Asunto(s)
Leiomioma/cirugía , Neoplasias Vasculares/cirugía , Adulto , Ecocardiografía , Femenino , Atrios Cardíacos , Humanos , Vena Ilíaca , Leiomioma/diagnóstico por imagen , Leiomioma/patología , Neoplasias Vasculares/diagnóstico por imagen , Neoplasias Vasculares/patología , Procedimientos Quirúrgicos Vasculares/métodos , Vena Cava InferiorRESUMEN
An aberrant right subclavian artery from the descending aorta is almost always reported as an isolated anomaly. We present the case of a four-year-old child with an anomalous origin of the right subclavian artery from the descending aorta, associated with an ostium secundum atrial septal defect. The patient underwent simultaneous repair of both the anomalies through median sternotomy, with implantation of the subclavian artery into the right common carotid artery. We believe that median sternotomy is the optimal surgical approach for the management of these lesions. Other operative approaches are also discussed.
Asunto(s)
Ecocardiografía , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Mixoma/diagnóstico por imagen , Mixoma/cirugía , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/cirugía , Procedimientos Quirúrgicos Cardiovasculares/métodos , Femenino , Neoplasias Cardíacas/complicaciones , Humanos , Persona de Mediana Edad , Mixoma/complicaciones , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Embolia Pulmonar/etiología , Resultado del TratamientoRESUMEN
Congenital absence of pericardium is rarely seen, often diagnosed intraoperatively during cardiac and thoracic surgeries. Left-sided pericardial defects are more common than right-sided ones. We present a case of an incidentally detected congenital absence of right pericardium with herniation of part of the right lung during ventricular septal defect closure surgery in a male child aged 4 years.
Asunto(s)
Neoplasias Cardíacas/diagnóstico , Pericardio/patología , Derrame Pleural Maligno/patología , Arteria Pulmonar , Rabdomiosarcoma/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Neoplasias Vasculares/patología , Adolescente , Biopsia/métodos , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Imagen por Resonancia Cinemagnética/métodos , Invasividad Neoplásica , Pericardio/diagnóstico por imagen , Derrame Pleural Maligno/diagnóstico por imagen , Neoplasias Vasculares/diagnóstico por imagenRESUMEN
A case of a 16-year-old female with tetralogy of Fallot and absent pulmonary valve is presented, who on coronary angiography and computerized tomography (CT) angiography had severe compression of the left main coronary artery by the dilated main pulmonary artery. The patient was successfully managed by surgical correction of the intracardiac defect, with right ventricular outflow tract reconstruction by the Contegra(®) bovine jugular vein conduit.
Asunto(s)
Aneurisma/complicaciones , Estenosis Coronaria/etiología , Atresia Pulmonar/complicaciones , Tetralogía de Fallot/complicaciones , Anomalías Múltiples , Adolescente , Aneurisma/congénito , Aneurisma/cirugía , Angiografía , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/cirugía , Diagnóstico Diferencial , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Atresia Pulmonar/diagnóstico , Atresia Pulmonar/cirugía , Tetralogía de Fallot/diagnóstico , Tomografía Computarizada por Rayos X , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
BACKGROUND: The ideal management of aortic stenosis in patients with a small aortic root remains controversial. Reports of adverse effects of patient-prosthesis mismatch (PPM) from a small-sized valve have to be weighed against the increased morbidity and mortality of aortic root enlargement procedures. METHODS: The present study retrospectively reviewed and compared clinical data of patients with predominant aortic stenosis with small aortic root (n = 209) who underwent isolated aortic valve replacement without (AVR group, n = 162) or with aortic root enlargement (AVR + ARE group, n = 47) using a single prosthesis type between January 2002 and June 2008 to assess their effect on perioperative outcomes. RESULTS: The in-hospital mortality (4.28% in AVR + ARE vs. 3.08% in AVR group) and other perioperative outcomes were similar in both the groups. Although patients of the AVR + ARE group had a greater degree of left-ventricular (LV) mass regression (-41.3 ± 32.1 vs. -21.5 ± 37.4) in the follow-up period at 12 months, there was no significant difference in functional outcome. Patients with severe postoperative PPM (indexed effective orifice area ≤0.65 cm²/m² body surface area) showed increased perioperative mortality (9.52 vs. 1.85%) and less regression of LV mass (-13.2.8 ± 27.1 vs. -27.6 ± 31.9), higher transvalvular gradient and were more symptomatic at 12-month follow-up (New York Heart Association class 1.44 ± 0.41 vs. 1.22 ± 0.28) compared to those who were having only mild to moderate PPM (indexed effective orifice area > 0.65). CONCLUSION: ARE procedures are invaluable techniques in surgical management of small aortic root patients and can be used without significantly increasing early morbidity and mortality, particularly in those cases in which AVR with a small prosthesis will lead to severe PPM.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Adulto , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Distribución de Chi-Cuadrado , Ecocardiografía Doppler , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Mortalidad Hospitalaria , Humanos , India , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
Occurrence of left ventricular aneurysm outside the realm of ischemic heart disease is uncommon and one following an iatrogenic trauma is very rare. We describe one such case of left ventricular pseudoaneurysm developing following pericardiocentesis and presenting one year after the procedure, and its successful surgical management.
Asunto(s)
Aneurisma Falso/diagnóstico , Ventrículos Cardíacos/patología , Enfermedad Iatrogénica , Pericardiocentesis/efectos adversos , Disfunción Ventricular Izquierda/diagnóstico , Adulto , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Femenino , Ventrículos Cardíacos/cirugía , Humanos , Factores de Tiempo , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/cirugíaAsunto(s)
Tabique Interatrial , Procedimientos Quirúrgicos Cardíacos/métodos , Puente Cardiopulmonar/métodos , Equinococosis/cirugía , Cardiopatías/cirugía , Adolescente , Diagnóstico Diferencial , Equinococosis/diagnóstico , Ecocardiografía , Estudios de Seguimiento , Cardiopatías/diagnóstico , Cardiopatías/parasitología , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Angiography in a 14-year-old boy with cyanosis since birth confirmed the diagnosis of tetralogy of Fallot with a subaortic ventricular septal defect, large overriding aorta, severe pulmonary stenosis, and a large collateral arising from the left circumflex artery. The collateral was isolated and ligated at its origin, and the patient underwent an uneventful repair with ventricular septal defect patch closure, infundibular resection, pulmonary valvotomy, and right ventricular outflow tract reconstruction with an autologous pericardial patch.
Asunto(s)
Circulación Colateral/fisiología , Anomalías de los Vasos Coronarios/cirugía , Tetralogía de Fallot/cirugía , Adolescente , Aorta/anomalías , Aorta/fisiopatología , Anomalías de los Vasos Coronarios/fisiopatología , Defectos del Tabique Interventricular/fisiopatología , Defectos del Tabique Interventricular/cirugía , Humanos , Masculino , Pericardio/trasplante , Estenosis de la Válvula Pulmonar/fisiopatología , Estenosis de la Válvula Pulmonar/cirugía , Tetralogía de Fallot/fisiopatología , Trasplante AutólogoRESUMEN
Dehiscence of the sternum is a serious and potentially devastating complication. The purpose of this prospective study was to determine whether a prophylactic sternal weave would decreased the incidence of noninfective sternal dehiscence, compared to routine sternal closure, in a high-risk group. Between 2000 and 2007, 200 patients undergoing median sternotomy for cardiac surgery, with one or more risk factors including New York Heart Association functional class III/IV, chronic obstructive pulmonary disease, osteoporosis, obesity, and off-midline sternotomy, were randomly assigned to group A (sternal weave closure, 100 patients) or group B (routine sternal wire closure, 100 patients). No patient in either group with a single risk factor had sternal dehiscence. The incidence of noninfective sternal dehiscence was significantly less in group A than group B in patients with 2 or more risk factors (2.5% vs. 12.5%). Routine sternal closure is sufficient in patients with a single risk factor, whereas a prophylactic sternal weave should be carried out in all patients with 2 or more risk factors, to decrease postoperative morbidity.
Asunto(s)
Hilos Ortopédicos , Procedimientos Quirúrgicos Cardíacos/instrumentación , Esternón/cirugía , Dehiscencia de la Herida Operatoria/prevención & control , Cicatrización de Heridas , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Selección de Paciente , Estudios Prospectivos , Reoperación , Medición de Riesgo , Factores de Riesgo , Dehiscencia de la Herida Operatoria/etiología , Dehiscencia de la Herida Operatoria/mortalidad , Resultado del TratamientoRESUMEN
Thrombogenicity of blood is known to have seasonal variations. The clinical implications of seasonal variations in the anticoagulation profile of patients with mechanical valves was assessed. Data of patients implanted with a mechanical heart valve for more than 3 months were collected at follow-up or on presentation to the emergency department. The mean time from the previous follow-up examination was 3.6 +/- 0.3 months. The number of patients with an international normalized ratio >3.5 and the incidence of hemorrhagic events peaked in hottest part of the year (June-July), with 128 cases of prolonged clotting and 43 hemorrhagic events in this period. The number of patients with rapid clotting and the incidence of embolic events peaked in coldest part of the year (December-January), with 120 cases of international normalized ratio <1.5 and 37 embolic events in this period. There was a significant correlation between temperature and thrombogenicity in patients with prosthetic heart valves on long-term anticoagulation.