ABSTRACT
We report a 72-year-old woman with severe congenital stenosis of the left coronary artery orifice and clinically significant atherosclerotic changes in both the right and left coronary arteries. The stenotic ostium was located at the point at which the left and posterior aortic valve leaflets joined to form the left commissure, just at the distal vertex of the left interleaflet triangle, between the left and posterior aortic sinuses. The right coronary artery was more developed in size than usual, whereas the left coronary artery consisted of a short left main coronary trunk that bifurcated into left anterior descending and left circumflex arteries. The left coronary artery system was filled retrogradely through two vessels proceeding from the right coronary artery, namely, the conal artery and a well-developed branch that ran across the interventricular septum. This abnormal arrangement of the coronary arteries showed striking functional similarities with atresia of the left main coronary artery. Current knowledge on the morphogenesis of the coronary arteries suggests that the present anomalous coronary artery pattern resulted from the penetration of the anticipated left coronary artery system into the aorta at a totally erroneus site. This hindered the normal development of the ostium, which subsisted as a punctiform, practically nonfunctional opening.
ABSTRACT
Objetivo: El momento ideal para indicar la cirugía en un paciente con rotura traumática de aorta torácica sigue siendo controvertido. Parece, a tenor de las últimas publicaciones, que existe una opinión favorable a demorar en lo posible dicha indicación. Revisamos con este objetivo nuestra experiencia. Material y métodos: Nuestra casuística es de 13 pacientes. Once fueron operados, 8 de ellos con carácter emergente y 3 programados a los 4, 15 y 120 días. Dos pacientes recibieron sólo tratamiento médico. Resultados: Cinco pacientes fallecieron (mortalidad operatoria del 38 por ciento). Tres de estos fallecidos fueron por fracaso multiorgánico a los 3, 10 y 40 días respectivamente. Estos tres pacientes fueron dos de ellos los que siguieron tratamiento médico y el tercero uno de los operados emergentemente. Los otros dos exitus fueron por shock hemorrágico. La mortalidad de los pacientes operados programadamente fue del 0 por ciento y la de los operados emergentemente del 37 por ciento. Conclusiones: Aunque en la mortalidad hospitalaria intervienen diversos factores, como grado e importancia de las lesiones asociadas, técnica quirúrgica, etc., consideramos que el tiempo ideal de indicación quirúrgica debe ser lo más precoz posible si no existen lesiones cerebrales o abdominales graves y el paciente está estabilizado metabólica y hemodinámicamente. Aunque existen diversas posibilidades de corrección, nos inclinamos por usar by pass parcial izquierdo lo que permite mejor protección medular y desarrollo de la técnica quirúrgica. Generalmente hemos usado la interposición de un injerto protésico
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aorta, Thoracic/injuries , Thoracic Injuries/surgery , Aorta, Thoracic/surgery , Aorta, Thoracic , Cardiovascular Surgical Procedures/methods , Elective Surgical Procedures/standardsABSTRACT
Objetivo: El momento ideal para indicar la cirugía en un paciente con rotura traumática de aorta torácica sigue siendo controvertido. Parece, a tenor de las últimas publicaciones, que existe una opinión favorable a demorar en lo posible dicha indicación. Revisamos con este objetivo nuestra experiencia. Material y métodos: Nuestra casuística es de 13 pacientes. Once fueron operados, 8 de ellos con carácter emergente y 3 programados a los 4, 15 y 120 días. Dos pacientes recibieron sólo tratamiento médico. Resultados: Cinco pacientes fallecieron (mortalidad operatoria del 38 por ciento). Tres de estos fallecidos fueron por fracaso multiorgánico a los 3, 10 y 40 días respectivamente. Estos tres pacientes fueron dos de ellos los que siguieron tratamiento médico y el tercero uno de los operados emergentemente. Los otros dos exitus fueron por shock hemorrágico. La mortalidad de los pacientes operados programadamente fue del 0 por ciento y la de los operados emergentemente del 37 por ciento. Conclusiones: Aunque en la mortalidad hospitalaria intervienen diversos factores, como grado e importancia de las lesiones asociadas, técnica quirúrgica, etc., consideramos que el tiempo ideal de indicación quirúrgica debe ser lo más precoz posible si no existen lesiones cerebrales o abdominales graves y el paciente está estabilizado metabólica y hemodinámicamente. Aunque existen diversas posibilidades de corrección, nos inclinamos por usar by pass parcial izquierdo lo que permite mejor protección medular y desarrollo de la técnica quirúrgica. Generalmente hemos usado la interposición de un injerto protésico (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aorta, Thoracic/injuries , Thoracic Injuries/surgery , Cardiovascular Surgical Procedures/methods , Elective Surgical Procedures/standards , Aorta, Thoracic/surgery , Aorta, Thoracic/diagnostic imagingABSTRACT
Among the 1,993 patients undergoing open-heart operations, our incidence rate of mediastinitis was 0.6%. Six patients have been treated with the pedicled omentum. Two of the 6 patients had a valvular disease and a coronary bypass the others. All patients had a good result with this procedure. After this experience, we think it is the best technique for management of this major complication.
Subject(s)
Heart Diseases/surgery , Mediastinitis/surgery , Omentum/surgery , Postoperative Complications/surgery , Adult , Aged , Female , Humans , Male , Mediastinitis/etiology , Middle Aged , ReoperationABSTRACT
Apicoaortic conduit implantation is easier and safer with cardiopulmonary bypass. We present an analysis of two cases in which the operation was successfully concluded without the bypass. The first patient had a simultaneous correction of aortic coarctation and tunnelliform subaortic stenosis 8 years ago and is asymptomatic at present. The second patient suffered from hyperlipoproteinemia, calcification of the ascending aorta and femoral arteries and severe aortic stenosis. One month after surgery be suffered cardiac arrhythmia and died. Although this experience is limited, we believe that information about this alternative method may be useful in some cases.
Subject(s)
Aortic Valve Stenosis/surgery , Blood Vessel Prosthesis , Cardiopulmonary Bypass , Ventricular Outflow Obstruction/surgery , Child , Female , Humans , Male , Middle Aged , Prostheses and ImplantsABSTRACT
We present 4 cases of dissection of the coronary arteries during coronary radiography, which required emergency surgery. The right coronary was dissected in 2 cases and the left coronary in the remaining cases. Coronary artery bypass was carried out using saphenous vein. Although one patient suffered myocardial infarction, all patients had successful recovery and evolution.
Subject(s)
Angiocardiography/adverse effects , Aortic Dissection/etiology , Cardiac Catheterization/adverse effects , Coronary Vessels/injuries , Adult , Aortic Dissection/surgery , Cardiac Catheterization/instrumentation , Coronary Angiography , Coronary Artery Bypass , Coronary Vessels/surgery , Emergency Medical Services , Female , Hemodynamics , Humans , Male , Middle Aged , Myocardial Infarction/etiologyABSTRACT
The case of a patient undergoing an emergency aortocoronary bypass to the right coronary artery after its acute dissection at coronariography is presented. Surgery was carried out two hours after the incident. After successful recovery and postoperative study, it was concluded that the main technical problem posed by this operation which was whether or not to ligate proximally the right coronary was satisfactorily solved by the initial decision not to ligate it.
Subject(s)
Angiography/adverse effects , Coronary Artery Bypass , Coronary Vessels/injuries , Adult , Emergencies , Humans , MaleSubject(s)
Heart Valve Prosthesis , Animals , Equipment Design , Equipment Failure , Evaluation Studies as Topic , Hemodynamics , Humans , Product LabelingABSTRACT
A new technique of circular tricuspid annuloplasty in the treatment of tricuspid insufficiency is described. One hundred and fifty patients have been operated on by this technique between April 1973 and March 1975. The operative findings and the results of the operation from 6 to 30 months after operation are described. The addition of tricuspid circular annuloplasty to mitral and aortic valve replacements where indicated has resulted in a gratifying fall in operative mortality and better long term functional result.
Subject(s)
Tricuspid Valve Insufficiency/surgery , Tricuspid Valve/surgery , Adolescent , Adult , Aged , Aortic Valve Insufficiency/surgery , Female , Heart Valve Prosthesis , Humans , Male , Middle Aged , Mitral Valve Insufficiency/surgery , Postoperative Complications/mortality , Suture TechniquesABSTRACT
We present four cases of late thrombotic obstruction of the Björk-Shiley aortic valve prosthesis. The incidence of this complication reported in the literature to vary from 0.7% to 5%. In our experience of a total of 623 Björk-Shiley aortic valve replacements, we observed this complication in only 4 patients (0.6%). Two of them had poorly controlled anticoagulation therapy. The clinical presentation was subacute in all four patients. Surgical treatment, thrombectomy and debridement, was performed in all of them. The diagnosis was made upon abrupt and progressive onset of dyspnoea, physical examination data and echocardiographic and radioscopic findings. Angiocardiographic studies were needed in two patients.
Subject(s)
Aortic Valve/surgery , Heart Valve Prosthesis/adverse effects , Thrombosis/etiology , Adult , Aged , Anticoagulants/therapeutic use , Aortography , Echocardiography , Female , Humans , Male , Middle Aged , Thrombosis/diagnosis , Thrombosis/surgeryABSTRACT
Three patients presented subacute right heart failure, 6, 12 and 22 months after replacement of the tricuspid valve with a Björk-Shiley prosthesis. The principal finding encountered on clinical examination was a tricuspid filling murmur with inspiratory accentuation. The mean prosthetic gradient found at cardiac catheterization was 7, 8 and 10 mm Hg. At surgery, the three prostheses were thrombosed on their ventricular aspect and all the three were replaced with new ones of the same model. The patients are alive and in good condition, 21, 17 and 8 months after the operation. Problems which relate to the surgical management of tricuspid valve disease are discussed.
