A remarkably infrequent anomaly, the criss-cross heart, is marked by an abnormal rotation of the heart around its longitudinal axis. this website Almost without exception, cases present with associated cardiac anomalies such as pulmonary stenosis, ventricular septal defect (VSD), and ventriculoarterial connection discordance. As such, most cases are eligible for the Fontan procedure due to right ventricular hypoplasia or straddling atrioventricular valves. A patient with a criss-cross heart and a muscular ventricular septal defect underwent an arterial switch operation; the case details are reported below. The patient's condition was characterized by the presence of criss-cross heart, double outlet right ventricle, subpulmonary VSD, muscular VSD, and patent ductus arteriosus (PDA). During the newborn period, pulmonary artery banding (PAB) was executed alongside PDA ligation, and an arterial switch operation (ASO) was intended for the 6-month mark. A near-normal right ventricular volume was revealed by preoperative angiography, and the echocardiography depicted normal subvalvular structures of the atrioventricular valves. Intraventricular rerouting, muscular VSD closure utilizing the sandwich technique, and ASO were successfully performed.
During a routine examination of a heart murmur and cardiac enlargement in a 64-year-old asymptomatic female patient, a two-chambered right ventricle (TCRV) was diagnosed, prompting surgical intervention for this condition. With cardiopulmonary bypass and cardiac arrest, we performed a right atrium and pulmonary artery incision, allowing for examination of the right ventricle through the tricuspid and pulmonary valves; nonetheless, visualization of the right ventricular outflow tract remained insufficient. The right ventricular outflow tract, having been incised along with the anomalous muscle bundle, was then patch-enlarged using a bovine cardiovascular membrane. A confirmation of the pressure gradient's disappearance in the right ventricular outflow tract occurred post-cardiopulmonary bypass weaning. The patient's postoperative experience was entirely uneventful, devoid of any complications, including arrhythmia.
Eleven years prior, a 73-year-old male received drug-eluting stent placement in his left anterior descending artery. Eight years later, a similar procedure was performed on his right coronary artery. His chest tightness was a key indicator of the severe aortic valve stenosis which was diagnosed. Coronary angiography, performed perioperatively, disclosed no substantial stenosis or thrombotic blockage of the DES. Antiplatelet medication was withdrawn from the patient's treatment plan five days before the scheduled surgery. Aortic valve replacement was conducted without any complications. Eighth postoperative day brought about a new symptom set, encompassing chest pain, a temporary lapse of consciousness, and notable changes in his electrocardiogram. The emergency coronary angiography revealed a thrombotic blockage of the drug-eluting stent in the right coronary artery (RCA), even after the postoperative administration of oral warfarin and aspirin. Percutaneous catheter intervention (PCI) brought about the restoration of the stent's patency. Concurrent with the percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) was initiated, and warfarin anticoagulation was continued. Stent thrombosis's clinical symptoms completely vanished immediately subsequent to the percutaneous coronary intervention. this website The patient's discharge occurred seven days subsequent to his PCI procedure.
In the wake of acute myocardial infection (AMI), the uncommon and life-threatening complication of double rupture is defined by the concurrence of two of three types of rupture: left ventricular free wall rupture (LVFWR), ventricular septal perforation (VSP), and papillary muscle rupture (PMR). A case of successful, staged repair for concomitant LVFWR and VSP ruptures is reported here. A 77-year-old female, diagnosed with anteroseptal AMI, experienced a sudden onset of cardiogenic shock immediately prior to commencing coronary angiography. Echocardiography revealed a rupture of the left ventricular free wall, leading to urgent surgical repair facilitated by intraaortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS), employing a bovine pericardial patch and felt sandwich technique. Ventricular septal perforation, situated on the apical anterior wall, was identified by intraoperative transesophageal echocardiography. Given the stable hemodynamic profile, a staged VSP repair was deemed preferable to operating on the recently infarcted myocardium. Following the initial procedure, a VSP repair was executed using the extended sandwich patch technique, accessed via a right ventricular incision, twenty-eight days later. The echocardiographic assessment carried out after the operation indicated the complete absence of a residual shunt.
We report a left ventricular pseudoaneurysm, a consequence of sutureless left ventricular free wall rupture repair. Subsequent to an acute myocardial infarction, a 78-year-old female underwent emergency sutureless repair for a left ventricular free wall rupture. The posterolateral wall of the left ventricle showed an aneurysm on an echocardiography scan, taken three months after initial presentation. The re-operation entailed opening the ventricular aneurysm, and a bovine pericardial patch was subsequently used to repair the defect in the left ventricular wall. From a histopathological perspective, the aneurysm's wall lacked myocardium, thus solidifying the pseudoaneurysm diagnosis. Sutureless repair, although a straightforward and potent method for addressing oozing left ventricular free wall ruptures, can unfortunately be associated with the development of post-procedural pseudoaneurysms, both in the acute and chronic phases. Accordingly, maintaining long-term follow-up is essential.
Aortic regurgitation in a 51-year-old male was addressed with aortic valve replacement (AVR) using minimally invasive cardiac surgery (MICS). Roughly one year after the surgical procedure, the wound's edges began to bulge, accompanied by persistent discomfort. An image from a computed tomography scan of his chest revealed the right upper lobe to be positioned outside the thoracic cavity, traversing the right second intercostal space. This presentation definitively pointed to an intercostal lung hernia, which was addressed with surgical repair involving a non-sintered hydroxyapatite and poly-L-lactide (u-HA/PLLA) mesh plate and a monofilament polypropylene (PP) mesh. Without incident, the postoperative phase proceeded, with no indication of the condition reappearing.
Acute aortic dissection frequently leads to a severe complication: leg ischemia. A limited number of cases reveal a connection between late-stage abdominal aortic graft replacement and lower extremity ischemia caused by dissection. Obstruction of true lumen blood flow by the false lumen at the proximal anastomosis of the abdominal aortic graft results in critical limb ischemia. The inferior mesenteric artery (IMA) is commonly re-attached to the aortic graft, thus preventing intestinal ischemia. In this Stanford type B acute aortic dissection case, a reimplanted IMA prevented lower extremity ischemia on both sides. The authors' hospital received a patient, a 58-year-old male with a history of abdominal aortic replacement, who experienced a sudden onset of epigastric pain followed by pain radiating to his back and the right lower limb, leading to his admission. Occlusion of the abdominal aortic graft and the right common iliac artery, in conjunction with a Stanford type B acute aortic dissection, were identified by computed tomography (CT). The reconstructed inferior mesenteric artery was used to perfuse the left common iliac artery following the previous abdominal aortic replacement. Following the procedure of thoracic endovascular aortic repair and thrombectomy, the patient experienced a favorable recovery. Residual arterial thrombi in the abdominal aortic graft were treated with oral warfarin potassium for sixteen days, concluding precisely on the day of discharge. Following that event, the thrombus has broken down, and the patient has experienced a favorable outcome, free from any lower extremity complications.
Our report outlines the preoperative evaluation of the saphenous vein (SV) graft, utilizing plain computed tomography (CT) scanning, specifically for endoscopic saphenous vein harvesting (EVH). From simple CT images, we produced detailed three-dimensional (3D) renderings of the subject of study, SV. this website Thirty-three patients had EVH performed on them between July 2019 and September 2020. A statistically calculated mean patient age of 6923 years was determined, and 25 patients were categorized as male. EVH's project demonstrated an unprecedented 939% success rate. The hospital demonstrated an impressive, 0% mortality rate. Not a single patient experienced postoperative wound complications after surgery. The early patency rate, a striking 982% (55 successes out of 56 attempts), was recorded. Surgical visualization of the SV in a constrained space heavily relies on the precision offered by 3D CT images. The early patency outcome is promising, and potential improvements in mid- and long-term EVH patency are achievable through the use of a safe and gentle technique employing CT information.
A computed tomography scan performed on a 48-year-old male complaining of lower back pain unexpectedly uncovered a cardiac tumor lodged within the right atrium. Echocardiographic imaging identified a tumor, characterized by a 30mm round shape, a thin wall, and iso- and hyper-echogenic inner content, originating in the atrial septum. Cardiopulmonary bypass facilitated the successful removal of the tumor; consequently, the patient was discharged in robust health. The cyst was filled with old blood; in addition, focal calcification was detected. The pathological examination demonstrated that the cystic wall's structure was comprised of thin, layered fibrous tissue, with endothelial cells forming the inner layer. Concerning treatment, early surgical removal is favored to prevent embolic complications, though this approach is subject to debate.