ABSTRACT
A 66-year-old Australian man underwent elective replacement of a severely stenotic aortic valve with a 22-mm Medtronic-Hall valve. Six weeks later, he was readmitted with worsening dyspnea, fever, and mild anemia. Investigations confirmed pulmonary edema and moderate periprosthetic aortic regurgitation. The pulmonary edema was managed conservatively, and a second 22-mm Medtronic-Hall valve was implanted. Infective endocarditis was suspected in the aortic annulus below the orifice of the right coronary artery. A bacteriological study revealed a rare bacteria of Streptomyces species. The patient received intensive antibiotic therapy over a 6-week period of hospitalization, and the aortic regurgitation disappeared one week postoperatively.
Subject(s)
Aortic Valve Insufficiency/microbiology , Aortic Valve Stenosis/surgery , Endocarditis, Bacterial/microbiology , Gram-Positive Bacterial Infections/microbiology , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis/adverse effects , Prosthesis-Related Infections/microbiology , Streptomyces/isolation & purification , Aged , Anti-Bacterial Agents/therapeutic use , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/diagnostic imaging , Elective Surgical Procedures , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/therapy , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/therapy , Humans , Male , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/therapy , Reoperation , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND/AIM: Anastomotic leak after esophagectomy is one of the most challenging complications resulting in a high morbidity and mortality and prolonged hospitalization. The study intended to assess the outcome of endoluminal self-expanding stent in the treatment of this problem. SETTINGS AND DESIGN: Department of Thoracic and Cardiovascular Surgery, Arhus University Hospital, Skejby, Arhus, Denmark. A retrospective study. PATIENTS AND METHODS: From January 2007 to December 2010, 209 patients underwent esophagectomy for malignant disease of the esophagus or the cardia. Twenty patients developed anastomotic leak. Treatment consisted of conservative measures, surgery, and stent placement. Details of treatment, clinical outcome, complications, and mortality were evaluated. STATISTICAL ANALYSIS: None. RESULTS: One hundred and forty-seven patients (70.3%) had carcinoma of the cardia, whereas 62 patients (29.7%) had esophageal carcinoma. Twenty patients (9.5%) developed anastomotic leak; small (<1 cm) in two patients (10%); managed conservatively and bigger than 1 cm in 15 patients (75%); treated with an esophageal stent (Hanaro stent, DIAGMED Healthcare, Thirsk, YO7 3TD, United Kingdom). In three patients (15%), perforation of the staple line of the intrathoracic gastric conduit was found and managed by reoperation. Functional sealing of anastomoses after stent placement could be achieved in 10 patients (67%). Stent-related morbidity developed in five patients (33%): Migration of the stent, n=3 and tracheoesophageal fistula, n=2. Stents were smoothly removed 3 weeks after discharge. The mean hospital stay was 25 days. There was only one stent-related death (6.6%). CONCLUSION: Endoluminal stent implantation is an effective and safe option in the management of postesophagectomy leaks.
Subject(s)
Anastomotic Leak/therapy , Esophagectomy/adverse effects , Stents , Aged , Aged, 80 and over , Anastomotic Leak/epidemiology , Anastomotic Leak/etiology , Cardia , Esophageal Neoplasms/surgery , Female , Foreign-Body Migration/surgery , Humans , Male , Middle Aged , Prosthesis Design , Prosthesis Implantation , Reoperation , Stents/adverse effects , Stomach Neoplasms/surgeryABSTRACT
Remote ischemic conditioning is a novel concept of protection against ischemia-reperfusion injury. Brief controlled episodes of intermittent ischemia of the arm or leg may confer a powerful systemic protection against prolonged ischemia in a distant organ. This conditioning phenomenon is clinically applicable and can be performed before--preconditioning, during--perconditioning, or after--postconditioning prolonged distant organ ischemia. The remote ischemic conditioning may have an immense impact on clinical practice in the near future.
