Pulmonary hypertension as a rare cause of postoperative chylothorax

Chylothorax in adult occurs most commonly in the wake of cardiac and thoracic procedures. Injuries to the common thoracic duct in the thorax or its branches in the mediastinum, injuries to the thymus tissues, dissection of the superior vena cava or ascending aorta, dissection of the aortic arch, disruption of the accessory lymphatics in the left or right thorax, and increased pressure in the systemic vein exceeding that of the thoracic duct [usually in the superior vena cava thrombosis, Glenn Shunt, and hemi-Fontan] have been proposed as the possible causes of chylothorax after surgery for congenital heart disease. However, pulmonary hypertension is an exceedingly rare cause of chylothorax in adults. We present a case of chylothorax after atrial septal defect surgery in a 30-year-old female patient with pulmonary hypertension. The postoperative period was complicated by chylothorax, which was confirmed by the high lipid content of chylous effusion. The patient was treated conservatively with diet therapy, and the effusion was abolished completely after two weeks. No recurrence of chylothorax was detected at 3 months' follow-up

Off-pump repair of a post myocardial infarction ventricular septal defect

Refractory cardiogenic shock meant that traditional patch repairs requiring cardiopulmonary bypass would be poorly tolerated and external sandwich closure of post myocardial ventricular septal defect [VSD] appears to be simple and effective after initial myocardial infarction [MI]. The three cases presented with a VSD after of acute MI with or without thrombolysed with streptokinase during patient admission. The general condition of the three patients was poor with pulmonary edema, low cardiac output and renal failure. The heart was approached through a median sternotomy. Off-pump coronary artery bypass grafting of the coronary artery lesion was done first using octopus and beating heart surgery method and latero - lateral septal plication was performed using sandwich technique. Low cardiac output managed with intra-aortic balloon pump in these patients accompanied with inotropic drugs. Post-operative transesophageal echocardiography revealed that VSD was closed completely in one patient and in two patients small residual VSD remained. More experience is required to ascertain whether this technique will become an accepted alternative to patch repairs

Congenital saccular aneurysm of coarctation of aorta: a case report

True saccular aneurysm is exceptional in coarctation of aorta in children. A 6-year-old girl with headache and systemic arterial hypertension referred to our center for cardiovascular evaluation. Physical examination revealed high blood pressure and weak lower extremity pulses. Two-dimensional and Doppler echocardiography and angiography demonstrated a saccular aneurysm of the descending aorta, 5×4 cm in size, associated with aortic coarctation. Aneurysmectomy was performed without cardiopulmonary bypass. The section of the aorta containing the coarctation and the aneurysm was resected and replaced with a 15 mm woven polyester graft. Histological examination revealed a thin walled aneurysm with hyalinosis changes and decreased elastic fibers. One-year echocardiographic follow-up revealed no gradient across of Dacron tube and hypertension decreased to normal level

Right atrial angiosarcoma with severe biventricular dysfunction and massive pericardial effusion

This paper presents the case of a 35 year-old woman with symptoms of heart failure from the last month. A physical examination at admission showed paleness, dyspnea, peripheral edema and fatigue. In a two-dimensional echocardiography and transesophageal echocardiography, normal thickness but severe left and right ventricular dysfunction with severe pericardial effusion and thickened pericardium were found. In the enlarged right atrium, an oval-shaped structure was found with features of continuity with lateral right atrial wall and also a bulging of the structure through the orifice of the tricuspid valve to the right ventricle. In the echocardiography, we did not saw any blocking of the tricuspid valve or the inflow from inferior vena cava [IVC] or superior vena cava [SVC] or coronary sinus. On the basis of the echocardiography examination and clinical presentation, tentative diagnosis of the right atrium myxoma was made. A coronary angiography revealed normal coronary arteries and no feeding of tumor by branch of right coronary artery [RCA]. Surgical removal of the tumor was performed without complication. The histopathological examination confirmed the diagnosis of angiosarcoma. In the follow-up echocardiography carried out after three months, severe left ventricular [LV] and right ventricular [RV] dysfunction continued and was demonstrated. Magnetic resonance imaging revealed no lymphadenopathy or re-growth of the tumor in the mediastinum or pericardium

Off-pump coronary bypass grafting causing stunned myocardium

The term "stunned myocardium" refers to abnormalities in the myocardial function following reperfusion and is common in on-pump coronary artery bypass grafting [CABG] and is exceedingly rare in off- pump CABG. A 53-year-old man presented with unstable angina due to the severe stenosis of the left anterior descending coronary artery [LAD] and the obtuse marginal. Laboratory findings and Chest X-ray revealed nothing abnormal. The intraoperative course was uneventful. The patient left the operating room without any inotropic support. Six hours later, however, he developed low cardiac output .At exploration, cardiac tamponade was excluded and flowmetry showed that the graft had adequate function. Cardiac enzymes were normal. High-dose adrenalin and Dobutamine were administrated and an intra-aortic balloon pump was used. After hemodynamic stabilization, the patient left the Intensive Care Unit without an intra-aortic balloon pump and inotropic support. On the fifth postoperative day, coronary angiography showed patent grafts and correct anastomotic sites. On the seventh postoperative day, the akinetic lateral wall of the left ventricle changed to dyskinesia. Finally after hospital discharge on the thirtieth postoperative day, an echocardiogram showed normal left ventricular function without regional wall motion abnormalities.