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.
ABSTRACT
A patient developed perioperative coronary artery spasms (CAS) twice, in initial and redo open heart operations for mitral stenosis. CAS was shown by sudden ST segment elevation, hypotension, bradycardia, and decreased cardiac output. The patient, a female, had the first CAS attack in the ICU following open mitral commissurotomy at the age of 48. The Second CAS attack occurred during redo surgery for mitral valve replacement at age of 56. Preoperative coronary angiography before both operations did not indicate significant organic lesions. Intraaortic balloon pumping in conjunction with intravenous nitroglycerin and norepinephrine were effective to treat CAS in this case.