BMJ case reports
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Case Reports
A silent compartment syndrome following elective minimally invasive mitral valve repair.
A 63-year-old male with severe mitral valve regurgitation underwent an elective minimally invasive mitral valve repair. Peripheral cannulation of the right femoral vein and artery was performed with a total cardiopulmonary bypass time of 268 min. There were no intraoperative complications. 12 hours postoperatively the patient reported mild pain in the right lower leg with a subjective decrease in sensation. ⋯ This rare case demonstrates the highly variable aetiology, pathophysiology and presenting symptoms of CS. Clinicians in any specialty should consider this diagnosis if there is a possibility of local vascular compromise secondary to an intervention/treatment. This diagnosis is not exclusive to patients with trauma and as such clinicians should have a high index of suspicion for this potentially devastating condition.
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Hypoparathyroidism patients present with features of hypocalcemia like carpopedal spasm, numbness and paresthesias but hypocalcemic cardiomyopathy leading to congestive heart failure (CHF) is a rare presentation. We present here a case of 55-year-old Asian man who was a known case of dilated cardiomyopathy for 6 months, presented with the chief complaints of shortness of breath on exertion and decreased urine output. On general physical examination, features suggestive of CHF were seen. ⋯ Echo showed severe global hypokinesia of left ventricle with left ventricle ejection fraction 15%. This CHF was refractory to conventional treatment, though, with calcium supplementation, the patient improved symptomatically. On follow-up after 3 months, an improvement was seen in the echocardiographic parameters with ejection fraction improving to 25%.
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Nutcracker syndrome (NCS) is a rare vascular compression disorder that involves compression of the left renal vein most commonly between the aorta and the superior mesenteric artery (SMA), although variations exist. It is associated with the formation of the left renal vein from the aortic collar during the 6th-8th week of gestation and abnormal angulation of the SMA from the aorta. Collateralisation of venous circulation including mainly the left gonadal vein and the communicating lumbar vein are the most significant effects. ⋯ Her CT scan showed marked compression of the left renal vein between the aorta and the SMA (nutcracker phenomenon), with upstream left renal, left gonadal and left lumbar vein dilatation. She was managed conservatively. This paper provides an overview of the aetiology, embryology, clinical manifestations, imaging modalities and management of NCS.