RESUMO
While a coronary artery fistula with aneurysmal formation is rare, a fistula/aneurysm combination occurring in single coronary artery is even rarer. Here, we report the successful surgical correction of a right ventricular fistula with a large aneurysm of 30 mm and a daughter aneurysm within a case of single coronary artery.
Assuntos
Aneurisma Coronário/cirurgia , Doença da Artéria Coronariana/cirurgia , Fístula/cirurgia , Ventrículos do CoraçãoRESUMO
A 75-year-old woman presented at a prior hospital with persistent cough and was treated conservatively for a thrombosed-type aortic dissection (Stanford A). One-year after discharge, follow-up computerized tomography revealed a DeBakey type II, chronic dissecting aortic aneurysm enlarged to 54 mm. She was referred to our hospital with slight edema in the face and extremities and chest radiography showed calcification around the heart. Computerized tomography performed at the prior hospital showed a large spherical mass in the anterior pericardium in addition to the aortic dissection. We therefore resected the mass immediately before a total aortic arch replacement. Surgery was successful and uneventful with patient discharge on postoperative day 21. The final differential diagnosis was idiopathic, localized, constrictive pericarditis.
Assuntos
Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Calcinose/cirurgia , Cardiomiopatias/cirurgia , Pericardite Constritiva/complicações , Pericardite Constritiva/cirurgia , Pericárdio/cirurgia , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/patologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/etiologia , Cardiomiopatias/patologia , Doença Crônica , Feminino , Humanos , Pericardite Constritiva/patologia , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Although devastating complications during simple coarctation of aorta repair now occur less frequently, some unique cases still require extra caution. Here, we report a case of coarctation of the aorta with a rare anomaly in the circle of Willis and an aberrant right subclavian artery, which required a thorough surgical strategy that prevented cerebral malperfusion.
Assuntos
Coartação Aórtica/complicações , Coartação Aórtica/cirurgia , Anormalidades Cardiovasculares/complicações , Anormalidades Cardiovasculares/cirurgia , Círculo Arterial do Cérebro/anormalidades , Artéria Subclávia/anormalidades , Coartação Aórtica/diagnóstico , Anormalidades Cardiovasculares/diagnóstico , Humanos , Lactente , Masculino , Artéria Subclávia/cirurgiaRESUMO
Adventitial cystic disease is an uncommon vascular anomaly known to occur in peripheral vessels but mediastinal appearances are extremely rare. Herein, we report the case of an adventitial cyst occurring in the right brachiocephalic vein which might have been associated with ovarian hyperstimulation syndrome.
Assuntos
Túnica Adventícia , Veias Braquiocefálicas , Cistos/diagnóstico por imagem , Cistos/cirurgia , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia , Adulto , Feminino , HumanosRESUMO
During extracorporeal life support (ECLS) in infants, cannulation of the right common carotid artery may result in a devastating ischaemic neurological injury. Herein, we present a case of an infant who encountered bilateral cerebral infarction during ECLS via the right carotid artery due to a rare and tragic anomaly of the circle of Willis. The magnetic resonance angiography complemented computed tomography in diagnosing the infarction and identifying this unique anatomy.
Assuntos
Infarto Cerebral/etiologia , Círculo Arterial do Cérebro/anormalidades , Oxigenação por Membrana Extracorpórea/métodos , Malformações Vasculares/complicações , Infarto Cerebral/diagnóstico , Círculo Arterial do Cérebro/diagnóstico por imagem , Humanos , Lactente , Angiografia por Ressonância Magnética/métodos , Masculino , Doenças Raras , Tomografia Computadorizada por Raios X , Malformações Vasculares/diagnóstico , Malformações Vasculares/terapiaRESUMO
We herein report the clinical course of a patient who had a good neurological outcome despite severe anemia, high serum lactate levels, and a long period of time from cardiac arrest (CA) to extracorporeal cardio-pulmonary resuscitation (ECPR) establishment. During the period of resuscitation, the tissue oxygenation index (TOI) values were measured continuously by a near-infrared spectroscopy monitoring device and were kept within the normal range. The TOI seems to reflect cerebral perfusion and the balance between the oxygen supply and demand in the brain during ECPR, thereby predicting the neurological outcome. Continuous TOI monitoring is useful for predicting the neurological outcome during ECPR.
Assuntos
Encéfalo/diagnóstico por imagem , Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea/métodos , Parada Cardíaca/patologia , Parada Cardíaca/terapia , Idoso , Anemia/complicações , Gasometria , Feminino , Parada Cardíaca/complicações , Humanos , Ácido Láctico/sangue , Consumo de Oxigênio/fisiologia , Espectroscopia de Luz Próxima ao Infravermelho , Tempo para o TratamentoRESUMO
AIMS: Landiolol hydrochloride, an ultra-short-acting highly cardio-selective ß-1 blocker, has become useful for various medical problems. Recent studies have demonstrated that co-treatment with landiolol protects against acute lung injury and cardiac dysfunction in rats of lipopolysaccharide (LPS)-induced systemic inflammation, and was also associated with a significant reduction in serum levels of the inflammation mediator HMGB-1 and histological lung damage. Endothelin (ET)-1, a potent vasoconstrictor, has been implicated in pathogenesis of sepsis and sepsis-induced multiple organ dysfunction syndrome. Here, we investigated whether landiolol hydrochloride can play important roles in ameliorating LPS-induced alterations in cardiac ET system of septic rats. MAIN METHODS: Eight-week-old male Wistar rats were administered LPS only for 3 h and the rest were treated with LPS as well as with landiolol non-stop for 3 h. KEY FINDINGS: At 3 h after LPS (only) administration, circulatory tumor necrosis factor (TNF)-α level, blood lactate concentration and percentage of fractional shortening of heart were significantly increased. In addition, LPS induced a significant expression of various components of cardiac ET-1 system compared to control. Finally, treatment of LPS-administered rats with landiolol for 3 h normalized LPS-induced blood lactate levels and cardiac functional compensatory events, without altering levels of plasma TNF-α and ET-1. Most strikingly, landiolol treatment significantly normalized various components of cardiac ET-1 signaling system in septic rat. SIGNIFICANCE: Taken together, these data led us to conclude that landiolol may be cardio-protective in septic rats by normalizing the expression of cardiac vasoactive peptide such as ET, without altering the circulatory levels of inflammatory cytokines.