RESUMEN
A 48-year-old woman experienced a high fever and precordial pain. Computed tomography revealed pericardial fluid, and she was diagnosed with viral pericarditis. The pericardial fluid gradually increased, and she experienced pre-shock. Pericardial drainage was therefore performed, and the fluid was found to be purulent on the 11th day. Pleural effusion and ascites retention, then increased, and she was diagnosed with constrictive pericarditis on the 21st day by the date of the right ventricular pressure. Excision of the pericardium was performed through median sternotomy on the 27th day after the onset. As the ventricular diastolic function improved, the heart swelled, and sternal closure became impossible. It was finally closed 5 days after the surgery. The patient had no recurring infection, and was discharged on the 36th postoperative day. Although purulent pericarditis is a rare disease, you should keep in mind that it may progress rapidly to constrictive pericarditis.
Asunto(s)
Pericarditis Constrictiva/patología , Pericarditis/patología , Constricción Patológica , Femenino , Humanos , Persona de Mediana EdadRESUMEN
We report a case of aortic dissection due to improper position of a percutaneous cardiopulmonary support (PCPS) cannula into the femoral artery during coronary artery bypass grafting (CABG). A 77-year-old man with 3-vessel disease underwent off-pump CABG (OPCAB). Blood pressure suddenly lowered during bypass grafting to the right coronary artery. PCPS was performed between the left femoral artery and the right atrium. Bradycardia occurred 37 min after initiation of PCPS, and transesophageal echocardiography revealed Stanford type A aortic dissection. By converting the perfusion site from the femoral artery to the right axillar artery, the false lumen disappeared and did not reccur after cessation of PCPS. Therefore, the aorta was not replaced. He had however, bilateral leg paralysis after surgery. Magnetic resonance imaging (MRI) revealed spinal cord infarction caused by aortic dissection. Computed tomography (CT) confirmed disappearance of the false lumen and no expansion of the aorta 1 month after surgery. Meticulous care should be taken of the site and size of the arterial cannula in the extracorporeal circuit in such cases.
Asunto(s)
Aneurisma de la Aorta Torácica/etiología , Disección Aórtica/etiología , Puente Cardiopulmonar/efectos adversos , Puente de Arteria Coronaria , Infarto/etiología , Médula Espinal/irrigación sanguínea , Anciano , Humanos , Complicaciones Intraoperatorias , MasculinoRESUMEN
PURPOSE: To evaluate the short-/long-term outcomes after acute thromboembolism of the upper extremity. MATERIALS AND METHODS: Twenty-one patients with acute arterial occlusion in the upper extremity were treated from January 1993 to July 2007 at our hospital. Their average age was 73.0, and 14 (66%) were male. The right and left limbs were affected in 15 cases (71%) and 6 cases (29%), respectively. The main associated disease was arrhythmia, in 20 cases (95%), including atrial fibrillation in 17 (81%). The time from onset to operation was 9.7 +/- 9.2 h (range: 2-41 h). All patients underwent thromboembolectomy with a Fogarty catheter. RESULTS: The symptoms showed regression in all cases after operation, but one patient died from cerebral infarction the following day. Anticoagulant and antiplatelet therapies are commonly prescribed in cases after thromboembolectomy. The free rates of thromboembolism were 74% and 27%, and cumulative actuarial survival rates were 95% and 61% at 1 and 3 years, respectively. CONCLUSION: Because of the high recurrence rates of thromboembolism, it seems necessary to severe anticoagulant therapy. Upper extremity thromboembolism should also be considered as one manifestation of a systemic embolism.
Asunto(s)
Cateterismo Periférico , Embolectomía , Trombectomía , Tromboembolia/terapia , Extremidad Superior/irrigación sanguínea , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Recurrencia , Estudios Retrospectivos , Tromboembolia/diagnóstico , Tromboembolia/etiología , Tromboembolia/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the authors' experiences with in situ saphenous vein bypasses that were performed using two types of valvulotomes and to respectively compare their efficacy on the basis of the operative outcomes. METHODS: Between June 1993 and December 2008, 103 constructive in situ saphenous vein bypasses were performed, of which 53 were performed between 1993 and 2000 using an Insitucat valvulotome (B Braun Melsungen AG, Germany), and 50 were performed between 2000 and 2008 using a LeMaitre valvulotome (LeMaitre Vascular Inc, USA). RESULTS: There were no statistical differences with regard to age, sex and bypass procedures between the two groups. Critical limb ischemia (P=0.021) and diabetes (P=0.005) were more frequent in the LeMaitre group than the Insitucat group. Intraoperative graft revisions (P=0.079) and graft spasms (P=0.638) were less frequent in the LeMaitre group. Graft failures in the perioperative period or within the first year were less frequent in the LeMaitre group. The five-year cumulative primary patency rates were 63.2% and 59.8% in the LeMaitre and Insitucat groups, respectively (χ(2)=0.390, not significant). The five-year cumulative secondary patency rates were 91.9% and 81.7% in the LeMaitre and Insitucat groups, respectively (χ(2)=2.690, not significant). CONCLUSIONS: The results suggested that there were no significant differences in the outcome and adverse effects between the two types of valvulotomes for in situ saphenous vein bypass.
RESUMEN
Na(+)/K(+) pump activation induced by normothermic reperfusion with high potassium cardioplegia may exert a protective effect on reperfusion-induced myocardial damage. We investigated (1) temperature dependency and extracellular potassium dependency of the Na(+)/K(+) pump current (Ip), (2) effects of high potassium or ouabain during reperfusion on the post-ischemic left ventricular (LV) function. Ip-voltage relation was constructed at 5.0 and 20 mM of KCl (37 degrees C) using a whole-cell clamp technique in guinea pig myocytes. Ip at -40 mV was measured at 37, 27 and 18 degrees C (KCl: 5.0 mM). Isolated rat hearts were Langendorff-perfused and subjected to 20 min of global ischemia (37 degrees C) followed by 35 min of reperfusion (37 degrees C). The post-ischemic recovery of LV developed pressure (%LVDP) was assessed in the four reperfusate groups (4.8 mM KCl, 10 mM KCl, 20 mM KCl, or 4.8 mM KCl plus 50 microM ouabain during the first 10 min of reperfusion). The 4.8 mM KCl and 10.0 mM KCl groups were compared under metabolic inhibition (glucose-free, NaCN, or hypoxia) during reperfusion. The Ip-voltage relation shifted upward when extracellular KCl was increased from 5.0 to 20 mM. Ip was significantly greater at 37 degrees C than at 18 degrees C (114.3+/-17.2 vs. 22.7+/-1.2 pA, respectively). %LVDP was significantly greater at the 10.0 mM KCl group than at the 4.8 mM KCl group (54.9+/-5.5% vs. 34.2+/-5.9%, respectively). Metabolic inhibition abolished the difference between the two groups. Ouabain significantly decreased %LVDP (15.9+/-1.6%). Potassium-induced cardiac arrest during normothermic reperfusion may exert a cardioprotective effect by inducing Na(+)/K(+) pump activation, which may be supported by aerobic metabolism during reoxygenation rather than by energy saving during cardiac arrest.
Asunto(s)
Soluciones Cardiopléjicas/farmacología , Paro Cardíaco Inducido/métodos , Daño por Reperfusión Miocárdica/prevención & control , Miocardio/enzimología , Oxígeno/farmacología , Compuestos de Potasio/farmacología , ATPasa Intercambiadora de Sodio-Potasio/metabolismo , Adenosina Trifosfato/metabolismo , Animales , Soluciones Cardiopléjicas/metabolismo , Inhibidores Enzimáticos/farmacología , Femenino , Cobayas , Técnicas In Vitro , Masculino , Potenciales de la Membrana , Daño por Reperfusión Miocárdica/enzimología , Daño por Reperfusión Miocárdica/fisiopatología , Ouabaína/farmacología , Oxígeno/metabolismo , Perfusión , Compuestos de Potasio/metabolismo , Ratas , Ratas Wistar , Recuperación de la Función , ATPasa Intercambiadora de Sodio-Potasio/antagonistas & inhibidores , Temperatura , Factores de Tiempo , Función Ventricular Izquierda/efectos de los fármacos , Presión Ventricular/efectos de los fármacosRESUMEN
Only 5 cases of ruptured aneurysm of the persistent sciatic artery have been previously reported to date. We experienced a case of ruptured aneurysm of the persistent sciatic artery presenting acute lower limb ischemia. Physical examination showed a pulsatile mass with a subcutaneous hemorrhage in the left buttock, drop foot and paresthesia of the foot due to limb ischemia. An enhanced computed tomography scan showed a ruptured aneurysm of the left persistent sciatic artery at the level of the greater trochanter. An exclusion of the aneurysm and creation of common iliac to popliteal artery bypass was performed as an emergency operation.
RESUMEN
We report 3 cases of removal of infected pacemaker leads under extracorporeal circulation. The infections occurred 12, 29, and 58 months after the implantations. A skin ulcer was at first formed over the pacemaker; then the pacemaker itself became infected. The right atrium was incised, and the infected leads were pulled out. The ventricular leads adhered to the tricuspid valve, the chordae tendineae and the endocardia. A lead tip could easily be extirpated with sharp scissors. Two cases underwent implantation of myocardial electrodes; the new generators were implanted below the fascia of the rectus abdominis muscle. In the other case, a pacemaker was implanted transvenously because an appropriate epicardial pacing site could not be found. Case infected by methicillin-resistant Staphylococcus aureus (MRSA) died from mediastinitis a month after the operation. The others did not have a recrudescence of their infections. Removal of the leads under extracorporeal circulation is an invasive but sure procedure to extirpate.
Asunto(s)
Remoción de Dispositivos/métodos , Electrodos Implantados/efectos adversos , Circulación Extracorporea , Marcapaso Artificial/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Electrodos Implantados/microbiología , Resultado Fatal , Femenino , Humanos , Masculino , Resistencia a la Meticilina , Marcapaso Artificial/microbiología , Infecciones Relacionadas con Prótesis/etiología , Sepsis/etiología , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/cirugía , Staphylococcus aureus/aislamiento & purificación , Resultado del TratamientoRESUMEN
We describe open exposure of the inferior gluteal artery to allow coil embolization on an enlarging internal iliac artery aneurysm after previous abdominal aortic aneurysm (AAA) repair. An 84-year-old man with a stoma had undergone open AAA repair surgery 8 years previously, during which the proximal aortic neck and both proximal external iliac arteries were ligated, followed by an aorta to right external iliac and left common femoral bypass. Eight years later, he complained of abdominal pain, and a computed tomographic (CT) scan revealed persistent flow in the right internal iliac artery with enlargement to 8 cm in diameter. Because prograde access to the internal iliac artery was not possible as a result of the previous exclusion, the inferior gluteal artery was exposed surgically. Coil embolization of the arteries supplying the internal iliac artery aneurysm was successfully performed. The AAA and internal iliac artery aneurysm were treated by the exclusion technique. Eight years after the operation, CT revealed that the iliac artery had expanded to approximately 8 cm in diameter. The patient was placed face down, and a catheter was directly inserted into the internal iliac artery from the inferior gluteal artery. Four embolization coils were placed in the internal iliac artery and its branches. Absence of blood flow and shrinkage of the aneurysm were subsequently confirmed in the aneurysm, as shown by echogram color duplex scanning and CT scanning at 1 year. This technique could also be applicable for persistent blood flow in an internal iliac aneurysm after endovascular AAA repair, and the size of the aneurysm was reduced to approximately 1 cm 1 year after the operation.
Asunto(s)
Nalgas/irrigación sanguínea , Embolización Terapéutica , Aneurisma Ilíaco/cirugía , Anciano de 80 o más Años , Arterias/cirugía , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Aneurisma Ilíaco/terapia , Masculino , Radiografía Intervencional , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We report a case of Stanford type A acute aortic dissection caused by blunt trauma in a patient with situs inversus. A 57-year-old man was involved in an explosion accident. It was indicated that he had suffered Stanford type A acute aortic dissection, cardiac tamponade, and situs inversus by contrast enhanced computed tomography and echocardiography. With the introduction of anesthesia, he went into shock. An extracorporeal circuit was immediately introduced with heart massage. The ascending aorta was replaced with a prosthesis using cardiopulmonary bypass. The branches of the aortic arch were mirror-image reversed. The patient's general condition improved, and he was discharged from our department 3 weeks after the operation.
Asunto(s)
Aorta/lesiones , Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Rotura de la Aorta/cirugía , Traumatismos por Explosión/cirugía , Situs Inversus/complicaciones , Heridas no Penetrantes/cirugía , Disección Aórtica/etiología , Aorta/cirugía , Aneurisma de la Aorta/etiología , Rotura de la Aorta/etiología , Traumatismos por Explosión/complicaciones , Implantación de Prótesis Vascular , Taponamiento Cardíaco/etiología , Puente Cardiopulmonar , Hemorragia Cerebral/etiología , Circulación Extracorporea , Masaje Cardíaco , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Choque/etiología , Choque/terapia , Heridas no Penetrantes/complicacionesRESUMEN
BACKGROUND: The early results of emergent coronary artery bypass grafting by conventional operative method for acute myocardial infarction are reported to be poor. The purpose of this study is to evaluate on-pump beating-heart coronary artery bypass grafting for acute myocardial infarction. METHODS: Thirty-one patients with acute myocardial infarction underwent emergent surgery between January 1998 and June 2004 at Nayoro City General Hospital. In 16 patients, on-pump surgery was performed on the arrested heart, and in the other 15, on-pump surgery was performed on the beating heart. Early results were compared between the two groups. RESULTS: Preoperative and perioperative patient characteristics revealed no significant differences between the two groups. Although there was no statistically difference between the two groups, the early mortality rates of on-pump arrested-heart coronary bypass grafting (31.3%) was higher than that of on-pump beating-heart coronary bypass grafting (13.3%). Postoperatively, the creatine kinase myocardial band value for the on-pump beating-heart group was significantly lower than that for the on-pump arrested-heart group (221 +/- 200 IU/L versus 666 +/- 540 IU/L, p = 0.008). The incidence of postoperative acute renal failure was significantly higher in the on-pump arrested-heart group than in the on-pump beating-heart group (p = 0.034). The durations of ventilator use and inotropic agent use were longer in the on-pump arrested-heart group than in the on-pump beating-heart group, though the differences were not statistically different (p = 0.152, p = 0.223). CONCLUSIONS: On-pump beating-heart coronary artery bypass grafting has the possibility to eliminate intraoperative global myocardial ischemia and to be an acceptable surgical option for acute myocardial infarction associated with lower postoperative mortality and morbidity.
Asunto(s)
Puente de Arteria Coronaria/métodos , Infarto del Miocardio/cirugía , Complicaciones Posoperatorias , Enfermedad Aguda , Lesión Renal Aguda/etiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Respiración Artificial , Estudios RetrospectivosRESUMEN
Osteosarcoma of the lung without an extrathoracic primary tumor is extremely rare, with only eight cases documented in the literature, to the best of our knowledge. We report a case of primary osteosarcoma of the lung found in an asymptomatic 74-year-old woman. Computed tomography showed a heterogeneous mass beside the aortic arch, and the patient underwent a left upper lobectomy. The pathology results confirmed a diagnosis of primary osteosarcoma.