ABSTRACT
Bipolar segmental clavicle fractures are simultaneous clavicle fractures of both proximal and distal ends. Few case reports describing these fractures have been published, and the management of these injuries have remained controversial. Non-operative treatment is likely to result in poor shoulder function due to the instability of the fracture in patients with high physical demands. In contrast, surgical treatment with fixation of both proximal and distal ends of the clavicle possibly may cause life-threatening complications. We present a 74-year old female farmer who had injured her left shoulder and was diagnosed with a bipolar segmental clavicle fracture. Taking the fracture mechanism into consideration, we surgically treated only the distal end of the clavicle fracture with a locking plate. The proximal end of the clavicle fracture was treated without surgical intervention. Both fracture sites achieved bony union after four months and she returned to her activities as a farmer. Quick DASH score was 5.0 with excellent results at three years after operation.
ABSTRACT
A 60 year-old female underwent mitral valve replacement with a Duromedics valve. She was in good condition during weaning from cardiopulumonary bypass. However, rupture of the left ventricle was manifested by massive bleeding just after dis-contination of cardiopulmonary bypass. A large hematoma accompanied by bleeding was observed in the posterior atrio-ventricular groove. The patient was quickly put back on total cardiopulmonary bypass. A slight laceration was suspected in the membranous portion of the ventricular septum just below the mitral annulus. Re-valve replacement was performed by reinforcing the mitral annulus with a Dacron patch. This patient was removed from cardiopulmonary bypass, but died of multiple organ failure in 7 days after operation. At autopsy, the left ventricular rapture was identified just below annuls in the area of the atrioventricular groove. Furthermore, extensive hematoma was noted in the posterior atrioventricular groove.
ABSTRACT
The current technique of retrograde coronary sinus perfusion (RCSP) has been provided double cannulation of the vanae cavae and isolation of these vessels, and right atriotomy. Most aortic valve and coronary artery bypass surgery are performed with single venous cannulation. We used a new RCSP catheter, Retroplegia (Research Medical Co.), and performed Cabrol procedure safely with single venous cannulation. This catheter can be cannulated to the coronary sinus through a right atrial purse-string suture without opening the right atrium. The occlusion balloon is inflated spontaneously by infusing the cardioplegic solution and occlude the coronary sinus adequately and nicely. This catheter has double lumen, one is for infusion of the cardioplegic solution, the other is for measurement of the coronary sinus pressure. We believe that this catheter is useful for RCSP of the cardiac surgery using single venous cannulation.
