methods: We carried out a retrospective evaluation of 405 diabetic patients admitted with an ACS during the period of 2 years in a single-center. Patients were followed for 5 years. All clinical incidents, such as death, cardiac death, myocardial infarction, stroke, revascularization, and stent thrombosis were recorded Results: We examined 405 patients with diabetes out of 1643 patients with ACS. Of these, 183 (45.1%) were included in the PCI group and 222 (54.8%) were in the CABG group. During 5-years follow-up, primary endpoints including death, MI, and stroke were observed in 31 patients (16.9%) in the PCI group and in 33 patients (14.9%) in the CABG group. There was no difference between the two groups in terms of primary endpoints. All-cause mortality during 5-years was observed in 17 patients (9.8%) in the PCI, 20 (9.1%) in the CABG group. Conclusion: There was no difference in all-cause mortality between the PCI and the CABG groups during 5-year follow-up. Repeated revascularization and myocardial infarction were higher in the PCI group and the stroke rates were higher in the CABG group. Amaç: Bu çalışmanın amacı diyabetik olgularda akut koroner sendrom (AKS) sırasında koroner arter baypas greft (KABG) ve Perkütan koroner girişim (PKG) (yeni nesil ilaç salınımlı stentlerle) uygulanmasının sonuçları arasındakifarkı belirlemekti. Gereç ve Yöntem: Tek merkezde 2 yıllık dönemde AKS ile başvuran 405 diyabetik hastayı retrospektif olarak değerlendirdik. Hastalar 5 yıl boyunca takip edildi. Tüm nedenlerle ilişkili ölüm, kardiyak ölüm, miyokard enfarktüsü, inme, revaskülarizasyon ve stent trombozu gibi tüm klinik olaylar buna göre kaydedildi. Bulgular: AKS'li 1643 hastanın 405'i diyabetli hastayı inceledik. Bunlardan 183'ü (% 45.1) PKG grubuna, 222'si (% 54.8) KABG grubuna dahil edildi. 5 yıllık takip sırasında, PKG grubunda 31 hastada (% 16.9) ve KABG grubunda 33 hastada (% 14.9) ölüm, MI ve inme gibi primer son noktalar gözlendi. İki grup arasında primer sonlanım noktaları arasında fark yoktu. 5 yıl boyunca tüm neden mortalite PKGI grubunda 17 hastada (% 9.8), KABG grubunda 20 hastada (% 9.1) gözlendi. Sonuç: 5 yıllık takip sırasında PKG ve KABG grupları arasında tüm nedenlere bağlı mortalite açısından fark yoktu. Tekrarlanan revaskülarizasyon ve miyokard enfarktüsü, PKG grubunda KABG grubuna göre daha yüksekti. Buna karşılık inme oranları KABG grubunda daha yüksekti.
Coronary Artery Occlusion; the Night Mare Post AVR
American Journal of Cardiovascular and Thoracic Surgery
Iatrogenic intra operative acute coronary artery obstruction is a rare and potentially fatal complication of valve surgery [1]. Sudden coronary spasm, embolization of calcium plaque, and surgical factors can induce acute coronary obstruction after AVR [2]. Initially described in 1967, following aortic valve surgery, it is now recognized that patients who develop myocardial ischemia postoperatively following valve surgery, should be investigated deeply to exclude this rare phenomenon as the cause of myocardial dysfunction [3]. Although most reports highlight the potential for coronary artery stenosis in the months following valve surgery there are few documented cases of intraoperative coronary embolism causing circulatory collapse and requiring prompt treatment [5]. After Ethical Committee approval and after written consent taken from the patient family for publication, we present a case of acute intra operative left main coronary artery obstruction after Aortic Valve Replacement (A...
Perfil clínico e evolução tardia de pacientes com trombose de stent não-farmacológico
Revista Brasileira de Cardiologia Invasiva, 2012
Background: Stent thrombosis is the sudden occlusion of a stented coronary artery due to thrombus formation. Our objective was to identify variables associated to definite stent thrombosis (ST) and assess the outcomes of patients treated with bare-metal stents. Methods: Consecutive patients treated between December 2007 and August 2012 were analyzed. Those with ST were compared to those without ST as to clinical and angiographic characteristics, and early and late outcomes. results: Of a total of 6,495 percutaneous coronary interventions (PCIs), 36 cases of ST (0.55%) were observed, of which 18 were early (50%), 14 (38.9%) late and 4 (11.1%) very late ST. Patients with ST were younger, with a greater prevalence of chronic renal failure and acute coronary syndromes. ST was more frequent in bifurcation lesions (11% vs. 4%; P = 0.03) or lesions with visible thrombus at angiography (55.5% vs. 2.8%; P < 0.01). All patients were submitted to emergency PCI, and in the inhospital phase, myocardial infarction (MI) and death were observed in 33.3% and 16.6%, respectively. Mean followup was 30.2 + 16.3 months and early discontinuation of dual antiplatelet therapy was observed in 6 of the 36 cases (16.7%). In the late follow-up target vessel revascularization was observed in 33.3%, MI in 20% and no additional deaths were observed. Conclusions: ST proved to be an event with high in-hospital mortality and late morbidity. The occurrence of this event was associated to more complex clinical and