MRSA infection was an independent risk factor for PSM-related in-hospital mortality. NPWT may improve the prognosis for patients with MRSA mediastinitis.
SummaryThe goal of this prospective study was to examine the effects of landiolol hydrochloride on prevention of atrial fibrillation and on hemodynamics in the acute postoperative phase after heart valve surgery. The subjects were 60 patients who underwent valve surgery at our hospital from April 2008 to July 2010. The patients were randomly divided into two groups: the landiolol group (30 patients) and the control (no landiolol) group (30 patients). In the landiolol group, continuous intravenous landiolol was initiated immediately on admission to the intensive care unit at a dose of 10 μg/kg/ minute. Occurrence of atrial fibrillation was compared between the groups over an observation period of 72 hours after surgery. Atrial fibrillation occurred in 6 patients (20%) in the landiolol group and 16 (53.3%) in the control group during the observation period. Landiolol hydrochloride significantly reduced the occurrence of atrial fibrillation in the acute postoperative phase after heart valve surgery. Heart rate was significantly decreased by landiolol, but aggravation of hemodynamics was not observed. These results suggest that landiolol is a useful drug for prevention of atrial fibrillation after valve surgery. (Int Heart J 2012; 53: 359-363) Key words: Heart valve disease, Ultra-short acting β -blocker A trial fibrillation or flutter (Af) is frequently observed during the perioperative period of cardiac surgery, with a reported incidence of 17% to 65%. 1,2) Postoperative Af may aggravate hemodynamics and cause embolic diseases, including cerebral infarction, and therefore prevention of this condition is an important issue in postoperative management. Various drugs have been developed for Af, including β -blockers that are useful for treatment of arrhythmia by decreasing heart strain through an antihypertensive effect. However, excessive inhibition of myocardial contraction and the strength of the antihypertensive effect are of concern in administration of a β -blocker after cardiac surgery.Landiolol hydrochloride (Ono Pharmaceutical Co., Ltd., Osaka, Japan) is highly selective for the β 1 receptor 3) and exerts a lower antihypertensive effect compared with its effect in decreasing heart rate. 4) Thus, landiolol has less impact on hemodynamics in the acute phase after cardiac surgery, compared to conventional β -blockers. Furthermore, since landiolol has a very short serum half-life of approximately 4 minutes, 4) it is easy to adjust the blood concentration without decreasing blood pressure or cardiac output. Recently, the utility of landiolol has been reported for prevention of Af after coronary artery bypass grafting (CABG).5-8) However, to our knowledge, the efficacy of landiolol for prevention of Af after heart valve surgery has not been examined. Therefore, in this study, we examined the effect of landiolol on Af and hemodynamics after heart valve surgery.
Methods
Patients and protocol:The study was performed in 60 patients who underwent valve replacement or valvuloplasty at our hospital from April 2008 to ...
Adventitial cystic disease is a rare non-atherosclerotic vascular disease. We report a 36-year-old man with right intermittent claudication by adventitial cystic disease. computed tomography (CT) and magnetic resonance imaging (MRI) revealed an ovoid cystic mass compressing the right popliteal artery and causing severe stenosis of the lumen. Percutaneous aspiration was performed, which improved his symptoms. However, he complained of identical intermittent claudication two weeks later. Radiographic findings revealed that the cystic lesion had progressed rapidly. The cystic lesion was resected and the affected arterial segment was interposed. We consider that conventional surgical intervention remains the favored treatment option in the management of adventitial cystic disease.
There were no significant differences in long-term outcomes between the RA and SVG groups. Predictors of graft occlusion differed between the groups. Notably, renal dysfunction impaired radial patency, emphasizing the importance of careful graft selection.
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