A case of a 16-year-old female with tetralogy of Fallot and absent pulmonary valve is presented, who on coronary angiography and computerized tomography (CT) angiography had severe compression of the left main coronary artery by the dilated main pulmonary artery. The patient was successfully managed by surgical correction of the intracardiac defect, with right ventricular outflow tract reconstruction by the Contegra(®) bovine jugular vein conduit.
Objective With progressive aging of population in developing nations, cardiac surgeons increasingly face elderly patients. These patients are usually symptomatic, yet at high risk for intervention. This study aims to review our experience in elderly Indian patients. Methods We reviewed the records of 128 elderly patients (mean age 74.6 years; range 70-84) operated at our institution from 2005 to 2009. Postoperatively, patients were followed-up in the out-patient-department. Results Surgery was performed on 10 as an emergency and 41 on an urgent (on the day of referral or the following day) basis. Mean left ventricular ejection fraction was 44%± 9.5. Early mortality (during current admission or within 30 days of discharge from the hospital) was 12 (9.3%). Mean New York Heart Association functional class was improved from 3.0±0.8 preoperatively to 1.5±0.7 postoperatively. Median Intensive Care Unit and in-hospital stay was 4 days (range 1-17) and 12 days (range 4-37), respectively. Postoperative complications included pneumonia (6.3%), stroke (5.5%), reoperation for bleeding (4.6%) and intra-aortic balloon pump requirement (4.6%). Emergency surgery was significantly associated (P<0.05) with an increased risk of early mortality-operative procedure and cardiopulmonary bypass time were not. Conclusion We conclude that cardiac surgery can be performed in elderly population with an acceptable early mortality. Postoperatively, patients attain an improved quality of life. Operative procedures and cardiopulmonary bypass times are not risk factors for increased mortality. Emergency surgery in this group of patients is less rewarding.
Endovascular stenting is commonly employed for coarctation of the aorta [1][2][3]. Complications following this procedure include stent migration and dissection of the aorta [4,5]. We report on one such case with extensive dissection of the aorta following stenting and its successful surgical management.A 21 year old male patient presented to us with a diagnosis of severe post-ductal coarctation of aorta, and underwent dilatation and stenting of the coarctation. Two Advanta TM V12 LD stents [Atrium Medical Inc, USA] were placed across the coarctation. The second stent however migrated distally resulting in dissection of the thoraco-abdominal aorta extending upto the level of the common iliac arteries (Figs. 1 (a) and (b), 2 and 3). He underwent emergency stent removal and repair of aortic dissection.At surgery he was placed on single right lung ventilation and femoro-femoral cardiopulmonary bypass was established. The descending aorta was approached through a left postero-lateral thoracotomy. The position of the stent was confirmed by palpating of the aorta. Aorta was found to be inflamed. The patient was cooled down to 18°C and circulatory arrest was established.The aorta was opened longitudinally (Fig. 4), the stent removed and a single entry point of dissection on the posterior aspect of aorta was closed by pledgetted nonabsorbable sutures. The aorta was closed using a Polytetrafluoroethylene (PTFE) patch. The first stent Fig. 1 a Axial CECT image at the level of T 5 ,T 6 vertebra showing cranial stent lying in the descending aorta (arrow). b CT image at a slightly lower level showing thin intimal flap separating the true and false lumen of the dissection. Beak sign (arrow) is seen in the false lumen
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