ABSTRACT
We report a surgical case of dextrocardia complicated with annuloaortic ectasia (AAE) and mitral regurgitation, which induced congestive heart failure. Preoperative electrocardiography-gated multidetector-row computed tomography (MDCT) showed the following complex cardiovascular abnormalities without motion artifacts: dextrocardia, situs inversus, polysplenia, AAE, absence of the inferior vena cava, azygos vein continuation, drainage of the hepatic vein into the right atrium, and bilateral superior venae cavae. On the basis of the MDCT data, we established a cardiopulmonary bypass; and a modified Bentall procedure (Piehler method) and mitral valve replacement were performed without complications.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Valve Insufficiency/surgery , Cardiac Surgical Procedures , Mitral Valve Insufficiency/surgery , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/etiology , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/etiology , Blood Vessel Prosthesis Implantation , Cardiac-Gated Imaging Techniques , Cardiopulmonary Bypass , Dextrocardia/complications , Dextrocardia/diagnosis , Dilatation, Pathologic , Genetic Diseases, X-Linked/complications , Genetic Diseases, X-Linked/diagnosis , Heart Failure/etiology , Heart Failure/surgery , Heart Valve Prosthesis Implantation , Heterotaxy Syndrome , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/etiology , Situs Inversus/complications , Situs Inversus/diagnosis , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Thrombosis is a very rare complication of Mycoplasma pneumoniae infection. We report the case of a previously healthy nine-year-old boy with cardiac thrombus in the right ventricle associated with M. pneumoniae pneumonia. This cardiac thrombus was detected eight days after the onset of respiratory symptoms. The mechanism underlying thrombosis may be related to autoimmune modulations and was attributable to the production of transient antiphospholipid antibodies.
Subject(s)
Heart Diseases/microbiology , Mycoplasma pneumoniae/pathogenicity , Pneumonia, Mycoplasma/microbiology , Thrombosis/microbiology , Anti-Bacterial Agents/therapeutic use , Antibodies, Antiphospholipid/blood , Bronchodilator Agents/therapeutic use , Cardiac Surgical Procedures , Child , Heart Diseases/diagnostic imaging , Heart Diseases/immunology , Heart Diseases/surgery , Humans , Male , Mycoplasma pneumoniae/immunology , Pneumonia, Mycoplasma/drug therapy , Pneumonia, Mycoplasma/immunology , Thrombosis/diagnostic imaging , Thrombosis/immunology , Thrombosis/surgery , Time Factors , Treatment Outcome , UltrasonographyABSTRACT
Patients with double-chambered right ventricle presenting with symptoms in adulthood are rare. From 1990 to 2004, 4 adults and 9 children with double-chambered right ventricle underwent surgical correction. The surgical results and clinical data of the adults were compared with those of the pediatric patients. All adult patients had dyspnea on exertion, 3 children showed growth delay but the others were asymptomatic. The mean age at operation was 44.5 +/- 6.3 years in adults and 5.2 +/- 1.9 years in children. The mean pressure gradient between the anatomically lower right ventricle and the pulmonary artery was significantly higher in adults than in children (91.8 +/- 14.1 vs. 42.2 +/- 5.9 mm Hg). The pulmonary-to-systemic flow ratio in adults was significantly lower than in pediatric patients (1.2 +/- 0.2 vs. 1.8 +/- 0.3). All adults and 8 of the 9 children survived. There were no late deaths or re-operations, and all survivors were in New York Heart Association functional class I. Surgical correction of double-chambered right ventricle in adults gave satisfactory midterm results although right ventricular outflow tract obstruction and clinical symptoms were severe in these patients.
Subject(s)
Heart Ventricles/abnormalities , Heart Ventricles/surgery , Age Factors , Aged , Aortic Valve Insufficiency/etiology , Cardiac Catheterization , Exercise Tolerance , Female , Humans , Male , Ventricular Outflow Obstruction/etiologyABSTRACT
An 81-year-old man with effort angina pectoris underwent coronary artery bypass grafting operation using the bilateral internal thoracic arteries and the right gastroepiploic artery (GEA). Angiography after operation showed that the bilateral internal thoracic arteries were patent. Abdominal angiography showed severe ostial stenosis in the celiac trunk. The GEA was not opacified by the celiac trunk but by the superior mesenteric artery, by collaterals. GEA flow could be detected from the epigastric lesion by contrast-enhanced Doppler echocardiography, and moreover, the flow velocity reserve of the graft was 2.4. This case suggests that the GEA graft can provide sufficient blood flow to the coronary artery despite ostial stenosis of the celiac trunk.
