ABSTRACT
We report a case of a dialysis patient with severe aortic stenosis(AS) along with bilateral pheochromocytomas. A 52-year-old man presented with syncope and was diagnosed with severe AS. Although aortic valve replacement(AVR) was scheduled, bilateral pheochromocytomas were found during preoperative examination. There was a high possibility of developing hemodynamical crisis during AVR, and we planned to perform adrenalectomy prior to AVR. To avoid circulatory collapse just after adrenalectomy, balloon aortic valvuloplasty (BAV) was performed beforehand. Two weeks after the adrenalectomy, AVR was performed in a stable condition.
Subject(s)
Adrenal Gland Neoplasms , Aortic Valve Stenosis , Balloon Valvuloplasty , Pheochromocytoma , Aortic Valve , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Renal Dialysis , Treatment OutcomeSubject(s)
Accidents, Traffic , Aorta, Thoracic/injuries , Vascular System Injuries/etiology , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aortography/methods , Blood Vessel Prosthesis Implantation , Cardiopulmonary Bypass , Circulatory Arrest, Deep Hypothermia Induced , Female , Humans , Middle Aged , Tomography, X-Ray Computed , Treatment Outcome , Vascular System Injuries/diagnostic imaging , Vascular System Injuries/surgerySubject(s)
Ductus Arteriosus, Patent/complications , Endarteritis/etiology , Pseudomonas Infections/etiology , Pseudomonas aeruginosa , Pulmonary Artery , Ductus Arteriosus, Patent/diagnostic imaging , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Endarteritis/diagnostic imaging , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/etiology , Female , Humans , Middle Aged , Pseudomonas Infections/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
A 52-year-old man was referred to our clinic because of chronic heart failure. A Levine 3/6 diastolic heart murmur was audible at the apex. Chest radiography showed an enlarged left ventricle. Transthoracic echocardiography showed moderately severe aortic regurgitation. Left ventricular end-diastolic/systolic diameter and ejection fraction were 75/59 mm and 41 %, respectively. Preoperative transesophageal 3-dimensional echocardiography revealed a quadricuspid aortic valve whose cusps were of almost equal size. Aortic valve replacement was performed via upper partial sternotomy.
Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve/surgery , Heart Valve Prosthesis Implantation/methods , Aortic Valve/abnormalities , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/complications , Chronic Disease , Heart Failure/etiology , Humans , Male , Middle Aged , Sternotomy , UltrasonographyABSTRACT
Open heart surgery in patients with liver cirrhosis is considered to be very risky, but the predictors of poor outcomes in such cases have not been established. We report the perioperative results of open heart surgery in patients with liver cirrhosis in our hospital. We reviewed the results of 13 cases in 12 patients with liver cirrhosis who underwent open heart surgery between January 2001 and December 2010. The Child-Turcotte-Pugh classification, the model for end-stage liver disease score, EuroSCORE, and perioperative data were used to identify risk factors for morbidity and mortality retrospectively. Ten patients had postoperative complications. Significant differences in morbidity were evident for Child-Turcotte-Pugh class, cardiopulmonary bypass time, and crossclamp time. Two patients died of liver failure, one at 40 days and the other at 2 years after surgery. Statistically significant differences in liver-related mortality were evident in the model for end-stage liver disease scores and serum cholinesterase levels. We concluded that a high Child-Turcotte-Pugh class was associated with increased morbidity. Cardiopulmonary bypass and crossclamp times were also related to high morbidity, while high model for end-stage liver disease scores and low serum cholinesterase levels predicted liver-related mortality.
Subject(s)
Cardiac Surgical Procedures , Heart Diseases/surgery , Liver Cirrhosis/complications , Adult , Aged , Biomarkers/blood , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality , Cardiopulmonary Bypass , Cholinesterases/blood , Female , Heart Diseases/complications , Heart Diseases/mortality , Hospital Mortality , Humans , Japan , Liver Cirrhosis/blood , Liver Cirrhosis/diagnosis , Liver Cirrhosis/mortality , Liver Failure/etiology , Liver Failure/mortality , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/mortality , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
A 68-year-old man presented at the outpatient clinic with epigastric discomfort. He had suffered a myocardial infarction 10 years previously. Chest radiography and computed tomography showed a giant calcified aneurysm in the left ventricle. Electrocardiography indicated atrial fibrillation. Echocardiography showed moderate mitral regurgitation and enlarged left atrium. End-diastolic volume and ejection fraction were 164 ml and 31%, respectively. Coronary angiography revealed total occlusion of the left anterior descending artery and diffuse stenosis of the right coronary artery. Aneurysmectomy, mitral annuloplasty, maze procedure, and coronary artery bypass were performed. The patient was discharged 16 days postoperatively in a satisfactory condition without complications.
Subject(s)
Calcinosis/surgery , Cardiac Surgical Procedures , Heart Aneurysm/surgery , Aged , Atrial Fibrillation/etiology , Atrial Fibrillation/surgery , Calcinosis/complications , Calcinosis/diagnosis , Calcinosis/physiopathology , Coronary Angiography , Coronary Artery Bypass , Coronary Stenosis/etiology , Coronary Stenosis/surgery , Echocardiography , Electrocardiography , Heart Aneurysm/complications , Heart Aneurysm/diagnosis , Heart Aneurysm/physiopathology , Humans , Male , Mitral Valve Annuloplasty , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/surgery , Predictive Value of Tests , Stroke Volume , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Ventricular Function, LeftABSTRACT
The efficacy of using composite arterial Y-grafts in off-pump coronary artery bypass has not been established. We assessed graft patency, long-term clinical outcomes, and the indications for composite arterial Y-grafting by reviewing 53 patients who underwent primary isolated elective off-pump coronary artery bypass with composite arterial Y-grafts between January 2002 and December 2008. Coronary angiography or 64-slice multidetector computed tomographic coronary angiography was used to assess graft patency. Follow-up ranged from 18 to 97 months. The rates of mortality, graft failure, and recurrence of ischemic heart disease were 0%, 22.6%, and 13.2%, respectively. Only 4 (7.5%) patients required additional procedures (percutaneous coronary interventions or repeat surgery) because of graft failure. A significantly higher rate of graft failure was evident when one end of the composite graft was anastomosed to a 75% stenosed branch of a native coronary artery and the other end to a branch with >90% stenosis. The long-term patency of composite arterial Y-grafts in off-pump coronary artery bypass requires proper judgment of the indications.
