Ligoniai ir metodai58 ligoniai (amþiaus vidurkis 66 metai), NYHA III-IV funkcinës klasës, suskirstyti á dvi grupes. Pirmoje grupëje (19 ligoniø) taikyta pastovi retrogradinë drungno kraujo kardioplegija, antroje (39 ligoniai) -antegradinë frakcinë drungno kraujo kardioplegija.Aortos perspaudimo laikas 93 ± 5 min. Abiejø grupiø ligoniams buvo vertinamas savaiminis ðirdies veiklos atsikûrimas po aortos atleidimo, EKG normalizavimosi laikas, trukmë nuo aortos atleidimo iki dirbtinës kraujo apytakos sustabdymo, adrenomimetikø poreikis pirmà pooperacinae parà, echoskopinis kairiojo skilvelio funkcijos ávertinimas prieð operacijà ir po jos. RezultataiIðgyveno 54 ligoniai, mirë 4 (po 2 ið abiejø grupiø). Vienas ligonis mirë nuo smegenø paþeidimo, du nuo dauginio organø nepakankamumo ir vienas nuo ðirdies silpnumo. Buvo geresni visø vertinamø tyrimø antros ligoniø grupës rezultatai (1 lentelë). IðvadosTrijø ðirdies voþtuvø korekcijos operacijose miokardo apsaugai tinkama naudoti tiek pastovi retrogradinë drungno kraujo kardioplegija, tiek frakcinë antegradinë drungno kraujo kardioplegija. Kiek geresni buvo antros ligoniø grupës rezultatai. Pagrindiniai þodþiai: kardioplegija, voþtuvø korekcija
TikslasAnalizuoti rizikos veiksniai 221 ligonio, kuriam atlikta kylanèiosios aortos aneurizmos esant aortos voþtuvø nesandarumui, korekcija konduitu. Ligoniai ir metodaiDarbas atliktas Vilniaus universiteto Ðirdies chirurgijos centre. Ligoniai stebëti nuo vieno mën. iki 20 metø po operacijos. Pacientai tirti suskirstyti á ðias tris grupes pagal klinikinae eigà:• 1 grupë -ûminë sluoksniuojanèioji kylanèiosios aortos aneurizma (ÛSA) -48 (21,7%) ligoniai, vidutinë simptomø atsiradimo trukmë -0,25 ± 0,11 mën.• 2 grupë -lëtinë sluoksniuojanèioji kylanèiosios aortos aneurizma (LSA) -44 (19,9%) ligoniai, vidutinë simptomø atsiradimo trukmë -24,4 ± 5,26 mën.• 3 grupë -lëtinë nesisluoksniuojanèioji kylanèiosios aortos aneurizma (LNA) -129 (58,4%) ligoniai, vidutinë simptomø atsiradimo trukmë -44,6 ± 5,06 mën.Prieðoperacinë vidutinë funkcinë klasë (f. kl.) (NYHA) klinikinëse grupëse atitinkamai buvo: 4,5 ± 0,08; 4,0 ± 0,12 ir 3,5 ± 0,05. RezultataiIðskirta 14 (p < 0,01) reikðmingø rizikos veiksniø, turëjusiø átakos ligoniø iðgyvenimui -amþius, ligos trukmë, prieðoperacinë funkcinë klasë, skausmas uþ krûtinkaulio, ðokas, prieðoperacinis miokardo infarktas Q+, KSdd, KSH, sistolinis arterinis kraujospûdis, DKA trukmë, galvos smegenø kraujotakos nepakankamumas, kairiojo skilvelio iðmetimo frakcija, kylanèiosios aortos skersmuo. Koreliacinë analizë parodë, kad yra glaudus tiesinis prieðoperacinës f. kl. ir DKA trukmës -r = 0,374 (p = 0,01) ryðys.
Osteoporozinis stuburo lûþis po ðirdies operacijos ISSN 1392-0995, ISSN 1648-9942 (online) LIETUVOS CHIRURGIJA Lithuanian Surgery 2007, 5(3), p. 435-437 ÁvadasOsteoporozë yra labai daþna vyresnio amþiaus þmoniø liga, taèiau tik nedidelë dalis pomenopauzinio amþiaus moterø ir vyresnio amþiaus þmoniø gauna tiesiogiai osteoporoziniø lûþiø rizikà maþinantá gydymà. Kaulø mineralinio tankio matavimas leidþia diagnozuoti ir pradëti gydyti osteoporozae dar prieð atsirandant klinikiniams padariniams (kaulø lûþiams) [1].Apraðome atvejá, kai slanksteliø osteoporozë buvo diagnozuota vëlai. Pooperacinis laikotarpis komplikavosi stuburo smegenø paþeidimo klinika, kuri sukëlë ávairiø komplikacijø, ir ligonë mirë. Osteoporozinis stuburo slanksteliø lûþis po ðirdies operacijos Vertebral bone breaks after heart surgery Kaestutis Ðalèius, Gintaras Turkevièius, Vytë Valerija Maneikienë Vilniaus universiteto ligoninës Santariðkiø klinikø Ðirdies chirurgijos centras, Santariðkiø g. 2, LT-08661 VilniusOsteoporozinis stuburo slanksteliø lûþis, ávykaes po ðirdies operacijos, yra kazuistinis atvejis. Apraðome torokalinës stuburo dalies spontaniná lûþimà, kurio padarinys -stuburo smegenø paþeidimas 61 metø ligonei po ðirdies operacijos. Pagrindiniai þodþiai: voþtuvø protezavimas, osteoporozëOsteoporotic vertebral break after heart surgery is a very rare complication. We report a case of 61-year-old woman who was diagnosed with later spontaneous backbone break after heart surgery.
Aim of the study. To investigate preoperative status and results of surgery of patients with confirmed diagnosis of aortic root infection. Materials and methods. We have analyzed data of 21 patients who were operated on at the Heart Surgery Center, Vilnius University, since January 1, 1997, till December 31, 2006. All these patients underwent surgery because of aortic root infection. The patients were aged 25–72 years (mean age, 53±14 years). There were 17 (80.9%) male patients. Sixteen patients (76%) preoperatively were in NYHA class IV. The abscesses of aortic root were confirmed preoperatively by means of esophageal echocardiography in 18 patients (86%). Blood cultures positive for Staphylococcus aureus were found in four patients (19.9%). All the patients underwent replacement of the aortic valve by mechanic prosthesis; one of these patients was reoperated because of persistent sepsis, and replacement of the aortic root with homograft was performed. The duration of follow-up of the patients was 1 to 10 years. Results. Inhospital mortality rate was 14.3%. The causes of death included sustained heart failure and sepsis. All these patients were in NYHA functional class IV preoperatively; one of these patients had culture positive for Staphylococcus aureus. Inhospital survival was 85.7%, one-year postoperative survival – 80.9%, and both five-year and ten-year survivals were 76.0%. The long-term survival was negatively influenced by recurrent infective endocarditis, heart failure, and age. Death occurred in 1 patient (11.1%) of the 9 patients who at the time of surgery were younger than 50 years and 4 patients (33.3%) of the 12 who were older than 50 years at the time of operation. Conclusions. The infection of aortic root is not common pathology; however, it is a complicated disease. Esophageal echocardiography is an informative method while diagnosing aortic root abscesses. The inhospital mortality is increased by the heart failure persisting after the operation and sepsis. The long-term survival is decreased by preoperative infective endocarditis of the prosthesis and heart failure. The mortality rate of patients older than 50 years is 3-fold higher than mortality rate of younger ones.
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