Achados oftalmológicos em pacientes que receberam transplante cardíaco

Pires, Cecília Sales; Remígio, Maria Cecília de Aguiar; Aguiar, Maria Inês Remígio de; Tenório, Deuzeny; Moraes, Carlos R.; Cavalcanti, Hellman

doi:10.1590/s0004-27492007000500008

Cited by 3 publications

(3 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lieberman et al and Portnoy et al presented cases of visible retinal emboli associated with AION and choroidal nonperfusion, as observed by fluorescein angiography, with emboli seen histopathologically in a short posterior ciliary artery supplying an infarcted optic disc 4 , 5 . PION as a post-operative complication of cardiac and spine surgery has also been reported 6 , 7 as well as juxtapapillary nerve fiber infarction and retinal nerve fiber layer loss in cardiac transplant recipients 8 , 9 …”

Section: Discussionmentioning

confidence: 99%

Bilateral central retinal/ophthalmic artery occlusion and near-complete ophthalmoplegia after bilateral lung transplant

Rady

Kini

et al. 2019

American Journal of Ophthalmology Case Reports

View full text Add to dashboard Cite

PurposeRecognize a rare yet existing risk of severe visual loss as a postoperative complication of bilateral lung transplant.ObservationsA 62-year-old male had undergone bilateral lung transplant for end-stage idiopathic pulmonary fibrosis and emphysema overlap syndrome. The operation was initially off-pump; however, during the left lung transplantation, cardiopulmonary bypass conversion was necessary to maintain intraoperative hemodynamic stability. On post-operative day 4, shortly after extubation and full recovery from sedation, the patient reported bilateral no light perception vision. There were no other associated neurologic symptoms. A computed tomographic (CT) of the head, cranial magnetic resonance (MR) scan of the head, MR angiogram of the circle of Willis and neck were negative. Neuro-ophthalmologic examination revealed no light perception vision in both eyes(OU). The pupils were non-reactive to light (amaurotic pupils). The intraocular pressure measured 18 mm Hg OU, and complete bilateral ophthalmoplegia was present. The fundus exam showed bilateral pallid optic disc edema, cherry red spots, with arteriolar attenuation, and mildly dilated and tortuous veins. Stroke work up was negative.Conclusions and importanceA case of post-operative visual loss and ophthalmoplegia carrying significant and permanent quality of life implications. It questions the role disruption of homeostasis during cardiopulmonary bypass contributes for this outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Bilateral central retinal/ophthalmic artery occlusion and near-complete ophthalmoplegia after bilateral lung transplant

Rady

Kini

et al. 2019

American Journal of Ophthalmology Case Reports

View full text Add to dashboard Cite

show abstract

“…Posterior ischaemic optic neuropathy as a perioperative complication of cardiac surgery has also been reported (Sweeney et al 1982;Moster 1998;Nuttall et al 2001;Buono & Foroozan 2005), as well as juxtrapapillary nerve fibre infarction after CABG or retinal nerve fibre layer loss in cardiac transplant recipients (Jarrell & Jones 1998;Pires et al 2007). …”

Section: Ischaemic Optic Neuropathymentioning

confidence: 98%

Vision impairment during cardiac surgery and extracorporeal circulation: current understanding and the need for further investigation

Nenekidis

Pournaras

Tsironi

et al. 2011

Acta Ophthalmologica

View full text Add to dashboard Cite

Extracorporeal circulation (ECC) constitutes a supreme tool for heart surgery allowing the surgeon to work on a secure surgical field by bypassing the cardiopulmonary system. However, pathophysiological hemodynamic changes occur from the use of the heart-lung device that regulates the venous return, cardiac output and oxygenation of blood. This condition is well described as 'surgical hypothermic controlled shock', or in cases of severe hypothermia, the term 'total arrest' is used to denote the lowest level of preservation that the body tolerates with respect to its metabolic needs. Hemodynamic Changes During ECCSignificant changes in homoeostasis occur at the very beginning of ECC as systemic vasodilatation prevails in order to maintain proper blood flow within vital organs. Additionally, the administration of heparin potentiates this vasodilatory effect. Following the establishment of hypothermia (moderate hypothermia, down to 25°C, or severe hypothermia, down to 18°C), the peripheral resistance increases because of severe vasoconstriction. During this phase, the metabolic profile changes because of the decreased metabolic demands of the organism. In general, it is believed that at a temperature of 29-30°C within approximately 130 min of ECC, the energy loss is approximately 330 KJ in a 75-to 90-kg patient (Pacifico et al. 1970 ABSTRACT. The aim of this article was to provide a comprehensive review of current knowledge regarding ocular hemodynamic alterations affecting the retinal neuroglial cells and optic nerve head (ONH) function during cardiac surgery. Literature indicates that visual loss after heart surgery is a rare but devastating complication provoked by two main causes of optic ischaemia and infarction during on-pump cardiac procedures: microembolism and ⁄ or hypoperfusion.Retinal ischaemia and ischaemic optic neuropathy are two possible major consequences of extracorporeal circulation in cardiac surgery. The hemodynamic modifications within the vascular beds of retina and ONH during cardiovascular operations have been incompletely studied. Consequently, it is of great interest to investigate the hemodynamic changes during cardiopulmonary bypass within the choroidal, retinal and optic nerve microcirculations as well as other potential causes of vaso-occlusion. Maintaining stable hemodynamic parameters during cardiovascular surgery seems to be the key to prevent visual impairment.

show abstract

“…In a study of more than 465,000 patients, the overall incidence of postsurgical central retinal artery occlusion was found to be 0.001% -0.07/10,000, but higher in patients aged > 65 years. Men were almost twice as women to build up retinal artery occlusion (8,23,24).…”

Section: Retinal Artery Occlusion: Branch and Central Retinal Artery mentioning

confidence: 99%

Ocular Complication in Cardiac Surgery

Ghavidel

Mosavi

Mohammadzadeh

2016

Multidiscip Cardio Annal

View full text Add to dashboard Cite

Visual loss after nonocular surgery is rare but devastating. Peak rates of perioperative visual loss are with heart and spine surgery. The two possible main causes of visual loss after cardiac surgery are ischemic optic neuropathy and retinal ischemia due to embolism and / or low perfusion secondary to hemodynamic changes through cardiopulmonary bypass within the retinal, optic nerve and choroidal circulation. Stable preservation of some hemodynamic factors during cardiac surgery seems to be the key to stop visual loss. The purpose of this article is to briefly review perioperative visual loss after cardiac surgery.

show abstract

Achados oftalmológicos em pacientes que receberam transplante cardíaco

Cited by 3 publications

References 4 publications

Bilateral central retinal/ophthalmic artery occlusion and near-complete ophthalmoplegia after bilateral lung transplant

Bilateral central retinal/ophthalmic artery occlusion and near-complete ophthalmoplegia after bilateral lung transplant

Vision impairment during cardiac surgery and extracorporeal circulation: current understanding and the need for further investigation

Ocular Complication in Cardiac Surgery

Contact Info

Product

Resources

About