Subject(s)
Cardiac Surgical Procedures/methods , Plastic Surgery Procedures/methods , Ventricular Outflow Obstruction/diagnostic imaging , Ventricular Outflow Obstruction/surgery , Adult , Female , Follow-Up Studies , Humans , Pulmonary Valve Stenosis/diagnostic imaging , Pulmonary Valve Stenosis/surgery , Severity of Illness Index , Tetralogy of Fallot/diagnostic imaging , Tetralogy of Fallot/surgery , Tomography, Spiral Computed , Treatment OutcomeABSTRACT
Endomyocardial fibrosis is a rare disease that is seen most commonly in tropical countries. It usually presents with characteristics of right-heart failure. Herein, we report the case of a 14-year-old adolescent boy who experienced endomyocardial fibrosis. Upon transthoracic echocardiography, the condition was mistakenly diagnosed as Ebstein's anomaly of the tricuspid valve. Sixteen months after undergoing tricuspid annuloplasty and receiving a bidirectional Glenn shunt, the patient showed no echocardiographic evidence of valvular regurgitation. We discuss imaging and surgical techniques that enable the diagnosis and treatment of endomyocardial fibrosis.
Subject(s)
Diagnostic Errors , Ebstein Anomaly/diagnosis , Endomyocardial Fibrosis/diagnosis , Adolescent , Cardiac Surgical Procedures , Ebstein Anomaly/surgery , Echocardiography , Endomyocardial Fibrosis/complications , Endomyocardial Fibrosis/surgery , Foramen Ovale, Patent/etiology , Foramen Ovale, Patent/surgery , Humans , Male , Treatment Outcome , Tricuspid Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/surgery , Ventricular Dysfunction/etiology , Ventricular Dysfunction/surgeryABSTRACT
Dissection of the pulmonary autograft is an extremely rare complication requiring emergent treatment as there is a chance of rupture and proximal aortic involvement. The autograft dissection can involve the aortic annulus, causing separation of leaflets from the annulus in addition to causing annular dilatation, thereby precluding resuspension of leaflets. The usual treatment in such cases is to perform the Bentall procedure, which involves placing a valved conduit (usually mechanical valve) and thereby necessitating anticoagulation. This report describes a case of successful valve-sparing aortic root replacement following the Ross procedure with dissection of autograft.
Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Aortic Valve/surgery , Blood Vessel Prosthesis , Pulmonary Valve/transplantation , Aortic Diseases/surgery , Aortic Rupture/prevention & control , Dilatation, Pathologic , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Sinus of Valsalva/surgery , Transplantation, AutologousABSTRACT
Endomyocardial fibrosis is a rare condition that occurs primarily in tropical countries. It can often mimick a variety of other common cardiac conditions such as apical hypertrophic cardiomyopathy and Ebstein anomaly. We report a case of a left ventricular mass that at histologic examination was found to be endomyocardial fibrosis.
Subject(s)
Endomyocardial Fibrosis/diagnosis , Heart Neoplasms/diagnosis , Adult , Diagnosis, Differential , Heart Ventricles , Humans , MaleABSTRACT
Minimally invasive vein harvesting is associated with better leg wound healing and a lower incidence of wound infections. We analyzed our experience in 2 prospectively enrolled groups of non-randomized patients undergoing elective coronary artery bypass grafting. Group 1 was 81 patients who had endoscopic vein harvesting; group 2 was 80 who had conventional open vein harvesting. The time taken for endoscopic harvest (skin incision to skin closure) was significantly less than that for open harvest (51.07 vs 75.94 min). The number of cases to reach a plateau on the learning curve for endoscopic vein harvest was 20 for 2 lengths of vein and 35 for 3 lengths of vein. Significantly more suture repairs per vein were required in group 1 (1.32) than group 2 (0.38). The incidence of wound infection was 1.2% in group 1 vs 8.8% in group 2. Endoscopic vein harvesting is not difficult to learn and it should be preferred over open vein harvest, given its benefits in wound healing.
Subject(s)
Coronary Artery Bypass , Coronary Artery Disease/surgery , Endoscopy , Leg/blood supply , Tissue and Organ Harvesting/methods , Clinical Competence , Coronary Artery Disease/physiopathology , Elective Surgical Procedures , Endoscopy/adverse effects , Feasibility Studies , Female , Humans , Learning , Male , Middle Aged , Prospective Studies , Surgical Wound Infection/etiology , Time Factors , Tissue and Organ Harvesting/adverse effects , Veins/transplantation , Wound HealingABSTRACT
Coronary artery fistulae are rare anomalies encountered in 0.1-0.2% of angiographic series. We recently encountered a patient evaluated for mitral valve disease who incidentally had bilateral coronary artery fistulae detected on preoperative angiogram. These fistulae drained into the pulmonary artery. She underwent successful transpulmonary closure of the fistula along with mitral valve repair. We discuss the embryological basis of this anomaly and the clinical as well as surgical significance.
Subject(s)
Arterio-Arterial Fistula/congenital , Coronary Vessel Anomalies/diagnostic imaging , Pulmonary Artery/abnormalities , Arterio-Arterial Fistula/diagnostic imaging , Arterio-Arterial Fistula/surgery , Coronary Vessel Anomalies/surgery , Female , Humans , Incidental Findings , Middle Aged , Mitral Valve Stenosis/complications , Mitral Valve Stenosis/surgery , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , RadiographyABSTRACT
Various techniques have been described for management of anomalous origin of the left coronary artery from the pulmonary artery presenting in adults. Three patients, 1 male and 2 females, aged 27-37 years, underwent transpulmonary pericardial patch closure with concomitant left internal thoracic artery anastomosis to the left anterior descending artery, under standard cardiopulmonary bypass, thus creating a two-coronary system. One patient had concomitant mitral valve repair. All 3 survived the operation. Postoperative angiography in 2 patients revealed good antegrade flow with decreased collaterals in one and competitive inhibition with increased collaterals in the other. This procedure is considered to be the safest and simplest in this subset of patients.
Subject(s)
Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/surgery , Pulmonary Artery/abnormalities , Pulmonary Artery/surgery , Adult , Anastomosis, Surgical/methods , Cardiopulmonary Bypass/methods , Coronary Angiography , Female , Humans , Male , Mammary Arteries/surgery , Mitral Valve/surgery , Rare Diseases , Treatment OutcomeABSTRACT
A 10-year-old boy presented with severe aortic regurgitation due to a dysplastic aortic valve. He underwent a Ross procedure employing a mini-root replacement technique. At surgery, he was found to have eccentrically located coronary ostia which were both reimplanted as a single button into the pulmonary autograft. Postoperatively, multislice computed tomographic coronary angiography demonstrated satisfactory reimplantation of the coronary artery ostia with no evidence of kinking or compression of the coronary arteries. This case report supports the technique of transfer of coronary ostia as a single button where coronary anatomy is unfavorable for their individual transfer.
