ABSTRACT
A left ventricular rupture might be one of the most disastrous complications after a mitral valve replacement. An acute atrioventricular groove rupture (type I) was detected in a 54-year-old female diagnosed with a mitral stenosis combined with severe tricuspid regurgitation. She had a prior medical history of an open mitral commissurotomy in Japan at 30 years ago. The surgical findings suggested that the previous procedure was not a simple commissurotomy but a commissurotomy combined with a posteromedial annuloplasty procedure. After a successful mitral valve replacement and a measured (De Vega type) tricuspid annuloplasty, the weaning from a cardiopulmonary bypass was uneventful. However, copious intraoperative bleeding from the posterior wall was detected and the cardiopulmonary bypass was restarted. Exposure of the posterior wall of the left ventricle showed bleeding from the atrioventricular groove 3 cm lateral to the left atrial auricle. Under the impression of a Type I left ventricular rupture, epicardial repair (primary repair of the Teflon felt pledgetted suture, continuous sealing suture using auto-pericardial patch and application of fibrin-sealant) was attempted. Successful local control was made and the patient recovered uneventfully. The patient was discharged at 14 postoperative days without complications. We report this successful epicardial repair of an acute type I left ventricular rupture after mitral valve replacement.
Subject(s)
Female , Humans , Middle Aged , Cardiopulmonary Bypass , Heart Ventricles , Hemorrhage , Japan , Mitral Valve Stenosis , Mitral Valve , Polytetrafluoroethylene , Rupture , Sutures , Tricuspid Valve Insufficiency , WeaningABSTRACT
Penetrating atherosclerotic ulcer involving the aortic arch has rarely been reported on in the literature. Acute rupture of a penetrating atherosclerotic ulcer involving the distal arch and the proximal descending thoracic aorta was found in a 78-year-old male, and he originally presented with acute-onset shoulder pain and hoarseness. Patch repair of the perforated arch and the proximal descending thoracic aorta was successfully done under total circulatory arrest.
Subject(s)
Aged , Humans , Male , Aorta, Thoracic , Atherosclerosis , Hoarseness , Rupture , Shoulder Pain , UlcerABSTRACT
The operation for esophageal cancer is both complex and challenging, and may be associated with significant morbidity and mortality compared to other oncologic surgeries. Minimally invasive surgeries have been applied on various kinds of surgery to enhance better recovery with minimal surgical complications. But for the esophageal cancer, it has not been actively applied yet. With improvement in instrumentations and increasing experience with endoscopic surgical techniques, minimally invasive surgical approaches to esophageal cancer are being explored to determine feasibility, results and potential advantages. We experienced eight cases of minimally invasive surgery for esophageal cancer and report here focusing on surgical techniques and tips.
Subject(s)
Esophageal Neoplasms , Laparoscopy , Mortality , Minimally Invasive Surgical Procedures , ThoracoscopyABSTRACT
BACKGROUND: Interrupted aortic arch is a rare congenital heart anomaly which still shows high surgical mortality. In this study, we investigated the causes of and the risk factors for mortality to improve the surgical outcomes for this difficult disease entity. MATERIAL AND METHOD: From 1984 to 2004, 42 patients diagnosed as IAA were reviewed retrospectively. Age, body weight at operation, preoperative diagnosis, preoperative PGE 1 requirement, type of interrupted aortic arch, degree of left ventricular outflow stenosis, CPB time, and ACC time were the possible risk factors for mortality. RESULT: There were 14 hospital deaths. Preoperative use of PGE1, need for circulartory assist and aortic cross clamp time proved to be positive risk factors for mortality on univariate analysis. Preoperative left ventricular outflow stenosis was considered a risk factor for mortality but it did not show statistical significance (p-value=0.61). Causes of death included hypoxia due to pulmonary banding, left ventricular outtract stenosis, infection, mitral valve regurgitation, long cardiopulmonary bypass time and failure of coronary transfer failure in TGA patients. CONCLUSION: In this study, we demonstrated that surgical mortality is still high due to the risk factors including preoperative status and long operative time. However preoperative subaortic dimension was not related statistically to operative death statistically. Adequate preoperative management and short operation time are mandatory for better survival outcome.
Subject(s)
Humans , Alprostadil , Hypoxia , Aorta, Thoracic , Body Weight , Cardiopulmonary Bypass , Cause of Death , Constriction, Pathologic , Diagnosis , Heart , Mitral Valve Insufficiency , Mortality , Operative Time , Prostaglandins E , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: The atrial fibrillation in patients with mitral valvular heart disease is frequently converted to sinus rhythm after the mitral valve surgery. This sinus restoration implies an important meaning in that it not only helps postoperative convalescence in patients with unstable hemodynamics but also reduces the rate of postoperative thromboembolism. MATERIAL AND METHOD: We retrospectively analyzed 184 patients who received mitral valve surgery from June 1986 to December 1996 to investigate the trend of rhythm change following mitral valve surgery and thus to clarify the predisposing factors of postoperative sinus rhythm conversion and its maintenance. RESULT: The sinus rhythm was restored after the operation in 54 out of 139 patients with atrial fibrillation preoperatively(38.8%). However, the atrial fibrillation recurred in 41 patients at the time of discharge showing a recurrence rate of 75.9 percent. The mean duration of sinus rhythm in patients with eventual atrial fibrillation recurrence was 8.2+/-5.9 days. Only 15 patients were in sinus rhythm at the time of late follow-up with the mean follow-up period of 84.4+/-34.7 months. While the age, duration of symptoms, duration of atrial fibrillation, left atral size, and pulmonary artery pressure were thought to be the predisposing factors for sinus conversion after the operation, only the duration of atrial fibrillation and ejection fraction were considered risk factors for the recurrence of the atrial fibrillation following sinus conversion. CONCLUSION: This study suggests that the early operation is mandatory for the satisfactory result regarding postoperative rhythm. Moreover, additional operative measure in adjunct to the intervention of mitral valve should be considered for the maintenance of restored sinus rhythm as reflected by high postoperative recurrence rate of atrial fibrillation.
Subject(s)
Humans , Atrial Fibrillation , Causality , Convalescence , Follow-Up Studies , Heart Valve Diseases , Hemodynamics , Mitral Valve , Pulmonary Artery , Recurrence , Retrospective Studies , Risk Factors , ThromboembolismABSTRACT
OBJECTIVES: This study was performed to investigate the relationship between age of onset in late-life depression and T2 hyperintensities observed in the brain MRI, we tried to see part of pathophysiology of late-life depression. METHOD: The subjects consisted of 18 patients whose first depressive episode occurred before age 50, and 20 patients whose first depressive episode occurred after age 50 years, and 20 agematched controls. Depressive patients were diagnosed according to DSM-IV. Established hyperintensity rating systems were used to analyse the T2 weighted images and blood pressure, cholesterol level, DM, EKG were measured to compare the relationships. RESULTS: 1) Signal hyperintensities on T2 weighted image were more severe in late-life depressive patients whose first depressive episode after age 50 (p<0.05) and there is no significant difference between patients whose first episode before age 50 and age-matched control subjects. 2) Mild signal hyperintensities were observed in all elderly depressed patients and control subjects, but severe hyperintensities were observed in late-onset depression. 3) Signal hyperintensities were related to age, hypertension, blood cholesterol level (p<0.05). CONCLUSION: The late onset depressive patients had more white matter hyperintensities on T2 weighted image than early onset depressive patients. this results support previous hypothesis that white matter change is the important biological factor of late-onset elderly depression and old age, hypertension, hypercholesterolemia may be associated with signal hyperintensities.
Subject(s)
Aged , Humans , Age of Onset , Biological Factors , Blood Pressure , Brain , Cholesterol , Depression , Diagnostic and Statistical Manual of Mental Disorders , Electrocardiography , Hypercholesterolemia , Hypertension , Magnetic Resonance ImagingABSTRACT
Radial artery is the most common site which is chosen for the continuous monitoring of arterial blood pressure and blood sampling in the critically ill patients. This method is regarded as a safe one though there are various complications. In most complications, the clinical sequelae do not have much significances. However, serious complications have been reported including cerebral embolism, or ischemic necrosis of hand or forearm requiring amputation although the incidences are rare. Post-cannulation radial artery aneurysm is not common in clinical practices. We report a case of post-cannulation radial artery aneurysm in a 23-year-old female patient undergoing mitral valvular replacement. Radial artery cathteter was indwelt for 14 days at the same site. It should be kept in mind that aseptic and atraumatic technique must be used and the catheter must not be indwelt at one point for a long time in arterial cannulation.
Subject(s)
Female , Humans , Young Adult , Amputation, Surgical , Aneurysm , Arterial Pressure , Blood Pressure , Catheterization , Catheters , Critical Illness , Forearm , Hand , Incidence , Intracranial Embolism , Necrosis , Radial ArteryABSTRACT
Two-dimensional Doppler echocardiographic velocity profiles of four cardiac valves in a group of 85 infants and children with left to right shunt lesions(VSD, ASD and PDA) are presented. Velocities were obtained before operation and 10 days afterward. The results were as follows ; 1) VSD(type 2) Peak velocities of mitral valve were significantly decreased when compared preop. with postop. echocardiogram(n=37, preop 132+/-24, postop 98+/-16 cm/sec, p0.05). Aortic valve velocities showed no significant changes (n=10, perop 134+/-23, postop 121+/-25cm/sec, p>0.05). Peak velocities of pulmonic valve were significantly decreased(n=28, perop 138+/-37, postop 107+/-27cm/sec, p<0.005). This study demonstrates that Doppler echocardiographic assessment of velovity changes are correlated with known hemodynamic data and also will be a good index in the evaluation of operation.