11/158. Left internal mammary artery to innominate vein fistula complicating pacemaker insertion. Treatment with endovascular transarterial coil embolization.arteriovenous fistula (AVF) is rarely encountered as a complication of pacemaker insertion. Percutaneous angiographic therapy of such iatrogenic fistulas can be both safe and effective, leading to important reductions in costs. A 60-year-old woman was admitted to the hospital four weeks after left subclavian pacemaker insertion complaining of signs of congestive heart failure. A loud continuous machinery bruit was heard over the left upper chest. An arteriogram revealed a false aneurysm from the LIMA, 6 mm in-diameter, with formation of an AVF between the LIMA and the left innominate vein. Embolization of the LIMA was carried out using seven platinum coils at the level of the AVF and the false aneurysm was embolized with 3 controlled-release IDC coils. The complete occlusion of the fistula was achieved and the distal LIMA persisted patent due to the opening of collateral vessels from the intercostal arteries. AVF between the subclavian artery or its branches and the subclavian or innominate veins have been reported to be congenital, traumatic and iatrogenic (associated to central venous access to hemodynamic monitoring, dialysis, and very infrequently to pacemaker insertion) but the internal mammary arteries are only rarely involved. The course of AVF is undefined, but generally, surgical or percutaneous embolization is warranted because of the potential appearance of a great number of complications. Surgical repair is associated with significant morbidity and mortality. Whenever possible, percutaneous nonsurgical occlusion of the AVF with coil embolization is the procedure of choice, because of its high success rate and low morbidity.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
12/158. Unusual origin and fistulization of an aortic pseudoaneurysm: "off-pump" surgical repair.Aortic pseudoaneurysm is an unusual complication of cardiac operations. The origin depends on the site of arterial wall disruption. rupture into the right side of the bronchial tree is an exceedingly rare evolution. Repair is commonly performed using cardiopulmonary bypass. In our report a male patient underwent two procedures for aortic dissection, and 6 months after the second operation massive hemoptysis appeared abruptly. A false aneurysm rose from a graft-to-graft anastomotic site and ruptured into a segmental bronchus of the right upper lobe. Repair was performed without cardiopulmonary bypass.- - - - - - - - - - ranking = 3.2272691675151keywords = cardiac (Clic here for more details about this article) |
13/158. Left ventricular pseudoaneurysm and mitral valve regurgitation. Conservative surgical therapy.A patient with posterolateral left ventricular pseudoaneurysm, severe mitral regurgitation and coronary artery disease is reported. mitral valve insufficiency was almost completely cured by simple closure of the left ventricular defect by edge to edge apposition along the long axis of the heart.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
14/158. aorta-cutaneous fistula as a rare complication of localized chronic mediastinitis.A 35-year-old man was admitted 5 years after congenital heart surgery complicated by staphylococcus aureus and a cutaneous fistula located at the left fourth intercostal space. He was febrile (40 degrees C), suffering from sternal pain and suppuration from the old fistula. During examination arterial blood suddenly discharged from the fistula, so that surgery was immediately instituted. An infected Dacron tube implanting on the ascending aorta for a central aorto-pulmonary shunt was at the origin of a false aneurysm: this had led to the repeat formation of an aorta-cutaneous fistula and outbreak of external bleeding.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
15/158. Acute rupture of a left ventricular false aneurysm.Left ventricular aneurysm develop when rupture of the free ventricular wall is contained by the inflammatory surrounding tissues. These false aneurysms rupture secondarily and should be treated soon after diagnosis. The diagnosis is suggested by echocardiography and confirmed by cardiac catheterization. Immediate surgery is recommended, with good survival in most reports. The patient presented in this report had ruptured his left ventricular false aneurysm before diagnosis. He was operated and had a good initial postoperative course. He died later from a severe pulmonary infection.- - - - - - - - - - ranking = 3.2272691675151keywords = cardiac (Clic here for more details about this article) |
16/158. Aortic pseudoaneurysm after ligation of aneurysmal saphenous vein graft.After an aneurysmal saphenous vein graft was ligated and divided at reoperation, the proximal stump continued to enlarge, rather than occluding by thrombosis, producing an aortic pseudoaneurysm that compressed adjacent cardiac structures. Oversewing the aortosaphenous junction of ligated vein graft remnants will prevent this complication.- - - - - - - - - - ranking = 3.2272691675151keywords = cardiac (Clic here for more details about this article) |
17/158. A large false aneurysm of the right ventricle within a giant epicardial lipoma.Lipomas, which account for approximately 10% of all neoplasms of the heart, may be detected in asymptomatic patients by chance during echocardiography, CT scan, or MRI scan. Occasionally, lipomas are complicated by arrhythmias. We describe a patient who presented with severe cardiomegaly and paroxysmal supraventricular tachycardia. An MRI scan showed a large intrapericardial lipoma with two large cavities inside communicating with each other and with the right ventricular chamber through a defect of the right ventricular wall. The mass was partially removed, and the right ventricle was patched. Surgery combined with antiarrhythmic therapy resulted in a good short-term result.- - - - - - - - - - ranking = 1keywords = heart (Clic here for more details about this article) |
18/158. Left ventricular pseudoaneurysm: diagnosis by cine magnetic resonance imaging.We report a case that illustrates the difficulty in diagnosing left ventricular (LV) pseudoaneurysm and the potential value of cine magnetic resonance imaging (MRI). A 69-year-old man with a history of ischemic congestive heart failure had a mass found on routine chest X-ray, contiguous with the cardiac silhouette. Neither CT nor echocardiography accurately defined the mass. The diagnosis of LV pseudoaneurysm was definitely made by cine MRI. Although the accuracy of various imaging modalities for detecting LV pseudoaneurysm is not known, cine MRI was the most useful test in this case. Despite refusing surgery to correct the pseudoaneurysm, the patient survived for nearly 4 years, treated only with anticoagulation.- - - - - - - - - - ranking = 4.2272691675151keywords = cardiac, heart (Clic here for more details about this article) |
19/158. Cellular allograft rejection affecting the donor aorta after combined heart-lung transplantation.BACKGROUND: Infectious pseudoaneurysms of the ascending aorta are a recognized major complication after heart-lung transplantation. METHOD: This report describes an unusual and previously unreported complication, that of cellular allograft rejection, which caused a pseudoaneurysm of the donor's ascending aorta in a patient who underwent combined heart-lung transplantation. Repair was performed by primary suture after mobilization of the aortic segments. RESULT: On histological examination the resected aneurysm showed evidence of proliferative vasculitis with perivascular infiltration of the vasa vasorum by mononuclear cells. The mononuclear cells were identified as CD4 and CD8 by immunohistological staining. CONCLUSIONS: This report shows that cellular allograft rejection may affect the donor aorta after heart-lung transplantation and may result in pseudoaneurysm formation, even under triple-drug immunosuppression after ABO-compatible allograft transplantation.- - - - - - - - - - ranking = 7keywords = heart (Clic here for more details about this article) |
20/158. Pseudoaneurysm of a septal perforator in beating heart coronary bypass grafting.A 46-year-old man with unstable angina underwent beating heart coronary bypass grafting for a left anterior descending coronary artery. Postoperative angiography showed intramuscular extravasation (6 x 8 mm) distal to the anastomosis, which was most likely the result of a needle injury caused by a snare during the operation. Follow-up angiography 2 weeks later revealed no extravasation.- - - - - - - - - - ranking = 5keywords = heart (Clic here for more details about this article) |
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