RESUMO
Carotid revascularization surgery is notorious for its neurological morbimortality. We report the case of a 74-year-old hypertensive patient, who underwent left internal carotid artery endarterectomy for a 90% stenosis under general anesthesia, presenting in the immediate postoperative period with right hemiplegia without consciousness disorders. Evaluation by cerebral ultrasound at bedside led to suspicion of intracerebral hemorrhage, which was confirmed by cerebral CT scan. The patient was treated by neuroresuscitation measures in the absence of the possibility of surgical intervention. This hemorrhage may be explained by a reperfusion injury due to the loss of cerebral autoregulation of these vessels, the loss of controlling blood pressure, and the use of heparin in vascular surgery. This is a rare but fatal complication with a high mortality rate.
RESUMO
INTRODUCTION: Total occlusion of the left main coronary artery is a very rare finding in coronary angiography because of its highly lethal nature. Right coronary artery dominance and extensive collateral circulation are the principal determinant factors of survival after total occlusion of the left main coronary artery. The impact on the left ventricle is often significant with a profound alteration of its systolic function. CASE PRESENTATION: We describe a 52-year-old North African man, a tobacco smoker, who presented symptoms of unstable angina related to a total chronic occlusion of his left main coronary artery with a right coronary artery stenosis. Unexpectedly, the impact on his left ventricle was absent with normal dimensions and systolic function. He underwent a successful on-pump coronary artery bypass grafting with uneventful postoperative course and good recovery. CONCLUSIONS: Total occlusion of the left main coronary artery is a rare condition, the fact that the left ventricle retains a normal size and systolic function makes it exceptional, which must be kept in mind to avoid dangerous examinations and delayed treatment. Coronary artery bypass surgery should be considered the main treatment of total chronic occlusion of the left main coronary artery.
Assuntos
Angina Instável/diagnóstico por imagem , Angiografia Coronária , Circulação Coronária/fisiologia , Doença das Coronárias/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Angina Instável/fisiopatologia , Angina Instável/cirurgia , Ponte de Artéria Coronária , Doença das Coronárias/fisiopatologia , Doença das Coronárias/cirurgia , Estenose Coronária/fisiopatologia , Estenose Coronária/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
We report a case of persistence of the 5th aortic arch associated with total interruption of the aortic arch. This clinical case shows the diagnostic pitfall of the persistence of the 5th aortic arch and its beneficial hemodynamic effect. Preoperative clinical picture was misleading, due to the persistence of femoral pulses and clinical signs of left-to-right shunt via a wide ductus arteriosus. The diagnosis was intraoperatively adjusted on the basis of blood pressure monitoring using catheter placed into the femoral artery.
Assuntos
Aorta Torácica/anormalidades , Doenças da Aorta/diagnóstico , Permeabilidade do Canal Arterial/diagnóstico , Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Cateterismo Cardíaco/métodos , Criança , Feminino , Artéria Femoral , HumanosRESUMO
INTRODUCTION: Cardiac surgery is frequently needed during active phase of infective endocarditis (IE). The purpose of this study was to analyze the immediate and late results and determine the risk factors for death. METHODS: We retrospectively reviewed 101 patients with IE operated in the active phase. The mean age was 40.5 ± 12.5 years. 16 patients (15.8%) were diagnosed with prosthetic valve endocarditis (PVE). 81 (80.9%) were in NYHA functional class III-IV. Blood cultures were positive in only 24 cases (23.9%). RESULTS: in-hospital mortality rate was 17.9% (18 cases). Multivariate analysis indentified five determinant predictor factors: congestive heart failure (CHF), renal insufficiency, high Euroscore, prolonged cardiopulmonary bypass time (> 120 min) and long ICU stay. The median follow-up period was 4.2 (2-6.5) years. Overall survival rate for all patients who survived surgery was 97% at 5 years and 91% at 10 years. CONCLUSION: Despite high in-hospital mortality rate, when patients receive operation early in the active phase of their illness, late outcome may be good.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Endocardite/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Adulto , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Infecções Relacionadas à Prótese/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Ponte Cardiopulmonar/métodos , Diabetes Mellitus Tipo 2/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Marrocos , Respiração Artificial/estatística & dados numéricos , Estudos RetrospectivosRESUMO
We report a 72 year-old man who presented symptoms of right heart failure and patent superior vena cava syndrome related to a huge ascending aortic aneurysm with a maximal diameter at 11 cm. The patient underwent a successful surgical repair by a modified Bentall operation with good recovery.
Assuntos
Aorta/cirurgia , Aneurisma Aórtico , Insuficiência Cardíaca , Síndrome da Veia Cava Superior , Idoso , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Radiografia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/cirurgiaRESUMO
Central venous catheterisation is a common procedure in intensive care and hemodialysis units. Tunnelled catheters of hemodialysis are a great contribution for patients for whom an arteriovenous fistula is not feasible, especially for prolonged use. However, multiple complications have been described from their practice. Through a case of perforation of the left brachio-cephalic vein with a venous catheter for dialysis and a review of the literature, the authors discuss the mechanisms and ways to prevent this complication.
Assuntos
Veias Braquiocefálicas/lesões , Cateteres de Demora/efeitos adversos , Diabetes Mellitus Tipo 1/complicações , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Diálise Renal/instrumentação , Fatores de RiscoRESUMO
PURPOSE: This study was designed to compare videolaryngoscopy with direct laryngoscopy with respect to ease of intubation when inserting a double lumen tube (DLT). METHODS: In this prospective randomized study 68 patients American Society of Anesthesiologists (ASA) physical status I and II were included. Patients with criteria indicating possible difficult intubation were excluded. The patients were randomized into two groups, depending on the tool used to facilitate intubation: videolaryngoscope (VL group) or direct laryngoscopy (DL group). The time required for intubation was the primary endpoint. Cormack and Lehane glottic visualization (CL) scores, the need for external laryngeal maneuvers and the number of attempts were measured. RESULTS: Glottic visualization was better in the VL group than in the DL group. The CL scores were I, II and III in 24, eight and two patients, respectively, in the VL group compared with 13, 11 and eight in the DL group (P = 0.025). Patients in the VL group required fewer attempts than the DL group (P = 0.019). Intubation time was 39.9 ± 4.4 sec in the VL group and 47.9 ± 5.4 sec in the DL group (P < 0.001). No intubation failure was noted in group VL compared with two in the DL group (not significant). CONCLUSION: The use of a videolaryngoscope reduces the time required for intubation with a DLT compared with the direct laryngoscopy in elective thoracic surgery.
Assuntos
Intubação Intratraqueal/instrumentação , Laringoscópios , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Gravação em VídeoRESUMO
The effects of cardiopulmonary bypass on patients who have active or dormant malaria are unknown. What is known is that malaria-induced hemolysis can be exacerbated by cardiopulmonary bypass. We report 3 cases in which patients with active or dormant malaria underwent open-heart surgery. Two of them received quinine prophylaxis, and the 3rd patient (who presented with an active infection) received longer-term preoperative treatment with quinine. In all 3 cases, the surgery was performed uneventfully. We suggest preoperative quinine prophylaxis for patients with a history of malaria whose blood smears are negative for parasites, and we advocate more radical preoperative treatment with quinine for patients whose blood smears are positive at presentation. These measures appear to prevent hemolysis and fever during both the preoperative and postoperative periods. However, there is need of a multicenter study to ascertain the actual effects of cardiopulmonary bypass on patients with malaria.
Assuntos
Antimaláricos/administração & dosagem , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Hemólise/efeitos dos fármacos , Malária/sangue , Quinidina/administração & dosagem , Criança , Esquema de Medicação , Feminino , Humanos , Malária/complicações , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Medição de Risco , Resultado do TratamentoRESUMO
Between 1972 and 2000, left ventricular false aneurysm was diagnosed in 5 patients. These patients consisted of three man and 2 women, aged between 58 and 70 years. Clinical presentation was characterized by severe heart failure, complicating a posterior myocardial infarction, in 4 patients. Left ventricular angiography, has confirmed the false aneurysm in all patients. Three patients underwent surgical management, with good result in 2 cases (follow-up of 9 and 13 years), and an early postoperative death in one case. Two patients refused surgery and died suddenly. Ischemic myocardial disease, represent the most frequent etiology. Left ventricular false aneurysm prognosis should be improved by emergent surgical management, preventing fatal rupture.