Nonocclusive mesenteric ischemia (NOMI) is rare but often lethal complication after cardiac surgery. The use of vasopressors, age, implantation of intra-aortic balloon pump, the duration of cardio-pulmonary bypass are the main risk factors described in the literature. The purposes of this study are to be represented the most typical prognostic factors and clinical manifestations of NOMI, condition which is not so effortlessly diagnosed.Methods: The study was designed as a retrospective study of all patients who underwent cardiac surgery in our institution from October 2002 to December 31, 2017. Data from clinical trials worldwide was also used for the preparation of this study.Results: 9298 patients were operated in our institution for the period 2002-2017. 114 (1.2%) developed abdominal complications after cardiac surgery. In 17 (0.2%), explorative laparotomy with bowel resection for nonocclusive mesenteric ischemia was performed. Nonocclusive mesenteric ischemia (NOMI) is rare but often lethal complication. The progression of NOMI is associated with poor prognosis for the patients. Despite the surgical exploration and necrotic bowel resection, the mortality rate in these patients is dramatically high (over 80%).Conclusion: Diagnosis and treatment of non-occlusive mesenteric ischemia (nomi) remain challenging in modern clinical practice, requiring accurate and punctual evaluation of all patients with predisposing factors for development of this dramatic and often fatal condition.
The hydatid disease is one of the most common tapeworm infections. It is caused most commonly by Echinococcus granulosus and has an endemic distribution. The transmission to humans, which are intermediate hosts, occurs by ingestion of contaminated food and water or by direct contact with infected animals. Involvement of heart and pericardium is an extremely rare condition. We present a case of an 18-year-old female patient, admitted in cardiology department complaining of chest pain and subfebrility. Transthoracic echocardiography and contrast enhanced CT revealed huge well-organized intramyocardial cyst in the lateral left ventricular wall with a few daughter cysts. The diagnosis of cardiac echinococcosis was confirmed by serological blood test - ELISA. We performed total resection of the cyst using extracorporeal circulation. The postoperative period was uneventful. Albendazole treatment was administered. The patient was followed-up one year with good postoperative result without any signs of relapse of the disease. Cardiac hydatid disease is rarity, but it is a life-threatening condition because of the high risk of cyst perforation. Early diagnosis and treatment are crucial. Echocardiographic findings are extremely valuable for diagnosis. The results of surgical echinococcectomy combined with oral antihelmintic therapy postoperatively are preferred rather than conservative strategy alone.
Takotsubo cardiomyopathy is a syndrome characterized by transient acute left ventricular dysfunction, electrocardiographic changes that can mimic acute myocardial infarction and minimal release of myocardial enzymes in the absence of obstructive coronary artery disease (CAD). Reports of Takotsubo syndrome after cardiac surgery are exceptional. We describe a case of Takotsubo cardiomyopathy in a 57-year-old man after elective aortic and mitral valve replacement following recent convalescence from infective endocarditis. Takotsubo syndrome should be considered in the differential diagnosis of patients presenting acute myocardial infarction, cardiogenic shock or any low cardiac output syndrome after cardiac surgery.
We present a case of 29-year-old-woman diagnosed with severe coarctation of the aorta 15mm distal to the left subclavian artery. The patient was admitted in our institution, computed tomohraphy(CT) scan was performed - confirming the diagnosis. After heart team meeting discussion, decision was taken for surgical correction as the best option for the case. Cardiac surgery procedure was performed including: resection of coarctation segment and aortic prosthesis interposition using left heart bypass for optimum spinal cord and visceral organs protection. The patient was discharged on postoperative day 7 on drug therpapy with antiplatelet and dual antihypertensive therapy with β-blocker and calcium channel blocker: Aspirine, Metoprolol and Lercanidipine. At late follow-up examination one year after the surgical correction the patient was normotensive at rest, as well as after treadmill stress test using the standart Bruce protocol. Despite the established good cardiac prophylaxis on newborns, sometimes this disease can remain undiagnosed until adulthood when the complications are starting to present.
Introduction. Median sternotomy represents a standard surgical access in cardiac surgery, despite the growing popularity of minimally invasive access. Posternotomy infections are a serious complication and are directly related to patients' survival in the short and long term. Despite prevention, their expression is still significant - from 0.5% to 6.8%, and associated hospital mortality rates range from 7% to 35%. Aims. Analysis of frequency, risk factors, microbiological agents, prevention options and surgical techniques for deep wound infections after open heart surgery for a 17 - year period. Materials and methods. For the period from October 2002 to June 2019, 146 (1.42% of 10,307 operated) patients were treated at the Cardiac Surgery Clinic at the University Hospital “St. Georgi "diagnosed with deep sternal infection. The study is a retrospective using data from medical records and hospital records. The Center of Disease Control (CDC) criteria were used to define deep sternal infections. Results. The sex ratio is 2.04: 1 – men: women. The average age for both sexes is 65.4 years. The average stay of patients in the intensive care unit was 5 days (from 0 to 46 days), and the average total hospital stay was 15.6 days (from 5 to 55 days). Early postoperative mortality was 13,7%. The most common risk factors were diabetes mellitus, obesity and emergency surgery. Conclusion. Cardiac surgery with total midline sternotomy is associated with a risk of developing mediastinitis. Despite the advances in cardiac surgery and the use of mini-invasive techniques, the rate of development of deep wound infections remains relatively high.
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