1/337. Stenting of the aorta for recurrent, long stenosis due to Takayasu's arteritis in a child.Balloon angioplasty followed by stenting of the thoracic aorta is reported in a 5-year-old girl with Takayasu's arteritis, who presented with severe hypertension and congestive heart failure. Her aortogram showed severe long segment stenosis of the descending thoracic aorta, which was successfully treated by balloon angioplasty on two occasions, but developed recurrences after 6 and 7 months of angioplasty. Balloon dilatation of the stenosed aorta, followed by sequential implantation of three 30-mm long Palmaz stents in tandem, bridging the full segment of the angioplastied aorta were performed successfully without any complications. The aortic diameter increased from 3.3 mm to 7.7 mm and the peak systolic pressure gradient decreased from 75 mmHg to 3 mmHg. There was no recurrence on clinical follow-up of 13 months.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
2/337. Iatrogenic left main coronary artery stenosis.Iatrogenic left main coronary artery stenosis is a potentially life-threatening complication of cardiac valve replacement surgery due to injury by perfusion cannulas. This requires prompt clinical recognition and diagnosis by repeat coronary angiography, and treatment by early coronary artery bypass grafting. We present 3 patients who had normal coronary arteries prior to valve replacement surgery, and who developed severe left main coronary artery stenosis after surgery. Accelerating angina and refractory ventricular arrhythmia were presenting clinical manifestations. coronary artery bypass grafting was successfully performed in all 3 patients.- - - - - - - - - - ranking = 0.41945201679471keywords = cardiac (Clic here for more details about this article) |
3/337. Combined aortic and mitral stenosis in mucopolysaccharidosis type I-S (Ullrich-Scheie syndrome).The genetic mucopolysaccharidosis syndromes (MPS) are autosomal recessive inborn errors of metabolism. Heart valve involvement in MPS is not uncommon but only a few case reports of successful cardiac surgery are available. In particular, reports of combined aortic and mitral stenosis associated with MPS type I-S are very rare. Both type I and type VI MPS are associated with significant left sided valvar heart disease that requires surgical valve replacement because of irregular valve thickening, fibrosis, and calcification. A 35 year old man had severe mitral valve stenosis after successful surgical replacement of a stenotic aortic valve. Valvar heart disease was investigated by cardiac ultrasound and left heart catheterisation. Histomorphological characterisation of the affected mitral valve was performed. The case illustrates typically associated clinical features of cardiac and extracardiac abnormalities found in MPS type I-S.- - - - - - - - - - ranking = 4.6778080671788keywords = heart, cardiac (Clic here for more details about this article) |
4/337. Recurrent endocarditis in silver-coated heart valve prosthesis.BACKGROUND AND AIM OF THE STUDY: In order to prevent prosthetic valve endocarditis (PVE), the implantation of a new silver-coated sewing ring has been introduced to provide peri- and postoperative protection against microbial infection. methods: A 56-year-old woman with aortic stenosis had elective replacement with a St. Jude Medical mechanical valve fitted with a silver-coated sewing ring (Silzone). The patient developed early PVE, which necessitated reoperation after one month. Despite a second Silzone prosthesis being implanted, the endocarditis recurred. During a third operation an aortic homograft was implanted, and after six months a fourth operation was performed for a pseudoaneurysm at the base of the homograft, in proximity to the anterior mitral valve leaflet. RESULTS: The diagnosis of PVE was confirmed by the presence of continuous fever, transesophageal echocardiography and growth of penicillin-resistant staphylococcus epidermidis from the valve prosthesis. CONCLUSION: The implantation of all prosthetic valves is encumbered with a risk of endocarditis. Although silver has bacteriostatic actions, the advantages of silver-coated prostheses in the treatment of this condition have yet to be assessed in clinical trials.- - - - - - - - - - ranking = 4keywords = heart (Clic here for more details about this article) |
5/337. Spontaneous native aortic valve thrombosis.Spontaneous thrombosis of a native aortic valve is an uncommon event that usually follows local trauma, such as cardiac surgery or left heart catheterization, or occurs as a complication of bacterial endocarditis. We report the case of a 65-year-old woman with a history of retinal artery occlusion and severe aortic valve stenosis, in whom transesophageal echocardiography revealed a mobile mass attached to the ventricular surface of the aortic valve. There was no evidence of any hypercoagulable state or infection process. Surgery was performed and a severely stenotic valve resected; a partially organized and firmly adherent free-floating thrombotic mass was observed on the ventricular surface of the aortic valve. Histologic examination demonstrated an organized thrombus. Eleven months after surgery the patient is doing well.- - - - - - - - - - ranking = 1.4194520167947keywords = heart, cardiac (Clic here for more details about this article) |
6/337. Doppler echocardiography as a predictor of pregnancy outcome in the presence of aortic stenosis: A case report.Aortic stenosis in pregnancy can be a life-threatening condition, but fortunately it is rare. In the modern era, careful obstetric and cardiologic monitoring, particularly through echocardiography, have improved fetal and maternal outcomes. However, a test that could predict outcome has not been available for patients with aortic stenosis who seek prepregnancy counseling. We report a case in which exercise Doppler echocardiography was used to predict cardiac function and maximal gradients in a woman with a bicuspid aortic valve who wished to become pregnant.- - - - - - - - - - ranking = 0.41945201679471keywords = cardiac (Clic here for more details about this article) |
7/337. Congenital subaortic stenosis by accessory mitral valve tissue, recognition and management.Accessory mitral valve tissue as the single cause for left ventricular outflow tract obstruction is a very rare cardiac malformation in normally connected hearts. We report a case in which this condition was present as single cause for left ventricular outflow tract obstruction. The surgical technique is described and a review of the literature presented.- - - - - - - - - - ranking = 1.4194520167947keywords = heart, cardiac (Clic here for more details about this article) |
8/337. Intrapericardial organized hematoma. A rare complication after open heart surgery.Intrapericardial organized hematoma, which compresses cardiac chambers late after open heart surgery, is extremely rare. We report a case of intrapericardial organized hematoma in a 63-year-old man who underwent aortic valve replacement 8 years prior, which may have aggravated rheumatic mitral valve regurgitation compressing the mitral valve anulus. Under extracardiopulmonary bypass and cardioplegic heart arrest, we removed the hematoma and replaced the mitral valve with a 27 mm St. Jude Medical valve. There were no bleeding points on the heart and pericardium at operation and no history of blunt chest trauma. The etiology of the hematoma is uncertain.- - - - - - - - - - ranking = 7.4194520167947keywords = heart, cardiac (Clic here for more details about this article) |
9/337. Neurotrophic corneal endothelial failure complicating acute horner syndrome.PURPOSE: The authors report the clinical findings of a unique case of rapid corneal endothelial decompensation in association with acute horner syndrome. STUDY DESIGN: Case report and literature review. methods: The authors followed a 38-year-old woman who developed horner syndrome after right jugular vein catheterization during cardiac valvular surgery. Shortly after the operation, horner syndrome accompanied by conjunctival hyperemia and stromal corneal edema developed in the right eye. Over the course of 4 months, the eye became painful, the corneal endothelial cell count dropped precipitously, and the stromal edema worsened, causing a difference of 100 microm in central corneal thickness compared to the unaffected eye. Deep stromal vascularization started at the limbus, resembling interstitial keratitis. RESULTS: A 3-week course of topical steroid treatment resulted in a dramatic improvement in the stromal corneal edema and regression of the deep stromal vascularization. Ocular and right hemicranial pain subsided shortly thereafter. CONCLUSION: The authors hypothesize that corneal endothelial failure in this unique case may have resulted from traumatic sympathectomy. According to experimental evidence in the reviewed ophthalmologic literature, sympathetic innervation may have a neurotrophic role in the cornea. Corneal pathology similar to the authors' case has been described in hemifacial atrophy (Parry-Robson syndrome), a disorder that is assumed to result from sympathetic denervation and that can be produced in animals by cervical sympathectomy. The authors therefore hypothesize that sympathetic denervation of the cornea may rarely cause endothelial decompensation and corneal edema. To the authors' knowledge, this is the first reported case of corneal endothelial failure in horner syndrome.- - - - - - - - - - ranking = 0.41945201679471keywords = cardiac (Clic here for more details about this article) |
10/337. Alkaptonuric aortic stenosis: a case report.alkaptonuria is a rare disease of phenylalanine, aromatic amino acids, and tyrosine metabolism. Because of a genetic deficiency of the enzyme homogentisic acid oxidase, an accumulation of homogentisic acid causes ochronotic pigment deposition. The most common clinical manifestations are arthropathy, urinary calculi and discoloration, cutaneous and cartilaginous pigmentation, and cardiac valvular disease. Arthropathy and aortic stenosis are the most debilitating manifestations of the disease. A case of alkaptonuric aortic stenosis is described. A 75-year-old woman with a history of alkaptonuria presented in the emergency department with complaints of progressive dyspnea. Upon examination, the patient was hypertensive, tachypneic, and tachycardic with premature ventricular contractions. She had pitting edema of the lower extremities and complaints of generalized weakness. Chest x-rays revealed congestive heart failure and pulmonary edema. diuretics were administered, and a continuous nitroglycerin infusion was initiated in the emergency department. The patient was admitted for further evaluation. The patient's respiratory status continued to decline. She was intubated endotracheally 1 day after admission. Subsequent cardiac evaluation revealed an ejection fraction of 35%, severe aortic stenosis, mild coronary artery disease, ischemic cardiomyopathy, and anteroapical akinesis. A dobutamine infusion was instituted for persistent hypotension, and renal dose dopamine was initiated for oliguric renal failure. The patient underwent an emergency operation for an aortic valve replacement with a Dacron patch 10 days after admission. cardiopulmonary bypass and mild hypothermia were used during the procedure. The patient's hemodynamic status remained tenuous throughout the procedure. Although the first attempt to wean off cardiopulmonary bypass failed, the second attempt was successful with the aid of an intra-aortic balloon pump, inotropic support, and atrioventricular pacing. These measures were maintained during transport to the surgical intensive care unit. In the intensive care unit, the patient did not have an audible blood pressure or a palpable pulse without the support of the intra-aortic balloon pump and atrioventricular pacing. Coarse atrial fibrillation was the underlying electrocardiogram rhythm in the absence of atrioventricular pacing. sodium bicarbonate was given without improvement. After discussion with the family, all life support measures were discontinued. The patient died 10 minutes after her arrival in the intensive care unit. alkaptonuria's pathogenesis is manifested as both local and systemic in nature. collagen vascular diseases share a similar pattern of multisystem involvement. Despite the negative outcome for the patient described, valuable insight can be obtained by studying this case and noting the anesthetic considerations specific to collagen vascular diseases in general.- - - - - - - - - - ranking = 1.8389040335894keywords = heart, cardiac (Clic here for more details about this article) |
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