[40-year-old patient with an aneurysm of the extracranial arteria carotis interna]. / 40-jährige Patientin mit einem Aneurysma der extrakraniellen Arteria carotis interna.

A case of extracranial internal carotid artery aneurysm Aneurysms of the extracranial internal carotid artery are uncommon but can be responsible for serious complications such as rupture, thrombosis, or embolism. The underlying causes of aneurysm include atherosclerosis, fibromuscular dysplasia, trauma, previous carotid artery surgery, infection, dissection, syphilis and a congenital defect. Five distinct clinical types of aneurysms are reported with different symptoms and treatment. We report a case of extracranial internal carotid artery aneurysm and its successfully surgical treatment.

Effect of coronary sinus diastolic balloon pulsation on ischemic myocardium.

OBJECTIVES: To evaluate the effect of coronary sinus diastolic balloon pulsation (CSDBP) on acute myocardial ischemia and infarction. It was hypothesized that this procedure would improve retrograde flow to ischemic areas and allow for more complete oxygen exchange and venous washout of metabolites, with elevated coronary sinus pressure and retrograde pulsation. ANIMALS AND METHODS: This two-part study was done on 10 dogs. First, CSDBP was applied to normal myocardium by a balloon catheter and a pump system at beat to beat cardiac cycles of 1:1, 2:1 and 3:1. Then coronary ischemia was obtained by coronary artery ligation and the procedure was repeated. Electrocardiographic (ECG), arterial and coronary sinus pressure alterations were monitored continuously, and arterial, mixed venous and coronary sinus blood lactate concentrations were measured at each stage of the study. RESULTS: In the first stage no hemodynamic deterioration was observed. In the second stage, mean ECG-ST segment elevation was 6.30+/-0.95 mm (P<0.01) and coronary sinus blood lactate concentration increased to 5.37+/-0.37 mmol/L from 1.95+/-0.31 mmol/L (P<0.01). ECG-ST segment elevation decreased to 3.73+/-0.64 mm and coronary sinus blood lactate concentration decreased to 4.79+/-0.28 mmol/L (P<0.05) with 1:1 beat to beat CSDBP. ECG-ST segment elevation decreased to 2.95+/-0.73 mm and coronary sinus blood lactate concentration decreased to 4.4+/-0.22 mmol/L with 2:1 CSDBP. ECG-ST segment elevation decreased to 3.6+/-0.42 mm and coronary sinus blood lactate concentration decreased to 4.17+/-0.22 mmol/L with 3:1 CSDBP as well. DISCUSSION: Results showed that CSDBP technique lowered the increased ECG-ST segment elevation and myocardial lactate production.

Sternal closure with resorbable synthetic loop suture material in children.

PURPOSE: The reliability of poly-p-dioxanone (PDS) suture for sternal closure was tested on 264 consecutive sternotomies in the authors' department from April 1987 to May 1998. METHODS: The reason for sternotomy was tetralogy of Fallot in 65 cases (24.6%), ventricular septal defect (VSD) in 38 cases (14.4%), atrial septal defect (ASD) in 77 cases (29.2%), ASD + VSD in 23 (8.7%), mitral valve replacement in 22 cases (8.3%), aortic valve replacement in 10 cases (3.8%), and other cardiac disorders in 29 cases (11.0%). RESULTS: Sternal wound infection, sternal dehiscence, and mediastinitis occurred in 1.5% of patients (4 of 264). The overall hospital mortality rate related to the mediastinitis was 1.1% (3 of 264) in the early postoperative period. CONCLUSION: This absorbable suture and our different technique are a safe alternative to standard sternotomy closure after pediatric open cardiac surgery.

Thyroid hormone alterations during and after cardiopulmonary bypass.

The haemodynamic effects of thyroid hormones are well known and include those on heart rate, contractility and myocardial oxygen consumption. Cardiopulmonary bypass produces various alterations in endocrine homoeostasis and may exert important haemodynamic effects postoperatively. The purpose of this prospective study was to determine the relation of cardiopulmonary bypass to changes in thyroid function. Blood samples were obtained from 20 patients preoperatively, at specific times before, during and after cardiopulmonary bypass. Total thyroxin (TT4), total triiodothyronine (TT3), free thyroxin (fT4), free triiodothyronine (fT3), thyroid-stimulating hormone (TSH), thyroid-binding globulin (TBG) and albumin were measured by radioimmunoassay and competitive immunoassay. Values of TT4, TT3 and fT3 were significantly depressed up to 24 h after cardiopulmonary bypass (P < 0.05). TSH and fT4 levels remained within normal ranges at all sampling times. It is increasingly evident that cardiopulmonary bypass affects thyroid hormone metabolism, leading to a transient depression characterized by low levels of circulating TT4, TT3 and fT3.

Tracheoinnominate artery fistula following tracheostomy.

Tracheoinnominate artery fistula is a relatively rare but highly lethal complication occurring in patients with long-standing tracheostomies. Early evaluation of this problem and prompt aggressive therapy are necessary. When massive haemorrhage begins, immediate arterial compression, control of the airway and subsequent treatment of the injured artery may be lifesaving. Immediate surgical exploration through a median sternotomy is necessary to control the proximal and distal innominate artery. After the damaged artery has been excised, vascular reconstruction can be performed to preserve the connection between the proximal and distal ends of the innominate artery. A pedicled pericardial patch was successfully used for the tracheal reconstruction.