ABSTRACT
Coronary artery fistulas are a rare clinical entity in cardiac anomalies, and in a significant portion of patients, the fistulas are accompanied by coronary aneurysm formation. In this article, we present a giant circumflex coronary artery aneurysm with a fistula into the coronary sinus.
Subject(s)
Arteriovenous Fistula/complications , Arteriovenous Fistula/diagnostic imaging , Computed Tomography Angiography , Coronary Aneurysm/complications , Coronary Aneurysm/diagnostic imaging , Coronary Sinus/diagnostic imaging , Diagnosis, Differential , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND: This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). METHODS: Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time. RESULTS: A comparison of patients between both groups revealed significantly high levels of IL-6 in the control group at T2, T3, and T4 with respect to T1 (T2: P < .001; T3: P < .001; T4: P < .001). IL-10 levels were significantly higher in the study group at T2 compared with the control group (P = .007). CK-MB levels were significantly lower in the study group than in the control group at T4 (P = .001). The increase of cTnT was higher in the control group at T3 and T4 compared with the study group (T3: P = .002; T4: P = .001). CONCLUSIONS: This study demonstrates that methylprednisolone is effective for ensuring better myocardial protection during cardiac surgery by suppressing the inflammatory response via decreasing the levels of IL-6 and by increasing anti-inflammatory activity through IL-10.
Subject(s)
Cardiopulmonary Bypass/adverse effects , Coronary Artery Bypass/adverse effects , Methylprednisolone/administration & dosage , Myocarditis/etiology , Myocarditis/prevention & control , Premedication/methods , Aged , Anti-Inflammatory Agents/administration & dosage , Cardiopulmonary Bypass/methods , Cardiotonic Agents/administration & dosage , Coronary Artery Bypass/methods , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
The rare combination of tetralogy of Fallot (TOF), absent pulmonary valve syndrome (APVS), and absent left pulmonary artery (ALPA) is reviewed herein. Children with TOF with APVS and ALPA should be closely monitored, even if they are asymptomatic or mildly symptomatic, and should undergo elective surgery at the end of infancy.
Subject(s)
Abnormalities, Multiple , Pulmonary Artery/abnormalities , Pulmonary Valve/abnormalities , Tetralogy of Fallot , Abnormalities, Multiple/diagnosis , Abnormalities, Multiple/surgery , Angiography , Cardiovascular Surgical Procedures , Echocardiography , Elective Surgical Procedures , Female , Heart Ventricles/diagnostic imaging , Humans , Infant , Male , Pulmonary Artery/surgery , Pulmonary Valve/surgery , Retrospective Studies , Syndrome , Tetralogy of Fallot/diagnosis , Tetralogy of Fallot/surgeryABSTRACT
A 70-year-old male patient with myasthenia gravis required coronary artery bypass grafting due to triple-vessel disease. The anesthetic management was performed with general anesthesia using reduced doses of muscle relaxants. He was extubated four hours after surgery and the postoperative course was uneventful. Coronary artery bypass surgery in myasthenic patients can be challenging to anesthesiologists and cardiac surgeons. In this rare condition, a meticulous assessment of the patient's neurologic and cardiac status, and careful perioperative anesthetic management were needed in order to avoid life-threatening complications in both intraoperative and postoperative periods.
Subject(s)
Anesthesia, General/methods , Cardiopulmonary Bypass/methods , Coronary Artery Bypass/methods , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Myasthenia Gravis/complications , Aged , Anesthetics, General/administration & dosage , Humans , Intraoperative Care/methods , Male , Muscle Relaxants, Central/administration & dosage , Perioperative Care/methods , Treatment OutcomeABSTRACT
BACKGROUND: Carotid body tumors are rare, highly vascularized neoplasms that arise from the paraganglia located at the carotid bifurcation. Surgery is the only curative treatment. However, treatment of bilateral carotid body tumors represents a special challenge due to potential neurovascular complications. CASE REPORT: We present the therapeutic management of a 34-year-old woman with bilateral carotid body tumors. The patient underwent surgical resection of the largest tumor. It was not possible to resect the tumor without sacrificing the ipsilateral vagal nerve. Due to unilateral vagal palsy, we decide to withhold all invasive therapy and to observe contralateral tumor growth with serial imaging studies. The patient is free of disease progression 5 years later. CONCLUSIONS: Treatment of bilateral CBTs should focus on preservation of the quality of life rather than on cure of the disease. In patients with previous contralateral vagal palsies, the choice between surgery and watchful waiting is a balance between the natural potential morbidity and the predictable surgical morbidity. Therefore, to avoid bilateral cranial nerve deficits, these patients may be observed until tumor growth is determined, and, if needed, treated by radiation therapy.
