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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have described previously the acute sternal devascularization produced by mobilization of one or both internal mammary arteries (IMAs). The present experiments were conducted to examine the time course of sternal revascularization and infection patterns after IMA use. Twenty-four 8-week-old domestic pigs were obtained from a herd in which active Streptococcus faecalis had been detected in recent litters. After control blood flow procedures (microspheres) were completed, each pig underwent a median sternotomy; one or both IMAs were mobilized as a pedicle, and the sternotomy was repaired. Repeat blood flow determinations were made in half the pigs at 1 week and in the remainder after 2 weeks. The pigs were killed, the wound was examined, cultures were taken as indicated, and tissue was harvested for blood flow analysis. Despite the retention of an intact IMA on the contralateral side, persistent, significant sternal ischemia existed 2 weeks after repair. However, when both IMAs were used, the extent of devascularization was exaggerated, and revascularization was impaired further. Revascularization of intercostal muscle occurred more rapidly and was essentially returned to normal 2 weeks after sternotomy and IMA harvest. Active mediastinitis with erosion of the sternum was found in one (17%) of six pigs at 1 week and in four (67%) of six pigs at 2 weeks when the IMAs had been rotated bilaterally. No wound infections were detected in the single IMA resection group. These data suggest that bilateral IMA mobilization may delay an already slow revascularization process and predispose to infectious complications.
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PMID:Internal mammary artery use. Sternal revascularization and experimental infection patterns. 193 21

Between December 1975 and February 1984 five patients with Transposition of the great arteries and large ventricular septal defect underwent repair by arterial switching with reimplantation of the coronary arteries. They ranged in age from 2 to 28 months and weighted between 3.2 and 10 kg. The oldest patient had underwent banding of the pulmonary artery together with a Blalock-Hanlon septectomy at 6 months of age. Direct reconstruction of the "new" pulmonary artery was achieved in 4 patients. The first of these patients operated upon on December 1975 died of acute left ventricular ischemia due to compression of the main left coronary artery caused by the newly reconstructed pulmonary artery. This death appears to be technically avoidable by using the method recently reported by Lecompte. One patient who was in good hemodynamic status died of mediastinitis 2 months after the repair. At necropsy the repair was found intact and the woven dacron conduit used to reestablish the continuity to pulmonary artery was found grossly infected. The remaining three patients continue to be asymptomatic 48, 40 and two months respectively after repair. Our small experience supports the anatomic correction as the procedure of choice for the surgical treatment of most of the patients with Transposition of the great arteries and large ventricular septal defect.
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PMID:[Anatomical correction of transposition of the great arteries associated with a large interventricular defect]. 400 70

Between 1987 and 1998, 22 patients underwent emergency coronary artery bypass grafting for the treatment of acute coronary syndrome. Overall hospital mortality was 22.7% (5/22) versus 1.8% (9/501) in patients operated on electively (p < 0.01). There were no hospital deaths in the unstable angina group. Three patients (37.5%) in the myocardial infarction group and two patients (40%) in the failed catheter intervention group died due to postoperative low cardiac output syndrome (LOS) or mediastinitis. As a complication of mechanical supports, lower extremity ischemia was a risk factor for mortality. Postoperatively six patients (27.3%) had LOS. Univariate analyses showed that age greater than 70 years, old myocardial infarction, poor ejection fraction, preoperative shock, and left main trunk or three vessel disease were significantly associated with increased LOS. To improve the surgical results, it is considered that improvement of intraoperative myocardial protection, effective combination with catheter interventional therapy and careful use of mechanical supports are needed for these compromised patients.
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PMID:[Emergency coronary artery bypass grafting for acute coronary syndrome]. 1044 60

The emergence of heart transplantation as the ultimate treatment for end-stage heart failure has been accompanied by new diagnostic challenges. Computed tomography (CT) has emerged as an important diagnostic tool in the evaluation of heart transplant recipients because many infectious, ischemic-hemorrhagic, and neoplastic complications are amenable to early detection with this modality. In the early postoperative period, CT is mostly indicated in the evaluation of infectious complications or cerebral symptoms. Later, CT is mostly performed for staging of infectious or neoplastic disease. Infectious complications include mediastinitis, soft-tissue inflammation, abscess formation, cerebral infarction, and aspergillosis. Complications related to ischemia or hemorrhage include allograft rejection and coronary allograft vasculopathy, the latter being the leading long-term cause of death in heart transplant recipients. CT is also indicated in malignant disease (eg, lymphoma, visceral carcinoma, skin tumors), which is the second most important long-term cause of death. Moreover, CT is helpful in identifying disease caused by immunosuppressive therapy (eg, leukoencephalopathy, osteoporosis, thoracic lipomatosis). CT has proved superior to both ultrasound and magnetic resonance imaging in the evaluation of heart transplant recipients. It has become the diagnostic modality of choice for many transplant-related complications and may help improve postoperative treatment of affected patients.
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PMID:CT of heart transplant recipients: spectrum of disease. 1111 18

We have experienced a case which developed mesenteric ischemia followed by necrosis of the rectus abdominal muscle after off pump coronary artery bypass grafting (OPCAB). A 62-year-old man with a history of long-term hemodialysis was diagnosed with left main trunk disease. He underwent triple OPCAB uneventfully. No inotropic agents were needed perioperatively. He underwent normal hemodialysis on the first postoperative day, and then complained of severe abdominal pain with progressive metabolic acidosis. A 170 cm length of the ileocecal segment fell into necrosis and was excised and an ileostomy was constructed in an emergency setting. He developed another abdominal pain 6 days after the second operation. An additional surgery confirmed necrosis of the right rectus abdominal muscle complicated with a significant infection. He developed mediastinitis and died of multi-system organ failure 37 days after OPCAB. The mechanism of this serious complication is discussed.
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PMID:Fatal ischemia of bowel and rectus abdominal muscle after off pump coronary artery bypass grafting in a dialysis patient. 1514 11

Esophageal necrosis with perforation secondary to traumatic aortic transection is extremely rare but usually fatal. A 47-year-old man complained of sudden swallowing difficulty 6 days after blunt trauma. Computed tomography showed a ruptured aorta and the midesophagus shifted to the right side with luminal obliteration because of the ruptured aorta. After primary repair of the partially transected aorta, unexpected mediastinitis because of esophageal perforation was noted. Upper endoscopy showed midesophageal ulceration, necrosis, and perforation. Biopsy samples were consistent with ischemia. The possibility of direct esophageal trauma or intraoperative esophageal injury was ruled out. Esophageal exclusion with thoracoscopic decortication and multiple antibiotics were ineffective, and the patient eventually died. Ischemic esophageal necrosis caused by mechanical compression can occur in a traumatic aortic transection. Dysphagia, when present with radiologic signs, indicates a displaced and compressed esophagus. In spite of aggressive surgical and medical treatment for a perforated esophagus, the prognosis remains poor.
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PMID:Ischemic esophageal necrosis secondary to traumatic aortic transection. 1556 Oct 68

Recently cardiac transplantation has an important place in treatment of end-stage cardiac failure. In Turkey between 2003 and 2005 at 10 centers 64 cardiac transplantations were performed including five at our facility. Herein we have presented our results. All patients were men of mean age 34.2 +/- 10.7 (17 to 44) years. Upon preoperative echocardiography their mean ejection fraction was 18% +/- 3.27% (17% to 23%). Pulmonary vascular resistance was 4.47 wood unit in one patient and in one case, there was Rh incompatibility between donor and recipient. We used HTK solution for protection of donor hearts. Mean ischemia time was 251.2 +/- 62.7 minutes (155 to 314). Mean aortic clamping time was 84 +/- 4.7 minutes (80 to 90). In all patients we performed a biatrial anastomosis technique. Hemofiltration was used to prevent hemodilution during operation. In the postoperative period four patients had acute renal dysfunction; one, a minor cerebrovascular accident; two, reoperated because of bleeding; one, cholestasis; one, temporary atrio-ventricular block; and one, mediastinitis. Mean follow-up time was 15.6 +/- 19.7 months (2 to 50). Neither early nor late mortality has occurred. All patients are in New York Heart Association class I. In all cases we used triple immunosuppressive therapy. In the follow-up period the mean number of cardiac biopsies per patient was 4.2 +/- 3.03 (2 to 8). Two cases had cardiac catheterization. As a complication of cardiac biopsy, pericardial tamponade developed in one patient; in another one we observed a right ventricular aneursym after cardiac biopsy. Cardiac transplantation was performed with low mortality and morbidity rates in end-stage cardiac failure patients with longer life expectancy and higher life quality. Unfortunately in our country, because of difficulties to find donor hearts, cardiac transplantations were small in number. For better results, we need a larger series.
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PMID:Our experience in cardiac transplantation in Baskent University. 1654 93

To minimize sternal ischemia, skeletonized internal mammary artery (IMA) harvesting has been performed in the last few years. The benefits of skeletonization in high risk patients, such as diabetic patients undergoing bilateral IMA grafting, are unknown. A total of 99 patients underwent isolated coronary artery bypass grafting (CABG) using a pedicled bilateral IMA between 6/1/1997 and 5/31/2000 (group P), and 115 patients receiving a skeletonized IMA between 6/1/2001 and 3/31/2002 (group S). An ultrasonic scalpel was used for skeletonization. The perioperative and early angiographic results of CABG using these two techniques were collected prospectively and compared. There were two (1.7%) perioperative myocardial infarctions in group S and one (1.0%) in group P (P=NS), none of which were related to the IMA graft. The incidence of mediastinitis was one (0.9%) in group S and three (3.0%) in group P, P=NS, however, minor chest wound complications were observed in four (3.5%) in group S, which was significantly less frequent than the 12 (12.1%) in group P (P<0.05). Angiographic control was obtained in 87 patients in group S and 36 in group P, revealing no IMA occlusions in either group. Bilateral skeletonized IMA grafting for diabetic patients is safe and may decrease wound complications.
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PMID:Skeletonized bilateral internal mammary artery grafting for patients with diabetes. 1767 49

We describe 2 patients with perivascular low-attenuation soft tissue and inflammatory changes surrounding the coronary arteries in the clinical setting of idiopathic retroperitoneal fibrosis. Neither patient had inducible ischemia on cardiac stress testing. The coronary arteries present an additional site of interest as connections between sclerosing diseases--including retroperitoneal fibrosis, fibrosing mediastinitis, autoimmune pancreatitis, sclerosing cholangitis, and other entities--continue to emerge.
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PMID:Coronary artery involvement in idiopathic retroperitoneal fibrosis: computed tomographic findings. 2151 43

Skeletonization is an advanced technique of graft harvesting for coronary artery bypass grafting (CABG), and while it requires meticulous attention, it has many advantages. For example, skeletonization of internal thoracic artery (ITA) can minimize sternal ischemia and lower the risk of mediastinitis, and is longer and larger than pedicled ITA. In this article we describe the surgical techniques demonstrated in our video, which details our techniques of skeletonization of arterial grafts and off-pump coronary artery bypass (OPCAB) exclusively using these in situ grafts. Our method of right gastroepiploic artery (GEA) skeletonization has only three technical steps. The first step is to pass thin vessel loops under the GEA. The second step is to unroof the tissue surrounding the GEA. The last step is to seal and sever all the branches. Skeletonization of the GEA not only prevents vasospasm but also leads to GEA dilatation, and facilitates inspection and makes sequential anastomosis easier. Bilateral use of the skeletonized ITA and use of the skeletonized GEA can cover most coronary artery target sites without any manipulation of the ascending aorta. In our consecutive series of over 1,000 patients, the stroke rate was 0.5%. Our method helps to make the technique simple and secure in this technically demanding operation, and we believe that OPCAB with these grafts provides the best possible coronary revascularization.
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PMID:Off-pump coronary artery bypass grafting using skeletonized in situ arterial grafts. 2397 35


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