RESUMEN
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.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Enfermedades de las Válvulas Cardíacas/cirugía , Válvula Mitral/cirugía , Puntaje de Propensión , Esternotomía/métodos , Toracotomía/métodos , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Reoperación/métodos , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
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.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Prótesis Valvulares Cardíacas/efectos adversos , Enfermedad de los Legionarios/diagnóstico , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Anciano de 80 o más Años , Endocarditis Bacteriana/terapia , Humanos , Enfermedad de los Legionarios/etiología , Enfermedad de los Legionarios/terapia , Masculino , Válvula Mitral , Infecciones Relacionadas con Prótesis/terapiaRESUMEN
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.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Taponamiento Cardíaco/cirugía , Anomalías de los Vasos Coronarios/cirugía , Rotura Cardíaca/cirugía , Proteínas/uso terapéutico , Infarto del Miocardio con Elevación del ST/etiología , Procedimientos Quirúrgicos sin Sutura , Adhesivos Tisulares/uso terapéutico , Enfermedades Vasculares/congénito , Anciano , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/etiología , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Rotura Cardíaca/diagnóstico por imagen , Rotura Cardíaca/etiología , Humanos , Masculino , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Choque Cardiogénico/etiología , Resultado del Tratamiento , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/cirugíaRESUMEN
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.
Asunto(s)
Paro Cardíaco Inducido , Hemangioma/cirugía , Hipotermia Inducida , Neoplasias Vasculares/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Vena Cava Inferior/cirugía , Puente Cardiopulmonar , Hemangioma/patología , Venas Hepáticas , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Neoplasias Vasculares/patología , Vena Cava Inferior/patologíaRESUMEN
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.
Asunto(s)
Anemia de Células Falciformes/terapia , Puente Cardiopulmonar/métodos , Recambio Total de Sangre/métodos , Insuficiencia de la Válvula Mitral/cirugía , Adulto , Anemia de Células Falciformes/complicaciones , Humanos , Masculino , Insuficiencia de la Válvula Mitral/complicaciones , Atención PerioperativaAsunto(s)
Enfermedades de la Aorta/etiología , Implantación de Prótesis Vascular , Extremidad Inferior/irrigación sanguínea , Neurofibromatosis 1/complicaciones , Enfermedades Vasculares Periféricas/etiología , Obstrucción de la Arteria Renal/etiología , Adulto , Anastomosis Quirúrgica , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/cirugía , Femenino , Humanos , Isquemia/etiología , Isquemia/cirugía , Angiografía por Resonancia Magnética , Neurofibromatosis 1/patología , Neurofibromatosis 1/cirugía , Enfermedades Vasculares Periféricas/patología , Enfermedades Vasculares Periféricas/cirugía , Obstrucción de la Arteria Renal/patología , Obstrucción de la Arteria Renal/cirugía , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Taponamiento Cardíaco/etiología , Neoplasias del Mediastino/complicaciones , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Teratoma/complicaciones , Adolescente , Electrocardiografía , Femenino , Humanos , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/patología , Derrame Pericárdico/complicaciones , Radiografía , Teratoma/diagnóstico por imagen , Teratoma/patologíaRESUMEN
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.
Asunto(s)
Aneurisma Coronario/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Tromboembolia/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
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.
Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Enfermedad Coronaria/cirugía , Rotura Cardíaca/cirugía , Ventrículos Cardíacos , Mediastinitis/cirugía , Infección de la Herida Quirúrgica/cirugía , Anciano , Anciano de 80 o más Años , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/diagnóstico , Estudios de Seguimiento , Rotura Cardíaca/etiología , Humanos , Masculino , Mediastinitis/diagnóstico , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Reoperación , Medición de Riesgo , Índice de Severidad de la Enfermedad , Esternón/fisiopatología , Esternón/cirugía , Infección de la Herida Quirúrgica/diagnóstico , Toracotomía/efectos adversos , Toracotomía/métodos , Trasplante de Tejidos/métodos , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
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.