Acute hemorrhage into an adenomatous goiter following cardiac surgery is a rare cause of acute upper airway obstruction. We report an unusual presentation of respiratory distress in a patient with goiter recovering from open heart surgery, which was successfully treated by left hemithyroidectomy. A mandatory evaluation of the upper trachea in patients with long-standing benign goiter is recommended prior to cardiac surgery.
Background: As the incidence of coronary artery disease (CAD) at young age is high in Asian countries, the number of coronary reoperations in this group of patients is increasing. The aim of this study was to define the incidence, risk factors and to discuss the methods of re-revascularization and early to mid-term outcomes in these patients.Methods: This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery (CABG) before the age of 45 years and underwent reoperation for recurrence of angina due to progression of native coronary artery disease and, or, graft occlusion. The data was also analyzed with regards to the risk factors contributing to the recurrence of the disease and the short to mid-term outcomes. During a six year period from January 1998 to October 2004, a total of 68 patients had reoperation for recurrence of angina. The mean interval of presentation following primary CABG was 12.48 _+ 3.11 years (ranged from 8 months to 16 years). Reoperation was performed under cardiopulmonary bypass (CPB) in 63 patients and in the remaining five patients on beating heart without using CPB.Results: Reoperation accounted for 4.6% of 2478 patients who underwent CABG between January 1998 through October 2004 at our institute. Among these 114 patients, 68 patients underwent primary CABG before the age of 45 years. These 68 patients received a total of 214 grafts (3.14 grafts per patient) of which 169 grafts were re-anastamosed to previously grafted target arteries. Left internal mammary artery was used in 61 patients (89.7%) who required graft to left anterior descending coronary artery at reoperation. The early mortality was 4.4% (3 out of 68). Two patients (2.94%) had perioperative myocardial infarction and two more patients were re-explored for mediastinal bleeding. Freedom from recurrence of symptom of angina at 2 and 4 years was 98.01%, 94.5% respectively.Conclusions: Redo CABG is associated with higher morbidity and mortality when compared to first-time CABG. Perioperative myocardial infarction and left ventricular dysfunction contribute significantly to the increased risk of redo CABG. (Ind J Thorac Cardiovasc Surg, 2005; 21: 199-203)
Postinfarction rupture of the interventricular septum is usually fatal without prompt surgical intervention. Repair of postinfarction ventricular septal rupture by an endocardial patch technique with infarct exclusion is associated with less morbidity and mortality. The results of this repair in 22 consecutive patients were analyzed retrospectively. After myocardial infarction, 16 patients were operated on within 7 days, 3 at 8-21 days, and 3 at 3-6 weeks. 2D-echocardiography, color Doppler studies and coronary angiography were performed in all patients prior to surgery. The mean age of the patients was 57.46 +/- 5.31 years and 20 were male; 15 were in cardiogenic shock or congestive heart failure at the time of operation. There were 5 (22.7%) operative deaths. Postoperative complications included low cardiac output, renal failure and respiratory failure. Preoperative cardiogenic shock, severe right ventricular dysfunction, residual ventricular septal defect, and preoperative renal failure were predictors of operative mortality. There were 2 late deaths. A rapid diagnosis, aggressive medical management and prompt surgical intervention are required to optimize survival and recovery in patients who present with septal rupture complicating myocardial infarction.
A right atrial myxoma arising from the crista terminalis was detected during follow-up echocardiography in a 74-year-old man who had undergone coronary artery bypass grafting one year earlier. The myxoma was excised en bloc with a wide cuff of normal atrial wall and the right atrium was reconstructed with autologous pericardium.
A 6-year-old girl underwent surgical excision of accessory mitral valve tissue causing significant subaortic stenosis. Preoperative 2-dimensional echocardiography gave the necessary information on this isolated anomaly. The approach through an aortotomy provided adequate exposure. Postoperatively, there was no residual gradient across the left ventricular outflow tract, or mitral regurgitation.
Methods: An infant with right isomerism, single ventricle, left sided SVC and an anomalous pulmonary vein to the SVC presented with cyanosis. During surgery, the SVC was transected above the opening of the anomalous pulmonary vein and fully mobilized of all its tributaries leaving the anomalous drainage intact. The MPA was transected and the branch pulmonary arteries mobilized. This enabled us to perform the anastomosis between SVC and LPA without any kink or tension.Results: The patient made an uneventful recovery and postoperative echocardiography showed a functioning BCPS with good pulmonary flow. The patient is on follow up with a saturation of 90 on 3 month follow up Conclusions: The technique adopted by us ensured approximation of SVC anJ LPA to perform a tension free BCPS. It does not involve a suture line in the artium that may need future revisions. This can displace the pulmonmy arteries upwards and can make the completion by lateral tunnel Fontan difficult. However, most of these cases undergo subequent completion by extra cardiac Fontan for fear of pulmonary vein obstruction by the intracardiac baffle.Background: First direct vision ASD closure (first open heart) was done in 1952 under surface hypothermia and inflow occlusion by F John Lewis in USA. With introduction of CP Bypass the trend slowly shifted to close majority of ASDs on bypass. Hypothermia and inflow occlusion became historical. Due to its simplicity and low cost we started using this method and report here.Methods: 25 patients between age of 5-29 yrs over a period of 6 months (May-Oct '05 ) having isolated secundum ASD were selected for this technique. 2D Echo was done to confirm diagnosis and rule out SVC defect, Primum ASD and other cardiac defects. After anesthesia, patient was cooled using rubber blankets through which cold water was circulated. At 30° C midsternotomy was done and pericardium was opened. Tapes were passed around SVC and IVC. At 28° C circulation was stopped by snaring the tapes and RA was opened and ASD was inspected. If it was found suitable for direct closure, it was closed with 3'O or 4'O prolene in two layers. No suction was done in LA and lungs were ventilated before tying the suture line to remove air from LA. Rt atriotomy was controlled with a large clamp and circulation was restarted by opening the snares. Rt atriotomy was closed. CP Bypass was kept as stand by. Patient was rewarmed to normal level.Results: ASD could be closed directly in all patients. Conversion to CP Bypass was not required in any patient. There were no neurological complications. Patients were extubated after few hrs. Post operative drainage was less than 200ml. Repeat Echo after 7-10 days did not show residual shunt in any patient. There was marked reduction in cost of operation (60-70%).Conclusions: Closure of simple secundum ASD undcr hypothermia and inflow occlusion is a safe, simple and cost saving technique. It avoids side effects of CP Bypass. Minimal blood transfusion is required. This technique should be used more frequently and i...
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