Texas Heart Institute journal
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A 36-year-old, otherwise-healthy woman with a 6-year history of progressive dysphagia underwent an esophagogram that revealed an oblique extrinsic defect with an inferior-to-superior (left-to-right) course consistent with an aberrant right subclavian artery. An aortogram confirmed the diagnosis of aberrant right subclavian artery. She underwent surgical repair, tolerated the procedure well, and was discharged home, symptom free, on postoperative day 3. We found that the right supraclavicular approach provides good exposure and avoids the morbidity of the classically described approach via a median sternotomy or thoracotomy.
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Case Reports
Pseudoaneurysm and aortobronchial fistula after aortic coarctation repair by patch aortoplasty.
Pseudoaneurysm and aortobronchial fistula are very rare complications of aortic coarctation repair by means of patch aortoplasty, and are usually fatal if not treated surgically. A 26-year-old man with recent-onset massive hemoptysis had undergone aortic coarctation repair by means of Dacron patch aortoplasty at the age of 10 in our hospital. Computed tomography of the chest showed a descending aortic pseudoaneurysm. ⋯ Lung parenchyma around the fistula was repaired, and the patient was discharged after an uneventful postoperative course. When hemoptysis occurs in a patient with a history of thoracic aortic surgery, aortobronchial fistula should be suspected. Close follow-up is mandatory for patients who have undergone coarctation repair.
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Patients who have dialysis-dependent renal disease frequently present with coronary artery disease but are considered at high risk for coronary artery bypass grafting. From 1 September 2000 through 31 August 2003, we performed complete off-pump coronary revascularization in 6 patients who had end-stage dialysis-dependent renal failure, and we prospectively studied the perioperative and early postoperative results. The effect of off-pump coronary artery bypass grafting on mortality, morbidity, postoperative complications, and transfusion requirements in this group of patients was investigated. ⋯ The mean duration of follow-up was 172 +/- 12.4 months. Patients with dialysis-dependent chronic renal failure who present with coronary artery disease should be thoroughly evaluated preoperatively for risk factors and coexistent severe diseases. We believe that in patients with end-stage dialysis-dependent chronic renal failure, off-pump coronary revascularization is a good alternative.
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Electrical injury can cause a variety of cardiac arrhythmias. Atrial fibrillation as a result of such injury is fairly rare, however, and is rarer still in cases of low-tension electrical injury. We present the case of a patient who developed acute atrial fibrillation in association with low-voltage electrical injury, which resolved after the intravenous administration of digoxin.