ABSTRACT
We undertook a retrospective study designed to ascertain the frequency of acute acalculous cholecystitis (AAC) following open heart surgery. In the study period 1982-1990, 22 of 6393 patients following open heart surgery were recognized to have developed AAC, an incidence of 0.34%. The majority of patients (16/22) presented within the first postoperative week. Vague right upper quadrant physical findings, nonspecific changes in the liver function chemistries and unexplained sepsis frequently led to radiologic evaluations. Ultrasonography was the most valuable radiologic study, with a diagnosis sensitivity of 82%. Technetium cholescintography can serve as a useful adjunct when interpreted in the context of other clinical findings. Cholecystectomy was performed in 20 patients and cholecystostomy in two. Nine (41%) patients had gangrenous gallbladders with frank perforation in two. A specific preoperative diagnosis was made in 19 patients (86%). Fifteen patients survived for a mortality rate of 32%. In 12 of 15 survivors (80%), the diagnosis of AAC was established and laparotomy performed within 48 hours of first clinical suspicion. Gangrene and perforation were seen in 87% of patients in whom surgery was delayed. AAC is a life-threatening condition especially in critically ill patients. Experience suggests that early diagnosis and operative intervention are the key elements of treatment. Delay of operative management on the grounds of recent cardiac surgery is not justified.
Subject(s)
Cardiac Surgical Procedures , Cholecystitis/epidemiology , Postoperative Complications/epidemiology , Acute Disease , Adult , Aged , Cholecystitis/diagnosis , Cholecystitis/surgery , Female , Humans , Incidence , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Survival Rate , Time FactorsABSTRACT
From June, 1982, through July, 1985, 39 (1.5%) of 2,570 patients undergoing open-heart procedures required insertion of a transthoracic intraaortic balloon pump (IABP). In all of these patients, a percutaneous attempt failed or was contraindicated. There were 24 (62%) men and 15 (38%) women. The mean age was 64.9 years. Five patients (13%) sustained complications potentially related to the transthoracic IABP. They included mediastinal infection in 1 patient (2.5%), balloon rupture in 2 patients (5%), and cerebrovascular accidents in 4 patients (10%). The overall survival was 44%. Survival for the group of patients weaned from transthoracic IABP support was 17 (81%) of 21. There were no deaths directly related to the transthoracic IABP. The transthoracic IABP was removed under local anesthesia without sternotomy in 19 (90%) of the patients weaned and with formal sternotomy in the remaining 2 (9%). In a select group of patients requiring intraaortic balloon counterpulsation, the use of the transthoracic IABP is a reasonable second choice for patients in whom other methods of balloon support are not feasible.
Subject(s)
Intra-Aortic Balloon Pumping/methods , Adult , Aged , Aorta , Cardiac Surgical Procedures , Evaluation Studies as Topic , Female , Humans , Intra-Aortic Balloon Pumping/adverse effects , Male , Middle Aged , Retrospective StudiesABSTRACT
Strut fracture with subsequent embolization of the Björk-Shiley mitral prosthesis is a rare but recognized complication. A case of disc embolization without strut fracture was managed successfully by early surgical intervention. The preoperative chest x-ray film demonstrating apparently intact major and minor struts underscores the importance of a high index of suspicion to make an early diagnosis.
