ABSTRACT
Intravenous leiomyomatosis (IVL) with cardiac extension is a rare uterine tumour. We present an unusual case of uterine leiomyoma that progressed along the inferior vena cava into the right atrium. Complete one stage removal of the tumour was performed using cardiopulmonary bypass and circulatory arrest. The literature review reveals that this is the first reported case in Australia of IVL with intracardiac extension which was successfully removed with a single stage procedure.
Subject(s)
Heart Neoplasms/secondary , Leiomyomatosis/pathology , Uterine Neoplasms/pathology , Vascular Neoplasms/secondary , Vena Cava, Inferior , Adult , Australia , Female , Heart Atria/pathology , Heart Neoplasms/pathology , Heart Neoplasms/surgery , Humans , Leiomyomatosis/diagnosis , Leiomyomatosis/surgery , Ultrasonography , Vascular Neoplasms/pathology , Vascular Neoplasms/surgery , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/pathologyABSTRACT
BACKGROUND: Antegrade cerebral perfusion is one of the most reliable methods of organ protection during hypothermic circulatory arrest for aortic arch surgery. We used a simplified antegrade cerebral perfusion technique with low mortality and morbidity. METHODS: Between January 2005 and August 2008, 21 patients underwent aortic arch surgery with unilateral antegrade selective cerebral perfusion through the brachiocephalic artery and moderate hypothermic circulatory arrest. The mean age for patients was 58.0+/-11.1 (27-82) years. Cardiopulmonary bypass was commenced and the ascending aorta was cross-clamped. Patients were cooled to 22-28 degrees C, whilst the proximal anastomosis was performed. The brachiochephalic artery was cannulated using a balloon tipped 15Fr catheter used for retrograde cardioplegia. Antegrade cerebral perfusion was established at the rate of 10 ml//kg/min. The perfusion pressure was controlled between 50 and 70 mm Hg whilst the distal anastomosis was completed. RESULTS: There were no operative deaths and no permanent neurological deficits. Four patients had temporary confusion. Mean antegrade cerebral perfusion time was 21.6+/-8.0 (12-48)min. Eight out of 20 patients had circulatory arrest at 28 degrees C and their mean circulatory arrest time was 22.8+/-4.7 (16-32)min. DISCUSSION: The mortality and neurological outcomes of aortic surgery using unilateral antegrade cerebral perfusion with moderate hypothermic circulatory arrest produced satisfactory results. Bilateral cannulation and deep hypothermia appear to be unnecessary in most cases. The coagulopathy from deep hypothermia is thereby avoided.
Subject(s)
Aorta, Thoracic/surgery , Cardiopulmonary Bypass/methods , Circulatory Arrest, Deep Hypothermia Induced/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Perfusion , Retrospective StudiesABSTRACT
We describe a technique for insertion of a mitral valve prosthesis in the presence of severe posterior annular calcification by plicating the left atrial tissue over the sewing ring. Extensive calcification often creates the technical difficulty of seating the prosthetic valve resulting in peri prosthetic leakage. Extensive decalcification may weaken the annulus and result in prosthetic valve dehiscence and atrioventricular dissociation.
Subject(s)
Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Aged , Atrial Function, Left , Calcification, Physiologic , Cardiac Catheterization , Female , Heart Atria/diagnostic imaging , Heart Atria/surgery , Humans , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/diagnostic imaging , Polytetrafluoroethylene/therapeutic use , Radiography , Treatment OutcomeABSTRACT
Atrioventricular disruption is an uncommon but often lethal complication in mitral valve replacement. We present the case of a 79-year-old woman in whom the disruption after mitral valve replacement was successfully repaired using BioGlue surgical adhesive, bovine pericardium, and polytetrafluoroethylene (Teflon) patch.
Subject(s)
Aortic Valve Insufficiency/surgery , Cardiac Tamponade/surgery , Heart Rupture/surgery , Heart Valve Prosthesis Implantation , Heart Ventricles/injuries , Intraoperative Complications/surgery , Mitral Valve Stenosis/surgery , Rheumatic Heart Disease/surgery , Tissue Adhesives/therapeutic use , Aged , Aortic Valve Insufficiency/diagnosis , Bioprosthesis , Blood Vessel Prosthesis Implantation , Cardiac Tamponade/diagnosis , Drug Combinations , Female , Glutaral/therapeutic use , Heart Atria/injuries , Heart Atria/surgery , Heart Rupture/diagnosis , Heart Ventricles/surgery , Hemostasis, Surgical , Humans , Hypothermia, Induced , Intraoperative Complications/diagnosis , Mitral Valve Stenosis/diagnosis , Resuscitation , Rheumatic Heart Disease/diagnosis , Serum Albumin, Bovine/therapeutic use , Suture TechniquesABSTRACT
A 22-year-old man presented with traumatic aortic transtion associated with rupture of the right atrium and underwent urgent median sternotomy to repair the right atrium. A T-shaped extended left anterior thoracotomy was performed, and ruptured descending thoracic aorta was repaired under total bypass. A Y-shaped connector was inserted in the arterial catheter to allow cannulation of both ascending aorta and femoral arteries. A 4-cm long Hemoshield graft was used to repair the aortic transection. The patient made a full recovery and was discharged 13 days after the accident.