RESUMO
We experienced a case of papillary fibroelastoma of aortic valve, which had been located for preoperative 12 years without any symptom. We could assess tumor growth rate of 0.17 mm/year. Because of recent reports of recurrence, close follow-up should be continued.
Assuntos
Fibroelastoma Papilar Cardíaco , Fibroma , Neoplasias Cardíacas , Humanos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Fibroelastoma Papilar Cardíaco/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Fibroma/diagnóstico por imagem , Fibroma/cirurgiaRESUMO
Unilateral pulmonary edema (UPE) has been reported as a re-expansion pulmonary edema that occurs following rapid re-expansion of a collapsed lung in a patient with pneumothorax or large volume of pleural fluid. Recently, UPE after minimally invasive cardiac surgery through right-sided thoracotomy has received considerable attention because of its increasing morbidity and mortality. However, development of UPE in patients undergoing cardiac surgery through median sternotomy has not generally been recognized. Herein, we present our experience of UPE of the right lung after aortic valve replacement through median sternotomy. UPE may reflect ventilation-induced lung injury in concomitant systemic inflammation by cardiopulmonary bypass. Heterogeneity of lung collapse and wide pleural opening, which induced lung overdistension during recruitement, were considered to be associated with the occurrence of UPE in this case. Preventive measures should be considered for patients with multiple risk factors, and a meticulous recruitment maneuver is required for lung re-expansion during cardiac surgery.
Assuntos
Implante de Prótese de Valva Cardíaca , Edema Pulmonar , Valva Aórtica , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Esternotomia , Toracotomia , Resultado do TratamentoRESUMO
Meningitis has not been described to the same extent as other neurological complications of infective endocarditis(IE). The appropriate selection and dosing of antibiotics for patients with IE and meningitis do not exist. Herein, we described an instructive surgical case of mitral valve endocarditis and meningitis caused in a patient with atopic dermatitis, that was successfully treated using a multi-disciplinary approach.
Assuntos
Dermatite Atópica , Endocardite Bacteriana , Endocardite , Meningite , Humanos , Valva MitralRESUMO
Cor triatriatum sinister is a rare congenital heart disease in which the left atrium is divided into 2 chambers by a membrane, causing resistance to the blood flow to the left ventricle. The onset of symptoms depends upon the effective size of the orifice in the membrane and the associated heart disease. Our case is a 67-year-old woman with cor triatriatum found by chance at the onset of myocardial infarction. Coronary artery bypass surgery and excision of the membrane were successfully performed. Preoperative left ventricular dysfunction was improved after surgery. Imaging examinations such as enhanced computed tomography(CT) and magnetic resonance imaging(MRI) were useful for selecting surgical approach.
Assuntos
Coração Triatriado , Infarto do Miocárdio , Disfunção Ventricular Esquerda , Idoso , Feminino , Átrios do Coração , Humanos , Infarto do Miocárdio/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Blunt chest trauma can cause life-threatening condition. We performed prompt drainage and operative repair for traumatic cardiac injury caused by striking at epigastric fossa. Close monitoring should be needed even for blunt chest trauma due to assault.
Assuntos
Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Drenagem , HumanosRESUMO
We present herein a patient with rocuronium anaphylaxis, which had been identified using skin test, underwent conventional coronary artery bypass surgery without any neuromuscular blocking agent. Immobility was achieved with sedatives and analgesics.
Assuntos
Anafilaxia/induzido quimicamente , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Bloqueadores Neuromusculares/efeitos adversos , Idoso , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , MasculinoRESUMO
Saphenous vein graft aneurysms are rare but are potentially fatal and their optimal management is not clearly established. Herein, we report a case of a saphenous vein graft aneurysm that was successfully treated with surgical intervention, including aneurysmal resection and re-grafting. The aneurysm, detected 36 years after coronary artery bypass grafting, was located at the proximal part of the saphenous vein graft to the posterolateral branch; the flow of the left anterior descending coronary artery was limited due to compression of the left internal thoracic artery by the adjacent aneurysm. The proximal anastomotic site was reconstructed under deep hypothermic circulatory arrest using a radial artery graft pre-sewn vascular prosthesis patch.
Assuntos
Aneurisma/cirurgia , Ponte de Artéria Coronária , Vasos Coronários/cirurgia , Veia Safena/cirurgia , Idoso , Humanos , MasculinoRESUMO
Cardiac papillary fibroelastoma is reported to be the 2nd most common cardiac tumor following myxoma. Owing to the risk of embolism, early surgical excision is the treatment of choice. We report a case of effective anticoagulation therapy prior to surgical excision of an aortic valve papillary fibroelastoma. A 78-year-old man was admitted to our hospital because of transient cerebral ischemic attack. The symptom was relieved in a short period. Echocardiography revealed a tumor at the aortic valve. Cardiac computed tomography revealed a sea-anemone-like appearance of the tumor. Cardiac papillary fibroelastoma was suspected on close examination. The operation was postponed because of gingivitis that required draining. During 3 months awaiting the operation, he continued receiving anticoagulation therapy, which successfully prevented thromboembolism. Administration of anticoagulation therapy may be considered, unless early surgical excision can be performed.
Assuntos
Valva Aórtica , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Ataque Isquêmico Transitório/complicações , Músculos Papilares , Varfarina/uso terapêutico , Idoso , Valva Aórtica/cirurgia , Fibroma/diagnóstico , Neoplasias Cardíacas/diagnóstico , Humanos , MasculinoRESUMO
BACKGROUND: The efficacy of retrograde cardioplegia for myocardial protection is still controversial. In our institution, we exclusively use intermittent administration of tepid, undiluted blood supplemented with potassium and magnesium for the cases with aortic insufficiency, requiring aortotomy, or undergoing mitral valve repair. In using this retrograde technique, we make a point of cannulating a retrograde perfusion catheter under direct vision following right atriotomy. The purpose of this retrospective study is to evaluate the clinical outcome of using this technique. METHODS: This study comprises 49 patients who underwent elective valve surgery using direct-vision retrograde cardioplegia exclusively, requiring more than 3h aortic cross-clamping. Their clinical outcome was reviewed retrospectively. RESULTS: There was no hospital mortality in this study. No patient was noted to have evidence of mediastinitis, myocardial infarction, or cerebral complications in the postoperative period. The case requiring the longest aortic cross-clamping time (380 min) survived the operation without the use of intra-aortic balloon pumping or percutaneous cardiopulmonary support, and the postoperative course was uneventful. CONCLUSIONS: Our result suggests that direct-vision retrograde cardioplegia is a safe and effective method of cardioplegia delivery, and provides a longer period of myocardial protection than previously thought.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Soluções Cardioplégicas/administração & dosagem , Parada Cardíaca Induzida/métodos , Idoso , Aorta/cirurgia , Soluções Cardioplégicas/efeitos adversos , Feminino , Parada Cardíaca Induzida/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Estudos RetrospectivosRESUMO
INTRODUCTION: Primary cardiac angiosarcoma is rare, and its prognosis remains poor. Complete surgical resection is the first choice among the available treatments, to ensure prolonged patient survival. PRESENTATION OF CASE: We report the case of a 72-year-old man with right atrial angiosarcoma who presented with bloody pericardial effusion due to tumor hemorrhaging. Emergency surgery was performed. The right atrial free wall and vena cava were reconstructed with pedicled autologous pericardium. The patient died 12 months later because of multiple organ failure due to metastasis. Autopsy showed a maintained right atrial chamber and only mild calcification. DISCUSSION: Pedicled autologous pericardium may have contributed to preserving cardiac function that could withstand chemotherapy and radiotherapy. CONCLUSION: Pedicled autologous pericardium was found to be useful for reconstructing the cardiac chamber after removal of a cardiac tumor.
RESUMO
Early cardiac surgery was successfully performed on a patient with infective endocarditis and extensive cerebral infarction due to septic embolus, following mechanical embolectomy for proximal middle cerebral artery occlusion. Mechanical embolectomy may be useful for the success of early cardiac surgery in these patients.
RESUMO
In conventional tricuspid valve replacement, there is a risk of valve detachment because stitches are placed on relatively fragile tissues. In the supra-annular implantation technique, stitches are placed lateral to the triangle of Koch and the coronary sinus instead of the anterior and septal leaflets as in conventional tricuspid valve replacement. This procedure relieves stress at the antero-septal commissural area, as well as avoids injury to the conduction system. However, there are a few drawbacks: (1) the valve sits obliquely at the annular surface, (2) the suture line becomes extremely long, and (3) the venous return to the coronary sinus may be impeded. We modified the suture line, which travels lateral to the triangle of Koch and medial to the coronary sinus, to solve these problems. We herein report the technique and results of four cases.
RESUMO
The impact of blood disorders on fibromuscular dysplasia is unknown, and cardiovascular surgery results are also unclear. Furthermore, there are only a few case reports about the association between fibromuscular dysplasia and blood disorders. We report a case of a coronary bypass surgery and an aortic root replacement for a patient who is hypereosinophilic with multisite vasculopathy of fibromuscular dysplasia, including that of the coronary artery and saphenous vein, which was diagnosed by a histopathologic examination after an autopsy was performed 5 months after surgery. The outcome of cardiovascular surgery can be unfavorable for fibromuscular dysplasia. Blood disorders may also have an impact on the outcome.
RESUMO
A floating thrombus in the ascending aorta was incidentally discovered in a patient with a descending thoracic aortic aneurysm and a history of alcoholism. The patient developed deep venous thrombosis and pulmonary embolism. However, he refused to undergo surgical excision of the thrombus in the ascending aorta. Therefore, treatment with rivaroxaban was administered for 3 months, and it completely dissolved the thrombus. Anticoagulant therapy may be an alternative treatment when surgery cannot be performed.
RESUMO
Paraplegia and paraparesis are major concerns in descending and thoracoabdominal aortic repair. A shorter period of spinal cord ischemia is preferred for protection. We have developed a new technique in which plural intercostal arteries are reattached in a short time. The lower descending aorta is tailored using automatic sutures, and a vascular tube is made with diameter about 2.0 cm. Blood supply of intercostal arteries including the Adamkiewicz artery is resumed by perfusing the vascular tube in not more than 20 min. This technique has been applied in four patients, and there was neither paraplegia nor paraparesis.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Isquemia do Cordão Espinal/prevenção & controle , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Humanos , Período Intraoperatório , Paraplegia/etiologia , Paraplegia/prevenção & controle , Paresia/etiologia , Paresia/prevenção & controle , Isquemia do Cordão Espinal/etiologia , Técnicas de Sutura , Tomografia Computadorizada por Raios XRESUMO
We performed emergency repeat surgery for aneurismal rupture due to graft perforation with mechanical stress of the Z stent in a kinking graft after frozen elephant trunk procedure. Graft kinking occurred due to cranial migration of the Z stent. It is important to prevent stent dislodgement in order to achieve long-term durability and reliability in the frozen elephant trunk procedure.
Assuntos
Aneurisma Roto/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Stents , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Falha de Equipamento , Humanos , Masculino , Reoperação , Esterno/cirurgia , Estresse Mecânico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Beating mitral valve replacement was performed for mitral valve stenosis in a patient with a porcelain aorta after aortic valve replacement. The 77-year-old patient had developed heart failure several times. A chest computed tomographic scan revealed severe calcification on the ascending aorta and aortic arch. A cardiopulmonary bypass was established by bicaval drainage and aortic return after epiaortic echographic evaluation of the ascending aorta. The mitral valve was successfully replaced under a beating heart.
Assuntos
Doenças da Aorta/cirurgia , Calcinose/cirurgia , Ponte Cardiopulmonar/métodos , Estenose da Valva Mitral/cirurgia , Idoso , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico , Calcinose/diagnóstico , Calcinose/patologia , Ecocardiografia , Humanos , Masculino , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Surgical site infection (SSI), particularly deep sternal wound infection (DSWI), is a serious complication after cardiovascular surgery because of its high mortality rate. We evaluated the effectiveness of an SSI bundle to reduce DSWI and identify the risk factors for DSWI. METHODS: During the period January 2004 to February 2012, 1374 consecutive patients undergoing cardiovascular surgery via sternotomy were included. The cohort was separated into periods from January 2004 through February 2007 (period I, 682 patients) and March 2007 through February 2012 (period II, 692 patients). During period II, all preventive measures for DSWI were completed as an SSI bundle. We compared the DSWI rate between the 2 periods. Univariate and multivariate analyses were performed for the entire period to identify the risk factors for DSWI. RESULTS: DSWI occurred in 13 patients (1.9%) during period I and in 1 patient (0.14%) during period II. The DSWI rate during period II was significantly decreased by 93%, compared with period I (P=.001). Independent risk factors for DSWI included obesity (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.00-11.75; P=.049), the use of 4 sternal wires (OR, 8.2; 95% CI, 1.39-48.14; P=.020), long operative time (OR, 4.4; 95% CI, 1.20-16.23; P=.026), and postoperative renal failure (OR, 9.0; 95% CI, 2.44-33.30; P=.001). CONCLUSIONS: Complete implementation of simple multidisciplinary prevention measures as a bundle can greatly decrease the incidence of DSWI.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Prestação Integrada de Cuidados de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde , Pacotes de Assistência ao Paciente , Serviços Preventivos de Saúde , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Equipe de Assistência ao Paciente , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
We performed descending thoracic aortic repair via posterolateral thoracotomy using retrograde cerebral perfusion with direct cannulation into the left internal jugular vein. No postoperative neurological dysfunction was observed. This patient was discharged without any adverse events.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Cateterismo Venoso Central , Circulação Cerebrovascular , Veias Jugulares/fisiopatologia , Perfusão/métodos , Procedimentos Cirúrgicos Vasculares , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Aortografia/métodos , Ponte Cardiopulmonar , Parada Circulatória Induzida por Hipotermia Profunda , Humanos , Masculino , Pessoa de Meia-Idade , Toracotomia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Although hypothermic circulatory arrest with antegrade selective cerebral perfusion is used for cerebral protection, optimal perfusion characteristics are still unclear. Between May 2006 and March 2008, 26 patients (mean age, 68.9 years; 14 males) underwent thoracic aortic repair with mild hypothermic circulatory arrest (34.3 degrees C +/- 1.9 degrees C) and antegrade selective cerebral perfusion (30 degrees C) for various indications including 16 acute type A aortic dissections. Mean cerebral perfusion rate was 21.1 +/- 4.3mL kg(-1) min(-1). Non-elective operations were carried out in 16 (61.5%) cases. Operative procedures were ascending aortic replacement in 16 patients, hemiarch replacement in 4, and total arch replacement in 6. Cardiopulmonary bypass time was 209 +/- 61 min, cardiac ischemic time was 141 +/- 45 min, cerebral perfusion time was 81 +/- 67 min, and lower body circulatory arrest time was 65 +/- 22 min. Mean rectal temperature drifted to 30.6 degrees C +/- 1.3 degrees C. There was 1 (3.8%) hospital death due to rupture of a residual descending thoracic aneurysm. One patient needed reexploration for bleeding, and 2 (7.7%) suffered permanent neurologic dysfunction. No postoperative spinal cord dysfunction was observed. Mild hypothermic circulatory arrest with antegrade selective cerebral perfusion could be performed safely in our patient population.