RESUMO
Left ventricular free wall rupture is a feared complication of acute myocardial infarction typically presenting with cardiogenic shock. We present a case of spontaneous coronary artery dissection with free wall rupture and cardiac tamponade in an uncommon demographic. Friable myocardial tissue frequently precludes suture technique making biological glue repair a suitable option.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Tamponamento Cardíaco/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Ruptura Cardíaca/cirurgia , Proteínas/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Procedimentos Cirúrgicos sem Sutura , Adesivos Teciduais/uso terapêutico , Doenças Vasculares/congênito , Idoso , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ruptura Cardíaca/diagnóstico por imagem , Ruptura Cardíaca/etiologia , Humanos , Masculino , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Choque Cardiogênico/etiologia , Resultado do Tratamento , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgiaRESUMO
BACKGROUND: There is, as yet, no broad consensus regarding the optimal surgical approach for patients requiring reoperative mitral valve surgery. Consequently, we sought to evaluate the perioperative outcomes for patients undergoing redo mitral surgery via right mini thoracotomy as compared with traditional resternotomy. METHODS: A comprehensive retrospective review of our prospectively collected database was undertaken from January 2011 to December 2017. We propensity matched 90 patients who underwent reoperative mitral valve surgery via right mini thoracotomy with a concurrent cohort of patients who had redo median sternotomy. Intraoperative data and short-term clinical outcomes were analyzed. RESULTS: The 30-day mortality was 3.3% (six deaths) in the entire cohort, not significantly different between redo sternotomy and mini thoracotomy groups. Patients who had their procedure via right mini thoracotomy had reduced intensive care unit (P = .029) and overall hospital (P < .0001) lengths of stay, a diminished requirement for perioperative transfusion (P = .023), and a trend towards faster postoperative extubation. Right thoracotomy patients experienced shorter cardiopulmonary bypass (P = .012) and cardiac arrest (P < .0001) times than did the sternotomy cases. Peripheral cannulation was utilized more frequently in the mini thoracotomy group, as were fibrillatory arrest techniques. CONCLUSION: Reoperative mitral valve surgery via right mini thoracotomy is safe, and is associated with shorter extracorporeal circulation times, reduced transfusion, and faster postoperative recovery.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Pontuação de Propensão , Esternotomia/métodos , Toracotomia/métodos , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Reoperação/métodos , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
We report a case of an obstructing hemangioma within the lumen of the inferior vena cava adjacent to the hepatic veins. The technique of resection and pathology are described.
Assuntos
Parada Cardíaca Induzida , Hemangioma/cirurgia , Hipotermia Induzida , Neoplasias Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior/cirurgia , Ponte Cardiopulmonar , Hemangioma/patologia , Veias Hepáticas , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Neoplasias Vasculares/patologia , Veia Cava Inferior/patologiaRESUMO
This report describes the case of an 80-year-old man with culture-negative prosthetic valve endocarditis who ultimately was given a diagnosis of Legionella pneumophila endocarditis.
Assuntos
Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Próteses Valvulares Cardíacas/efeitos adversos , Doença dos Legionários/diagnóstico , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Idoso de 80 Anos ou mais , Endocardite Bacteriana/terapia , Humanos , Doença dos Legionários/etiologia , Doença dos Legionários/terapia , Masculino , Valva Mitral , Infecções Relacionadas à Prótese/terapiaRESUMO
Cardiac tamponade, the accumulation of fluid in the pericardial space, leads to impaired venous return, loss of left ventricular preload, and hemodynamic collapse. The many causes of tamponade include malignancy, infection, inflammation, connective tissue disorders, and uremia. Herein, we report the case of a young woman who presented with syncope. She was found to have cardiac tamponade secondary to a chylous pericardial effusion that was due to a mature and benign anterior mediastinal cystic teratoma. Numerous reports have described pericardial effusions secondary to an anterior mediastinal cystic teratoma; however, to our knowledge, this is the 1st case of a teratoma causing chylopericardium that presented as tamponade.
Assuntos
Tamponamento Cardíaco/etiologia , Neoplasias do Mediastino/complicações , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Teratoma/complicações , Adolescente , Eletrocardiografia , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Derrame Pericárdico/complicações , Radiografia , Teratoma/diagnóstico por imagem , Teratoma/patologiaRESUMO
Gas embolism is a known complication of minimal access procedures in which carbon dioxide insufflation is used. We report a case of significant venous and right heart gas embolization, which occurred during performance of routine minimally invasive vein harvesting. This was manifest by hemodynamic deterioration secondary to transmission by a patent foramen ovale into the left heart and coronary circulation. Techniques to predict, diagnose, and prevent this rare but potentially fatal complication of minimally invasive vein harvesting are suggested.
Assuntos
Embolia Aérea/etiologia , Endoscopia/efeitos adversos , Veia Safena/cirurgia , Manejo de Espécimes/efeitos adversos , Idoso , Dióxido de Carbono , Ponte de Artéria Coronária , Doença das Coronárias/complicações , Doença das Coronárias/cirurgia , Embolia Aérea/terapia , Feminino , Comunicação Interatrial/complicações , Comunicação Interatrial/cirurgia , Humanos , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Veia Safena/transplanteRESUMO
A coronary artery aneurysm is defined as coronary dilatation that exceeds the diameter of normal adjacent artery segments, or is 1.5 times the diameter of the largest coronary artery. Coronary artery aneurysms are rare with an incidence of between 1.5% to 5%. The aneurysm is caused by destruction of the vessel media, thinning of the arterial wall, increased wall stress, and progressive dilatation of a segment of the coronary artery. The most common cause is atherosclerotic coronary artery disease. These aneurysms occasionally rupture but more commonly develop thrombus and hematoma leading to the appearance of the presence of an intramyocardial mass. We present the case of a 60-year-old man with hypertension who presented with a mass that was identified initially by transthoracic echocardiography in the setting of an inferior wall myocardial infarction, which was later recognized to be a thrombosed right coronary artery aneurysm.
Assuntos
Aneurisma Coronário/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Tromboembolia/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
Cardiac operations in patients with sickle cell disease present the surgical team with many challenges. We describe a method of complete intraoperative exchange transfusion in the operating room that reduces the hemoglobin S (Hb S) level to less than 5%, without preoperative exchange transfusions. Plasma and platelet fractions separated intraoperatively from the patient's native red cell mass were used, in addition to hemoconcentration while on cardiopulmonary bypass, to effectively reduce the red cell and clotting factor transfusion requirements after the procedure. The technique is useful in reducing transfusion requirements, avoiding cardiovascular stress associated with exchange transfusion before the operation, and can be used in urgent situations.
Assuntos
Anemia Falciforme/terapia , Ponte Cardiopulmonar/métodos , Transfusão Total/métodos , Insuficiência da Valva Mitral/cirurgia , Adulto , Anemia Falciforme/complicações , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Assistência PerioperatóriaAssuntos
Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Esternotomia , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Spontaneous right ventricular disruption is a rare and frequently catastrophic event that occurs during the treatment of mediastinitis complicating median sternotomy wound. OBJECTIVE: The purpose of this study is to understand the pathogenesis of the spontaneous right ventricular disruption and to suggest strategies for the prevention and treatment of this rare but potentially fatal complication of cardiac surgery. METHODS: We report three cases as an introduction to the review of 39 cases found in the English-language literature. RESULTS: The majority of patients (71%) underwent coronary artery bypass grafting as the primary procedure prior to the development of a sternal infection. Staphylococcus Aureus and Staphylococcus Epidermidis were cultured most frequently from the sternal wound (31% and 24%, respectively). The mean interval between sternal debridement and the right ventricular disruption was 2.9 days. Most patients (24 of 42) required cardiopulmonary bypass for the repair of the right ventricular disruption. Biologic patches and adjuncts were used in 15 patients (36%). Eight patients (19%) died either preoperatively or on the operating-room table. CONCLUSIONS: Spontaneous right ventricular disruption is a potentially preventable complication. To prevent this complication we recommend: (1) avoidance of delay between diagnosis and operative treatment of mediastinitis; (2) complete lysis of adhesions between the posterior sternal edge and anterior surface of the right ventricle under general anesthesia with heart-lung machine stand-by; (3) repair of the right ventricular tear using biologic patches with heart-lung machine stand-by; (4) early (if possible immediate) closure of the chest with a myocutaneous flap.