RESUMEN
Retroperitoneal sarcoma (RPS) is a rare disease. RPS invading the abdominal aorta is exceedingly rare and has a poor prognosis. There have been scattered cases of RPS treated with combined abdominal aortic replacement. However, the average survival time for these cases was only 8 months, with a 2-year survival rate of 21%, indicating a poor prognosis. In this case study, a 44-year-old man presented to our hospital complaining of abdominal pain. Multiple imaging findings suggested a retroperitoneal mass that was diagnosed as a malignant tumor. The patient underwent tumor resection with abdominal aortic replacement due to an RPS tumor invading the abdominal aorta. The histopathological grade was determined to be grade 3, the most malignant grade tumor, according to the Fédération Nationale des Centres de Lutte Contre le Cancer grading system. Postoperative chemotherapy with doxorubicin and ifosfamide was administered for five cycles. The patient has been alive for over 8 years after the operation without any recurrence. This case presents a long-term survival of RPS requiring abdominal aortic replacement.
RESUMEN
The aVR sign characterized by ST-segment elevation in lead aVR and diffuse ST-segment depression on the electrocardiogram indicates potential life-threatening conditions. We report the case of a 53-year-old male with a history of ascending aortic replacement for acute aortic dissection, who presented to our institution in shock. The initial electrocardiogram revealed the aVR sign, consisting of ST-segment elevation in lead aVR and ST-segment depression in leads II, III, aVF, and V3-6, leading to the initiation of salvage veno-arterial extracorporeal membrane oxygenation (ECMO) due to deteriorating hemodynamics. The aVR sign resolved shortly after ECMO initiation, and hemodynamics stabilized even with reduced ECMO flow. Subsequent coronary angiography showed no impaired coronary perfusion, whereas contrast-enhanced CT revealed severe supra-valvular stenosis due to pseudoaneurysm-induced graft kinking. The patient was then managed with emergency surgery for the pseudoaneurysm. In this report, we encountered a salvaged case of critical circulatory failure presenting with the aVR sign due to severe graft kinking caused by pseudoaneurysm formation.
RESUMEN
PURPOSE: Achieving a secure anastomosis and complete hemostasis is essential for surgically treating type A acute aortic dissection (TAAAD). This study assessed the clinical feasibility of "tailored stand-up collar (TSC)" technique for constructing the distal stump. METHODS: We enrolled 68 patients who underwent ascending aortic repair for TAAAD. Patients were categorized according to the technique for distal stump construction: conventional (C) group using only a felt strip (32 cases); post-aortotomy (P) group, with a Hydrofit-felt strip attached after aortotomy (18 cases), and TSC group, where a Hydrofit-felt strip attached during cooling (18 cases). Pre-operative characteristics, procedural profiles, and post-operative outcomes were evaluated. RESULTS: The pre-operative characteristics were identical among the groups. The durations of cardiopulmonary bypass, hemostasis, and surgery were significantly shorter in the P and TSC groups. The duration of open distal in the TSC group (21 min) was significantly shorter than the other two groups. Post-operative additional procedures were not required for the TSC group and their post-operative hospital stay was significantly shorter (47.1% of patients were discharged within 2 weeks). CONCLUSION: The TSC technique would be practical because of its high reproducibility in terms of ease of use, shorter anastomotic time, and secure hemostasis.
Asunto(s)
Disección Aórtica , Implantación de Prótesis Vascular , Estudios de Factibilidad , Tiempo de Internación , Humanos , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Femenino , Masculino , Resultado del Tratamiento , Persona de Mediana Edad , Anciano , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Factores de Tiempo , Enfermedad Aguda , Estudios Retrospectivos , Tempo Operativo , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Adulto , Complicaciones Posoperatorias/etiologíaRESUMEN
We describe our first experience with the Triolifter (Fuji Systems, Yokohama, Japan) in cardiac surgery. The Triolifter is a less expensive, novel organ fixation device developed as a fixation indenter mainly for traction of the lung under video-assisted surgery and is now available in Japan. An 84-year-old man diagnosed with unstable angina pectoris underwent emergency coronary artery bypass grafting (CABG) under cardiac arrest. Following the declamping of the aorta and the resumption of the beating heart, bleeding from the left anterior descending artery (LAD) anastomosis site was observed. The Triolifter was used as a heart positioner to expose the anastomosis site for hemostasis in the setting of an on-pump beating heart. Hemostasis of the posterior descending artery (PDA) anastomosis site could also be confirmed by traction of the right ventricular anterior wall using the Triolifter. It could be effectively and safely used with neither significant subepicardial hematoma nor epicardial injury. In Japan, the Triolifter might be used as one of the insurance-covered devices in off-pump CABG in the future, but globally, it could also be used in on-pump CABG without hesitation because it is so inexpensive.
RESUMEN
Double rupture is a very rare, and life-threatening complication after acute myocardial infection (AMI), which defined as the coexistence of any two of the three types of rupture include left ventricular free wall repture (LVFWR), ventricular septal perforation (VSP) and papillary muscule repture (PMR). We report here a case of successful staged repair of double rupture combined LVFWR and VSP. A 77-year-old woman with diagnosis of AMI in the anteroseptal area fell into cardiogenic shock suddenly just before starting coronary angiography. Echocardiography showed left ventricular free wall rupture, then an emergent operation was performed under intraaortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS) assistance using bovine pericardial patch and felt sandwich technique. Intraoperative transesophageal echocardiography revealed ventricular septal perforation on the apical anterior wall. Her hemodynamic condition was stable, therefore we selected a staged VSP repair to avoid surgery on freshly infarcted myocardium. Twenty-eight days after the initial operation, VSP repair was performed using the extended sandwich patch technique via right ventricle incision. Postoperative echocardiography revealed no residual shunt.
Asunto(s)
Rotura Cardíaca , Infarto del Miocardio , Rotura Septal Ventricular , Humanos , Femenino , Animales , Bovinos , Anciano , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/etiología , Rotura Septal Ventricular/cirugía , Infarto del Miocardio/complicaciones , Infarto del Miocardio/cirugía , Rotura Cardíaca/diagnóstico por imagen , Rotura Cardíaca/etiología , Rotura Cardíaca/cirugía , Choque Cardiogénico , Angiografía CoronariaRESUMEN
Stanford type A acute aortic dissection after off-pump coronary artery bypass grafting( OPCAB) is a rare but potentially fatal complication. A 61-year-old man with subacute Stanford type B aortic dissection underwent a triple OPCAB using an automated proximal anastomotic device. On postoperative day 4, he had a sudden syncope. An enhanced computed tomography (CT) scan revealed Stanford type A acute aortic dissection. He underwent emergent total aortic arch replacement along with an open stent graft deployment. The entry of the dissection was located at the proximal anastomosis site of the vein graft. This case demonstrates that this device should be used carefully in patients with a history of Stanford type B aortic dissection.
Asunto(s)
Disección Aórtica , Puente de Arteria Coronaria Off-Pump , Anastomosis Quirúrgica , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Puente de Arteria Coronaria , Humanos , Masculino , Persona de Mediana Edad , StentsRESUMEN
A 48-year-old woman who was diagnosed with Turner syndrome in her childhood presented with sudden onset of low back pain and respiratory discomfort. Contrast enhanced computed tomography scan revealed Stanford type A acute aortic dissection with persistent left superior vena cava (PLSVC). Emergency ascending aortic replacement was performed. After cardiopulmonary bypass was established through cannulating right femoral artery and right superior vena cava, inferior vena cava, another venous cannula was directly placed into the left superior vena cava. After core cooling, the right atrium was incised for retrograde cardioplegia. At a tympanic temperature of 25 â, circulatory arrest was started and retrograde cerebral perfusion was performed through right and left superior vena cava. Her postoperative course was uneventful.
Asunto(s)
Disección Aórtica , Vena Cava Superior Izquierda Persistente , Síndrome de Turner , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Niño , Femenino , Paro Cardíaco Inducido/métodos , Humanos , Persona de Mediana Edad , Síndrome de Turner/complicaciones , Vena Cava SuperiorRESUMEN
An 82-year-old man underwent total aortic arch replacement with a 24 mm Triplex four-branched graft for aortic arch aneurysm. After two years, he was diagnosed with pseudoaneurysms due to bleeding from a non-anastomotic site of the branch graft to the left common carotid artery and minor leakage from a distal anastomotic site of the main graft. A self-expandable Fluency covered stent and cTAG thoracic endograft were used for the aneurysm. After four years, he was referred to our hospital with a complaint of pulsatile swelling of the anterior chest wall. Contrast enhanced computed tomography (CT) revealed a pseudoaneurysm arising from a non-anastomotic site of the branch graft to the left common carotid artery, which extended into the anterior chest wall and the skin through the sternum. He underwent emergency endovascular repair using a Niti-S ComVi covered stent. The postoperative course was uneventful. Postoperative CT showed shrinkage of the pseudoaneurysm. The patient was discharged and required no reintervention during the follow-up.
Asunto(s)
Aneurisma Falso , Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Humanos , Masculino , Stents , Esternón , Resultado del TratamientoRESUMEN
A 72-year-old man was referred to our hospital for the suspicion of ruptured abdominal aortic aneurysm. Before admission, he was suspected of having a malignant lymphoma and underwent excisional biopsy in his right groin. A contrast enhanced computed tomography scan revealed a massive retroperitoneal hematoma with an extravasation arising from the infrarenal abdominal aorta coexisting with an extensive retroperitoneal mass surrounding the aorta. An emergency endovascular aneurysm repair was performed and the postoperative course was uneventful. After the treatment, histological examination of the previous biopsy confirmed the diagnosis of mantle cell lymphoma.
RESUMEN
Mitral valve replacement with preservation of the mitral leaflets and subvalvular apparatus is considered to maintain left ventricular geometry and function and reduce the risk of myocardial rupture. However, the routine use of this technique may lead to early complications such as left ventricular outflow tract obstruction and even mitral inflow obstruction, requiring reoperation. We describe a rare case of bioprosthetic mitral valve dysfunction caused by a native valve preserving procedure.
Asunto(s)
Bioprótesis , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/etiología , Válvula Mitral/cirugía , Falla de Prótesis , Anciano , Remoción de Dispositivos , Ecocardiografía Doppler en Color , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/cirugía , Diseño de Prótesis , Reoperación , Resultado del TratamientoRESUMEN
This report describes a case of synchronous left atrial myxomas from Carney complex resected through a right thoracotomy. The patient was a 30-year-old female that had previously been diagnosed with Carney complex following a genetic examination. Preoperative echocardiography showed a left atrial tumor, but intraoperative inspection revealed another tumor in the left atrium. Carney complex was first described in the 1980s and cardiac myxoma from Carney complex can occur in any cardiac chamber, presenting multiple times with postoperative recurrences, occurring at any age and without any predilection for gender, and is inherited in an autosomal-dominant manner. Treatment for cardiac myxoma from Carney complex is very important for patient mortality and morbidity and, despite the endocrine nature of the disorder, cardiologists and cardiac surgeons play an important role.
Asunto(s)
Complejo de Carney/cirugía , Neoplasias Cardíacas/cirugía , Mixoma/cirugía , Neoplasias Primarias Múltiples/cirugía , Toracotomía/métodos , Adulto , Complejo de Carney/diagnóstico por imagen , Complejo de Carney/patología , Ecocardiografía , Femenino , Atrios Cardíacos , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/patología , Humanos , Mixoma/diagnóstico por imagen , Mixoma/patología , Resultado del TratamientoRESUMEN
A 55-year-old male with an intermittent high-grade fever was diagnosed with infective endocarditis. He was indicated for surgery because periodic echocardiography revealed worsening mitral regurgitation and growing vegetation despite medication. An aneurysm of the P2 portion and all vegetations were removed via quadrangular resection of the P2 leaflet, and then the defect was repaired. An intraoperative assessment identified Staphylococcus lugdunensis as the causative bacterium. After postoperative antibiotic therapy for 5 weeks, the patient was discharged without either mitral regurgitation or signs of infection. Infective endocarditis caused by aggressive and destructive S. lugdunensis should be promptly and accurately treated via a surgical approach that prevents progressive tissue destruction and simplifies the surgical procedure for repair, rather than replacement.
Asunto(s)
Endocarditis/microbiología , Endocarditis/cirugía , Anuloplastia de la Válvula Mitral/métodos , Insuficiencia de la Válvula Mitral/cirugía , Infecciones Estafilocócicas , Staphylococcus lugdunensis , Endocarditis/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/etiología , Resultado del TratamientoRESUMEN
A 73-year-old man with a severely stenosed bicuspid valve and an aneurysm of the ascending aorta underwent valve and aortic surgery. Preoperative imaging revealed a single coronary artery arising from the right side of the sinus of Valsalva and a branch that perfused into the left side of the heart to pass through the front of the pulmonary artery. We replaced the aortic valve and ascending aorta, painstakingly avoiding damage to the coronary artery and obstruction of the sole coronary ostium.
Asunto(s)
Aorta/cirugía , Aneurisma de la Aorta/cirugía , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Implantación de Prótesis Vascular , Anomalías de los Vasos Coronarios , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Anciano , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico , Enfermedad de la Válvula Aórtica Bicúspide , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico , Ecocardiografía Transesofágica , Enfermedades de las Válvulas Cardíacas/diagnóstico , Humanos , Masculino , Seno Aórtico , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To compare vascular measurements to determine stent types and configurations for abdominal endovascular aneurysm repair (EVAR) by comparing results of contrast material-enhanced computed tomographic (CT) angiography and nonenhanced magnetic resonance (MR) angiography. MATERIALS AND METHODS: This prospective study was institutional review board approved, and all patients provided written informed consent. Fifty patients (45 men and five women; mean age, 76.0 years) admitted for elective abdominal EVAR underwent preoperative abdominal CT angiography (triplanar reformatted images; section thickness of 1-3 mm) and nonenhanced MR angiography (triplanar two-dimensional single-shot turbo field-echo images; section thickness of 6 mm). Two observers independently completed standard measurement and device selection forms for endovascular stent planning for CT and MR angiography. Pearson and intraclass correlation coefficients were calculated to evaluate intermodality and interobserver differences. RESULTS: No significant difference was found in aortic neck diameter (observer 1: CT, 18.5 mm; MR, 19.0 mm; P = .43) (observer 2: CT, 19.6 mm; MR, 19.3 mm; P = .59), aortic neck diameter 15 mm distal to the lowest renal artery (observer 1: CT, 19.2 mm; MR, 19.2 mm; P = .38) (observer 2: CT, 19.6 mm; MR, 19.6 mm; P = .91), aortic neck length (observer 1: CT, 43.6 mm; MR, 43.6 mm; P = .85) (observer 2: CT, 44.4 mm; MR, 44.0 mm; P = .93), or other key vascular measurements (P = .23-.99) for preoperative planning. These included aneurysm diameter, lowest renal artery to aortic bifurcation length, aortic bifurcation diameter, common iliac artery diameters, external iliac artery diameters, length between orifices of lower renal and internal iliac arteries, and iliac artery sealing length. CT and MR angiography measurements showed very strong correlation (r = 0.92-0.99). Intraclass correlation coefficients between observers ranged from 0.90 to 0.98. Stent types and configurations determined with CT measurements remained unaltered when reassessed with MR measurements. CONCLUSION: Measurements obtained with nonenhanced MR angiography appear equally accurate to those of CT angiography in the preoperative planning of abdominal EVAR.
Asunto(s)
Aneurisma de la Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares , Angiografía por Resonancia Magnética/métodos , Stents , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Angiografía/métodos , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Medios de Contraste , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios ProspectivosRESUMEN
A 68-year-old man underwent double-valve replacement (DVR) for active infective endocarditis caused by Enterococcus faecalis. Postoperative coronary angiography (CAG) revealed a saccular aneurysm originating from the distal portion of LMCA with severe stenosis at the ostium of the left anterior descending (LAD) artery and left circumflex artery (LCx). Emergent surgical resection with concomitant coronary artery bypass grafting were performed.Mycotic coronary artery aneurysms have a great tendency to rupture, and this may result in cardiac tamponade and sudden death. Early recognition and prompt surgical intervention is mandatory to minimize those fatal complications.
Asunto(s)
Aneurisma Infectado/microbiología , Válvula Aórtica/cirugía , Aneurisma Coronario/microbiología , Endocarditis Bacteriana/cirugía , Enterococcus faecalis/aislamiento & purificación , Infecciones por Bacterias Grampositivas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Válvula Mitral/cirugía , Anciano , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/cirugía , Antibacterianos/uso terapéutico , Válvula Aórtica/microbiología , Aneurisma Coronario/diagnóstico , Aneurisma Coronario/cirugía , Angiografía Coronaria , Puente de Arteria Coronaria , Diagnóstico Precoz , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Válvula Mitral/microbiología , Valor Predictivo de las Pruebas , Reoperación , Resultado del TratamientoRESUMEN
Acute type A aortic dissection in a patient with persistent with left superior vena cava is a very rare condition. There are some technical problems encountered during cardiovascular surgery in such a patient. We describe successful repair of acute type A aortic dissection complicated persistent with left superior vena cava, and the technical difficulties encountered during surgery.
Asunto(s)
Aneurisma de la Aorta Torácica/complicaciones , Disección Aórtica/complicaciones , Vena Cava Superior/anomalías , Enfermedad Aguda , Anciano , Disección Aórtica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Femenino , HumanosRESUMEN
We describe a case of a 64-year-old man with constrictive pericarditis of unusual anatomy. Preoperative investigations revealed the thickened and calcified pericardial ring encircling the right and left ventricular cavity at the level of the atrioventricular (AV) groove and crossing the left anterior descending coronary artery, leading to strangulation of the heart. Off-pump complete pericardiectomy was performed successfully. The patient's postoperative course was uneventful.
Asunto(s)
Pericardiectomía/métodos , Pericarditis Constrictiva/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
This case report describes a right subclavian artery aneurysm secondary to long-term repetitive blunt trauma. A 62-year-old man with a right subclavian artery aneurysm had had a history of bird hunting using a shotgun that impacted substantially against his right clavicula and shoulder weekly for >20 years. The patient underwent open repair with partial sternotomy and distal balloon control. The aneurysmal sac was resected, and the right subclavian artery was reconstructed with a primary end-to-end anastomosis. Histopathologic examination of the resected aneurysmal wall revealed that all three layers of the arterial wall were comparatively intact, with fibrosis and lipid deposition in the intima and in various degrees of degeneration in the media, suggesting a true aneurysm.
Asunto(s)
Aneurisma/cirugía , Traumatismos en Atletas/cirugía , Trastornos de Traumas Acumulados/cirugía , Arteria Subclavia , Heridas no Penetrantes/cirugía , Anastomosis Quirúrgica , Aneurisma/diagnóstico por imagen , Traumatismos en Atletas/diagnóstico por imagen , Trastornos de Traumas Acumulados/diagnóstico por imagen , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico por imagenRESUMEN
The optimal surgical management of patients with concomitant abdominal aortic aneurysm (AAA) and gastrointestinal malignancy remains controversial. A 79â year-old man who presented with hematemesis was found to have advanced gastric cancer concomitant with infrarenal AAA. The patient underwent simultaneous endovascular aneurysm repair (EVAR) and distal gastrectomy. The postoperative course was uneventful. The present case illustrates the clinical utility of EVAR for the high-risk patient with concomitant AAA and gastrointestinal malignancy.
RESUMEN
Endovascular repairs of thoracic and thoracoabdominal aortic aneurysm have recently been proposed as a less invasive alternative to conventional open surgical repair. In selective cases, adjunctive bypass surgery may be required to provide an adequate landing zone. We describe a case of staged hybrid debranching and thoracic endovascular aneurysm repair for distal aortic arch and thoracoabdominal aortic aneurysms after conventional open repair of the descending aorta.