ABSTRACT
<p>Central diabetes insipidus (CDI) is a disease that caused by insufficient or no anti-diuretic hormone (ADH) secretion from the posterior pituitary, which results in an increase in urine volume. CDI is controlled with ADH supplementation thereby reducing urine output and correcting electrolyte imbalance. However, reports on perioperative management for CDI patient are scarce, especially for patients who underwent cardiac surgery. We herein report our experience of the management of a CDI patient who underwent surgery for valvular heart disease.</p><p>The case is a 72-year-old woman who developed secondary CDI after pituitary tumor removal. She had been controlled with orally administered desmopressin acetate hydrochloride. She underwent aortic valve replacement and mitral valve repair for severe aortic, and moderate mitral regurgitation. Immediately after surgery, we started vasopressin div, which yielded good urine volume control. However, once we started to switch vasopressin to oral desmopressin administration, the control became worse. We thus made a sliding scale for subcutaneous injection of vasopressin every 8 h according to the amount of urine output, which resulted in good control. Overlapping administration of vasopressin and oral desmopressin between postoperative day 12 and 17 resulted in successful transition. The patient was discharged with oral desmopressin administration. Management with sliding scale for vasopressin subcutaneous injection after surgery was useful in controlling a CDI patient who underwent major cardiac surgery.</p>
ABSTRACT
A 61-year-old man underwent percutaneous coronary intervention (PCI) for the right coronary artery. However, he had an acute onset of right neck pain and swelling after PCI. Contrast enhanced computed tomography (CT) revealed extravasation into the mediastinum and aberrant right subclavian artery. After transfer to our hospital, we performed emergency endovascular repair for iatrogenic arterial injury. His postoperative course was uneventful.
ABSTRACT
The patient was a 65-year-old man who had undergone AVR (SJM Regent : 19 mm) for AR in June 2007. Since March 2008 there had been an increase in the pressure gradient between the aorta and the left ventricle on transthoracic echocardiography (peak PG : 46 mmHg, mean PG : 27 mm Hg). Plain x-ray films of the valve showed limited opening of the metallic valve. However, no symptoms of heart failure were observed on a physical examination. Blood tests performed in December 2007 showed a PT-INR value of 1.22. Since the effects of warfarin anticoagulant therapy were insufficient, its dose was adjusted on follow-up. An examination in June revealed further stenosis of the valve (peak PG : 93 mmHg, mean PG : 58 mmHg). Valve thrombosis was suspected because the condition was poorly controlled by warfarin. Thus, thrombolytic therapy using t-PA was performed (800,000 units). However, the patient complained of chest pain 1 h 30 min after initiation of thrombolytic therapy. Twelve-lead electrocardiography was performed, and ST-segment elevations were observed in the limb and chest leads. Acute myocardial infarction due to a free-floating thrombus was suspected, and emergency cardiac catheterization was performed. Segment 7 was totally occluded, and reperfusion was achieved by thrombus aspiration. Embolization of the coronary artery was speculated to have occurred because of the improved mobility of the metallic valve and dissolution of a thrombus adhering to the valve. A case of acute myocardial infarction as a complication of thrombolytic therapy for valve thrombosis is rare. This case reaffirms the necessity of careful monitoring during thrombolytic therapy.
ABSTRACT
A 73-year-old man presented with gastric adenocarcinoma 14 months after coronary artery bypass grafting with an <i>in situ</i> right gastroepiploic artery (RGEA) to left circumflex branch (LCx). He underwent a partial gastrectomy after successful percutaneous coronary intervention (PCI) to the occluded lesion of LCx. Though the RGEA graft was injured and sacrificed intraoperatively, gastrectomy was safely accomplished without any complication and the postoperative course was uneventful. Preoperative PCI was useful for a gastrectomy in a patient with an <i>in situ</i> RGEA.
ABSTRACT
A 45-year-old woman was admitted for acute left hemiplegia and left hypogastric pain. Central CT showed a right parietal lobe infarction. Abdominal CT demonstrated ovarian tumor and infarction of the liver, spleen and kidney. Chest radiography showed moderate cardiomegaly. Transthoracic echocardiography demonstrated vegetation in the aortic valves and severe aortic regurgitation. Aortic valve replacement and bi-adnexectomy were performed urgently. Intraoperative examination revealed normal aortic valves except for small amounts of vegetation on leaflet surfaces. Pathological diagnosis of vegetation was fibrin without inflammatory cells or bacteria. The postoperative course was uneventful, and the patient was discharged 13 days after surgery without a permanent neurological deficit. Trousseau syndrome caused by ovarian cancer and nonbacterial thrombotic endocarditis is rare, and it is important to be aware of this syndrome in the case of a young cerebral infarction patient with malignant disease.
ABSTRACT
A 24-year-old man was transferred to our hospital because of traumatic rupture of the thoracic aorta suffered in a traffic accident. On admission, he had recovered from shock and was alert. Chest CT showed massive hematoma around the total extent of the descending aora and the intimal flap at the diatal descending aorta. We performed an emergency operation. Through left thoracotomy, we found dilatation of the descending aorta. Epiaortic echo revealed that the aortic intima was completely transecred between Th 10 and Th 11. The pseudoaneurysm was replaced with a Hemashield vascular graft under partial cardiopulmonary bypass. The intercostal artery was preserved. His postoperative course was uneventful and paraplegia was not seen. We reported a rare case of traumatic rupture of the distal descending thoracic aorta above the diaphragm followed by successful surgical treatment.
ABSTRACT
A 54-year-old man was admitted to our hospital because of hypertrophic obstructive cardiomyopathy (HOCM). Medical treatment was not effective. Cardiac catheterization showed a peak systolic pressure gradient of 143mmHg between the left ventricle and the ascending aorta. Echocardiogram showed a systolic anterior motion and moderate mitral regurgitation without asymmetric septal hypertrophy. He underwent mitral valve replacement (MVR) with a 27-mm SJM instead of myectomy due to his relatively thin ventricular septum of 16mm. Postoperative cardiac catheterization revealed no significant pressure gradient between the left ventricle and the ascending aorta. MVR is the most effective surgical treatment of HOCM without asymmetric septal hypertrophy.
