A 13 cm asymptomatic abdominal aortic aneurysm complicated with arterial obstruction in the left lower limb: A Case report.

Abdominal aortic aneurysm is often asymptomatic when it is small to medium in size, up to a maximum of 8 cm, in this case, a patient presented to the vascular surgery department with a complaint of acute pain in the left lower extremity with pallor due to the presence of arterial obstruction. On physical examination, we found a large pulsating mass in the abdomen. After performing a multislice computed tomography, we confirmed the presence of aneurysm with diameters of 13 × 8 cm below the level of the renal arteries. The rarity of this case in the medical literature come from that the aneurysm has reached this size and did not even rupture and did not cause any digestive discomfort or abdominal pain only complicated with an arterial obstruction in the lower left extremity as a result of the dissection that occurred. An emergency surgical operation was performed to remove the aneurysm and install the Dacron joint, and the patient was placed for 24 hours under intensive care and discharged after 5 days to have excellent results with the patient's condition improving without any complications after the operation. In conclusion, aneurysms constitute a serious condition facing vascular surgeons, especially if they are large in size without any symptoms.

Obstructive accessory mitral valve tissue in an adult patient: a case report.

BACKGROUND: Accessory mitral valve tissue is a rare congenital anomaly that is commonly diagnosed in early childhood and rarely in adulthood. It is usually asymptomatic. However, it may cause left ventricular outflow tract obstruction in a way that mimics various other causes of obstruction. A 72-year-old Caucasian man complained of chest discomfort and exertional dyspnea for 3 months. There were no specific findings from a physical examination except systolic murmur. Transthoracic echocardiography demonstrated a mass on the mitral valve extending to the intraventricular septal, raising the pressure gradient flow across the aortic valve. Transesophageal echocardiography showed parachute-like tissue connected to the anterior leaflet of the mitral valve causing left ventricular outflow tract obstruction. During the surgery preparation period, he underwent coronary angiography and computed tomography to study the anatomy surrounding the mass. After surgery, biopsy showed non-specific findings. CONCLUSION: When facing a case of aortic valve stenosis, accessory mitral valve tissue should be kept in mind as one of the possible underlying causes despite its rarity. Although it is simple and noninvasive, echocardiography remains the best diagnostic procedure to make the correct decision about management and to define the golden time for surgical intervention.

Does the preoperative mild renal dysfunction effect mortality and morbidity following valve cardiac surgery?

AIMS: The objective of this study was to investigate the effect of preoperative mild renal dysfunction (RD), not requiring dialysis, on mortality and morbidity after valve cardiac surgery (VCS). POPULATION: We studied 340 consecutive patients (2008-2012), who underwent VCS with or without coronary artery bypass graft (CABG). METHODS: Preoperative RD was calculated with the abbreviated Modification of Diet in Renal Disease formula and was defined as a glomerular filtration rate <60ml/min/1.73m(2). Logistic regression analysis was used to assess the effect of preoperative renal dysfunction (RD) on operative and adverse outcomes. RESULTS: 80 patients (30%) had preoperative mild RD. Patients with preoperative RD were older, had a higher rate of preoperative anemia (43% vs. 25%, p<0.001), and more comorbidities. Patients with preoperative RD had worse outcomes with more reoperation (6.8% vs. 2.3%, p<0.001). CONCLUSION: Preoperative RD was significantly and independently associated with more red blood cell transfusions and longer hospital stay (median 9 vs. 8 days, p<0.001). Mortality was similar in both groups (3.4% vs. 2.3%, p=0.43). Preoperative mild RD in patients undergoing cardiac valve surgery is an independent marker of postoperative morbidity.