RESUMEN

BACKGROUND: Aneurysm of a coronary artery branch with a fistula is extremely rare. Here, we present a case of giant aneurysm of the left circumflex artery branch with a fistula to the coronary sinus treated successfully with aneurysmectomy. CASE PRESENTATION: A 58-year-old woman was referred to our hospital due to an abnormal pericardial mass found by multidetector computed tomography. Imaging examination revealed a dilated left circumflex artery branch with a 30-mm aneurysm. Coronary angiography confirmed a left circumflex artery branch aneurysm with a fistula to the coronary sinus. As percutaneous occlusion of the aneurysm by catheterization was considered unsuccessful, the aneurysm was resected, and the fistula was occluded surgically with excellent outcome. Pathological examination suggested that congenital factors may have contributed to the development of the aneurysm. Computed tomography showed no recurrence of the aneurysm at 1-year postoperative follow-up. CONCLUSIONS: We presented a case of giant aneurysm of the left circumflex artery branch with a fistula to the coronary sinus. This is the first report of the combination of a giant coronary artery branch aneurysm with a fistula to the coronary sinus. Surgical aneurysmectomy should be considered in such cases to avoid fatal aneurysmal complications.

Asunto(s)

RESUMEN

We herein present a case of massive intratracheal hemorrhage due to pulmonary artery catheter (PAC) use during triple valve surgery. A 75-year-old woman underwent biological aortic valve replacement along with mitral and tricuspid valve annuloplasty. Operative procedures were uneventful. Shortly after weaning from cardiopulmonary bypass, massive blood and froth filled the endotracheal tube. As her blood pressure and arterial oxygen saturation dropped, extracorporeal membrane oxygenation(ECMO) support through the right femoral artery and vein was promptly initiated. After the tip of the PAC was identified in the right pulmonary artery by chest Xray, an endobronchial blocker was used to protect the opposite lung. After clinical stability was achieved, she underwent pulmonary artery angiography and subsequent successful transcatheter embolization. Right heart unloading using ECMO and transcatheter embolization might have played key roles in the management of intraoperative pulmonary artery rupture.

Asunto(s)

RESUMEN

An aortic aneurysm was incidentally diagnosed in a 75-year-old woman during a thorough examination for other diseases. She had a history of total arch replacement( TAR) for aortic arch aneurysm 17 years previously. Contrast-enhanced computed tomography( CT) revealed a proximal aortic aneurysm with a maximum diameter of 67 mm protruding to the lateral side. She was treated by elective ascending aortic replacement. The resected aneurysm was not a pseudoaneurysm, but a true aneurysm. The etiology of this aneurysm might be long-term hemodynamic stress from the left ventricle and inadequate blood pressure control in addition to the anatomical position of the proximal residual aorta after first surgery. Therefore, to prevent aneurysm formation, it is important to replace the ascending aorta as proximally as possible at first surgery and to continue strict postoperative blood pressure control.

Asunto(s)

Asunto(s)

RESUMEN

We report a successful case of hybrid coronary revascularization of minimally invasive coronary artery bypass grafting( MICS-CABG) and percutaneous coronary intervention(PCI). The patient was a 78-year-old man with angina pectoris due to left main trunk (LMT) lesion, and had a history of repeated PCI to the left anterior descending artery (LAD) and the left circumflex artery (LCX) for angina pectoris. He presented with a chest pain on effort in June, 2015. A coronary angiogram showed a severe stenosis in the LMT extending to LAD and LCX. We performed hybrid therapy of CABG to LAD, and PCI to LMT and the proximal portion of LCX because the lesion was technically and suitable for PCI. CABG to LAD was performed via left mini thoracotomy using the left inter mammary artery (LIMA). LIMA was harvested under 3-dimentional endoscope. On the 5th post-operative day, PCI was performed to LMT and LCX. The postoperative course was uneventful and he was discharged on the 11th post-operative day. This case suggests that hybrid coronary revascularization is less invasive and feasible for selected patients with multi-vessel disease.

Asunto(s)

RESUMEN

We present a case of heparin resistance whereby open heart surgery was discontinued. A 53-year-old woman who was diagnosed with ventricular septal defect and atrial septal defect was scheduled for intracardiac repair. However, after intravenous heparin (400 U kg-1) supplementation, the activated clotting time (ACT) increased only to seconds. The operation was discontinued because the addition of heparin( 200 U kg-1) did not show sufficient prolongation of ACT, fully indicative of heparin resistance. Additional antithrombin III concentrate was also ineffective. Postoperative study of the administration of heparin in vitro to the patient's serum showed the probability of transient heparin resistance arising from the stress of surgery.

Asunto(s)

RESUMEN

A single coronary artery, arising from the left sinus of Valsalva, associated with a bicuspid aortic valve and annuloaortic ectasia, is very rare. We report on a surgical case of bicuspid aortic valve regurgitation, annuloaortic ectasia, and dilation of the ascending aorta to the aortic arch in a patient with a single coronary artery. We successfully performed aortic root replacement with reimplantation of the single coronary artery and total arch replacement. The reimplantation of the coronary orifice required particular attention. Postoperative CT demonstrated the expected contours from the aortic annulus to the aortic arch with a patent implanted coronary artery.

Asunto(s)

RESUMEN

From August 2003 to June 2013, 9 patients with aortic valve endocarditis underwent aortic root replacement using homografts which were harvested and preserved in our institute. The median patient age was 62 years (range 46~84) and 5 patients were men. Four cases were prosthetic valve infections. The in-hospital mortality was 0%. In 8 of 9 cases were evaluated on midterm outcomes. At a median of 52 months (range 19~156), overall survival was 100%, freedom from cardiovascular events was 87.5%. The peak aortic pressure gradient was 9.04 ± 4.2 mmHg. Aortic regurgitation was less than 2 of 4 in all cases.

Asunto(s)

RESUMEN

The patient was an 84-year-old man. He had a history of 3-time median sternotomy with a functioning coronary bypass graft. Because of his dependence on inotropic agents caused by a progressing mitral and tricuspid valve insufficiency, we decided to perform surgery. To avoid heart damage and injury to the bypass graft by adhesiotomy, we performed on-pump beating heart mitral and tricuspid valve annuloplasty via right mini-thoracotomy approach. He was discharged 16 days after surgery. The on-pump beating heart valve repair via right mini-thoracotomy approach was useful in a selected case with multiple surgeries.

Asunto(s)

RESUMEN

BACKGROUND: In single-access laparoscopic colectomy, the number of instruments that can be inserted through the single-access site is limited by instrument collision. To compensate, triangulation is necessary, but the operative field becomes inadequate. To overcome this problem, intracorporeal attachable and detachable instruments can broaden the field of visceral tissue by retracting from at least 2 points. OBJECTIVE: We tested this new procedure for colon cancer surgery. DESIGN: This is a prospective study. SETTING: This study was conducted at a single-center hospital. PATIENTS: Ten consecutive patients (3 male and 7 female) with stage II or III colon cancer underwent the procedure. INTERVENTIONS: All patients received a 3.0-cm incision at the umbilicus or right iliac fossa. At least 2 clips and a suspending bar were inserted through a 12-mm port in a multiport access device. The clips grasped the mesocolon at different points and were retracted with either an extracorporeal magnet or fine-loop retractors; this broadened the operative field in the mesocolon by at least 2 points. The mesocolon was dissected with a medial to lateral approach. The suspended bar was tied to 2 fine-loop retractors and manipulated to enlarge the operative field in the mesocolon. The roots of the vascular pedicles were isolated and divided during lymph node dissection. After extracting the specimen, an anastomosis was performed. MAIN OUTCOME MEASURES: Intra- and postoperative complications due to inadequate access were the primary outcomes measured. RESULTS: There were no intraoperative complications and no need for conversions to open surgery or second access ports. The median total surgical time was 182 minutes (range, 122-245). Surgical blood loss was slight (range, 1-20 mL) in all patients. No postoperative complications occurred. The postoperative hospital stay was 5 to 7 days. LIMITATIONS: The sample size was small. CONCLUSIONS: This study showed that intracorporeal attachable and detachable instruments were safe and feasible for this procedure.

Asunto(s)