ABSTRACT
Computed tomography is performed in every patient before lung tumour resection. The presented case realises how important it is to perform this study with contrast. In a 75-year-old male we detected a tumour ingrowing from the right lung through the right lower pulmonary vein into the left atrium of the heart. The patient was qualified for primary sternotomy with extracorporeal circulation and resection of the intracardiac part of the tumour. In the second stage, right-sided thoracotomy was performed, and right lower lung lobectomy was done. Mixed heterogeneous lung cancer was diagnosed (squamous cell and non-small cell endocrine) in stage IIIa. The perioperative period was uncomplicated. The patient, due to renal failure, was not eligible for adjuvant chemotherapy. If the patient were qualified for lobectomy based directly on computed tomography without contrast, there would have been a high risk of perioperative death due to embolic incidents and heart failure. Effective multidisciplinary collaboration allowed us to avoid this sort of complication.
ABSTRACT
BACKGROUND: Intraoperative transoesophageal echocardiography (IOTEE) is an integral part of many cardiac surgical procedures and is employed during major non-cardiac operations to monitor cardiac performance, particularly in high-risk patients. In the case of elective coronary artery bypass grafting (CABG) procedures this examination is performed according to experience and availability in a given centre. AIM: To evaluate the value of IOTEE in monitoring left ventricular (LV) function in patients undergoing elective CABG with the use of cardiopulmonary bypass (CPB). METHODS: In fifty five patients (mean 66 +/- 9 years), mean EuroSCORE: 4.5 +/- 2.9 scheduled for elective CABG in CPB, IOTEE was performed after induction of anaesthesia, 5 and 30 min after weaning from CPB. Intraoperative parameters of LV function and volume (EDV/BSA) were compared with the data obtained by transthoracic echocardiography (TTE) performed before and 30 days after surgery. RESULTS: Significant depression of LV ejection fraction (LVEF) was found after induction of aesthesia (decline from 52.2 +/- 11.2% to 49.8 +/- 11.5%, p = 0.003). Subsequent improvement of LVEF was noticed at 1-month follow-up (p = 0.01). The highest wall motion score index (WMSI) (1.5 +/- 0.43) was found after weaning from CPB, the lowest at follow-up (1.36 +/- 0.4). Change of EF and WMSI at each stage of examination was significant (p < 0.001). Significant decrease of EDV/BSA was found 30 min after weaning from CPB (decline from 53.5 +/- 23.2 to 49.1 +/- 21.9 ml/m2, p = 0.05). Significant depression of EF 5 min after weaning from CPB was detected only in patients with CPB time longer than 120 min (decline of 4.2%, p = 0.001). CONCLUSION: Intraoperative transoesophageal echocordiography during elective CABG allows one to control difficult stages of the surgical procedure and to select patients at risk of perioperative haemodynamic deterioration. Our study supports the routine application of IOTEE in elective CABG.
Subject(s)
Cardiopulmonary Bypass , Coronary Artery Bypass/methods , Echocardiography, Transesophageal , Ventricular Dysfunction, Left/diagnostic imaging , Aged , Female , Hemodynamics , Humans , Male , Monitoring, Intraoperative , Stroke Volume , Treatment Outcome , Ventricular Dysfunction, Left/physiopathologyABSTRACT
We describe a case of 65-year-old woman with unstable angina, who was admitted to our institution. Physical examination revealed the presence of a systolic cardiac murmur. Transthoracic echocardiography showed subvalvular aortic stenosis. The patient underwent successful coronary artery by-pass surgery and myectomy surgery. Diagnosis and treatment of subvalvular stenosis coexistent with coronary artery disease are discussed.
