ABSTRACT
Fistulous communication between the aorta and the pulmonary parenchyma developed in a 38-year-old woman 19 years after repair of a congenital aortic coarctation with Dacron patch aortoplasty. The fistula, inducing intermittent hemoptysis, arose from the suture line between the prosthetic fabric and the aorta. There was no infectious background or aneurysm at the primary repair site. The aortic segment including the prosthetic patch was resected and replaced with a Dacron tubular vascular prosthesis.
Subject(s)
Aorta, Thoracic/surgery , Aortic Coarctation/surgery , Aortic Diseases/surgery , Blood Vessel Prosthesis Implantation , Fistula/surgery , Lung Diseases/surgery , Polyethylene Terephthalates , Postoperative Complications/surgery , Vascular Fistula/surgery , Adult , Anastomosis, Surgical , Aorta, Thoracic/pathology , Aortic Coarctation/pathology , Aortic Diseases/pathology , Female , Fistula/pathology , Follow-Up Studies , Hemoptysis/etiology , Humans , Lung Diseases/pathology , Postoperative Complications/pathology , Prosthesis Failure , Reoperation , Sutures , Vascular Fistula/pathologyABSTRACT
BACKGROUND: Levosimendan is a compound with vasodilatory and inotropic properties. Experimental data suggest effective reversal of stunning and cardioprotective properties. METHODS: This prospective, randomized, placebo-controlled, double-blind study included 60 patients with 3-vessel coronary disease and left ventricular ejection fraction (LVEF) of less than 0.50. Levosimendan administration (12 microg/kg bolus, followed by an infusion of 0.2 microg/kg/min) was started immediately after induction anesthesia. Predefined strict hemodynamic criteria were used to assess the success of weaning. If weaning was not successful, CPB was reinstituted and an epinephrine infusion was started. If the second weaning attempt failed, intraaortic balloon pumping (IABP) was instituted. RESULTS: The groups had comparable demographics. The mean (standard deviation) preoperative LVEF was 0.36 (0.8) in both groups. The baseline cardiac index was 1.8 (0.3) L/min/m(2) in the levosimendan group and 1.9 (0.4) L/min/m(2) in the placebo group. The mean duration of CPB to primary weaning attempt was 104 (25) minutes in the levosimendan and 109 (22) minutes in the placebo group. Primary weaning was successful in 22 patients (73%) in the levosimendan group and in 10 (33%) in the placebo group (p = 0.002). The odds ratio for failure in primary weaning was 0.182 (95% confidence interval, 0.060 to 0.552). Four patients in the placebo group failed the second weaning and underwent IABP compared with none in the levosimendan group (p = 0.112). CONCLUSIONS: Levosimendan significantly enhanced primary weaning from CPB compared with placebo in patients undergoing 3-vessel on-pump coronary artery bypass grafting. The need for additional inotropic or mechanical therapy was decreased.