The heart surgery forum
-
The heart surgery forum · Jan 2008
Case ReportsA complex case of congenital cardiac anomaly: pulmonary atresia and ventricular septal defect associated with major aortopulmonary collaterals.
Pulmonary atresia and ventricular septal defect associated with major aortopulmonary collaterals (MAPCAs) is a rare, complex, and heterogeneous congenital cardiac anomaly. The majority of untreated patients present with severe congestive heart failure and respiratory distress in the first decade of life. We describe a 15-year-old cyanotic boy, both of whose pulmonary arteries arise from the arcus aorta via patent ductus arteriosus. In addition to this anomaly, the patient has MAPCAs originating from the descending aorta that perfuse the right upper lobe of the lung, a persistent superior vena cava, an aberrant right subclavian artery, pulmonary atresia, and ventricular septal defect.
-
The heart surgery forum · Jan 2008
Reconstruction of chronic aseptic sternal pseudoarthrosis after median sternotomy: initial experience with the Ley prosthesis.
It has previously been reported that the Ley prosthesis, a 0.5-mm-thick titanium alloy plate designed for reconstruction and stabilization of the unstable sternotomy, leads to shorter hospital stay and reduces the need for further surgical procedures in patients with postoperative mediastinitis after open heart surgery. We report our initial experience with the Ley prosthesis in patients with chronic aseptic sternotomy dehiscence. The study included 6 male patients (age 42-80 years) with opiate-derivate-dependent intractable pain and significantly reduced quality of life caused by noninfected sternal pseudoarthrosis and unstable sternotomy with large sternal bone tissue deficit. ⋯ One patient who received a bone transplant developed wound infection, and the prosthesis was removed 5 weeks after implantation. At 6-month follow-up all sternotomies were found stable, and patients reported that pain had decreased and quality of life was significantly improved. Our results demonstrate that the Ley prosthesis can be safely and efficiently used for the reconstruction and stabilization of the sternum in patients with intractable pain caused by noninfected postoperative sternal dehiscence and large sternal bone tissue deficit.
-
The heart surgery forum · Jan 2008
Case ReportsEsophageal perforation after catheterization of the subclavian vein.
The insertion of a central venous catheter (CVC) via the subclavian vein is often associated with complications. We report a case in which a patient suffered an esophageal lesion with severe bleeding and a pneumothorax with mediastinal shift induced by the insertion of the dilator of a CVC. ⋯ The patient survived the complication. However, he died 1 week later from multiple organ failure not associated with the CVC insertion.
-
The heart surgery forum · Jan 2008
Case ReportsBullet embolism after gunshot injury: a case report.
We describe a case of gunshot injury presenting with cardiac tamponade in which a dummy bullet advanced through the aorta and caused embolization in the right renal interlobar artery after passing above the sternoclavicular joint and penetrating into the aorta. Emergency surgery with cardiopulmonary bypass was performed to repair the cardiac tamponade and aortic injury. ⋯ The procedure was successful, and the patient was discharged on postoperative day 8. In gunshot injuries, if all entrance points are not paired with exit points, the possibility of an organ or extremity embolism caused by the presence of a bullet or shrapnel fragments in circulation should be borne in mind, although such occurrences are rare.
-
The heart surgery forum · Jan 2008
Case ReportsIatrogenic aortic dissection during right coronary artery stenting.
Aortic dissection limited to one sinus of Valsalva has been observed as an iatrogenic complication during coronary intervention. We report on a 65-year-old female patient who had a diagnosis of acute inferior myocardial infarction and experienced type A aortic dissection during stenting of the right coronary artery (RCA). Dissection was seen during aortic injection. ⋯ An opening was seen intraoperatively in the right sinus of Valsalva. The opening was immediately and successfully sutured. The RCA was bypassed.