ABSTRACT
A 72-year-old man presented with a chief complaint of chest pain. Since ECG showed ST elevation in leads III and <sub>a</sub>V<sub>F</sub>, suggestive of acute myocardial infarction, we performed emergency coronary angiography which revealed total occlusion of RCA#3, 75% stenosis of LAD#6, and 99% stenosis of LAD#7. Thus, RCA occlusion was the likely cause of the chest pain, and a drug-eluting stent (DES) was placed in RCA#3. OPCAB of the LITA to the LAD (LITA-LAD) was performed 44 days later. The volume of postoperative drainage was very low, and, since the DES was in place, the administration of aspirin 100 mg once daily and ticlopidine 200 mg twice daily was started on the first morning after surgery. On the second morning after surgery, the CVP rose rapidly to 16, and then to 23 mmHg. Chest CT revealed massive hemopericardium and hemomediastinum, and re-thoracotomy was performed for hematoma removal. There was no bleeding at the anastomosis or graft sites, with minimal bleeding from mediastinal adipose tissue. Thereafter, his condition improved uneventfully, and he was discharged on the 19th postoperative day. Since the DES was in place, the administration of antiplatelet agents was resumed in the early postoperative period to prevent occlusion, which resulted in the development of cardiac tamponade due to bleeding. We report the case of severe postoperative complication due to DES placement.
ABSTRACT
A 71-year-old man with obstruction of the left anterior descending branch (#7) suffered an acute myocardial infarction. A ventricular septal perforation (VSP) and a widespread left ventricular aneurysm were detected in the anteroseptal region by both cardiac ultrasonography and cardiac catheterization. Surgery was performed at week 7 after onset. After establishing extracorporeal circulation, the left ventricular aneurysm was longitudinally excised from the left side of the left anterior descending branch while the patient was maintained in a state of cardiac arrest. A septal anterior ventricular exclusion (SAVE) operation was performed using oblong equine pericardial patches to exclude the left ventricular aneurysm and the VSP portion. The VSP was directly closed with sutures because the surrounding tissues were relatively strong at week 7 after the onset of the myocardial infarction and the portion was excluded with an equine pericardial patch. At the same time, CABG (LITA-LAD) was also performed. After surgery, left ventriculography found no residual shunts and we were able to obtain both a good morphology and satisfactory functioning of the left ventricle. The present method is thus considered to be an effective surgical method that excludes both the VSP portion and the infracted portion, while improving the morphology of the left ventricle for VSP with a left ventricular aneurysm.
ABSTRACT
A 63-year-old man had been receiving medical treatment for hypertrophic cardiomyopathy (HCM) for 20 years. Sustained ventricular tachycardia (VT) had often occurred over the previous 2 years in spite of the administration of antiarrhythmic drugs. He therefore received an implantable cardioverter defibrillator (ICD). However, his symptoms did not improve thus dilated-phase HCM was diagnosed. Because sustained VT often occurred subsequently, the ICD had to be frequently used. An electrophysiological study (EPS) using the CARTO electroanatomical mapping system revealed the earliest activation site to be in the posterolateral wall of the left ventricle (LV). VT did not stop despite 2 endocardial catheter ablation procedures. Therefore, the VT foci was thought to be a reentry circuit on the epicardial side of the posterolateral LV wall. A part of the posterolateral LV wall that involved the reentry circuit was therefore resected. Since undergoing this surgical procedure, the patient has experienced no recurrence of VT during a follow-up period of 14 months.
ABSTRACT
Acute aortic occlusion is an infrequently observed but frequently fatal event requiring prompt surgical treatment. We encountered 4 cases of acute non-aneurysmal abdominal aortic occlusion caused by different mechanisms and reviewed the literature concerning surgical management. The patients consisted of 2 men and 2 women with a mean age of 68.7±5.7 years (range, 63 to 75 years). Three of the 4 patients had a history of atrial fibrillation. Clinical presentations included acute limb ischemia and neurological deficit in all 4 cases. The mechanisms of acute aortic occlusion were mainly divided into embolisms and thrombosis related to aortoiliac occlusive disease. Operation was done at mean intervals of 8.6h (range, 5 to 11h). Two patients underwent transfemoral thrombectomy under local anesthesia, one thromboendarterectomy under laparotomy on hemodialysis, and one axillobifemoral bypass procedure. One patient had to undergo fasciotomy immediately because of compartment syndrome, 2 other patients needed additional procedures (one had femoro-popliteal bypass and the other had mitral valve replacement). The perioperative mortality rate was 25%, related to massive cerebral infarction. The outcomes of these patients depend on prompt diagnosis, systemic heparinization and early revascularization by appropriate operation; initial attempt of transfemoral thrombectomy, and axillobifemoral bypass in high risk patients. After revascularization, patients must be carefully monitored for reperfusion syndrome, myonephropathic metabolic syndrome, acute renal failure and compartment syndrome.