ABSTRACT
Bronchopulmonary sequestration is an uncommon congenital anomaly. Although systemic arterial supply to the abnormal lung tissue is usually derived from the aorta, other nutrient vascular sources have also been described, including, infrequently, the coronary circulation. A right-sided aortic arch is another rare vascular abnormality, generally present in the setting of a vascular ring. We report a case of pulmonary sequestration receiving arterial supply from the right coronary artery, in the presence of a right-sided aortic arch, a constellation of anomalies not previously described.
ABSTRACT
OBJECTIVE: Patients who undergo successful percutaneous transluminal coronary angioplasty (PTCA) may subsequently require operative myocardial revascularization. This review examines whether prior successful PTCA alters outcomes following subsequent coronary artery bypass grafting (CABG). The costs of interventional cardiology procedures and definitive surgery were also examined. METHODS: From January 1981 through December 1997, 361 patients underwent CABG following initially successful PTCA (interval group). This group was compared with 11,909 patients who underwent CABG as the primary intervention for coronary artery disease (control group). RESULTS: The average time interval to CABG following initial PTCA was 13.7 months. The post-CABG myocardial infarction rate was 4% for patients in the interval group and 3% for patients in the control group. The 30-day mortality was similar for both patient groups (2%). For the interval group, the average cost of total interventional management was 24,220 dollars per patient. This included average costs of 13,873 dollars for CABG and 10,347 dollars for all preoperative interventional cardiology procedures. CONCLUSION: There is little doubt that PTCA procedures may provide successful myocardial revascularization. However, these procedures often need to be repeated over time and may serve only to delay coronary surgery, at substantial financial and personal cost.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Artery Bypass , Coronary Disease/therapy , Adult , Aged , Aged, 80 and over , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/economics , Angioplasty, Balloon, Coronary/mortality , Chi-Square Distribution , Coronary Angiography/economics , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/economics , Coronary Artery Bypass/mortality , Coronary Disease/surgery , Costs and Cost Analysis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Odds Ratio , Patient Selection , Postoperative Complications , Prospective Studies , Treatment OutcomeSubject(s)
Carcinoma, Papillary/diagnosis , Ovarian Neoplasms/diagnosis , Struma Ovarii/diagnosis , Thyroid Neoplasms/diagnosis , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/surgery , CA-125 Antigen/blood , Carcinoma, Papillary/pathology , Carcinoma, Papillary/surgery , Female , Histocytochemistry , Humans , Ovarian Neoplasms/pathology , Ovarian Neoplasms/surgery , Struma Ovarii/pathology , Struma Ovarii/surgery , Thyroglobulin/analysis , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgeryABSTRACT
Ludwig's angina, although uncommon, remains a potentially life-threatening condition because of the risk of impending airway obstruction. Effective treatment is based on early recognition of the clinical process, with the appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection. We present a case of Ludwig's angina together with a brief review of the relevant literature.
