ABSTRACT
Leiomyosarcoma is a rare malign neoplasm, representing about 5-7% of all tissue sarcomas while inferior vena cava leiomyosarcomas accounts for only 1%. This paper presents the case of a 74 years old patient that was diagnosed with an abdominal venous leiomyosarcoma involving the inter-renal segment of the inferior vena cava. Tumor was treated by complete in bloc resection. Reconstruction of the vascular axis was performed with an autologous venous tube graft achieved with segments of the right superficial femoral vein. Recurrent free survival and freedom from local or systemic recurrence was observed at 2 years after the intervention thanks to the aggressive radical surgical management.
Subject(s)
Leiomyosarcoma , Vascular Neoplasms , Aged , Femoral Vein/surgery , Humans , Leiomyosarcoma/diagnosis , Leiomyosarcoma/surgery , Neoplasm Recurrence, Local , Vascular Neoplasms/diagnosis , Vascular Neoplasms/surgery , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgerySubject(s)
Anticoagulants/adverse effects , Aortic Valve/surgery , Bioprosthesis/adverse effects , Coronary Artery Bypass , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis/adverse effects , Heparin/adverse effects , Thrombocytopenia/chemically induced , Aged , Anti-Bacterial Agents/therapeutic use , Ceftazidime/therapeutic use , Drug Therapy, Combination , Fatal Outcome , Female , Heart Valve Prosthesis Implantation/methods , Humans , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/etiology , Prosthesis Failure , Vancomycin/therapeutic useABSTRACT
OBJECTIVES: Ascending aorta false aneurysms after cardiac surgery are uncommon. Resternotomy is hazardous and may result in massive and uncontrollable hemorrhage if the false aneurysm is entered. Here we report our experience with the use of deep hypothermia and circulatory arrest to avoid this risk. METHODS: From March 2000 to December 2007, seven patients (mean age 50 years) were reoperated for an ascending aorta false aneurysm. Three patients had undergone an aortic valve replacement (n=2) or an aortic valve repair (n=1). Three had undergone an ascending aorta replacement with a valved conduit (n=2) or an aortic valve repair (n=1) for type A dissection. One had undergone a coronary artery bypass grafting. Mean delay to reoperation was 133 months (range 22-324 months). Two patients had positive blood cultures (Staphylococcus species). Cardiopulmonary bypass was established by extramediastinal access. Patients were cooled to 18 °C. RESULTS: Resternotomy was performed uneventfully under total circulatory arrest in all patients. Four patients underwent an ascending aorta replacement with a valved conduit (n=2) or a dacron conduit (n=2) associated with a mitral valve replacement in one patient. Direct suture was performed in two patients and in one patient the aorta was repaired using a saphenous vein patch. There was one hospital death. Mean follow-up was 53 months (range 14-90 months). CONCLUSION: Resternotomy under circulatory arrest and deep hypothermia is a safe technique well-adapted to patients with an ascending aorta false aneurysm.
Subject(s)
Aneurysm, False/surgery , Aneurysm, Infected/surgery , Aortic Aneurysm/surgery , Cardiac Surgical Procedures/adverse effects , Circulatory Arrest, Deep Hypothermia Induced , Sternotomy , Vascular Surgical Procedures , Adult , Aged , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Aneurysm, False/mortality , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/etiology , Aneurysm, Infected/mortality , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/etiology , Aortic Aneurysm/mortality , Aortography/methods , Belgium , Cardiac Surgical Procedures/mortality , Circulatory Arrest, Deep Hypothermia Induced/adverse effects , Circulatory Arrest, Deep Hypothermia Induced/mortality , Female , Hospital Mortality , Humans , Male , Middle Aged , Reoperation , Retrospective Studies , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/mortalityABSTRACT
BACKGROUND: The benefit of the Cox Maze procedure combined with heart surgery was evaluated at long-term follow-up. METHODS: The outcome for 37 patients who underwent a Cox Maze III procedure combined with heart surgery (Maze group) was compared with that of 66 patients who had heart surgery alone (control group). All patients were in persistent atrial fibrillation preoperatively. The two groups had similar preoperative characteristics and were operated upon during the same era (1996 to 2004). RESULTS: Five-year survival, including hospital deaths, was 89% +/- 5% in the Maze group and 60% +/- 7% in the control group (log rank p = 0.008). Causes of death were predominantly related to heart failure (1 of 37 in the Maze group and 12 of 66 in the control group; p = 0.02) and to sudden death (0 of 37 in the Maze group and 9 of 66 in the control group; p = 0.02). After correction for preoperative variables, Cox regression analysis showed that the Maze procedure improved survival independently (p = 0.019). In a subgroup of patients with left atrial diameter of more than 60 mm preoperatively, the 5-year survival estimate was 92% +/- 6% in the Maze group versus 59% +/- 9% in the control group (log rank p = 0.012). The 5-year estimate of conversion to sinus rhythm was 91% +/- 7% in the Maze group and 33% +/- 7% in the control group (log rank p < 0.001). CONCLUSIONS: The restoration of sinus rhythm by a Maze procedure combined with heart surgery markedly improved long-term survival in this series.
Subject(s)
Atrial Fibrillation/mortality , Atrial Fibrillation/surgery , Cardiac Surgical Procedures/mortality , Catheter Ablation/mortality , Hospital Mortality/trends , Aged , Analysis of Variance , Atrial Fibrillation/diagnosis , Cardiac Surgical Procedures/methods , Case-Control Studies , Catheter Ablation/methods , Cause of Death , Combined Modality Therapy , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Multivariate Analysis , Probability , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Survival Rate , Treatment OutcomeABSTRACT
BACKGROUND: Dilatation of the pulmonary autograft is a major concern after root replacement for the Ross operation. The inclusion technique would avoid this drawback, but few data are available on the long-term results of this technique. We retrospectively analyze long-term results of both techniques. METHODS: Of 218 patients undergoing the Ross operation between 1991 and 2006, 148 (68%) had root replacement and 70 (32%) underwent the inclusion technique. The mean age of the patients was 40 +/- 10 years (range, 16 to 64). Mean follow-up was 94 +/- 44 months (range, 13 to 196). Echocardiographic controls were available in 197 patients. Proximal aorta dilatation was defined as diameter > 40 mm. RESULTS: In the root and inclusion groups, 10-year overall survival was 94% +/- 4% and 97% +/- 4%, respectively. Freedom from autograft reoperation was 81% +/- 10% and 84% +/- 13%, respectively. Main cause of reoperation was autograft dilatation in the root group (13 of 16) and valve prolapse in the inclusion group (5 of 6). Freedom from proximal aorta dilatation was 57% +/- 12% and 80% +/- 15%, respectively. In the root group, dilatations (n = 48) affected systematically the autograft sinuses or sinotubular junction, whereas in the inclusion group, dilatations (n = 10) affected principally the ascending aorta (8 of 10). Freedom from severe autograft regurgitation was 86% +/- 9% and 83% +/- 13%, respectively. Root technique, follow-up length, and preoperative aortic valve regurgitation were predictors of proximal aorta dilatation. CONCLUSIONS: In the long term, both techniques showed excellent survival and similar rates of autograft failure. For root replacement, autograft dilatation was the main cause of failure. For the inclusion technique, the autograft, but not the ascending aorta, was protected against dilatation and autograft valve prolapse was the main cause of failure.
Subject(s)
Aortic Valve/surgery , Cardiac Surgical Procedures/methods , Heart Valve Diseases/surgery , Pulmonary Valve/transplantation , Adolescent , Adult , Analysis of Variance , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/mortality , Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/surgery , Cardiac Surgical Procedures/adverse effects , Cohort Studies , Confidence Intervals , Dilatation, Pathologic/diagnostic imaging , Dilatation, Pathologic/surgery , Echocardiography, Doppler , Female , Follow-Up Studies , Graft Rejection , Graft Survival , Hemodynamics/physiology , Humans , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Reoperation , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Survival Analysis , Transplantation, Autologous/adverse effects , Treatment Outcome , Young AdultABSTRACT
A simplified technique to treat patients in stand-alone atrial fibrillation with a right thoracoscopic approach is described. An electrical isolation of the four pulmonary veins (box lesion) is achieved with a microwave antenna.
