RESUMEN
Continued enlargement of the aneurysm sac after thoracic endovascular aortic repair (TEVAR) is a known risk after endovascular treatment of thoracic aortic aneurysms. For this reason, periodic outpatient follow-up is required to identify situations that require repair. Here, we describe an aortobronchial fistula (ABF) in a patient lost to follow-up, that presented 3 years after an elective TEVAR done for a primary, descending thoracic aortic aneurysm. Our patient arrived in extremis and suffered massive hemoptysis leading to her demise. Computed tomography (CT) angiogram near the time of her death demonstrated a bleeding ABF immediately distal to her previous TEVAR repair. Aortic aneurysmal disease remains life threatening even after repair. Improved endovascular techniques and devices have resulted in decreased need for reintervention. However, this case demonstrates the risk of thoracic aortic disease progression and highlights the importance of establishing consistent, long-term follow-up after TEVAR.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Enfermedades de la Aorta/etiología , Implantación de Prótesis Vascular/efectos adversos , Fístula Bronquial/etiología , Procedimientos Endovasculares/efectos adversos , Fístula Vascular/etiología , Anciano de 80 o más Años , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico por imagen , Aortografía/métodos , Fístula Bronquial/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Resultado Fatal , Femenino , Hemoptisis/etiología , Humanos , Factores de Tiempo , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagenRESUMEN
We present a rare late complication after inferior vena cava filter (IVC) placement. A 52-year-old woman with an IVC presented with sudden onset of chest pain. Cardiac catheterisation and echocardiography revealed an embolised IVC filter strut penetrating the right ventricle. Endovascular retrieval was considered but deemed unsafe due to proximity to the right coronary artery and concern for migration to pulmonary circulation. Urgent removal of the strut was performed via sternotomy. The postoperative course was uneventful. Two weeks later, she was asymptomatic. Minimally invasive approaches have been described for retrieval of intact IVC filters that have migrated to the right heart but not for embolised filter fragments. We recommend traditional sternotomy as the preferred method of retrieval as it limits the likelihood of further migration or trauma.
Asunto(s)
Síndrome Coronario Agudo , Ventrículos Cardíacos/cirugía , Perforación Espontánea , Filtros de Vena Cava/efectos adversos , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/cirugía , Femenino , Humanos , Persona de Mediana Edad , Perforación Espontánea/diagnóstico , Perforación Espontánea/cirugíaRESUMEN
Pericardial effusions compress the heart, decrease cardiac output, and lead to haemodynamic collapse. Ultrasound (US)-guided pericardiocentesis is the gold standard for treating pericardial effusions. Recently, the incorporation of computed tomography (CT) guidance has increased patient safety while entering the pericardium. Despite the superior performance of CT-guided pericardiocentesis in smaller, complex effusions, this procedure is not routinely performed by cardiologists and surgeons. Unlike those with an intact pericardium, patients with mediastinal trauma, pericardial adhesions, temporary pacing wires, and vascular conduits are high risk for pericardiocentesis. Tamponade physiology also increases patient susceptibility to the hypotensive effects of anaesthesia during surgical drainage. Here we illustrate the technique of CT-guided pericardiocentesis and demonstrate its application in specific clinical scenarios. We conclude that CT-guided pericardiocentesis provides a useful, alternative strategy for treating cardiac tamponade in high risk patients.
Asunto(s)
Cardiopatías , Hipertensión , Pericardio , Tomografía Computarizada por Rayos X , Anciano , Cardiopatías/diagnóstico por imagen , Cardiopatías/cirugía , Humanos , Hipertensión/diagnóstico por imagen , Hipertensión/cirugía , Masculino , Pericardio/diagnóstico por imagen , Pericardio/cirugíaRESUMEN
Objective: A kaolin-based nonresorbable hemostatic gauze, QuikClot Control+, has demonstrated effective hemostasis and safety when used for severe/life-threatening (grade 3/4) internal organ space bleeding. We evaluated the efficacy and safety of this gauze for mild to moderate (grade 1-2) bleeding in cardiac surgery compared with control gauze. Methods: This was a randomized, controlled, single-blinded study of patients who underwent cardiac surgery between June 2020 and September 2021 across 7 sites with 231 subjects randomized 2:1 to QuikClot Control+ or control. The primary efficacy end point was hemostasis rate (ie, subjects achieving grade 0 bleed) through up to 10 minutes of bleeding site application, assessed using a semiquantitative validated bleeding severity scale tool. The secondary efficacy end point was the proportion of subjects achieving hemostasis at 5 and 10 minutes. Adverse events, assessed up to 30 days postsurgery, were compared between arms. Results: The predominant procedure was coronary artery bypass grafting, and 69.7% and 29.4% were sternal edge and surgical site (suture line)/other bleeds, respectively. Of the QuikClot Control+ subjects, 121 of 153 (79.1%) achieved hemostasis within 5 minutes, compared with 45 of 78 (58.4%) controls (P < .001). At 10 minutes, 137 of 153 patients (89.8%) achieved hemostasis compared with 52 of 78 controls (68.4%) (P < .001). At 5 and 10 minutes, hemostasis was achieved in 20.7% and 21.4% more QuikClot Control+ subjects, respectively, compared with controls (P < .001). There were no significant differences in safety or adverse events between treatment arms. Conclusions: QuikClot Control+ demonstrated superior performance in achieving hemostasis for mild to moderate cardiac surgery bleeding compared with control gauze. The proportion of subjects achieving hemostasis was more than 20% higher in QuikClot Control+ subjects at both timepoints compared with controls, with no significant difference in safety outcomes.
RESUMEN
Colonization with Aspergillus sp. usually occurs in previously formed lung cavities. Cystectomy is a widely used surgical technique for hydatid lung disease that can also leave residual cavities and potentially result in aspergilloma. We present two cases of this rare entity and a case with Aspergillus sp. colonization of an existing ruptured hydatid cyst.
Asunto(s)
Aspergilosis/complicaciones , Aspergilosis/cirugía , Equinococosis Pulmonar/microbiología , Adulto , Aspergilosis/diagnóstico por imagen , Equinococosis Pulmonar/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Hydatid cyst can simultaneously affect the liver and lung. Some patients might have additional comorbidities that can make management more challenging. Here, we present a 10-year-old boy with hepatopulmonary hydatid cysts and severe mitral regurgitation, who was successfully managed with a staged surgical approach treating the lung first, followed by the liver and finally, the heart.
Asunto(s)
Equinococosis Hepática/cirugía , Equinococosis Pulmonar/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Niño , Equinococosis Hepática/complicaciones , Equinococosis Hepática/diagnóstico por imagen , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/diagnóstico por imagen , Humanos , Masculino , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: This study intended to evaluate the safety and hemostatic efficacy of a novel vascular sealant (Tridyne; Neomend, Inc, Irvine, CA) compared with an accepted adjunctive hemostatic agent applied to aortotomy and sutures lines in cardiovascular operations. METHODS: Patients undergoing aortic valve replacement, ascending aortic replacement, or aortic root replacement were randomly assigned 2:1 to Tridyne (n = 107) or Gelfoam Plus (Baxter Healthcare Corp, Hayward, CA) (n = 51). These groups were similar with regard to age, sex, race, medical history, duration of bypass and cross-clamping, and number of suture lines treated. Suture lines were treated after confirmation of some leakage but before formal removal of the clamp. RESULTS: The median bleeding time was significantly lower for Tridyne versus Gelfoam Plus (0 versus 10.0 minutes, p < 0.0001). Immediate hemostasis was achieved in 59.4% of the Tridyne group versus 16.0% of Gelfoam Plus group (p < 0.0001). A significantly greater proportion of patients in the Tridyne group achieved successful hemostasis at the aortic suture line than patients in the Gelfoam Plus group (85.7% versus 40.0%, p < 0.0001). The Clinical Events Committee adjudicated 7 patients with possible device-related serious adverse events: 3 patients (2.9%) in the Tridyne group and 4 patients (8.2%) in the Gelfoam Plus group (p = 0.2097). CONCLUSIONS: Tridyne was safe and effective when used as an adjunct to conventional hemostasis to treat high-pressure vessels in patients who receive anticoagulation agents, in reducing time to hemostasis, and in promoting both immediate and persistent hemostasis.
Asunto(s)
Enfermedades de la Aorta/cirugía , Pérdida de Sangre Quirúrgica/prevención & control , Enfermedades de las Válvulas Cardíacas/cirugía , Hemostáticos/uso terapéutico , Polietilenglicoles/administración & dosificación , Tensoactivos/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Válvula Aórtica , Reactivos de Enlaces Cruzados , Femenino , Esponja de Gelatina Absorbible , Hemostasis Quirúrgica/métodos , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Sutura , Adhesivos Tisulares/administración & dosificación , Adulto JovenRESUMEN
Resident education has changed dramatically over the past 10 years. With the implementation of restricted work hours on clinical training, questions have arisen whether these restricted hours will affect clinical competency. This manuscript attempts to answer this question through a survey performed to assess the perception of residents about duty-hour restrictions and the potential effect on residents' clinical exposure. In this study, a majority of the respondents did believe that work-week restrictions significantly affected patient care and clinical exposure. However, few respondents were willing to accept an additional year of training to compensate for the loss of this clinical exposure. Regardless, work-hour restrictions are here to stay and will probably be further limited in the future. Training programs will have to adjust to provide the necessary clinical exposure while complying with these new ACGME guidelines.
Asunto(s)
Internado y Residencia/normas , Carga de Trabajo/psicología , Humanos , Estrés Psicológico/psicología , Encuestas y CuestionariosRESUMEN
Heart disease can affect anyone at any time, and pregnant women are not exceptions. Some type of cardiac pathologic disease can be seen in 1% to 2% of all pregnant women. Because of the high fetal mortality rate and the high relative rate of maternal mortality in surgery, medical management is the first line of treatment. Nevertheless, when medical treatment fails, cardiac surgery may be necessary. Here we present such a case of cardiac valvular disease complicated by pregnancy. Current decision-making, treatment, and trends are reviewed.
Asunto(s)
Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Complicaciones Cardiovasculares del Embarazo/cirugía , Adulto , Puente Cardiopulmonar/métodos , Ecocardiografía , Femenino , Monitoreo Fetal , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Embarazo , Cardiopatía Reumática/cirugía , Insuficiencia de la Válvula Tricúspide/cirugíaAsunto(s)
Fístula Cutánea/etiología , Hernia Diafragmática/cirugía , Hernias Diafragmáticas Congénitas , Complicaciones Posoperatorias , Fístula del Sistema Respiratorio/etiología , Absceso Abdominal/complicaciones , Absceso Abdominal/diagnóstico , Absceso Abdominal/terapia , Niño , Fístula Cutánea/diagnóstico , Fístula Cutánea/cirugía , Humanos , Recién Nacido , Masculino , Fístula del Sistema Respiratorio/diagnóstico , Fístula del Sistema Respiratorio/cirugía , Infección de la Herida Quirúrgica/complicaciones , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/terapia , Cicatrización de HeridasRESUMEN
Iatrogenic intraoperative tracheal injuries are rare in cardiac operations. Management of this complication is not well described because of the low incidence and lack of reported cases. We present an 82-year-old woman who sustained a tracheal injury during aortic valve replacement. Soft tissue coverage of the trachea was obtained, the original cardiac operation was completed, and she was otherwise managed conservatively. She recovered without further complication and was discharged home 1 week after the surgical procedure.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Complicaciones Intraoperatorias/terapia , Tráquea/lesiones , Anciano de 80 o más Años , Femenino , HumanosAsunto(s)
Taponamiento Cardíaco/etiología , Vasos Coronarios/lesiones , Fundoplicación/efectos adversos , Laparoscopía , Complicaciones Posoperatorias/etiología , Grapado Quirúrgico/efectos adversos , Lesiones del Sistema Vascular/etiología , Taponamiento Cardíaco/diagnóstico , Femenino , Fundoplicación/instrumentación , Fundoplicación/métodos , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Grapado Quirúrgico/instrumentación , Suturas/efectos adversos , Lesiones del Sistema Vascular/diagnósticoRESUMEN
PURPOSE: To assess if patients with chronic obstructive pulmonary disease (COPD) receiving periodontal debridement for treatment of chronic periodontitis with ultrasonic or hand instrumentation experienced changes in quality of life or incidents of illness following treatment or no treatment. METHODS: The study design was a 3 group, randomized, controlled pre- and post-test experimental pilot study. Volunteers with COPD and chronic periodontitis (n=30) were recruited from physician offices or fliers and randomly assigned to 1 of 3 groups. Of those, 2 groups had periodontal debridement using either magnetostrictive ultrasonic instrumentation (n=10) or hand instrumentation (n=10). A control group (n=10) received no treatment. Primary outcomes, quality of life and illness were measured by the St. George's Respiratory Questionnaire (SGRQ-A) and Illness Questionnaire, respectively. Subjects completed the questionnaires as pre-tests at baseline and as post-tests 4 weeks post-treatment/no treatment. Repeated measures ANOVA was used to compare groups on continuous variables (p ≤ 0.05) measured by SGRQ-A total scores and symptoms, activities and impacts subscales. Percentages, frequencies and cross tabulations were calculated for categorical data. RESULTS: SGRQ-A and Illness Questionnaire scores showed no significant differences between groups in quality of life or illness following periodontal debridement. Total SGRQ-A scores decreased slightly for all groups with no significant difference among groups (p=0.138) and no interaction (p=0.794). Cross tabulations showed no relationship between indicators of self-reported illness before and after treatment/no treatment. No adverse events were reported. CONCLUSION: Based on this small-scale study, it seems periodontal debridement for chronic periodontitis has no effect on quality of life and illness in patients with COPD, and it may be performed with ultrasonic or hand instruments without adverse events.
Asunto(s)
Periodontitis Crónica/terapia , Enfermedad Pulmonar Obstructiva Crónica/psicología , Calidad de Vida , Actividades Cotidianas , Actitud Frente a la Salud , Periodontitis Crónica/psicología , Tos/fisiopatología , Femenino , Estudios de Seguimiento , Recesión Gingival/terapia , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Pérdida de la Inserción Periodontal/terapia , Desbridamiento Periodontal/instrumentación , Índice Periodontal , Bolsa Periodontal/terapia , Proyectos Piloto , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Ruidos Respiratorios/fisiopatología , Esputo/química , Resultado del Tratamiento , Ultrasonido/instrumentaciónRESUMEN
We present a patient with aortoesophageal fistula that occurred years after an acute type B aortic dissection that was treated medically. This patient developed aneurysmal dilatation of the chronically dissected aorta, which finally eroded into the esophagus. Endovascular management with the placement of a stent graft was performed, but the patient ultimately died of multiorgan failure and possible myocardial infarction.
Asunto(s)
Aneurisma de la Aorta Torácica/complicaciones , Enfermedades de la Aorta/etiología , Disección Aórtica/complicaciones , Fístula Esofágica/etiología , Fístula Vascular/etiología , Anciano , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Angiografía/métodos , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/patología , Aneurisma de la Aorta Torácica/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Implantación de Prótesis Vascular , Dilatación Patológica , Fístula Esofágica/diagnóstico por imagen , Extravasación de Materiales Terapéuticos y Diagnósticos , Resultado Fatal , Humanos , Masculino , Choque/complicaciones , Stents , Factores de Tiempo , Tomografía Computarizada por Rayos X , Fístula Vascular/diagnóstico por imagen , Incisión VenosaRESUMEN
Patients with central venous occlusion who are ''tunneled catheter dependent'' are a challenge for hemodialysis access. A relatively new option for them is the hemodialysis reliable outflow (HeRO) device that can be totally implanted subcutaneously. However, patients still require a tunneled hemodialysis catheter that is used until the HeRO device is mature, 4 to 6 weeks later. Here, we describe a conversion of an existing tunneled hemodialysis catheter into a HeRO device, which was combined with a ''self-sealing'' Flixene graft. This allowed almost immediate use of the HeRO device without the need for placement of a catheter.
Asunto(s)
Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Catéteres de Permanencia , Fallo Renal Crónico/terapia , Diálisis Renal/instrumentación , Adulto , Diseño de Equipo , Humanos , Masculino , Diseño de Prótesis , Resultado del TratamientoRESUMEN
The Hemodialysis Reliable Outflow (HeRO) device is a novel alternative for dialysis access in patients with no suitable veins in the upper extremities. We placed a HeRO device in a 67-year-old woman with end-stage renal disease and 2 months later, it was being used for hemodialysis. After 1 month of uneventful use, the device thrombosed and it was rescued with a percutaneous endovascular approach. The device remains patent 6 months after the intervention.
Asunto(s)
Angioplastia de Balón/instrumentación , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Oclusión de Injerto Vascular/terapia , Falla de Prótesis , Diálisis Renal/instrumentación , Stents , Trombosis/terapia , Anciano , Anastomosis Quirúrgica , Implantación de Prótesis Vascular/efectos adversos , Arteria Braquial/cirugía , Constricción Patológica , Diseño de Equipo , Femenino , Fibrinolíticos/administración & dosificación , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Humanos , Venas Yugulares/cirugía , Fallo Renal Crónico/terapia , Politetrafluoroetileno , Diseño de Prótesis , Radiografía , Diálisis Renal/efectos adversos , Trombectomía , Terapia Trombolítica , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/fisiopatología , Activador de Tejido Plasminógeno/administración & dosificación , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Aneurysms of the iliac vein are rare. They can occur in association with arteriovenous fistulae located elsewhere. Here, we present a 30-year-old man who developed a large left external iliac vein aneurysm in association with a chronic traumatic arteriovenous fistula in the left thigh. Less than 25 cases of iliac vein aneurysms have been reported in the last 40 years. The presentation and treatment of this condition has been heterogeneous. We suggest that adequate surgical treatment can be offered in a staged approach: aneurysm resection with reconstruction should be done first, followed by closure of the arteriovenous fistula 6 months later.
Asunto(s)
Aneurisma/cirugía , Fístula Arteriovenosa/cirugía , Implantación de Prótesis Vascular , Arteria Femoral/cirugía , Vena Femoral/cirugía , Vena Ilíaca/cirugía , Heridas Punzantes/complicaciones , Adulto , Aneurisma/diagnóstico por imagen , Aneurisma/etiología , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/etiología , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/lesiones , Vena Femoral/diagnóstico por imagen , Vena Femoral/lesiones , Humanos , Vena Ilíaca/diagnóstico por imagen , Masculino , Técnicas de Sutura , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We present an adult woman with total anomalous pulmonary venous return (TAPVR) and Mayer-Rokitansky-Kuster-Hauser syndrome that was diagnosed intraoperatively during a planned atrial secundum defect closure. Surgical repair of TAPVR was performed with good outcome.