Anomalous left coronary artery originating from the pulmonary artery (ALCAPA) is an infrequent congenital anomaly. Presentation of this syndrome is rare in adults. Nevertheless, adult patients are at risk of ischaemia, arrhythmias or sudden cardiac death and always require surgical intervention. At our institution, a specific technique of interposition of the right internal iliac artery as a free-graft for left coronary artery reimplantation was used in adult ALCAPA patients. The aim of this report is to determine long-term results and experiences with this surgical technique.
- MeSH
- anomálie koronárních cév * diagnostické zobrazování chirurgie MeSH
- anomální odstup levé koronární tepny * MeSH
- arteria iliaca diagnostické zobrazování chirurgie MeSH
- arteria pulmonalis diagnostické zobrazování chirurgie abnormality MeSH
- dospělí MeSH
- lidé MeSH
- replantace MeSH
- syndrom Bland-White-Garland * chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- dlouhodobá péče MeSH
- kardiologie přístrojové vybavení MeSH
- lidé MeSH
- podpůrné srdeční systémy * klasifikace normy MeSH
- pooperační komplikace MeSH
- srdeční selhání * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
Pseudoaneurysma hrudní aorty je raritní diagnóza asociovaná s vysokou mortalitou. Prezentujeme případ pacienta, u kterého vznikla velká falešná výduť deset let po provedení Bentallovy operace a jednonásobného aortokoronárního bypassu. Zároveň s daným nálezem se u něho prokázala covid-19 pozitivita. Po zaléčení pneumonie byla úspěšně provedena operace, a to sešitím dvou defektů v aortálním konduitu. Jedná se o unikátní případ, kdy pacient přežil dva život ohrožující stavy.
Pseudoaneurysm of the thoracic aorta is a rare condition associated with high mortality. We present a case of a patient who developed a huge pseudoaneurysm 10 years after the Bentall procedure and one aortocoronary bypass while simultaneously being COVID-19 positive. After treating pneumonia, the surgery was successfully performed with suturing two defects in the aortic conduit. It is a unique case report where the patient survived two life-threatening conditions.
- MeSH
- aorta thoracica diagnostické zobrazování patologie MeSH
- COVID-19 * komplikace MeSH
- dospělí MeSH
- kardiochirurgické výkony metody škodlivé účinky MeSH
- lidé MeSH
- nepravé aneurysma * chirurgie diagnostické zobrazování etiologie komplikace MeSH
- revaskularizace myokardu škodlivé účinky MeSH
- výsledek terapie MeSH
- vzácné nemoci chirurgie diagnostické zobrazování komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
IMPORTANCE: Left ventricular assist devices (LVADs) enhance quality and duration of life in advanced heart failure. The burden of nonsurgical bleeding events is a leading morbidity. Aspirin as an antiplatelet agent is mandated along with vitamin K antagonists (VKAs) with continuous-flow LVADs without conclusive evidence of efficacy and safety. OBJECTIVE: To determine whether excluding aspirin as part of the antithrombotic regimen with a fully magnetically levitated LVAD is safe and decreases bleeding. DESIGN, SETTING, AND PARTICIPANTS: This international, randomized, double-blind, placebo-controlled study of aspirin (100 mg/d) vs placebo with VKA therapy in patients with advanced heart failure with an LVAD was conducted across 51 centers with expertise in treating patients with advanced heart failure across 9 countries. The randomized population included 628 patients with advanced heart failure implanted with a fully magnetically levitated LVAD (314 in the placebo group and 314 in the aspirin group), of whom 296 patients in the placebo group and 293 in the aspirin group were in the primary analysis population, which informed the primary end point analysis. The study enrolled patients from July 2020 to September 2022; median follow-up was 14 months. INTERVENTION: Patients were randomized in a 1:1 ratio to receive aspirin (100 mg/d) or placebo in addition to an antithrombotic regimen. MAIN OUTCOMES AND MEASURES: The composite primary end point, assessed for noninferiority (-10% margin) of placebo, was survival free of a major nonsurgical (>14 days after implant) hemocompatibility-related adverse events (including stroke, pump thrombosis, major bleeding, or arterial peripheral thromboembolism) at 12 months. The principal secondary end point was nonsurgical bleeding events. RESULTS: Of the 589 analyzed patients, 77% were men; one-third were Black and 61% were White. More patients were alive and free of hemocompatibility events at 12 months in the placebo group (74%) vs those taking aspirin (68%). Noninferiority of placebo was demonstrated (absolute between-group difference, 6.0% improvement in event-free survival with placebo [lower 1-sided 97.5% CI, -1.6%]; P < .001). Aspirin avoidance was associated with reduced nonsurgical bleeding events (relative risk, 0.66 [95% confidence limit, 0.51-0.85]; P = .002) with no increase in stroke or other thromboembolic events, a finding consistent among diverse subgroups of patient characteristics. CONCLUSIONS AND RELEVANCE: In patients with advanced heart failure treated with a fully magnetically levitated LVAD, avoidance of aspirin as part of an antithrombotic regimen, which includes VKA, is not inferior to a regimen containing aspirin, does not increase thromboembolism risk, and is associated with a reduction in bleeding events. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04069156.
- MeSH
- Aspirin škodlivé účinky MeSH
- cévní mozková příhoda * etiologie prevence a kontrola farmakoterapie MeSH
- dvojitá slepá metoda MeSH
- fibrinolytika škodlivé účinky MeSH
- inhibitory agregace trombocytů škodlivé účinky MeSH
- krvácení etiologie MeSH
- lidé MeSH
- podpůrné srdeční systémy * škodlivé účinky MeSH
- srdeční selhání * patofyziologie MeSH
- tromboembolie * etiologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- komentáře MeSH
- práce podpořená grantem MeSH
The Aeson total artificial heart (A-TAH) has been developed for patients at risk of death from biventricular failure. We aimed to assess the inflammatory status in nine subjects implanted with the A-TAH in kinetics over one year. Laboratory assessment of leukocyte counts, inflammatory cytokines assay, and peripheral blood mononuclear cell collection before and after A-TAH implantation. Leukocyte counts were not significantly modulated according to time after A-TAH implantation (coefficient of the linear mixed effect model with 95% CI, -0.05 (-0.71 to -0.61); p = 0.44). We explored inflammatory cytokine after A-TAH and did not observe, at any time, a modified profile compared to pre-implantation values (all p -values > 0.05). Finally, we compared the distribution of circulating immune cell subpopulations identified based on sequential expression patterns for multiple clusters of differentiation. None of the population explored had significant modulation during the 12-month follow-up (all p -values > 0.05). In conclusion, using a cytokine multiplex assay combined with a flow cytometry approach, we demonstrated the absence of inflammatory signals in peripheral blood over a period of 12 months following A-TAH implantation.
(1) Background: C1q TNF-related protein 3 (CTRP3) is an adipokine with anti-inflammatory and cardioprotective properties. In our study, we explored changes in serum CTRP3 and its gene expression in epicardial (EAT) and subcutaneous (SAT) adipose tissue in patients with and without coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) undergoing elective cardiac surgery. (2) Methods: SAT, EAT, and blood samples were collected at the start and end of surgery from 34 patients: (i) 11 without CAD or T2DM, (ii) 14 with CAD and without T2DM, and (iii) 9 with both CAD and T2DM. mRNA levels of CTRP3 were assessed by quantitative reverse transcription PCR. Circulating levels of CTRP3 and other factors were measured using ELISA and Luminex Multiplex commercial kits. (3) Results: Baseline plasma levels of TNF-α and IL6 did not differ among the groups and increased at the end of surgery. Baseline circulating levels of CTRP3 did not differ among the groups and decreased after surgery. In contrast, baseline CTRP3 mRNA levels in EAT were significantly decreased in CAD/T2DM group, while no differences were found for TNF-α and IL6 gene expression. (4) Conclusions: Our data suggest that decreased EAT mRNA levels of CTRP3 could contribute to higher risk of atherosclerosis in patients with CAD and T2DM.
- MeSH
- diabetes mellitus 2. typu * komplikace genetika chirurgie MeSH
- interleukin-6 metabolismus MeSH
- kardiochirurgické výkony * MeSH
- lidé MeSH
- messenger RNA metabolismus MeSH
- nemoci koronárních tepen * komplikace genetika chirurgie MeSH
- perikard metabolismus MeSH
- TNF-alfa genetika metabolismus MeSH
- tuková tkáň metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- antikoagulancia škodlivé účinky MeSH
- bioprotézy * škodlivé účinky MeSH
- chirurgická náhrada chlopně * MeSH
- hemokoagulace MeSH
- heparin nízkomolekulární škodlivé účinky MeSH
- heparin MeSH
- lidé MeSH
- umělé srdce * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- hemodynamické monitorování klasifikace metody přístrojové vybavení MeSH
- kardiostimulátor MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- software MeSH
- telemedicína metody přístrojové vybavení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
