RESUMEN
BACKGROUND: Coronary artery bypass grafting (CABG) surgery is a common procedure for managing multi-vessel coronary artery disease to revascularize the myocardium. Among the various conduits used, the left internal mammary artery (LIMA) is preferred due to its better long-term patency rate. However, CABG procedures involving LIMA may result in rare but serious complications, such as avulsion of the LIMA post-CABG, which leads to disruption of blood flow to the myocardium and the development of fatal cardiac tamponade. CASE PRESENTATION: We hereby present a unique case of spontaneous avulsion of a LIMA graft to the left anterior descending artery (LAD) away from the site of anastomosis, twenty-four hours following CABG surgery in a 67-year-old male patient. Emergency re-exploration and repair of the LIMA with interposition vein graft were performed and resulted in successful stabilization of the patient's critical condition. However, this was followed by a complicated recovery period involving atrial fibrillation, acute kidney injury, and wound infection. CONCLUSION: Avulsion of LIMA graft following CABG is rare, yet a fatal complication that requires high clinical suspicion and prompt management. Avulsion has been reported a few times in literature following both minimal invasive and conventional CABG. Understanding the etiology, clinical presentation, and management of this complication is crucial to avoid catastrophic outcomes.
Asunto(s)
Puente de Arteria Coronaria , Arterias Mamarias , Humanos , Masculino , Anciano , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Arterias Mamarias/trasplante , Arterias Mamarias/lesiones , Arterias Mamarias/cirugía , Complicaciones Posoperatorias/cirugía , Enfermedad de la Arteria Coronaria/cirugía , Anastomosis Interna Mamario-Coronaria/efectos adversosAsunto(s)
Fracturas Óseas , Arterias Mamarias , Traumatismos Torácicos , Heridas no Penetrantes , Bovinos , Animales , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/diagnóstico por imagen , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico por imagen , Arterias Mamarias/diagnóstico por imagen , Arterias Mamarias/lesiones , Esternón/diagnóstico por imagen , Esternón/lesionesRESUMEN
Pseudoaneurysm of the internal thoracic artery (ITA) or bleeding from the ITA is an extremely rare complication after cardiovascular surgery via a median sternotomy. Early treatment is needed in the case of massive haemorrhage or a rapidly enlarging pseudoaneurysm. Herein, we present a rare case of a delayed large pseudoaneurysm of the right ITA in a 49-year-old woman with Marfan syndrome who underwent redo aortic root replacement via re-median sternotomy and pacemaker implantation. Diagnostic selective angiography revealed the origin of the pseudoaneurysm, and simultaneous transcatheter embolisation of the ITA was successfully performed. Follow-up computed tomography imaging showed no evidence of contrast media extravasation from the ITA and recurrent extra-pleural haemorrhage. Our findings suggest that postoperative management of patients who have undergone median sternotomy, including cardiovascular surgeries, should also focus on the prevention or early detection of pseudoaneurysm of the ITA to avoid life-threatening conditions.
Asunto(s)
Aneurisma Falso/etiología , Arterias Mamarias/lesiones , Síndrome de Marfan/complicaciones , Esternotomía/efectos adversos , Lesiones del Sistema Vascular/etiología , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Embolización Terapéutica , Femenino , Humanos , Arterias Mamarias/diagnóstico por imagen , Síndrome de Marfan/diagnóstico , Persona de Mediana Edad , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/terapiaRESUMEN
Extrinsic compression of the heart consequent to intrapleural fluid is a rare cause of cardiac tamponade. Cases of massive hemothorax resulting in external cardiac tamponade due to injury of the internal thoracic artery (ITA) following blunt or penetrating trauma have been described in the literature. Here, we present a case of iatrogenic injury to the right ITA complicating mastectomy and deep inferior epigastric perforator flap reconstruction. It manifested as hemodynamic instability that persisted despite aggressive fluid resuscitation. Investigation with an intraoperative transesophageal echocardiogram demonstrated cardiac tamponade secondary to a massive hemothorax which resolved following surgical placement of an intercostal drain.
Asunto(s)
Neoplasias de la Mama/cirugía , Taponamiento Cardíaco/diagnóstico por imagen , Colgajos Tisulares Libres/efectos adversos , Arterias Mamarias/lesiones , Mastectomía/efectos adversos , Taponamiento Cardíaco/etiología , Procedimientos Quirúrgicos Electivos/efectos adversos , Femenino , Hemodinámica , Hemotórax/complicaciones , Hemotórax/etiología , Humanos , Enfermedad Iatrogénica , Mamoplastia/efectos adversos , Arterias Mamarias/diagnóstico por imagen , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Coronary artery anomalies (CAA) are anatomical aberrations in the origin, structure, and course of the epicardial arteries. Literature has detailed common anomalies or fistulas formed because of coronary artery bypass grafting (CABG) manipulation of intrathoracic vessels. Despite the commonality of the CABG procedure, there are a few CAA and fistula findings which remain extremely rare. We present a case of left internal mammary artery to pulmonary artery fistula causing coronary steal syndrome that presented symptomatically as a malignant arrhythmia. Following a literature review of therapy, intervention, and management we recommend a team based approach when faced with this extremely rare case presentation. The goal of management should to reduce symptoms, and ischemia, by reducing or stopping flow through the fistula and out of the coronary blood supply.
Asunto(s)
Fístula Arterio-Arterial/terapia , Puente de Arteria Coronaria/efectos adversos , Síndrome de Robo Coronario-Subclavio/terapia , Arterias Mamarias/lesiones , Intervención Coronaria Percutánea , Arteria Pulmonar/lesiones , Lesiones del Sistema Vascular/terapia , Fibrilación Ventricular/terapia , Anciano , Fístula Arterio-Arterial/diagnóstico por imagen , Fístula Arterio-Arterial/etiología , Síndrome de Robo Coronario-Subclavio/diagnóstico por imagen , Síndrome de Robo Coronario-Subclavio/etiología , Humanos , Masculino , Arterias Mamarias/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Fibrilación Ventricular/diagnóstico , Fibrilación Ventricular/etiologíaRESUMEN
Cardiopulmonary resuscitation (CPR) is essential for the survival of cardiac arrest patients. High-quality chest compressions are critical for survival, but energetic resuscitation efforts can lead to chest injuries. Internal mammary artery (IMA) injury is a rare complication of CPR, but can lead to life-threatening intrathoracic hemorrhage. Early detection of IMA injury should be considered in all post cardiac arrest syndrome (PCAS) with anemia refractory to transfusion. To the best of our knowledge, no cases of CPR-associated bilateral IMA laceration have ever been reported. We report a unique CPR complication resulting in anterior mediastinal hemorrhage that was detected by ECHO, verified by computed tomography angiography, and treated with endovascular intervention.
Asunto(s)
Reanimación Cardiopulmonar/efectos adversos , Paro Cardíaco/terapia , Hemorragia/etiología , Arterias Mamarias/lesiones , Infarto del Miocardio con Elevación del ST/terapia , Lesiones del Sistema Vascular/etiología , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Ecocardiografía Transesofágica , Embolización Terapéutica , Paro Cardíaco/diagnóstico , Paro Cardíaco/fisiopatología , Hemorragia/diagnóstico por imagen , Hemorragia/terapia , Humanos , Laceraciones , Masculino , Arterias Mamarias/diagnóstico por imagen , Persona de Mediana Edad , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/fisiopatología , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/terapiaAsunto(s)
Aneurisma Falso/etiología , Hipertensión Pulmonar/etiología , Enfermedad Iatrogénica , Arterias Mamarias/lesiones , Procedimientos Quirúrgicos Vasculares/efectos adversos , Lesiones del Sistema Vascular/etiología , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Angioplastia de Balón/instrumentación , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/fisiopatología , Masculino , Arterias Mamarias/diagnóstico por imagen , Stents , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/terapiaRESUMEN
BACKGROUND: Percutaneous coronary intervention (PCI) is widely used to treat coronary artery disease (CAD). However, complications of PCI are inevitable. Internal mammary artery (IMA) injury is an infrequent but potentially lethal complication of PCI. CASE PRESENTATION: A 78-year-old man was diagnosed with multivessel lesions by coronary angiography. The IMA was injured during PCI, then cured by early identification and active rescue. CONCLUSIONS: This is the first reported case, to our knowledge, of injury to the IMA during PCI. We we report this case to discuss how to treat this injury effectively and avoid this complication during clinical therapy.
Asunto(s)
Enfermedad de la Arteria Coronaria/cirugía , Arterias Mamarias/lesiones , Intervención Coronaria Percutánea/efectos adversos , Lesiones del Sistema Vascular/etiología , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Embolización Terapéutica , Humanos , Masculino , Arterias Mamarias/diagnóstico por imagen , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/terapiaAsunto(s)
Ventrículos Cardíacos/lesiones , Ventrículos Cardíacos/cirugía , Arterias Mamarias/lesiones , Arterias Mamarias/cirugía , Adulto , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Arterias Mamarias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVES: The in situ internal thoracic artery (ITA) is recognized as the best conduit for coronary artery bypass surgery. The ITA-if it is used as an in situ graft-has a much higher late patency rate than any other arterial graft, including a free ITA graft. We sought to determine if the use of the ITA as an in situ/free graft and its storage in preservation solutions, have an effect on endothelial function. METHODS: The ITA was harvested as either a free or in situ graft in a porcine model. Free grafts were stored in different preservation solutions (saline, Custodiol and Tiprotec [both Köhler Chemie GmbH, Bensheim, Germany]). The ITA was anastomosed off pump to the left anterior descending artery (as in situ/free graft). Freshly harvested ITA served as a control. After 2 hours of reperfusion, the implanted grafts were harvested. The assessment of endothelial function, histopathological analysis, and gene expression were performed. RESULTS: Endothelial function and integrity were severely impaired after reperfusion in the free ITA groups, however, it was partially preserved in the Tiprotec group. Reperfusion injury resulted in increased nitro-oxidative stress, DNA breakage, vascular cell adhesion protein 1, intercellular adhesion molecule-1, and caspase-3 scores, and a decreased endothelial nitric oxide synthase score in the free ITA groups. The in situ ITA graft showed no signs of injury. mRNA levels were significantly altered among the groups. CONCLUSIONS: An early, severe endothelial dysfunction of the stored, free ITA as described, could be completely prevented by the use of an in situ ITA graft. Tiprotec might be a feasible option for storage of free arterial grafts during coronary artery bypass grafting.
Asunto(s)
Arterias Mamarias/trasplante , Daño por Reperfusión/etiología , Animales , Puente de Arteria Coronaria , Perfilación de la Expresión Génica , Supervivencia de Injerto , Arterias Mamarias/lesiones , Arterias Mamarias/metabolismo , Arterias Mamarias/fisiopatología , Preservación de Órganos , Reacción en Cadena de la Polimerasa , Daño por Reperfusión/diagnóstico , Daño por Reperfusión/metabolismo , PorcinosAsunto(s)
Humanos , Masculino , Adulto , Ventrículos Cardíacos/cirugía , Ventrículos Cardíacos/lesiones , Arterias Mamarias/cirugía , Arterias Mamarias/lesiones , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ventrículos Cardíacos/diagnóstico por imagen , Arterias Mamarias/diagnóstico por imagenRESUMEN
El objetivo es discutir el manejo del hemotórax traumático con cirugía videoasistida (VATS) y una revisión de sus principales indicaciones. Se presenta el caso de un paciente con hemotórax por traumatismo penetrante. Inicialmente manejado con pleurostomía, evoluciona con persistencia del sangrado, por lo que se explora. Como hallazgo se encuentra una lesión de arteria torácica interna que se controla con clips de VATS. El paciente evoluciona estable, sin dolor, por lo que se da de alta al tercer día. El manejo quirúrgico preferido del traumatismo de tórax clásicamente ha sido la toracotomía, pero los abordajes mínimamente invasivos han ganado espacio gracias a su menor morbilidad asociada. Algunos de sus beneficios son el menor dolor en el posoperatorio, menor sangrado y menor tiempo operatorio. Algunas indicaciones validadas son el hemotórax retenido y la persistencia del sangrado, siempre que el paciente se encuentre hemodinámicamente estable y no haya sospecha de lesión cardíaca o de grandes vasos. Se concluye que la VATS es una técnica apropiada en casos seleccionados de hemotórax traumático, pero el abordaje de elección sigue siendo la toracotomía tradicional.
The objective is to discuss the use of video assisted thoracic surgery (VATS) in thoracic trauma and to review the most common indications. A young male with a hemothorax due to penetrating trauma is seen at the emergency department. Initial management with a pleural tube revealed persistence of bleeding so surgical exploration was performed. A lesion of the internal thoracic artery was found and controlled with VATS using laparoscopic clips. The patient had an uneventful postoperative course and was discharged home on the third day posterior to surgery. Usually, surgical management of thoracic trauma has been thoracotomy, but minimally invasive procedures have gained terrain in this area thanks to their lower morbility. Some benefits of these are less postoperative pain, less bleeding, and shorter surgical time. Its validated indications include retained hemothorax and persistent bleeding, but only if the patient is hemodinamically stable and cardiac or large vessel lesions are not suspected. As a conclussion, VATS is an appropriate technique for selected cases of traumatic hemothorax, but thoracotomy still remains as the prefered surgical approach.
Asunto(s)
Humanos , Masculino , Adulto , Traumatismos Torácicos/cirugía , Cirugía Torácica Asistida por Video/métodos , Tórax/diagnóstico por imagen , Toracotomía , Angiografía por Tomografía Computarizada/métodos , Hemotórax/cirugía , Arterias Mamarias/lesionesRESUMEN
A 54-year-old Chinese woman presented with a 10-year history of repeated paroxysmal palpitations. She was diagnosed with paroxysmal supraventricular tachycardia by 12-lead electrocardiogram and was advised to undergo catheter-based radiofrequency ablation. During the procedure, a rare complication occurred that was diagnosed as a right internal mammary artery penetrating injury. After appropriate emergency treatment with arterial embolization and membrane-covered stent implantation, the patient was out of immediate danger of haemorrhaging. Follow-up computed tomography angiography of the subclavian artery at 3 months after she was discharged from hospital revealed stent-graft patency with no evidence of in-stent thrombosis or stent stenosis. No problems were observed at the 6-month follow-up visit.
Asunto(s)
Ablación por Catéter/efectos adversos , Embolización Terapéutica/métodos , Complicaciones Intraoperatorias/cirugía , Arterias Mamarias/cirugía , Stents , Heridas Penetrantes/cirugía , Ablación por Catéter/métodos , Angiografía por Tomografía Computarizada , Electrocardiografía , Femenino , Humanos , Enfermedad Iatrogénica , Complicaciones Intraoperatorias/patología , Arterias Mamarias/diagnóstico por imagen , Arterias Mamarias/lesiones , Persona de Mediana Edad , Taquicardia Paroxística/diagnóstico por imagen , Taquicardia Paroxística/fisiopatología , Taquicardia Paroxística/cirugíaRESUMEN
Vascular injuries caused by cardiopulmonary resuscitation (CPR) can be associated with major complications. If patients who have received CPR have sudden abnormal hemodynamic findings, it is necessary to consider the possibility of these injuries. We report a 73-year-old man who had cardiac tamponade due to an injury to the internal mammary artery following manual chest compression. This very rare injury was detected by computed tomography and was treated by thoracotomy and hematoma evacuation.
Asunto(s)
Taponamiento Cardíaco/etiología , Reanimación Cardiopulmonar/efectos adversos , Arterias Mamarias/lesiones , Anciano , Humanos , Masculino , Arterias Mamarias/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: Demonstrate the role of endovascular management in the treatment of internal mammary artery (IMA) injuries using transcatheter embolization reviewing our 7-year experience. MATERIALS AND METHODS: Our retrospective analysis of cases consists of a total of 12 patients (8 M and 4 F; mean age 52 years) who underwent angiographic studies and transcatheter embolization for IMA injuries. Causes of vascular injury were divided in high-energy trauma (n = 6), iatrogenic (n = 3) and penetrating injuries (n = 3). Type of trauma, associated injury, imaging findings, treatments and complications were assessed. Imaging findings included active haemorrhage, pseudoaneurysm and focal dissection. RESULTS: Embolization was performed with microcoils in all patients; complete thrombosis was obtained in four patients by additional injection of Spongostan pledgets and in two patients with 300-500 µm particles. The technical success rate was 100%. No patient died as a direct result of vascular injury; one died of myocardial contusion and one for severe multiorgan failure related to high-energy trauma. No major and minor complications were registered. No patient required emergency surgery or subsequent surgical treatment. CONCLUSION: Transcatheter embolization offers an effective, efficient and safe alternative to conventional surgical management of IMA injuries.
Asunto(s)
Embolización Terapéutica/métodos , Arterias Mamarias/lesiones , Lesiones del Sistema Vascular/terapia , Adulto , Anciano , Angiografía , Femenino , Humanos , Italia , Masculino , Arterias Mamarias/diagnóstico por imagen , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagenRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Aneurisma Falso/cirugía , Marcapaso Artificial , Procedimientos Endovasculares/métodos , Arterias Mamarias/lesiones , Enfermedad Iatrogénica , Cateterismo Cardíaco/efectos adversosRESUMEN
BACKGROUND: Cardiopulmonary resuscitation-related bleeding, especially internal mammary artery injuries, can become life-threatening complications after initiating venoarterial extracorporeal membrane oxygenation owing to the frequent involvement of concomitant anticoagulant treatment, antiplatelet treatment, targeted temperature management, and bleeding coagulopathy. We report the cases of five patients who experienced this complication and discuss their management. CASE PRESENTATION: We retrospectively evaluated five patients with cardiopulmonary resuscitation-related internal mammary artery injuries who were treated between February 2011 and February 2016 at our institution. All five patients were Asian men, aged 56 to 68-years old, who had received concomitant intravenously administered unfractionated heparin (3000 units) with antiplatelet therapy. Four patients received targeted temperature management. The injuries and hematomas were detected using contrast-enhanced computed tomography in all cases. Three patients were treated using transcatheter arterial embolization within 6 hours following cardiopulmonary arrest, and two were resuscitated and received appropriate treatment following early recognition of their injuries. Two patients died of hemorrhagic shock with delayed intervention. Four of the five patients had excessively prolonged activated partial thromboplastin times before their interventions. CONCLUSIONS: Computed tomography should be performed as soon as possible after the return of spontaneous circulation to identify injuries and consider appropriate treatments for patients who have experienced cardiac arrest. Delayed bleeding may develop after treating hypovolemic shock and relieving arterial spasms; therefore, transcatheter arterial embolization should be performed aggressively to prevent delayed bleeding even in the absence of extravasation. This approach may be superior to thoracotomy because it is less invasive, causes less bleeding, and can selectively stop arterial bleeding sooner. A 3000-unit intravenous bolus of unfractionated heparin may be redundant; heparin-free extracorporeal cardiopulmonary resuscitation may be a more appropriate alternative. Unfractionated heparin treatment can commence after the bleeding has stopped.
Asunto(s)
Reanimación Cardiopulmonar/efectos adversos , Embolización Terapéutica/métodos , Oxigenación por Membrana Extracorpórea/métodos , Masaje Cardíaco/efectos adversos , Hemorragia/mortalidad , Arterias Mamarias/lesiones , Administración Intravenosa , Anciano , Anticoagulantes/efectos adversos , Reanimación Cardiopulmonar/mortalidad , Resultado Fatal , Paro Cardíaco/mortalidad , Paro Cardíaco/terapia , Masaje Cardíaco/mortalidad , Hemorragia/terapia , Heparina/administración & dosificación , Heparina/efectos adversos , Humanos , Hipotermia Inducida , Masculino , Arterias Mamarias/diagnóstico por imagen , Persona de Mediana Edad , Estudios Retrospectivos , Fracturas de las Costillas/diagnóstico por imagen , Esternón/diagnóstico por imagen , Esternón/lesiones , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
The formation of a fistula between the internal mammary artery and the pulmonary vasculature (IMA-to-PV) is a rare anomaly. The etiology can be congenital; however, most recent cases have been associated with coronary artery bypass grafting, trauma, inflammatory conditions, chronic infections, or neoplasia. The knowledge base on the formation of these fistulas is derived primarily from case reports. To our knowledge, no systematic reviews or guidelines are available that provide information on how to manage these cases, and the treatment of an IMA-to-PV fistula is controversial. To our knowledge, this report is the first to review 80 cases of IMA-to-PV fistulas reported in the literature. We describe the etiologies, clinical presentation, and management of these fistulas.