Pub Date : 2018-01-01DOI: 10.35841/cardiovascular-surgery.1.3.52-56
M. Sacchini, Laura Capirchio, L. Desimone, A. Brambilla, G. Capponi, R. Roperto, E. Bennati, G. Spaziani, Giulio Porcedda, G. Calabri, N. Assanta, S. Favilli
{"title":"Abrupt onset of pulmonary hypertension and atypical haemolytic-uremic syndrome in a young child; diagnosis and successful treatment of rare metabolic disorder.","authors":"M. Sacchini, Laura Capirchio, L. Desimone, A. Brambilla, G. Capponi, R. Roperto, E. Bennati, G. Spaziani, Giulio Porcedda, G. Calabri, N. Assanta, S. Favilli","doi":"10.35841/cardiovascular-surgery.1.3.52-56","DOIUrl":"https://doi.org/10.35841/cardiovascular-surgery.1.3.52-56","url":null,"abstract":"","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70038954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.35841/CARDIOVASCULAR-SURGERY.2.1.18-21
Olutayo Ariyo
The Subclavian Steal Syndrome is a retrograde flow in the vertebral artery as a result of proximal subclavian artery occlusion or severe stenosis. This retrograde flow presupposes that the vertebral artery is of usual origin from the superior surface of its ipsilateral subclavian artery. We present a rare variant of the right vertebral artery originating as part of a trifurcated brachiocephalic trunk in a 76-year-old female cadaver. Our discussion is focused on the clinical implication of this variant should there be a proximal occlusion to the right subclavian artery or such occlusion occurring in the proximal origin of the brachiocephalic trunk off the aortic arch. Even though aberrant vertebral arteries are often asymptomatic, but a good search should be made to locate their aberrant origins. Good knowledge of the anatomic location of the vertebral artery is important to endovascular, and maxillofacial and neurosurgeons engaged in surgical interventions in the head and neck region to assist in the selection of appropriate surgical interventions and to neuroradiologists, in the interpretation of images. The main thrust of our report is focused on a modeled occlusion in the proximal region of the subclavian artery or in the proximal segment of the brachiocephalic trunk and the clinical outcome of retrograde flow in the variant right vertebral artery originating from a bifurcated brachiocephalic trunk in both circumstances. When a retrograde flow is modeled in a hypothetical proximal occlusion to the subclavian artery only, this does not give any vascularization to the subclavian artery since the occlusion is occurring distally to the retrograde flow. However, in the case of occlusion occurring, the proximal origin of the brachiocephalic trunk before trifurcating, and before the trifurcation, a reversed flow from the variant vertebral artery will send blood to vascularize both the right common carotid and the right subclavian arteries, resulting in a hypothesized combined Common Carotid-Subclavian Steal Syndrome (CC-SSS). This emphasizes clinically that varying origins of the vertebral artery would play dissimilar roles in occlusion or stenosis in the proximal segments of the major supra-aortic vessels.
{"title":"A rare origin of the right vertebral artery and its clinical implications in a proximal occlusion to proximal origin to the brachiocephalic trunk","authors":"Olutayo Ariyo","doi":"10.35841/CARDIOVASCULAR-SURGERY.2.1.18-21","DOIUrl":"https://doi.org/10.35841/CARDIOVASCULAR-SURGERY.2.1.18-21","url":null,"abstract":"The Subclavian Steal Syndrome is a retrograde flow in the vertebral artery as a result of proximal subclavian artery occlusion or severe stenosis. This retrograde flow presupposes that the vertebral artery is of usual origin from the superior surface of its ipsilateral subclavian artery. We present a rare variant of the right vertebral artery originating as part of a trifurcated brachiocephalic trunk in a 76-year-old female cadaver. Our discussion is focused on the clinical implication of this variant should there be a proximal occlusion to the right subclavian artery or such occlusion occurring in the proximal origin of the brachiocephalic trunk off the aortic arch. Even though aberrant vertebral arteries are often asymptomatic, but a good search should be made to locate their aberrant origins. Good knowledge of the anatomic location of the vertebral artery is important to endovascular, and maxillofacial and neurosurgeons engaged in surgical interventions in the head and neck region to assist in the selection of appropriate surgical interventions and to neuroradiologists, in the interpretation of images. The main thrust of our report is focused on a modeled occlusion in the proximal region of the subclavian artery or in the proximal segment of the brachiocephalic trunk and the clinical outcome of retrograde flow in the variant right vertebral artery originating from a bifurcated brachiocephalic trunk in both circumstances. When a retrograde flow is modeled in a hypothetical proximal occlusion to the subclavian artery only, this does not give any vascularization to the subclavian artery since the occlusion is occurring distally to the retrograde flow. However, in the case of occlusion occurring, the proximal origin of the brachiocephalic trunk before trifurcating, and before the trifurcation, a reversed flow from the variant vertebral artery will send blood to vascularize both the right common carotid and the right subclavian arteries, resulting in a hypothesized combined Common Carotid-Subclavian Steal Syndrome (CC-SSS). This emphasizes clinically that varying origins of the vertebral artery would play dissimilar roles in occlusion or stenosis in the proximal segments of the major supra-aortic vessels.","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"2 1","pages":"18-21"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70039425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.35841/CARDIOVASCULAR-SURGERY.1.1.1-7
D. M. Røpcke
Background and aim: Leaflet augmentation to treat restrictive mitral leaflet motion in type IIIB mitral regurgitation is well-known. Leaflet augmentation of the tricuspid valve is less well described. The aim of this retrospective study was to assess short- and long-term valve function and patient outcome in all patients receiving tricuspid valve leaflet augmentation with either Cormatrix or bovine/autologous pericardium in our institution from 2007 to 2016. Materials and methods: NYHA class, diagnosis, type of surgery and health state were found through chart review. Echocardiography exams before surgery, 1 month after, 6 months after, and latest exam were analyzed regarding biventricular function, valve function, leaflet mobility and –thickness. Results: In eight patients; Cormatrix (n=4), bovine pericardium (n=3), and autologous pericardium (n=1) were used for 7 anterior leaflet extensions and 1 septal leaflet extension. Follow-up ranged from 6 to 132 months. Three patients had died, two in the Cormatrix group, and one in the pericardial group. Over time, coaptation length (12 ± 5 mm vs. 8 ± 3 mm, p=0.03) decreased significantly in the Cormatrix group, while none of the other parameters differed significantly. A tendency towards reduced leaflet mobility and thickening of the pericardialextended leaflets were seen over time. Conclusion: Cormatrix and pericardium as patch material for tricuspid leaflet extension are comparable regarding valve performance and durability of the repair in this study, though resorption of Cormatrix material seems to take place leading to decreasing coaptation height. This is a sign of tissue remodelling. Leaflet mobility was reduced in the pericardial repair group and may likely be related to thickening of pericardial patch material that occurred over time.
背景与目的:小叶增强术治疗IIIB型二尖瓣反流的限制性小叶运动是众所周知的。小叶增大的三尖瓣没有很好的描述。本回顾性研究的目的是评估2007年至2016年在我院接受Cormatrix或牛/自体心包三尖瓣瓣叶增强术的所有患者的短期和长期瓣膜功能和患者预后。材料与方法:通过病历复习，了解NYHA分级、诊断、手术类型及健康状况。分析术前、术后1个月、术后6个月及术后超声心动图双室功能、瓣膜功能、小叶活动性及厚度。结果:8例患者;采用Cormatrix (n=4)、牛心包(n=3)和自体心包(n=1)进行7次前小叶伸展和1次中隔小叶伸展。随访时间为6 ~ 132个月。3例患者死亡，Cormatrix组2例，心包组1例。随着时间的推移，Cormatrix组的覆盖长度(12±5 mm vs. 8±3 mm, p=0.03)显著减少，而其他参数无显著差异。随着时间的推移，可以看到小叶流动性降低和心包延伸小叶增厚的趋势。结论:在本研究中，Cormatrix和心包膜作为三尖瓣小叶延伸的补片材料，在瓣膜性能和修复耐久性方面具有可比性，尽管Cormatrix材料的吸收似乎导致了贴合高度的降低。这是组织重塑的标志。心包修复组小叶活动性降低，可能与心包贴片物质随时间的增厚有关。
{"title":"Comparison of Cormatrix? porcine extracellular matrix and pericardial patch augmentation for tricuspid valve leaflet reconstruction - A singlecenter experience.","authors":"D. M. Røpcke","doi":"10.35841/CARDIOVASCULAR-SURGERY.1.1.1-7","DOIUrl":"https://doi.org/10.35841/CARDIOVASCULAR-SURGERY.1.1.1-7","url":null,"abstract":"Background and aim: Leaflet augmentation to treat restrictive mitral leaflet motion in type IIIB mitral regurgitation is well-known. Leaflet augmentation of the tricuspid valve is less well described. The aim of this retrospective study was to assess short- and long-term valve function and patient outcome in all patients receiving tricuspid valve leaflet augmentation with either Cormatrix or bovine/autologous pericardium in our institution from 2007 to 2016. Materials and methods: NYHA class, diagnosis, type of surgery and health state were found through chart review. Echocardiography exams before surgery, 1 month after, 6 months after, and latest exam were analyzed regarding biventricular function, valve function, leaflet mobility and –thickness. Results: In eight patients; Cormatrix (n=4), bovine pericardium (n=3), and autologous pericardium (n=1) were used for 7 anterior leaflet extensions and 1 septal leaflet extension. Follow-up ranged from 6 to 132 months. Three patients had died, two in the Cormatrix group, and one in the pericardial group. Over time, coaptation length (12 ± 5 mm vs. 8 ± 3 mm, p=0.03) decreased significantly in the Cormatrix group, while none of the other parameters differed significantly. A tendency towards reduced leaflet mobility and thickening of the pericardialextended leaflets were seen over time. Conclusion: Cormatrix and pericardium as patch material for tricuspid leaflet extension are comparable regarding valve performance and durability of the repair in this study, though resorption of Cormatrix material seems to take place leading to decreasing coaptation height. This is a sign of tissue remodelling. Leaflet mobility was reduced in the pericardial repair group and may likely be related to thickening of pericardial patch material that occurred over time.","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"1 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70038611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.35841/CARDIOVASCULAR-SURGERY.1.1.24-29
B. Muñoz, D. Domingo-Valero, Alicia Maceira-González, J. Rueda-Soriano, F. Valera, J. I. Carrasco, Alej, R. Sanchez-Vazquez, A. Montero-Argudo
Background: Nowadays, evaluation of the need for intervention in patients with aortic coarctation (AC) is based on anatomical and clinical data. The purpose of the study was to analyze the utility of assessing flow in the thoracic descending aorta using magnetic resonance imaging (MRI) in patients with AC. Methods: Patients with a diagnosis or suspicion of AC, who underwent MRI study between 2008-2016 in a single tertiary center, were retrospectively studied. MRI standardized protocol included gadolinium enhanced angiographic 3-D sequences to evaluate relative stenosis (RS) and phase contrast imaging to assess flow in the descending aorta. Results: 106 patients {70 men (66%), mean age 22 ± 17 years} were included. Of these, 28 (26%) required surgical intervention during the first year after evaluation and 9 (9.3%) required percutaneous treatment. AUROC curves were applied to find best cut-off points of imaging variables. Imaging variables were entered into a multivariate logistic regression model including the presence of arterial hypertension. Percentage of flow increase was shown to be an independent predictor of the need for an intervention (OR, 7.2; 95%CI, 1-20; p=0.03) and adding this parameter in the standard work-up represented a significant increase in diagnostic accuracy (S, 85%; Sp, 89%; vs. S, 62%; Sp, 92%). Conclusion: physiological assessment of flow pattern in descending aorta by MRI significantly increases the ability to evaluate the need for invasive treatment in AC patients beyond standard clinical and anatomical study.
{"title":"Usefulness of assessing the descending aorta flow pattern for predicting the need for intervention in patients with aortic coarctation","authors":"B. Muñoz, D. Domingo-Valero, Alicia Maceira-González, J. Rueda-Soriano, F. Valera, J. I. Carrasco, Alej, R. Sanchez-Vazquez, A. Montero-Argudo","doi":"10.35841/CARDIOVASCULAR-SURGERY.1.1.24-29","DOIUrl":"https://doi.org/10.35841/CARDIOVASCULAR-SURGERY.1.1.24-29","url":null,"abstract":"Background: Nowadays, evaluation of the need for intervention in patients with aortic coarctation (AC) is based on anatomical and clinical data. The purpose of the study was to analyze the utility of assessing flow in the thoracic descending aorta using magnetic resonance imaging (MRI) in patients with AC. Methods: Patients with a diagnosis or suspicion of AC, who underwent MRI study between 2008-2016 in a single tertiary center, were retrospectively studied. MRI standardized protocol included gadolinium enhanced angiographic 3-D sequences to evaluate relative stenosis (RS) and phase contrast imaging to assess flow in the descending aorta. Results: 106 patients {70 men (66%), mean age 22 ± 17 years} were included. Of these, 28 (26%) required surgical intervention during the first year after evaluation and 9 (9.3%) required percutaneous treatment. AUROC curves were applied to find best cut-off points of imaging variables. Imaging variables were entered into a multivariate logistic regression model including the presence of arterial hypertension. Percentage of flow increase was shown to be an independent predictor of the need for an intervention (OR, 7.2; 95%CI, 1-20; p=0.03) and adding this parameter in the standard work-up represented a significant increase in diagnostic accuracy (S, 85%; Sp, 89%; vs. S, 62%; Sp, 92%). Conclusion: physiological assessment of flow pattern in descending aorta by MRI significantly increases the ability to evaluate the need for invasive treatment in AC patients beyond standard clinical and anatomical study.","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"01 1","pages":"24-29"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70039069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.35841/CARDIOVASCULAR-SURGERY.1.2.41-43
A. Mahmoud
The intra-myocardial LAD is totally different from the myocardial bridging despite some authors do not discriminate sharply between both categories. The bridge in most cases is a limited length of the LAD covered by muscle fibers that squeeze the LAD in systole meanwhile the muscle fibers of the intra-myocardial LAD just cover it without significant dynamic closure. The covered part of the LAD in some cases is not atherosclerotic [7-10]. The LAD may be embedded in the epicardial fat and it is just covered by variable thickness of fat or might be covered with transverse (perpendicular) myocardial fibers for variable distances of its length or depth. This might hinder some surgeons to identify the most important target in the CABG procedure; the LAD [8-10].
{"title":"IMLAD is not a contraindication for OPCAB","authors":"A. Mahmoud","doi":"10.35841/CARDIOVASCULAR-SURGERY.1.2.41-43","DOIUrl":"https://doi.org/10.35841/CARDIOVASCULAR-SURGERY.1.2.41-43","url":null,"abstract":"The intra-myocardial LAD is totally different from the myocardial bridging despite some authors do not discriminate sharply between both categories. The bridge in most cases is a limited length of the LAD covered by muscle fibers that squeeze the LAD in systole meanwhile the muscle fibers of the intra-myocardial LAD just cover it without significant dynamic closure. The covered part of the LAD in some cases is not atherosclerotic [7-10]. The LAD may be embedded in the epicardial fat and it is just covered by variable thickness of fat or might be covered with transverse (perpendicular) myocardial fibers for variable distances of its length or depth. This might hinder some surgeons to identify the most important target in the CABG procedure; the LAD [8-10].","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70039104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.35841/cardiovascular-surgery.2.1.10-17
Chighaly El Hadj Sidi, I. Mgarrech, A. Tarmiz, S. Jerbi
Objective: The main objective of this study is to evaluate the performance of the predictive model (EuroSCORE II) on a Tunisian population in order to validate its use in our country. Methods: This is a retrospective study of data from 418 adult patients undergoing cardiac surgery with cardiopulmonary bypass between 1st January 2015 and 31 December 2016 in the department of cardiovascular and thoracic surgery of the Sahloul University Hospital of Sousse. The EuroSCORE ΙΙ is calculated using the application validated on the site www.euroscore.org. The performance of the score is evaluated by analyzing its discriminative power by constructing the ROC curve and analyzing its calibration using the Hosmer-Lemeshow statistics. Results: The EuroSCORE II shows good discriminative power in our population with an area under the ROC curve >0.7 in all study groups (0.864 ± 0.032 for general cardiac surgery, 0.822 ± 0.061 for coronary surgery, 0.864 ± 0.052 for valvular surgery, and 0.900 ± 0.041 for urgent cardiac surgery). The model appears to be calibrated as well by obtaining ρ values above the statistical significance level of 0.05 (0.638 for general cardiac surgery, 0.543 for coronary surgery, 0.179 for valvular surgery, and 0.082 for urgent cardiac surgery). Conclusion: The EuroSCORE II presents acceptable performance in our population, attested by a good discriminative power and an adequate calibration.
{"title":"External validation of European System for Cardiac Operative Risk Evaluation II in a Tunisian population","authors":"Chighaly El Hadj Sidi, I. Mgarrech, A. Tarmiz, S. Jerbi","doi":"10.35841/cardiovascular-surgery.2.1.10-17","DOIUrl":"https://doi.org/10.35841/cardiovascular-surgery.2.1.10-17","url":null,"abstract":"Objective: The main objective of this study is to evaluate the performance of the predictive model (EuroSCORE II) on a Tunisian population in order to validate its use in our country. Methods: This is a retrospective study of data from 418 adult patients undergoing cardiac surgery with cardiopulmonary bypass between 1st January 2015 and 31 December 2016 in the department of cardiovascular and thoracic surgery of the Sahloul University Hospital of Sousse. The EuroSCORE ΙΙ is calculated using the application validated on the site www.euroscore.org. The performance of the score is evaluated by analyzing its discriminative power by constructing the ROC curve and analyzing its calibration using the Hosmer-Lemeshow statistics. Results: The EuroSCORE II shows good discriminative power in our population with an area under the ROC curve >0.7 in all study groups (0.864 ± 0.032 for general cardiac surgery, 0.822 ± 0.061 for coronary surgery, 0.864 ± 0.052 for valvular surgery, and 0.900 ± 0.041 for urgent cardiac surgery). The model appears to be calibrated as well by obtaining ρ values above the statistical significance level of 0.05 (0.638 for general cardiac surgery, 0.543 for coronary surgery, 0.179 for valvular surgery, and 0.082 for urgent cardiac surgery). Conclusion: The EuroSCORE II presents acceptable performance in our population, attested by a good discriminative power and an adequate calibration.","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"2 1","pages":"10-17"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70039317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.35841/CARDIOVASCULAR-SURGERY.1.3.71-69
Charles D Ghee, W. Vigneswaran
Background: Minimally invasive surgical approaches are generally desired and recommended for many thoracic procedures as they preserve function and allow for more rapid recovery of patients. Despite these advantages, the adaptation has been poor. The robotic approach allowing more intuitive movement, greater flexibility, and high definition 3D vision appears to encourage surgeons to adapt the technique. Methods: This review examines the recent English lit of the early surgical experience of the da Vinci robotic system in the treatment of lung cancer, esophageal resection and mediastinal pathology. Conclusion: The application of robotic technology to thoracic surgery has proven to be at least comparable to open or video assisted thoracoscopic techniques in several areas and in some, possibly superior. If the widespread application of robotic technology allows greater access to minimally invasive thoracic surgery, with equivalent or superior oncological and perioperative outcomes, then it seems logical that robotic technique will become the standard for many general thoracic surgical procedures.
{"title":"Robot assisted thoracic surgery: a review of current literature","authors":"Charles D Ghee, W. Vigneswaran","doi":"10.35841/CARDIOVASCULAR-SURGERY.1.3.71-69","DOIUrl":"https://doi.org/10.35841/CARDIOVASCULAR-SURGERY.1.3.71-69","url":null,"abstract":"Background: Minimally invasive surgical approaches are generally desired and recommended for many thoracic procedures as they preserve function and allow for more rapid recovery of patients. Despite these advantages, the adaptation has been poor. The robotic approach allowing more intuitive movement, greater flexibility, and high definition 3D vision appears to encourage surgeons to adapt the technique. Methods: This review examines the recent English lit of the early surgical experience of the da Vinci robotic system in the treatment of lung cancer, esophageal resection and mediastinal pathology. Conclusion: The application of robotic technology to thoracic surgery has proven to be at least comparable to open or video assisted thoracoscopic techniques in several areas and in some, possibly superior. If the widespread application of robotic technology allows greater access to minimally invasive thoracic surgery, with equivalent or superior oncological and perioperative outcomes, then it seems logical that robotic technique will become the standard for many general thoracic surgical procedures.","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70039611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.35841/CARDIOVASCULAR-SURGERY.1.3.76-79
Bashir A. Hawaelrasoul, Atif Alsahari, A. Elwy
Anomalous origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) is a rare congenital anomaly, which presents with myocardial ischemia and infarction in children. If left untreated, it carries a high mortality rate in the first year of life. In patients who survive to the adulthood, the coronary steal phenomenon and retrograde left-sided coronary flow provide a substrate for chronic sub-endocardial ischemia, which may lead to left ventricular dysfunction, ischemic mitral regurgitation, malignant ventricular arrhythmias, and sudden cardiac death. We report a case of an 8 years old Saudi female, who was referred to our cardiac center as a case of coronary artery fistula from RCA to RV and referred for possible transcatheter closure and was found to have the anomalous origin of the left coronary artery from the pulmonary artery that was subsequently surgically corrected. The Patient was medically free, asymptomatic apart from on and off palpitations during asthma exacerbations especially after taking Ventolin, she has no history of chest pain, her ECG showed no signs of ischemia, echocardiography showed normal ventricular systolic function which is unusual for ALCAPA cases due to multiple coronary collaterals
{"title":"Late presentation of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was confused with coronary artery fistula","authors":"Bashir A. Hawaelrasoul, Atif Alsahari, A. Elwy","doi":"10.35841/CARDIOVASCULAR-SURGERY.1.3.76-79","DOIUrl":"https://doi.org/10.35841/CARDIOVASCULAR-SURGERY.1.3.76-79","url":null,"abstract":"Anomalous origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) is a rare congenital anomaly, which presents with myocardial ischemia and infarction in children. If left untreated, it carries a high mortality rate in the first year of life. In patients who survive to the adulthood, the coronary steal phenomenon and retrograde left-sided coronary flow provide a substrate for chronic sub-endocardial ischemia, which may lead to left ventricular dysfunction, ischemic mitral regurgitation, malignant ventricular arrhythmias, and sudden cardiac death. We report a case of an 8 years old Saudi female, who was referred to our cardiac center as a case of coronary artery fistula from RCA to RV and referred for possible transcatheter closure and was found to have the anomalous origin of the left coronary artery from the pulmonary artery that was subsequently surgically corrected. The Patient was medically free, asymptomatic apart from on and off palpitations during asthma exacerbations especially after taking Ventolin, she has no history of chest pain, her ECG showed no signs of ischemia, echocardiography showed normal ventricular systolic function which is unusual for ALCAPA cases due to multiple coronary collaterals","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"46 1","pages":"76-79"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70039667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.35841/cardiovascular-surgery.1.1.8-10
R. Afghani
Aspiration of foreign body can occur in children and adults. Children swallow objects due to their curiosity and are prone to aspiration. However in adults there are different risk factors for aspiration; such as alcohol consumption, addiction, drug consumption, senility, seizure, trauma, mental retardation, and artificial dentures [1]. In some cases, it may happen accidentally, and risk factors are not involved. In this particular case, air gun bullet has been swallowed (Figure 1). The shooter had put a bullet in his mouth in order to reload his gun and shoot rapidly; then swallowing and aspiration happened. In this case, because the foreign body is opaque, chest X-ray can be helpful for diagnosis (Figure 2). The alternative way to diagnose is fiberoptic bronchoscopy; which is sometimes considered a therapeutic strategy (Figure 3). Foreign body aspiration in tracheobronchial tree requires immediate diagnosis and removal; because the ignored objects may result in complications like infection, abscess, empyema, and haemoptysis or even bronchopleural fistula [2]. Therapeutic options to remove aspirated foreign bodies from the respiratory tract are carried out through fiberoptic and rigid bronchoscope [3]. In cases of immediate removal of the foreign body, the outcome will be excellent; and there will be no specific complication and sequel. In some rare cases, surgery is needed to remove the foreign body; however, surgery is mostly required in situations with late diagnosis and occurrence of complications.
{"title":"Unusual aspiration of foreign body in adults.","authors":"R. Afghani","doi":"10.35841/cardiovascular-surgery.1.1.8-10","DOIUrl":"https://doi.org/10.35841/cardiovascular-surgery.1.1.8-10","url":null,"abstract":"Aspiration of foreign body can occur in children and adults. Children swallow objects due to their curiosity and are prone to aspiration. However in adults there are different risk factors for aspiration; such as alcohol consumption, addiction, drug consumption, senility, seizure, trauma, mental retardation, and artificial dentures [1]. In some cases, it may happen accidentally, and risk factors are not involved. In this particular case, air gun bullet has been swallowed (Figure 1). The shooter had put a bullet in his mouth in order to reload his gun and shoot rapidly; then swallowing and aspiration happened. In this case, because the foreign body is opaque, chest X-ray can be helpful for diagnosis (Figure 2). The alternative way to diagnose is fiberoptic bronchoscopy; which is sometimes considered a therapeutic strategy (Figure 3). Foreign body aspiration in tracheobronchial tree requires immediate diagnosis and removal; because the ignored objects may result in complications like infection, abscess, empyema, and haemoptysis or even bronchopleural fistula [2]. Therapeutic options to remove aspirated foreign bodies from the respiratory tract are carried out through fiberoptic and rigid bronchoscope [3]. In cases of immediate removal of the foreign body, the outcome will be excellent; and there will be no specific complication and sequel. In some rare cases, surgery is needed to remove the foreign body; however, surgery is mostly required in situations with late diagnosis and occurrence of complications.","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"1 1","pages":"8-10"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70039132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The aim of the study was to present our experience with covered stent graft to close the tear induced by distal stent after Frozen Elephant Trunk operation (FET). Methods: From November 2012 to July 2015, 21 patients suffering from distal Stent Graft New Entry (d-SINE) after FET accepted interventional treatment with a covered stent graft. Computer Tomographic Angiography (CTA) was performed at 3, 6 and 12 months after surgery to observe the position and shape of the stent and the eventual endoleaks. Results: All patients were implanted with a covered stent graft. After surgery, angiography showed that the stents were in the proper position and fully expanded. Two patients died after surgery. Followup was 24-55 (mean, 40 ± 10) months. No stroke, paraplegia, or death occurred. CTA showed that the stents had a proper form and were in the correct position without any displacement or endoleak. False lumen expansion did not occur. Parts of the false lumen showed thrombosis. Conclusion: The results suggest that implantation of covered stents in the descending aorta to manage d-SINE after FET may achieve a good therapeutic effect.
{"title":"Covered stent graft for distal stent graft-induced new entry after frozen elephant trunk operation for aortic dissection","authors":"Ren Wang, Guoxing Weng, Lian-jun Huang, Zhiqun Chen, Xiao-yong Huang, Yuguo Xue","doi":"10.35841/CARDIOVASCULAR-SURGERY.1.3.57-62","DOIUrl":"https://doi.org/10.35841/CARDIOVASCULAR-SURGERY.1.3.57-62","url":null,"abstract":"Background: The aim of the study was to present our experience with covered stent graft to close the tear induced by distal stent after Frozen Elephant Trunk operation (FET). Methods: From November 2012 to July 2015, 21 patients suffering from distal Stent Graft New Entry (d-SINE) after FET accepted interventional treatment with a covered stent graft. Computer Tomographic Angiography (CTA) was performed at 3, 6 and 12 months after surgery to observe the position and shape of the stent and the eventual endoleaks. Results: All patients were implanted with a covered stent graft. After surgery, angiography showed that the stents were in the proper position and fully expanded. Two patients died after surgery. Followup was 24-55 (mean, 40 ± 10) months. No stroke, paraplegia, or death occurred. CTA showed that the stents had a proper form and were in the correct position without any displacement or endoleak. False lumen expansion did not occur. Parts of the false lumen showed thrombosis. Conclusion: The results suggest that implantation of covered stents in the descending aorta to manage d-SINE after FET may achieve a good therapeutic effect.","PeriodicalId":79324,"journal":{"name":"Cardiovascular surgery (London, England)","volume":"1 1","pages":"57-62"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70039398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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