ABSTRACT
BACKGROUND: The aim of this study was to analyze the results of pulmonary endarterectomy (PEA) performed simultaneously with additional cardiac procedures in a single tertiary-level center. METHODS: Data of patients who underwent PEA with additional cardiac procedures for chronic thromboembolic pulmonary hypertension (CTEPH) in our clinic were retrospectively reviewed using patient records. RESULTS: Between March 2011 and April 2019, 56 patients underwent PEA with additional cardiac surgery. The most common additional procedure was coronary artery bypass grafting (21 patients; 38%). The median intensive care unit and hospital stays were 4 (3-6) days and 10 (8-14) days. Mortality was recorded in six patients (11%). In multivariate analysis, only preoperative pulmonary vascular resistance (PVR) (p = 0.02; odds ratio [OR]: 1.003) and cardiopulmonary bypass duration (p = 0.02; OR: 1.028) were associated with mortality. When the cutoff value of 1000 dyn.s.cm-5 was taken in the receiver operating characteristic curve analysis, preoperative PVR predicted mortality with 83% sensitivity and 94% specificity (area under curve = 0.89; p < 0.01). CONCLUSION: PEA for CTEPH may be performed safely with other cardiac operations. This type of surgery is a complex procedure that should be performed only in expert centers. Patients with high preoperative PVR are at increased risk of perioperative complications.
Subject(s)
Cardiac Surgical Procedures , Endarterectomy , Hypertension, Pulmonary/surgery , Pulmonary Artery/surgery , Pulmonary Embolism/surgery , Adult , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality , Chronic Disease , Endarterectomy/adverse effects , Endarterectomy/mortality , Female , Hospital Mortality , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/mortality , Hypertension, Pulmonary/physiopathology , Length of Stay , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/mortality , Pulmonary Artery/physiopathology , Pulmonary Embolism/diagnosis , Pulmonary Embolism/mortality , Pulmonary Embolism/physiopathology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Cardiac myxomas are benign primer cardiac tumors of the heart. They can be fatal with a thromboembolic presentation. Myocardial infarction is one of these unusual thromboembolic presentations. We report a patient who presented with cardiac arrest due to ventricular fibrillation related to myocardial infarction. After successful resuscitation, coronary angiography and transthoracic echocardiography were performed. A left atrial mass was observed and interpreted as a possible cause of coronary embolism leading to myocardial infarction. After surgical excision, the pathological examination confirmed myxoma, which was the essential cause of the tendency to arterial embolism.
Subject(s)
Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/etiology , Heart Neoplasms/complications , Myxoma/complications , Coronary Angiography , Echocardiography , Female , Heart Arrest/etiology , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/surgery , Humans , Middle Aged , Myocardial Infarction/etiology , Myxoma/diagnostic imaging , Myxoma/surgery , Ventricular Fibrillation/etiologyABSTRACT
Intervention is inevitable in complicated Type B aortic dissections. Classical surgical procedures and endovascular interventions are far from ideal treatments due to their high risk of periprocedural complications and mortality. There is often a need for alternative method in cases of difficult anatomy. We present the combined use of frozen elephant trunk and antegrade visceral debranching methods in the treatment of a 54-year-old male patient with complicated Type B aortic dissection.