Search

We report the development of two anastomotic pseudoaneurysms in a patient with Behçet's disease eighteen months after abdominal aortic aneurysm repair. Major asymptomatic vascular complications should be suspected in patients with Behçet's disease with a history of vascular surgery and treated expediently due to the risk of rupture. Magnetic resonance angiography, contrast-enhanced computed tomography or ultrasound scanning should be performed at least every 6 months after vascular surgery.

Background: Adverse effects on the respiratory system can be severe in many instances after coronarv artery bypass grafting (CABG) with cardiopulmonary bypass (CPBP). Recently, operative techniques without CPBP have gained widespread consent, thanks to the newly developed retractors that allow satisfactory immobilisation of the surgical field., Methods: Thirty-seven patients operated upon in our Institution between April 1997 and April 1998 showed an obstructive and/or restrictive pulmonary disease. Twenty-one patients were operated on without CBPB (group A), while 16 patients were operated using CPBP (group B, control). The allocation in each group had been randomised., Results: The length of the operation in group A was less than in group B (196+/-35 minutes vs 235+/-60 minutes), (p=0.014). A significant difference was found in postoperative bleeding: 562+/-381 ml vs 776+/-378 (p=0.046), in postoperative red cell count, hemoglobin level and Hct. Permanence on the ventilator was 19.1+/-13 hours in group B and 13.1+/-6.1 hours in group A (p=0.03). The length of stay in ICU was significantly different: 33.8+/-16.2 hours for group A vs 53.6+/-29.3 hours for group B (p=0.01). No respiratory failure occurred in group A; two patients experienced slow weaning from ventilation assistance and one died from that complication in group B., Conclusions: Myocardial revascularization without CPBP allows a better postoperative clinical course in patients with advanced pulmonary disease.

The authors describe a simple method to perform left ventricular biopsies during open heart surgery. An automatic gun shaped device is used by one hand of the surgeon: the sample is obtained in a few seconds, at any time of the surgical procedure. It consists of a transmural piece of tissue, averaging 18 mm3 in quantity. The device has been used in 20 patients who underwent coronary artery revascularization. All the biopsies were successful. No complications occurred.

Prosthetic valve endocarditis (PVE) remains an uncommon but serious complication of cardiac valve replacement. We analysed several risk factors (active or healed, early or late endocarditis, congestive heart failure, arterial emboli etc.) in order to identify the factors which may predict bad outcome. The overall mortality rate was 46.8% (15/32 patients). There was a significantly higher mortality rate in patients with early endocarditis (80%) than in those with late endocarditis (38%) (p less than 0.01). In the group of patients who underwent reoperation, the mortality rate was higher in those with active endocarditis (70%) than in those with healed endocarditis (28.5%) (p less than 0.05). We believe that combined medical and surgical treatment is the best management for bioprosthetic valve endocarditis, with the institution of appropriate preoperative antibiotic therapy, to attempt to achieve sterilization.

Intraoperative thermographic evaluation of regional myocardial cooling induced by cardioplegia, in patients with coronary artery disease, was conducted in 22 cases. Pictures were obtained at the beginning of the cardiopulmonary by-pass, after general cooling and during cardioplegic infusion. Uneven myocardial cooling was observed related to the degree of coronary artery stenosis. After the distal anastomosis of the saphenous vein by-pass graft was completed, injection of cold solution in to the graft showed marked cooling of the dependent myocardium, proving the patency of the graft. In the case of internal mammary artery graft (IMA), after the anastomosis was completed, releasing the bull-dog clamp on the IMA graft, allowed a flow of relatively warm (30 degrees C) blood in the anterolateral wall of the cold (20 degrees C) heart. A warm spot appeared in the thermographic pictures, assessing the patency of the IMA graft. Thermography appears to be a useful tool during myocardial revascularization in order to assess proper myocardial cooling during cardioplegia, and to check intraoperative patency of saphenous vein graft and IMA graft. The use of a special mirror prevents interference with the surgeon's work.

Two cases of aneurysmatic vascular lesions (a large cranio-encephalic angiodysplasia with arterio-venous communications and a post-traumatic aneurysm of the vertebral artery) are reported; both were of a very difficult surgical approach and were successfully treated with the use of extra-corporeal circulation. The partial cardiopulmonary bypass, with femoro-femoral cannulation, allowed complete recovery of the lost blood, controlled hypotension, and a certain degree of hypothermia. These factors were decisive for the good outcome of the operations.

A case with marked factor VII deficiency, undergoing open heart surgery for atrial myxoma, is reported. The syndrome was unknown to the patient and only pre-operative routine coagulation studies showed a low prothrombin activity (22%). Further investigations revealed a severe factor VII deficiency. The operation was carried out under factor VII concentrate administration and no bleeding complication occurred.

False aneurysm from the aortic vent site is an uncommon complication following open heart surgery. An ascending aorta false aneurysm developed in a patient four months after mitral and aortic valve replacement. Extensive adhesions precluded aortic dissection and cross-clamping. Femoro-femoral cannulation, low flow, low pressure, and low temperature cardiopulmonary by-pass was used. The aneurysm was resected and then repaired with a Dacron patch. A Foley catheter was placed in the ascending aorta through the defect to obtain a bloodless field. This surgical approach can be useful in managing this difficult situation.

In coronary artery surgery, when a poor distal run of can predict an early graft failure, it might be useful to perform the last anastomosis to a low pressure chamber thus creating a small arterio-venous (A-V) fistula. From January throughout December 1984, 4 patients underwent coronary angiography for severe symptoms of angina. The coronary angiography showed multiple stenoses on the left anterior descending (LAD), ventricular branches of the circumflex (CX), and posterior descending of the right coronary artery (PD). At operation the patients received a sequential aortocoronary bypass graft with reversed saphenous vein, plus the creation of a small A-V fistula into the right atrium in order to improve the graft flow and patency. All patients experienced a clinical improvement. No adverse effects have been observed and the patients, controlled clinically with non invasive and in two cases with invasive techniques, showed satisfactory revascularization.

An unusual complication of the median sternotomy is reported. A 37-year-old male experienced a left innominate vein thrombosis 20 months after surgery. The combined treatment consisting of local infusion with Urokinase, surgical removal of the wire and balloon catheter dilatation, was completely successful.