ABSTRACT
A rare case of insufficient right-sided unilateral cerebral perfusion during emergent aortic arch replacement in a patient with an acute aortic dissection is reported. On the basis of intraoperative monitoring using near-infrared spectroscopy, the insufficient perfusion of the contralateral hemisphere was detected and the bilateral perfusion was performed, which led to normalization of cerebral perfusion and an uncomplicated neurological outcome.
Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Brain Ischemia/prevention & control , Cerebrovascular Circulation/physiology , Monitoring, Intraoperative , Vascular Surgical Procedures , Aged , Brain Ischemia/physiopathology , Female , HumansABSTRACT
A 64-year-old man was referred for aortic valve replacement due to severe stenosis. He also suffered chronic sternal osteomyelitis with skin fistula subsequent to radiation therapy. Both pathologies were approached simultaneously by sternal resection, omental plasty, and valve replacement, which led to favorable primary and mid-term result.
Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/radiation effects , Heart Valve Prosthesis Implantation , Osteomyelitis/surgery , Radiation Injuries/surgery , Staphylococcal Infections/surgery , Staphylococcus epidermidis , Sternum/radiation effects , Sternum/surgery , Streptococcal Infections/surgery , Viridans Streptococci , Aortic Valve Stenosis/diagnostic imaging , Chronic Disease , Combined Modality Therapy , Cutaneous Fistula/diagnostic imaging , Cutaneous Fistula/surgery , Fractures, Spontaneous/diagnostic imaging , Fractures, Spontaneous/surgery , Humans , Image Processing, Computer-Assisted , Male , Middle Aged , Osteomyelitis/diagnostic imaging , Radiation Injuries/diagnostic imaging , Radiodermatitis/diagnostic imaging , Radiodermatitis/surgery , Sarcoma/radiotherapy , Staphylococcal Infections/diagnostic imaging , Sternum/diagnostic imaging , Sternum/injuries , Streptococcal Infections/diagnostic imaging , Surgical Flaps , Thoracic Neoplasms/radiotherapy , Tomography, X-Ray ComputedABSTRACT
A 49-year-old man had severe neurocognitive dysfunction after urgent operation for acute type A aortic dissection. Complete aortic arch replacement with single reimplantation of the arch branches was performed with the patient under deep hypothermic circulatory arrest. Retrospectively, my colleagues and I consider the atresia of the right vertebral artery to be responsible for this complication and discuss whether knowledge of the anomaly and adapting the operative strategy accordingly would have improved the neurologic outcome.
Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Brain Damage, Chronic/etiology , Brain Ischemia/etiology , Cognition Disorders/etiology , Postoperative Complications/etiology , Vertebral Artery/abnormalities , Vertebrobasilar Insufficiency/complications , Aortic Dissection/complications , Aortic Dissection/diagnostic imaging , Aortic Aneurysm/complications , Aortic Aneurysm/diagnostic imaging , Blood Vessel Prosthesis Implantation , Cardiopulmonary Bypass/adverse effects , Congenital Abnormalities/diagnosis , Emergencies , Heart Arrest, Induced/adverse effects , Humans , Male , Middle Aged , Personality Disorders/etiology , Preoperative Care , Recognition, Psychology , Tomography, Spiral ComputedABSTRACT
A 52-year-old man, who presented with two-vessel coronary artery disease and severe arterial occlusive disease with occlusions and/or stenoses of all aortic arch branches, underwent simultaneously coronary artery bypass grafting and bilateral aortic-subclavian as well as left-sided aortic-carotidal bypass grafting.
Subject(s)
Aortic Arch Syndromes/surgery , Coronary Artery Disease/surgery , Aortic Arch Syndromes/complications , Coronary Artery Bypass/methods , Coronary Artery Disease/complications , Humans , Male , Middle AgedABSTRACT
OBJECTIVE: To assess aortocoronary grafts and internal mammary artery bypasses by means of EKG-triggered contrast-enhanced multi-slice spiral CT, and to evaluate the diagnostic accuracy of this new imaging modality. MATERIAL AND METHODS: 59 patients with up to 5 aortocoronary grafts and/or internal mammary artery bypasses per patient were examined with regard to bypass morphology, the free passage, and the proximal as well as the distal anastomoses using multislice computed tomography. Axial source images were calculated by means of retrospective triggering at different diastolic delay times, and were postprocessed in several planes with the multiplanar volume reconstruction (MPVR) software. RESULTS: On the pre-condition that data sets were acquired at sinus rhythm and at a heart rate lower than 65/min, aortocoronary grafts and internal mammary artery bypasses could be depicted in adequate diagnostic quality in about 80% of all cases with contrast-enhanced multi-slice spiral CT. Both, the free passage of the bypasses as well as the morphology of the proximal anastomoses were sufficiently assessed with multiplanar volume reconstruction (MPVR), whereas the distal anastomoses couldn't be depicted sufficiently in 20% of all cases. CONCLUSION: As a non-invasive method, contrast-enhanced and ECG-triggered multi-slice spiral computed tomography has gained diagnostic potential for the accurate visualization of aortocoronary grafts and the internal mammary artery bypasses.