Double Whammy: Concomitant Acute Type B Aortic Dissection and Acute Pulmonary Embolism

The concomitant occurrence of acute type B aortic dissection (TBAD) and acute pulmonary embolism (PE) is a rare but challenging condition. Although anticoagulation therapy is essential in the treatment of PE, it may increase the risk of aortic rupture and bleeding complications. We herein describe a patient with acute TBAD complicated by PE, which was successfully treated with early thoracic endovascular aortic repair (TEVAR) followed by anticoagulation. The present case report demonstrates that early TEVAR not only treats the aortic pathology but also allows the safe initiation of anticoagulation therapy.

Surgical Repair for Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a very rare congenital heart defect. Herein, we describe three cases of ARCAPA in an 8 months old, 18 months old, and 4 year old child. Two cases were incidentally diagnosed using a computed tomographic angiograph, and the other was incidentally diagnosed using a coronary angiograph. These cases underwent a reimplantation technique on diagnosis and resulting in positive clinical outcomes during the follow-up period which was a mean of 1.5 years.

Impact of intact pleura during left internal mammary artery harvesting on clinical outcome

Pleurotomy during coronary artery bypass grafting [CABG] may cause post-operative events, mostly pulmonary complications. In this study, we evaluated the influence of pleurotomy during CABG on the clinical outcome following left internal mammary artery [LIMA] harvesting. Between March and August 2009, 102 patients who underwent cardiac surgery were enrolled in this study and divided into two groups: group A [n = 48, 36 male and 12 female patients at a mean age of 56.5 +/- 11.2 years] underwent routine CABG and pleurotomy and group B [n = 54, 46 male and 8 female patients at a mean age of 55.4 +/- 10.3 year] had CABG with intact pleura. The patients were compared regarding their demographic data, surgical data, and postoperative events. The incidence of postoperative pericardial effusion was similar between the groups, but the incidence of postoperative pulmonary complications such as pleural effusion [except for mildpleural effusion] on the second [no: 10.4%, mild: 41.7%, moderate: 45.8% and severe: 2.7% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B] and fifth postoperative days [no: 27.1%, mild: 33.3%, moderate: 35.4%, and severe: 4.2% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B] was significantly lower in group B [p value < 0.001 and p value = 0.007, respectively]. Also, the incidence of atelectasis [except for mild atelectasis] on the second [no: 2.1%, mild: 22.9%, moderate: 72.9%, and severe: 2.1% in group A versus no: 9.2%, mild: 59.3%, moderate: 31.5%, and severe: 0 in group B] and fifth postoperative days [no: 22.9%, mild: 39.6%, moderate: 35.4%, and severe: 2.1% in group A versus no: 39.6%, mild: 49.1%, moderate: 11.3%, and severe: 0 in group B] was significantly higher in group A [p value < 0.001 and p value = 0.004, respectively]. Postoperative partial oxygen pressure and 02 saturation were similar between the groups, but partial carbon dioxide pressure was significantly lower in group A [p value = 0.017]. Amount of bleeding [p value = 0.008] and duration ofhospitalization [p value =0.002] were significantly higher in group A than those in group B. Our results indicate that keeping the pleura intact has beneficial effects on the respiratory function, without increasing the incidence of postoperative pericardial effusion

huge coronary artery aneurysm in osteogenesis imperfecta: a case report

Osteogenesis imperfecta [OI] as an inherited connective tissue disorder can affect all tissues that contains type I collagen. Well-known cardiac complications of this disease such as aortic root dilatation, aortic regurgitation and mitral valve prolapse have been rarely reported in the literature. Coronary artery aneurysm is a rare cardiac complication in OI, as reported in a 19 year old female presenting with myocardial infarction and hypotension

Comparison of the clinical efficacy of Bovine thrombin and compression method in femoral pseudoneurysm of parients undergoing percutaneous coronary intervention

Pseudoaneurysm has been an increasingly common complication of catheterization procedures during the past two decades, with the greatest incidence being in the femoral artery. Treatment of iatrogenic femoral artery pseudoaneurysm with the injection of thrombin is reported to be an efficacious and safe procedure. In this study, we evaluated the efficacy and success rate of percutaneous ultrasonographically-guided thrombin injection and compression method for the treatment of pseudoaneurysm and for studying of the effect of thrombin injection on systemic coagulation parameters. This cohort clinical trial was conducted on patients with femoral pseudoaneurysm after percutaneous intervention [PCI] in Shaheed Rajaie Cardiovascular Medical and Research Center. The patients were divided into two randomized groups and treated with either the compression method or the percutaneous ultrasonographically-guided thrombin injection method. Pseudoaneurysm size, pseudoaneurysm neck size, thrombin dose, thrombosis time, outcome of therapy, and complications were documented prospectively. Duplex sonographic follow-up examinations were performed at 0 and 24 hours afterwards. Partial thrombin time as well as the Quick test [prothrombin time] was monitored before and after the intervention. Thirty patients between 15 and 85 years of age with femoral pseudoaneurysm following catheterization were enrolled in this study. The average length and width of the pseudoaneurysms were respectively 2.45 +/- 1.15 cm and 2.06 +/- 1.07 cm. In total, 13 thrombin injections were administered. The mean thrombin dose was 500-2000 IU. The success rate of thrombin injection was %92.30 [12 of 13 patients], which was significantly higher than that of compression 82.35% [13 of 17 patients] [p value<0.05]. No thromboembolic, infectious, or allergic complications occurred. In this study, the percutaneous ultrasonographically-guided thrombin injection method was successful and safe in the management of femoral pseudoaneurysms. Changes in coagulating factors indicated the possibility of thrombin passage into the arterial circulation.