RESUMO
Pulmonary artery catheterization is almost uniformly used nowadays in cardiac surgery. Although rare, rupture of the pulmonary artery following catheterization is highly lethal. This review examines ways of avoiding its occurrence and means of improving outcomes in case of rupture.
Assuntos
Procedimentos Cirúrgicos Cardíacos/instrumentação , Cateterismo de Swan-Ganz/efeitos adversos , Artéria Pulmonar/lesões , Idoso , Broncoscopia , Consenso , Embolização Terapêutica , Emergências , Feminino , Hemoptise/etiologia , Hemoptise/terapia , Hemorragia/etiologia , Hemorragia/terapia , Hemotórax/etiologia , Hemotórax/terapia , Humanos , Hipertensão Pulmonar/complicações , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Radiografia , Estudos Retrospectivos , Fatores de Risco , RupturaRESUMO
Primary malignant cardiac tumours are extremely rare. The authors report a case of primary cardiac lymphoma nine years after implantation of a double leaflet mitral valve prosthesis. Malignant lymphoma is a haematological form of sarcoma. Exceptionally rare, it is a tumour of the immune system occurring principally in immuno-depressed patients. It typically presents as a nodular or diffuse myocardial infiltrate explaining its clinical expression as cardiac failure and atrioventricular block. In view of the usual degree of infiltration, surgery is rarely possible. Survival after "pure" medical therapy (chemotherapy alone or associated with radiotherapy) is 6 to 8 months after diagnosis. Dacron has been implicated in the pathogenesis of primary cardiac sarcoma. Oppenheimer demonstrated experimental induction of sarcoma in the rat by subcutaneous implantation of polymers. In conclusion, although primary cardiac lymphoma is a rare condition, it should be considered, as with thrombosis, a possible differential diagnosis of acute dysfunction of cardiac valvular prostheses.
Assuntos
Neoplasias Cardíacas/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Linfoma Imunoblástico de Células Grandes/etiologia , Polietilenotereftalatos/efeitos adversos , Neoplasias Abdominais/tratamento farmacológico , Neoplasias Abdominais/secundário , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Astenia/etiologia , Erros de Diagnóstico , Evolução Fatal , Feminino , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Humanos , Linfoma Imunoblástico de Células Grandes/diagnóstico , Linfoma Imunoblástico de Células Grandes/tratamento farmacológico , Linfoma Imunoblástico de Células Grandes/cirurgia , Valva Mitral/cirurgia , Insuficiência de Múltiplos Órgãos/etiologia , Mixoma/diagnóstico , Sarcoma/induzido quimicamente , Trombose/diagnósticoRESUMO
The chronic constrictive pericarditis is a rare affection, with multiple etiologies and concerning especially the adult. We report a case of chronic constrictive pericarditis in an African child in whom no etiology was found. A review of the literature raises the characteristics of chronic constrictive pericarditis for a better therapeutic management.
Assuntos
Pericardite Constritiva/diagnóstico , África Oriental , Criança , Doença Crônica , Humanos , MasculinoRESUMO
A 16-year-old male with bone marrow failure due to chemotherapy for recurrent acute lymphoblastic leukemia developed an abscess in the lower lobe of the left lung draining through a bronchogastric fistula, as well as mitral valve endocarditis with large vegetations. After a course of antifungal therapy, the left lobe was removed and the fistula closed. The mitral valve was then replaced, after a failed attempt at valve repair, by a mechanical, double-leaflet prosthesis. Microscopy of the lung and heart specimens disclosed hyphae. Cultures of both specimens on Sabouraud's medium recovered a fungus, which was identified by culturing on Czapek's medium as Aspergillus flavus. Despite further antifungal therapy, fatal embolism developed. The emboli contained the same A. flavus as the valve and lung specimens. This case confirms the grim prognosis of primary Aspergillus endocarditis in immunocompromised patients, and suggests that delayed surgical treatment and the presence of another focus of Aspergillus infection may increase the risk of death.