Left ventricular pseudoaneurysm after acute influenza A myocardiopericarditis.

We describe the successful management of a rare case regarding an adult Caucasian who developed a left inferior ventricular pseudoaneurysm as a consequence of an influenza A virus infection of the upper respiratory tract followed by acute myocardiopericarditis. The cardiovascular features of this case illustrate the importance of raising a sufficient clinical index of suspicion for this common, but potentially lethal, entity.

Endovascular stent-graft treatment for diseases of the descending thoracic aorta.

OBJECTIVE: Assessment of endovascular stent-graft treatment for diseases of the descending thoracic aorta as a valid and effective alternative to surgery. METHODS: From March 1999 to August 2000, a total of 16 patients underwent deployment of endovascular stent-grafts in the descending thoracic aorta. Patients were divided into three groups according to the type of lesion. Group A (n=8) included five patients with atherosclerotic aneurysm and three with chronic post-traumatic pseudoaneurysm. Patients with acute post-traumatic pseudoaneurysm (n=3) and type B aortic dissection (n=5) were included in Groups B and C, respectively. All patients underwent 5-mm chest spiral angio-computerized tomography (CT) scan and angiography as preoperative assessment. The deployed stent-graft systems were Talent-Medtronic and Excluder-Gore. RESULTS: A total of 20 stent-grafts were placed. Two patients required deployment of two grafts, while three grafts were juxtaposed in a third patient in order to treat larger lesions. There was no mortality related to the procedure, although one patient (6.2%) died because of multiorgan failure 24h post-operatively. The placement of the graft was successful in all cases except one affected with type B dissection and characterized by a very large intimal flap, which was eventually fenestrated by graft guidewire. Therefore, an optimal sealing of the grafts was achieved in 15 patients. However, in one patient the descending aorta had to be surgically replaced because of the calcified pseudoaneurysm still compressing the trachea and left bronchus. Two patients required a left carotid-subclavian by-pass in order to achieve a sufficient neck for the proximal placement of the graft. No spinal cord injuries were observed. At the follow-up, performed with chest spiral angio-CT scan within 72 h and scheduled at 6 and 12 months and once a year, no stent-graft related complications have been detected. CONCLUSIONS: Endoluminal stent-graft treatment may represent a valid option in well-selected cases of descending thoracic aorta diseases. A longer follow-up in a larger series of patients is desirable to confirm these initial positive results.

Successful use of central venous catheter as permanent hemodialysis access: 84-month follow-Up in lucania.

Cuffed tunneled venous access catheters are commonly used for temporary and permanent access in hemodialysis (HD) patients. These catheters serve an essential role in providing permanent access in subjects in whom all other access options have been exhausted. The predominant complications are catheter thrombosis, catheter fibrin sheating and infection. The aim of this study was to evaluate long-term survival and complications of permanent venous catheters (PVC) placed for the purpose of HD during the period from January 1992 to December 1998, at the Dialysis Units of Lucania (a southern Italian region). A total of 98 PVC were placed in 88 patients during this period. The catheters used were of three types: (a) 72 VasCath Soft Cell catheters (Bard Instrument Company, Toronto, Ont., Canada); (b) 22 PermCath catheters (Quinton Instrument Company, Seattle, Wash., USA), and (c) 4 Tesio catheters (Bellco SpA, Mirandola, Italy). Survival curves of catheters were calculated using the Kaplan-Meier product-limit estimator. The patient survival was 60% at the 78th month. Actually, 52 patients (27 males, 25 females) are still alive: 15 (26.9%) of these patients have diabetes mellitus and 1 has been transplanted. The actuarial survival rate of PVC was 89% in the whole population studied and 82% in subjects alive after 84 months. Twenty-five patients (28.4%) had PVC as the first reliable vascular access. Long-term complications occurred 27 times (1 episode every 44.81 month/patient) as: breakage (3.1%); thrombosis (10.2%); displacement (2.0%); subcutaneous tunnel bleeding (3.1%); inadequate blood flow (7.1%), and infection (10.2%). In conclusion, our data confirm that PVC might represent an effective long-term blood access route for HD. Again, PVC are getting the access of choice for selected patients (i.e., older subjects with cardiovascular diseases and cancer patients) and are enjoying a dramatic increase in use for subjects who are terrified of repetitive venopuncture.

Survival following treatment of a cardiac malignant fibrous histiocytoma.

The authors report the successful surgical and chemotherapeutic management of a malignant fibrous histiocytoma with localization in the heart. This rare malignancy has specific morphologic characteristics and is diagnosed in adults when it is already locally aggressive or metastasized. The average survival time for patients with malignant fibrous histiocytoma is < 12 months. Neither clinical nor instrumental signs of recurrence have been detected in this patient after an aggressive surgical resection and a specific therapeutic approach.

Repair of abdominal aortic aneurysm in severe Factor VII deficiency.

Congenital Factor VII deficiency is a rare disorder associated with reduced levels of Factor VII activity. Replacement therapy is necessary to control hemorrhaging or if surgery is needed. We report operative treatment of one case of chronic abdominal aortic aneurysm in a patient affected by a severe form of congenital Factor VII deficiency (endogenous FVII level <1%). The operation was carried out after the administration of Factor VII concentrate raised the Factor VII concentration to hemostatic levels. The patient continued to receive the concentrate every 6 hrs during the first three postoperative days. Dosage was assessed to obtain Factor VII levels not lower than 25%. No postoperative bleeding or thrombotic events were observed. The patient was discharged in excellent condition.

Acquired aortopulmonary fistula. A case report.

A 63-year-old male patient with no prior history of heart disease was admitted in acute heart failure with diagnosis of pulmonary thromboembolism. 2D-echocardiography and color-Doppler echocardiography showed a severe aortic stenosis associated with an acquired aorto-pulmonary fistula bridging the ascending aorta and the main pulmonary artery. The diagnosis was confirmed by aortography. The patient underwent replacement of the aortic valve with a bileaflet mechanical valve. The fistula was obliterated with a Dacron patch anchored on the edges of its aortic opening. He did well postoperatively and was discharged with no complaint.

Treatment of haemorrhage following rupture of aortic leiomyosarcoma. Survival for 4.2 years.

This paper describes a case of hemorrhage from an aortic leiomyosarcoma in which the patient exceptionally survived for 4.2 years after surgery. The operation consisted of resection of the aortic tract involved by the tumour and graft of a prosthesis. The diagnosis of aortic leiomyosarcoma had been based on the histological analysis and confirmed by histochemical and immunohistochemical findings.

The surgical treatment of vascular and gastrointestinal implications in Behçet disease. Report of four cases.

This study reports 4 cases of Behçet Syndrome which came under our observation and were surgically treated for vascular or gastrointestinal manifestations. These cases included 3 males and 1 female, mean age 26.5 years, of which 2 were treated with implantation of prosthesis for aneurysm of the abdominal aorta with recurrence of Behçet vasculitis and prosthesis substitution three years later in one case, 1 with total colectomy for ulcerous rectocolitis, while the last case (female) required excision and plastic reconstruction, for a perforated duodenal ulcer. Immediate and long-term results of the surgical treatment of the gastrointestinal and vascular manifestations and/or complications were satisfactory, whereas the long-term results of the medical treatment of the basic disease were unsuccessful in 50% of cases. BS is a rare affliction, whose pathogenesis is still poorly defined and in which the results of medical treatment cannot be regarded as satisfactory to date. Surgical treatment of its vascular and gastrointestinal manifestations and complications, on the other hand, was effective in our experience.

[A global evaluation of the quality of care in cardiac surgery]. / Valutazione globale della qualità delle cure in cardiochirurgia.

Until now, all reflections about cardiac surgery have been quantitative. Currently, quantitative saturation of cardiac surgery needs in France has been reached or even exceeded in some areas. Consequently, a qualitative approach becomes fundamental: to provide each patient, prior to the operation, with an assessment of his/her vital risk at a specific site; to allow cardiologists to objectively and statistically know the complete results obtained by various surgical teams; to incite improvements among surgical teams; and lastly, to allow the administration to assess services provided to patients. This study concerns 1271 patients consecutively operated on between January 1990 and December 1993 by the very same surgeon and represents the outline of a logical method of controlling clinical results.