Cardiac surgery in a patient with multiple myeloma combined with renal amyloidosis.

We present a case of a 62-year-old woman who underwent mitral valve and aortic valve replacement owing to infective endocarditis. Previously, the patient had been diagnosed with renal amyloidosis and multiple myeloma. She underwent chemotherapy and autologous peripheral blood stem cell transplantation and has achieved nearly complete remission. The patient's postoperative course was almost uneventful, and she was discharged on the 22nd postoperative day. This is the first case report about cardiac surgery for the patient with multiple myeloma combined with renal amyloidosis.

Effect of low-dose landiolol, an ultrashort-acting beta-blocker, on postoperative atrial fibrillation after CABG surgery.

OBJECTIVE: Postoperative atrial fibrillation is the most common complication after coronary artery bypass grafting (CABG). This complication is associated with prolongation of the intensive care unit stay and hospitalization time with attendant increased hospitalization costs, and it is an important risk factor for perioperative cerebrovascular accidents. Landiolol is a newly developed ultrashort-acting beta-adrenoceptor antagonist with a half-life of 3 min that is eight times more cardioselective than esmolol. The purpose of this study was to investigate the prophylactic effect of continuous administration of low-dose landiolol on postoperative atrial fibrillation. METHODS: We reviewed all patients who underwent CABG alone at our hospital from April 2002 and September 2006. Patients with a previous history of atrial arrhythmias were excluded. The remaining patients were divided to two groups: landiolol group (n = 20), and control group (n = 35). Administration of landiolol started after cardiopulmonary bypass with a loading dose of 1.5-2.5 mug.kg(t-1).min(-1) and continued for the first 2 days after surgery. The incidence of postoperative atrial fibrillation was noted. Continuous variables were compared between groups by means of Student's t-test. Categorical variables were compared by means of the chi(2) test or Fisher's exact test. RESULTS: The occurrence of atrial fibrillation after CABG in the control group was statistically more than in the landiolol group (P = 0.04). There were no statistical differences between the groups regarding the cardiac index or the dose of inotropic agents during the perioperative period. CONCLUSION: Intraoperative and perioperative administration of low-dose landiolol has a preventive effect on the appearance of atrial fibrillation after CABG surgery.

Cardiac surgery in three patients infected with the human immunodeficiency virus.

Human immunodeficiency virus infection (HIV) is the fourth leading cause of death worldwide.1 Recently, the introduction of highly active antiretroviral therapy (HAART) improved the survival rate of HIV-infected patients. However, the number of HIV-infected patients to be referred for cardiac surgery will increase because cardiovascular risk is increased with the use of HAART. Herein, we report three HIV-infected patients who underwent open heart surgery with cardiopulmonary bypass; we followed their progress by monitoring their CD4+ T-lymphocyte counts. Based on our experience, it seems that cardiopulmonary bypass does not accelerate progression of HIV disease.

Poststernotomy pseudoaneurysm of the internal mammary artery.

We present a case of a 79-year-old man who underwent mitral valve and aortic valve replacement. The patient's postoperative period was almost uneventful. At his cardiac preoperative examination, a malignant tumor of the urinary tract had been suspected, so computed tomography (CT) was performed after discharge, on the 48th postoperative day. The CT scan demonstrated a pseudoaneurysm of the internal mammary artery (IMA). Angiography demonstrated that it was a pseudoaneurysm of the left internal manmary artery. The lesion was embolized using coils, which successfully occluded the lesion.

Conservative treatment for rupture of thoracic aortic aneurysm.

We present a case of an 88-year-old female with a history of tuberculosis, who was transferred to our hospital due to the sudden onset of epigastralgia and back pain. A chest X-ray demonstrated a bilateral shadow of the upper lung, which suggested the history of tuberculosis. A computed tomography scan demonstrated a large amount of hematoma from the neck to mediastinum and leakage of contrast medium around the distal aortic arch. We diagnosed rupture of thoracic aortic aneurysm, and selected conservative treatment. The patient was intubated under sedation and blood pressure was controlled with vasodepressors. The patient was completely off the ventilator after 65 days of disease, and the patient was discharged after 4 months. This is the first successful case of conservative therapy for ruptured thoracic aortic aneurysm.

Five cases of blunt traumatic cardiac rupture: success and failure in surgical management.

We report five cases of blunt cardiac rupture seen in our hospital during the last 6 years. All these patients sustained blunt chest trauma due to motor vehicle or motorcycle accidents, and all had vital signs on arrival at the emergency department. We suspected cardiovascular injuries from the findings of echocardiography and CT scans, and all five cases were operated on 2-6 h after injury. Four had a median sternotomy, and one had a lateral thoracotomy. During the operations, we found that two patients had pericardium injuries and all five patients had right chamber injuries, which included multiple, ventricle, and large venous injuries in three patients. The tears were repaired using simple suture or ligation techniques for all patients, with cardiopulmonary bypass in three patients. One patient died during the operation, and four patients survived, therefore the survival rate was 80%. We believe that patients with cardiac rupture who are alive when they reach hospital can often be saved by prompt diagnosis and immediate, adequate surgical repairs.