ABSTRACT
Intravenous uterine leiomyomatosis is the invasion of the para-uterine veins by bundles of benign uterine muscle. These muscle bundles can grow and extend directly to pelvic organs or embolize to the right cardiac chambers or pulmonary artery. We report a patient who presented with two large mobile atrial masses that were seen on echocardiography. She was treated by excision of a 18cm mass from the right atrium, two masses from the right ventricle and a huge mass from the pulmonary artery. The tricuspid valve that was rendered insufficient, was repaired by the creation of PTFE neo chordae. Two weeks later a massively enlarged uterus, ovaries, a paracolic and three intraluminal masses in the inferior vena cava were removed. The patient recovered well. One year after surgery she was asymptomatic and no masses are seen in her echocardiogram. The tricuspid valve was competent. Patients presenting with cardiac tumors from intravenous uterine leiomyomatosis must undergo aggressive surgical management to achieve a cure. We recommend a two stage (thoracic and abdominal) approach.
Subject(s)
Humans , Female , Adult , Leiomyomatosis/pathology , Leiomyomatosis/surgery , Neoplastic Cells, Circulating , Heart Neoplasms/secondary , Heart Neoplasms/surgery , Uterine Neoplasms/pathology , Pulmonary ArteryABSTRACT
Posterior lacerations of the coronary arteries that occur during arteriotomy should be repaired if significant. We describe a modification of the standard technique to repair posterior coronary artery lacerations. This technique avoids distortion and narrowing of the coronary artery.
Subject(s)
Coronary Vessels/injuries , Coronary Vessels/surgery , Humans , Iatrogenic Disease , Suture TechniquesABSTRACT
Aortic friability is a problem of great concern and frustration for those performing operations on patients with ascending and arch aortic aneurysms, and particularly, on patients with annuloaortic ectasia. We have used 25% glutaraldehyde to successfully strengthen the distal aorta of three such patients. After the application, the aorta wall held sutures without tearing. Postoperative bleeding was minimal in each case. No neurological events were noticed, and all of the patients were discharged home within 2 weeks. The application of this tanning solution to such a friable aortic tissue should be considered as a helpful alternative to reduce postoperative bleeding, which is the most common complication after this type of surgery.
Subject(s)
Aorta/drug effects , Aortic Aneurysm, Thoracic/drug therapy , Aortic Aneurysm/drug therapy , Aortic Diseases/drug therapy , Glutaral/therapeutic use , Aged , Aortic Aneurysm/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Diseases/surgery , Female , Glutaral/pharmacology , Humans , MaleABSTRACT
Right coronary arteries that arise from the left sinus or ectopically from the right sinus with a slit ostium can cause myocardial ischemia, myocardial infarction, or sudden death. The surgical repair of these anomalies has evolved toward a simpler operation that widens the orifice of origin and reduces the compression of the intramural segment. We have repaired these anomalies without mortality in 8 patients. We summarize our experience and the evolution of this procedure.
Subject(s)
Cardiopulmonary Bypass/methods , Coronary Artery Bypass/methods , Coronary Vessel Anomalies/surgery , Myocardial Revascularization/methods , Adult , Cardiac Catheterization , Coronary Angiography , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/mortality , Female , Humans , Male , Middle Aged , Polyethylene Terephthalates , Saphenous Vein/transplantation , Survival RateABSTRACT
Jehovah's Witnesses (J.W.) can undergo successful cardiac operations. We have operated five J.W. patients. Of these patients, two had coronary artery bypass surgery and three had correction of congenital anomalies. These included an atrial septal defect with infundibular pulmonic stenosis, a tetralogy of Fallot and a patient with a ventricular septal defect. Our treatment protocol includes a meticulous surgery, the use of early heparinization to collect all shed blood into the pump oxygenator, observation in the operating room for early exploration if the patient bleeds and administration of iron preparations. Recombinant human erythropoietin, although available and in our treatment protocol, has not been used yet. All patients survived the operation and left the hospital with an excellent hemoglobin and hematocrit. The length of stay varied from 7 to 15 days.
Subject(s)
Cardiac Care Facilities , Cardiac Surgical Procedures , Christianity , Adolescent , Adult , Cardiac Surgical Procedures/methods , Humans , Intraoperative Care/methods , Middle Aged , Postoperative Care/methods , Preoperative Care/methods , Puerto RicoABSTRACT
Prompt left ventricular assistance by the centrifugal pump enables the survival of many patients with postoperative low cardiac output who cannot be weaned from cardiopulmonary bypass with the aid of balloon counterpulsation and inotropic agents. Successful weaning from the centrifugal pump, however, depends on the careful selection of appropriate candidates as well as the strict control of pump flow, oncotic pressure, coagulopathy, blood pressure, and systemic afterload. The installation of a hemoconcentration device into the pump line helps control hemodilution and maintain adequate oncotic pressure. The management of a patient who was totally dependent upon left ventricular assistance is described.