Spontaneous coronary artery dissection in puerperium.

Spontaneous coronary artery dissection in puerperium is uncommon and most often occurs in the third trimester of pregnancy and in the early postpartum period. Two weeks after delivery, a 41-year-old woman presented with typical retrosternal chest pain and inverted T-waves in leads II, V5 and V6, and Q-waves in aVR. Her peak troponin I level was 16.39 µgcL(-1) Coronary angiography showed left main spiral dissection extending to the mid left anterior descending artery and involving the first diagonal branch. Urgent coronary artery bypass grafting was performed successfully. The mechanism and approach are discussed.

Spontaneous bleeding from liver after open heart surgery.

INTRODUCTION: Intra-abdominal hemorrhage after open heart surgery is very uncommon in routine clinical practice. There are case reports of having bleeding from spleen or liver after starting low molecular weight heparin (LMWH) postoperatively. PRESENTATION OF CASE: Our patient is a 58-year-old man with mitral valve regurgitation, who underwent mitral valve repair and developed intra-abdominal hemorrhage 8h after open heart surgery. The exploratory laparotomy revealed the source of bleeding from ruptured sub-capsular liver hematoma and oozing from raw areas of the liver surface. Liver packing was done to control the bleeding. DISCUSSION: The gastrointestinal complications after open heart surgery are rare and spontaneous bleeding from spleen has been reported. This is the first case from our hospital to have intra-abdominal hemorrhage after open heart surgery. CONCLUSION: Spontaneous bleeding from liver is a possible complication after open heart surgery. We submit the case for the academic interest and to discuss the possible cause of hemorrhage.

Combined coronary artery bypass grafting and surgical resection of right atrial myxoma complicated with pulmonary embolism / Cirugía combinada de bypass de arteria coronaria y resección quirúrgica de un mixoma auricular derecho complicado por una embolia pulmonar / Chirurgia combinada de bypass da artéria coronária e ressecção cirúrgica de um mixoma auricular direito complicado por uma embolia pulmonar

Although the association between right atrial myxoma and pulmonary embolism is rare, it has been recognized for many years. This condition is fatal unless surgical intervention is performed for resection of right atrial mass and pulmonary embolectomy. A 68 years old diabetic, hypertensive male patient was admitted to our hospital with severedy spnea and chest pain. An echocardiogram and pulmonary CT angiography revealed right atrial mass and pulmonary embolism. Further more, coronary angiography was done and showed a three vessels disease. Complete surgical removal of the right atrial myxoma and parts of the tumor embolectomy from the right pulmonary artery were successfully performed combined with coronary artery bypass grafting to LAD, obtuse marginal and diagonal branches. Histological examination of the primary tumor as well as the embolus confirmed the diagnosis of benign myxoma. The patientwas discharged after 15 days of his successful operation. We report this case, as it is unique because of the rarity of the combined surgery of right atrial myxoma complicated with pulmonary embolism and coronary artery bypass grafting.

Si bien la asociación entre el mixoma auricular derecho y la embolia pulmonar es poco frecuente, se conoce su existencia desde hace años. La condición es fatal salvo si se realiza una intervención quirúrgica para la resección de la masa auricular derecha y una embolectomía pulmonar. Ingresa a nuestro hospital un paciente masculino diabético e hipertenso de 68 años con disnea severa y dolor de pecho. Un ecocardiograma y una angioTac de pulmón revelan un masa auricularderecha y una embolia pulmonar. Además, la coronario angiografia realizada identifica enfermedad en tres vasos. Se realiza con éxito la resección quirúrgica completa del mixoma auricular derecho y parte de la embolectomia tumoral de la arteria pulmonar derecha junto con un bypass de la arteria coronaria a la descendente anterior, la marginal obtusa y las ramas diagonales. El examen histopatológico del tumor primario y de la embolia confirman el diagnóstico de mixoma benigno. El paciente fue dado de alta 15 días después de la exitosa operación. Publicamos este caso ya que es único porque es poco frecuente es combinar la cirugía de un mixoma auricular derecho complicado por una embolia pulmonar con una cirugía de bypass de la arteria coronaria.

Apesar da associação entre mixoma auricular direito e embolia pulmonar ser pouco frequente, sua existência é conhecida há anos. A condição é fatal salvo se realizamos uma intervenção cirúrgica para a resecção da massa auricular direita e uma embolectomia pulmonar. Ingressa ao nosso hospital um paciente masculino diabético e hipertenso de 68 anos com dispnéia severa e dor no peito. Um ecocardiograma e um angioTAC do pulmão revelam uma massa auricular direita e uma embolia pulmonar. Além disso, a coronario angiografia realizada identifica comprometimento de três vasos. Realiza-se com êxito a resecção cirúrgica completa do mixoma auricular direito e parte da embolectomia tumoral da artéria pulmonar direita junto com um bypass da artéria coronária àdescendente anterior, a artéria obtusa marginal e os ramos diagonais. O exame histopatológico do tumor primário e da embolia confirmam o diagnóstico de mixoma benigno. O paciente recebeu alta 15 dias depois da exitosa operação. Publicamos este caso por ser único devido à pouco frequência em combinar a cirurgia de um mixoma auricular direito complicado por uma embolia pulmonar com uma cirurgia de bypass da artéria coronária.

Cor triatriatum with persistent levoatrial cardinal vein late presented as severe mitral stenosis.

Cor triatriatum is a rare congenital cardiac anomaly that usually becomes symptomatic in the first years of life. We present a 28-year-old pregnant female patient presented with shortness of breath, palpitations and decreased exercise tolerance. Transthoracic (TTE) and transesophageal (TEE) echocardiography showed cor triatriatum, features of severe mitral stenosis and atrial septal defect (ASD). The patient underwent successful surgical correction with an uneventful postoperative course.

Atrial septal defect with drainage of the inferior vena cava into the left atrium.

Atrial septal defect (ASD) with drainage of the inferior vena cava (IVC) into the left atrium (LA) is a rare congenital anomaly. Few cases have been reported in the literature. We present a 17-year-old female with an ASD and an anomalous drainage of the IVC into the LA leading to cyanosis since early childhood. Diagnosis was documented by computed tomography (CT) angiography and confirmed intra-operatively. The patient underwent successful surgical correction with an uneventful postoperative course.