RESUMEN
We report a case of pneumopericardium occuring after cardiac surgery. Pneumopericardium is a rare condition; trauma is the most frequent etiology. Nontraumatic causes include fistulae in relationship with the bronchial tree or oesophagus and intrapericardial gazeous production due to bacterial pericarditis. Pericardiocentesis is indicated in case of air tamponade and local infection.
Asunto(s)
Neumopericardio/diagnóstico , Esternón/microbiología , Dehiscencia de la Herida Operatoria/complicaciones , Anciano , Puente de Arteria Coronaria/efectos adversos , Humanos , Masculino , Neumopericardio/etiología , Infecciones Estafilocócicas/complicaciones , Dehiscencia de la Herida Operatoria/microbiologíaRESUMEN
We report the case of a 81-year-old man presenting with stable exercise angina pectoris. The stress test is positive and the coronaro-angiographic evaluation demonstrates a coronary fistula between the left anterior descending (LAD) artery and the pulmonary artery trunk. The mid LAD presents a significant lesion after the origin of the fistula. A cardiac computed tomography is used before surgical treatment. Coronary artery fistulas are unusual congenital or acquired coronary artery abnormalities in which blood is shunt into a cardiac chamber, great vessel or other structure. Low-pressure structure is the most common site of drainage of the coronary fistula. The clinical presentation of coronary fistulas is mainly dependent on the severity of the left-to-right shunt. Various cardiac imaging modalities are used for diagnosis and anatomical exploration before surgical or percutaneous intervention if the closure of the fistula is indicated.
Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Humanos , Masculino , Cuidados PreoperatoriosRESUMEN
A case of fixed subvalvular aortic stenosis is reported. This clinical observation is the occasion to review the pathophysiology of this lesion and the last developments in the surgical treatment.
Asunto(s)
Estenosis Aórtica Subvalvular/fisiopatología , Adolescente , Estenosis Aórtica Subvalvular/diagnóstico por imagen , Ecocardiografía , Humanos , MasculinoRESUMEN
The routine use of arterial grafts in coronary surgery is facilitated by peroperative adjunction of antispasmodic drug to reduce the event of spasm. Diltiazem has been favoured in most clinical studies devoted to the radial artery graft. The aim of this study was to assess the efficacy of a spasm preventing protocol associating hydrostatic dilation of the graft with a diluted solution of papaverine and nicardipine infusion, starting preoperatively and continued postoperatively in i.v. and per os forms. Between September 1996 and March 1997, a consecutive series of 50 patients underwent myocardial revascularization using the radial artery. The radial artery was prepared by hydrostatic dilation with papaverine (1%) and nicardipine was administrated at 0.25 microgram/kg/min and titrated according to the arterial systemic pressure. Operative mortality was 4% (sepsis). There was no evidence of perioperative MI nor hypoperfusion syndrome. Mean CKMB level at 18 hours was 36 micrograms/l. No ischaemic anomalies of the ECG were detected. Angiography performed in the last 20 patients showed a 98% (51/52) permeability rate for all graft; 19/20 radial grafts (95%) were patent. One radial graft presented a 50% stenosis at the proximal anastomosis, and another a moderate spasm (40%) in the middle part of the conduit. This study confirms that the radial artery conduit can be used with satisfactory results for routine coronary artery bypass. The use of nicardipine allows the control the vasoreactivity of the radial graft without totally obviating at least angiographic spasm. This drug is easy to titrate, and well tolerated in association to beta-blockers in the routine perioperative management of the coronary patients.
Asunto(s)
Puente de Arteria Coronaria/métodos , Nicardipino/uso terapéutico , Vasodilatadores/uso terapéutico , Angiografía Coronaria , Vasoespasmo Coronario/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Papaverina/uso terapéutico , Arteria Radial/cirugíaRESUMEN
The observation of four clinical cases of Shone's complex, two of them presenting first with predominant coarctation of the aorta, prompted us to review the pertinent literature. Patients with multiobstructive lesions of the left heart, including Shone's complex, represent a surgical challenge where the adequate management of mitral valve anomalies, subaortic stenosis, and coarctation constitutes the key prognostic factor for satisfactory mid-term outcome.
Asunto(s)
Coartación Aórtica/etiología , Síndrome del Corazón Izquierdo Hipoplásico/complicaciones , Válvula Mitral/anomalías , Niño , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Masculino , Válvula Mitral/cirugía , Pronóstico , Factores de RiesgoRESUMEN
A case of complete arterial revascularization using both mammary arteries and the left radial artery is reported. The operation was done on the beating heart with the adjunct of a Y graft owing to a severely calcified ascending aorta. This observation is the occasion to review the basic principles of beating heart surgery.
Asunto(s)
Aorta/patología , Arterias Mamarias/trasplante , Revascularización Miocárdica/métodos , Arteria Radial/trasplante , Aorta/cirugía , Calcinosis , HumanosRESUMEN
We report the case of a patient who developed an evolutive chronic aortic dissection after ascending aorta replacement for acute type A aortic dissection. Owing to the development of severe aortic regurgitation, aortic root pseudoaneurysm and aneurysmal dilatation of the arch and descending aorta, reoperation was adviced. Reoperation included Cabrol modification of the Bentall operation and aortic arch replacement with elephant trunk performed under deep hypothermic circulatory arrest. The incidence of late aneurysmal formation in type 1 aortic dissection has been reported to be 30%. Close postoperative follow-up of the aortic diameter is necessary to detect a critical dilatation and to permit elective reoperation.
Asunto(s)
Aorta Torácica/anomalías , Aorta Torácica/cirugía , Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Aneurisma Falso , Bioprótesis , Enfermedad Crónica , Humanos , Masculino , Persona de Mediana Edad , ReoperaciónAsunto(s)
Puente de Arteria Coronaria/efectos adversos , Oclusión de Injerto Vascular/etiología , Arterias Mamarias/lesiones , Arterias Mamarias/trasplante , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/cirugía , Oclusión de Injerto Vascular/cirugía , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Pronóstico , Reoperación , Medición de RiesgoRESUMEN
Coarctation of the aorta presents with characteristic and distinctive physical findings. Because delayed detection of severe forms may be fatal and late detection of classic forms is associated with premature cardiovascular disease in adult life, early detection and treatment is important. However, in our survey a few patients in whom aortic coarctation was ultimately diagnosed had the correct diagnosis made by the referring physician. Our survey suggests that an incomplete physical examination explains the diagnostic failure. This survey reaffirms the need for palpation of pulses and proper measurement of blood pressure in all infants and children to facilitate early recognition of coarctation.
Asunto(s)
Coartación Aórtica/diagnóstico , Presión Sanguínea , Niño , Preescolar , Diagnóstico Diferencial , Humanos , Lactante , Recién Nacido , Examen Físico , Pulso ArterialRESUMEN
The pulmonary autograft operation consists of an aortic replacement using the autologous pulmonary valve. The pulmonary valve is substituted by a cryopreserved pulmonary homograft. This operation is in fact a delicate double valve replacement whose benefits are linked to the viability of the new aortic substitute. The pulmonary autograft has superb hemodynamic features and very low thrombogenicity. The report of a selected observation offers the occasion of defining the current indications of this operation in aortic valve surgery.
Asunto(s)
Válvula Aórtica/cirugía , Implantación de Prótesis Vascular/métodos , Enfermedades de las Válvulas Cardíacas/cirugía , Válvula Pulmonar/trasplante , Válvula Aórtica/patología , Criopreservación , Humanos , Trasplante AutólogoRESUMEN
Mitral valve repair has demonstrated its superiority over valve replacement. Mitral valve repair constitutes the optimal therapeutic option in case of degenerative dystrophic, rheumatic, congenital or ischemic mitral valve disease. These surgical techniques can also be successfully and advantageously applied in case of bacterial endocarditis or tumoral valvular disease. We report a case of staphylococcal endocarditis and another case of posterior leaflet fibroelastoma to show the place of conservative mitral surgery in these unusual indications.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Endocarditis Bacteriana/cirugía , Fibroma/cirugía , Neoplasias Cardíacas/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Infecciones Estafilocócicas/cirugía , Adulto , Procedimientos Quirúrgicos Cardíacos/instrumentación , Femenino , Fibroma/patología , Neoplasias Cardíacas/patología , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
We present a case of double aortic arch corrected by surgical interruption and full mobilization of the trachea and the esophagus. The vascular malformations of the supraaortic trunks, which form more or less complete vascular rings encircling the esophagus and the trachea, are reviewed. The different presentations of double aortic arch, aberrant subclavian arteries, and abnormal development of the pulmonary arteries are discussed.
Asunto(s)
Aorta Torácica/anomalías , Enfermedades de la Aorta/congénito , Arteria Pulmonar/anomalías , Arteria Subclavia/anomalías , Aorta Torácica/patología , Aorta Torácica/cirugía , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/cirugía , Niño , Esófago/irrigación sanguínea , Femenino , Humanos , Arteria Pulmonar/cirugía , Arteria Subclavia/cirugía , Tráquea/irrigación sanguíneaRESUMEN
Coffin-Lowry syndrome is an X-linked recessive syndrome of mental retardation, characteristic facies and skeletal anomalies. In one patient with the syndrome, we observed early recurrent episodes of congestive heart failure with intercurrent normalization and the late development of mitral insufficiency due to annular dilation and congenital abnormalities of the valve apparatus. This unusual course of cardiac involvement, the non-adaptation of the left ventricular contractility to the aggravation of the mitral insufficiency and the postoperative persistence of the ventricular dysfunction, underline the possible role of an associated primary myocardial disease. This clinical observation demonstrates clearly that a mitral valve malformation can occur in patients with the syndrome, but also the role of a dilated cardiomyopathy, which can be secondary to the mitral regurgitation, but is more likely a myocardial disorder occurring as part of the syndrome.
Asunto(s)
Anomalías Múltiples/diagnóstico , Cardiomiopatía Dilatada/diagnóstico , Enfermedades Genéticas Congénitas/diagnóstico , Insuficiencia de la Válvula Mitral/diagnóstico , Anomalías Múltiples/genética , Cardiomiopatía Dilatada/cirugía , Cardiomiopatía Dilatada/terapia , Preescolar , Enfermedades Genéticas Congénitas/terapia , Humanos , Masculino , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/terapia , Fenotipo , Mutación Puntual , Proteínas Quinasas S6 Ribosómicas/genética , Síndrome , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/terapiaRESUMEN
OBJECTIVE: Evaluation of the results obtained in the management of congenital heart diseases in Liège. MATERIAL AND METHODS: We evaluated the results, the mortality and the morbidity of diagnostic and interventional cardiac catheterization, and of the cardiac surgery in the 123 cardiac children who were referred to us during the three first years of operation of our medico-surgical team. RESULTS: 89 children underwent a catheterization, including 12 therapeutic interventions, whereas 68 were operated. In the two domains, the results are completely comparable with those of the established centers. CONCLUSIONS: The widening of the activity of paediatric cardiology and the creation of an activity of pediatric cardiac surgery in Liège appeared important to us for the quality of management of the cardiac children. This goal could be reached only if our results were comparable with those of the literature. The bet seems to be held. The ultimate objective is to contribute by an adequate policy of management to the quality of life and the health of the cardiac children.
Asunto(s)
Cardiopatías Congénitas/terapia , Adolescente , Bélgica/epidemiología , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/mortalidad , Cateterismo Cardíaco/estadística & datos numéricos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Niño , Preescolar , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Calidad de la Atención de Salud , Reoperación , Tasa de SupervivenciaRESUMEN
In general surgery, the aim of new techniques is to reduce the length of the skin incisions and/or to use endoscopic or laparoscopic instruments. The cardiac surgery makes not an exception. During the last two years, the material and the techniques are following a progressive evolution. Concerning the cardiac surgery of the adult, three techniques which are the mini-incision or thoracotomy and the surgery of the port-access are in full evolution. We describe the advantages and disadvantages.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos/instrumentación , Puente de Arteria Coronaria , Procedimientos Quirúrgicos Dermatologicos , Endoscopía , Circulación Extracorporea , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Laparoscopía , Microcirugia/instrumentación , Microcirugia/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Esternón/cirugía , Toracoscopía , Toracotomía/métodosRESUMEN
The case of a 24-year-old woman with cor triatriatum sinister and a persistent left superior vena cava connected to the junction of the left upper pulmonary vein and left atrium is reported. A diagnosis of partial anomalous pulmonary venous return had been made and the patient underwent surgery. Inspection of the left atrium revealed a complex form of left triatrial heart. The general haemodynamics of the malformation are discussed, with particular emphasis on the features accounting for variation in the clinical presentation. This rare anomaly often remains undiagnosed before surgery and should be considered whenever obstruction of pulmonary venous flow above the mitral valve is not explained by pulmonary vein stenosis, mitral or mitral valve-linked abnormalities, atrial tumours or anomalous pulmonary venous drainage with high resistance to flow.