ABSTRACT
Pulmonary valve replacement is an uncommon surgical procedure, yet lifesaving when performed under the appropriate circumstances. The patient reported on here had the classic indications for valve replacement: increased pulmonary vascular resistance and associated pulmonary valve incompetence following repair of a congenital heart defect resulting in right heart failure and secondary tricuspid insufficiency. A review of the literature provides the basis for the decision to replace the pulmonary valve with a glutaraldehyde-preserved porcine heterograft.
Subject(s)
Aortic Valve/transplantation , Bioprosthesis , Heart Valve Prosthesis , Pulmonary Valve/surgery , Transplantation, Heterologous , Animals , Child , Female , Follow-Up Studies , Heart Septal Defects, Ventricular/surgery , Heart Valve Prosthesis/methods , Humans , Hypertension, Pulmonary , Postoperative Complications , SwineSubject(s)
Infant, Newborn, Diseases/surgery , Pneumopericardium/surgery , Acidosis, Respiratory/etiology , Bradycardia/etiology , Cardiac Tamponade/etiology , Cyanosis/etiology , Drainage , Female , Humans , Hypotension/etiology , Infant, Newborn , Male , Pneumopericardium/diagnosis , Pneumopericardium/diagnostic imaging , Radiography , Respiratory Distress Syndrome, Newborn/complicationsABSTRACT
The first patient with an abdominal aortic aneurysm with rupture into the inferior vena cava associated with a horseshoe kidney is reported. Rupture of an aortic aneurysm into the inferior vena cava with formation of an aortocaval fistula has been reported in 100 patients. Aortic aneurysm in combination with horseshoe kidneys has been described in 34 patients. The diagnosis was made by an abdominal aortogram. The patient's preoperative condition was characterized by circulatory and renal failure subsequent to the development of a large aortocaval fistula. Operative repair was performed by dividing and rotating the kidney, dividing a renal polar artery, incising the aneurysm, and over-sewing the fistula from within. The patient's postoperative course was complicated by renal failure and sepsis and he died two months later. It is essential to preserve renal function in patients with this combination of anomalies.
Subject(s)
Aortic Aneurysm/surgery , Aortic Rupture/surgery , Arteriovenous Fistula/surgery , Kidney/surgery , Venae Cavae/surgery , Aorta, Abdominal/surgery , Aortic Aneurysm/complications , Aortic Rupture/complications , Aortography , Arteriovenous Fistula/etiology , Blood Vessel Prosthesis , Humans , Kidney/abnormalities , Male , Middle Aged , Postoperative Complications/surgerySubject(s)
Aorta/surgery , Aortic Valve Stenosis/complications , Arteries/abnormalities , Coronary Vessel Anomalies/complications , Adolescent , Adult , Aorta, Thoracic/abnormalities , Aortic Valve/abnormalities , Aortic Valve Stenosis/surgery , Aortography , Brachiocephalic Trunk/abnormalities , Cardiac Catheterization , Carotid Arteries/abnormalities , Child , Child, Preschool , Female , Heart Murmurs , Humans , Male , Pulmonary Artery/abnormalitiesSubject(s)
Fructose/metabolism , Parenteral Nutrition , Amino Acids/administration & dosage , Blood Glucose/analysis , Dietary Proteins/administration & dosage , Fructose/administration & dosage , Gastrointestinal Diseases/surgery , Humans , Insulin/blood , Nitrogen/metabolism , Parenteral Nutrition/methods , Postoperative CareABSTRACT
The predictive value of free-water clearance measurements for the early recognition of acute renal insufficiency was evaluated in 59 patients immediately following cardiopulmonary bypass. Blood urea nitrogen and serum creatinine measurements were taken before and after operation. Intraoperatively, immediately after completion of bypass, urine and serum samples were obtained for osmolality. Duration of bypass, urine output, degree of hemolysis, and quality of perfusion were recorded. Fifty-four patients developed no signs of renal insufficiency following bypass, and all had free-water clearance values equal to or less than -20 ml per hour. Five patients who had free-water clearance values equal to greater than -8 ml per hour developed manifestations of an acute renal insufficiency state. There were no false-negative or false-positive determinations. Consequently, free-water clearance measurements appear to be a reliable indicator of those patients who will develop renal insufficiency following cardiopulmonary bypass. Early recognition provides an opportunity immediately after operation for initiating treatment consisting of administration of diuretics, potassium restriction, and oliguric fluid regimens.
