RESUMO
BACKGROUND: Cardiac surgery for myelodysplastic syndrome (MDS) patients is challenging because anemia and neutropenia develop as a result of the syndrome, leading to infection and bleeding tendency during surgery. We report the case of minimally invasive mitral valve repair via a right mini-thoracotomy and perioperative use of granulocyte colony-stimulating factor (G-CSF) in a patient with MDS. CASE PRESENTATION: A 77-year-old man with myelodysplastic syndrome (MDS) was referred for surgical treatment for mitral valve regurgitation and underwent a minimally invasive mitral valve repair via a right mini-thoracotomy (MICS mitral procedure). On admission, laboratory results showed a leukocyte count of 1500/µL and neutrophils at 190/µL. Prior to surgery, a subcutaneous injection of granulocyte colony-stimulating factor (G-CSF) was given, based on a diagnosis of MDS by a hematologist. The MICS-mitral procedure using artificial chordae and an annular ring prosthesis was completed without requiring re-exploration for bleeding. Postoperatively, a G-CSF injection was administered and transfusion was required. There was no infection complication and the postoperative course was uneventful. CONCLUSION: A MICS-mitral procedure may be an effective option for MR patients with MDS who require a mitral valve repair to avoid postoperative infection and reduce the incidence of perioperative transfusion.
Assuntos
Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Síndromes Mielodisplásicas/diagnóstico , Neutropenia/tratamento farmacológico , Assistência Perioperatória/métodos , Toracotomia/métodos , Idoso , Transfusão de Sangue , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/complicações , Síndromes Mielodisplásicas/complicações , Neutropenia/etiologia , Complicações Pós-Operatórias , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
An inferior mesenteric artery (IMA) aneurysm is the rarest among visceral artery aneurysms. A 69-year-old man was referred to our hospital with an asymptomatic IMA aneurysm associated with occlusion of the superior mesenteric artery (SMA) and celiac artery (CA). After revascularization of the SMA with an 8-mm expanded polytetrafluoroethylene (ePTFE) graft, the aneurysm was resected, and the IMA was reconstructed. The "jet disorder" phenomenon has been thought to cause an IMA aneurysm in the case of CA and SMA obstruction. We consider it better to revascularize not only an IMA but also an SMA or CA for preventing that phenomenon.
RESUMO
A 42-year-old Japanese man who had undergone amputation of the left leg below the knee because of Buerger disease required emergency thrombectomy 7 months later. He complained of acute abdominal pain after thrombectomy. At aortography the distal superior mesenteric artery and its branches were not well visualized. Emergency laparotomy was performed because of suspected intestinal ischemia, and the terminal ileum and cecum and part of the ascending colon were resected. In total, the patient underwent laparotomy four times. Histopathologic findings revealed that the arteries and veins of the resected small intestine were occluded with organized thrombi. Inflammatory cell infiltration was recognized mainly in the intima. These findings are compatible with Buerger disease.
