ABSTRACT
BACKGROUND: The left ventricular (LV) vent is commonly inserted via the right superior pulmonary vein (RSPV) and directed toward the LV cavity through the mitral valve. We report a rare case in which the tip of the LV vent was misplaced into the aortic root across the aortic valve. CASE PRESENTATION: An 88-year-old man was scheduled to undergo the Bentall procedure. After initiation of cardiopulmonary bypass, the LV vent was inserted via the RSPV. Anterograde cardioplegia was administered via the aortic root cannula after the ascending aorta was cross-clamped. The electrocardiogram did not result in complete cardiac arrest, even after delivery of two-thirds of the planned dose. A transesophageal echocardiographic examination showed that the tip of the LV vent was misplaced into the aortic root across the aortic valve. CONCLUSIONS: It is important to confirm the tip position by transesophageal echocardiography to prevent severe complications associated with the LV vent.
ABSTRACT
We report a case of a patient with two previous histories of resection of thymoma using median sternotomy and repair for an ascending aortic pseudoaneurysm using median thoracotomy undergoing endovascular aortic repair of the recurrence of pseudoaneurysm in the same site. Due to severe adhesion and calcification in the tissue after two histories of thoracotomy, we expected it impossible to repair the pseudoaneurysm with open thracotomy. We concluded that endovascular aortic repair was the best way for the case. Only problem was the limitation of the characters of current devices for thoracic endovascular aortic repair. If the procedure is done in the ordinary way, the tips of stent graft delivery systems are so long that there may be a danger of damaging the aortic valve, coronary artery, and left ventricle. This is why we decided to use a transapical approach through the left ventricular apex by using left thoracotomy. For the operation, an arterial line and central venous line were secured and one-lung ventilation was performed. We used femoral-femoral bypass to prepare for unexpected bleeding. During the deployment of the stent graft, ventricular fibrillation was produced by the fibrillator to locate in the appreciate site. In the end, the operation was successful.
Subject(s)
Aneurysm, False/surgery , Aortic Aneurysm/surgery , Vascular Surgical Procedures/methods , Aorta , Humans , Male , Middle Aged , Stents , Thoracotomy/methodsABSTRACT
We experienced two cases of anaphylaxis during anesthesia using rocuronium in two months. In both cases, we carried out intradermal test and positive reaction occurred with rocuronium. In both cases, the second anesthesia without neuromuscular blockade was uneventful. Though it is difficult to diagnose anaphylaxis, we should suspect anaphylaxis when cardiovascular collapse, bronchospasm and/or dermal symptoms occur after induction of anesthesia.
