ABSTRACT
The effects of antegrade and antegrade with retrograde delivery of cardioplegic solution were evaluated in 60 patients who underwent myocardial revascularisation. All patients had triple vessel coronary artery disease and underwent revascularisation using arterial and vein grafts. Myocardial protection consisted of administration of the St.Thomas' Hospital cardioplegic solution, topical slushed ice and systemic hypothermia (28 degrees C-30 degrees C). The patients were categorised into: group A (n=30), who received antegrade cardioplegia alone, and group B (n=30), who received antegrade and retrograde cardioplegia. With the exception of the total dose of cardioplegic solution ('p'=0.02), there was no significant difference between the two groups. Cardiac function was assessed before and after the patient was weaned from the cardio-pulmonary bypass. There was a significant increase in the right atrial pressure and a significant decrease in the mean arterial pressure from the baseline ('p'<0.05), 10 minutes after cardiopulmonary bypass in group A. All patients in-group B had a spontaneous return to sinus rhythm after release of the aortic cross clamp, whereas 3 patients in group A required defibrillation to restore sinus rhythm. Intra aortic balloon pump support was necessary in 4 patients in group A, as against 1 patient in group B to terminate the cardiopulmonary bypass. The clinical outcome was similar in both groups. We conclude that the use of a combination of retrograde and antegrade cardioplegia facilitates early recovery of left ventricular function after coronary artery bypass grafting.
Subject(s)
Bronchi , Foreign Bodies , Inhalation , Adolescent , Endoscopy , Female , Foreign Bodies/surgery , Humans , Video RecordingABSTRACT
Surgical reconstruction of the trachea is a relatively complex procedure. We had 20 cases of tracheal stenosis. We have a modest experience of 16 tracheal reconstructions for acquired tracheal stenosis. Two patients underwent laser treatment while another two died before any intervention. The majority of these cases were a result of prolonged ventilation (14 cases), following organophosphorous poisoning (11 cases), Guillain-Barré syndrome, bullet injury, fat embolism and surprisingly only one tumor, a case of mucoepidermoid carcinoma, who had a very unusual presentation. There were 12 males and 4 females in this series, age ranging from 12-35 years. The duration of ventilation ranged from 1-21 days and the interval from decannulation to development of stridor was between 5-34 days. Six of them were approached by the cervical route, 5 by thoracotomy and cervical approach, 2 via median sternotomy and 3 by thoracotomy alone. Five of them required an additional laryngeal drop and 1 required pericardiotomy and release of pulmonary veins to gain additional length. The excised segments of trachea measured 3 to 5 cms in length. All were end to end anastomosis with interrupted Vicryl sutures. We have had no experience with stents or prosthetic tubes. Three patients developed anastomotic leaks which were controlled conservatively. Almost all of them required postoperative tracheo-bronchial suctioning with fibreoptic bronchoscope. We had one death in this series due to sepsis.
Subject(s)
Plastic Surgery Procedures/methods , Trachea/surgery , Adolescent , Adult , Bronchoscopy , Child , Female , Follow-Up Studies , Humans , Male , Retrospective Studies , Tomography, X-Ray Computed , Trachea/diagnostic imaging , Tracheal Stenosis/diagnosis , Tracheal Stenosis/etiology , Tracheal Stenosis/surgerySubject(s)
Anesthesia, Inhalation , Bronchial Fistula/congenital , Esophageal Fistula/congenital , Adult , Bronchial Fistula/diagnosis , Bronchial Fistula/surgery , Bronchiectasis/diagnosis , Bronchiectasis/surgery , Contrast Media , Diatrizoate Meglumine , Esophageal Fistula/diagnosis , Esophageal Fistula/surgery , Humans , Intubation, Intratracheal , Male , Pneumonectomy , Positive-Pressure Respiration , ThoracotomyABSTRACT
We report a rare case of left ventricular myxoma with embolization to the right coronary artery, presenting as an acute myocardial infarction. The tumor was excised from the left ventricle, and the tumor embolus was removed from the right coronary artery. Saphenous vein bypass grafting was also performed successfully.
Subject(s)
Coronary Disease/surgery , Heart Neoplasms/surgery , Myxoma/surgery , Neoplastic Cells, Circulating , Adult , Coronary Artery Bypass , Coronary Disease/diagnosis , Heart Ventricles , Humans , Male , Myocardial Infarction/diagnosisSubject(s)
Bronchoscopes , Ventilators, Mechanical , Bronchi , Equipment Design , Foreign Bodies/therapy , Humans , TracheaSubject(s)
Agglutinins/blood , Mitral Valve/surgery , Adult , Cold Temperature , Cryoglobulins , Humans , Male , Methods , Mitral Valve Stenosis/surgery , ReoperationABSTRACT
A 40-year-old female presented with a year's history of atrial fibrillation. Transthoracic echocardiography identified the presence of a biatrial mass and transoesophageal echocardiography delineated its extent. At surgery, a huge myxoma originating from the fossa ovalis and straddling the inter-atrial septum was removed and the atrial septum repaired. This report highlights the role of transthoracic and transoesophageal echocardiography in the diagnosis and management of this extremely rare cardiac tumour.
