J Cardiovasc Surg
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Case Reports
Membranous obstruction of the inferior vena cava and Budd-Chiari syndrome. Report of a case.
Membranous obstruction of the inferior vena cava (MOIVC) is a rare, congenital or acquired, cause of Budd-Chiari syndrome leading to hepatocellular carcinoma in 20 to 40% of the patients. It has a very poor prognosis when treated medically and balloon angioplasty (PTA) represents, nowadays, the treatment of choice, having no mortality or significant morbidity with follow-up as long as 5 years; transatrial membranotomy, direct reconstruction of IVC and bypass surgery are alternative techniques when PTA is not feasible. ⋯ A successful inferior vena cava-right atrium PTFE bypass, with a 3.5-year follow-up, was performed. This surgical approach is a valuable alternative to transatrial membranotomy and direct reconstruction of the IVC.
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We describe a simple technique to prevent the lower limb ischemia during femoral veno-arterial cardiopulmonary support (CPS). ⋯ Active perfusion through a 14-gauge Teflon catheter downstream to the ipsilateral SFA is effective in preventing lower limb ischemia during prolonged femoral veno-arterial CPS after cardiac surgery.
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Late cardiac tamponade after open heart surgery is a relatively uncommon, but potentially serious complication. We retrospectively analyzed 14 patients who had posterior cardiac tamponade 13 to 210 days after open heart surgery. ⋯ 2-D echocardiography guid pericardiocentesis through left anterior axillary line was found to be a useful, safe, and simple technique. It can be used as an alternative treatment to surgical pericardiotomy for posterior cardiac tamponade after open heart surgery.
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We hypothesized that the relationship between oxygen delivery (DO2) and oxygen consumption (VO2) in patients undergoing cardiopulmonary bypass (CPB) may differ from the normal physiologic state because of oxygen debts acquired during CPB. Blood gas analysis and hemodynamic parameters were repeatedly measured for determination of DO2 and VO2 in 40 patients undergoing CPB every 8 hours during the first 48 hours postoperatively. Twenty patients of acute myocardial infarction (AMI) also were studied in the same protocol as controls. ⋯ However, such supply-dependent oxygen consumption was not observed in the AMI patients. Perioperative parameters which had a significant relationship with oxygen extraction rate (VO2/DO2 x 100) were Hb concentration, cardiac index, systemic vascular resistance, age of the patients, duration of CPB, SaO2 and SvO2. These results suggest that patients undergoing CPB need a much higher oxygen supply to recover from the oxygen debt during open heart surgery.
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Thirty four children with blunt thoracic trauma were treated at the university hospital, Trabzon. Eighteen of them were sustained in motor vehicle accidents, 14 were falls and two were a result of miscellaneous causes. Rib fracture developed in 16 patients and pulmonary contusion occurred in 18 patients. ⋯ Complications developed in five patients. Four patients were lost due to multiple system injuries. In this study, the injury patterns, complications and mortality of blunt thoracic injuries were discussed.