Results of Aortic Diaphragm Surgery in Senegal: About 20 Cases
Diop Momar Sokhna,
Ba Pape Salmane,
Diagne Papa Amath,
Sow Ndeye Fatou,
Thiam Ibou,
Diatta Souleymane,
Gaye Magaye,
Leye Mohamed,
Sene Etienne Biram,
Doumbia Modibo,
Dieng Pape Adama,
Ciss Amadou Gabriel,
Ndiaye Assane,
Ndiaye Mouhamadou
Issue:
Volume 2, Issue 2, June 2018
Pages:
19-22
Received:
27 March 2018
Accepted:
14 May 2018
Published:
30 May 2018
Abstract: Introduction: The subaortic diaphragm is a semilunar or circular membrane that is inserted into both the septal wall of the left ventricle and the base or adjacent part of the ventricular surface of the large mitral valve. It represents for 8-20% of all obstacles to left ventricular ejection. Material And Methods: This is a retrospective and descriptive study of patients with aortic stenosis under aortic diaphragmatic surgery operated over an 11-year period (January 2004-December 2015). Our study included 20 patients, 13 of which were male. The sex ratio was 1.85. The average age of patients was 16.6 years [4-51 years]. Stage 2 dyspnea (NYHA) was the primary reason for consultation (17 patients). The heartbeat was regular sinus rhythm in 17 patients. Transthoracic echocardiography (TTE) found left ventricular hypertrophy in 19 patients. The average trans-aortic gradient was 55.68mmHg [24 - 92.5 mmHg]. Aortic insufficiency (IA) was found in 14 patients. An associated congenital heart defect was found in 9 patients. The approach was vertical median sternotomy and transverse aortotomy. The diaphragm was circular in 12 patients and semicircular in 8 patients. The aortic valve was tricuspid in 18 patients and bicuspid in 2 patients. The mean duration of extracorporeal circulation (ECC) was 74.66 minutes [35-119mn] and the mean duration of aortic cross-clamping was 49.11 minutes [20-102mn]. Results: After surgery, disorders of rhythm and conduction were present in 6 patients. At transthoracic ultrasound, left ventricular dysfunction was noted in 3 patients. A tamponade occurred in 1 patient justifying emergency drainage. Two recurrences of subaortic diaphragm were noted, one of which was reoperated after 9 years with a resection of the membrane and a replacement of the aortic valve by a mechanical prosthesis. One death was recorded four days postoperatively. The average postoperative gradient was 21.46mmhg. The average follow-up time was 38 months [5 months - 115 months].
Abstract: Introduction: The subaortic diaphragm is a semilunar or circular membrane that is inserted into both the septal wall of the left ventricle and the base or adjacent part of the ventricular surface of the large mitral valve. It represents for 8-20% of all obstacles to left ventricular ejection. Material And Methods: This is a retrospective and descri...
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Use of Conventional Ultrafiltration in Patients with Pulmonary Hypertensive Mitral Valve Disease Undergoing Valve Surgery
Burak Can Depboylu,
Serkan Yazman,
Bugra Harmandar
Issue:
Volume 2, Issue 2, June 2018
Pages:
23-28
Received:
24 April 2018
Accepted:
14 May 2018
Published:
12 June 2018
Abstract: Adverse effects of cardiopulmonary bypass on blood and lungs are encountered more severelyin pulmonary hypertensive patients undergoing mitral valve surgery. Aim of this study is to identify the favorable effects of conventional ultrafiltration on postoperative pulmonary functions, hemodynamics, morbidity or mortality in pulmonary hypertensive patients undergoing mitral valve surgery. 40 patients with severe pulmonary hypertension who underwent mitral valve surgery were included in study. Patients were divided into two groups according to whether conventional ultrafiltration was applied or not. Demographic data, preoperative transthoracic echocardiography, respiratory functions, complete blood count, biochemical parameters, alterations in pulmonary functions, bleeding, use of inotropic agents and blood products, intubation time, mortality, morbidity, length of intensive care unit and hospital stay, were evaluated. Intubation time (7.97±2.77 vs. 10.12±2.95; p<0.05), intensive care stay (42.20±65.99 vs. 44.25±14.13; p<0.05), hospital stay (7.20±1.13 vs. 10.12±3.27; p<0.05), bleeding (370.00±216.28 vs. 506.25±247.03; p<0.05) were significantly shorter in study group. Use of blood products (4.20±1.23 vs. 4.90±2.13; p>0.05) and inotropic agents (14 vs. 18; p>0.05) were less than the control group. Increase of pulmonary compliance, cardiac index, oxygen index, decrease of alveolar-arterial oxygen pressure difference and ventilation index were significant in both groups. Hematocrit (28.07±3.18 vs. 26.96±2.51; p>0.05) and white blood cell (13.56±2.37 vs. 13.03±2.51; p>0.05) were higher in the study. No morbidity and mortality were presentin both groups. Conventional ultrafiltration decreased the intubation time, intensive care unit stay, hospital stay, bleeding, use of blood products and inotropic agents. Favorable effects were also detected on pulmonary compliance, cardiac index, oxygen index, alveolar-arterial oxygen pressure difference and ventilation index. Studies with larger patient population, application of conventional and modified ultrafiltration together may give significant results for pulmonary functions.
Abstract: Adverse effects of cardiopulmonary bypass on blood and lungs are encountered more severelyin pulmonary hypertensive patients undergoing mitral valve surgery. Aim of this study is to identify the favorable effects of conventional ultrafiltration on postoperative pulmonary functions, hemodynamics, morbidity or mortality in pulmonary hypertensive pati...
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Benefit Absence of Therapeutic Moderate Hypothermia in the Treatment of Cardiac Arrest: A Systematic Review and Meta-Analysis
García García Miguel Ángel,
Rosero Arenas María de los Ángeles,
Pérez Lluna Leticia,
Martínez Cornejo Alfonso,
Arizo León David
Issue:
Volume 2, Issue 2, June 2018
Pages:
29-48
Received:
10 August 2018
Accepted:
30 August 2018
Published:
25 September 2018
Abstract: Background: Hyperthermia is frequent after cardiac arrest, and is associated with poor vital and neurological prognosis. In the last few years there have been published some studies that show benefits with moderate hypothermia in these patients, and other studies haven´t shown such benefits. Aim: To collect all clinical trials evaluating the utility of moderate therapeutic hypothermia in survivors of a cardiac arrest. Method: A comprehensive search of clinical trials evaluating moderate hypothermia in patients who survive a cardiac arrest was carried out. The mortality and quality of life of the survivors were evaluated. The quality of the included studies, the publication bias and the heterogeneity of the results were evaluated. Results: there is no significant reduction in mortality (RR 0.97, 95% CI 0.93-1.01) or increase in quality of life (RR 1.07, 95% CI 0.94-1.21) of the patients undergoing moderate hypothermia versus those not treated with that. There are no different results in patients with cardiac arrest with defibrillable and non – defibrillable rhythms, with the different used cooling methods, or even with the induction of intra – cardiac arrest hypothermia. The mortality of these patients is high, and there are no significant differences in relation to the age or sex of them. Conclusion: In patients who survive a cardiac arrest, the induction of moderate hypothermia is not recommended.
Abstract: Background: Hyperthermia is frequent after cardiac arrest, and is associated with poor vital and neurological prognosis. In the last few years there have been published some studies that show benefits with moderate hypothermia in these patients, and other studies haven´t shown such benefits. Aim: To collect all clinical trials evaluating the utilit...
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