Texas Heart Institute journal
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A 45-year-old man underwent repair of a congenital bicuspid aortic valve and complex aortic-root aneurysm with an aortic-root xenograft. A CentriMag® left ventricular assist device was implanted for cardiac support and was subsequently replaced with a HeartMate II® left ventricular assist device. ⋯ The patient underwent thrombus removal, oversewing of the prosthetic valve, and bypass of the left anterior descending coronary artery. This case emphasizes the hazard of bypassing a failed left ventricle with a cardiac assist device after aortic valve replacement, even with a bioprosthesis.
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Biography Historical Article
Reflections on a heart surgery career with insights for Western-trained medical specialists in developing countries.
Herein, I describe my experience (spanning 40 years) in helping to develop the specialty of cardiovascular surgery in Syria. Especially in the early years, the challenges were daunting. We initially performed thoracic, vascular, and closed-heart operations while dealing with inadequate facilities, bureaucratic delays, and poorly qualified personnel. ⋯ We have 12 cardiac surgeons, 10 surgical residents, a formal 6-year surgical residency program, a pediatric cardiac unit, an annual caseload of 1,600, and plans to double our productivity in 2 years. The tribulations of establishing sophisticated surgical programs in a developing country are offset by the variety of clinicopathologic conditions that are encountered, and even more so by the psychological rewards of overcoming adversity and serving a population in need. This account may prove to be insightful for Western-trained physicians who seek to develop specialized medical care in emerging societies.
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Herein, we describe late complications after the transcatheter device closure of a patent foramen ovale in a patient with migraine headaches. The clinical presentation included acute neurologic symptoms and new-onset atrial fibrillation. ⋯ Despite complete surgical closure and the termination of atrial fibrillation, the patient continued to experience neurologic events. Although transcatheter patent foramen ovale closure is associated with low complication rates, a careful risk-benefit evaluation is warranted in view of the potentially severe complications and the current lack of robust pathophysiologic and clinical trial data to support this therapy in the treatment of migraine headaches.
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Candida albicans infections after prosthetic graft implantation due to acute aortic dissection are rare. A combination of surgical resection and lifelong antifungal drug therapy is the gold standard for treatment of aortic graft infection, yet surgical interventions are associated with high mortality rates. Herein, we present the case of a 57-year-old man who presented with peripheral microembolism due to late-onset C. albicans infection of a prosthetic graft of the thoracic aorta, which was diagnosed by positron emission tomographic imaging. ⋯ During a follow-up of 500 days, he remained asymptomatic, with slightly elevated inflammatory markers. This case suggests that in some instances, particularly in patients with high operative risk, Candida prosthetic graft infection can be managed conservatively with antifungal therapy alone. However, such an approach should be applied with caution and necessitates close follow-up on a long-term basis.
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Case Reports
Hypotension due to dynamic left ventricular outflow tract obstruction after percutaneous coronary intervention.
Persistent hypotension subsequent to percutaneous coronary intervention is attributed to access-site bleeding, re-infarction, or mechanical complications either of myocardial infarction or of the procedure itself (for example, pericardial tamponade). Dynamic left ventricular outflow tract obstruction after an uncomplicated percutaneous coronary intervention is an unusual, and to our knowledge not previously reported, complication that manifests itself as hypotension refractory to the usual therapy with inotropic agents. We discuss the clinical course, pathophysiology, diagnosis, and management of hypotension due to left ventricular outflow tract obstruction after percutaneous coronary intervention. Early recognition and accurate diagnosis that determines appropriate therapy will improve the patient's prospects.