Delayed cardiac rupture occurring two months after blunt chest trauma.

We describe a rare case of successful repair of delayed cardiac rupture due to blunt chest trauma; the cardiac rupture occurred 74 days after the trauma. A 75-year-old woman with a history of blunt chest trauma that caused multiple rib fractures underwent an emergent thoracotomy due to left hemothorax. A coin-sized pericardial defect and cardiac rupture on the left ventricle was found to be close to a fractured rib, which was thought to have damaged the myocardium and thus induced time-dependent myocardial degeneration. The cardiac rupture and the pericardial defect did not induce life-threatening cardiac tamponade; however, the cardiac rupture did induce hemothorax, which could be successfully treated.

Protection from postischemic spinal cord injury by perfusion cooling of the epidural space during most or all of a descending thoracic or thoracoabdominal aneurysm repair.

OBJECTIVE: It is reported that hypothermia has some protective effect against ischemia of the spinal cord during thoracoabdominal aneurysm repair. However, it has not been elucidated clinically whether regional spinal cord hypothermia by epidural perfusion cooling is effective and safe. The purpose of this study was to assess the effect and safety of perfusion cooling of the epidural space during most or all of descending thoracic or thoracoabdominal aneurysm repair. METHODS: From January 1998 to December 2007, a total of 102 patients with a mean age of 61 years underwent replacement of most or all of the descending thoracic aorta or thoracoabdominal aorta with the aid of mild hypothermia via epidural perfusion cooling and cerebrospinal fluid (CSF) drainage. Risk factors for spinal cord injury and hospital death were analyzed using univariate and multivariate analyses. The actuarial survival rate was calculated by the Kaplan-Meier method. RESULTS: The mean lowest CSF temperature was 23.3 degrees C during epidural perfusion cooling. The mean temperature difference between the nasopharynx and CSF was 8.4 degrees C. The incidence of spinal cord injury was 3.9% (4/102), and that of hospital death was 5.9% (6/102). There was no significant risk factor associated with spinal cord injury. Type III aneurysm and postoperative cerebrovascular accident, respiratory failure, liver failure, and infection were predictors of hospital death. The actuarial survival rates at 3 and 5 years were 82.1% and 75.9%, respectively. CONCLUSION: Epidural perfusion cooling is a safe method to employ in clinical situations. Our contemporary management strategies enabled patients to undergo thoracoabdominal aneurysm repair with excellent early and late survival and acceptable morbidity.

Double-chambered right ventricle associated with infective endocarditis complication of the pulmonary valve: surgical management.

Double-chambered right ventricle (DCRV) is a rare congenital heart disease characterized by the presence of anomalous muscle bundles, which divide the right ventricle into two chambers: a high-pressure proximal chamber and a low-pressure distal chamber. Most DCRV patients are diagnosed and treated during childhood, and presentation in adulthood is not common. Many congenital heart diseases are often associated with other complications such as infective endocarditis (IE). Right-side endocarditis, which usually involves infection of the tricuspid valve, is uncommon, and endocarditis of the pulmonary valve is extremely rare. We report a 51-year-old woman with undiagnosed DCRV and ventricular septal defect associated with pulmonary valve endocarditis. The diagnostic evaluation and the surgical management are discussed.

[Large hiatus hernia compressing the heart and impairing the respiratory function: a case report].

A 76-year-old female presented with a large hiatus hernia with intrathoracic stomach manifesting as severe exertion dyspnea. She had no cardiac or pulmonary disease, and neither anemia nor cyanosis, but respiratory function was mildly impaired. Chest roentogenography showed a large abnormal shadow overlapping the lower half of the heart. Transthoracic echocardiography demonstrated a mass compressing the left atrium and extending to the posterior part of the left ventricle, but the actual cause of the mass was not clear. Cross-sectional spiral computed tomography(CT) revealed a large hiatus hernia with intrathoracic stomach located just behind the left atrium with resultant mild anterior shift of the whole heart. Moreover, three-dimensional curved reformation CT suggested that the intrathoracic stomach was located in the upside-down position, which was confirmed by subsequent gastroesophagography. She experienced gradual progression of exertion dyspnea during the following 3 months. Follow-up CT revealed no significant increase of left atrial compression, but subsequent spirometric study showed increased impairment of respiratory function. Surgical repair for the hiatus hernia was successfully performed, and eventually achieved resolution of the symptoms. The cause of exertion dyspnea was probably cardiac compression and impaired respiratory function. The therapeutic strategy of surgical repair is recommended in elderly patients with hiatus hernia complicated with cardiac compression and respiratory impairment.

Fatal delayed esophageal rupture following aortic clamping for treatment of Stanford type B dissection.

A 65-year-old man underwent a thromboexclusion operation for management of chronic Stanford type B dissecting aneurysm in 1991. However, long-term follow-up CT scans after the operation revealed that the ascending aorta gradually enlarged and was eventually complicated by recurrent aortic dissection. The patient complained of frequent bloody sputum, whereas chest roentogenography showed no pulmonary abnormalities. Subsequent swallow esophagogram demonstrated that the upper esophagus was deviated to the right and the middle esophagus was greatly compressed by the aortic clamp. Esophageal endoscopy showed a bloody inner surface and marked swelling of the middle esophagus. The patient eventually died of massive hematemesis in 2001. We describe the imaging features of unanticipated complications such as recurrent dissecting aneurysm or impending esophageal rupture. Furthermore, we discuss the cause of hematemesis and document that the aortic clamp migrated and resulted in development of a recurrent aneurysmal dissection, which in turn resulted in esophageal rupture with aneurysmal disruption.