ABSTRACT
Patients diagnosed with ocular myasthenia gravis (MG) and mitral valve disease represent a significant perioperative management problem, especially for the anaesthesiologist, due to complex inter-actions between the disease, drugs to treat the disease, and anaesthetic agents, such as neuromuscu-lar blocking agents (NMBAs). This paper describes the successful management of a 31-year-old female with mitral valve stenosis and ocular MG who was diagnosed with MG 4 years prior to the indication for cardiac surgery. Preoperatively, the patient was under treatment with Pyridostigmine and Prednisone. Mitral valve replacement and full thymectomy were performed, under general anaesthesia, using Fentanyl, Sevoflurane and low doses of non-depolarising NMBAs. The postoperative course was uneventful, the patient was extubated at 6 hours postoperatively, in-tensive care unit stay was 48 hours, and the patient was discharged after 6 days without any compli-cations. After 3 months, at the follow-up examination, the patient's ocular symptoms (eyelid ptosis) disappeared.
Subject(s)
Heart Valve Prosthesis Implantation/methods , Mitral Valve Stenosis/surgery , Mitral Valve/surgery , Myasthenia Gravis/surgery , Thymectomy , Adult , Anesthetics, Combined , Anti-Inflammatory Agents/therapeutic use , Drug Interactions , Female , Fentanyl , Humans , Mitral Valve Stenosis/complications , Myasthenia Gravis/complications , Myasthenia Gravis/drug therapy , Prednisone/therapeutic use , Pyridostigmine Bromide/therapeutic use , SevofluraneABSTRACT
Since the discovery of penicillin, the incidence of tertiary syphilis dramatically has decreased. However, cases of cardiovascular complications of syphilis still are present. Ascending aortic aneurysms are some of the most devastating complications. Nonetheless, syphilitic aortitis (SA) can appear and should be suspected in patients with syphilis and aortic aneurysm. We report a case of a 57-year-old patient with a large ascending aortic aneurysm with cartilage and rib erosion. The purpose of this article is to discuss the particular surgical aspects of this unusual case.
Subject(s)
Aorta/surgery , Aortic Aneurysm, Thoracic/surgery , Syphilis, Cardiovascular/complications , Syphilis/complications , Thoracic Wall , Aorta/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/etiology , Blood Vessel Prosthesis Implantation , Cardiopulmonary Bypass , Echocardiography , Humans , Male , Middle Aged , Operative Time , Rib Fractures/diagnostic imaging , Syphilis Serodiagnosis , Thoracic Wall/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Coronary artery spasm (CAS) after coronary artery bypass grafting (CABG) is rare, and in time may be fatal for the patient if undiagnosed. The purpose of the present study is to report the case of a patient who survived after experiencing a persistent spasm of all native coronary arteries following successful arterial myocardial revascularization. Furthermore, we aimed to discuss the therapeutic strategies which may prevent the occurrence of a coronary artery spasm in settings of myocardial revascularization, in the context of reviewed specific literature evidences.
