RESUMEN
It is important to detect anatomic variants of the supraaortic trunks prior to cardiovascular surgery in order to adjust the surgical technique. We report here, an anatomic variant that was not described previously, detected on a chest multidetector CT and confirmed during surgery. This variant consists of a left innominate artery, arising from the ascending aorta before the right subclavian and common carotid arteries that arise separately from the aortic arch. It is important to notice the absence of associated cardiovascular malformations. We formulate a possible explanation of the described variant through an embryologic study of the vasculogenesis.
Asunto(s)
Aorta/anomalías , Tronco Braquiocefálico/anomalías , Anciano , Aorta Torácica/anomalías , Humanos , Masculino , Tomografía Computarizada por Rayos X , Procedimientos Quirúrgicos VascularesRESUMEN
BACKGROUND: Great saphenous vein is one of the most used grafts in cardiovascular surgery. There is little amount of data in the medical literature describing dimensions of this vein. This series describes dimensions of the great saphenous vein in a coronary population and their variations. PATIENTS AND METHODS: Retrospective series of patients admitted to the cardiovascular surgery department of Hotel-Dieu de France Hospital - Beirut, between January 2003 and June 2006 for elective coronary artery bypass grafting and having a preoperative Doppler ultrasound of the saphenous veins according to a standardized protocol. Great saphenous vein dimensions were analyzed with regard to patients' characteristics using multivariable analysis of variance. RESULTS: Four hundred and two subjects were included with a mean age 64.4+/-9.3 years and a mean body mass index 27.9+/-4.5 kg/m(2). Women presented 22.6% of the series. Great saphenous vein dimensions' variations according to gender were significant (Multivariate Pillay trace=0.001) below the knee. Dimensions' variations were also significant as function of body mass index (P=0.001) and body surface (P=0.001). Age and cardiovascular risk factors did not influence GSV diameters. CONCLUSION: This series allowed constructing reference tables of the great saphenous vein segmental diameters in patients admitted for coronary artery surgery. Female sex is associated with lower segmental diameters below the knee and body mass index and body surface are linearly associated with segmental diameters at all levels.
Asunto(s)
Enfermedad Coronaria/patología , Vena Safena/anatomía & histología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Vena Safena/patologíaRESUMEN
Pulmonary hypertension is a serious disorder, difficult to treat especially in the severe forms. The treatment consists mainly of calcium channel blockers, anti-coagulation, intravenous epoprostenol, inhaled nitric oxide and recent agents as bosentan and sildenafil. Sildenafil, a phosphodiesterase 5 specific inhibitor, has been largely evaluated in primary pulmonary hypertension, and in some cases of secondary pulmonary hypertension including parenchymal and thromboembolic diseases; it has not yet been evaluated in severe pulmonary hypertension with elevated pre-capillary resistance in operated mitral stenosis. We report the cases of two patients operated from mitral valve replacement for severe mitral stenosis with elevated pre-capillary resistance, where oral sildenafil, introduced empirically immediately after the surgical procedure at the dose of 50 mg/d, permitted a significant decrease in pulmonary pressures and resistances, allowing a rapid withdrawal of nitric oxide and reducing therefore hospitalization time in the intensive care unit. We think that this simple treatment, with or without association to nitric oxide, should be generalized to persistent pulmonary hypertension following cardiac surgery.
Asunto(s)
Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/tratamiento farmacológico , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/cirugía , Inhibidores de Fosfodiesterasa/uso terapéutico , Piperazinas/uso terapéutico , Sulfonas/uso terapéutico , Capilares , Femenino , Humanos , Persona de Mediana Edad , Cuidados Posoperatorios , Purinas/uso terapéutico , Índice de Severidad de la Enfermedad , Citrato de SildenafilAsunto(s)
Embolia por Colesterol/cirugía , Cardiopatías/cirugía , Anciano , Cristalización , Humanos , MasculinoAsunto(s)
Puente de Arteria Coronaria/efectos adversos , Paraplejía/etiología , Anciano , Humanos , MasculinoRESUMEN
The authors report an unusual case of left atrial myxoma in a 30-year-old woman, discovered after a recurrent stroke. This tumor was misdiagnosed earlier because of an exclusive neurologic symptomatology, a normal cardiac exam without any sign of mitral obstruction (unusual high implantation of the myxoma within the roof of the left atrium), and the lack of doing an echocardiography which should be systematically done after an ischemic stroke, even if its etiology seems to be evident. Surgical resection of the tumor led to prevent further myxomatous emboli, but unfortunately, the patient keeps severe neurological sequelae.
Asunto(s)
Atrios Cardíacos , Neoplasias Cardíacas/complicaciones , Embolia Intracraneal/etiología , Mixoma/complicaciones , Adulto , Diagnóstico Diferencial , Ecocardiografía , Femenino , Atrios Cardíacos/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Humanos , Embolia Intracraneal/diagnóstico por imagen , Mixoma/diagnóstico por imagen , RecurrenciaRESUMEN
Left ventricular aneurysm develop when rupture of the free ventricular wall is contained by the inflammatory surrounding tissues. These false aneurysms rupture secondarily and should be treated soon after diagnosis. The diagnosis is suggested by echocardiography and confirmed by cardiac catheterization. Immediate surgery is recommended, with good survival in most reports. The patient presented in this report had ruptured his left ventricular false aneurysm before diagnosis. He was operated and had a good initial postoperative course. He died later from a severe pulmonary infection.
Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Ecocardiografía , Aneurisma Cardíaco/diagnóstico por imagen , Rotura Cardíaca/diagnóstico por imagen , Anciano , Aneurisma Falso/cirugía , Resultado Fatal , Estudios de Seguimiento , Aneurisma Cardíaco/cirugía , Rotura Cardíaca/cirugía , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/cirugía , Humanos , MasculinoAsunto(s)
Estenosis Carotídea/diagnóstico por imagen , Ultrasonografía Doppler Dúplex/normas , Angiografía/normas , Velocidad del Flujo Sanguíneo , Arteria Carótida Interna , Estenosis Carotídea/fisiopatología , Humanos , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Between January 1993 and January 1995, seventy patients over 70 years of age underwent coronary artery revascularization and were retrospectively reviewed. The anesthetic protocole, the surgical technique and the intraoperative myocardial protection were similar for all patients. Fourteen patients (19.8%) suffered major postoperative complications: stroke (3 cases), myocardial infarction (5 cases), left ventricular failure with intraaortic counter-pulsation (2 cases), gastrointestinal hemorrhage (2 cases), respiratory failure (2 cases). Thirty patients (42.6%) had minor complications with no impact on survival or hospital stay. Hospital mortality was 7.1% (5 patients) and was caused by left ventricular failure (2 cases), stroke (1 case), gastrointestinal hemorrhage (1 case), respiratory failure (1 case). Mortality was found to be correlated with preoperative renal failure, peripheral vascular disease and concomitant carotid endarterectomy. Patients remained in the cardiac surgery unit for 60 hours. The mean length of hospital stay was 8.2 days. Follow-up from 1 to 24 months revealed NYHA angina class I-II in 85% of the patients. These results are similar to other studies. We conclude that coronary artery revascularization in the elderly yields good results, with fair mortality and morbidity rates.
Asunto(s)
Anciano , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Causas de Muerte , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
Vascular complications, mostly hematomas and false aneurysms, are rare after coronary angiography. Infectious problems are even less frequent and a mycotic aneurysm is an extremely rare complication. Our patient presented with a mycotic aneurysm of the external iliac artery following percutaneous transluminal coronary angioplasty.
Asunto(s)
Aneurisma Infectado/etiología , Angioplastia Coronaria con Balón/efectos adversos , Arteria Ilíaca , Adulto , Aneurisma Infectado/cirugía , Prótesis Vascular , Estudios de Seguimiento , Humanos , Arteria Ilíaca/cirugía , Masculino , Politetrafluoroetileno , Factores de TiempoRESUMEN
Cholesterol embolization sometimes occurs after invasive procedures involving manipulation of the aorta or its major branches, and less commonly occurs after thrombolytic therapy for acute myocardial infarction. Rarer still is spontaneous cholesterol embolization, a case of which we now report. Our patient experienced peripheral embolization, the origin of which was traced to the infrarenal aortic segment and the common iliac vessels. Aortoiliac reconstruction was successful; we believe that surgical management of this condition should be performed in selected cases.
Asunto(s)
Embolia por Colesterol/etiología , Pierna/irrigación sanguínea , Aorta Abdominal/cirugía , Embolia por Colesterol/cirugía , Humanos , Arteria Ilíaca/cirugía , Masculino , Persona de Mediana EdadAsunto(s)
Hemangiosarcoma/diagnóstico , Neoplasias Pulmonares/secundario , Neoplasias Ováricas/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Resultado Fatal , Femenino , Hemangiosarcoma/tratamiento farmacológico , Hemangiosarcoma/patología , Humanos , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patologíaRESUMEN
Embolization of cholesterol crystals from atheromatous plaques is a rare entity most often seen after invasive procedures involving manipulation of the aorta. Spontaneous CE has been reported in very rare cases. Peripheral signs include livedo reticularis, muscle pain and palpable pulses. Depending on the site of the responsible plaque, emboli may involve visceral organs and produce a systemic illness. Diagnosis is confirmed using skin, muscle and/or renal biopsies. Surgery is recommended when the atheromatous disease is localized to a unique segment which can be replaced.
Asunto(s)
Embolia por Colesterol , Aortografía , Biopsia , Prótesis Vascular , Embolia por Colesterol/complicaciones , Embolia por Colesterol/diagnóstico , Embolia por Colesterol/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Acute traumatic rupture of the thoracic aorta due to blunt trauma is a relatively common injury after deceleration accidents. However, only one fifth of these patients survive to reach medical facilities. The limiting factor to successful management is early diagnosis and prompt treatment. A case of acute traumatic rupture of the descending aorta due to blunt trauma is presented. Diagnostic and management modalities are discussed.
Asunto(s)
Aorta Torácica/lesiones , Rotura de la Aorta/etiología , Heridas no Penetrantes , Accidentes por Caídas , Adulto , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/cirugía , Prótesis Vascular , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Following inhalation of cocaine two young men developed haemoptysis associated with dyspnoea. One of these patients had severe clinical symptoms. There was blood eosinophilia, and haemosiderin was found in the macrophages that were present in the fibroscopic alveolar lavage fluid. X-ray films of the chest showed bilateral micronodular opacities. The outcome was favourable after treatment with parenteral dexamethasone, oxygen therapy and mask-administered continuous positive pressure ventilation. The frequency of cocaine-induced alveolar haemorrhage is probably underestimated; the condition must be suspected in subjects who inhale cocaine and have haemoptysis, no matter how small.
Asunto(s)
Cocaína/efectos adversos , Hemorragia/inducido químicamente , Enfermedades Pulmonares/inducido químicamente , Administración por Inhalación , Adolescente , Adulto , Cocaína/administración & dosificación , Terapia Combinada , Dexametasona/uso terapéutico , Hemorragia/terapia , Humanos , Enfermedades Pulmonares/terapia , Masculino , Terapia por Inhalación de Oxígeno , Respiración Artificial , Trastornos Relacionados con SustanciasRESUMEN
Excision of a myxoma involving the tricuspid valve often necessitates tricuspid valve replacement or a less than optimal margin of resection. We report a successful tricuspid valve repair after en bloc resection of a myxoma involving the septal leaflet of the tricuspid valve.
Asunto(s)
Neoplasias Cardíacas/cirugía , Mixoma/cirugía , Válvula Tricúspide/cirugía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Preliminary experimental studies in our laboratory have shown that autologous pericardium treated with glutaraldehyde prevents late deterioration and calcification of the tissue. For this reason, glutaraldehyde-treated autologous pericardium has been used in a series of 64 patients who underwent operations for leaflet extension of the mitral valve between 1980 and 1989. Ages ranged from 2.5 to 60 years (mean 19 +/- 15). The causes of mitral valve insufficiency were rheumatic fever (69%), bacterial endocarditis (17%), congenital (8%), endomyocardial fibrosis (4.5%), and trauma (1.5%). The autologous tissue was fixed in a 0.62% glutaraldehyde solution for 15 minutes and rinsed in saline for an additional 15 minutes. Patching techniques varied depending on the site and the extent of the lesion. Associated mitral valve repair techniques (Carpentier's techniques) were mandatory in all patients. The period of follow-up extended from 6 months to 9 years (mean 3.1 +/- 2.5 years). There were no operative deaths in this series, and there was one late death (2%). In the six patients (12%) who underwent reoperation, there has been no case of calcification of the pericardial patch. Postoperative mitral valve function was assessed by bidimensional color Doppler echocardiographic techniques. Mitral valve insufficiency was trivial or absent in 80% of the patients. This experience permits us to conclude that leaflet extension is a simple and safe technique in valve reconstruction, allowing repair of mitral valves that otherwise would need to be replaced. It permits use of an adult-size prosthetic ring in children. Glutaraldehyde-treated autologous pericardium is the material of choice for this type of repair.
Asunto(s)
Bioprótesis , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Pericardio/trasplante , Adolescente , Adulto , Niño , Preescolar , Femenino , Estudios de Seguimiento , Glutaral/farmacología , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Pericardio/efectos de los fármacos , Complicaciones Posoperatorias/epidemiología , Reoperación , Conservación de Tejido/métodos , UltrasonografíaRESUMEN
Mitral valve replacement in patients with an extensively calcified mitral annulus is associated with an increased risk of ventricular rupture. Until now techniques of mitral valve repair have not been applied to patients with a heavily calcified mitral valve annulus. We present 12 patients who underwent extensive decalcification of the annulus with subsequent mitral valve repair between 1987 and 1990. Ages ranged from 11 to 78 years; 6 patients were in New York Heart Association functional class II, 4 were in class III, and 2 were in class IV. All patients had varying degrees of mitral insufficiency. There were no deaths, reoperations, or thromboembolic events. Postoperative echocardiography revealed minimal residual mitral insufficiency in only 2 of 12 patients. All patients are currently in New York Heart Association class I or II. We believe mitral valve repair can be done safely on patients with an extensively calcified mitral annulus, thus avoiding the risks of left ventricular rupture, thromboembolic events, and hemorrhagic complications associated with mitral valve replacement.
Asunto(s)
Calcinosis/cirugía , Estenosis de la Válvula Mitral/cirugía , Adolescente , Adulto , Anciano , Niño , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/etiología , Complicaciones PosoperatoriasRESUMEN
The aim of this study was to determine the specific conditions and pitfalls of immediate assessment of the reconstructed mitral valve in open chest patients. Sixty-two patients had a mitral reconstruction controlled by transoesophageal echocardiography and colour Doppler (TEE) from the moment when cardiac activity restarted under extracorporeal circulation (ECC), until complete rewarming of the patient and weaning off the by-pass. The following conditions altered the imaging quality: (1) dried probe in the oesophagus or air bubbles, (2) non-aspirated air from the stomach, (3) small or empty left atria, (4) invagination of the left atrial appendage, (5) trapped air in the posterior pericardium, (6) spontaneous contrast. Transient mitral regurgitation disappeared completely in 12/62 patients: five had temporary impairment of LV function, two had reduced filling of the heart, one had left ventricular outflow obstruction exacerbated by isoproterenol and nitroglycerin, two had ventricular ectopic rhythms, and two epicardial pacing. Only one of the 62 patients had persistent significant MR which required a second run of ECC. We conclude that mitral regurgitation after mitral valve repair is closely related to the quality of LV function. A decision to reoperate should eliminate the possible pitfalls, and take into consideration the specific conditions of immediate postoperative cardiac function.
Asunto(s)
Ecocardiografía Doppler/métodos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Monitoreo Intraoperatorio/métodos , Humanos , Insuficiencia de la Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/cirugía , Función Ventricular IzquierdaRESUMEN
From 1969 to 1985, mitral valve repairs using Carpentier's technique were performed for acquired mitral valve incompetence. 72 patients required a reoperation 3 days to 13 years later (mean 5 +/- 3.5 years). The reoperation rate risk was dependent upon the etiology: Barlow 0.6 +/- 0.2% patient year, fibro-elastic deficiency 0.7 +/- 0.3, endocarditis 1.7% Rheumatic disease 4.6 +/- 1.4%. The risk of reoperation in Rheumatic disease is significantly higher (p less than 0.05) than in degenerative disease. The causes of failures could be categorized into two groups according to whether they are surgeon related or valve related: Group I, Prosthetic ring dehiscence or malposition 15%, anulus dilatation (when no ring was implanted) 4%, triangular resection of the anterior leaflet 4% residual prolapse 8.3%. Group II, Recurrent prolapse 16.6% valve stenosis 17%, leaflet retraction 35%. Failures in Group I can be reduced with "increased" experience as opposed to group II. At reoperation valve repair was possible in 15.3% of the cases whereas valve replacement was necessary in 84.7% with an overall operative mortality of 1.4%. We conclude that mitral valve repair in acquired mitral incompetence carries out a small risk of reoperation. Most of the repair failures are surgeon related in degenerative disease and valve related in rheumatic disease.