Background and aimsArteriovenous fistula (AVF) maturation failure rates remain high in patients with end-stage renal disease (ESRD). Although preoperative morphological and functional assessment of blood vessels by duplex ultrasonography (DUS) has been shown to improve AVF maturation, there is no consensus regarding the optimal vein (VD) and artery (AD) diameters to be universally used for AVF creation. To improve patient selection, set out to investigate if there is a correlation between preoperative VD/AD and clinical covariates, and postoperative AVF outcome.MethodsThis was a prospective cohort study conducted during January–August 2014. ESRD patients referred to “Niculae Stăncioiu” Heart Institute Cluj-Napoca, who had a VD ≥1.9 mm and AD ≥1.5 mm, as measured by DUS, and underwent AVF creation were enrolled. We assessed whether preoperative VD/AD and clinical covariates were associated with AVF maturation rate and primary patency at 2 years after AVF creation.ResultsOf 115 patients referred for AVF creation, 93 were included in the study. Mean (± standard deviation) VD was 3.3 ± 1.1 mm and VDs were distributed in quartile Q1 <2.55 mm, Q2: 2.56–3.10 mm, Q3: 3.11–3.70 mm and Q4: >3.71 mm. Mean AD was 3.3 ± 1.4 mm and ADs were distributed in Q1 <2.55 mm, Q2: 2.56–3.10 mm, Q3: 3.11–3.70 mm, and Q4, >3.71 mm. AVF maturation rate increased proportionally with VD from Q1 (62%) to Q2 (70%), Q3 (82%) to Q4 (96%) (p=0.03). Based on AD, a higher AVF maturation rate was observed in Q3 (86%), Q4 (83%) vs Q1 (71%) and Q2 (67%). Long-term primary patency of AVFs seemed not to be influenced by VD and AD. In older patients and those with peripheral arterial disease, AVF maturation failure tended to be higher.ConclusionsOur findings suggest that a preoperative VD ≥1.9 mm and AD ≥1.5 mm have a successful maturation rate of AVF greater than 60% in ESRD patients. The maturation rate of surgical AVF increases proportionally with the size of VD used for AVF creation.

Despite the medical and surgical advancements in the treatment of patients with acute infective endocarditis (IE), neurologic complications remain problematic. They can arise through various mechanisms consisting of stroke or transient ischemic attack, cerebral hemorrhage, mycotic aneurysm, meningitis, cerebral abscess, or encephalopathy. Most complications occur early during the course of IE and are characteristic to left-sided pathology of native or prosthetic valves. We present a case of a 46 year old male patient who presented to our clinic with mitral valve IE caused by coagulase negative staphylococcus. Although under correct antibiotic treatment, he continued to be feverish and started to present unspecific neurological symptoms (amnesia, confusion, asthenia and general malaise). The cerebral magnetic resonance imaging (MRI) revealed multiple cerebral abscesses. Because the patient was hemodynamically stable we decided to address the cerebral abscess first and the cardiac lesion second. The patient made a full recovery after undergoing antibiotic treatment and surgical procedures of drainage of the cerebral abscess and mitral valve replacement. After reviewing the literature regarding the management of patients with IE and cerebral complications and based on this particular case, we conclude that in select cases of stable patients with cerebral abscess and IE, the neurological lesion should always be addressed first and cardiac surgery should be performed second.

Objectives. This paper assesses the importance and contribution of cardiovascular rehabilitation programs in the short- and long-term outcome following surgical revascularization procedures for patients with coronary artery disease (CAD). Methods. We present the case of a 64-year-old patient who benefited from a coronary artery bypass graft (CABG) procedure for CAD, followed by an individualized cardiac rehabilitation program. The case particularity consisted of the presence of associated peripheral vascular disease that imposed additional challenge in decision-making process regarding surgical therapy. Results and discussion. Immediately after surgery, the patient was included in a phase II residential recovery program, preceded by a ramp effort test. The rehabilitation program consisted of partial toning massage of the lumbosacral spine, and individual physiotherapy. Coronary revascularization procedures often cause lowered exercise capacity and declining physical activity levels. In our case even preoperative assessment showed a limited physical effort capacity, further reduced by the surgical intervention. The physiotherapy plan should be personalized, safe, effective, and must increase the independent mobility of patient soon after open heart surgery. Conclusions. The main contribution of cardiac rehabilitation program should be the improvement of physical and social status of patients undergoing surgical myocardial revascularization. This program should be included in the management of all cardiac heart disease patients who benefit from cardiac surgery procedures. Implementation of CR programs at most hospitals and community centres, as well as awareness about their efficacy, would result in higher participation after coronary revascularization interventions and improvement of functional parameters and quality of life.

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