Acute heparin-induced thrombocytopenia (HIT) without thrombocytopenia post aortocoronary bypass grafting.

Heparin-induced thrombocytopenia (HIT) after cardiac surgery is a clinical condition associated with increased incidence of thromboembolic events and mortality. HIT without thrombocytopenia is a rare clinical entity poorly reported in the literature, especially after cardiac surgery. In this case report, we present the case of a post aortocoronary bypass grafting patient who presented with HIT in the absence of thrombocytopenia.

Cardiac Surgery during the Covid-19 Pandemic: Evidence from the first wave

BackgroundThe Covid-19 pandemic has affected human behaviour and burdened health systems and has thus had an impact on other health outcomes. ObjectiveThis paper studies whether there was a decrease in cardiac surgery operations in Greece during the first wave of the Covid-19 pandemic. Data and MethodsWe used data from 7 major hospitals that geographically cover about half the country and more than half the population, including a mix of public, private, military and childrens hospitals. We used a difference-in-differences econometric approach to compare trends in cardiac surgery before and after the pandemic in 2020, to the same months in 2019, controlling for seasonality and unemployment, and using hospital fixed effects. ResultsWe found that during the first wave of the pandemic and the associated lockdown, there were 35-56% fewer cardiac surgery operations compared to what we would have expected in the absence of the pandemic. ConclusionsThere was a steep decline in Cardiac surgery operations in Greece during the first wave of the Covid-19 pandemic. Possible reasons may include people not seeking medical attention to avoid the risk of catching Covid-19; fewer referrals; and working from home, thus not being exposed to a stressful work environment or commute.

Arc of Buhler: A lifesaving anatomic variation. A case report.

The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).

A presença da síndrome de má perfusão em casos de dissecção aórtica aguda do tipo B complicada é um fator preditor negativo, e uma intervenção urgente é indicada. As variações anatômicas, tais como o arco de Buhler, contribuem como canais anastomóticos e podem preservar o suprimento sanguíneo visceral. Neste relato de caso, descrevemos o manejo geral de um paciente do sexo masculino, de 54 anos, que apresentou uma dissecção aórtica do tipo B. Inicialmente, o manejo conservador foi escolhido, conforme indicado para dissecção do tipo B não complicada, mas a dissecção sofreu deterioração. Apesar de uma oclusão grave da artéria celíaca ter sido detectada na angiotomografia computadorizada, a variação anatômica do arco de Buhler estava presente, contribuindo para o suprimento sanguíneo visceral adequado. Após levar em consideração esse achado, o paciente foi tratado de forma efetiva com reparação endovascular da aorta torácica.

Arc of Buhler: A lifesaving anatomic variation. A case report / Arco de Buhler: uma variação anatômica que salva vidas - relato de caso

Abstract The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).

Resumo A presença da síndrome de má perfusão em casos de dissecção aórtica aguda do tipo B complicada é um fator preditor negativo, e uma intervenção urgente é indicada. As variações anatômicas, tais como o arco de Buhler, contribuem como canais anastomóticos e podem preservar o suprimento sanguíneo visceral. Neste relato de caso, descrevemos o manejo geral de um paciente do sexo masculino, de 54 anos, que apresentou uma dissecção aórtica do tipo B. Inicialmente, o manejo conservador foi escolhido, conforme indicado para dissecção do tipo B não complicada, mas a dissecção sofreu deterioração. Apesar de uma oclusão grave da artéria celíaca ter sido detectada na angiotomografia computadorizada, a variação anatômica do arco de Buhler estava presente, contribuindo para o suprimento sanguíneo visceral adequado. Após levar em consideração esse achado, o paciente foi tratado de forma efetiva com reparação endovascular da aorta torácica.