RESUMO
A 49-year-old man was transferred to our hospital by ambulance due to blunt chest trauma sustained in a car accident. Echocardiography and enhanced computed tomography showed hemopericardium without other vital organ damage. Emergent surgery was performed under strong suspicion of traumatic cardiac rupture. Careful inspection showed a rupture of the right upper pulmonary vein at the junction of the left atrium, a laceration of the inferior vena cava, and a left-side pericardium rupture, and they were repaired with running 4-0 polypropylene suture. Postoperative hemodynamics were stable. The patient was discharged ambulatory on postoperative day 15.
Assuntos
Átrios do Coração/lesões , Veias Pulmonares/lesões , Traumatismos Torácicos/complicações , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/complicações , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/fisiopatologia , Tomografia Computadorizada por Raios X , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/fisiopatologia , Ferimentos não Penetrantes/cirurgiaRESUMO
We report herein a case of subdural hematoma following aortic root and subtotal aortic arch replacement with selective cerebral perfusion in a 78-year-old woman. Her level of consciousness gradually deteriorated on postoperative day (POD) 2. Subdural hematoma, including fresh bleeding in bilateral frontal and parietal regions, was detected on brain computed tomography (CT) on POD 3. No head injury had been sustained previously. As the brain was not under pressure and disturbance of consciousness improved the next day, she was observed conservatively with follow-up brain CT. The subdural hematoma disappeared within about 2 months. The patient recovered completely and was discharged without sequelae.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Hematoma Subdural/etiologia , Idoso , Aneurisma da Aorta Torácica/fisiopatologia , Ponte Cardiopulmonar , Circulação Cerebrovascular , Feminino , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/terapia , Humanos , Perfusão , Tomografia Computadorizada por Raios XRESUMO
A 45-year old man was admitted to our hospital with chest pain occurring suddenly upon exercise and disappearing with rest within several minutes. A continuous murmur was heard at the upper sternum border. Conventional electrocardiography showed no evidence of myocardial ischemia. Coronary angiography and cardiac catheterization demonstrated a fistula originating from the left coronary artery to the pulmonary artery with an aneurysm 2 cm in size, and Qp/Qs 1.08. Treadmill exercise testing showed no ST-T change at the maximum heart rate of 160 beats/min. Stress/Rest (99m)Technetium-MIBI single-photon emission computed tomography (SPECT) and 123I-15-(p-iodo-phenyl)-3,R,S-methylpentadecanoic acid (BMIPP) scintigraphy were performed to evaluate myocardial ischemia and ischemia was identified at the perfusion area of the left anterior descending artery. From these results, the patient was diagnosed as having a coronary artery to pulmonary artery fistula with myocardial ischemia. Consequently, surgical treatment was chosen under cardiopulmonary bypass. The determination of a surgical indication using stress/rest (99m)Tc-MIBI SPECT and BMIPP scintigraphy is useful in cases showing normal TMT, such as this case.
