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Biomedical subjects

Walter J Gomes

Publications and source records attributed to Walter J Gomes.

10 recordsLinked to original sources
PubMed2006

Coronary stenting and inflammation: implications for further surgical and medical treatment.

The introduction of percutaneous coronary interventions (PCI) with stent implant has substantially shifted the treatment of coronary artery disease. The current approach to coronary artery disease treatment includes first-choice PCI in selected subgroups; and once this therapy fails, frequently the patient is referred for coronary artery bypass graft surgery. However, evidence of chronic inflammatory reaction and endothelial dysfunction after PCI has been emerging and that might be interfering with patient outcome when surgical or medical treatments are subsequently required. The clinical significance of these complications after PCI, herein examined, has been less studied and needs better assessment. Also, the premise that coronary artery bypass graft surgery can safely be performed in patients with coronary stenting failure may not hold true, as graft patency might be adversely affected. Furthermore, the superimposed inflammatory reaction may blunt the efficacy of medical treatment.

Angioplasty, Balloon, Coronary↗
PubMed2005

Inflammatory reaction after sirolimus-eluting stent implant.

Sirolimus-eluting stents (SES) are supposed to attenuate cell proliferation and reduce restenosis rate. Histologic finding from coronary artery after SES implant showed fibrosis and inflammatory infiltrate, revealing a chronic inflammatory reaction. Extension of coronary inflammatory reaction after stenting needs clarification. The long-term consequences are unknown.

Anti-Bacterial Agents↗
PubMed2005

Invited commentary.

Explore the source record for details and available documents.

Aortic Dissection↗
PubMed2003

Coronary artery and myocardial inflammatory reaction induced by intracoronary stent.

BACKGROUND: Intracoronary stents have been extensively used in percutaneous coronary revascularization. However, despite the breakthroughs and developments associated with this new technology, novel complications and findings have emerged compelling the cardiac surgeon to cope with this new scenario. The presence of an intracoronary foreign body (stent) might induce an inflammatory reaction to the coronary artery and surrounding cardiac muscle. METHODS: Six patients who previously (2 to 72 weeks) underwent stent insertion and subsequently coronary artery bypass graft surgery had a biopsy taken from the grafted coronary artery distal to the stent and from the adjacent muscle. The samples were processed and stained with hematoxylin and eosin and histologically studied. RESULTS: Histologic examination of the coronary artery distal to the stent revealed chronic inflammation and an intimal acute inflammatory infiltrate, with polymorphonuclear leukocytes. The myocardium adjacent to the stent exhibited a significant chronic inflammatory infiltrate and fibrosis, compatible with myocarditis. CONCLUSIONS: The presence of an intracoronary stent induces a persistent, acute and chronic inflammatory reaction, with involvement of the distal coronary artery and surrounding myocardium. This may have implications when choosing the optimal site distal to the stent for coronary artery bypass grafting.

Aged↗
PubMed2003

Vasoplegic syndrome after off-pump coronary artery bypass surgery.

OBJECTIVE: The vasoplegic syndrome (VS) has been implicated in life-threatening complications after open heart surgery, where the whole-body inflammatory reaction is attributed to the cardiopulmonary bypass (CPB). Off-pump coronary artery bypass grafting (OPCAB) has been recently achieving growing enthusiasm mainly due avoiding the side effects of CPB. However herein the occurrence of VS in OPCAB is reported. METHODS: The vasoplegic syndrome usual findings occurring in the early postoperative period include severe hypotension, tachycardia, normal or elevated cardiac output and low systemic vascular resistance. Four patients underwent to OPCAB presented all the signs of VS intraoperatively or within the first 6 postoperative h. RESULTS: The patients needed aggressive vasoactive drug support for hemodynamic stabilization and all of them developed complications. These patients also had tendency to require administration of blood and blood derivatives due to diffuse and oozing type bleeding. Mean intensive care unit stay of surviving patients was 70 h and mean period of postoperative hospitalization was 9 days. Tumor necrosis factor-alpha blood levels in one patient were elevated postoperatively though no signs of infection were observed. One patient died. CONCLUSIONS: Although vasoplegic syndrome can complicate OPCAB surgery, the rationale for avoiding CPB remains valid considering the benefits provided by OPCAB.

Aged↗
PubMed2003

Successful treatment of accidental air embolism in warm heart surgery.

Normothermic cardiopulmonary bypass has recently been proposed as a superior technique for maintaining body metabolism. However, its use remains controversial since the degree of cerebral protection provided might be inferior to that conferred by conventional hypothermic techniques. We report a case of accidental massive air embolism during coronary artery bypass surgery under normothermia, which was successfully managed with induced hypothermia at 20 degrees C and retrograde cerebral perfusion.

Brain Ischemia↗
PubMed2002

Repair of damaged internal mammary artery.

The use of the internal mammary artery (IMA) in coronary artery bypass graft surgery is an independent predictor of late survival in all subsets of patients and should not be denied to any subgroup. Therefore damage to the IMA during harvesting is a catastrophic complication after which the graft is usually discarded. We present here a simple and safe technique for repair of a damaged left IMA that allowed its rescue for grafting to the left anterior descending artery.

Anastomosis, Surgical↗
PubMed2002

Treatment of delayed rupture of the left ventricle after mitral valve replacement.

Rupture of the left ventricle following mitral valve replacement is a catastrophic complication with deadly consequences. We report here the case of a 75-year-old man who underwent elective mitral valve replacement for severe mitral regurgitation. Delayed type 1 rupture of the left ventricle developed 3 hours postoperatively in the intensive care unit. A salvaging maneuver was used, which gained time, allowing reoperation and successful intraventricular repair.

Aged↗