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Alteration of endothelium-derived hyperpolarizing factor due to hypoxia-reoxygenation: implications in cardiac surgery.January 2005 (has links)
Dong Yingying. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 99-125). / Abstracts in English and Chinese. / Declaration --- p.i / Acknowledgement --- p.ii / Publication list --- p.iii / Abstract (English) --- p.ix / Abstract (Chinese) --- p.xii / Abbreviations --- p.xiv / List of figures / tables --- p.xvi / Chapter Chapter 1. --- General Introduction / Chapter 1.1 --- The role of endothelium in regulating vascular tone --- p.1 / Chapter 1.1.1 --- Nitric oxide (NO) --- p.2 / Chapter 1.1.2 --- Endothelium-derived hyperpolarizing factor (EDHF) --- p.7 / Chapter 1.1.3 --- Prostacyclin (PGI2) --- p.20 / Chapter 1.2 --- EDHF-mediated endothelial function in coronary circulation --- p.22 / Chapter 1.2.1 --- Role of EDHF in coronary microarteries --- p.23 / Chapter 1.2.2 --- Role of EDHF in cardiac veins --- p.24 / Chapter 1.3 --- Effect of ischemia-reperfusion on endothelial function in coronary circulation --- p.25 / Chapter 1.3.1 --- Ischemia-reperfusion injury --- p.26 / Chapter 1.3.2 --- Effect of ischemia-reperfusion on endothelial function in coronary microarteries --- p.28 / Chapter 1.3.3 --- Effect of ischemia-reperfusion on endothelial function in cardiac veins --- p.29 / Chapter 1.4 --- Alteration of endothelial function during cardiac surgery / Chapter 1.4.1 --- Cardioplegia and organ preservation solutions --- p.31 / Chapter 1.4.2 --- Combined effects of hypoxia-reoxygenation and ST solution on endothelial function in coronary microarteries/cardiac veins --- p.34 / Chapter 1.4.3 --- Effect of nicorandil on endothelial function --- p.34 / Chapter Chapter 2. --- Materials and Methods --- p.37 / Chapter 2.1 --- Isometric force study in micro arteries/veins --- p.37 / Chapter 2.1.1 --- Preparation of vessels --- p.37 / Chapter 2.1.1.1 --- Preparation of porcine coronary microarteries --- p.37 / Chapter 2.1.1.2 --- Preparation of porcine cardiac veins --- p.37 / Chapter 2.1.2 --- Technique of setting up --- p.39 / Chapter 2.1.2.1 --- Mounting of microvessels --- p.39 / Chapter 2.1.2.2 --- Normalization procedure for microvessels --- p.39 / Chapter 2.1.3 --- EDHF-mediated vasorelaxation --- p.40 / Chapter 2.1.3.1 --- Precontraction and stimuli of EDHF --- p.40 / Chapter 2.1.3.2. --- “Truéحresponse of EDHF --- p.40 / Chapter 2.1.4 --- Data acquisition and analysis --- p.41 / Chapter 2.2 --- Hypoxia and reoxygenation --- p.41 / Chapter 2.2.1 --- Calibration of 02-special electrode --- p.41 / Chapter 2.2.2 --- Measurement of --- p.02 / Chapter 2.3 --- Statistical analysis --- p.42 / Chapter 2.4 --- Chemicals --- p.43 / Chapter Chapter 3. --- Hypoxia-Reoxygenation in Coronary Microarteries: Combined Effect with St Thomas Cardioplegia and Temperature on the Endothelium- derived Hyperpolarizing Factor and Protective Effect of Nicorandil --- p.44 / Chapter 3.1 --- Abstract --- p.44 / Chapter 3.2 --- Introduction --- p.45 / Chapter 3.3 --- Experimental design and analysis --- p.47 / Chapter 3.3.1 --- Vessel Preparation --- p.47 / Chapter 3.3.2 --- Normalization --- p.48 / Chapter 3.3.3 --- Hypoxia --- p.48 / Chapter 3.3.4 --- Effect of H-R on EDHF-mediated relaxation in coronary microarteries --- p.49 / Chapter 3.3.5 --- Combined effects ofH-R and ST solution on EDHF-mediated relaxation in coronary microarteries --- p.49 / Chapter 3.3.6 --- Effect of addition of nicorandil Krebs or ST solution under H-R on EDHF-mediated relaxation in coronary microarteries --- p.49 / Chapter 3.3.7 --- Data analysis --- p.50 / Chapter 3.4 --- Results --- p.51 / Chapter 3.4.1 --- Resting force --- p.51 / Chapter 3.4.2 --- U46619-induced contraction force --- p.51 / Chapter 3.4.3 --- Partial pressure of oxygen in hypoxia --- p.51 / Chapter 3.4.4 --- EDHF-mediated relaxation in coronary microarteries --- p.51 / Chapter 3.4.4.1 --- Effect of H-R --- p.51 / Chapter 3.4.4.2 --- Combined effects ofH-R and ST solution on EDHF-mediated relaxation --- p.52 / Chapter 3.4.4.3 --- Effects of addition of nicorandil to Krebs or ST solution under H-R on EDHF-mediated relaxation --- p.52 / Chapter 3.5 --- Discussion --- p.53 / Chapter 3.5.1 --- EDHF-mediated relaxation after exposure to H-R --- p.53 / Chapter 3.5.2 --- EDHF-mediated relaxation after H-R in ST solution at different temperature --- p.54 / Chapter 3.5.3 --- Effect of addition of nicorandil to Krebs or ST solution during H-R on EDHF-mediated relaxation --- p.55 / Chapter 3.5.4 --- Clinical implications --- p.56 / Chapter Chapter 4. --- Hypoxia-Reoxygenation in Cardiac Microveins: Combined Effect with Cardioplegia and Temperature on the Endothelial Function --- p.68 / Chapter 4.1 --- Abstract --- p.68 / Chapter 4.2 --- Introduction --- p.69 / Chapter 4.3 --- Experimental design and analysis --- p.73 / Chapter 4.3.1 --- Vessel Preparation --- p.73 / Chapter 4.3.2 --- Normalization --- p.73 / Chapter 4.3.3 --- Hypoxia --- p.73 / Chapter 4.3.4 --- Effect of H-R on EDHF-mediated relaxation in cardiac micro veins --- p.74 / Chapter 4.3.5 --- Combined effects of H-R and ST solution on EDHF-mediated relaxation in cardiac microveins --- p.74 / Chapter 4.3.6 --- Data analysis --- p.75 / Chapter 4.4 --- Results --- p.75 / Chapter 4.4.1 --- Resting force --- p.75 / Chapter 4.4.2 --- U46619-induced contraction force --- p.76 / Chapter 4.4.3 --- Partial pressure of oxygen in hypoxia --- p.76 / Chapter 4.4.4 --- EDHF-mediated relaxation after H-R in Krebs solution at 37°C --- p.76 / Chapter 4.4.5 --- EDHF-mediated relaxation after exposure to H-R in ST solution at different temperatures --- p.77 / Chapter 4.5 --- Discussion --- p.78 / Chapter 4.5.1 --- Effect of H-R on EDHF-mediated relaxation --- p.78 / Chapter 4.5.2 --- Combined effects of H-R with ST solution on EDHF-mediated relaxation --- p.80 / Chapter 4.5.3 --- Clinical implications / Chapter Chapter 5. --- General Discussion --- p.89 / Chapter 5.1 --- EDHF-mediated endothelial function in porcine coronary circulation --- p.89 / Chapter 5.1.1 --- EDHF in porcine coronary microarteries --- p.92 / Chapter 5.1.2 --- EDHF in porcine cardiac veins --- p.90 / Chapter 5.2 --- Alteration of EDHF-mediated function after exposure to H-R --- p.91 / Chapter 5.2.1 --- In coronary microarteries --- p.91 / Chapter 5.2.2 --- In cardiac veins --- p.92 / Chapter 5.3 --- Alteration of EDHF-mediated function after exposure to ST solution under H-R --- p.92 / Chapter 5.3.1 --- In coronary microarteries --- p.93 / Chapter 5.3.2 --- In cardiac veins --- p.93 / Chapter 5.4 --- EDHF-mediated function in nicorandil-supplemented ST solution under H-R in coronary microarteries --- p.93 / Chapter 5.5 --- Clinical implications / Chapter 5.5.1 --- H-R injury --- p.94 / Chapter 5.5.2 --- H-R injury and cardioplegic solution --- p.95 / Chapter 5.5.2 --- Nicorandil-supplementation in cardioplegic solution --- p.95 / Chapter 5.6 --- Limitation of the study --- p.96 / Chapter 5.7 --- Future investigations --- p.96 / Chapter 5.8 --- Conclusions --- p.97 / References --- p.99
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Tratamento endovascular de pacientes com doenças da aorta torácica: avaliação de resultados em longo prazo.Brandi, Antonio Carlos 20 May 2015 (has links)
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Previous issue date: 2015-05-20 / Introduction: Thoracic aortic diseases, including dissections, aneurysms, pseudoaneurysms among other, are serious conditions that bring serious risks of morbidity and mortality. Its incidence is low, but has been growing gradually due to the increase in life expectancy of the population, that in most cases, is associated with hypertension, smoking and diabetes mellitus. Advances in diagnostic techniques have also contributed to the identification of an increasing number of cases. The development of minimally invasive endovascular procedures has been used successfully in the treatment of these diseases, including patients with no indication for conventional surgical treatment. Objective: Evaluate the long-term results of endovascular treatment of patients with diseases of the thoracic aorta underwent implantation of self-expandable stent-grafts. Methods: This prospective study evaluated 112 patients who underwent percutaneous implantation of endoprosthesis of the thoracic aorta, from October 1998 to August 2013. Self-expandable endoprosthesis stent-graft Braile Biomédica ®, made of stainless steel and nitinol were employed. The occurrence of intraoperative and postoperative primary success, endoleaks, mortality, late evolution of the endoprosthesis and survival were evaluated in long term follow-up. Results: The mean time of the procedures was 72.66 ± 43.36 minutes (range 30-240 minutes). A total of 150 self-expandable stents were implanted in 112 patients, 61 (40.66%) of stainless steel and 89 (59.33%) of nitinol. The diameter and length of the stents of stainless steel and nitinol ranged from 24-45 mm (median 33) and 70-130 mm (median 90) 22-46 mm (median 35) and between 40 and 230 mm (median 110) respectively. The number of stents implanted per patient ranged from 1 to 4 (median 1). Primary success was observed in 100 (82.14%) of 112 patients treated. Immediate mortality occurred in seven (6.25%) patients, five (4.46%) from cardiovascular causes and two (1.78%) for non-cardiovascular causes. Late mortality occurred in 31 (27.68%) patients, 10 (8.93%) from cardiovascular causes, 12 (10.71%) for non-cardiovascular causes, two (1.78%) from natural causes-seven (6.25%) with no diagnosis. There hospital type I endoleaks occurred in four patients (3.57%), type II in five (4.46%) and three type IV (2.68%). Late endoleaks type I occurred in five (4.46%) patients and type IV in three (2.68%). Twenty-two patients (19.64%) had clinical complications in the immediate postoperative period, including nine (8.03%) pulmonary complications, four (3.57%) neurological abnormalities, three (2.67%) acute renal failure, two (1.78%) infections in the surgical incision, two (1.78%) with progression to post-implantation syndrome and one (0.89%) with laceration of the arterial access. Follow-up time ranged from 1 to 179 months (median 46). The acturial survival curve was 79,3% (IC95% 67,0-91,7) at 132 months free of death from cardiovascular causes. The logistic regression analysis showed that renal failure was the only risk factor that showed a statistically significant difference. Conclusions: The low levels of intra and postoperative complications demonstrate that the treatment is safe and effective. The high rate of survival after 132 months of follow-up for these critically ill patients show the benefits of endovascular technique to treatment of thoracic aorta diseases. / Introdução: Doenças da aorta torácica, incluindo as dissecções, aneurismas, pseudoaneurismas entre outras, são condições graves que trazem sérios riscos de morbimortalidade. Sua incidência é baixa, porém, vem crescendo gradativamente em virtude do aumento da expectativa de vida da população que, na maioria dos casos, está associada à hipertensão arterial, tabagismo e diabetes. Os avanços nas técnicas diagnósticas também têm contribuído para a identificação de um número cada vez maior de casos. O desenvolvimento de procedimentos endovasculares minimamente invasivos vem sendo utilizado com sucesso no tratamento destas doenças, inclusive em pacientes sem indicação para tratamento cirúrgico convencional. Objetivo: Avaliar os resultados em longo prazo do tratamento endovascular de pacientes portadores de doenças da aorta torácica submetidos ao implante de endopróteses autoexpansíveis stent-grafts. Casuística e Métodos: Estudo prospectivo que avaliou 112 pacientes submetidos ao implante percutâneo de endoprótese na aorta torácica, no período de outubro de 1998 a agosto de 2013. Foram empregadas endopróteses autoexpansíveis stent-grafts da Braile Biomédica®, confeccionadas em aço inox e nitinol. Foram avaliadas a ocorrência de complicações intra e pós-operatórias, sucesso primário, endoleak, mortalidade, evolução tardia da endoprótese e a sobrevivência em seguimento de longo prazo. Resultados. O tempo médio dos procedimentos foi de 72,66±43,36 minutos (variação 30-240 minutos). Foram implantadas um total de 150 endopróteses autoexpansíveis em 112 pacientes, sendo 61 (40,66%) de aço inox e 89 (59,33%) de nitinol. O diâmetro e comprimento dos stents de aço inox e de nitinol variaram de 24-45 mm (mediana 33) e 70-130 mm (mediana 90), 22-46 mm (mediana 35) e 40 a 230 mm (mediana 110), respectivamente. O número de endopróteses implantadas por paciente variou de 1 a 4 (mediana 1). Sucesso primário foi observado em 100 (82,14%) dos 112 pacientes tratados. A mortalidade hospitalar ocorreu em sete (6,25%) pacientes, cinco (4,46%) por causas cardiovasculares e dois (1,78%) por causas não cardiovasculares. A mortalidade tardia ocorreu em 31 (27,68%) pacientes, 10 (8,93%) por causas cardiovasculares, 12 (10,71%) por causas não cardiovasculares, dois (1,78%) por causas naturais e sete (6,25%) sem diagnóstico. No período hospitalar, ocorreu endoleak do tipo I em quatro pacientes (3,57%), tipo II em cinco (4,46%) e tipo IV em três (2,68%). Endoleak tardio do tipo I ocorreu em cinco (4,46%) pacientes e do tipo IV em três (2,68%). Vinte e dois pacientes (19,64%) apresentaram complicações clínicas no pós-operatório imediato, incluindo nove (8,03%) complicações pulmonares, quatro (3,57%) alterações neurológicas, três (2,67%) pacientes com insuficiência renal aguda, duas (1,78%) incisões cirúrgicas com infecção, duas (1,78%) síndromes pós-implante e uma (0,89%) laceração do acesso arterial. O tempo de seguimento variou de 1 a 179 meses (mediana 46). A curva atuarial de sobrevivência foi de 79,3% (IC95% 67,0-91,7) aos 132 meses livre de mortalidade por causas cardiovasculares. A análise de regressão logística mostrou que a insuficiência renal foi o único fator de risco para mortalidade que apresentou diferença estatisticamente significante. Conclusões. Os baixos índices de complicações intra e pós-operatórias demonstram que o tratamento é seguro e eficaz. O alto índice de sobrevivência após 132 meses de seguimento para estes pacientes graves mostram os benefícios da técnica endovascular no tratamento das doenças da aorta torácica.
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Cirurgia da fibrilação atrial crônica com ultrassom em pacientes com lesão valvar mitral.Brick, Alexandre Visconti 06 May 2016 (has links)
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Previous issue date: 2016-05-06 / Introduction: Atrial fibrillation (AF) is the most common arrhythmia with high
morbidity and mortality rates. The use of catheter ablation for treatment of AF
has stimulated the use of energy sources such as ultrasound (US) in surgery to
cause injuries in endocardial way, epicardial way or both, replacing the section
and suture of the atrial wall. The presence of previous heart disease, most often
injury of the mitral valve in patients with chronic atrial fibrillation (CAF) justifies
the surgical treatment of this arrhythmia concomitant to the valve surgery.
Objective: To evaluate surgical treatment of CAF with US in patients with mitral
valve disease, considering: 1- Preoperative clinical characteristics of patients
undergoing surgical treatment of CAF and 2- Follow up of patients in the
immediate postoperative period, in hospital and later high up to 60 months.
Patients and Method: We retrospectively and consecutively studied 100
patients with CAF and mitral valve disease who underwent surgical treatment
using US ablation, aged between 18 and 70 years (43.56 ± 4,94 anos), 63
(63%) were female and 37 (37%) were male. Patient data were reviewed
prospectively by consulting the control reports, including demographic variables
(gender and age) and heart [signs and symptoms, underlying disease,
functional class, hospital stay, surgical procedure time, ablation time,
intraoperative and postoperative (immediately discharged and later up to 60
months)]. It was used the actuarial curve (Kaplan-Meier) for the study of
permanence without recurrence after 12, 24, 36, 48 and 60 months in patients with CAF. Results: From the patients studied, 86% had rheumatic mitral valve
disease, 14% degeneration of the mitral valve, 40% were patients with mitral
regurgitation, 19% of mitral lesion, 36% of mitral stenosis and 5% of mitral
restenosis. The main symptoms included palpitations related to tachycardia by
CAF (70%), congestive heart failure (70%), previous episodes of acute
pulmonary edema (27%), stroke by thromboembolism accident (13%) and
peripheral embolism (7%). The functional class of patients was III/IV. The early
results showed that 94% of patients undergoing ablation US reversed the rate
of CAF, being 86% in sinus rhythm and 8% in atrioventricular block, which was
transient. At hospital discharge was observed maintenance of sinus rhythm in
86% of patients and recurrence of CAF in 8%. At follow-up after 60 months
83.8% of patients maintained the sinus rhythm. Conclusions: Patients with
rheumatic mitral valve disease often have failure and mitral stenosis,
palpitations related to tachycardia by CAF and congestive heart failure. Surgical
treatment of CAF with US concomitant to the mitral valve surgery is feasible and
satisfactory, with maintenance of sinus rhythm in most patients (83.8%) after 60
months of follow-up. / Introdução: A fibrilação atrial (FA) é a mais frequente arritmia com taxa
elevada de morbimortalidade. A utilização de ablação por cateter para
tratamento de FA estimulou o uso de fontes de energia como ultrassom (US)
em procedimento cirúrgico para provocar lesões por vias endocárdica,
epicárdica ou ambas, em substituição à secção e sutura da parede atrial. A
presença de cardiopatia prévia, na maioria das vezes, lesão da valva mitral, em
pacientes com fibrilação atrial crônica (FAC), justifica o tratamento cirúrgico
dessa arritmia concomitante à cirurgia valvar. Objetivo: Avaliar tratamento
cirúrgico da FAC com US em pacientes com lesão valvar mitral, considerandose:
1- caracterização clínica pré-operatória de pacientes submetidos a
tratamento cirúrgico da fibrilação atrial crônica e, 2- acompanhamento de
pacientes no pós-operatório imediato, na alta hospitalar e tardio até 60 meses.
Casuística e Método: Foram estudados retrospectivamente e de forma
consecutiva 100 pacientes portadores de FAC e lesão valvar mitral submetidos
a tratamento cirúrgico por meio de ablação com US, com idade entre 18 e 70
anos (43,56 ± 4,94 anos), sendo 63 (63%) do sexo feminino e 37 (37%) do
masculino. Dados dos pacientes foram revisados prospectivamente por meio
de consulta a fichas de controle, incluindo variáveis demográficas (sexo e
idade) e cardíacas [sinais e sintomas, doença de base, classe funcional, tempo
de permanência hospitalar, tempo de procedimento cirúrgico, tempo de
ablação, complicações intra e pós-operatórias (imediato, alta hospitalar e tardio
até 60 meses)]. Foi utilizada a curva atuarial (Kaplan-Meier) para estudo da permanência sem recidiva após 12, 24, 36, 48 e até 60 meses em pacientes
com FAC. Resultados: Dos pacientes estudados, 86% tinham doença mitral
reumática, 14% degeneração da valva mitral, 40% eram portadores de
insuficiência mitral, 19% de dupla lesão mitral, 36% de estenose mitral e 5% de
reestenose mitral. Os principais sintomas incluíram palpitações relacionadas à
taquicardia pela FAC (70%), insuficiência cardíaca congestiva (70%), episódio
prévio de edema agudo de pulmão (27%), acidente vascular encefálico por
tromboembolismo (13%) e embolia periférica (7%). A classe funcional dos
pacientes foi III/IV. Os resultados imediatos mostraram que 94% dos pacientes
submetidos à ablação com US reverteram o ritmo de FAC, sendo 86% em ritmo
sinusal e 8% em bloqueio atrioventricular, que foi transitório. Na alta hospitalar
observou-se manutenção do ritmo sinusal em 86 pacientes e recidiva da FAC
em 8. No acompanhamento, após 60 meses, 83,8% dos pacientes mantinham
o ritmo sinusal. Conclusões: Pacientes com doença mitral reumática
apresentam frequentemente insuficiência e estenose mitral, palpitações
relacionadas à taquicardia pela fibrilação atrial crônica e insuficiência cardíaca
congestiva. O tratamento cirúrgico da FAC com US concomitante a cirurgia
valvar mitral é factível e satisfatório, com manutenção do ritmo sinusal na
maioria dos pacientes (83,8%), após 60 meses de seguimento.
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Avaliação da função respiratória antes e depois da cirurgia cardíaca com circulação extracopórea em pacientes anestésiados, entubados e curarizados: estudo da mecânica respiratória com um novo método baseado em fluxo inspiratório. Estudo da ventilação e da oxigenação pulmonar / aluation of respiratory function before and after cardiac surgery with extracorporeal circulation in anesthetized, intubated and curarized patients. Study of respiratory mechanics with a new method based on constant inspiratory flow. Study of lung ventilation and oxygenationJose Otavio Costa Auler Junior 05 December 1986 (has links)
O presente trabalho teve por finalidade estudar as alterações do sistema circulatório provocadas pela cirurgia cardíaca sob circulação extracorpórea, 12 pacientes adultos, anestesiados e curarizados, selecionados aleatoriamente, sendo 6 deles valvopatas e 6 coronariopatas. As alterações respiratórias foram verificadas por medidas da mecânica respiratória e da ventilação-oxigenação pulmonar. Do ponto de vista mecânico, o sistema respiratório foi analisado como um todo e individualizando os seus componentes - pulmões e parede torácica, tanto do ponto de vista elástico como também fluxo-resistivo. A análise das propriedades resistivas do sistema respiratório foi feita através de um método que se utiliza da insuflação pulmonar com fluxo constante, seguida de uma oclusão súbita das vias aéreas. Esta análise permite que tanto para o sistema respiratório como também para os pulmões e parede torácica, obtenha-se o valor resistivo máximo (Rmax) bem como o valor mínimo da resistência (Rmin) ao lado das resistências geradas pelas desigualdades do sistema (Ru). Este estudo foi feito graças a estimativa das diferentes respostas de frequência de cada um destes componentes. As medidas de ventilação-oxigenação foram aferidas pelo cálculo do \"shunt\" pulmonar (Qs/Q) e gradiente alvéolo-arterial de oxigenio P(A-a)O2. Tanto as medidas mecânicas como as de ventilação-oxigenação foram feitas na vigência de uma fração inspirada de O2 de 100% e realizadas de 15 a 30 minutos após a entubação traqueal, sendo repetidas logo após o fechamento do tórax. [...] / The aim of this work was to study the respiratory alterations caused by cardiac surgery under cardiopulmonary bypass in 12 randomly selected anesthetized paralyzed adult patients; 6 with acquired valvar disease and 6 with ischmic cardiopathy. Respiratory alterations were assessed by respiratory mechanics and lung ventilation-oxygenation measurements. Respiratory mechanics analyzed the respiratory system as a whole and partitioned into its components: lung and chest wall, measuring both the elastic and resistive properties were measured using a constant inflation flow followed bu a sudden occlusion. This analysis provides the maximum resistance value (Rmax), the minimum resistance value (Rmin), and the resistance caused by the uneven distribution of mechanical properties within the system (Ru), for respiratory system, lung and chest wall. This analysis is based on the frequency dependence differences of each component of respiratory system. The ventilation-oxygenation evaluation was done by the calculation of pulmonary shunt and the alveolar arterial oxygen gradient (P (A-a)O2). Both mechanical and ventilation-oxygenation measurement were done with a oxygen inspired fraction of 1 and performed 15 to 30 minutes after tracheal intubation and repeated just after thorax closure. [...]
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DIFERENÇA DA MORTALIDADE ENTRE OS SEXOS APÓS CIRURGIA DE REVASCULARIZAÇÃO DO MIOCARDIO / DIFFERENCE OF THE MORTALITY BETWEEN THE SEXES AFTER CABG SURGERYCoutinho, Léa Barroso 20 April 2012 (has links)
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Previous issue date: 2012-04-20 / Objective: To compare the mortality of men and women undergoing coronary artery bypass surgery (CABG) alone and identifying factors related differences occasionally found.
Methods: Retrospective cohort study conducted with 215 patients who underwent coronary bypass surgery consecutively from January 2007 to December 2008.
Results: Women had a higher average age. Low body surface and dyslipidemia was more prevalent in women (1.65 vs. 1.85, p <0.001: 53% vs 30%, p = 0.001), whereas smoking history and previous myocardial infarction were more prevalent among men (35 % vs 14.7% p = 0.001, 20% vs 2.7%, p = 0.007). Regarding the complications in the postoperative period, there was a higher rate of transfusions in women. The overall mortality rate was 5.6%, however there was no statistically significant difference in mortality between men and women. It was observed that among patients who died the mean body surface was lower than that of patients who progressed without this complication. Conclusion: There was no difference in mortality between the sexes after CABG in our department. / Objetivo: Comparar a morbimortalidade de homens e mulheres submetidos à cirurgia de revascularização isolada e identificando fatores relacionados as diferenças eventualmente encontradas.
Métodos: Estudo de Coorte retrospectivo realizado com 215 pacientes, submetidos a cirurgia de revascularização miocárdica isolada, consecutivamente, de janeiro de 2007 a dezembro de 2008.
Resultados: As mulheres apresentaram idade media mais elevada. Baixa superfície corpórea e dislipidemia foram mais prevalentes nas mulheres (1,65 vs 1,85, p<0,001: 53% vs 30%, p=0,001), enquanto história de tabagismo e infarto do miocárdio prévio foram mais prevalentes nos homens (35% vs 14,7%p=0,001; 20% vs 2,7%, p=0,007). Em relação às complicações no pós-operatório, houve maior taxa de transfusão de hemoderivados nas mulheres. A taxa de mortalidade geral foi de 5,6%, no entanto não houve diferença estatisticamente significante na mortalidade entre homens e mulheres. Foi observado que entre os pacientes que evoluíram para óbito a media da superfície corpórea era menor que a dos pacientes que evoluíram sem essa complicação.
Conclusão: Não houve diferença de mortalidade entre os sexos após revascularização miocárdica neste serviço.
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Avaliação da função respiratória antes e depois da cirurgia cardíaca com circulação extracopórea em pacientes anestésiados, entubados e curarizados: estudo da mecânica respiratória com um novo método baseado em fluxo inspiratório. Estudo da ventilação e da oxigenação pulmonar / aluation of respiratory function before and after cardiac surgery with extracorporeal circulation in anesthetized, intubated and curarized patients. Study of respiratory mechanics with a new method based on constant inspiratory flow. Study of lung ventilation and oxygenationAuler Junior, Jose Otavio Costa 05 December 1986 (has links)
O presente trabalho teve por finalidade estudar as alterações do sistema circulatório provocadas pela cirurgia cardíaca sob circulação extracorpórea, 12 pacientes adultos, anestesiados e curarizados, selecionados aleatoriamente, sendo 6 deles valvopatas e 6 coronariopatas. As alterações respiratórias foram verificadas por medidas da mecânica respiratória e da ventilação-oxigenação pulmonar. Do ponto de vista mecânico, o sistema respiratório foi analisado como um todo e individualizando os seus componentes - pulmões e parede torácica, tanto do ponto de vista elástico como também fluxo-resistivo. A análise das propriedades resistivas do sistema respiratório foi feita através de um método que se utiliza da insuflação pulmonar com fluxo constante, seguida de uma oclusão súbita das vias aéreas. Esta análise permite que tanto para o sistema respiratório como também para os pulmões e parede torácica, obtenha-se o valor resistivo máximo (Rmax) bem como o valor mínimo da resistência (Rmin) ao lado das resistências geradas pelas desigualdades do sistema (Ru). Este estudo foi feito graças a estimativa das diferentes respostas de frequência de cada um destes componentes. As medidas de ventilação-oxigenação foram aferidas pelo cálculo do \"shunt\" pulmonar (Qs/Q) e gradiente alvéolo-arterial de oxigenio P(A-a)O2. Tanto as medidas mecânicas como as de ventilação-oxigenação foram feitas na vigência de uma fração inspirada de O2 de 100% e realizadas de 15 a 30 minutos após a entubação traqueal, sendo repetidas logo após o fechamento do tórax. [...] / The aim of this work was to study the respiratory alterations caused by cardiac surgery under cardiopulmonary bypass in 12 randomly selected anesthetized paralyzed adult patients; 6 with acquired valvar disease and 6 with ischmic cardiopathy. Respiratory alterations were assessed by respiratory mechanics and lung ventilation-oxygenation measurements. Respiratory mechanics analyzed the respiratory system as a whole and partitioned into its components: lung and chest wall, measuring both the elastic and resistive properties were measured using a constant inflation flow followed bu a sudden occlusion. This analysis provides the maximum resistance value (Rmax), the minimum resistance value (Rmin), and the resistance caused by the uneven distribution of mechanical properties within the system (Ru), for respiratory system, lung and chest wall. This analysis is based on the frequency dependence differences of each component of respiratory system. The ventilation-oxygenation evaluation was done by the calculation of pulmonary shunt and the alveolar arterial oxygen gradient (P (A-a)O2). Both mechanical and ventilation-oxygenation measurement were done with a oxygen inspired fraction of 1 and performed 15 to 30 minutes after tracheal intubation and repeated just after thorax closure. [...]
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Effects of Deep Breathing Exercises after Coronary Artery Bypass SurgeryWesterdahl, Elisabeth January 2004 (has links)
<p>Deep breathing exercises are widely used in the postoperative care to prevent or reduce pulmonary complications, but no scientific evidence for the efficacy has been found after coronary artery bypass grafting (CABG) surgery. </p><p>The aim of the thesis was to describe postoperative pulmonary function and to evaluate the efficacy of deep breathing exercises performed with or without a blow bottle device for positive expiratory pressure (PEP) 10 cmH<sub>2</sub>O or an inspiratory resistance-positive expiratory pressure (IR-PEP) mask with an inspiratory pressure of -5 cmH<sub>2</sub>O and an expiratory pressure of +10 to +15 cmH<sub>2</sub>O. </p><p>Patients undergoing CABG were instructed to perform 30 slow deep breaths hourly during daytime for the first four postoperative days. Patient management was similar in the groups, except for the different breathing techniques. </p><p>Measurements were performed preoperatively, on the fourth postoperative day and four months after surgery. The immediate effect of the deep breathing exercises was examined on the second postoperative day. Pulmonary function was assessed by spirometry, diffusion capacity for carbon monoxide and arterial blood gases. Atelectasis was determined by chest roentgenograms or spiral computed tomography (CT). </p><p>Lung volumes were markedly reduced on the fourth postoperative day. Four months after surgery the pulmonary function was still significantly reduced. On the second and fourth postoperative day all patients had atelectasis visible on CT. A single session of deep breathing exercises performed with or without a mechanical device caused a significant reduction in atelectasis and an improvement in oxygenation. No major differences between deep breathing performed with or without a blow bottle or IR-PEP-device were found, except for a lesser decrease in total lung capacity in the blow bottle group on the fourth postoperative day. Patients who performed deep breathing exercises after CABG had significantly smaller atelectasis and better pulmonary function on the fourth postoperative day compared to a control group who performed no exercises.</p>
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Effects of Deep Breathing Exercises after Coronary Artery Bypass SurgeryWesterdahl, Elisabeth January 2004 (has links)
Deep breathing exercises are widely used in the postoperative care to prevent or reduce pulmonary complications, but no scientific evidence for the efficacy has been found after coronary artery bypass grafting (CABG) surgery. The aim of the thesis was to describe postoperative pulmonary function and to evaluate the efficacy of deep breathing exercises performed with or without a blow bottle device for positive expiratory pressure (PEP) 10 cmH2O or an inspiratory resistance-positive expiratory pressure (IR-PEP) mask with an inspiratory pressure of -5 cmH2O and an expiratory pressure of +10 to +15 cmH2O. Patients undergoing CABG were instructed to perform 30 slow deep breaths hourly during daytime for the first four postoperative days. Patient management was similar in the groups, except for the different breathing techniques. Measurements were performed preoperatively, on the fourth postoperative day and four months after surgery. The immediate effect of the deep breathing exercises was examined on the second postoperative day. Pulmonary function was assessed by spirometry, diffusion capacity for carbon monoxide and arterial blood gases. Atelectasis was determined by chest roentgenograms or spiral computed tomography (CT). Lung volumes were markedly reduced on the fourth postoperative day. Four months after surgery the pulmonary function was still significantly reduced. On the second and fourth postoperative day all patients had atelectasis visible on CT. A single session of deep breathing exercises performed with or without a mechanical device caused a significant reduction in atelectasis and an improvement in oxygenation. No major differences between deep breathing performed with or without a blow bottle or IR-PEP-device were found, except for a lesser decrease in total lung capacity in the blow bottle group on the fourth postoperative day. Patients who performed deep breathing exercises after CABG had significantly smaller atelectasis and better pulmonary function on the fourth postoperative day compared to a control group who performed no exercises.
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The Immune Response to One-Lung Ventilation : Clinical and Experimental StudiesSchilling, Thomas January 2009 (has links)
One-lung ventilation (OLV) as an established procedure during thoracic surgery may be injurious in terms of increased mechanical stress characterised by alveolar cell stretch and overdistension, increased cyclic tidal recruitment of alveolar units, compression of alveolar vessels and increased pulmonary vascular resistance. This may result in ventilation-induced lung injury with pro-inflammatory cytokine production, leukocyte recruitment and neutrophil-dependent tissue destruction. Despite the consequences of delivering the whole tidal volume (VT) to only a single lung, relatively high VT are used during OLV to maintain arterial oxygenation and carbon dioxide elimination. However, this may increase mechanical stress in the dependent lung and may aggravate alveolar injury. There is a lack of data on the alveolar immune consequences of OLV. Therefore, the present studies investigate the epithelial damage and pro-inflammatory response induced by mechanical ventilation and OLV. OLV induced pulmonary injury, but alveolar damage in the ventilated lung decreased by reduction of the tidal volume in patients scheduled for thoracic surgery (study I). The use of the volatile anaesthetic desflurane in OLV patients attenuated the OLV-induced alveolar immune response (study II). Furthermore, an experimental model of thoracic surgery was established to investigate the systemic and pulmonary consequences of OLV and thoracic surgery in comparison with the effects of conventional two-lung ventilation and spontaneous breathing. The experimental data indicate that beside the pulmonary immune response volatile anaesthetics have also modulated the plasma concentrations of cytokines during and after OLV (study III). In contrast, OLV and thoracic surgery increased the expression of pro-inflammatory mRNA in BAL cells and lung tissue samples. General anaesthesia did not affect this response (study 4). The results of the present studies indicate that OLV and thoracic surgery may be injurious to the lung tissue to a similar degree. The recruitment and activation of alveolar granulocytes characterise the alveolar damage. The administration of different anaesthetics modulates the activation of alveolar cells, specified by decreased inflammatory mediator release in subjects that receive desflurane anaesthesia, which does not affect the expression of cytokine mRNA in alveolar cells and lung tissue samples.
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Vaizdo torakoskopija urgentineje torakalineje chirugijoje: galimybes ir rezultatai / Video-assisted thoracoscopy in urgent thoracic surgery: possibilities and resultsSamiatina, Diana 04 October 2005 (has links)
1. INTRODUCTION
Spontaneous pneumothorax is one of the most common types of aeropathic syndrome, caused by chronic obstructive pulmonary diseases, tuberculosis and complicated lung cancer.
Nearly two hundred years have passed since the first description of the first cases of pneumothorax. Although during this period the scientist´s view of the etiology, pathogenesis, diagnostics and treatment methods has changed, a number of issues related to the diagnostics and treatment of this complication of pulmonary diseases remain unsolved.
The aim of the treatment of spontaneous pneumothorax is to remove the cause of this condition, to perform the decompression of the pleural cavity, to induce the obliteration of the pleural cavity and to prevent the recurrence of the disease.
Pleural puncture and drainage of the pleural cavity are not sufficiently effective – the incidence of incomplete lung expansion and rapid recurrence of the disease (relapse) reaches 25% [Mova VA, 1999]. Urgent thoracotomy is performed in cases when the drainage of the pleural cavity fails to reduce the symptoms of the aeropathic syndrome and breathing and blood circulation insufficiency caused by the spontaneous pneumothorax. Frequently thoracotomy is performed after pleural drainage in cases of exudative pleuritis or starting pleural empyema. The postoperative period is marked by a large number of complications and prolongation of hospital stay, and post-operative mortality in the group of geriatric... [to full text]
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