Résumé
A 62-year-old man suddenly felt severe back pain. An enhanced computed tomography (CT) demonstrated an acute Stanford type B dissection and the true lumen was severely compressed by the false lumen. We started conservative therapy because there was no sign of organ ischemia. A 23 days from onset, he developed bilateral limb ischemia and renal failure because the compression of the true lumen increased. After bilateral axillo-femoral bypass the organ ischemia disappeared. Four months later, CT showed the dilatation of the true lumen and occlusion of the bilateral grafts. In spite of graft occlusion, there was no sign of organ ischemia.
Résumé
We report 4 cases of delayed hypersensitivity reaction to Vancomycin (VCM) after cardiac surgery. Case 1: A patient developed sepsis and mediastinitis after aortic valve replacement (AVR) for aortic valve insufficiency. Case 2: A patient developed mediastinitis after coronary artery bypass grafting (CABG) for effort angina pectoris. Case 3: A patient developed pneumonia after AVR for aortic valve infective endocarditis. Case 4: A patient developed sepsis after CABG for acute myocardial infarction. All of them received VCM intravenously and their infections improved. However, sudden high fever, skin rush and eosinophilia occurred 12 or 13 days after the initiation of therapy. These symptoms resolved after halting VCM administration. We need to take examine eosinophils when considering further administration of VCM.
Résumé
Minimally invasive direct coronary artery bypass grafting (MIDCAB) has been performed in some institutions and mid-term results have been reported. However, because of its technical difficulty, the procedure has not been gaining acceptance among cardiovascular surgeons. We report the clinical results of our MIDCAB series and describe the effect and role of the MIDCAB in the therapy of ischemic heart disease. From May 1999 through May 2002, 65 patients (age 29 to 90 years) underwent MIDCAB via a small left thoracotomy. Postoperative angiography was performed before discharge in all patients. No conversions to sternotomy were necessary. There were no operative, hospital or mid-term mortalities, nor were these any major complications, including myocardial infarction, stroke, respiratory failure, and other organ failure. Wound infection occurred in 1 patient. No graft occlusion was seen. Graft stenosis was seen in only 1 patient. The graft patency rate was 98.5% (66/67). Postoperative cardiac events included 2 incidents of angina, and 4 of atrial fibrillation. There were no incidents of congestive heart failure. MIDCAB is a safe and less-invasive operation. According to our clinical results, MIDCAB is an alternative to conventional coronary artery bypass grafting for selected patients, especially for those at high risk.
Résumé
There are few reports of successful CABG for coronary lesions due to collagen disease. In particular, there is no report of CABG in progressive systemic sclerosis (PSS). A 60-year-old female with PSS underwent successful coronary artery grafting for angina pectoris. She had a history of PSS and had been on predonisolon for the previous 2 years. Three months prior to admission, she began to complain of angina on mild exersion. Selective coronary angiogram revealed 90% stenosis in the midportion of the right coronary artery and 90% stenosis in the proximal portion of the left anterior descending artery. Based on these findings she underwent saphenous vein grafting to the left anterior descending branch and the posterior descending branch of the RCA. Despite the history of PSS, the patient's postoperative course was uneventful and she is now doing well with no attack of angina. Postoperative angiography showed both vein grafts were patent, but there was a slight stenotic lesion in the midportion of the graft to the right coronary artery. From our experience, careful consideration of the bypass conduit is important in patients requiring steroids.