ABSTRACT
A case of a septic paradoxic embolus due to an infected pacemaker lead associated with a patent foramen ovale (PFO) is described. Treatment consisted of immediate intracardiac embolectomy, pericardial patch closure of the PFO, total removal of the infected pacemaker lead and generator, and placement of a new permanent epicardial lead pacemaker system.
Subject(s)
Embolism, Paradoxical/etiology , Heart Septal Defects, Atrial/complications , Pacemaker, Artificial/adverse effects , Staphylococcal Infections/etiology , Staphylococcus epidermidis , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Few reports address the high-risk patient population with concomitant critical carotid and left main coronary disease with left ventricular dysfunction. To decrease the risks involved with the simultaneous and traditional staged surgical approaches, we developed a rapid staging strategy using an intraaortic balloon pump. METHODS: Between 1992 and 1996, 20 patients presented with a high-risk "triad" defined by greater than 70% stenosis of the left main coronary artery, ejection fraction less than 0.30, and greater than 90% stenosis of the internal carotid artery. An intraaortic balloon pump was placed immediately before carotid endarterectomy under angiographic guidance. Less than 24 hours later (mean, 18 hours) coronary artery bypass grafting was performed, and the intraaortic balloon pump was removed the day of coronary artery bypass grafting in all cases (total IABP duration, <36 hours). RESULTS: Eighteen patients (18/20) were extubated on the day of coronary artery bypass grafting (mean, 12 hours). Sixteen patients (16/20) were transferred from the intensive care unit within 48 hours, with total hospital stay ranging from 6 to 12 days (mean, 8 days). There were no 30-day postoperative deaths, myocardial infarctions, or neurologic, vascular, bleeding, or other major complications. At a mean 29.4-month follow-up, there were two noncardiac deaths and no neurologic events. Six-month, 1-year, and 2-year follow-up ultrasounds showed all operative carotid arteries remained patent. CONCLUSIONS: A rapid staged procedure with angiographically guided placement of the intraaortic balloon pump was safe and effective in this very high risk patient population. It may be an option to decrease the risks involved with simultaneous operations and increase the efficiency and safety of "traditional" staged carotid and coronary artery bypass grafting procedures.
Subject(s)
Carotid Stenosis/surgery , Coronary Artery Bypass/methods , Coronary Disease/surgery , Endarterectomy, Carotid/methods , Intra-Aortic Balloon Pumping , Ventricular Dysfunction, Left/surgery , Aged , Carotid Artery, Internal , Carotid Stenosis/complications , Carotid Stenosis/epidemiology , Coronary Disease/complications , Coronary Disease/epidemiology , Female , Follow-Up Studies , Humans , Male , Risk Factors , Time Factors , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/epidemiologyABSTRACT
Clinical and angiographic observations have been presented in a patient with subacute dissecting aneurysms of the descending thoracic aorta (Type III) who underwent a two-stage operation. The first stage consisted of insertion of an ascending to lower abdominal aorta bypass graft through a midline incision, the second stage of exclusion of the dissected segment through a separate left thoracotomy a week later. The patient remained asymptomatic through the two years' observation period. Repeated angiograms showed persistent obliteration of the dissected segment and good flow through the aorto-aortic bypass.
