Asian cardiovascular & thoracic annals
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Asian Cardiovasc Thorac Ann · Oct 2014
Case ReportsObstructive bioprosthetic mitral valve thrombus: management options?
Bioprosthetic valve thrombosis is an extremely rare event, therefore, long-term anticoagulation can be avoided. There is limited experience in the diagnosis and treatment of such a situation. We present the case of a patient with a porcine mitral bioprosthesis who presented with acute pulmonary edema, likely secondary to obstructive valve thrombosis. A favorable outcome was observed after conservative anticoagulant treatment.
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Asian Cardiovasc Thorac Ann · Oct 2014
Case ReportsDirect aortic transcatheter valve implantation in a porcelain aorta.
Transcatheter aortic valve implantation has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery, and is generally performed retrogradely with vascular access. However, in certain patients, this access is either not possible or deemed to carry a high risk of vascular injury. We report our experience of a direct aortic approach in a 78-year old man with severe aortic stenosis, excluded from standard aortic valve replacement due to a porcelain aorta, and affected by severe aortic, iliac-femoral, and subclavian arteriopathy, rendering the transfemoral or subclavian approach unemployable.
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Asian Cardiovasc Thorac Ann · Oct 2014
Is continuation of antiplatelets until coronary artery bypass safe in Asians?
Controversies have arisen about the risks of discontinuing antiplatelets prior to coronary artery bypass grafting. ⋯ Continuation of antiplatelets until 2 days before coronary artery bypass in Asian patients in our institution is unlikely to increase the risks of bleeding and perioperative transfusion. Taking antiplatelets within 24 h of surgery seems to be associated with a higher rate of 1-year major adverse cardiovascular events and bleeding, and an increased risk of blood product transfusion. Thirty-day and 1-year major adverse cardiovascular event rates were higher in patients without antiplatelet treatment.
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Asian Cardiovasc Thorac Ann · Oct 2014
Virchow's triad and intestinal ischemia post cardiac surgery.
Intestinal ischemia is associated with a very high mortality rate. We combined the principles of Virchow's triad to produce preoperative and postoperative models for the development of intestinal ischemia. ⋯ Potentially remedial causes of intestinal ischemia include blood product usage, reoperation for bleeding, and creatine kinase-MB release. Age, female sex, peripheral vascular disease, intraaortic balloon pump usage, and preexisting renal failure are fixed risk factors. Despite the continuing trend of reduced blood product usage in the field of cardiac surgery, the increase in patients' risk factors will mean that incidences of intestinal ischemia may increase in the future.