A & A case reports
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Patients who have undergone complete cavopulmonary anastomosis, the Fontan procedure, have passive venous blood flow from the superior and inferior vena cava into the pulmonary circulation without passing through the right ventricle. Although this procedure is an effective means of palliation, the resultant chronically increased central venous pressure, leads to several types of hepatic dysfunction including chronic congestion, cardiac cirrhosis, and even hepatocellular carcinoma. In this case report, we describe a patient with Fontan-associated hepatocellular carcinoma who successfully underwent a right hepatectomy.
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In this report, we review 2 cases of coronary revascularization in patients with a diagnosis of coronary artery disease and preoperative protein S deficiency, an established hypercoagulable condition. In an attempt to normalize protein S levels, fresh frozen plasma was used as the priming fluid for the cardiopulmonary bypass circuit before the initiation of extracorporeal circulation. On the basis of a low risk of bleeding and the theoretical risk of thrombosis, neither patient received intraoperative antifibrinolytic treatment nor did they develop perioperative thrombotic complications.
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Prothrombin complex concentrates are increasingly used during complex cardiac surgery with cardiopulmonary bypass. Reports describing massive thromboembolism after administration of prothrombin complex concentrates are rare. We report a case of a patient developing massive intracardiac and pulmonary artery thrombus formations during infusion of a moderate dose of prothrombin complex concentrate after separation from cardiopulmonary bypass for complex open heart surgery.
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A 25-year-old man presented for revision of a dialysis fistula in his left upper arm. An ultrasound-guided left supraclavicular block was performed, and 4 hours later during wound closure, the patient developed intermittent airway obstruction accompanied by edema of the face and upper airway. ⋯ Partial obstruction of the left brachiocephalic vein and right internal jugular vein were identified while the patient was in the radiology suite. Sympathetic block and increased venous return from the left arm likely contributed to his airway obstruction that mimicked superior vena cava syndrome.