ABSTRACT
Although the anticoagulant complications of Impella are well known, the timing of heparin administration when using Impella immediately after open heart surgery has not been established. We report a case of a 59-year-old man with Impella-assisted repair of a ventricular septal perforation after acute myocardial infarction who developed thromboembolism of the lower extremity arteries after removal of Impella.
ABSTRACT
An 81-year-old man underwent total arch replacement for thoracic aortic aneurysm 8 years ago and catheter ablation for paroxysmal atrial fibrillation 1 year ago. Transthoracic echocardiography revealed a mass in the right atrium, and the patient was admitted for close examination and treatment. Transesophageal echocardiography revealed a 23×17 mm large well-defined mass above the cavotricuspid isthmus. Two venous drainage cannulas were inserted directly to the superior vena cava and to the inferior vena cava via the right femoral vein, in order to avoid the direct contact with the right atrium prior to institution of cardiopulmonary bypass. The right atrial tumor was found attached to the cavotricuspid isthmus, and was resected together with the right atrial wall. Pathological examination showed myxomatous tissue. Postoperative course was uneventful. He was discharged 23 days after the operation.
Subject(s)
Catheter Ablation , Heart Atria , Heart Neoplasms , Myxoma , Humans , Myxoma/surgery , Myxoma/diagnostic imaging , Male , Aged, 80 and over , Heart Neoplasms/surgery , Heart Neoplasms/diagnostic imaging , Heart Atria/surgeryABSTRACT
A 75-year-old woman was diagnosed with type B acute aortic dissection 14 years ago and 3-channeled aortic dissection 7 years ago. She received total arch replacement 6 years ago and descending aortic replacement with double barrel anastomosis technique for distal anastomosis 5 years ago. Computed tomography( CT) revealed giant thyroid tumor and thoracoabdominal aortic aneurysm( 58 mm in diameter). She suffered from back pain during her follow-up period. CT revealed ruptured thoracoabdominal aortic aneurysm. First, the false lumen of descending aorta was closed by thoracic endovascular aortic repair, and then thoracoabdominal aortic replacement was performed uneventfully.
Subject(s)
Aortic Aneurysm, Thoracic , Aortic Aneurysm, Thoracoabdominal , Aortic Dissection , Aortic Rupture , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Humans , Female , Aged , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Aorta/surgery , Aortic Rupture/diagnostic imaging , Aortic Rupture/surgery , Blood Vessel Prosthesis Implantation/methods , Anastomosis, Surgical , Treatment OutcomeABSTRACT
An 97-year-old woman was diagnosed with complete atrioventricular block and underwent pacemaker implantation( PMI). Three days after the PMI, computed tomography revealed cardiac perforation and migration of the lead to the abdominal cavity. Surgical procedure through median sternotomy was performed, and the penetrated lead was removed. The holes of the right ventricle and diaphragm were repaired. Abdominal organ was not injured. She was discharged 14 days after the surgical procedure.
Subject(s)
Heart Injuries , Pacemaker, Artificial , Female , Humans , Aged, 80 and over , Heart Ventricles/diagnostic imaging , Heart Ventricles/surgery , Diaphragm/diagnostic imaging , Diaphragm/surgery , Pacemaker, Artificial/adverse effects , Thorax , Heart Injuries/diagnostic imaging , Heart Injuries/etiology , Heart Injuries/surgeryABSTRACT
An 85-year-old woman underwent aortic arch replacement and thoracic endovascular aortic repair (TEVAR) 5 years ago. She suffered from chest and back pain. Computed tomography (CT) demonstrated enlargement of the aortic aneurysm by a type â ¢b endoleak. TEVAR was performed to close a type â ¢b endoleak with a relining technique uneventfully. Intraoperative completion aortography and postoperative CT confirmed the disappearance of a type â ¢b endoleak. She was discharged 27 days after the treatment.
Subject(s)
Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Female , Humans , Aged, 80 and over , Blood Vessel Prosthesis , Endoleak/diagnostic imaging , Endoleak/etiology , Endoleak/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/methods , Endovascular Aneurysm Repair , Stents , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Treatment Outcome , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Retrospective StudiesABSTRACT
An 82-year-old woman suddenly developed chest pain and apoplexy. Computed tomography (CT) showed acute type A aortic dissection, the true lumen in the brachicephalic artery was severely compressed by the faulse lumen. Pulsation in the either leg was not detected during induction of anesthesia. We evaluated the cerebral blood flow and lower extremity blood flow using near infrared spectroscopy (NIRS) during the operation, tissue oxygenation index (TOI) was continuously monitored during the operation. Cardiopulmonary bypass( CPB) was established by puncturing the true lumen in the ascending aorta and bicaval venous drainage. TOI was returned to normal range by CPB. Although the central repair (ascending aorta replacement) was performed, leg ischemia persisted. We performed ascending aorta-bifemoral bypass. After the operation, leg ischemia disappeared and CT revealed patency of the bypass graft. Postoperative course was uneventful without deterioration of neurological function. She was discharged 49 days after the operation.
Subject(s)
Aortic Dissection , Leg , Female , Humans , Aged, 80 and over , Leg/blood supply , Aortic Dissection/complications , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Aorta/surgery , Ischemia/diagnostic imaging , Ischemia/etiology , Ischemia/surgery , Lower Extremity/surgeryABSTRACT
CLINICAL IMPACT: We developed a novel Endovascular aortic repair technique for internal iliac artery preservation using a physician modified Endurant contralateral limb. This procedure was safe and reliable for preserving internal iliac artery flow in 24 patients with common and internal iliac artery aneurysms. We believe that our technique has the potential to expand the anatomic indications for internal iliac artery preserving procedures.
ABSTRACT
A large full-thickness defect of the lower lip is difficult to reconstruct. Preservation of eating and speaking functions based on maintenance of oral sphincter and muscle function, sensation, and the oral aperture are the basic aims. It is also important to achieve a good aesthetic appearance. Here, we describe a new procedure using combined bilateral hatchet and nasolabial advancement flaps for a large full-thickness defect of the lower lip. The aim of use of the hatchet flap is to make a natural curve from the mentolabial fold to the mental protuberance using the "dog ear" resulting from suturing medially advanced bilateral hatchet flaps and to preserve a more certain blood supply to the medial edge of the flap. Our results indicate that the procedure using combined bilateral hatchet flaps and nasolabial flaps is useful for a U-shaped large full-thickness defect, with good functional and aesthetic outcomes.