This retrospective study compared the immediate post-operative (first month) and mid-term (up to 5 years post-operation) results of 22 patients with isolated ventricular septal defects who underwent surgical correction with bovine pericardium with 57 similar patients who received a polytetrafluoroethylene (PTFE) patch. There were no cases of early (in the first month) mortality in either group and the 3-month post-operative echocardiographical studies showed no evidence of calcification or aneurysm formation around the patch. Recurrent ventricular septal defects due to dehiscence of the patch occurred in the early follow-up period in four patients who had the PTFE patch but this was not statistically significant. Annual echocardiographical examination revealed some calcification in both groups. We conclude that although there are no significant differences between the two materials in outcome after ventricular septal defects closure, we prefer bovine pericardium because of its handling characteristics, elasticity and the lower risk of endocarditis.
A free-floating tumor thrombus in the left atrium is an unusual metastasis of non-small cell lung cancer. Surgical resection of free-floating tumor thrombus prior to adjuvant therapy relieves cardiac symptoms such as exertional dyspnea, and prevents life-threatening complications including systemic embolization, mitral obstruction, or sudden death.
As a consequence of the progress in the development of endovascular techniques, hybrid treatment is becoming a more popular option for the treatment of coarctation accompanied by cardiac diseases. Two-stage procedures and extra-anatomical bypass might be alternative techniques if endovascular procedures are contraindicated or failing.
The purpose of this study was to assess the viability and dilator response of the saphenous vein segments harvested during cardiac surgery. The saphenous veins were incubated with either normal saline (group A) or papaverine solutions (group B). The viability of saphenous vein endothelial cells was assessed by counting the number of total cells. Maximal endothelium-dependent vasodilator response to acetylcholine was also investigated. Cell viability of vein samples was decreased after 4 hours of incubation with normal saline (34 +/- 6.5%) as compared to solution containing papaverine (92 +/- 3.7%). By 24 hours, the viabilities of the endothelial cells incubated with saline and papaverine solutions were 22 +/- 4.5% and 87 +/- 5%, respectively.There was significant difference in vasodilatation responses to acetylcholine between saline-incubated and papaverine-incubated groups. By 4 hours of incubation, the relaxation response to acetylcholine significantly deteriorated in group A when compared to the initial value (P < 0.001). Furthermore, the decrease in this vasorelaxation response has also continued throughout the observation period and the values obtained by 24 hours were observed to be significantly lower than those obtained at the end of 4 hours (P < 0.01). In contrast, although a decrease was noticed in group B over time, this decrease was not statistically significant (P, not significant). We thus conclude that the use of papaverine solution improves endothelial cell viability and is associated with preservation of the maximal endothelial-dependent vasodilator response of a vein segment.
A case is reported of an inferior mesenteric artery aneurysm that starts approximately 1 cm from its origin and ends at the proximal portion of the bifurcation of the sigmoidal and left colic arteries accompanied with complete absence of the celiac axis and superior mesenteric arteries. Additionally, left renal artery stenosis existed. The diagnosis was made by digital subtraction arteriography and confirmed by magnetic resonance arteriogram. Disease involving the inferior mesenteric artery is extremely uncommon. This may be the first reported case of neurofibromatosis in combination with renal artery stenosis and inferior mesenteric artery aneurysm associated with celiac and superior mesenteric artery occlusion and treated surgically.
Retrograde (proximal) migration of an abdominal aortic aneurysm endograft is an extremely rare event during endovascular insertion and may lead to occlusion of the bilateral renal arteries and dialysis-dependent renal failure. This case report describes the intraoperative retrograde migration of a bifurcated abdominal aortic endograft during the initial endovascular procedure after deployment of an extender limb graft into the right iliac artery and associated bilateral renal artery occlusion. This was treated with renal artery bypass, and the patient had a favorable outcome.
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