ABSTRACT
Surgical management is recommended for a patient with intractable pericardial effusion indicating medical treatment resistance and cardiac tamponade. We report our experience of surgical treatment applying a Denver shunt for intractable pericardial effusion. A 60-year-old woman suffered pericarditis accompanying pericardial effusion complications of systemic lupus erythematosus. She had repeatedly undergone pericardial drainage, however, there was a possibility of increased cardiac tamponade. Surgical treatment consisted of pericardial fenestration with thoracoscopic assist and right pleuro-peritoneal shunt using a Denver shunt. The heart failure symptoms disappeared and pericardial effusion considerably decreased after surgery. The postoperative course was uneventful without recurrence after 1-year of follow up. In the literature, postoperative complications such infection and shunt obstruction have been reported. Careful follow up is mandatory and selection of self-manageable cases is important.
ABSTRACT
A 55-year-old man was referred to our hospital for hemolytic anemia 21 months after an ascending aortic replacement for acute type A aortic dissection. The enhanced CT revealed an aortic pseudoaneurysm formation at the proximal anastomosis. The cause of hemolysis was verified to be the pressure by an aortic pseudoaneurysm formation at the vascular graft stenosis. At the reoperation, the previous vascular graft was found to have partially detached from the aortic stump over the non-coronary cusp. Ascending aortic replacement was performed with a tailoried vascular graft in a scallop shape, corresponding to the non-coronary cusp. The postoperative course was uneventful and hemolysis diminished soon after the operation.
ABSTRACT
The objective of this study was to evaluate the inflammatory responses in patients who received 1 of 2 different types of woven Dacron grafts. Abdominal aortic surgery was performed in 154 patients between 2002 and 2006, and 102 patients were enrolled in this study. Sealed woven Dacron grafts (INTERGARD<sup>TM</sup> woven graft, Group I) were implanted in 77 patients and non-sealed woven Dacron grafts (UBE woven graft, Group N) were implanted in 25 patients. All patients received either a bifurcated graft or straight graft replacement. Body temperature (BT), white blood cell counts (WBC), and C-reactive protein (CRP) levels were measured preoperatively and on postoperative days 1, 3, 5, 7 and 14, and were compared between the 2 groups. There were no differences in the patient's mean ages, 73±9 and 71±7 years, or operation time, 213±57 and 210±63 min, between Groups I and N, respectively. Postoperative changes in BT and WBC were similar in both groups. CRP levels were higher in Group N than Group I on postoperative days 5 and 7, but these differences were clinically insignificant. Prolonged inflammatory response which lasted longer than 2 weeks occurred in 2 patients in Group I and in 1 patient in Group N. All patients eventually returned to baseline conditions without special treatments. Thus the postoperative inflammatory responses to coated and non-coated woven Dacron grafts were similar in abdominal aortic surgery.