1/84. phrenic nerve injury following cardiac surgery: a review.phrenic nerve injury following cardiac surgery is variable in its incidence depending on the diligence with which it is sought. Definitive studies have shown this complication to be related to cold-induced injury during myocardial protection strategies and possibly to mechanical injury during internal mammary artery harvesting. The consequences are also variable and depend to a large extent on the underlying condition of the patient, particularly with regard to pulmonary function. The response of the patient may range from an asymptomatic radiographic abnormality to severe pulmonary dysfunction requiring prolonged mechanical ventilation and other associated morbidities and even mortality. Two cases are presented to demonstrate the variability in clinical responses to diaphragmatic dysfunction secondary to phrenic nerve injury from cardiac surgery. In addition, treatment strategies are reviewed including early tracheostomy and diaphragmatic plication, which appear to be the most effective options for patients who are compromised by phrenic injuries.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
2/84. Atrial thrombosis in cardiac amyloidosis: diagnostic contribution of transesophageal echocardiography.Few cases of atrial thrombosis detected by transesophageal echocardiography (TEE) in cardiac amyloidosis have been reported recently. We present the cases of 3 consecutive patients affected by AL-type cardiac amyloidosis, symptomatic for heart failure and in sinus rhythm. All patients had a cardiac restrictive pattern at Doppler examination. TEE showed left atrial thrombus in 2 patients and biatrial thrombi in 1 patient; conventional transthoracic echocardiography detected only 1 left atrial thrombus. Our experience confirms the association between cardiac amyloidosis and atrial thrombosis, even in sinus rhythm. TEE should be considered to assess thromboembolic risk in all cases of cardiac amyloidosis with severe diastolic dysfunction.- - - - - - - - - - ranking = 0.5keywords = dysfunction (Clic here for more details about this article) |
3/84. A case of arrhythmogenic right ventricular cardiomyopathy in sinus rhythm associated with thrombus in the right atrium.We describe a patient with arrhythmogenic right ventricular cardiomyopathy (ARCV) in sinus rhythm associated with thrombus in the right atrium. The occurrence of a right heart thrombus in ARCV is extremely rare and, to our knowledge, has been previously reported only in the right ventricle. In our case, ARCV most probably led to right atrial spontaneous echo contrast, and later, right atrial thrombus formation by blood stasis caused by right ventricular systolic dysfunction. In conclusion, our case suggests that right atrial thrombus may occur in ARCV, even in sinus rhythm.- - - - - - - - - - ranking = 0.5keywords = dysfunction (Clic here for more details about this article) |
4/84. Systemic lupus erythematosus with myocardial dysfunction due to microvasculopathy.A 25-year-old Japanese woman with systemic lupus erythematosus (SLE) had myocardial dysfunction. Heart catheterization showed normal coronary anatomy. Left ventricular cineangiography demonstrated hypokinesis in the anterior and posterior segments. Myocardial scintigraphy revealed patchy defects in the regions unrelated to coronary arteries. These data suggested that the myocardial dysfunction was due to microvasculopthy. In addition, it was speculated that the microvasculopathy was caused by vasculitis but not by thrombi, since she did not have antiphospholipid syndrome. In support of this speculation, corticosteroid therapy without any thrombolytic agents was effective. This report represents the first live patient with SLE in whom myocardial dysfunction due to microvasculopathy has been demonstrated.- - - - - - - - - - ranking = 3.5keywords = dysfunction (Clic here for more details about this article) |
5/84. Biatrial thrombosis after acute inferior wall myocardial infarction--a case report.The authors describe a case of biatrial thrombosis after acute inferior wall myocardial infarction (MI) with sinus rhythm. The presence of atrial thrombosis in patients with acute MI has recently been recognized with the aid of echocardiography. However, to the author's knowledge, a case of biatrial thrombosis after acute MI has not been reported previously. In this case, blood stasis, resulting from both left ventricular and right ventricular systolic dysfunction, was the most likely cause of the biatrial thrombi formation. In summary, this case suggests that biatrial thrombosis may occur in acute MI, even in the presence of sinus rhythm.- - - - - - - - - - ranking = 0.5keywords = dysfunction (Clic here for more details about this article) |
6/84. Novel approach to bleeding in patients undergoing cardiac surgery with liver dysfunction.We describe two patients with significant liver dysfunction (child--Pugh class B) who underwent cardiac surgery at our institution facilitated by the use of a prothrombin complex concentrate for the management of postoperative bleeding.- - - - - - - - - - ranking = 2.5keywords = dysfunction (Clic here for more details about this article) |
7/84. A case of coronary artery fistula draining into the pericardium causing hematoma.A 28-yr old female patient admitted to our clinic because of dyspnea and chest pain. Her transesophageal echocardiography demonstrated a huge mass on the anterolateral wall of the left ventricle causing dysfunction of the myocardium. coronary angiography demonstrated left anterior descending artery fistula draining into the pericardial cystic mass. Hydatic cyst was suspected and ELISA and hemagglutinin tests were both negative for echinococcus granulosus. Magnetic resonance image of the heart showed a mass thought to be a hematoma inside the cyst. She underwent surgery. The cystic lesion with a pure hematoma inside, was excised, and the fistula between left anterior descending artery and the mass was ligated without any complications. To our knowledge, this is the first case of a pericardial hematoma due to a coronary artery fistula, in the English literature.- - - - - - - - - - ranking = 0.5keywords = dysfunction (Clic here for more details about this article) |
8/84. Assessment of coronary morphology and flow in a patient with guillain-barre syndrome and ST-segment elevation.patients with guillain-barre syndrome often have cardiac disturbances as a manifestation of autonomic dysfunction. Such abnormalities consist of arrhythmias and disturbances of heart rate and blood pressure. We report a case of a patient with guillain-barre syndrome who developed ST-segment elevation in the inferolateral leads, suggestive of an acute coronary syndrome. cardiac catheterization revealed angiographically normal coronary arteries. Intracoronary ultrasound was also normal. Intracoronary Doppler flow measurements revealed an elevated baseline coronary flow velocity of up to 41 cm/s and decreased coronary flow reserve, particularly in the left circumflex artery. Myopericarditis as cause of the electrocardiographic changes could be ruled out by echocardiography and endomyocardial biopsy. We postulate that the intracoronary Doppler findings are caused by autonomic dysfunction with decrease of coronary resistance and redistribution of the transmural myocardial blood flow.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
9/84. Metabolic acidosis, rhabdomyolysis, and cardiovascular collapse after prolonged propofol infusion.The authors present the hospital course of a 13-year-old girl with a closed head injury who received a prolonged infusion of propofol for sedation and, subsequently, died as a result of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse. The patient had been treated for 4 days at a referring hospital for a severe closed head injury sustained in a fall from a bicycle. During treatment for elevations of intracranial pressure, she received a continuous propofol infusion (100 microg/kg/min). The patient began to exhibit severe high anion gap/low lactate metabolic acidosis, and was transferred to the pediatric intensive care unit at the authors' institution. On arrival there, the patient's glasgow coma scale score was 3 and this remained unchanged during her brief stay. The severe metabolic acidosis was unresponsive to maximum therapy. Acute renal failure ensued as a result of rhabdomyolysis, and myocardial dysfunction with bizarre, wide QRS complexes developed without hyperkalemia. The patient died of myocardial collapse with severe metabolic acidosis and multisystem organ failure (involving renal, hepatic, and cardiac systems) approximately 15 hours after admission to the authors' institution. This patient represents another case of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse observed after a prolonged propofol infusion in a pediatric patient. The authors suggest selection of other pharmacological agents for long-term sedation in pediatric patients.- - - - - - - - - - ranking = 0.5keywords = dysfunction (Clic here for more details about this article) |
10/84. Left atrial free-floating ball thrombus with recent cardioembolic stroke.A 67-year-old man was admitted to a local hospital complaining of hemiparesis. Because of coexisting arrhythmia, he was examined by echocardiography and found to have an oval free-floating thrombus in the left atrium concomitant with mitral and aortic stenosis. He was transferred to our hospital for emergency surgery. He underwent an operation on the ninth day from the onset of neurological dysfunction, when a 2.5 x 2.5 x 3.0 cm ball thrombus was removed, and the diseased mitral and aortic valves were replaced. His postoperative course was uneventful, with no neurological sequelae. Though left atrial ball thrombus is rarely found in patients with mitral valve disease, when it is found, then immediate surgical intervention is recommended to avoid sudden death. However, there is a high risk that any cerebral lesion may worsen due to systemic heparinization. Therefore, the optimal time of surgery in a patient with a recent neurological deficit is controversial.- - - - - - - - - - ranking = 0.5keywords = dysfunction (Clic here for more details about this article) |
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