Troponin I values around 2.5 ng/mL in the postoperative period should call attention to the need for more aggressive diagnostic or therapeutical measures.
Objetivo: Apresentar a experiência com a realização de revascularização do miocárdio com técnica minimamente invasiva, via minitoratocotomia anterior esquerda sem circulação extracorpórea (MIDCAB). Casuística e Métodos: 46 pacientes foram submetidos a MIDCAB de fevereiro de 1997 a janeiro de 1998. Todos eram portadores de doença obstrutiva na porção proximal do ramo interventricular anterior (RIA). A técnica consistiu em pequena incisão, de cerca de 8,0 cm, transversal, na região inframamária esquerda, obtendo-se fácil acesso para dissecção da artéria torácica interna (ATI) e posterior anastomose com o RIA. A avaliação dos resultados foi feita com controle clínico, laboratorial e angiográfico. Resultados: O tempo médio de operação foi de 2 horas, com cerca de 18 horas de internação na UTI e permanência hospitalar máxima de 5 dias. Não ocorreram óbitos intra-operatórios. Houve 1 caso de morte súbita após alta (15º PO). Os pacientes acompanhados ambulatorialmente não referiram dor anginosa. Documentou-se 4 casos de oclusão da ATI e 2 estenoses do RIA pós anastomose, provavelmente decorrentes da bandagem desse vaso durante o procedimento. Não houve correlação entre níveis de troponina-I e oclusão do enxerto. Verificou-se, porém, que os níveis de troponina I dos pacientes submetidos à MIDCAB foram significativamente menores que no procedimento convencional. Não ocorreram complicações clínicas de significância. Conclusão: A MIDCAB demonstrou ser procedimento útil e de baixa morbidade e mortalidade, com possibilidade de menor permanência hospitalar e conseqüente menor custo. Os baixos níveis sangüíneos de troponina I indicam menor sofrimento miocárdico com o procedimento. Objective: To present the experience with myocardial revascularization by Minimally Invasive Direct Coronary Artery Bypass Graft via left anterior minithoracotomy without extracorporeal circulation (MIDCAB). Material and Methods: 46 patients were submitted to MIDCAB from February 1997 to January 1998. Everyone has obstructive disease in the proximal portion of the interventricular descending artery (IDA). The technique consisted of a small transverse incision, of about 8.0 cm, traverse, in the left infra-mammary area, allowing good visibility and easy access for dissection of the thoracic internal artery (TIA) and anastomosis with IDA. The evaluation of the results was made by clinical, laboratory and angiographic control. Results: The mean duration of operation was 2 hours with about 18 hours of permanence in ICU and 5 days of maximum hospital stay. There were no intra-operative deaths. There was a case of sudden death after discharge (15º post-operative day). The patients followed did not refer anginal pain. Four cases of TIA occlusion and 2 AIA stenoses were documented, probably secondary to vessel banding during the procedure. There was no correlation between troponin-I blood levels and occlusion of the graft. It was verified that the levels of troponin-I in patients submitted to MIDCAB were significantly lower than in the conventional procedur...
IntrodutionThe transcatheter aortic valve implantation in the treatment of high-risk
symptomatic aortic stenosis has increased the number of implants every year. The
learning curve for transcatheter aortic valve implantation has improved since the
last 12 years, allowing access alternatives.ObjectiveThe aim of this study is to approach the implantation of transcatheter aortic
valve through transaortic via associated with off-pump cardiopulmonary bypass
surgery in a 67-year-old man, with chronic obstructive pulmonary disease, arterial
hypertension and kidney transplant.MethodsOff-pump coronary artery bypass surgery was performed and the valve in the aortic
position was released successfully.ResultsThere were no complications in the intraoperative and postoperative period.
Gradient reduction, effective orifice increasing of the prosthesis and absence of
valvular regurgitation after implantation were observed by transesophageal
echocardiography.ConclusionProcedural success demonstrates that implantation of transcatheter aortic valve
through the ascending aorta associated with coronary artery bypass surgery without
CPB is a new option for these patients.
RBCCV 44205-760Impacto da troponina I cardíaca sérica na evolução tardia de pacientes submetidos a ressincronização com estimulação biventricular: seguimento de até 59 meses
287LEAL, JCF ET AL -Impact of serum troponin I in the long-term evolution of patients submitted to resynchronization with biventricular stimulation: follow-up of up to 59 months
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