scholarly journals Effectiveness of posterior pericardiotomy in preventing cardiac tamponade and effusion pericarditis in the early period after interventions on the thoracic aorta

2021 ◽  
Vol 25 (1) ◽  
pp. 64
Author(s):  
R. N. Komarov ◽  
A. I. Katkov ◽  
A. M. Ismailbaev ◽  
A. O. Danachev
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Thoracic Aorta ◽  
Conflict Of Interest ◽  
Pleural Cavity ◽  
Early Period ◽  
Group Versus ◽  
Control Group ◽  
Artificial Circulation ◽  
Left Pleural Cavity

<p><strong>Background.</strong> Interventions on the thoracic aorta involving prolonged artificial circulation, clamping of the aorta and extensive dissection of the mediastinal structures are associated with a higher incidence of pericardial effusion and cardiac tamponade compared to other interventions. We suggest that routine implementation of posterior pericardiotomy may significantly affect the incidence of postoperative pericardial effusion syndrome and cardiac tamponade after interventions on the thoracic aorta.</p><p><strong>Aim.</strong> Evaluation of the effectiveness of posterior pericardiotomy regarding the development of cardiac tamponade, effusion pericarditis and the postoperative course of patients in the early period after interventions on the thoracic aorta.</p><p><strong>Methods.</strong> We conducted a retro- and prospective study that included 100 patients with thoracic aorta pathologies who were operated on in the cardiac surgery department of clinic from 2017 to 2020. All subjects were divided into two groups: a treatment group of 40 patients who underwent routine posterior pericardiotomy, and a control group of 60 patients without posterior pericardiotomy but with standard installation of postoperative drains. Assessment of the effect of posterior pericardiotomy on pericardial effusion, cardiac tamponade and the early postoperative period was conducted on the basis of transthoracic echocardiography that was performed daily during hospitalisation (the maximum amount of effusion during the observation period was taken as the control point), as well as up to one month after discharge from hospital.</p><p><strong>Results.</strong> The study groups did not differ regarding parameters such as time of artificial circulation (p = 0.39), time of myocardial ischaemia (p = 0.42), length of intensive care unit stay (p = 0.79) and length of hospitalisation (p = 0.21). Evaluation of pericardial effusion of varying severity during hospital follow-up revealed its presence in 15 (37.5%) patients in the PPt group and in 54 (90%) in the control group (p = 0.0001). Early postoperative cardiac tamponade developed in 4 (6.7%) patients in the control group, but was not observed in the PPt group (p = 0.09). At the same time, 5 (8.3%) patients without pericardiotomy required pericardiocentesis; however, this procedure was not performed in the PPt group (p = 0.06). Additionally, we did not find a statistically significant difference between the groups in relation to the frequency of puncture of the left pleural cavity (37.5% in the PPt group versus 43.3% in the control group, p = 0.56). According to the results of control echocardiography after one month, effusion of varying severity was found in 21 (35%) patients in the control group versus 1 (2.5%) in the PPt group (p = 0.0001).</p><p><strong>Conclusion.</strong> Posterior pericardiotomy is an affordable, applicable, safe and effective method for preventing postoperative pericardial effusion and cardiac tamponade after thoracic aortic surgery. This manipulation did not significantly affect the length of hospitalisation or the incidence of postoperative atrial fibrillation in this cohort of patients. Posterior pericardiotomy is not associated with a more frequent need for puncture of the left pleural cavity.</p><p>Received 13 October 2020. Revised 10 December 2020. Accepted 11 December 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

scholarly journals IMMEDIATE AND LONGTERM RESULTS OF ENDOVASCULAR STENT-GRAFTING IN DISSECTIONS AND ATHEROSCLEROTIC ANEURYSMS OF THORACIC AORTA

2018 ◽  
pp. 135-140
Author(s):  
Kyaw K. Latt ◽  
Alexey A. Moiseev ◽  
Natalya R. Chernaya ◽  
Konstantin N. Vasilyev ◽  
Nikolay L. Bayandin ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Thoracic Aorta ◽  
Pleural Cavity ◽  
Clinical Results ◽  
Endovascular Stent ◽  
Stent Grafting ◽  
Endovascular Stent Grafting ◽  
Left Pleural Cavity

Objective: to analyze the results of endovascular stent-graftingin dissections and atherosclerotic aneurysms of descending part of thoracic aorta.Material and method: in this analysis includes 28 patients with dissections and atherosclerotic aneurysms of descending part of thoracic aorta. Acute aortic dissection type 3 was occurred in 10 patients and two of them were complicated with rupture into the left pleural cavity. 10 patients with chronic aortic dissection type bunderwent operations and one of them was complicated with rupture into the left pleural cavity. Among 8 operated patients due to chronic aneurysms of descending part of thoracic aorta, 4 patients were manifested with symptoms of hemothorax. In 3 patients with aortic dissection type 1 in long-term period, endovascular stent-grafting was performed concerning with the dilatation of descending thoracic aorta and patent false lumen. During in-hospital and long-term periods immediate clinical results, serious clinical complications and long-term survival were compared.Results: technical success of endovascular stent-grafting was achieved in 100 % of cases. In-hospital mortality was 4 (14,2 %) and 30-day mortality was 3 (10,7 %). Events of paraplegia, TIA (Transient Ischemic Attack), prosthetic infection were not found in our research. Two clinical occurrences of vascular approach site complication were found; one case of endoleak type 1 and stent-graft dislocation which required repeated endovascular stent-grafting and one case of endoleak type 2 which was performed subclaviancarotid bypass and ligation of left subclavian artery. Prolong intubation was needed in 5 patients (18,5 %).conclusion: Endovascular stent-grafting in dissections and atherosclerotic aneurysms of descending part of thoracic aorta contributes good immediate clinical results associating with less quantity of serious complications.

scholarly journals Efficacy of posterior pericardiotomy in prevention of atrial fibrillation and pericardial effusion after aortic valve replacement: a randomized controlled trial

2017 ◽  
Vol 21 (2) ◽  
pp. 60
Author(s):  
V. I. Kaleda ◽  
S. Yu. Boldyrev ◽  
S. A. Belash ◽  
I. I. Yakuba ◽  
S. S. Babeshko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pericardial Effusion ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Conflict Of Interest ◽  
Postoperative Atrial Fibrillation ◽  
Control Group ◽  
Exclusion Criteria ◽  
Postoperative Stay

<p><strong>Aim.</strong> Postoperative atrial fibrillation is one of the most frequent complications in cardiac surgery. The aim of this trial was to evaluate the effectiveness of posterior pericardiotomy in the prevention of postoperative atrial fibrillation and pericardial effusion in patients undergoing isolated primary aortic valve replacement.<br /><strong>Methods.</strong> The trial was approved by the local ethics committee. It included adult patients under 70 y.o. who had signed the informed consent for participation in the study and who were planned to undergo isolated primary aortic valve replacement. Exclusion criteria were a history of atrial fibrillation, hyperthyroidism, amiodarone intake, severe chronic obstructive pulmonary disease, left ventricle ejection fraction less than 30%, the size of the left atrium exceeding 50 mm, active infective endocarditis, the presence of adhesions in the pericardium and/or left pleural cavity and mini-sternotomy. From October 2013 to April 2015 607 patients in our clinic underwent different aortic valve procedures. 507 patients were excluded from the study because of the inclusion and exclusion criteria. The remaining 100 patients were randomized into two groups: 49 patients underwent posterior pericardiotomy and 51 patients made up the control group. In both groups the frequency of postoperative atrial fibrillation, pericardial effusion greater than 5 mm, surgery-discharge time, as well as posterior-pericardiotomy-related complications were studied. Trial number: ISRCTN11129539.<br /><strong>Results.</strong> There were no deaths, stroke or cardiac tamponade during the postoperative stay. Neither were there any complications associated with the performance of posterior pericardiotomy. The incidence of atrial fibrillation, pericardial effusion and average duration of the postoperative stay were similar in both groups: 16% in posterior pericardiotomy group vs 14% in the control group (p=0.71), 10% in posterior pericardiotomy group vs 12% in the control group (p=0.80) and 12.4±4.3 days in posterior pericardiotomy group vs 11.9±4.1 days in the control group (p=0.27), respectively.<br /><strong>Conclusion.</strong> The trial did not confirm the effectiveness of posterior pericardiotomy in preventing postoperative atrial fibrillation and pericardial effusion during the in-hospital period after isolated primary aortic valve replacement in low risk patients. However, further investigations are needed.</p><p>Received 1 December 2016. Accepted 14 February 2017.</p><p><strong>Funding:</strong> The trial was carried out within the dissertation research and according to the research calendar of Kuban State Medical University. There was no additional funding except for the resources allocated for postgraduate scholarships.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: V.I. Kaleda, K.O. Barbuhatti.<br />Data collection and analysis: V.I. Kaleda, S.Yu. Boldyrev, S.A. Belash, I.I. Yakuba, S.S. Babeshko, I.A. Belan. <br />Drafting the article: V.I. Kaleda.<br />Critical revision of the article: V.I. Kaleda.<br />Final approval of the version to be published: V.I. Kaleda, S.Yu. Boldyrev, S.A. Belash, I.I. Yakuba, S.S. Babeshko, I.A. Belan, K.O. Barbuhatti.</p><p><strong>Acknowledgements:</strong> The authors would like to express their gratitude to Cand. Sci. (Engineering) V.P. Leonov (“Biometrika”) for assistance in statistical data processing.</p>

The Predictive Role of Biochemical Plasma Factors in Patients with Severe Traumatic Brain Injuries

2019 ◽  
Vol 70 (5) ◽  
pp. 1754-1757
Author(s):  
Marius Toma Papacocea ◽  
Ioana Anca Badarau ◽  
Mugurel Radoi ◽  
Ioana Raluca Papacocea
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Cell ◽  
Brain Injuries ◽  
Hematological Parameters ◽  
Group Versus ◽  
Public Health Problem ◽  
Traumatic Brain Injuries ◽  
High Rate ◽  
Control Group

Traumatic brain injuries (TBI) represent a high impact public health problem due to a high rate of death , long term disability and occurrence especially in young adults. Despite several promising animal studies, several parameters were proposed as biological markers and were assessed for this aim. Our study proposes the study of the early biochemical changes in association to hematological parameters for severe TBI patients prognosis. 43 patients with acute TBI were included in study based on clinical, laboratory and imagistic findings. The severity of the TBI was established by Glasgow Coma Scale GCS 3-8. In all patients were evaluated hematologic parameters (Red blood cell count - RBC, Hematocrit, blood Hemoglobin, White blood cell - WBC, Platelet count and biochemical parameters (glucose, urea, creatinine, electrolytes). Outcome was expressed as Glasgow Outcome Scale (GOS), between 1-5. Values were compared to control group -15 cases. Significant early differences in body temperature, heart rate, and systolic blood pressure were observed in TBI group versus control (p[0.05). After correlation, laboratory findings significantly associated to severe outcome - GOS = 1, 2 - (p[0.05) were plasma Na decrease and significant glucose increase. An early increase of temperature and decrease of Na may predict a severe outcome in patients with acute TBI; association with shifts in heart rate and blood pressure, imposes aggressive treatment measures.

scholarly journals The Effects of Silver-Releasing Foam Dressings on Diabetic Foot Ulcer Healing

2021 ◽  
Vol 10 (7) ◽  
pp. 1495
Author(s):  
Yu-Chi Wang ◽  
Hsiao-Chen Lee ◽  
Chien-Lin Chen ◽  
Ming-Chun Kuo ◽  
Savitha Ramachandran ◽  
...  
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Early Period ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Wound Management ◽  
Control Group ◽  
Diabetic Patients ◽  
High Morbidity

Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management.

Regression of cardiac amyloid deposits with novel therapeutics: reaching new frontiers in cardiac ATTR amyloidosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Chacko ◽  
A Martinez-Naharro ◽  
T Kotecha ◽  
R Martone ◽  
D Hutt ◽  
...  
Keyword(s):  
Treatment Group ◽  
Cardiac Amyloidosis ◽  
T1 Mapping ◽  
Group Versus ◽  
Control Group ◽  
Cardiac Amyloid ◽  
Attr Amyloidosis ◽  
Amyloid Load ◽  
The Impact

Abstract Background Cardiac involvement is the main driver of outcome in ATTR amyloidosis. Advances in therapeutics hold potential in transforming the course of the disease but the impact on cardiac amyloid load is unknown. The aim of this study was to evaluate the impact of patisiran, a new double stranded RNA based gene silencing therapy and a stabilizer, diflunisal, on cardiac amyloid load as measured by CMR and T1 mapping, in patients with ATTR amyloidosis. Methods and results Thirty-two patients with hereditary cardiac amyloidosis were studied. Sixteen patients received treatment with patisiran, and sixteen control subjects did not receive any disease modifying treatment. Patients were assessed with echocardiogram, CMR, NT-proBNP and six-minute walk time measurements at baseline and at 1 year (Mean interval 11.45±3.08 months in treatment group, mean interval 12.82±5.06 months in the control group). CMR analysis comprised LV volumes, T1 mapping to measure the extracellular volume (ECV) occupied by amyloid, T2 mapping and late gadolinium enhancement imaging. At 1-year follow-up, there was a substantial reduction in cardiac amyloid burden, in keeping with cardiac amyloid regression in 45% of patients on treatment. Overall the treatment group showed a reduction in ECV at 1 year follow up compared to an increase in ECV at 1 year in the control group (−1.37%, 95% CI: −3.43 to 0.68% versus 5.02%, 95% CI: 2.86% to 7.18% respectively, p&lt;0.001). The treatment group also showed an improvement in change in 6MWT at 1 year follow up compared to 6MWT at 1 year in the control group (−8.12 meters, 95% CI: −50.8 to 34.6 meters in the treatment group versus −132.27 meters, 95% CI: −216 to −48.6 meters in the control group, p=0.002). The treatment group showed a reduction in BNP at 1 year follow up compared to an increase in the control group (−567.87, 95% CI: −1288.90 to 153.15 in the treatment group versus 2004, 95% CI: 12.82 to 3995.45 in the control group, p&lt;0.001). There was no significant difference from baseline and 1-year data between the control and treatment groups for the difference in echocardiographic parameters, native T1, T2. There was a significant reduction in the percentage of injected dose by 99Tc-DPD scintigraphy in treated patients at 1 year compared to baseline. Conclusions These findings provide the first compelling evidence of substantial cardiac amyloid regression in ATTR amyloidosis, as well as the potential for CMR to be used to track response in treated patients with ATTR cardiac amyloidosis. Combination therapy with transthyretin knock down and stabilizing agents may well be synergistic given enhanced stoichiometry of stabilizers in the face of much reduced plasma transthyretin concentration. Funding Acknowledgement Type of funding source: None

FMS Effects of a Motor Program for Children With Autism Spectrum Disorders

2021 ◽  
pp. 003151252110100
Author(s):  
Liangshan Dong ◽  
Bo Shen ◽  
YanLi Pang ◽  
Mingting Zhang ◽  
Yuan Xiang ◽  
...  
Keyword(s):  
Motor Development ◽  
Group Versus ◽  
Motor Program ◽  
Autism Spectrum ◽  
Control Group ◽  
Gross Motor Development ◽  
Children With Asd ◽  
Individualized Approach ◽  
Experimental Group ◽  
Ball Skills

The current study evaluated the effectiveness of a motor program that specifically targeted fundamental motor skills (FMS) in children with ASD. The experimental group (n=21) participated in a 9-week program with motor instructions for 80 minutes/day, three days/week, while the control group (n=29) did not participate in the program. We measured FMS (using the Test of Gross Motor Development-3) one-week before, one-week after, and two-months after the program. Children in the experimental group had significantly larger FMS improvements than the controls on both locomotor and ball skills immediately following the program, and these participants showed continuous improvement on locomotor, but not ball skills, at 2-months follow-up. In individual analyses, 80% of children in the experimental group versus 29% of children in the control group showed continuous locomotor skills improvement beyond their pre-test levels. These findings highlight the importance of both a long-term motor development intervention and an individualized approach for evaluating improved FMS among children with ASD.

scholarly journals Malignant pericardial effusion complicated by cardiac tamponade under atezolizumab

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110360
Author(s):  
Lardinois Benjamin ◽  
Goeminne Jean-Charles ◽  
Miller Laurence ◽  
Randazzo Adrien ◽  
Laurent Terry ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Cardiac Toxicity ◽  
Checkpoint Inhibitors ◽  
Final Diagnosis ◽  
Pericardial Fluid ◽  
Malignant Pericardial Effusion ◽  
Typical Cell ◽  
High Fluorescence ◽  
Tomography Scan

Immune-related adverse events including cardiac toxicity are increasingly described in patients receiving immune checkpoint inhibitors. We described a malignant pericardial effusion complicated by a cardiac tamponade in an advanced non-small cell lung cancer patient who had received five infusions of atezolizumab, a PDL-1 monoclonal antibody, in combination with cabozantinib. The definitive diagnosis was quickly made by cytology examination showing typical cell abnormalities and high fluorescence cell information provided by the hematology analyzer. The administration of atezolizumab and cabozantinib was temporarily discontinued due to cardiogenic hepatic failure following cardiac tamponade. After the re-initiation of the treatment, pericardial effusion relapsed. In this patient, the analysis of the pericardial fluid led to the final diagnosis of pericardial tumor progression. This was afterwards confirmed by the finding of proliferating intrapericardial tissue by computed tomography scan and ultrasound. This report emphasizes the value of cytology analysis performed in a hematology laboratory as an accurate and immediate tool for malignancy detection in pericardial effusions.

scholarly journals Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 463
Author(s):  
Mar Gomis-Pastor ◽  
Sonia Mirabet Perez ◽  
Eulalia Roig Minguell ◽  
Vicenç Brossa Loidi ◽  
Laura Lopez Lopez ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Patient Experience ◽  
Mobile Application ◽  
Standard Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Group Versus ◽  
Control Group ◽  
P Value ◽  
Adherence Score

Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed.

Sign in / Sign up

Export Citation Format

Share Document