ABSTRACT
A 48-year-old man was refered to our hospital for the treatment of bicusp aortic valve and severe aortic regurgitation. He underwent Bentall procedure (SJM 25mm+HemashieldØ 28 mm composite graft). Temporary epicardial pacing lead( TPL) was placed on the right ventricle at the opetation, and was cut on his skin surface prior to discharge because of difficulty in traction removal. After 15 years from operation, follow up computered tomography and echocardiography showed migration of 2 retaining TPLs extending from vascular graft of ascending aorta to the right innominate artery. We performed Redo-median sternotomy and removed the TPLs. This is the 1st reported case of a migrated temporary pacing lead into the vascular graft of ascending aorta under noninfectious conditions.
Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/diagnostic imaging , Cardiovascular Surgical Procedures , Echocardiography, Three-Dimensional , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Hereditary spherocytosis is a genetic, frequently familial hemolytic blood disease characterized by varying degrees of hemolytic anemia, splenomegaly, and jaundice. There are few reports on adult open-heart surgery for patients with hereditary spherocytosis. CASE PRESENTATION: We report a rare case of an adult open-heart surgery associated with hereditary spherocytosis. A 63-year-old man was admitted for congestive heart failure due to bicuspid aortic valve, aortic valve regurgitation, and sinus of subaortic aneurysm. The family history, the microscopic findings of the blood smear, and the characteristic osmotic fragility confirmed the diagnosis of hereditary spherocytosis. Furthermore, splenectomy had not been undertaken preoperatively. The patient underwent a successful operation by means of a centrifugal pump. Haptoglobin was used during the cardiopulmonary bypass, and a biological valve was selected to prevent hemolysis. No significant hemolysis occurred intraoperatively or postoperatively. CONCLUSION: There are no previous reports of patients with hereditary spherocytosis, and bicuspid aortic valve. We have successfully performed an adult open-heart surgery using a centrifugal pump in an adult patient suffering from hereditary spherocytosis and bicuspid aortic valve.
Subject(s)
Aortic Valve/abnormalities , Cardiac Surgical Procedures/methods , Cardiopulmonary Bypass/instrumentation , Heart Failure/surgery , Heart Valve Diseases/surgery , Spherocytosis, Hereditary/complications , Aortic Aneurysm/complications , Aortic Aneurysm/surgery , Aortic Valve/surgery , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/surgery , Bicuspid Aortic Valve Disease , Heart Failure/etiology , Heart Valve Diseases/complications , Humans , Male , Middle Aged , Sinus of Valsalva/surgeryABSTRACT
The case is reported of a 48-year-old man who underwent distal pancreatectomy, splenectomy, and 4 cycles of postoperative chemotherapy for stage I pancreatic cancer, at the age of 47. Four days after completion of chemotherapy, the patient developed high-grade fever (40 degrees C). In addition, on day 10, he developed disturbance of consciousness, followed by symptoms of shock, which led to emergency hospitalization. On day 4 of admission, the patient was diagnosed as having infective endocarditis and severe mitral valve insufficiency, and was started on antibiotic and heart failure therapy. Surgery was performed on day 16 of admission; the mitral valve infection had spread to the valve cusp and ring, and thence to the posterior wall of the left atrium. After excision of the lesions, the patient underwent mitral valve replacement with a collared prosthesis valve and a translocation procedure. The postoperative course was uneventful, and there has been no recurrence of inflammation or paraprosthetic leakage over the year and 6 months since the operation.
