1/73. Three ventriculoplasty techniques applied to three left-ventricular pseudoaneurysms in the same patient.A 59-year-old male patient underwent surgery for triple-vessel coronary artery disease and left-ventricular aneurysm in 1994. Four months after coronary artery bypass grafting and classical left-ventricular aneurysmectomy (with Teflon felt strips), a left-ventricular pseudoaneurysm developed due to infection, and this was treated surgically with an autologous glutaraldehyde-treated pericardium patch over which an omental pedicle graft was placed. Two months later, under emergent conditions, re-repair was performed with a diaphragmatic pericardial pedicle graft due to pseudoaneurysm reformation and rupture. A 3rd repair was required in a 3rd episode 8 months later. Sternocostal resection enabled implantation of the left pectoralis major muscle into the ventricular defect. Six months after the last surgical intervention, the patient died of cerebral malignancy. Pseudoaneurysm reformation, however, had not been observed. To our knowledge, our case is the 1st reported in the literature in which there have been 3 or more different operative techniques applied to 3 or more distinct episodes of pseudoaneurysm formation secondary to post-aneurysmectomy infection. We propose that pectoral muscle flaps be strongly considered as a material for re-repair of left-ventricular aneurysms.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
2/73. Repeat syncopal attacks due to postsurgical right ventricular pseudoaneurysm.Pseudoaneurysm of the right ventricular outflow tract is a rare lesion caused by disruption of the ventricular wall that allows the blood to leak into the surrounding space. It often complicates surgery involving right ventriculotomy and progressively increases in size, therefore causing airway compression, pulmonary perfusion asymmetry, thromboembolism, and rupture. We report on a patient who developed right ventricular pseudoaneurysm early after surgery for atrio-ventricular septal defect with tetralogy of fallot and needed emergency surgical repair due to low cardiac output and repeat syncopal attacks.- - - - - - - - - - ranking = 437.8033599077keywords = embolism (Clic here for more details about this article) |
3/73. Post-traumatic basilar artery thrombosis in a young man with atrial septum aneurysm and prothrombin gene G20210A polymorphism.prothrombin gene G20210A polymorphism has been recently identified as a cause of venous thrombosis. However the association between this mutation and arterial thrombosis remains uncertain. Some authors have suggested that the polymorphism in the 3' region of the prothrombin gene may precipitate cerebral arterial thrombosis in young patients with prothrombotic conditions. We report a case of post-traumatic basilar artery thrombosis in a young patient carrier of the prothrombin gene G20210A polymorphism. Thirty-six hours after sustaining a head injury in the occipital region, a young man developed vomiting, headache, dizziness and truncal ataxia, without signs of focal impairment. magnetic resonance imaging and selective angiography carried out 2 days later showed an obstruction of the basilar artery, with infarction of the right cerebellar region. A transthoracic echocardiogram showed a patent foramen ovale with little left-to-right shunt and an aneurysm of the interatrial septum. blood examination showed a heterozygous status for prothrombin gene G20210A polymorphism. We conclude that this prothrombin gene mutation and the coexisting particular head injury and interatrial septal aneurysm could have contributed simultaneously to the development of basilar artery occlusion and cerebellar infarction. We suggest that in selected cases of cerebellar ischemia a prothrombin gene G20210A polymorphism should be considered.- - - - - - - - - - ranking = 174.91697090594keywords = thrombosis, cerebral (Clic here for more details about this article) |
4/73. Atrial septal defect with interatrial aneurysm and Axenfeld-Rieger syndrome.PURPOSE: The aim of this presentation is to report a rare association between interatrial aneurysm and Axenfeld-Rieger syndrome. methods: We present a 20-year-old girl with Axenfeld-Rieger syndrome, in whom the diagnosis was confirmed by the facial dysmorphic appearance, slit-lamp examination, applanation tonometer, gonioscopy, and cardiovascular examination. RESULTS: The patient had prominent Schwalbe's line in all quadrants, iris atrophy, and secondary glaucoma in both eyes. The echocardiogram revealed an atrial septal defect with interatrial aneurysm. CONCLUSION: This is the first case report of coexisting Axenfeld-Rieger syndrome and interatrial aneurysm. We would like to stress that aneurysm can be a potential occult source of cerebral embolism.- - - - - - - - - - ranking = 4775.3894564864keywords = cerebral embolism, embolism, cerebral (Clic here for more details about this article) |
5/73. Multiple coronary artery aneurysms resulting in myocardial infarction in a young man: treatment by double aorta-coronary saphenous vein bypass grafting.A 26-year-old Japanese man was treated for a transmural myocardial infarct caused by multiple aneurysms of the left main (LMC), left anterior descending (LAD), and the right coronary arteries (RCA). He underwent successful double aorta-coronary saphenous vein bypass grafting. The etiology of the aneurysm remains uncertain but an inflammatory origin is most probable. review of the literature has indicated that this is the seventh case of coronary artery aneurysms without arteriovenous fistulas to be managed by grafting techniques with the saphenous vein. This experience has suggested that young patients presenting with anginal pain or myocardial infarction whould be carefully examined for coronary artery aneurysms. Since most of the patients developed myocardial infarction probably from thrombotic occlusion or embolism of the distal vessel, this lesion should be considered for surgery whenever anatomically feasible. Coronary artery reconstruction by grafting techniques, with or without resection of the aneurysm, is the treatment of choice. Although surgical treatment has provided good clinical amelioration to our patient as well as the patients previoulsy reported, a careful long-term follow-up should be continued for patients with multiple coronary artery aneurysms of doubtful origin.- - - - - - - - - - ranking = 437.8033599077keywords = embolism (Clic here for more details about this article) |
6/73. Successful recovery after ventricular fibrillation in a patient with Kawasaki disease.Kawasaki disease (KD) is an uncommon cause of sudden death in young adults in europe. Angiographically, the disease is characterized by coronary artery aneurysms which can be fully obstructed by acute thrombosis or by progression of the disease. If diagnosis of KD is made, immediate investigation should be made to determine whether ischemia is occurring and if so, to establish optimal time for revascularisation or cardiac transplantation. We describe an 18-year-old Caucasian male who was not previously known to have KD and who suffered from an acute myocardial infarction complicated by ventricular fibrillation, caused by acute thrombosis of a coronary artery aneurysm.- - - - - - - - - - ranking = 43.479242726486keywords = thrombosis (Clic here for more details about this article) |
7/73. Solitary focal coronary artery aneurysm in a middle aged male with atypical chest pain.A 52 year old hypertensive Malay man, a smoker who presented with a one month history of mild chest discomfort not related to exertion and had a positive stress test with ST segment depression in the lateral leads. coronary angiography showed stenosis in the right coronary artery and a coronary aneurysm in the proximal segment of his left anterior descending. The aneurysm was situated just distal to a stenotic lesion. The aneurysm is most likely related to atherosclerotic coronary artery disease. The patient was treated with oral nitrates, aspirin, angiotensin converting enzyme inhibitor and warfarin to prevent thromboembolism related to the coronary aneurysm. He remains asymptomatic one year after diagnosis.- - - - - - - - - - ranking = 437.8033599077keywords = embolism (Clic here for more details about this article) |
8/73. A case of orthodeoxia caused by an atrial septal aneurysm.Platypnea-orthodeoxia is an uncommon syndrome that may occur due to the postpneumonectomy state, cirrhosis of the liver, recurrent pulmonary embolism, and intracardiac shunting. We describe a patient who was found to have a positional change in desaturation after being admitted for dehydration. Workup revealed an atrial septal defect with aneurysm. Following surgical repair, the orthodeoxia resolved. Different mechanisms explain positional desaturation, such as atriovenous malformations at the lung base of cirrhotic patients. In an atrial septal defect, the increased shunting of blood across a malformed septum in an upright position may cause orthodeoxia. This case highlights the necessity of heightened awareness of this syndrome and the need for documenting orthostatic changes in cases of severe hypoxemia.- - - - - - - - - - ranking = 437.8033599077keywords = embolism (Clic here for more details about this article) |
9/73. Congenital aneurysm of the left ventricle associated with supravalvular aortic stenosis and aneurysm of the left main coronary artery: case report and review of the literature.We report a unique case of a 33 year old female with congenital aneurysm of the left ventricular apex associated with an aneurysm of the left main coronary artery and surgically repaired supravalvular aortic stenosis. The congenital aneurysm of the left ventricular apex was not associated with a midline thoraco-abdominal defect, as reported in the medical literature. The patient survived two episodes of thrombo-embolism and is well after 10 years of medical follow-up.- - - - - - - - - - ranking = 437.8033599077keywords = embolism (Clic here for more details about this article) |
10/73. glycogen storage disease associated with left ventricular aneurysm in an elderly patient.glycogen storage disease (GSD) types II, III, IV, and V may be associated with cardiomyopathy, but, with the exception of type III GSD, adult cases are extremely rare. A 62-year-old man was found to have GSD and a concomitant left ventricular aneurysm. He had been comparatively well until the age of 62 years, although he had suffered a cerebral infarction at the age of 35 years. The damage caused by glycogen deposition was strictly confined to the myocardium. Left ventriculography revealed a left ventricular aneurysm in the apex. The serial change on electrocardiogram, as well as the findings of the echocardiogram and of cardiac catheterization, resembled those of the dilated phase of hypertrophic cardiomyopathy. However, a left ventricular endomyocardial biopsy specimen revealed central vacuolar degeneration of myocytes with depositions of glycogen. The GSD type remains unknown in the present patient, because the activity of debranching enzyme (type III) measured from the skeletal muscle specimen was normal, whereas that of acid maltase (type II) was slightly low. It is possible that there is a specific malfunction of the acid maltase of the myocardium in the present patient.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
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