RESUMEN
Bovine serum albumin (BSA) tissue adhesive (BioGlue, Cryolife Inc., Kennesaw, GA, USA) is often used as a hemostatic adjunct in adult patients undergoing open surgical repair of large vessels, such as the aorta, femoral, and carotid arteries. We present a case of intraoperative anaphylaxis attributed to the use of BioGlue during thoracoabdominal aortic replacement. The patient suddenly developed hypotension, hypoxemia, and airway edema after the BioGlue application. BioGlue is composed of purified BSA and glutaraldehyde. Despite the BSA component being an allergen that can cause anaphylaxis in some patients, reported occurrences of anaphylaxis are extremely rare. We need to recognize BSA tissue adhesive as a potential allergen. In the event of an intraoperative shock, prompt recognition and investigation of the underlying cause are necessary.
RESUMEN
Endovascular stent-graft therapy is a commonly performed procedure for aortic lesions worldwide and complications unique to stent grafts, such as postoperative endoleaks, are well known. However, as this treatment modality becomes more popular, physicians should carefully monitor for other unexpected complications, which may not always be related to the graft. This study presents a case of leiomyosarcoma of the aorta that developed during follow-up for a type II endoleak (T2EL) after thoracic endovascular aortic repair. The presence of the T2EL hindered the diagnosis of the sarcoma at an early stage. These findings suggest that an apparent aneurysm that grows suddenly during follow-up after stent grafting should raise the index of suspicion for a neoplasm as well as an endoleak.
Asunto(s)
Endofuga , Reparación Endovascular de Aneurismas , Leiomiosarcoma , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Endofuga/diagnóstico por imagen , Endofuga/etiología , Endofuga/cirugía , Reparación Endovascular de Aneurismas/efectos adversos , Leiomiosarcoma/diagnóstico por imagen , Leiomiosarcoma/cirugía , Leiomiosarcoma/complicaciones , Complicaciones Posoperatorias , Estudios Retrospectivos , Stents/efectos adversos , Resultado del TratamientoRESUMEN
A 73-year-old man had Stanford type B acute aortic dissection 11 years before. He had underwent thoracoabdominal aortic replacement due to thoracoabdominal aneurysm nine years before and hemiarch aortic replacement due to Stanford type A acute aortic dissection four years before. We performed surgery because the dissecting aortic aneurysm in the distal arch has enlarged. We selected thoracic endovascular aortic repair( TEVAR) because of reoperation, but the true lumen of the descending aorta was highly narrowed, we had to deploy stent-grafts into the false lumen. Since the proximal and distal parts of endovascular thoracic stent-grafts were deployed into the previously implanted Dacron grafts, we could deploy them without vascular injury. If both proximal and distal parts of stent-grafts can be deployed into vascular prosthesis, deploying the stent-grafts into the false lumen may be a feasible option.
Asunto(s)
Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular , Humanos , Masculino , Estudios Retrospectivos , Stents , Resultado del TratamientoRESUMEN
A 76-year-old woman underwent screening echocardiography. A cardiac mass was detected in the left atrium. It was located at the atrial septum, and was around 3 cm in size. Its surface was smooth and there was cystic cavity inside. Coronary angiography revealed rich blood flow from bilateral coronary arteries to the mass and massive shunt to the left atrium, which formed a fistulous connection. We performed tumor resection under cardiopulmonary bypass. Postoperative course was uneventful. Histopathologically, the tumor was myxoma. Cardiac myxoma is the most common primary cardiac tumor, but myxoma exhibiting coronary artery-left atrial fistula is fairly uncommon.