A gauze-pad wrapping of the heart can save a patient's life

Abstract We describe one case of iatrogenic rupture of the left ventricle after mitral valve replacement and myectomy of the outflow tract. The cause and site of the rupture could not be identified, neither from the internal nor from the external examination. After unsuccessful use of hemostatic patches in the surface of the ruptured area, wrapping of the ventricles with a surgical gauze pad controlled the hemorrhage, hence saving the patient's life.

A Gauze-Pad Wrapping of the Heart Can Save a Patient's Life.

We describe one case of iatrogenic rupture of the left ventricle after mitral valve replacement and myectomy of the outflow tract. The cause and site of the rupture could not be identified, neither from the internal nor from the external examination. After unsuccessful use of hemostatic patches in the surface of the ruptured area, wrapping of the ventricles with a surgical gauze pad controlled the hemorrhage, hence saving the patient's life.

[The role of percutaneous renal fenestration in the management of acute aortic dissection. Case report]. / Papel da Fenestração Renal Percutânea no Tratamento da Dissecção Aórtica Aguda. Caso Clínico.

Aortic dissection is one of the most feared vascular disease, coursing with high rate of complications. Depending on the location of the intimal tear, aortic dissection could implicate the ascending aorta, the heart and descending aorta, or only the descending aorta. The first case (type A) has absolute surgical indication. Independently of a good surgical result, vascular complications may occur, such as arterial renal compression, associated with flow disturbances to these organs. Percutaneous fenestration has been proven as a good solution in selected patients, in experienced hands. We present a case in which the percutaneous technique was successfully used.

[Sternal fractures - a case report, our hospital experience and a review of the literature]. / Fraturas do esterno. Revisão da literatura, a propósito de um caso clínico.

Thoracic trauma is a common cause of consultation in the emergency department, and may include fractures of the sternum in about 8% of cases. Due to the anatomical relations of this bone, in complicated cases, the fracture is associated with lesions of vital organs, which should be readily identified. In this paper, we present a case recently operated in our Department, make a statistical evaluation of the treatment of these fractures in our hospital in the last ten years and review of the relevant literature.

Coronary artery bypass graft surgery during heart transplantation.

We report the case of a patient who was submitted to coronary artery bypass graft surgery (CABG) during heart transplant as, during bench exploration, the donor heart presented a palpable atherosclerotic lesion in the anterior descending artery, not detected before harvesting. The patent internal thoracic artery from a previous CABG was used.

Aortic valve surgery in patients who had undergone surgical myocardial revascularization previously.

OBJECTIVES: A very high percentage of patients submitted to coronary artery bypass grafting (CABG) develop symptomatic aortic disease requiring surgery upon ageing. The surgical risk of the redo procedure is controversial. We describe our recent experience with patients submitted to this surgery under such conditions. METHODS: From July 1999 to July 2010, 51 patients (mean age, 70.3 ± 7.0 years, 86.3% male) submitted to CABG previously required aortic valve surgery (AVS). The mean interval between the surgeries was 7.1 ± 3.9 years. Twenty-one patients (41.2%) had also undergone AVS during the first surgery [12 patients (57.7%) had valve replacement and 9 patients (42.8%) had valvuloplasty]. At presentation, 51.0% were in New York Heart Association Class III/IV and the standard and logistic EuroSCOREs were 10.1 ± 2.5 and 20.9 ± 16.5%, respectively. RESULTS: Aortic valve replacement was performed in 48 patients (94.1%). Two patients had undergone a surgery for the closure of a peri-prosthetic leak and one patient a valvuloplasty. Thirteen patients (25.5%) needed to undergo additional cardiac procedures, including root enlargement (three patients, 5.9%). Valve surgery was performed with non-dissection of the internal thoracic artery graft, when patented, and antegrade cardioplegic arrest of other territories. Hospital and 30-day mortality rate was 2% (n = 1). The mean duration of hospital stay was 13.0 ± 11.1 days. The most frequent complication was arrhythmias - in 25.5% of the patients, and mostly due to atrial fibrillation (19.6%). Permanent pacemaker for A-V block was required in 5.9% of the cases, stroke was documented in two cases (3.9%) and early re-intervention was observed in two cases. CONCLUSIONS: Redo AVS performed in patients submitted to CABG previously results in mortality and morbidity rates that are much lower than what is expected, bringing clear benefits to the patients.

Simultaneous cardiac and renal transplantation late after hepatic transplantation.

Multiple organ transplantation is rarely performed because the combination in a single patient of the clinical conditions with that indication is uncommon. Besides, the scarcity of organ donors dictates a policy of maximisation of the results. We present the case of a patient who previously had a liver transplantation and was subsequently submitted to a successful simultaneous cardiac and renal transplantation.