Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Aug 2008
Case ReportsMobile biatrial thrombus in a patient with mitral stenosis under heparin infusion.
A 58-year-old female patient with complaints of sudden presenting pain and pallor on her left foot was referred to our clinic for urgent embolectomy. On her cardiovascular examination there was an apical grade 2/6 systolic murmur and a grade 2/4 diastolic murmur. The presenting electrocardiography revealed atrial fibrillation with rapid ventricular response. ⋯ This study indicated a thrombus formation in the deep veins of the left leg. The origin of the right atrial thrombus was probably a snapped piece of thrombus from the calf deep-veins after the initiation of intravenous UF heparin. In summary, we have reported an extremely rare case of biatrial thrombus in a patient under UF heparin infusion.
-
Interact Cardiovasc Thorac Surg · Aug 2008
Hemiarch aortic replacement for acute type A dissection in a Marfan patient with twin pregnancy.
Type A aortic dissection is a high risk surgical emergency. Its occurrence during pregnancy represents an extremely high risk for death and sequelae for both the mother and the fetus. ⋯ She underwent cesarean delivery of male twins followed by repair of the ascending aorta and proximal arch using deep hypothermia and circulatory arrest. The mother and twin babies survived without sequelae and are alive at two years.
-
Interact Cardiovasc Thorac Surg · Aug 2008
Case ReportsA novel use of the implantable ventricular assist device for isolated right heart failure.
Isolated right heart failure after cardiac surgery is uncommon and the prognosis remains poor. Additionally, managements for these patients are difficult. Profound postcardiotomy right heart failure developed in a 45-year-old woman after aortic root replacement for critical aortic stenosis with small aortic root. ⋯ The patient was discharged from the hospital at 17 days after the RVAD implantation. After 79 days of support, right ventricular function had recovered, the fully rehabilitated patient was successfully weaned from the RVAD, and the RVAD was explanted. The patient has no recurrence of heart failure 668 days after RVAD explantation.
-
Interact Cardiovasc Thorac Surg · Aug 2008
Case ReportsCirculatory support with right ventricular assist device and intra-aortic balloon counterpulsation in patient with right ventricle failure after pulmonary embolectomy.
Severe pulmonary embolism may lead to acute right ventricular failure despite immediate surgical embolectomy, which is regarded as the treatment of choice after recent CABG surgery. We report a case of a patient with massive pulmonary thromboembolism which resulted in acute right ventricular failure following early surgical embolectomy. Pulmonary embolism developed two days after an elective off-pump CABG surgery. ⋯ After the completion of the embolectomy and failure to wean the patient from CPB, upon clinical signs of low cardiac output and akinetic right ventricle, the decision was made to support its function with a centrifugal pump. The substantial improvement of the right ventricular function observed in the next 24 h allowed weaning the patient from right ventricle support. In spite of hemodynamic recovery, the patient remained in a coma on discharge from the cardiac-surgical ICU after 18 days, and died 10 days later from systemic infection.
-
Interact Cardiovasc Thorac Surg · Aug 2008
Thrombocytopenia after aortic valve replacement with the Freedom Solo stentless bioprosthesis.
Stentless bioprostheses have been considered to achieve superior hemodynamics over stented bioprostheses for aortic valve replacement with improved long-term performance. We observed severe thrombocytopenia in patients who received the Sorin Freedom Solo aortic stentless pericardial bioprosthesis within the first days after implantation. Absolute and relative platelet counts within 2 weeks after implantation of either a stentless (Sorin Freedom Solo) or a stented (Sorin Mitroflow) bovine pericardial bioprosthesis were compared in a matched-pairs analysis in 40 patients. ⋯ No bleeding complications or other morbidity occurred. Attention should focus on the platelet count after implantation of the Freedom Solo bioprosthesis, especially in patients who are supposed to receive platelet inhibitors. However, the described phenomenon remains unexplained.