Case 9[mdash ]2001 cardiac surgery in patients with mobile aortic atheromas (original) (raw)

Subclinical Thrombosis of the Ascending Aorta: A Possible Paraneoplastic Syndrome

The Annals of Thoracic Surgery, 2009

delivery through femoral artery for CPB, with required blood flow rates of 1 to 5 L. This cannula is an 81-cm-long flexible tube with 3 lumens and an inflatable balloon at the distal end that provides aortic occlusion instead of aortic cross-clamping. The device has a central lumen for the delivery of arterial blood through multiple distal outlets, a lumen for both the delivery of cardioplegia and left ventricular venting at the aortic root, and finally, a small lumen for control of the distal balloon.

A Diagnostic and Therapeutic Dilemma: An Unusual Complication of a Coronary Artery Bypass Surgery

Journal of Cardiac Surgery, 2007

Cerebral swelling after cardiopulmonary bypass might trigger a critical cerebral consequence resulting from intracranial spaceoccupying lesion. We experienced a 75-year-old woman who suffered from a delayed left hemiplegia after mitral valve replacement. Urgent diagnostic imaging revealed the presence of a brain tumor with perifocal cerebral edema. Fluid shifts occurring within a few days after the cardiopulmonary bypass, manifesting the focal cerebral edema, played a key role in this unique clinical course.

Coarctation of the aorta with lower blood pressure at the right upper extremity

Heart (British Cardiac Society), 2002

Objective: To examine the clinical outcome of percutaneous coronary intervention where the procedure was complicated by vessel perforation. Setting: Tertiary referral centre. Methods: The procedural records of 6245 patients undergoing coronary intervention were reviewed. In 52 patients (0.8%) the procedure was complicated by vessel perforation, ranging from wire exit to free flow of contrast into the pericardial space. The majority of lesions treated were complex (37% type B, 59% type C) and 9 of 52 (17%) were chronic occlusions. Ten patients (19%) received abciximab. Four underwent rotational atherectomy (8%). Results: In 28 of 52 patients (54%) the perforation was benign and managed conservatively without the development of haemodynamically significant sequelae. In 24 of 52 (46%) a significant pericardial effusion ensued requiring drainage. Of these 24 procedures 6 had involved the treatment of a chronic occlusion (25%). Eight of the 24 patients were referred for emergency bypass surgery (33%), 3 of whom died. Of the remaining 16 not referred for surgery, 3 died. Of the 10 procedures complicated by vessel perforation where abciximab had been administered, 9 (90%) led to pericardial tamponade. Latterly 2 vessel perforations were successfully treated by the deployment of a covered stent. Conclusions: Coronary artery perforation with sequelae during intervention is rare-26 of 6245 (0.4%). This complication was seen in the treatment of chronic occlusions, which are therefore not riskfree procedures. The development of pericardial tamponade carries a high mortality. While prompt surgical intervention may be life saving, expertise in the use of covered stents may provide a valuable rescue option for this serious complication. Caution should be exercised where coronary perforation occurs and abciximab has been used.

Stent-Graft Repair of an Aortic Rupture Caused by Invasive Hemangiopericytoma

The Annals of Thoracic Surgery, 2006

Suspecting evolving cerebral embolism during cardiac surgery is a particular situation in which the intraoperative countermeasures of confirmed efficacy and reliability do not exist. Although there is some evidence that flow reversal could attenuate or prevent stroke caused by cerebral embolism . Although this evidence was collected in very different clinical situations, the principle is appealing (ie, the mobilization of the emboli off their wedge position in major branches of the cerebral arteries). The technique of retrograde cerebral perfusion proposed by Ueda and colleagues [5] for cerebral protection during circulatory arrest in aortic surgery was initially introduced for treatment of massive air embolism during cardiopulmonary bypass [6] aiming at the same effect (ie, flow reversion). Although the nutritive effect of retrograde cerebral perfusion is debatable, flow reversal in the main cerebral arteries has been documented [7]. The case described lacks a specific proof of cerebral embolism, as well as the proof of the contribution of retrograde cerebral perfusion in preventing brain injury. The positive neurologic outcome does not necessarily prove the efficacy of the treatment even though this may seem appealing. The aim of this report is to illustrate a potentially helpful strategy when brain damage due to significant intraoperative embolism seems apparently inevitable. The availability of a potentially effective maneuver for reversing suspected cerebral embolism should absolutely not encourage the deviation from the strategy of prevention of cerebral embolism by thorough preoperative and intraoperative diagnostic evaluation of the ascending aorta and aortic arch.

Sequestration of the Lung Arising From the Circumflex Coronary Artery

The Annals of Thoracic Surgery, 1998

anastomosis was done on total circulatory arrest with continuous 6-0 Prolene to avoid manipulation of the aorta and the suture line. The patient was then rewarmed. Hemostasis was done and after complete rewarming the patient was weaned off cardiopulmonary bypass successfully. The patient did well after the operation and was discharged home. Both patients were followed up after the operation and found to be free of any symptom. Postoperative aortography was performed on our second patient and confirmed good results (Fig 3). Comment The incidence of thromboembolism has been proved to be significant with application of an aortic cross-clamp in cardiac operations [1]. Many surgeons try to avoid manipulating the ascending aorta during operations in patients with very severe atherosclerotic disease [2]. Atherosclerotic disease involving the neck and great vessels is commonly treated by an extraanatomic bypass operation. Patients with hemodynamically significant bilateral stenosis of the aortic arch vessels that are not bypassable in the neck can be treated by transthoracic bypass grafts with good early and late results [3]. The extent of the severity of the disease in the ascending aorta can be assessed using transesophageal echocardiography or intraoperative surface echocardiography of the aorta to select the type of operation [3, 4], and it has been proved that endarterectomy of the ascending aorta using deep hypothermic circulatory arrest has a good outcome [5]. In our two examples, in addition to atherosclerotic disease in the aortic arch there was proximal involvement of the great vessels with atheroma, and 1 patient had significant stenosis in the proximal right coronary artery, which necessitated a bypass graft. Recent advances in cerebral protection with hypothermic circulatory arrest render the complications much less than in previous experiences. Retrograde cerebral perfusion was not used in either patient, but topical cooling and steroids were used for brain protection, and also gradual rewarming was performed to avoid a temperature gradient greater than 3°C. We conclude that aortic arch endarterectomy is a safe procedure with good results for atherosclerotic disease of the arch and the great vessels. We thank Joanie Livermore, MCI, for the outstanding work in making the illustrations.

Embolic coronary occlusion after the arterial switch procedure

The Journal of Thoracic and Cardiovascular Surgery, 2001

T he arterial switch operation (ASO) for transposition of the great arteries (TGA) is currently performed with low morbidity and mortality. 1,2 Although thromboembolic events have been described with a number of other neonatal cardiac repairs, 3 they have not been commonly associated with the ASO. In this report we describe this complication, its recognition, and its management.

Right Coronary Artery With High Takeoff

The Annals of Thoracic Surgery, 2007

after major aortic surgery and prolonged ECMO support. Further detailed studies in this regard are warranted. References 1. Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia and cardiac surgery. Ann Thorac Surg 2003;76: 2121-31. 2. Smedira NG, Dyke CM, Koster A, et al. Anticoagulation with bivalirudin for off-pumpcoronary artery bypass grafting: the results of the EVOLUTION-OFF study. J Thorac Cardiovasc Surg 2006;131:686 -92. 3. Dyke CM, Smedira NG, Koster A, et al. A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery with cardiopulmonary bypass: the EVOLUTION-ON study. J Thorac Cardiovasc Surg 2006; 131:533-9. 4. Veale JJ, McCarthy HM, Palmer G, Dyke CM. Use of bivalirudin as an anticoagulant during cardiopulmonary bypass. J Extra Corpor Technol 2005;37:296 -302. 5. Koster A, Yeter R, Buz S, et al. Assessment of hemostatic activation during cardiopulmonary bypass for coronary artery bypass grafting with bivalirudin: results of a pilot study.