European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 1994
Case ReportsSuccessful surgical management for multiple cerebral mycotic aneurysms involving both carotid and vertebrobasilar systems in active infective endocarditis.
Mycotic aneurysm is usually found in the middle cerebral artery associated with infective endocarditis. Previous reports we have identified include only 4 cases of vertebrobasilar aneurysm. We report on a 29-year-old female who had multiple mycotic aneurysms involving both the carotid and vertebrobasilar systems complicated by intracranial hemorrhage with infective endocarditis, in whom staged operations, mitral valve replacement and craniotomies, were successfully performed.
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Eur J Cardiothorac Surg · Jan 1994
Randomized Controlled Trial Clinical TrialPre-operative aspirin decreases platelet aggregation and increases post-operative blood loss--a prospective, randomised, placebo controlled, double-blind clinical trial in 100 patients with chronic stable angina.
Aspirin has an established benefit in reducing the incidence of coronary events and vein graft occlusion. We have now assessed the risk of pre-operative aspirin in a prospective, randomised, double-blind clinical trial in 100 patients scheduled for elective coronary artery surgery. Any prescribed aspirin and non-steroidal anti-inflammatory drugs were discontinued 2 weeks pre-operatively and these were replaced by a randomly assigned tablet of either aspirin 300 mg daily or placebo taken until the day of surgery. ⋯ All patients survived to be discharged home (see Table). Aspirin decreases platelet aggregation to arachidonic acid and to collagen both pre- and post-operatively. The benefit of pre-operative aspirin has to be balanced against the risk of increasing post-operative blood loss, re-exploration for excessive bleeding and transfusion requirements.
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Clinical observation led us to believe that aprotinin fails to preserve haemostatic function in patients undergoing deep hypothermic perfusion with or without circulatory arrest. A retrospective study was made of blood loss in 80 consecutive acute Type A dissection patients before and during the aprotinin era (1987-1992). After 1988 all patients were cooled below 20 degrees C pending circulatory arrest. ⋯ We suggest that aprotinin inhibits the protease enzymes which maintain the fluid state of blood during hypothermic low flow and arrest states. Disseminated intravascular coagulation may consume platelets thereby predisposing to abnormal bleeding and potentially fatal thrombotic events. The use of aprotinin in profoundly hypothermic perfusion should be adopted cautiously.
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Eur J Cardiothorac Surg · Jan 1994
Case ReportsCardiac tamponade secondary to intrapericardial rupture of a hepatic amoebic abscess.
We report the case of a patient who underwent an emergency subxiphoid pericardiectomy with evacuation of 1700 cc of anchovy sauce-like fluid. On pericardial inspection a fistulous communication was seen with a cavity in the left hepatic lobe. ⋯ The hepatic cavity and pericardium were drained: bacteriological investigation of the fluid yielded entamoeba histolytica and chloroquine was administered. Apart from the rarity of the observation in western countries, we discuss surgical approaches in cases of unknown purulent pericardial effusions, stressing the possibility of achieving a good surgical result even with a minor surgical procedure such as subxiphoid pericardiectomy and drainage.
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Eur J Cardiothorac Surg · Jan 1994
Case ReportsStent-angioplasty of an anastomotic stenosis of the pulmonary artery after lung transplantation.
Anastomotic stenosis of the pulmonary artery after lung transplantation is a rare complication, which commonly necessitates surgical correction. Transesophageal Doppler sonography and pulmonary arteriogram are standard diagnostic means for visualization of venous and arterial anastomoses. Balloon dilatation combined with implantation of a vascular endoprosthesis was successfully used for treatment of severe anastomotic stenosis of the pulmonary artery after lung transplantation.