RESUMEN
Cardiovascular surgery in Jehovah's Witness is challenging for surgeons on the ground that they refuse blood transfusion. We report 11 cases of cardiovascular surgery. All of the patients underwent elective surgery with cardiopulmonary bypass. Two cases underwent minimally invasive procedures. The mean preoperative hemoglobin level was 13.0 g/dl, and hematopoietic medicines were preoperatively administrated in 4 patients. Although 10 patients recovered satisfactory without blood transfusion, 1 surgical case was lost due to uncontrollable postoperative bleeding. The clinical outcomes of the Jehovah's Witness patients are considered to be satisfactory. However, careful indication is recommended in high risk cases.
Asunto(s)
Procedimientos Quirúrgicos Cardiovasculares , Testigos de Jehová , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
Effusive constrictive pericarditis is a rare clinical entity characterized by concurrent pericardial effusion and visceral pericardial constriction. The most effective therapy for this state is pericardiectomy with complete removal of the parietal and visceral membranes, although the perioperative mortality and morbidity can be high. We presented a case of a 45-year-old man in whom a visceral pericardiectomy with waffle procedure was successfully performed using an ultrasonic scalpel without use of cardiopulmonary bypass. His postoperative course was uneventful and cardiac hemodynamics restored to normal. There were no signs or symptoms of recurrence in 2 years of follow-up.
Asunto(s)
Derrame Pericárdico/patología , Derrame Pericárdico/cirugía , Pericardiectomía/instrumentación , Pericarditis/patología , Pericarditis/cirugía , Pericardio/patología , Pericardio/cirugía , Procedimientos Quirúrgicos Ultrasónicos/instrumentación , Constricción Patológica , Diagnóstico por Imagen , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico , Pericardiectomía/métodos , Pericarditis/diagnóstico , Resultado del Tratamiento , Procedimientos Quirúrgicos Ultrasónicos/métodosRESUMEN
The development of a fistula between the aorta and the right atrium is a relatively rare but well-documented complication after cardiac surgery and proximal aortic dissection, and has a high mortality rate if it is not diagnosed adequately and surgically treated without delay. We report a rare case of extracardiac aorta-right atrial fistula. An 86-year-old woman underwent aortic valve replacement via median sternotomy. Two weeks after surgery, the upper median skin incision reopened, which exposed the sternum and revealed purulent discharge inside the wound. Wound and blood cultures were positive for methicillin-resistant Staphylococcus aureus. The wound was treated, and healed in approximately 2 weeks. Six weeks after surgery, the patient suddenly presented with dyspnea because of heart failure.Extracardiac aorto-right atrial fistula was confirmed by computed tomography. During surgery, we found an extracardiac fistula formed in the hematoma between the sites where the aortic vent suture was tied and the caval cannula was removed. The infection seemed to have contributed to the development of the fistula and may have persisted in the ascending aorta or artificial valve, which may have led to cerebral hemorrhage resulting in death 4 months later.
RESUMEN
Spontaneously occurring left atrial hematomas are very rare and most of them followed acute clinical course due to hemodynamic deterioration. We presented a case of gradually developing hematoma protruding into the left atrial cavity as a round mass, which was completely encapsulated with intact endocardial wall. Emergency surgery was successfully performed. Histopathological study demonstrated subendocardial-aged hematoma with papillary endothelial hyperplasia.
RESUMEN
OBJECTIVES: The exact role of pressure gradient across the prosthetic valve estimated from Doppler flow velocity remains controversial. This in-vivo study was designed to assess the actual discrepancy between Doppler and catheter measurements of the pressure gradients for small bileaflet prosthetic valves in the aortic position. METHODS: Bileaflet prosthetic valves (19 mm-ATS) were implanted into the aortic position in pigs, and pressure gradients across the valves were examined by volume loading under right heart bypass. The pressure gradient obtained by catheter was defined as the conventional peak-to-peak gradient between the left ventricle and aorta. The peak Doppler gradients were calculated from the maximal instantaneous Doppler velocity with the ultrasound probe positioned on the diaphragm at the level of the cardiac apex. RESULTS: There were strong correlations between pressure gradients and cardiac output. The Doppler gradient was constantly higher than the catheter values, and the resultant discrepancy between Doppler and catheter measurements was directly dependent on cardiac output (y=9.9x+0.6, r2=0.55). For cardiac output > or = 5.0 L/min, the difference between Doppler and catheter gradients reached 40 mmHg, and maximum differences of up to 80 mmHg were observed. CONCLUSIONS: In view of the presence of striking overestimation of catheter gradient by Doppler measurement, Doppler ultrasound should be used cautiously to assess small-size bileaflet prosthetic valve function with consideration of the patient's hemodynamic state.
Asunto(s)
Cateterismo Cardíaco , Prótesis Valvulares Cardíacas , Ultrasonido , Animales , Presión , PorcinosAsunto(s)
Aorta Torácica/diagnóstico por imagen , Enfermedades de la Aorta/etiología , Angiografía por Tomografía Computarizada/métodos , Imagenología Tridimensional , Arteritis de Takayasu/diagnóstico , Vísceras/irrigación sanguínea , Constricción Patológica/diagnóstico , Constricción Patológica/etiología , Humanos , Masculino , Persona de Mediana Edad , Arteritis de Takayasu/complicacionesAsunto(s)
Aneurisma de la Aorta Torácica/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Implantación de Prótesis Vascular/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Anillo Vascular/diagnóstico por imagen , Anciano de 80 o más Años , Anastomosis Quirúrgica , Disección Aórtica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Bioprótesis , Terapia Combinada , Angiografía por Tomografía Computarizada/métodos , Ecocardiografía/métodos , Tratamiento de Urgencia , Femenino , Estudios de Seguimiento , Humanos , Imagenología Tridimensional , Enfermedades Raras , Síncope/diagnóstico , Síncope/etiología , Factores de Tiempo , Resultado del Tratamiento , Anillo Vascular/cirugíaRESUMEN
We present a case of a 61-year-old man who underwent aortic valve replacement for aortic regurgitation complicated with left ventricular noncompaction. The pathogenesis of this condition remains unknown. In advanced form, left ventricular noncompaction produces marked disability and carries a poor prognosis. We underscore that familiarity with this disease entity will help to stimulate early diagnosis and timely treatment when necessary.
Asunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Cardiopatías Congénitas/diagnóstico , Implantación de Prótesis de Válvulas Cardíacas/métodos , Ventrículos Cardíacos/anomalías , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/diagnóstico , Bioprótesis , Angiografía Coronaria , Ecocardiografía Doppler , Endoscopía/métodos , Estudios de Seguimiento , Cardiopatías Congénitas/complicaciones , Humanos , Hallazgos Incidentales , Cuidados Intraoperatorios/métodos , Masculino , Persona de Mediana Edad , Cintigrafía/métodos , Medición de Riesgo , Resultado del TratamientoRESUMEN
OBJECTIVE: Washout rate of iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy is correlated with the degree of myocardial damage. The aim of this study is to ascertain whether there is any relationship between QRS complex duration at right ventricle (RV) pacing and the degree of myocardial damage assessed by I-123 MIBG myocardial scintigraphy in normally functioning left ventricle. METHODS: The study included 22 patients (10 men and 12 women, ranging in age from 48 to 89 years), with atrioventricular (AV) block (n = 15) and sick sinus syndrome (n = 7). All patients had baseline QRS duration of less than 120 ms and received implantation of a DDD-mode permanent pacemaker. Iodine-123 MIBG myocardial scintigraphy was performed before the pacemaker implantation, and QRS duration at RV pacing at a rate of 70 ppm was calculated immediately after the implantation. RESULTS: With the use of RV pacing, QRS duration was prolonged ranging from 122.4 to 185.6 ms with a mean of 153.2 +/- 15.2 ms. Washout rate of I-123 MIBG myocardial scintigraphy (WR) was calculated as ranging from 5.0 to 83.0% with a mean of 44.2 +/- 17.5%. There was a strong correlation between WR and QRS duration at RV pacing (r = 0.735, p < 0.001). CONCLUSIONS: It was confirmed that WR of I-123 MIBG was correlated positively with QRS duration at RV pacing. Measurement of QRS duration may be helpful to evaluate the degree of underlying myocardial damage even in the normally functioning left ventricle.
Asunto(s)
3-Yodobencilguanidina , Estimulación Cardíaca Artificial , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Miocardio/patología , Función Ventricular Izquierda , Anciano , Anciano de 80 o más Años , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Imagen de Perfusión Miocárdica , Factores de TiempoRESUMEN
Blunt traumatic cardiac rupture is associated with a high mortality rate. Motor vehicle accidents account for most cardiac ruptures, but crush injury is relatively rare. We describe a case of a 77-year-old man who had the left atrial 'basal' appendage ruptured through blunt trauma due to a fall. He was surgically treated and recovered without complication.
Asunto(s)
Apéndice Atrial/lesiones , Lesiones Cardíacas/cirugía , Heridas no Penetrantes/cirugía , Accidentes por Caídas , Anciano , Apéndice Atrial/cirugía , Lesiones Cardíacas/complicaciones , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/etiología , Resultado del Tratamiento , UltrasonografíaRESUMEN
Arteriovenous shunt is one of the causes of heart failure, but heart failure caused by common iliac arteriovenous fistula is relatively rare. A 64-year-old man who developed acute heart failure due to venous perforation of a common iliac aneurysm and also had bilateral aneurysms (diameter 58 mm) was referred to our department. On admission, the patient complained of dyspnea and swollen left leg, so diuretic agent was administered to treat the heart failure. Cardiac catheterization showed a shunt rate of 80.6%, as well as 5.0 Qp/Qs and O2 step-up across perforation of the common iliac vein. Despite the therapy, pleural effusion and ascites exacerbated, and the heart failure became difficult to control, so surgical treatment was performed. The aneurysm was replaced with an artificial vessel, and the fistula was closed by direct suturing. Postoperatively, the symptoms disappeared, and the patient is in good health.
Asunto(s)
Aneurisma/complicaciones , Fístula Arteriovenosa/complicaciones , Insuficiencia Cardíaca/etiología , Arteria Ilíaca , Vena Ilíaca , Enfermedad Aguda , Aneurisma/cirugía , Fístula Arteriovenosa/cirugía , Implantación de Prótesis Vascular , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The present case involves a 48-year-old male patient who presented with Pasteurella multocida endocarditis associated with preexisting mitral valve stenosis. A mitral valve replacement was successfully performed after 3 weeks of intravenous infusion with antibiotics. Pasteurella multocida is a normal inhabitant of the oral cavity of dogs and cats. Therefore, people who have frequent contact with these animals should be examined periodically for signs of infection.
Asunto(s)
Endocarditis Bacteriana/cirugía , Infecciones por Pasteurella/cirugía , Pasteurella multocida , Endocarditis Bacteriana/microbiología , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Pasteurella/microbiologíaRESUMEN
To clarify whether inflammation is a cause or consequence of atrial fibrillation (AF), we measured high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) before and after pharmacological cardioversion in 15 patients with paroxysmal AF. Levels of hs-CRP, IL-6, and TNF-alpha after cardioversion were significantly higher than those in controls (P < 0.05). Furthermore, the levels of these indices did not differ significantly even at 24 hours and 2 weeks after cardioversion. These results suggest that inflammation is a causative agent of paroxymal AF.
Asunto(s)
Fibrilación Atrial/sangre , Fibrilación Atrial/terapia , Proteína C-Reactiva/análisis , Cardioversión Eléctrica , Adulto , Anciano , Fibrilación Atrial/etiología , Humanos , Inflamación/sangre , Interleucina-6/sangre , Masculino , Persona de Mediana Edad , Factor de Necrosis Tumoral alfa/análisisRESUMEN
We encountered a 72-year-old woman with a left atrial hemangioma arising in the appendage and growing like an extracardiac mass. Life-threatening cardiac tamponade, recurrent over a 5-year clinical course, was the only sign of this rare tumor. The extraatrial growth pattern of the tumor made it difficult to distinguish the cardiac origin from a paracardiac mass. With the aid of cardiopulmonary bypass, the tumor was removed from the left atrium at the base of the appendage. Pathologic diagnosis was a combination of cavernous- and venous-type hemangioma. The postoperative course was uneventful, and the patient was doing well with no pericardial effusion at the 10-month follow-up.