ABSTRACT
We operated on a patient who had been paraplegic since sustaining a spinal cord injury 11 years ago. We made a reversed L-shaped sternum incision and cannulated all tubes for the cardiopulmonary bypass through a wound window. This provided an excellent surgical view without restricting the patient's upper limbs (needed for wheel chair operation), and recovery was good. Just after surgery, however, it was difficult to control blood pressure and the loss of serum albumin. We believe this is the first report of open-heart surgery undertaken in a paraplegic patient and that the reversed L-shaped incision and careful monitoring of hemodynamics each played an important role in the successful outcome. We hope that this report will help in the treatment of other paraplegic patients who need open-heart surgery.
Subject(s)
Heart Neoplasms/surgery , Myxoma/surgery , Paraplegia/complications , Activities of Daily Living , Cardiopulmonary Bypass/instrumentation , Cardiopulmonary Bypass/methods , Coronary Angiography , Drainage/instrumentation , Drainage/methods , Echocardiography , Heart Neoplasms/complications , Heart Neoplasms/diagnosis , Humans , Infusions, Intra-Arterial/instrumentation , Infusions, Intra-Arterial/methods , Male , Middle Aged , Monitoring, Intraoperative/methods , Myxoma/complications , Myxoma/diagnosis , Paraplegia/psychology , Perioperative Care/methods , Quality of Life , Schizophrenia/complications , Treatment OutcomeABSTRACT
We removed from 4 patients pacemaker leads that had migrated or become infected. Case 1: A 62-year-old man developed uncontrollable infection of the pacing leads. Case 2: A 78-year-old man, whose infected pacemaker was removed, had a second one implanted in the contralateral side; the pacing lead infection from the first procedure, however, was uncontrollable. Case 3: A 56-year-old woman presented with dyspnea and hepatomegaly subsequent to the second implantation of a pacemaker; the pacing leads from the first procedure caused severe stenosis in both the superior and inferior vena cavae. Case 4: A 60-year-old woman had a ruptured and migrated pacing lead in the right ventricle. We operated using a cardiopulmonary bypass and a specially designed plastic tube for removal of the leads. Although Case 2 required reconstruction of the vena cavae, all patients recovered. When removal of pacing leads is necessary, it should be done as soon as possible with cardiopulmonary bypass.
Subject(s)
Cardiopulmonary Bypass , Electrodes, Implanted/adverse effects , Foreign-Body Migration/surgery , Pacemaker, Artificial , Aged , Device Removal , Electrodes, Implanted/microbiology , Female , Humans , Male , Middle AgedABSTRACT
We report the case of a 71-year-old man with chronic myelomonocytic leukemia who developed cardiogenic shock twice due to a stenosis of the left main trunk of the coronary artery. We performed coronary artery bypass grafting to the left anterior descending artery with the left internal thoracic artery without using a cardiopulmonary bypass. The patient had no infection, leukemic transformation, or cardiac event after the surgery. Off-pump coronary artery bypass grafting is safe and useful for high risk patients, such as those with leukemia.
