RESUMO
Umbilical arterial and venous catheters are used widely in management of critically ill neonates. Being delicate, they can get inadvertently damaged by needles, scissors, or tight purse-string sutures during insertion and removal. Umbilical artery catheter embolization is a rare and dreaded complication, with less than 15 cases reported to date. We describe a term neonate, in whom a 3.5-Fr umbilical artery catheter, accidentally broken and dislodged, was surgically retrieved through right common iliac arteriotomy, safely and completely. Direct surgical retrieval of umbilical catheters while avoiding attempts at local exploration maybe considered a first line in management, particularly if endovascular facilities are unavailable or inaccessible.
RESUMO
A fistula between the right pulmonary artery and the left atrium is a very rare congenital anomaly, for which there is no definitive embryogenetic explanation. Patients present with cyanosis or clubbing, and the treatment strategy is to close the fistula, which can be done by an open surgical technique or by percutaneous intervention. Although rare, this condition should be considered in the differential diagnosis when evaluating a patient with central cyanosis.
RESUMO
INTRODUCTION: Aneurysms of sinuses of Valsalva are rare aortic anomalies having an incidence of 1.4-4.94% in the Asian population. Spontaneous rupture is the most common complication and ruptured aneurysms usually present with congestive cardiac failure. AIM: Our study was aimed at evaluating the clinical profile of patients with ruptured sinus of Valsalva aneurysms (RSOVA) and their distribution, the surgical management and post-operative course. MATERIAL AND METHODS: We retrospectively identified 21 patients who presented to us with RSOVA over a period of 7 years and underwent surgery for the same. RESULTS: RSOVA was more common in young males. Most cases involved the right coronary sinus (RCS) followed by the non-coronary sinus (NCS). The site of rupture was mostly the right ventricular outflow tract or the right atrium. All patients had a relatively asymptomatic post-operative course in the ward. On follow-up, most of the patients were symptom free. CONCLUSIONS: Surgery on cardiopulmonary bypass with moderate hypothermia with excision of windsock deformity and patching of the rupture site is a safe method of treating ruptured sinus of Valsalva aneurysms. Patients need to be followed up regularly to monitor for the development of aortic regurgitation.
RESUMO
INTRODUCTION: Creation of arteriovenous fistulas (AVF) for providing vascular access in patients dependent on hemodialysis is a very frequent type of surgery. One of the common complications of such a fistula is the formation of an aneurysm or a pseudoaneurysm and the risk of impending rupture. These are a few of the reasons why such surgically created AVF have to be taken down surgically. Some of these may be taken down for cosmetic reasons electively while some present in an emergency due to rupture of the aneurysm itself. AIM: This is a retrospective study of 26 patients who underwent AVF takedown at our center over a period of 4 years. MATERIAL AND METHODS: We intended to study the patient profile, the surgery that they underwent and the post-operative course of these patients. RESULTS: We found that aneurysm formation was the most common reason for a takedown, although we did see a good percentage of patients who presented to us with a ruptured AVF aneurysm. Our procedure was a ligation of the aneurysm with resection of the aneurysmal segment and maintaining arterial continuity. No attempt to preserve the fistula was made in any of these cases. CONCLUSIONS: This article gives a brief overview of our experience in AVF takedown.