General thoracic and cardiovascular surgery
-
Gen Thorac Cardiovasc Surg · Nov 2008
Case ReportsSurgical management and treatment of a traumatic right atrial rupture.
We have treated three patients with blunt traumatic right atrial rupture, all of whom survived after an emergent cardiac repair without cardiopulmonary bypass. Cardiac tamponade was seen in two of the three cases on ultrasonographic cardiography (UCG). ⋯ Some patients with a right atrial rupture respond to initial volume resuscitation. Suspecting some cardiac injuries in patients with traumatic pericardial effusion on UCG, a patient with a right atrial rupture can survive with a high probability, without the use of cardiopulmonary bypass.
-
Gen Thorac Cardiovasc Surg · Nov 2008
Case ReportsThrombotic occlusion of Blalock-Taussig shunt in a patient with unnoticed protein C deficiency.
A 6-month-old girl with a diagnosis of double-outlet right ventricle and pulmonary stenosis had a left modified Blalock-Taussig shunt. Chest computed tomography (CT) performed on postoperative day 11 showed good patency of the shunt. However, on postoperative day 16, oxygen saturation suddenly dropped below 40%, and chest CT showed thrombotic occlusion of the shunt. ⋯ Examination of coagulation factors revealed low levels of both the amount and activity of protein C (27% and 31%, respectively). Diagnosis of heterozygous hereditary protein C deficiency was made, and the patient was placed on warfarin. She is currently in good condition.
-
Gen Thorac Cardiovasc Surg · Sep 2008
Case ReportsHybrid myocardial revascularization complicated by delayed anastomotic bleeding.
We present a case of hybrid coronary revascularization complicated by delayed bleeding from an anastomotic site. Anastomosis of the left internal mammary artery to the left anterior descending coronary artery was successfully performed via a lateral anterior small thoracotomy. Scheduled subsequent percutaneous coronary intervention of residual stenoses was successfully performed 13 days after the surgery, but cardiac tamponade due to anastomotic site dehiscence was disclosed soon after the percutaneous procedure. We discuss the causation of the delayed bleeding that occurred after the hybrid coronary revascularization.
-
Gen Thorac Cardiovasc Surg · Aug 2008
Case ReportsExtracardiac aneurysm of the interleaflet triangle above the aortic-mitral curtain due to infective endocarditis of the bicuspid aortic valve.
A previously healthy 33-year-old man presented to our hospital with fever, left hemiparalysis, motor aphasia, and clouding of consciousness. Echocardiography revealed vegetation attached to the bicuspid aortic valve as well as an aneurysm originating below the annulus. Head computed tomography showed multiple infarctions. ⋯ Operative findings showed an extracardiac aneurysm of the interleaflet triangle above the aortic-mitral curtain. Because there was no sign of active inflammation, the orifice was closed with an autologous pericardial patch, and the aortic valve was replaced with a mechanical valve. We should be aware of extracardiac aneurysm of the interleaflet triangle when dealing with infective endocarditis, which should be operated as soon as it is found because of the risk for extracardiac aneurysmal rupture.
-
Gen Thorac Cardiovasc Surg · Jul 2008
Case ReportsSuccessful management of postoperative acute respiratory distress syndrome in a patient with lung cancer.
Acute respiratory distress syndrome after pulmonary resection for lung cancer frequently has a lethal outcome. Treatment with a combination therapy of neutrophil elastase inhibitor and steroid administration was used to achieve good control, without impairing lung function, in a patient with postoperative acute respiratory distress syndrome. ⋯ After 10 postoperative days, he had acute respiratory distress syndrome. He was given a corticosteroid and a neutrophil elastase inhibitor, which resulted in rapid improvement without lung dysfunction.