1/44. cardiac tamponade and death from intrapericardial rupture [corrected] of sinus of valsalva aneurysm.A 35-year-old woman presented with dyspnea and chest pain. She had a large aneurysm of the non-coronary sinus of valsalva. Before her scheduled urgent surgery, the patient collapsed and died of cardiac tamponade secondary to intrapericardial rupture of the aneurysm. We would advocate urgent repair of this type of lesion to prevent such an outcome. We are aware of no other specific reports addressing extracardiac rupture of non-coronary cusp aneurysms [corrected].- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/44. Surgical treatment for a supra sinotubular junctional saccular aneurysm associated with aortic regurgitation.We reported a patient with a saccular ascending aortic aneurysm located just above the non-coronary sinotubular junction. The aneurysm produced severe aortic regurgitation and two episodes of cardiac tamponade. By intraoperative inspection, the border between the aneurysmal wall and non-dilated portion of the normal aortic wall was distinct, and the aortic valve leaflets and aortic annulus appeared normal. aortic valve dysfunction appeared to be caused by dilation of the noncoronary sinotubular junction and mild distortion of the noncoronary sinus because of the aneurysmal formation. We performed patch closure of the aneurysmal ostium and repaired the dilated noncoronary sinotubular junction. Postoperative echocardiography and aortography demonstrated a good coaptation of the aortic valve leaflets with trivial aortic regurgitation. Although a rupture site, dissection or carcinomatous pericarditis which is attributable to the two episodes of cardiac tamponade could not be found, pathologic examination of the aneurysm wall revealed intramural blood leakage between the mucoid degenerated media and notably thickened adventitia. In addition, there was thinning and interruption of the elastic fibers of the media. These findings are consistent with a leaking aneurysm which cause the slow development of cardiac tamponade.- - - - - - - - - - ranking = 1.5714285714286keywords = aneurysm (Clic here for more details about this article) |
3/44. cardiac tamponade: an unusual, fatal complication of infective endocarditis.Infective endocarditis still occurs in Western countries and so far, it has been an important medical problem. The spectrum of infective endocarditis complications may be extremely wide. We report two unusual cases of infective endocarditis complicated with heart rupture and pericardial effusion. In one case, the infective process spread from the aortic valve developing a sinus of valsalva aneurysm with subsequent aortic perforation. The perforation reached the right auricular epicardial region with subsequent epicardial rupture and hemopericardium. In the other patient, an infective process of the aortic cusps induced the formation of multiple abscesses in the left ventricle and in the right atrium. An annular abscess of the tricuspid valve was found. From the right atrium, an infected fistula spread through the atrial wall and perforated the epicardial surface of the right auricle. Aside from the rare occurrence of these complications in patients affected with infective endocarditis, these cases are of clinical interest because they raise the problem of the need of greater sensitivity to the diagnosis of endocarditis and proper diagnostic approach.- - - - - - - - - - ranking = 0.14285714285714keywords = aneurysm (Clic here for more details about this article) |
4/44. Successful repair of myocardial free wall rupture after thrombolytic therapy for acute infarction.BACKGROUND: Controversy exists regarding the timing of thrombolytic administration and rupture rate. methods: hospital records at St. Luke's-Roosevelt Hospital of the 4 study patients were reviewed and compared with those of 41 patients from a group of 537 patients concurrently admitted with a diagnosis of myocardial infarction (MI). RESULTS: Four patients experienced ventricular free wall rupture after having a MI between November 17, 1993, and July 28, 1995. All received tissue plasminogen activator. In 1 patient, pericardial effusion associated with a pseudoaneurysm was discovered in the operating room. The 3 others developed clinical pericardial tamponade before surgery. All 4 patients survived and left the hospital on postoperative days 10, 11, 11, and 82, respectively. During this same time period, 537 patients were admitted with MI, 41 of whom died; the study's 4 patients were compared with these 41. CONCLUSIONS: These data demonstrate that rupture of the ventricular free wall can occur early after thrombolytic therapy and may have a subacute course. Prompt diagnosis and surgery offer excellent chances of surviving this fatal condition.- - - - - - - - - - ranking = 0.41455795715054keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
5/44. Post-traumatic left ventricular false aneurysm.Most false aneurysms of the heart represent contained ventricular free wall ruptures after myocardial infarction. Post-traumatic aneurysms also may follow penetrating or non-penetrating trauma to the chest. Regardless of the origin of the false aneurysm there is a propensity for aneurysm rupture. We report a patient who developed a false aneurysm of her left ventricle that developed post-motor vehicle accident. Her orthopedic problems were the clinical problems identified and after a hospital admission of 10 days she was discharged home. Four weeks later she died suddenly from anterior left ventricle false aneurysm rupture and tamponaide. patients with significant chest wall trauma should be assessed for cardiac pathology prior to discharge. Presentation may be delayed and be overshadowed by more evident pathology. Trauma-related aneurysms may cause sudden death, and this may occur some later time after the trauma. Attributing the cause of death to the trauma, which may be remote, is important for the forensic investigator to remember.- - - - - - - - - - ranking = 1.5714285714286keywords = aneurysm (Clic here for more details about this article) |
6/44. Anesthetic implications of subacute left ventricular rupture following acute myocardial infarction: a case report.Rupture of the free wall of the left ventricle, a relatively common complication of acute myocardial infarction, is associated with a high mortality rate. The clinical course can vary from catastrophic, that is death, to incomplete rupture with the formation of a pseudoaneurysm. Subacute rupture is a condition that demands expeditious diagnosis and surgical repair if the patient is to survive. Surgical repair can be difficult at best. This article reports a case of subacute rupture of the left ventricle that was successfully repaired using a novel surgical technique and discusses the anesthetic implications surrounding the case.- - - - - - - - - - ranking = 0.41455795715054keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
7/44. cardiac tamponade. A study of 50 hearts.Fifty hearts with a rupture of the free wall were studied. From a correlation between gross and microscopic features and the clinical history, several interesting features evolved. Firstly, the gross aspect of the rupture enabled a distinction of three types. Type I, characterized by an abrupt, slit-like tear, which correlated clinically with a recent infarct, mostly of less than 24 hours previously. Type II which showed an 'erosion' of the infarcted myocardium, indicative of a slowly progressing tear. This type correlated with a somewhat larger time interval between onset of symptoms and tamponade. Type III, characterized by early aneurysm formation, which correlated clinically with older infarcts. Furthermore, occasionally, marked discrepancies were found between the histological and clinical dating. This lends support to the concept that in some patients the onset of symptoms may be secondary to the onset of rupture, in the setting of an otherwise silent infarction. Clinically, the acute episode is diagnosed as the onset of infarction. The term 'concealed rupture' is proposed for this phenomenon.- - - - - - - - - - ranking = 0.14285714285714keywords = aneurysm (Clic here for more details about this article) |
8/44. cardiac tamponade secondary to rupture of a distal aortic arch aneurysm.We report the rare rupture of a distal aortic arch aneurysm protruding into the pericardial cavity. A 70-year-old woman who suddenly lost consciousness and was transferred to our hospital by ambulance in profound shock was found in emergency computed tomography and echocardiography to have a dilated distal aortic arch and massive pericardial effusion. Suspecting that a distal aortic arch aneurysm had ruptured, causing cardiac tamponade, we undertook an operation. We found a defect in the aneurysmal wall leading to the pericardium near the main pulmonary artery that was plugged temporarily with an atheromatous mass. We conducted total arch replacement successfully under selective cerebral perfusion and moderate hypothermia.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
9/44. Rupture of an aneurysm resulting from a coronary artery fistula: a case report.A rare case of coronary-to-pulmonary artery fistulas associated with formation of a saccular aneurysm that ruptured into the pericardium occurred in a 69 year-old-female who had experienced an episode of unconsciousness 3 months earlier and who suffered a second episode. She was diagnosed as having a cardiac tamponade caused by rupture of a coronary artery aneurysm formed by a left coronary artery - pulmonary artery fistula. The hemorrhage stopped after pericardial drainage. She was referred for surgical treatment of the aneurysm and suture closure of the afferent coronary artery into the aneurysm, transpulmonary closure of the fistulas, and aneurysmorrhaphy. There was adhesion between the aneurysm and pericardium. Her postoperative course was uneventful and she has remained well for 4 months after the operation.- - - - - - - - - - ranking = 1.4285714285714keywords = aneurysm (Clic here for more details about this article) |
10/44. Fatal Kawasaki disease due to coronary aneurysm rupture with massive cardiac tamponade.Kawasaki disease (KD), an acute febrile childhood vasculitis of unknown etiology, preferentially involves the coronary arteries. diagnosis typically rests on strict clinical criteria. If untreated, KD may be complicated by coronary arteritis and progress to aneurysm formation, thereby predisposing the child to a small but significant risk of death. We report a case of atypical KD causing death due to rupture of a coronary artery aneurysm with massive cardiac tamponade. The clinical challenge to recognize KD during the acute phase--especially in atypical cases when the diagnostic criteria are incomplete--is critical. Therapeutic intervention with intravenous gamma-globulin (IVIG) and aspirin during the first 10 days of onset is highly effective not only in reducing nearly tenfold such potentially fatal cardiac complications by arresting the immune-mediated necrotizing arteritis, but also in alleviating the acute symptoms related to systemic inflammation.- - - - - - - - - - ranking = 0.85714285714286keywords = aneurysm (Clic here for more details about this article) |
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