RESUMEN
Patients diagnosed with ocular myasthenia gravis (MG) and mitral valve disease represent a significant perioperative management problem, especially for the anaesthesiologist, due to complex inter-actions between the disease, drugs to treat the disease, and anaesthetic agents, such as neuromuscu-lar blocking agents (NMBAs). This paper describes the successful management of a 31-year-old female with mitral valve stenosis and ocular MG who was diagnosed with MG 4 years prior to the indication for cardiac surgery. Preoperatively, the patient was under treatment with Pyridostigmine and Prednisone. Mitral valve replacement and full thymectomy were performed, under general anaesthesia, using Fentanyl, Sevoflurane and low doses of non-depolarising NMBAs. The postoperative course was uneventful, the patient was extubated at 6 hours postoperatively, in-tensive care unit stay was 48 hours, and the patient was discharged after 6 days without any compli-cations. After 3 months, at the follow-up examination, the patient's ocular symptoms (eyelid ptosis) disappeared.
Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas/métodos , Estenosis de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Miastenia Gravis/cirugía , Timectomía , Adulto , Anestésicos Combinados , Antiinflamatorios/uso terapéutico , Interacciones Farmacológicas , Femenino , Fentanilo , Humanos , Estenosis de la Válvula Mitral/complicaciones , Miastenia Gravis/complicaciones , Miastenia Gravis/tratamiento farmacológico , Prednisona/uso terapéutico , Bromuro de Piridostigmina/uso terapéutico , SevofluranoRESUMEN
Since the discovery of penicillin, the incidence of tertiary syphilis dramatically has decreased. However, cases of cardiovascular complications of syphilis still are present. Ascending aortic aneurysms are some of the most devastating complications. Nonetheless, syphilitic aortitis (SA) can appear and should be suspected in patients with syphilis and aortic aneurysm. We report a case of a 57-year-old patient with a large ascending aortic aneurysm with cartilage and rib erosion. The purpose of this article is to discuss the particular surgical aspects of this unusual case.
Asunto(s)
Aorta/cirugía , Aneurisma de la Aorta Torácica/cirugía , Sífilis Cardiovascular/complicaciones , Sífilis/complicaciones , Pared Torácica , Aorta/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/etiología , Implantación de Prótesis Vascular , Puente Cardiopulmonar , Ecocardiografía , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Fracturas de las Costillas/diagnóstico por imagen , Serodiagnóstico de la Sífilis , Pared Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Coronary artery spasm (CAS) after coronary artery bypass grafting (CABG) is rare, and in time may be fatal for the patient if undiagnosed. The purpose of the present study is to report the case of a patient who survived after experiencing a persistent spasm of all native coronary arteries following successful arterial myocardial revascularization. Furthermore, we aimed to discuss the therapeutic strategies which may prevent the occurrence of a coronary artery spasm in settings of myocardial revascularization, in the context of reviewed specific literature evidences.