J Cardiovasc Surg
-
Comparative Study
Use of MIDCAB procedure for redo coronary artery bypass.
Reoperative coronary artery bypass grafting (CABG) procedures are growing in importance due to the increasing number of patients requiring another bypass operation. Conventional redo-procedures are associated with an increased mortality and morbidity. To reduce risk, minimally invasive direct coronary artery bypass (MIDCAB) using the left internal mammary artery (LIMA) to the left anterior descending branch (LAD) may be preferable, when indicated, in selected patients. We report a series of patients who underwent this procedure for redo-CABG in our center. ⋯ Our results indicate that MIDCAB using IMA grafts for reoperation is a safe procedure with low risk for morbidity and mortality. This surgical technique is a useful alternative to conventional redo CABG in selected patients when complete revascularisation is not indicated.
-
Case Reports Comparative Study
Washing of the residual solution of cardiopulmonary bypass circuit after coronary artery bypass grafting in idiopathic thrombocytopenic purpura.
A 76-year-old female with chronic idiopathic thrombocytopenic purpura required coronary bypass grafting. Preoperative treatment with high-dose intravenous immunoglobulin at a dose of 0.4 g/kg/day raised the platelet count from 57,000 to 110,000/microL. After termination of cardiopulmonary bypass (CPB) the residual blood in the CPB circuit was washed to reduce total immunoglobulin G (IgG) level, including platelet-associated immunoglobulin G (PA-IgG), and returned to the patient. ⋯ The postoperative level of IgG and PA-IgG remained significantly lower than preoperatively. The postoperative course was uneventful and without bleeding complications. Perioperative management of a patient with idiopathic thrombocytopenic purpura undergoing open-heart surgery is discussed.
-
Case Reports
Severe obstruction of the superior vena cava caused by tumor invasion. Recanalization using a PTFE-covered Z stent.
Bare stents are commonly used for the treatment of malignant vena cava stenoses. However, the therapeutic effect of treatment using bare stents for cases with intraluminal tumor invasion is not satisfactory. We report a case with severe obstruction of the superior vena cava caused by tumor invasion of mediastinal lymph node metastases from colon cancer, which was successfully treated by the recanalization of superior vena cava using a polytetrafluoroethylene-covered Z stent. ⋯ So, the additional balloon dilatation made the stent expend fully on another day of stenting. After the balloon dilatation blood flow improved immediately and the clinical symptoms associated with the superior vena cava obstruction resolved. Thereafter no symptomatic recurrence has been observed in 12 months of follow-up period.
-
Cholesterol embolism is often an unrecognized complication of some cardiac and vascular procedures (i.e. coronarography, angioplasty, aortocoronary bypass, abdominal aortic aneurysmectomy) and of therapies affecting coagulation (thrombolysis, anticoagulation). The degree of pain associated with ischaemic and necrotic lesions secondary to cholesterol embolism involving the lower limbs is disproportionate to the extension of tissue involvement. Spinal cord stimulation (SCS) has been recognized as effective in relief of pain of ischaemic and neuropathic nature, although its mechanism of action is still not completely clear. ⋯ Pain control is the most critical aspect of the management of peripheral cholesterol embolism without visceral organ involvement. SCS provided effective pain relief in the reported cases and its established ability to improve peripheral microcirculation allowed rapid resolution of necrotic lesions. Temporary SCS should be considered in the management of painful necrotic skin lesions secondary to iatrogenic cholesterol embolism.
-
Case Reports
Tuberculous aortitis, ruptured 48 years after therapeutic implantation of synthetic balls.
A case of tuberculous aortitis, ruptured 48 years after an implantation of synthetic balls into the extrapleural space was reported. Those balls were implanted as a therapeutic alternative to artificial pneumothorax for treating pulmonary tuberculosis. Free perforation was triggered by debridement of an expanding cold abscess. A tuberculous abscess adjacent to the arterial wall should be carefully managed even in the absence of the blood flow by image analysis.