Effect of waiting time for COVID-19 screening on postoperative outcomes of type A aortic dissection: An institutional study.

BACKGROUND: Since November 2020, all patients undergoing emergency surgery at our hospital have been subjected to preoperative reverse transcription polymerase chain reaction (RT-PCR) screening to prevent nosocomial COVID-19 infection, with admission to the operating room requiring a negative result. Herein, we compared the pre- and postoperative outcomes of acute type A aortic dissection surgery before and after implementing the RT-PCR screening for all patients. METHODS: We compared the postoperative results of 105 patients who underwent acute type A aortic dissection emergency surgery from January 2019 to October 2020 (Group I) and 109 patients who underwent the surgery following RT-PCR screening from November 2020 to March 2022 (Group II). RESULTS: The average waiting time from arrival at the hospital to admission to the operating room was 36 and 81 min in Groups I and II, respectively. Ruptured cardiac tamponade was observed preoperatively in 26.6% and 21.1% of Groups I and II patients, respectively. The preoperative waiting time due to RT-PCR screening did not contribute to the cardiac tamponade. Surgical complications such as bleeding (reopened chest), respiratory failure, cerebral neuropathy, or mediastinitis did not increase significantly. The number of deaths 30 days after surgery (Group I = 13 and Group II = 3) showed no significant difference between the groups. There were no cases of nosocomial COVID-19 infections. CONCLUSIONS: Preoperative COVID-19 screening is an important method to prevent nosocomial infections. The associated waiting time did not affect the number of preoperative ruptures or affect postoperative complications or mortality.

A case of successful radiofrequency catheter ablation for atrial tachycardia originating from the inferior vena cava using high-resolution mapping.

A 60-year-old man presented with sustained supraventricular tachycardia. Atrial tachycardia (AT), with the earliest atrial activation (EAA) occurring at the ostium of the coronary sinus, was reproducibly induced. Three-dimensional electroanatomical mapping (3DEAM) using a 3.5-mm distal electrode tip linear catheter (Thermocool) and radiofrequency energy (RF) was performed at the fractionated atrial electrogram site. It preceded at 30 ms to the EAA but did not terminate AT. Further 3DEAM using a multielectrode mapping catheter (Pentaray) demonstrated a centrifugal propagation pattern at the boundary zone between the right atrium and inferior vena cava. RF application here terminated AT, which then became non-inducible.

A rare case of asymptomatic right coronary artery ectasia associated with giant aneurysm.

A rare case of giant coronary artery ectasia associated with coronary artery aneurysm was recognized. A 69-year-old woman presented with an ischemic electrocardiogram changes during a medical check-up. Coronary computed tomography angiography showed right coronary artery (RCA) ectasia associated with a giant aneurysm originating from the distal RCA. She was asymptomatic and exhibited no risk factors, including Kawasaki disease, hypertension, diabetes mellitus or family history. The patient underwent surgery for giant coronary aneurysms to prevent rupture. The aneurysm was on the peripheral side of the right coronary artery; hence, coronary artery bypass was not performed. The patient's postoperative course was uneventful. Histopathological examination of the aneurysm revealed degeneration due to atherosclerosis. She was prescribed warfarin and aspirin for thrombus prevention.

[Four Times Aortic Valve Replacement for Recurrent Aortic Annulus Destruction Due to Behçet's Disease:Report of a Case].

Surgical results of aortic regurgitation with Behcet's aortitis is associated with high morbidity and mortality due to risk of annular dehiscence. Here we describe a case of severe aortic regurgitation with Behcet's disease in 51-year-old man who underwent aortic valve replacement and subannular patch reconstruction for suspected infectious endocarditis with severe aortic regurgitation and subannular abcess. Then we performed three times aortic valve replacement for recurrent prosthetic valve dehiscence. Before the fourth operation, the patient was diagnosed with Behcet's disease and given immunosuppressant. Postoperative course was uneventful and he was discharged on postoperative day 59th, and doing well.

Hybrid treatment of a giant coronary artery aneurysm in a patient with immunoglobulin G4-related disease.

A 62-year-old man was diagnosed with a giant coronary artery aneurysm associated with immunoglobulin G4 (IgG4)-related disease. He had previously undergone two thoracic operations with sternotomies and abdominal aortic aneurysm repair for IgG4-related aortopathy. We opted for hybrid open and endovascular repair to reduce risk and avoid complications of a resternotomy and extracorporeal circulation. This first successful case of hybrid repair of a giant coronary artery aneurysm shows that the procedure is safe and feasible in patients with IgG4-related vasculopathy. It is critical to carefully monitor these patients for the occurrence of new IgG4-related aneurysms and other manifestations of vasculopathy.

Post-myocardial infarction left ventricular septal dissecting aneurysm: a case report.

BACKGROUND: Post-infarction perforation of the ventricular septum is recognized as a major complication of post-myocardial infarction. However, post-infarction ventricle dissection is seldom reported, as the ventricular shunt often accompanying this condition is a significant cause of cardiogenic shock. We encountered a rare case of ventricular dissection unaccompanied by a shunt, which caused a state of shock. CASE PRESENTATION: A 67-year-old man was diagnosed with acute myocardial infarction with a left ventricular oozing rupture. The occlusion of the left anterior descending artery was aspirated, followed by drainage of the pericardial bleeding and hemostasis of the left ventricle. After 15 h, he presented with sudden cardiogenic shock requiring extra-corporeal membrane oxygenation. The transesophageal echocardiogram showed a left ventricular septal aneurysm. Five days later, he underwent an operation, in which a ventricular septal wall dissection with a tear-forming large pseudoaneurysm was found. The tear was closed with a patch. He was weaned off extra-corporeal membrane oxygenation the next day. Αfter 4 months, he was discharged in a stable condition. CONCLUSIONS: Recognizing and identifying the cause of cardiogenic shock after myocardial infarction is crucial to provide the best treatment and surgical approach. Ventricular septal dissection should be considered, in addition to the usual complications, such as possible papillary muscle rupture, cardiac rupture, and perforation of the interventricular septum.

Intravenous magnesium sulfate as a preanesthetic medication: A double-blind study on its effects on hemodynamic stabilization at the time of tracheal intubation.

The effects of magnesium sulfate (MgSO4) as a preanesthetic medication were studied with regard to whether it can sedate or relieve a patient who is scheduled to undergo surgery, and whether it can control the hemodynamic response to tracheal intubation. Twenty adult patients in ASA status 1-2 undergoing elective surgery were studied. Ten patients received 50 mg·g-1 MgSO4 intravenously by drip infusion from 30 min before the induction of anesthesia, and another ten patients received saline as a control. The changes in mean arterial pressure (MAP) and rate pressure product (RPP) after the intubation were significantly suppressed in magnesium-treated patients, but a sedative effect was not observed. Therefore, MgSO4 was useful as a preanesthetic medication in suppressing the hemodynamic response associated with tracheal intubation.