Journal of cardiac surgery
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Antegrade cerebral perfusion (ACP) under moderate hypothermia may improve cerebral protection. Intraoperative measurement of cerebral regional oxygen saturations (rSO2) using near-infrared spectroscopy (NIRS) can provide accurate monitoring of cerebral perfusion during ACP. We evaluated the role, outcomes, and advantages of using NIRS in providing effective cerebral protection with ACP. ⋯ Cerebral rSO2 and left radial artery pressure monitoring with ACP during aortic surgery provides accurate measurement of cerebral perfusion resulting in minimal neurological and perioperative complications and good midterm QoL outcomes.
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Ascending aorta and aortic arch replacement combined with antegrade stent grafting of the descending thoracic aorta represents an emerging hybrid surgical approach for complex and extensive thoracic aortic disease. We present a case of a patient at low risk for spinal cord ischemia who underwent hybrid thoracic aortic surgery (aortic arch replacement and E-vita prosthesis implantation) and developed a spinal cord injury (SCI) after the intervention. Treatment aimed at increasing spinal cord perfusion pressure with the aid of cerebrospinal fluid (CSF) drainage was effective in recovering neuromuscular function.
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Aortoesophageal fistula is a rare manifestation of thoracic aortic surgery or esophageal disease. We describe a patient who underwent emergent endovascular repair of an aortoesophageal fistula due to a ruptured penetrating ulcer of the descending thoracic aorta and review the literature on this subject.
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Clinical Trial
Relationship between left atrial volume and atrial fibrillation following coronary artery bypass grafting.
Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG). However, limited information is available about the role of preoperative echocardiographic left atrial evaluation to predict AF occurrence after CABG. Thus, we prospectively compared the ability of echocardiographic measurements of left atrial volume to predict AF in this setting. ⋯ Preoperative echocardiographic evaluation of patients with isolated CABG demonstrated that left atrium volume measurements were independently correlated to the occurrence of POAF. Further investigations should focus on the opportunity to target prophylactic antiarrhythmic treatments to patients with large left atrial volumes.
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Review Case Reports
Endovascular stent graft placement in the treatment of a ruptured tuberculous pseudoaneurysm of the descending thoracic aorta secondary to Pott's disease of the spine.
Ruptured thoracic aortic tuberculous pseudoaneurysms as a complication of mycobacterium tuberculosis infection of the spine are rare. Conventional treatment of a ruptured tuberculous pseudoaneurysm involves surgery with graft interposition or patch repair. We report successful repair of a ruptured tuberculous pseudoaneurysm of the descending thoracic aorta by endovascular stent graft placement and provide a literature review of such entities.