Cases reported "Cardiomegaly"

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1/46. Right lateral transthoracic approach mimicking standard transesophageal echocardiographic views in a patient with giant left atrium.

    We describe the case of a patient with long-standing severe mitral periprosthetic regurgitation and a giant left atrium. The patient was referred for surgery. On the third postoperative day, after resuture of the dehiscence of the valve sewing ring, the patient complained of dyspnea. Transthoracic ultrasound examination was performed to eliminate pleural effusion. The severe right lateral displacement of an aneurysmatic left atrial cavity contacting with the thoracic wall allowed us to obtain excellent images of the posterior cardiac anatomy by a right lateral thoracic view. The new transthoracic approach made it possible to safely assess the atrial side of the mitral prosthesis, eliminating mitral regurgitation after surgery without transesophageal echocardiographic examination.
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ranking = 1
keywords = operative
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2/46. Oesophageal perforation following perioperative transoesophageal echocardiography.

    Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing. Although TOE is considered safe, it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure and thermal damage is increased. patients on cardiopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed and non-specific. Delay in investigation, diagnosis and treatment will increase morbidity and mortality.
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ranking = 5
keywords = operative
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3/46. Successful treatment of a neonate with vein of Galen aneurysmal malformation.

    We present a follow-up study on a 5-year-old boy who was born with vein of Galen aneurysmal malformation (VGAM) accompanied by extreme cardiovascular distress. He was successfully treated by the staged endovascular technique during the neonatal stage. Postoperative angiographic study confirmed complete occlusion of the VGAM and the establishment of normal brain perfusion. At 5 years of age, the child is growing normally without neurological deficits or developmental retardation. We suggest that the restoration of normal brain perfusion in neonates with VGAM can cause normal brain development.
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ranking = 1
keywords = operative
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4/46. A novel technique for giant left atrium reduction.

    We herein describe a safe and reproducible technique for left atrial volume reduction in patients with a giant left atrium. In a 56-year-old patient undergoing redo mitral valve replacement, the left atrium measured 18 x 20 x 17 cm occupying the middle-lower segment of the right hemithorax with compression of the adjacent organs. The left atrial volume was reduced by triangular resections of the atrial wall and the mitral valve was replaced using a mechanical prosthesis. The postoperative course was uneventful and the left atrial diameter was 11.2 cm at the latest control.
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ranking = 1
keywords = operative
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5/46. Transplantation of an oversized heart.

    In response to the limited number of available donors, the criteria for accepting hearts have been expanded. In a 46-year-old female (160 cm, 56 kg) with a body surface area (BSA) of 1.58 m(2), an orthotopic heart transplantation was performed. She received the heart from a 34-year-old male donor (190 cm, 90 kg, BSA 2.58 m(2)). During transplantation, the obvious difference between the donor's heart and the recipient's pericardium did not cause a technical problem. However, the postoperative course was characterized by severe circulation problems. Due to a hemodynamically significant right heart impression, a consecutive pericardectomy had to be performed. After excision of the left and the right side of the pericardium, the patient returned to a stable condition. The consecutive course was without cardiopulmonary problems and the patient was discharged from the hospital 20 days later. The last twelve-month follow-up showed good cardiac function and excellent physical condition. We conclude that an oversized donor heart can be used for heart transplantation as long as the pericardium is left open and a left and right pericardectomy is performed.
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ranking = 1
keywords = operative
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6/46. Idiopathic chylopericardium: 131-I-triolein scan for noninvasive diagnosis.

    We report idiopathic chylopericardium in a physically active, asymptomatic 29-year-old man. Preoperative diagnosis was made by external cardiac imaging after oral administration of 131-I-labeled triolein. To our knowledge this is the first report of preoperative noninvasive diagnosis of chylopericardium. After open drainage and pericardial biopsy, the patient is asymptomatic without recurrence after 8 months.
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ranking = 2
keywords = operative
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7/46. Apparent coexistent valvular and subvalvular left ventricular outflow tract obstruction.

    A patient is presented in whom coexisting bicuspid valvular aortic stenosis and asymmetrical septal hypertrophy were suggested by echocardiography. A focal area of hypertrophy noted at operation was excised. Subsequent histological examination did not reveal evidence to support the echographic and surgical observations. The necessity for careful intraoperative assessment of the degree and nature of subvalvular muscular hypertrophy is stressed. The absence of classic echographic findings in these patients is noted.
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ranking = 1
keywords = operative
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8/46. cor triatriatum: echocardiograhic findings.

    The echocardiographic findings in a patient with cor triatriatum are presented. The preoperative echocardiogram demonstrated an unusual structure behind the mitral valve that moved anteriorly during atrial systole. There was also echocardiographic evidence of abnormalities of mitral valve motion, right ventricular and left atrial enlargement, and pulmonary hypertension. Postoperatively, the unusual echo behind the mitral valve had disappeared and the mitral valve appeared more normal. Left atrial and right ventricular dimension had decreased and the pulmonary valve appeared more normal. Fine diastolic mitral valve fluttering, an abnormal echo behind the anterior mitral valve leaflet moving anteriorly with atrial systole, an abnormal pulmonary valve echogram suggesting pulmonary hypertension, and marked right ventricular and left atrial enlargement were the main echocardiographic findings in our patient.
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ranking = 2
keywords = operative
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9/46. Surgical "correction" of solitus-concordant, double-outlet left ventricle with L-malposition and tricuspid stenosis with hypoplastic right ventricle.

    This report concerns a 2-year-old boy who had situs solitus and atrioventricular concordance with double-outlet left ventricle, L-malposition of the aorta, pulmonary stenosis, tricuspid stenosis, hypoplastic right ventricle, ventricular septal defect, and secundum atrial septal defect. These lesions were correctly diagnosed preoperatively, and "correction" was achieved by closing the atrial septal defect and tricuspid valve and performing a fontan procedure using an antibiotic-sterilized aortic homograft for the conduit. The patient initially did well postoperatively but, despite vigorous diuretic therapy, developed large bilateral pleural effusions necessitating frequent aspiration. He died unexpectedly one month after the operation. Postmortem examination showed the repair to be intact. Despite his death, we are encouraged to consider this operation in such cases in the future.
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ranking = 2
keywords = operative
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10/46. Aortoventriculoplasty: a new technique for the treatment of left ventricular outflow tract obstruction.

    Aortoventriculoplasty is a new method of treatment for left ventricular outflow tract obstructions. The concept is based on creating a surgical defect which is patched in such a way as to provide the largest possible outflow to the left ventricle. The incision of the aorta continues down as far as necessary, with the right ventricular wall, the aortic ring, and the septum being cut. Reconstruction with an inner Dacron patch on the septum is completed by replacing the aortic valve with an adequate prosthesis, covering the aortic incision with the same patch, and patching the right venticular opening with an outer patch. This method was used in 4 children with tunnel-like subaortic stenosis, 3 of whom had had unsuccessful previous surgical attempts. Other associated lesions including parachute mitral valve were also corrected during aortoventriculoplasty. Hemodynamic results were excellent following this operation. Two patients died postoperatively, one from advanced myocardial damage and progressive failure and the other from cerebral ischemia caused by insufficient retrograde perfusion through an aortic coarctation that was not repaired earlier. No arrhythmias were observed following the procedure. The other 2 patients are well 7 and 5 months postoperatively with excellent hemodynamic function.
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ranking = 2
keywords = operative
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