Subject(s)
Catheterization, Central Venous/methods , Defibrillators, Implantable , Electric Countershock/instrumentation , Jugular Veins , Prosthesis Failure , Prosthesis Implantation/methods , Aged, 80 and over , Electric Countershock/adverse effects , Female , Humans , Jugular Veins/diagnostic imaging , Phlebography , Prosthesis Design , Treatment OutcomeSubject(s)
Bone Cements/adverse effects , Foreign-Body Migration/etiology , Heart Atria , Heart Ventricles , Vertebroplasty/adverse effects , Aged , Cardiac Surgical Procedures , Echocardiography , Female , Foreign-Body Migration/diagnosis , Foreign-Body Migration/surgery , Heart Atria/surgery , Heart Ventricles/surgery , Humans , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: Coronary angiography (CAG) is an invasive diagnostic procedure, which could lead to procedure related complications. One of the well known post-procedural complications is cerebral embolic infarction with or without symptoms. Silent embolic cerebral infarction (SECI) has clinical significance because it can progress to a decline in cognitive function and increase the risk of dementia in the long term. The aim of this study was to detect the incidence and predictors of SECI after diagnostic CAG using diffusion-weighted magnetic resonance imaging (DW-MRI). METHODS: A total of 197 patients with coronary artery disease who underwent DW-MRI for evaluation of intracranial vasculopathy before coronary artery bypass graft surgery were retrospectively enrolled in the present study. DW-MRI was performed within 48 h after diagnostic CAG. SECI was diagnosed as presence of focal bright high signal intensity in DW-MRI. Patients were divided into groups according to presence/absence of SECI (+ SECI vs. - SECI, respectively). The clinical and angiographic characteristics were analyzed and independent predictors were evaluated. RESULTS: Of the 197 patients, SECI occurred in 20 patients (10.2%) after diagnostic CAG. Age, female gender, frequency of underlying atrial fibrillation, extent of coronary disease, and fluoroscopic time during diagnostic CAG were not different between the + SECI and - SECI groups. Left ventricular ejection fraction was significantly lower in the + SECI group than in the - SECI group (45.9 ± 8.5% vs. 51.4 ± 13.1%, p=0.014) and performance rate of internal mammary artery (IMA) angiography was significantly higher in the + SECI group compared with the - SECI group (85% vs. 37.2%, p<0.001). By multivariate analysis, performing IMA angiography was the only predictor of SECI (OR=14.642; 95% CI=3.201 to 66.980, p=0.001). CONCLUSIONS: The incidence of SECI after diagnostic CAG was not infrequent. Diagnostic CAG with IMA angiography may increase the risk of SECI.
Subject(s)
Asymptomatic Diseases/epidemiology , Cerebral Infarction/epidemiology , Coronary Angiography/adverse effects , Coronary Angiography/statistics & numerical data , Coronary Artery Disease/diagnostic imaging , Intracranial Embolism/epidemiology , Aged , Cerebral Infarction/pathology , Diffusion Magnetic Resonance Imaging , Female , Humans , Incidence , Intracranial Embolism/pathology , Male , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Retrospective StudiesABSTRACT
Constrictive pericarditis is a rare complication after coronary artery bypass grafting In most cases pericardiectomy is required as a definitive treatment. However, there are several types of constrictive pericarditis such as transient cardiac constriction. Some types of constrictive pericarditis can only be managed with medical therapy. We report a 72-year-old female patient who developed subacute transient constrictive pericarditis with persistent left pleural effusion as a result of postcardiac injury syndrome. The patient went through coronary bypass surgery that was successfully treated with postoperative steroid therapy.
ABSTRACT
An atherosclerotic aortic arch aneurysm associated with a common origin for both carotid arteries is a rare condition. An aberrant right subclavian artery is just as rare, especially with a retroesophageal course. A combination of these two conditions, we believe, has never been reported.
Subject(s)
Aorta, Thoracic/abnormalities , Aortic Aneurysm/pathology , Carotid Arteries/abnormalities , Subclavian Artery/abnormalities , Aorta, Thoracic/surgery , Aortic Aneurysm/surgery , Atherosclerosis/pathology , Blood Vessel Prosthesis , Carotid Arteries/surgery , Humans , Male , Middle Aged , Subclavian Artery/surgeryABSTRACT
Esophageal necrosis with perforation secondary to traumatic aortic transection is extremely rare but usually fatal. A 47-year-old man complained of sudden swallowing difficulty 6 days after blunt trauma. Computed tomography showed a ruptured aorta and the midesophagus shifted to the right side with luminal obliteration because of the ruptured aorta. After primary repair of the partially transected aorta, unexpected mediastinitis because of esophageal perforation was noted. Upper endoscopy showed midesophageal ulceration, necrosis, and perforation. Biopsy samples were consistent with ischemia. The possibility of direct esophageal trauma or intraoperative esophageal injury was ruled out. Esophageal exclusion with thoracoscopic decortication and multiple antibiotics were ineffective, and the patient eventually died. Ischemic esophageal necrosis caused by mechanical compression can occur in a traumatic aortic transection. Dysphagia, when present with radiologic signs, indicates a displaced and compressed esophagus. In spite of aggressive surgical and medical treatment for a perforated esophagus, the prognosis remains poor.
