RESUMEN
Residual tumor mass after large cardiac fibroma resection carries long-term risk, but cryoablation is useful during surgery to remove such tissue. Here, we present a case of a large cardiac fibroma of the posterior wall of the left ventricle, discovered during long-term, episodic ventricular tachycardia. Resection with cryoablation completely removed the tumor, eliminating postoperative, distant ventricular arrhythmias.
Asunto(s)
Criocirugía , Fibroma , Neoplasias Cardíacas , Taquicardia Ventricular , Fibroma/diagnóstico por imagen , Fibroma/patología , Fibroma/cirugía , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/cirugía , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Taquicardia Ventricular/etiología , Taquicardia Ventricular/cirugíaRESUMEN
Median sternotomy near an existing tracheostoma risks deep sternal wound infection after cardiac surgery. We present herein a case of acute type A aortic dissection in a patient with a permanent tracheostoma after laryngectomy. Total arch replacement with both frozen elephant trunk and extra-anatomical bypass for supra-aortic trunks was performed through T-shaped partial sternotomy, resulting in recovery without deep sternal wound infection.
Asunto(s)
Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Humanos , Stents , Esternotomía/métodos , Traqueostomía/efectos adversos , Resultado del TratamientoRESUMEN
An 83-year-old woman who had undergone total arch replacement for a thoracic aortic aneurysm seven years prior experienced concurrent rupture of second and third branch anastomotic pseudoaneurysms. A stent graft was initially deployed across the pseudoaneurysm from the third branch to the left subclavian artery. Following the left axillary and left carotid arterial bypass, the origin of the second branch was embolized with metallic coils. As a result, both anastomotic pseudoaneurysms were undetectable by both completion angiogram and postoperative CT. By combining surgical and endovascular procedures, ruptured anastomotic pseudoaneurysms after total arch replacement can be repaired without a risky resternotomy.
Asunto(s)
Aneurisma Falso , Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Femenino , Humanos , Stents , Resultado del TratamientoRESUMEN
BACKGROUND: We evaluated the impact of persistent preformed donor-specific antibody (DSA) and de novo DSA (dnDSA) detected at 1 year posttransplantation on long-term death-censored graft survival. METHODS: One hundred and sixty adult patients who received living kidney allograft with pretransplant-negative T-cell complement-dependent cytotoxicity crossmatch (CDCXM), and without periodic screening for DSA, were eligible for this study. All enrolled patients were retrospectively tested for DSA using the Luminex assay. The presence of DSA was analyzed in stored serum samples collected at 1 year posttransplantation. If the recipients had DSA, it was analyzed in the pretransplant serum sample. The detection of DSA solely in the 1 year posttransplant sample was defined as dnDSA, and DSA detection in both pretransplant and 1 year posttransplant samples was defined as persistent preformed DSA. RESULTS: DSAs were identified in 14 (8.8%) of the 160 patients. Seven patients had persistent preformed DSA, 6 had dnDSA, and 1 had both persistent preformed and dnDSA at 1 year posttransplantation. Death-censored allograft survival rates of patients with DSA versus those without DSA at 7 and 11 years were 77.9 vs. 97.8% and 60.6 vs. 89.2%, respectively. The graft survival rate was lower in patients with persistent preformed DSA and/or dnDSA. Each case of preformed DSA and dnDSA was associated with long-term graft survival. CONCLUSION: The presence of persistent preformed DSA or dnDSA at 1 year posttransplantation may be a predictor of long-term graft survival. Further study is needed to evaluate whether periodic screening for DSA improves long-term graft survival.
Asunto(s)
Supervivencia de Injerto , Antígenos HLA/inmunología , Isoanticuerpos/sangre , Trasplante de Riñón , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Femenino , Antígenos HLA/genética , Prueba de Histocompatibilidad , Humanos , Japón , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
We report a case of a newborn infant who experienced circulatory collapse caused by a calcified lesion occluding the main pulmonary artery (PA). The baby was full-term at birth at a normal birth weight. Cyanosis was noted immediately after birth. Echocardiography revealed a main PA occlusion caused by a calcified lesion. Bradycardia and circulatory failure occurred at postnatal day 4, and an urgent surgical resection was successfully performed. Idiopathic calcification causing both PA obstruction and circulatory collapse is rare. Our report indicates that PA calcification can cause hemodynamic instability requiring early surgical intervention.
