ABSTRACT
Spontaneous intracranial hypotension (SIH) occurs without any preceding events such as lumbar puncture, surgery, trauma, or medical illness. It is characterized by a postural headache that is aggravated in the erect or sitting position, and relieved in the supine position. A postural headache usually resolves either spontaneously or with conservative treatment. An autologous epidural blood patch (EBP) is an effective strategy for managing a postural headache that persists or is aggravated despite conservative treatments. We report a case of SIH with confirmed cerebrospinal fluid (CSF) leakage at the thoracic level, which was managed successfully with an autologous EBP at the lumbar and thoracic levels. We believe that success rate of an epidural blood patch in these cases is dependent on the approximation of the blood injection to the leak site.
Subject(s)
Blood Patch, Epidural , Cerebrospinal Fluid , Headache , Intracranial Hypotension , Spinal Puncture , Supine PositionABSTRACT
Minimally invasive coronary artery bypass grafting without using cardiopulmonary bypass (CPB) is a recently accepted modality of myocardial revascularization prcedures which is particularly suitable to the patients with lesions in the left anterior descending (LAD) and the right coronary arteries. Of the consecutive 35 patients of coronary artery bypass grafting performed at Sejong General Hospital from March to August 1996, six patients underwent minimally invasive coronary artery bypass grafting without CPB. All had stenotic lesions of the LAD more than 90%. Bypass grafting of the LAD was approached through midline sternotomy in one, through ministernotomy in two, and through limited left anterior thoracotomy in three patients, respectively. The internal mammary arteries were prepared without the use of thoracoscope. The mobilized mammary arteries were connected directly to the LAD in 5 patients, and the anastomosis required interposition of a segment of the radial artery in the remaining one. The diagonal branch was revascularized with the saphenous vein graft at the same time in one patient. No blood transfusion was necessary in 2 patients, and average blood required during surgery was 800ml in 4 patients. All patients were extubated from 4 to 14 hours (mean 9 hours) after operation. Early postoperative coronary angiography in 5 patients between 7 and 10 days after surgery has proved full patency of the grafts. With these limited clinical experiences, the clinical results demonstrated that minimally invasive coronary artery bypass grafting without CPB is an useful procedure especially in patients with isolated lesion in the proximal LAD.
Subject(s)
Humans , Blood Transfusion , Cardiopulmonary Bypass , Coronary Angiography , Coronary Artery Bypass , Coronary Vessels , Hospitals, General , Mammary Arteries , Myocardial Revascularization , Radial Artery , Saphenous Vein , Sternotomy , Minimally Invasive Surgical Procedures , Thoracoscopes , Thoracotomy , TransplantsABSTRACT
We experienced a case of anomalous origin of right pulmonary artery from the ascending aorta associated with pulmonary atresia, ventricular septal defect, absence of left pulmonary artery and multiple major aortopulmonary collateral artery (MAPCA). At ten month of age, left pulmonary artery creation with unifocalization and right pulmonary artery banding were performed as the first stage, followed by coil embolization of right MAPCA 1 month later, and 1 year later, the total correction was done. After total repair, the patient showed good postoperative course, and excellent angiographic and hemodynamic results at 1 year follow-up study.
Subject(s)
Humans , Aorta , Arteries , Embolization, Therapeutic , Follow-Up Studies , Heart Septal Defects, Ventricular , Hemodynamics , Pulmonary Artery , Pulmonary AtresiaABSTRACT
We experienced a case of aneurysm of the sinus of Valsalva dissecting into the ventricular dseptum. This dissection was induced by paravalvular leakage after aortic and mitral valve replacement. This 37-year-old male was admitted via emergency room due to progressive dyspnea. He had undergone aortic valve replacement(carbomedic(R) 23 mm) and mitral valve replacement(carbomedic(R) 31 mm) due to aortic regurgitation and mitral regurgitation about 6 years prior to admission and followed up regularly. The diagnosis was made by transthoracic and transesophageal echocardiography and reconfirmed by root aortography. The inlet of the ventricular septal aneurysmal sac was repaired by one layer suture with 3-0 prolene of the endocardium, epicardium and homograft muscle shoulder altogether. Postoperative course was uneventful and the patient was discharged on the 11th postoperative day.
Subject(s)
Adult , Humans , Male , Allografts , Aneurysm , Aortic Valve , Aortic Valve Insufficiency , Aortography , Bays , Diagnosis , Dyspnea , Echocardiography, Transesophageal , Emergency Service, Hospital , Endocardium , Mitral Valve , Mitral Valve Insufficiency , Pericardium , Polypropylenes , Shoulder , Sinus of Valsalva , Sutures , Ventricular SeptumABSTRACT
In small children with left ventricular outflow tract obstruction, a few methods of surgical treatment could be considrred. The pulmonary autogrart provides a promising options for aortic valve replacement as part of the aortoventriculoplasty procedure in children. We report a successfully treated congenital aortic stcnoinsufricicncy with severe left ventricular dysfunction in an early infant with the aortoventriculoplasty using thc pulmonary autograft (the Ross-Konno procedure).