RESUMO
Which graft material is the optimal graft material for the treatment of aortic graft infections is still a matter of controversy. We used a branched xenopericardial roll graft to replace an infected aortic arch graft as a "rescue" operation. The patient is alive and well 37 months postoperatively without recurrence of the infection and any surgical complication. This procedure may have the possibility to serve as an option for the treatment of aortic arch graft infection.
Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Infecções Relacionadas à Prótese/cirurgia , Idoso , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Xenoenxertos , Humanos , Imageamento Tridimensional , Masculino , Falha de Prótese , Infecções Relacionadas à Prótese/diagnóstico , Reoperação , Tomografia Computadorizada por Raios XRESUMO
With advances in cancer chemotherapy, the importance of the new clinical discipline of cardio-oncology, which is concerned with the cardiac effects of chemotherapy, is increasing. Herein we describe the case of a 48-year-old woman with a history of breast cancer who presented with symptoms of heart failure due to chemotherapy-induced cardiomyopathy. Treatment for the patient's breast cancer had included surgery and chemotherapy with anthracyclines and trastuzumab. Echocardiography revealed multiple mobile thrombi in the left ventricle and atrium. In addition, brain magnetic resonance imaging revealed small acute cerebral infarctions due to embolization. Given the high risk of re-embolization, surgical thrombectomy was performed. Thus far, there are no standardized therapeutic guidelines for left-sided cardiac thrombi and the optimal treatment remains contentious. Although this patient was managed successfully with surgical thrombectomy, patients should be managed individually, taking into consideration embolization, bleeding, and surgical risks. With further improvements in cancer chemotherapy, there may be an increase in the incidence of complications such as multiple cardiac thrombi. From the cardio-oncology standpoint, we propose close interactions between cardiologists and oncologists for the optimal care of cancer patients.
Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Cardiomiopatias , Trombose Coronária , Antineoplásicos/uso terapêutico , Cardiomiopatias/induzido quimicamente , Cardiomiopatias/diagnóstico , Trombose Coronária/induzido quimicamente , Trombose Coronária/diagnóstico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Bleeding is a serious concern during surgery for acute aortic dissections. We have used Hydrofit and Surgicel together to achieve hemostasis at the graft anastomotic sites during replacement of the ascending aorta and aortic arch. Complete hemostasis was achieved without further need for any additional sutures.
Assuntos
Aorta Torácica/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Celulose Oxidada/administração & dosagem , Adesivo Tecidual de Fibrina/administração & dosagem , Hemostasia Cirúrgica/métodos , Doença Aguda , Anastomose Cirúrgica/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
A cardiac calcified amorphous tumor (CAT) is a non-neoplastic cardiac mass composed of calcified nodules surrounded by amorphous fibrous tissue in a context of degeneration and chronic inflammation. Although CAT cases are increasingly reported, its clinical manifestation remains unclear. We aimed to conduct a narrative review of CAT and identify its clinical characteristics. We conducted a comprehensive literature search using PubMed, with the keyword "Cardiac Calcified Amorphous Tumor" to identify relevant articles. A total of 113 articles published between 1997 and 2022 were retrieved. The clinical features allowing for assess patient background, differences with and without end-stage renal disease (ESRD), symptom-related factors, risk factors for embolism caused by CAT, and features of CAT, such as shape, location, mobility, pathology, and treatment, were statistically analyzed in 106 criteria-matched cases. The mean patient age was 60.2 ± 18.6 years, with 45 men and 61 women. Of the data collected from 21 countries, 52 patients were from Japan. Mobile CAT was more common in the chronic renal failure group. Linear, club-shaped, and spindle-shaped CAT tended to be mobile and more common in the ESRD group as well as located in the mitral valve region. The shape, mobility, location, and underlying mechanism of CAT depended on the presence or absence of ESRD. The risk of embolism was considered high because mobile CAT was more common in the ESRD group, and CAT originated in the mitral valve region. Hence, early diagnosis based on periodic examination in patients with ESRD and aggressive surgical treatment are necessary.
RESUMO
Left atrial appendage (LAA) closure may prevent atrial fibrillation (AF)-induced thromboembolism. We describe a rare case of right atrial (RA) thrombus after thoracoscopic left atrial appendectomy and pulmonary vein isolation. Careful evaluation for the presence of RA thrombus in patients with persistent AF after LAA occlusion may be necessary. (Level of Difficulty: Intermediate.).
RESUMO
The increasing use of total arch replacement and frozen elephant trunk (FET) is expected to lead to an increase in the prevalence of graft infections requiring replacement involving an FET, which is generally a more invasive procedure than the initial surgery. Herein, we describe a novel method for FET removal using a polyvinyl tube as the storage device. The procedure is completed using the same median sternotomy approach as the initial surgery. We report on the outcomes for six patients. Our procedure is simple to perform and safe and caused no injury to the aorta in our case series.
Assuntos
Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Aorta/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Humanos , Polivinil , Estudos RetrospectivosRESUMO
BACKGROUND: Creating a box lesion in the posterior wall of the left atrium from the epicardial side of the beating heart remains a challenge. Although a transmural lesion can be created by applying radiofrequency (RF) energy at clampable sites, it is still difficult to create a transmural lesion at unclampable sites because the inner blood flow in the unclampable free wall weakens the thermal effect on the outside. Our aim was to apply the newly developed infrared coagulator to create linear transmural lesions on the beating heart thoracoscopically to treat atrial fibrillation (AF). CASE PRESENTATION: A 71-year-old male was referred to our hospital with a diagnosis of hypertrophic cardiomyopathy and permanent atrial fibrillation. The patient was first diagnosed with atrial fibrillation 20 years before. Direct current cardioversion had been performed every few years a total of four times, but sinus rhythm restoration had always been temporary. On February 27, 2020, thoracoscopic PV isolation together with infrared roof- and bottom-line ablation to create a box lesion and left atrial appendage amputation (LAAA) were performed. The coagulator could be applied to clinical thoracoscopic surgery to successfully create a box lesion without any complication. The patient restored a regular sinus rhythm, it has been maintained for eleven months, and there have been no adverse events. CONCLUSIONS: The infrared coagulator might have enough potential to create transmural lesions on the beating heart in thoracoscopic AF surgery.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Idoso , Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Humanos , Masculino , Toracoscopia , Resultado do TratamentoRESUMO
A coronary artery aneurysm (CAA), the etiology and treatment of which are still not fully understood, is uncommonly encountered. A giant CAA is extremely rare and only a limited number of cases have been reported. We report the case of a 37-year-old female with a giant right coronary artery aneurysm that was successfully treated by surgical excision.
Assuntos
Procedimentos Cirúrgicos Cardiovasculares , Aneurisma Coronário/cirurgia , Adulto , Aneurisma Coronário/diagnóstico , Diagnóstico por Imagem , Feminino , Humanos , Resultado do TratamentoRESUMO
To reduce the risk of stroke during open surgery for the treatment of descending thoracic or thoracoabdominal aortic diseases, we attempted to insert a proximal elephant trunk to stabilize the atherosclerosis at the site of the proximal anastomosis. Although the patients had dense atherosclerotic lesions, they recovered well without neurologic complications. This technique is simple and may be effective for preventing stroke when replacing the descending thoracic or thoracoabdominal aorta through a left thoracotomy.
Assuntos
Aorta Torácica/cirurgia , Arteriosclerose , Procedimentos Cirúrgicos Cardíacos/métodos , Acidente Vascular Cerebral/prevenção & controle , Toracotomia/métodos , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Parada Cardíaca Induzida , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Comportamento de Redução do Risco , Acidente Vascular Cerebral/etiologia , Toracotomia/efeitos adversosRESUMO
Coronary malperfusion due to acute aortic dissection (AAD) is a relatively rare, but fatal condition. We experienced a case of acute myocardial infarction (AMI) with cardiogenic shock due to compression of the left main trunk (LMT) by a false lumen of an AAD. Percutaneous coronary intervention (PCI) to the LMT was firstly performed, followed by a definitive surgery under a stable hemodynamic condition. Stanford type A AAD is an indication for emergency operation and stenting to the LMT is controversial. However, it might be an essential strategy to perform precedent PCI to the LMT which quickly relieves global ischemia, and achieves hemodynamic stability for the following definitive surgery.
Assuntos
Aneurisma da Aorta Torácica/terapia , Dissecção Aórtica/terapia , Infarto do Miocárdio/etiologia , Stents , Idoso , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Humanos , MasculinoRESUMO
Immunoglobulin G4 (IgG4)-related disease is a systemic chronic inflammatory disease caused by infiltration of IgG4-positive plasma cells into the systemic organs. IgG4-related arterial disease is relatively rare not only in the aorta but also in the small to medium-sized arteries. If IgG4-related vasculitis is suspected on the basis of the preoperative medical history and radiologic and serologic examination findings, a definitive diagnosis can be obtained by open repair and pathologic examination to determine the prognosis and need for additional treatment. Here, we report the successful treatment of arterial-bronchial fistula caused by a ruptured IgG4-related subclavian artery aneurysm.
RESUMO
BACKGROUND: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly that results in high mortality if left untreated. Our aim was to extend our knowledge of the histological, angiographic, and clinical characteristics of ALCAPA in order to deepen our understanding of this rare entity. CASE PRESENTATION: We were involved in the assessment, treatment, and pathological evaluation of two adult ALCAPA patients who were rescued from ventricular fibrillation and then surgically treated to establish a dual coronary artery system. Histological studies indicated various chronic ischemic changes in the myocardium, patchy fibrosis, and severely thickened arteriolar walls in both ventricles. The first patient is alive and well 11.5 years after surgical correction without any implantable cardioverter defibrillator (ICD) activations. The second patient required re-do surgery 9 months after the initial operation but subsequently died. Histologically, chronic ischemic alteration of the myocardium and thickened arteriolar walls persisted even after surgical correction, and coronary angiography (CAG) showed an extremely slow flow phenomenon even after surgical correction in both patients. The average postoperative opacification rate in the first case was 7.36 + 1.12 (n = 2) in the RCA, 3.81 + 0.51 (n = 3) in the left anterior descending (LAD) artery, and 4.08 + 0.27 (n = 4) in the left circumflex (LCx) artery. The slow flow phenomenon may represent persistent high arteriolar resistance in both ventricles. CONCLUSIONS: Seldom reported or new findings in adult ALCAPA were identified in two cases. More frequent diagnosis of adult ALCAPA can be expected because of the widespread availability of resuscitation and more advanced diagnostic modalities. Accumulation of pathological and clinical findings and confirmation of the long-term follow-up results after treatment may contribute to expanding our knowledge of this rare entity and establishing optimal treatment.
Assuntos
Artéria Coronária Esquerda Anormal , Síndrome de Bland-White-Garland , Adulto , Artéria Coronária Esquerda Anormal/patologia , Artéria Coronária Esquerda Anormal/cirurgia , Síndrome de Bland-White-Garland/patologia , Síndrome de Bland-White-Garland/cirurgia , Procedimentos Cirúrgicos Cardíacos , Anomalias dos Vasos Coronários/patologia , Anomalias dos Vasos Coronários/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidadesRESUMO
Left ventricular free wall rupture (LVFWR) is a catastrophic complication of myocardial infarction. In these cases, cardiopulmonary bypass (CPB) should be performed for left ventricular repair, but can impact hemodynamic stability. An 87-year-old man presented with acute shock. He was diagnosed with LVFWR after myocardial infarction. We describe a simple, effective, and reproducible technique to achieve hemostasis at the LVFWR site during emergency operation using Hydrofit® and Surgicel® surgical hemostatic agents. We simply placed and manually pressed the Hydrofit® and Surgicel® composite on the bleeding site. This technique provides complete hemostasis without CPB establishment.
Assuntos
Ruptura Cardíaca Pós-Infarto/terapia , Ventrículos do Coração/cirurgia , Hemostáticos/administração & dosagem , Infarto do Miocárdio/complicações , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Celulose Oxidada , Ruptura Cardíaca/cirurgia , Ruptura Cardíaca Pós-Infarto/etiologia , Hemostasia , Humanos , MasculinoRESUMO
BACKGROUND: It is still difficult to create a secure linear conduction block on a beating heart from the epicardial side. To overcome this drawback we developed an infrared coagulator equipped with a cuboid light-guiding quartz rod. This study was designed to electrophysiologically confirm the efficacy of a new ablation probe using infrared energy in a clinical case. METHODS: The infrared light from a lamp is focused into the newly developed cuboid quartz rod, which has a rectangular distal exit-plane that allows 30 mm × 10 mm linear photocoagulation. Two pairs of electrodes were attached to the right atrium of a patient who was undergoing surgery. Each pair of electrodes was placed 10 mm from an ablation line. The change in conduction time between the two pairs of electrodes was measured during ablation. The predicted conduction time delay ratio was 1.54. RESULTS: The actual conduction time after ablation was 1.38-1.43 times longer than the pre-ablation conduction time. CONCLUSIONS: The infrared ablation using a newly developed cuboid probe made it possible to create a linear conduction block on the beating right atrial free wall clinically.
Assuntos
Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Sistema de Condução Cardíaco/cirurgia , Raios Infravermelhos/uso terapêutico , Pericárdio/cirurgia , Animais , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Ablação por Cateter , Galinhas , Eletrodos , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Átrios do Coração/efeitos da radiação , Sistema de Condução Cardíaco/patologia , Sistema de Condução Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/efeitos da radiação , Humanos , Modelos Animais , Pericárdio/patologia , Pericárdio/fisiopatologia , Pericárdio/efeitos da radiaçãoRESUMO
BACKGROUND: Several proximal anastomosis devices have been developed to shorten the time required for a proximal anastomosis and to avoid aortic cross-/side-clamping during coronary artery bypass grafting. This study retrospectively examined the patency of saphenous vein grafts (SVGs) using the PAS-Port System (Cardia Inc, Redwood City, CA). METHODS: From 2004 to 2014, 451 patients underwent coronary artery bypass graft operations requiring at least 1 proximal anastomosis using a PAS-Port device. A total of 802 PAS-Port devices were used, and 95.0% (762 of 802) were implanted successfully. Among the successfully implanted anastomoses, 76.8% (585 of 762) were evaluated using coronary angiography or multidimensional computed tomography, or both. The evaluations were performed between postoperative days 4 and 3,182 (mean, 319 ± 624 days). The early (1 to 365 days) and the midterm to long-term (more than 366 days) occlusion rates were examined. A complete postoperative clinical course was recorded for 70.7% of the patients. RESULTS: Overall, 93.8% (549 of 585) of the device-dependent SVGs were patent. The patency rates of device-dependent SVGs that were 1, 2, 3, 4, 5, 6, 7, and 8 years old were 90.1% ± 1.8%, 87.1% ± 2.3%, 86.1% ± 2.5%, 82.9% ± 3.3%, 80.6% ± 3.9%, 77.2% ± 5.0%, 77.2% ± 5.0%, and 70.2% ± 8.1%, respectively. The longest follow-up period was 3,182 days (8.7 years). The occlusion rate for device-dependent SVGs tended to decrease as the number of patients accumulated. CONCLUSIONS: The PAS-Port system provided acceptable SVG patency and clinical outcome for the early and midterm to long-term. There may be a learning curve for the use of PAS-Port device that affects the device-dependent SVG patency.
Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/fisiopatologia , Monitorização Intraoperatória/instrumentação , Veia Safena/fisiopatologia , Grau de Desobstrução Vascular , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Desenho de Equipamento , Feminino , Seguimentos , Oclusão de Enxerto Vascular/diagnóstico , Oclusão de Enxerto Vascular/epidemiologia , Humanos , Incidência , Japão/epidemiologia , Masculino , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/transplante , Taxa de Sobrevida/tendênciasAssuntos
Neoplasias Cardíacas/irrigação sanguínea , Neoplasias Cardíacas/cirurgia , Mixoma/irrigação sanguínea , Mixoma/cirurgia , Neovascularização Patológica , Procedimentos Cirúrgicos Cardíacos , Feminino , Átrios do Coração , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Humanos , Imagem Cinética por Ressonância Magnética , Pessoa de Meia-Idade , Mixoma/diagnóstico , Mixoma/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVES: Retrograde cerebral perfusion (RCP) has been used as a cerebroprotective method under hypothermic circulatory arrest (HCA) during aortic surgery. As reported in an animal model in 2005, intermittent pressure-augmented-RCP (IPA-RCP) provides more effective cerebral perfusion than RCP. In 2013, the clinical efficacy of IPA-RCP was described in terms of clinical outcomes and regional cerebral oxygen saturation using infrared spectroscopy. However, the state of cerebral microcirculation during IPA-RCP has not been investigated in humans. The aim of the present study was to investigate cerebral microcirculation during IPA-RCP in humans by assessing the retinal vessels. METHODS: Between 2013 and 2014, 8 consecutive patients underwent elective total replacement of the aortic arch for true thoracic aortic aneurysms. The IPA-RCP protocol consisted of a continuous venous pressure that was intermittently augmented at 45 mmHg for 30 s and then decreased to 20 mmHg for 120 s after isolated HCA for 300 s. The retinal vessels were assessed via non-invasive direct visualization of the cerebral microcirculation using a fundus camera. Assessments were done before cardiopulmonary bypass, during isolated HCA, and during IPA-RCP at 20 and 45 mmHg. Ratio of the diameter of retinal vessels to that of the optic disc was calculated from the diameters of the retinal arteries, veins and optic disc at each time point and was statistically examined. RESULTS: There were no neurological deficits and mortality. When compared with the control group and both IPA-RCP groups, the retinal vessels in the isolated HCA group were collapsed and the peripheral retinal vessels could not be clearly observed. The RVR was significantly larger in the control group and in both IPA-RCP groups when compared with the isolated HCA group. The RVR of the control group was similar to that of both IPA-RCP groups with regard to the retinal arteries and veins. The RVR of IPA-RCP at 45 mmHg was significantly larger than that at 20 mmHg with regard to the retinal veins. CONCLUSIONS: Our study suggested that intermittently augmented venous pressure at 45 mmHg opened the cerebrovenous vessels and enabled adequate cerebral perfusion. IPA-RCP may provide more effective cerebral perfusion under HCA in humans.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Ponte Cardiopulmonar/métodos , Circulação Cerebrovascular/fisiologia , Parada Cardíaca Induzida/métodos , Hipotermia Induzida/métodos , Vasos Retinianos/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Determinação de Ponto Final , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Microcirculação/fisiologia , Pessoa de Meia-Idade , Oxigênio/sangue , Perfusão/métodos , Pressão , Resultado do TratamentoRESUMO
We experienced two adult cases of anomalous origin of the left coronary artery from the pulmonary artery, so-called Bland-White-Garland (BWG) syndrome, that presented with ventricular tachycardia (VT) and ventricular fibrillation during exertion in daily life. They presented to our hospital with syncope due to VT, and recovered following application of an automated external defibrillator with cardiopulmonary resuscitation. We diagnosed BWG syndrome by multi-detector computed tomography angiography and coronary angiography. We analyzed the mechanisms of lethal arrhythmias in relation to myocardial ischemia on exertion. Coronary flow modification and implantable cardioverter defibrillator implantation were performed in order to prevent future lethal arrhythmia due to myocardial ischemia. It is important to be aware of congenital heart disease in ordinary cases.