Ascending aortic aneurysm associated with lymphoplasmacytic thoracic aortitis mimics acute type A intramural hematoma - case report.

INTRODUCTION: Lymphoplasmacytic thoracic aortitis is still underrecognized cause of thoracic aortic aneurysm. CASE REPORT: We herein report a case of symptomatic inflammatory ascending aortic aneurysm and pericarditis diagnosed on CT scan as acute type A intramural hematoma. Patient underwent emergency supracoronary ascending aorta replacement with a prosthetic graft. Marked inflammatory thickening of aneurysm wall was the intraoperative finding. Histopathologic examination of the excised aortic tissue showed inflammation with lymphoplasmacytic pattern of aortitis. CONCLUSION: This case demonstrates that lymphoplasmacytic aortitis may mimic symptoms and radiological findings of intramural hematoma.

Direct oxymetric peripheral tissue perfusion monitoring during open heart surgery with the use of cardiopulmonary bypass: preliminary experience.

BACKGROUND: Regional hypoperfusion has been associated with the development of postoperative organ dysfunction in cardiac surgery involving cardiopulmonary bypass (CPB). Direct tissue oxymetry is a potentially new method for monitoring the quality of the peripheral tissue perfusion during CPB. The aim of this study was to assess the effects of CPB in skeletal muscle oxygenation when measured in the deltoid muscle by direct oxymetry during perioperative period. METHOD: Seven patients underwent on-pump coronary artery bypass grafting. Direct oxymetry was performed by an optical cathether introduced into the deltoid muscle. Continuous measurement was made during the surgical procedure and the postoperative period. Mean arterial blood pressure, blood flow during CPB, laboratory markers of tissue hypoperfusion, blood gases and body temperature were also recorded. RESULTS: Interstitial muscle tissue oxygen tension (pO(2)) decreased after the introduction to anaesthesia and, more significantly, during CPB. After the disconnection from CPB at the end of the operation, the pO(2) returned to pre-anaesthetic values. During the first hours after admission of the patients to the intensive care unit, the pO(2) progressively decreased, reached a minimum value after four hours, and increased slowly thereafter. There was a significant correlation of pO(2) with mean arterial blood pressure and blood flow during that time. CONCLUSION: The result of this first measurement seems to demonstrate that the standard technique of conducting cardiopulmonary bypass produces low muscle oxygen tension and, thus, little perfusion of skeletal muscle. The data also indicate that both high mean arterial blood pressure and high flow are necessary during CPB to ensure skeletal muscle perfusion. The investigation is continuing.

[Intra-aortic balloon counterpulsation in cardiac surgery patients--experiences of Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Králove, University Hospital Hradec Králové, Czech Republic]. / Intraaortálna balóniková kontrapulzácia u kardiochirurgických pacientov--skúsenosti na Kardiochirurgickej klinike Lékarské fakulty Univerzity Karlovy v Hradci Králové a Fakultní nemocnice Hradec Králové.

AIM: To evaluate the use of intra-aortic balloon pump (IABP) at the Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and identifying the complications of this method and their frequency in long-term follow-up. METHOD: Retrospective analysis of the outcome of IABP use. From September 1994 to September 2007, 10,024 cardiosurgery operations were performed at the Department of Cardiac Surgery, University Hospital Hradec Králové, Czech Republic. IABP was applied in 363 cases (3.6%). Therapeutic indication for initiation of IABP at our department was the syndrome of low cardiac output in the postoperative period and during operation (difficulty in weaning from cardio-pulmonary bypass) and severe acute ischemic changes of myocardium refractory to pharmacotherapy. Prophylactic IABP was elective introduction of support before cardiac surgery in hemodynamically stable high risk patients. OUTCOME: From the group of 363 counterpulsated patients 192 were succesfully treated (52.9%), 171 patients (47.1%) died in consequence of cardiogenic shock and multiorgan failure. In 20 cases (5.5%) the IABP was introduced before the operation. Complications were observed in 61 patients (16.8%). Vascular complications were found in 27 cases (7.4%) including ischemic changes of the limb (14 cases 3.9%), significant bleeding occurred at the site of puncture (7 cases 1.9%), dissection of the femoral and iliac arteries (2 cases--0.55%), perforation of the iliac artery (1 case--0.3%). In 1 case (0.3%) the balloon was removed for intramural hematoma of the descending aorta without dissection. In 2 cases (0.55%) the balloon was led into the venous system. Thrombocytopenia occurred in our group in 23 patients (6.3%). Technical complications were observed in 7 cases (1.9%). None from our group of couterpulsated patinets had infectious complication. CONCLUSION: IABP is an effective and clinically verified mechanical cardiac support. Our results are similar to other studies.