Because of the high percent of the variations, hemodynamically significant during unilateral SCP, a suggestion for routine preoperative CT-angio of CoW could be made. Furthermore, an intraoperative follow-up with NIRO, transcranial Doppler, EEG, and so forth could also be recommended.
Although cardiovascular malformations are common in patients with Turner syndrome, dissecting thoracic aortic aneurysm is unusual. Stent-graft repair would appear to be feasible in this situation, but long-term implantation in young patients has not been explored.
Background: The aim of this report is to present a case of a blunt abdominal trauma with vascular and spinal involvements of an overweight man, caused by the front seat safety belt. Case presentation: It took place as a result of the car bonnet collision with a roadside pillar. During the primary inspection of the crash site, it was found that the car had collided with a roadside pillar. The driver was found dead in the driver's seat with the seat belt on. The lower part of the belt was in the inguinal region and the upper part was high on the chest, separated by the bulky midriff. The autopsy revealed a transverse fracture of the body of tenth thoracic vertebra, complicated by a torn abdominal aorta, and severe bleeding into the abdominal cavity, which was the cause of the death. The complications of the abdominal trauma result from the atypical position of the seat belt holding the upper and lower part of the body to the seat at two very distant levels, while between them the bulky, heavy midriff continued to move forward, carrying with it the vertebral column and surrounding anatomical structures. On the other hand, the forceful contact between the abdominal wall and the instrumental panel of the car generates pressure which transmits force through the adjacent organs to the aortic wall. The specific anthropometric features of the victim had an impact on the mechanism of death. The improper position of the seat belt relative to the body affected the severity of abdominal injuries, instead of protecting from them. Conclusions: The driver's body disproportion, combined with the restraining effect of the seat belt, could increase the risk of a fatal outcome. It is incorrect to think that if the victim had not worn a seat belt, he would have survived. The safest seatbelt type for occupants with a similar anthropometric data would be the 4-point seat belt system, which is used in children's car seats. This type of safety belt is crossed over the chest and abdomen and holds the entire trunk better at dynamic loads in all directions.
Coarctation of thoracic aorta is an uncommon diagnosis in adults. Catheter-based intervention consisting of primary ballooning and stenting is becoming one of the methods of choice for the treatment of native coarctation. We describe the case of a young adult with coarctation of the aorta treated unsuccessfully with percutaneous transluminal angioplasty and stent implantation that resulted in stent migration into the aortic arch and led to an urgent operative intervention. In one step, we performed the evacuation of the foreign body from the aortic arch as well as the treatment of the aortic coarctation through an extra-anatomical vascular graft interposition between the ascending and descending thoracic aorta. In this article, we discuss the need for emergency surgical intervention in this case.
Background: Myocardial protection in reoperations in cardiac
surgery is extremely difficult in patients with previous coronary
surgery and a working LIMA-LAD graft, and it largely determines the
outcome of surgery and long-term prognosis. We use a the method of
percutaneous angiographic balloon LIMA occlusion and cardioplegic
arrest. Aims: The aim of this study was to compare the data of
patients with angiographic balloon LIMA-occlusion and those without
occlusion in operations related to PVE, and previous coronary surgery
with permeable LIMA graft, determining the degree of safety and benefits
of method. Study design and Methods: A total of 20 patients
undergoing surgery for prosthesis valve endocarditis with patent
LIMA-LAD graft were analyzed retrospectively. We divide the patients
into 2 groups. Group A patients - with LIMA occlusion and Group B
patients - without LIMA occlusion). The pre-, intra- and postoperative
results were compared and the degree of safety and benefits of the
application of the method were studied. Results: 80% of patients
in group A needed only dopamine infusion and 20% needed the addition of
a second catecholamine (Adrenaline) at the end of CPB. In group B, the
need for double catecholamine maintenance is in 50% of patients. The
need for implantation of an intra-aortic balloon pump due to refractory
heart failure was registered in 10% of patients in group A and in 20%
of patients in group B. It was found that the average duration of
mechanical ventilation in group A is 10.5 hours postoperatively, and in
group B - 12.5 hours. The mean duration of catecholamine infusion in
both groups was 3 days. The average stay in intensive care is shorter
for patients in Group A - 2.5 days, and in Group B is 3.5 days. In terms
of survival - mortality in the group with LIMA occlusion is 0%, while
in the group without LIMA occlusion is 20%. Conclusion: Our
reported results from the use of the LIMA balloon occlusion method in
patients with prosthetic valve endocarditis who are high-risk and
complicated patients and nevertheless the mortality in this group
studied by us is 0% and no serious complications of the applied method
have been registered. Therefore, we believe that the angiographic
balloon LIMA occlusion is a reliable, easily applicable and relatively
safe technique that improves the surgical results and prognosis of
patients in need of reoperative cardiac surgery.
Cardiac hemangiomas as a primary heart tumor are extremely rare. We
present a clinical case of a 54-year-old woman with atypical thoracic
and abdominal discomfort and cavernous hemangiomas of the right atrium
and the liver.
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