Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2019
Discontinuation of dual antiplatelet therapy and bleeding in intensive care in patients undergoing urgent coronary artery bypass grafting: a retrospective analysis.
Our goal was to evaluate the impact of the discontinuation times of dual antiplatelet therapy with clopidogrel, prasugrel or ticagrelor on postoperative bleeding rates and the use of blood products in patients undergoing isolated urgent coronary artery bypass grafting (CABG). ⋯ Discontinuation of ticagrelor and prasugrel for more than 72 h before urgent CABG was not associated with higher bleeding rates compared to treatment with ASA monotherapy. In contrast, discontinuation for less than 24 h was associated with higher use of blood products. For ticagrelor, this study supports evidence and recent guidelines proposing a shorter discontinuation time of 3 days and raises the question of whether the same could be true for prasugrel.
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Interact Cardiovasc Thorac Surg · Apr 2019
Ketoacidosis related to sodium glucose cotransporter 2 inhibitors after emergency coronary surgery.
Sodium glucose cotransporter 2 inhibitors are currently widely used antihyperglycaemic medications that are considered to be associated with euglycaemic diabetic ketoacidosis. We report 2 cases of patients who received sodium glucose cotransporter 2 inhibitors until emergency coronary artery bypass grafting (CABG) and developed euglycaemic ketoacidosis after surgery; they were treated with sugar replenishment and insulin infusion. In one case, coronary angiography revealed a spastic change of the bypass graft possibly due to severe acidosis. A rapid diagnosis and proper intervention are crucial to achieve better outcomes with CABG.
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Interact Cardiovasc Thorac Surg · Apr 2019
Case ReportsLate complication of intramural coronary transfer during the arterial switch operation.
Intramural coronary arteries remain a major risk factor and technical challenge of the arterial switch operation for transposition of the great arteries. We report a 27-year-old woman who presented with acute coronary syndrome late after arterial switch with a complex coronary pattern (intramural left and right coronary from sinus 2). Computed tomography demonstrated that the pericardial 'saddle bag' used to reconstruct the intramural coronary was compressed between the neoaortic root and the neopulmonary trunk. During surgery, the coronary system was laid open into the neoaorta with patch enlargement, and the patient made an uneventful recovery.
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Interact Cardiovasc Thorac Surg · Apr 2019
Biography Historical ArticleSandro Botticelli's Madonna of the Pomegranate: the hidden cardiac anatomy.
Sandro Botticelli was one of the most renowned artists of the 15th century. He was based in Florence during the flourishing of the Renaissance, a time when anatomical knowledge of ancient times was reclaimed through cadaveric dissection. This report proposes that such knowledge enabled Botticelli to enhance the iconography of his masterpieces, Madonna of the Pomegranate, by incorporating a concealed image of the heart and cardiac anatomy within it.
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Interact Cardiovasc Thorac Surg · Apr 2019
Morphological predictor of remodelling of the descending thoracic aortic false lumen that remains patent after repair of acute type A dissection.
Some patients achieve complete recovery through false lumen remodelling in the descending aorta after surgery for acute type A aortic dissection. Our goal was to investigate the relationship between false lumen remodelling during later postoperative stages and quantitative analysis of the true lumen shape during the early postoperative stages. ⋯ Quantitative evaluation of shape of the true lumen in the early postoperative stages after surgery for acute type A dissection can serve as a viable predictor for false lumen remodelling in later stages. Furthermore, the first principal component could serve as a more astute predictor than other quantitative parameters according to multivariate analysis.