RESUMEN
We describe the successful management of a stent protruding from the right coronary ostium into the aortic root in the setting of aortic valve replacement for aortic stenosis. Due to advances in medical care more elderly patients present for aortic valve surgery after percutaneous coronary intervention. Therefore, with an aging population due to advances in medical care, more patients will present for aortic valve surgery after percutaneous coronary intervention. We suggest a degree of caution before valve deployment in transcatheter aortic valve intervention or during annular manipulation in patients undergoing traditional aortic valve replacement with coexisting patent proximal stents.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Enfermedad de la Arteria Coronaria/cirugía , Vasos Coronarios/cirugía , Prótesis Valvulares Cardíacas , Stents/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Estenosis de la Válvula Aórtica/complicaciones , Enfermedad de la Arteria Coronaria/complicaciones , Humanos , Masculino , Falla de PrótesisRESUMEN
We report a novel use of cerebral oximetry in cardiac surgery using the Fore-Sight absolute cerebral oximeter (CAS Medical Systems Inc, Branford, CT). A patient with a persistent left superior vena cava underwent mitral and aortic valve replacement. We decided to tape and occlude the persistent left superior vena cava and used cerebral oximetry to compare left and right hemispheric oxygen saturation levels to ensure that cerebral perfusion was not impaired. The procedure was uneventful, and the patient was extubated 8 hours later without neurocognitive deficit.
Asunto(s)
Encéfalo/metabolismo , Procedimientos Quirúrgicos Cardíacos , Oxígeno/metabolismo , Vena Cava Superior/anomalías , Adulto , Puente Cardiopulmonar , Humanos , Masculino , OximetríaRESUMEN
PURPOSE: The distal tip of a Coopdech bronchial blocker has a preformed angulation to aid placement in the desired bronchus. We report two cases wherein this design may have resulted in distal tip fracture due to entanglement at the level of the Murphy's eye of the endotracheal tube or at the carina. CLINICAL FEATURES: A 49-yr-old female had a Coopdech bronchial blocker inserted into her right main bronchus for video-assisted thoracoscopic (VAT) lung biopsy. Resistance was encountered on its insertion, followed by confirmation of its position by fibreoptic bronchoscopy. As lung isolation was inadequate, bronchoscopy was repeated during surgery. This showed fracture of the blocker tip that required patient repositioning and insertion of another blocker. In a second incident, a bronchial blocker was inserted into the right main bronchus of a 19-yr-old male for VAT bullectomy. This procedure was performed under continuous fibreoptic guidance. Nevertheless, it was difficult to pass the blocker tip beyond the Murphy's eye of the endotracheal tube, as repeated attempts resulted in its entanglement and fracture. Another blocker was inserted by maneuvering the tip beyond the Murphy's eye. CONCLUSION: The preformed tip of the Coopdech bronchial blocker can be damaged at the Murphy's eye of the endotracheal tube or at the carina. This can result in tip fracture, especially during insertion into the right main bronchus. Maneuvering the tip away from the Murphy's eye can circumvent this problem. Continuous bronchoscopic guidance should be used as recommended by the manufacturer.