ABSTRACT
Giant atria may trigger respiratory failure, which often requires surgical intervention. We report a patient who presented with respiratory failure due to bilateral giant atria. The patient was a 75-year-old woman with rheumatic heart disease. She had undergone mitral valve replacement and tricuspid annuloplasty at another hospital 17 years ago but recently developed respiratory dysfunction. Compression to the lungs by enlarged atria was diagnosed as the main cause of respiratory dysfunction. Hence, the anterior-to-posterior left atrial wall was plicated by para-annular and superior-half plication, respectively, and the right atrial wall was excised into an ellipse shape. Tricuspid valvuloplasty was performed on four sets of eight artificial chordae with CV5 sutures and an annuloplasty ring. Respiratory failure was alleviated after the surgery.
Subject(s)
Atrial Fibrillation , Mitral Valve Insufficiency , Respiratory Insufficiency , Tricuspid Valve Insufficiency , Female , Humans , Aged , Mitral Valve/surgery , Tricuspid Valve/surgery , Tricuspid Valve Insufficiency/surgery , Respiratory Insufficiency/etiology , Respiratory Insufficiency/surgery , Heart Atria/surgery , Mitral Valve Insufficiency/surgeryABSTRACT
We present a case of redo stentless valve operation in a 73-year-old man who underwent aortic valve replacement via the subcoronary approach with a freestyle aortic bioprosthesis 23 years ago at our institution. He was referred for surgery because an echocardiogram showed severe aortic regurgitation due to structural valve deterioration, and aortic valve replacement was planned. Severe circumferential calcification and adhesion were noted during the surgery between the freestyle and native roots. Redo-aortic valve replacement was successful despite the technical difficulty. In stentless valve reoperations following aortic valve replacement via the subcoronary method, the planning of valve-in-valve transcatheter aortic valve implantation and sutureless valve implantation may be a practical and safe strategy.
ABSTRACT
A 54-year-old male presented with haemoptysis. Bronchial arteriography revealed a bent, meandering and dilated bronchial artery with vascular hyperplasia in multiple locations. The patient was diagnosed as having primary racemose haemangioma of the bronchial artery. Using a microcatheter, TorconNB (5 Fr) and Progreat (2.7 Fr), selective gelfoam embolization of the descending branch of the right bronchial artery was performed using the double catheter method. This approach would allow effective treatment of the haemorrhage and avoid spinal cord injury.
Subject(s)
Bronchial Arteries , Embolization, Therapeutic , Gelatin Sponge, Absorbable/therapeutic use , Hemangioma/therapy , Hemostatics/therapeutic use , Vascular Neoplasms/therapy , Hemangioma/diagnosis , Humans , Male , Middle Aged , Vascular Neoplasms/diagnosisABSTRACT
A 70-year-old female presented with yellow discoloration of the nail beds of all fingers and toes, as well as bilateral pleural effusions. The patient was diagnosed as having the yellow nail syndrome based on the triad of yellow nails, lymphedema, and pleural effusions. The patient's intractable bilateral pleural effusion was treated with pleurodesis using OK-432. The treatment prevented the accumulation of pleural fluid for a long period of time. Pleural effusion associated with yellow nail syndrome is thought to be difficult to treat; however, this patient's excellent clinical course suggests that pleurodesis with OK-432 could be used to treat the disease in the future.
Subject(s)
Antineoplastic Agents/administration & dosage , Lymphedema/therapy , Nail Diseases/therapy , Picibanil/administration & dosage , Pigmentation Disorders/therapy , Pleural Effusion/therapy , Aged , Female , Humans , Lymphedema/diagnosis , Nail Diseases/diagnosis , Pigmentation Disorders/diagnosis , Pleural Effusion/diagnosis , Pleurodesis , Syndrome , Treatment OutcomeABSTRACT
A 76-year-old man, who was in the hospital for the treatment of type 2 diabetes mellitus and was receiving gonadotropin-releasing hormone (GnRH) agonist treatment for prostate cancer, developed fever and hypoxemia. Imaging revealed diffuse interstitial shadows, and PCR of the bronchoalveolar lavage fluid was positive for Pneumocystis jirovecii. The patient's absolute CD4-positive lymphocyte count dropped to 145/microl, but the HIV antibody was negative. After trimethoprim-sulfamethoxazole (TMP/SXT) treatment, the absolute CD4 positive lymphocyte count returned to normal. This patient with type 2 diabetes mellitus developed Pneumocystis pneumonia and developed a transient decrease in CD4-positive lymphocytes.
Subject(s)
Diabetes Mellitus, Type 2/complications , Pneumonia, Pneumocystis/etiology , Aged , Anti-Infective Agents/therapeutic use , Bronchoalveolar Lavage Fluid/microbiology , CD4 Lymphocyte Count , Humans , Male , Pneumocystis carinii/isolation & purification , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/drug therapy , Pneumonia, Pneumocystis/immunology , Pneumonia, Pneumocystis/microbiology , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
We report a case of drug-induced pneumonitis and hepatitis associated with the herbal medication Bofutsusyo-san. A 41-year-old woman was admitted to our hospital with pneumonitis and hepatitis. She complained of fever and dyspnea. Fine crackles were heard on chest auscultation and a chest X-ray film revealed diffuse reticulo-nodular shadow in both lung fields. Cessation of the medication improved the patient' s clinical and X-ray findings. Bronchoalveolar lavage showed an increase of the lymphocytes and a diminished CD4/CD8 ratio. A drug-induced lymphocyte stimulation test was positive. Challenge tests for Bofutsusyo-san were positive. A diagnosis of drug-induced pneumonitis and hepatitis was made. Our findings suggested an association with Ou-gon.
