Splenic abscess is a well-described but rare complication of infective endocarditis. Rapid diagnosis and treatment are essential as its course can be fatal. We present three case reports that describe the management of splenic abscesses in patients initially diagnosed with infective endocarditis. In all cases, the diagnosis was based on the findings of abdominal computed tomography (CT) scan or magnetic resonance imaging (MRI). In two of the cases, splenectomy was performed before valve surgery; while in the third case, the spleen was removed after cardiac surgery. All three patients recovered fully, with satisfactory follow-up as outpatients. Immediate splenectomy, combined with appropriate antibiotics and valve replacement surgery alongside multi-disciplinary team work could be the treatment of choice in this clinical scenario.
Left ventricular pseudoaneurysms occur as a consequence of left ventricular free wall rupture contained by pericardium. This clinical situation is an uncommon but lethal complication of acute myocardial infarction. Surgery usually is the preferred therapeutic option but is associated with significant perioperative risk. We present a case of successful percutaneous closure of left ventricular ruptured pseudoaneurysm post myocardial infarction in a patient who failed two previous surgical repairs.
Objective: The purpose of this study was to evaluate the true incidence and the risk factors associated with carotid disease in the sitting of high risk patients undergoing coronary artery bypass graft (CABG) using carotid duplex scan and to find out if routine preoperative carotid duplex scan is needed among all these patients. Methods: This retrospective study included 402 consecutive patients who underwent bilateral carotid duplex scan admitted for CABG during the period from January 2006 to December 2008. We excluded patients in cardiogenic shock who were taken to operating room emergently. Results: The prevalence of associated risk factors showed diabetes mellitus recorded the highest (93.3%) whereas peripheral vascular disease the lowest (1.7%), hypertension (89.3%), dyslipidemia (72.6%), smoker (21.1%), left main disease (4.7%), and previous stroke (3%). Patients undergoing CABG has high incidence of carotid disease (68.7%) and severe stenosis is more in patients aged 60 and above (13.5%) versus (2.3%) in age <60. There is a high risk group for severe carotid stenosis (age > 60, previous stroke and left main disease). Conclusion: This study showed that carotid screening is recommended for all patients who are undergoing CABG due to high incidence of carotid disease.
rupture of a papillary muscle is an uncommon but often fatal complication of acute myocardial infarction (MI) which is responsible for approximately 5% of death after MI (1,2). the characteristics of the underlying coronary disease will define the clinical presentation and prognosis; the mortality could be as high as 80% during the first week of post MI. The rupture of the posteromedial papillary muscle is most common, seen in about 75% of cases. the posteromedial muscle has a single blood supply from the posterior descending branch of a dominant right coronary artery, and is associated with inferior wall infarctions. the rupture of the anterolateral muscle is less common, occurring in 25% of cases, as it has dual blood supplies: from the first obtuse marginal, originating from the left circumflex; and from the first diagonal branch, originating from the left anterior descending. the rupture of the latter is seen with anterior or postero-lateral MI 3,4 .A 62-year-old sudanese male presented to the emergency room with chest pain for 6 hours. He had mild concomitant shortness of breath. there was no history of orthopnea or paroxysmal nocturnal dyspnoea. past medical history was remarkable for hypertension, non-compliant with medications and he was an active smoker. there was no family history of coronary artery disease. He had similar chest pain 5 days prior to presentation but he did not seek medical advice due to eligibility issues. on physical examination the patient was conscious and oriented, with a blood pressure of 150/80 mmHg, heart rate 100 bpm and regular, and respiratory rate 20/min. Neck veins were not distended and he had no ankle edema. on examination of the cardiovascular system he had a regular s1 and s2. No murmur was heard. He had normal vesicular breathing in both lungs. Initial eKg showed st elevation and the inferior leads (II, III and aVF) with ST depression at V2, V3 and V4 (fig 1). The chest radiography showed normal size of the heart with normal lung parenchyma. patient was taken to the cath lab within 40 minutes at acute steMI. Coronary angiogram revealed: dominant right coronary artery which was totally occluded at the mid segment. Left circumflex artery with 60 % disease at the proximal segment, with small caliber first obtuse marginal (OM1) and second obtuse marginal (oM2), both sub-totally occluded at the proximal end. underwent primary pCI (percutaneous intervention) to the right coronary artery (fig 2).
Background: With increasing incidence of coronary artery disease (CAD) in Saudi Arabia and its fatal co-morbidity, this has resulted in a more complex pool of cases referred to cardiac surgeons. In selected cases, achieving optimal revascularization of diffuse CAD necessitates adjunctive techniques such as coronary endarterectomy (CE). The aim of our study is to evaluate the early mortality and post-operative morbidity related to CE. Method: Retrospective study from Jan 2009 to Dec 2010. Inclusion of 186 patients: 38 patients had CABG with CE and 148 patients had CABG alone. Results: Pre-operative percutaneous coronary intervention (PCI) was higher in the CE with CABG group (25.8%) compared with CABG alone (8.9%) (p = 0.009). Intra-operative data showed a higher mean cardiopulmonary bypass time (CBT) of 160 minutes and a mean cross-clamp time (XCT) of 109 minutes in the CE with CABG, compared to a mean CBT of 129 minutes and a mean XCT of 87 minutes in the CABG alone group (p = 0.001). The most common vessel endarterectomized was left anterior descending artery (LAD) (47%) followed by right coronary artery (RCA) (22%). Post-operatively, the mortality amongst the CE with CABG group (7.9%) was higher than CABG only group (1.4%), however it wasn't statistically significant (p = 0.06). With regards to morbidity, hemodynamic instability requiring intra aortic balloon pump (HIR-IABP) was higher in the CE with CABG group (10.5%) compared to the CABG only group (1.4%) (p = 0.018). Conclusion: Our study showed that CE when combined with CABG wasn't associated with a higher mortality rate when compared with CABG alone.
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