RESUMEN
We experienced the rare case of an elderly woman with uncorrected tetralogy of Fallot. She also had significant mitral and tricuspid regurgitation with deteriorated ventricular function and ischemic coronary artery disease. We performed a radical repair of the tetralogy of Fallot, valvular operations for the mitral and tricuspid regurgitation, and coronary artery bypass grafting. Although mechanical circulatory support was required postoperatively, she recovered well to New York Heart Association functional class II.
Asunto(s)
Anuloplastia de la Válvula Cardíaca , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral/cirugía , Tetralogía de Fallot/cirugía , Insuficiencia de la Válvula Tricúspide/cirugía , Anciano , Angiografía por Tomografía Computarizada , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/fisiopatología , Ecocardiografía , Femenino , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/fisiopatología , Hipertrofia Ventricular Izquierda/cirugía , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/fisiopatología , Volumen Sistólico , Tetralogía de Fallot/complicaciones , Tetralogía de Fallot/diagnóstico , Tetralogía de Fallot/fisiopatología , Resultado del Tratamiento , Insuficiencia de la Válvula Tricúspide/complicaciones , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/cirugía , Función Ventricular IzquierdaRESUMEN
A 61-year-old woman underwent right axillobifemoral bypass using a reinforced expanded polytetrafluoroethylene T-shaped graft for high aortic occlusion. One year later, anastomotic pseudoaneurysm of the axillary artery was noted. We performed pseudoaneurysmectomy and graft interposition at the same anastomotic site through an infraclavicular approach. Unfortunately, the pseudoaneurysm recurred four months later. Therefore, we performed a second reoperation through a supraclavicular approach, in addition to the infraclavicular one. We were able to achieve better exposure from the axillary artery to the distal part of the subclavian artery, and reconstruct the bypass with secure and safe arterial clamping and reanastomosis.
RESUMEN
We experienced 2 cases of left ventricular pseudoaneurysm located at the posterolateral wall. Case 1 was an 80-year-old woman who developed a left ventricular pseudoaneurysm 4 months after sutureless repair of left ventricular free wall rupture due to acute myocardial infarction. The pseudoaneurysm was repaired through a left thoracotomy. Case 2 was a 77-year-old woman who was diagnosed with left ventricular pseudoaneurysm incidentally by computed tomography. Aneurysmorrhaphy was conducted through a standard median sternotomy.
Asunto(s)
Aneurisma Falso/cirugía , Procedimientos Quirúrgicos Cardíacos , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos/cirugía , Esternotomía , Toracotomía , Anciano , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico , Aneurisma Falso/etiología , Femenino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Hallazgos Incidentales , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
A 59-year-old man had undergone aortic root replacement for annuloaortic ectasia (AAE) and aortic regurgitation (AR) 18 years before. The computed tomography (CT) showed a pseudoaneurysm of ascending aorta 4 years after the 1st operation. Re-aortic root replacement was done 15 years after the 1st operation because of the pseudoaneurysm. However, 3 years after the 2nd operation, the patient suffered from fever and another pseudoaneurysm was revealed by CT. Echocardiography showed a vegetation attached to the aortic valve. The 3rd operation was successfully performed using rifampicin-soaked vascular prosthesis. The postoperative course was uneventful. Thus, graft infection was effectively treated with a rifampicin-soaked vascular prosthesis.
Asunto(s)
Aneurisma Falso/cirugía , Aneurisma Infectado/cirugía , Antibióticos Antituberculosos/administración & dosificación , Prótesis Vascular , Infecciones Relacionadas con Prótesis/prevención & control , Rifampin/administración & dosificación , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Intraoperative transesophageal echocardiography (TEE) assessment of coronary artery graft anastomosed to posterior descending artery (PDA) was evaluated. Twenty-one patients with a saphenous vein (SV) graft (n=17) or right gastroepiploic artery (RGEA) graft (n=4) anastomosed to the PDA were examined. In the transgastric mid short-axis view, the graft was depicted as an echo-free zone between the right ventricle and diaphragm. The depth, diameter, angle for Doppler measurement, and angle-corrected blood flow velocity were determined. The graft was visualized in 20 cases (95.2%). The diameter of the SV graft was 3.0-6.5 mm (mean 4.0 mm), while that of RGEA graft was 2.2-2.9 mm (mean 2.5 mm), at the depth of 1.2-4.4 cm (mean 2.4 mm) with incident angle of 14-57 degrees (mean 38.6 degrees ). Blood flow was detected in 17 cases but was difficult to detect in three cases (velocity <10 cm/s). Postoperative coronary angiography showed patent graft in 16 of former cases (one case of operative death excluded) but occluded graft in all of latter cases. Intraoperative TEE assessment was feasible nearly consistently. Diastolic blood flow velocity <10 cm/s suggests an early occlusion of the graft.
Asunto(s)
Puente de Arteria Coronaria , Circulación Coronaria , Vasos Coronarios/cirugía , Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Oclusión de Injerto Vascular/diagnóstico por imagen , Ultrasonografía Intervencional , Grado de Desobstrucción Vascular , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Angiografía Coronaria , Puente de Arteria Coronaria/efectos adversos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Estudios de Factibilidad , Femenino , Arteria Gastroepiploica/trasplante , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Proyectos Piloto , Valor Predictivo de las Pruebas , Vena Safena/trasplante , Resultado del TratamientoRESUMEN
We report on the rare and successful surgical treatment of a case of spontaneous rupture of the ascending thoracic aorta resulting in a mimicking pseudoaneurysm. A 72-year-old male who had complained of sudden onset of severe chest pain was admitted to our hospital. Initially, acute type A closing aortic dissection was suspected because computed tomography (CT) showed a small ulcer-like projection (ULP) in the posterior aspect of the ascending aortic wall, but it also revealed no intimal flap, false lumen or aortic aneurysm. CT and magnetic resonance imaging (MRI) indicated a change in the radiographic aspect of the ULP and revealed a mimicking saccular-type pseudoaneurysm and gradual increasing size of the pseudoaneurysm. Surgery was performed after considering the risk of pseudoaneurysmal rupture. We replaced the ascending aorta and diagnosed it as a spontaneous aortic rupture by histological examination of the rupture site after failing to observe an aneurysm or dissection. We discuss these results with reference to the literature, including our pathological and radiographical findings.
Asunto(s)
Aneurisma Falso/cirugía , Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Anciano , Aneurisma Falso/etiología , Aneurisma Falso/patología , Aorta Torácica/patología , Rotura de la Aorta/complicaciones , Rotura de la Aorta/patología , Humanos , Masculino , Rotura Espontánea , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: A study was undertaken to evaluate the validity and efficacy of video-assisted thoracic surgery (VATS) for the diagnosis of indeterminate pulmonary nodules. MATERIALS AND METHODS: Between April 2001 and November 2004, 57 adult patients (31 males, 26 females) with a clinical diagnosis of pulmonary nodules by preoperative chest computed tomographic (CT) scanning were included in this study. RESULTS: A definitive tissue diagnosis was obtained in all 57 patients. The mean age of the patients was 66+/-9.8 yrs. The mean size of the tumor was 1.76+/-0.67 cm. 38 patients (67%) had malignant disease. Twenty eight patients (49%) had primary lung cancer and 10 patients (18%) had metastatic lung cancer from an extrathoracic primary neoplasm. The rate of malignancy was 65% in the tumor sizes equal to or less than 2 cm. Among primary lung cancer, most patients had primary adenocarcinoma (24 cases)(86%). Pathologic staging showed T1N0 (stage IA) in 18 cases (69%), T2N0 (stage IB) in 4 cases (15%), T2N1 (stage IIB) in 1 case (4%), and T1N2 (stage IIIA) in 3 cases (12%). In 10 patients (18%) who required preoperative placement of a localization hookwire with a string near the nodule, the rate of malignancy was 70%. In 7 patients with positive positron emission tomography (PET) imaging with F-18 fluorodeoxyglucose (FDG), the rate of malignancy was 57% and proved to be falsely positive in 3 cases (43%). There was no operative mortality and no significant morbidity in all cases. CONCLUSION: We proposed that VATS, which is safe and offers virtually 100% sensitivity and specificity, should be performed for most small (<3 cm in diameter) and all indeterminate pulmonary lesions on the basis of these results.
Asunto(s)
Neoplasias Pulmonares/patología , Nódulo Pulmonar Solitario/patología , Cirugía Torácica Asistida por Video , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tomografía de Emisión de Positrones , Sensibilidad y Especificidad , Nódulo Pulmonar Solitario/cirugíaRESUMEN
A 61-year-old male had complained of cough and dyspnea on effort, with right pleural effusion. Computed tomography demonstrated a calcific pericardium surrounding the entire heart, with thickening of 10 mm. Cardiac catheterization showed no coronary disease, but a dip-and-plateau of the pressure curve of both ventricles. We diagnosed congestive heart failure due to chronic constrictive pericarditis, and performed a subtotal pericardiectomy, using an Ultrasonic Scalpel through a median sternotomy combined with anterior left thoracotomy at the level of the fifth rib, without cardiopulmonary bypass (CPB). After the subtotal pericardiectomy, his postoperative recovery was uneventful and his functional status improved. We consider that our surgical technique is a useful method for treatment of chronic constrictive pericarditis, and advocate the use of the Ultrasonic Scalpel for a safe and easy pericardiectomy.
Asunto(s)
Pericarditis Constrictiva/cirugía , Terapia por Ultrasonido , Enfermedad Crónica , Disección/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Pericardiectomía , Pericarditis Constrictiva/diagnóstico por imagen , Pericardio/diagnóstico por imagen , Radiografía , Terapia por Ultrasonido/instrumentaciónRESUMEN
We report a 58-year-old man who underwent surgical treatment of primary lung cancer arising from the wall of a giant bulla. Chest roentgenography and computed tomography revealed multiple emphysematous bullae in the bilateral upper lobes, and a right upper giant bulla with a mass measuring 6 cm arising on the bulla wall. Right upper lobectomy was performed, the postoperative pathological diagnosis was large cell carcinoma arising from the wall of a giant bulla. Although the postoperative course was uneventful and he was discharged, he underwent partial resection of the jejunum for recurrence of carcinoma in the jejunum, and postoperative chemotherapy, and he was alive 20 months after that operation. In general, patients with both pulmonary bullous disease and primary lung cancer have a very poor prognosis, because they receive treatment when the tumor is at an advanced stage. On the basis of our review of the literature, we recommend that middle-age male patients with a giant bulla who smoke should have annual chest roentgenography and/or chest computed tomography to screen for lung cancer arising in or close to the bullous disease, and that a giant bulla should be resected in patients older than 50 years because of the high incidence of coexisting cancer and bulla, to improve the prognosis of this disease.
Asunto(s)
Vesícula/complicaciones , Carcinoma de Células Grandes/complicaciones , Enfermedades Pulmonares/complicaciones , Neoplasias Pulmonares/complicaciones , Vesícula/diagnóstico por imagen , Carcinoma de Células Grandes/patología , Carcinoma de Células Grandes/cirugía , Humanos , Neoplasias del Yeyuno/cirugía , Enfermedades Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugía , Pronóstico , RadiografíaRESUMEN
We report a very rare case of primary malignant lymphoma arising in the pleura with no history of persistent pyothorax. A 72-year-old male was hospitalized with dyspnea on effort and chest CT demonstrated a mass along the right chest wall. Right thoracotomy with complete en bloc resection of the pleural tumor was performed. Immunohistochemical examination of the pleural tumor showed that the histology was marginal zone B-cell malignant lymphoma. We considered that this tumor had originated from the soft tissue in the chest wall based on radiographical and surgical findings. As diagnosis and treatment of pleural malignant lymphoma seems to have been difficult in most cases reported in the literature, it is thought that early active and accurate biopsy with large-bore needles, or, if possible, surgical incision for early diagnosis and aggressive surgery to achieve complete resection combined with radiation therapy and/or chemotherapy would be very important for a good prognosis.