Cases reported "Heart Aneurysm"

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1/10. Totally endoscopic atrial septal defect closure using robotic techniques: report of two cases.

    BACKGROUND: The development of minimally invasive cardiac surgery has shown good clinical results with shorter recovery time and better cosmetic results. We report 2 cases of totally endoscopic atrial septal defect (ASD) closure using a robotic system. Open-heart closure of an ASD without opening the chest has never been previously reported. methods: Following percutaneous cannulation for cardiopulmonary bypass, aortic occlusion and delivery of cardioplegia, 2 patients with an ASD were successfully operated on using a robotic surgical device. After exclusion of the right lung, two robotic arms and an endoscopic camera were inserted through ports in the right hemithorax. A fourth port was inserted for an accessory endoscopic instrument. The ASD closure was carried out with interrupted stitches in one case and with a continuous suture in the other. RESULTS: cardiopulmonary bypass and cardioplegic arrest times were respectively 130 and 75 min in the first and 87 and 60 min in the second case. Extubation was carried out 3 and 5 hours postoperatively. Both patients resumed a totally normal lifestyle 1 week after the operation. CONCLUSIONS: Totally endoscopic open-heart ASD closure can be carried out safely using robotic techniques with rapid postoperative recovery and excellent cosmetic results. This modality of treatment can be considered an alternative to the transcatheter closure of ASD.
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2/10. Surgical management of left ventricular aneurysms by endoventricular pericardial patch plasty.

    BACKGROUND: Early and late surgical outcomes of endocardial resection and aneursymectomy repaired with an autologous pericardial patch were studied. methods: We studied 125 patients who underwent endoaneurysmorrhaphy with pericardial patch during the period from June 1993 until June 2000. Preoperative, early and late postoperative results, annual postoperative echocardiography of all patients and hemodynamic controls of 35 patients within a mean follow-up of 64 /-8 months were analyzed. RESULTS: Mean NYHA improved to postoperative 2.1 /-0.5 from preoperative 2.8 /-0.4. Mean number of bypass grafts was 2.6 /-1.1. Left ventricular ejection fraction rate improved to 36.2 /-8% in one month, 39.3 /-9% in 6 months, 42.3 /-8% in one year versus preoperative 29.2 /-9% (P< or =0.05).Perioperative mortality was 6.4% (eight patients) and 11 deaths were observed in the late follow-up (9.4%). CONCLUSION: Endoaneurysmorrhaphy with pericardial patch may be an alternative option in the management of left ventricular aneurysms within acceptable surgical results.
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3/10. pulse methylprednisolone therapy in the treatment of immune globulin-resistant Kawasaki disease: case report and review of the literature.

    A subgroup of patients with Kawasaki disease (KD) did not respond to intravenous immune globulin (IVIG) therapy. Corticosteroid therapy remains a controversial alternative in such cases. We report two young children with KD who failed to respond to three courses of IVIG therapy and subsequently received pulse methylprednisolone as an alternative. One had a satisfactory outcome but the other developed giant coronary aneurysms and had a myocardial infarction 2 months after onset of the illness. A review of relevant literature showed that the timing of initiation of pulse methylprednisolone therapy is important. It is suggested that pulse methylprednisolone therapy should be considered if there is no response to two standard doses of IVIG treatment.
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4/10. Surgical revision of an uncommonly dislocated self-expanding Amplatzer septal occluder device.

    Open heart surgery is the standard procedure for closure of ostium secundum atrial septal defects. Recently, percutaneous transcatheter procedures emerged as therapeutic alternatives for closure of both atrial septal defects and patent foramen ovale. Unfortunately, however, such percutaneous procedures may require surgical intervention for early or late complications. We report a case with emergent surgery for dislocation of the Amplatzer septal occluder into the aortic arch diagnosed 30 days after percutaneous closure of an atrial septal defect.
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5/10. Endocavitary patch repair for a left ventricular pseudoaneurysm: an alternative approach.

    We present a case of postinfarction posterolateral left ventricular wall pseudoaneurysm with severe mitral regurgitation and poor left ventricular function. The patient had new york Heart association (NYHA) class IV heart failure at the time of surgery, which was performed on an emergency basis. The surgical approach included coronary revascularization, surgical posterior mitral leaflet detachment with patch closure of the pseudoaneurysm neck from inside of the left ventricular cavity followed by mitral valve reconstruction, and subsequent implantation of a mitral annuloplasty ring.
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6/10. A case of left ventricular pseudoaneurysm with long survival and congestive heart failure as first presentation. Case report and review of the literature.

    BACKGROUND: Left ventricular pseudoaneurysm is a rare and extremely fatal complication of acute myocardial infarction. It is defined as a rupture of the myocardium contained by epicardial adhesions or the epicardial wall. CASE REPORT: A 76-year-old woman was brought to our department suffering from acute pulmonary edema and left ventricular pseudoaneurysm. This condition was caused by an unrecognized high lateral myocardial infarction, which was diagnosed and treated conventionally. Four years after the diagnosis was made, the patient is in good physical condition. The presentation, imaging findings, and the prognosis of such cases are briefly discussed. We have especially focused on the imaging techniques currently used to confirm the diagnosis and on the fact that although the patient refused to have an operation (most appropriate for the diagnosis), she still lives in good physical condition (NYHA II). CONCLUSIONS: We report a case of post infarction pseudoaneurysm along with review of the literature on the subject. We discuss the role of computed tomography and magnetic resonance imaging to ascertain the diagnosis and the algorithm of therapeutic management. Based on current literature, we believe that surgical resection is the treatment of choice for patients in whom a pseudoaneurysm is detected within three months after myocardial infarction, for patients with other indications for cardiac surgery, and for symptomatic patients with ventricular tachycardia or recurrent embolism related to the pseudoaneurysm. Optimum medical therapy is the only alternative in those high-risk patients who refuse surgical operation.
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7/10. Giant intraatrial septal aneurysm originating from a branch of the left coronary artery.

    We present the case of a 38-year-old woman who had a large intraatrial aneurysm occupied by old thrombosis. The aneurysm was successfully removed, and the atrium was repaired. Pathohistological findings indicated that the inflow artery of the aneurysm had an anomalous origin from the left main coronary artery, and its pathogenesis was unknown. It is occasionally difficult to distinguish a large coronary aneurysm from a mediastinal tumor because this aneurysm is a rare entity, even more so in an atrial septum. A giant coronary aneurysm should be considered an alternative diagnosis in the event of a mediastinal mass. Surgery is recommended for a large coronary aneurysm.
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8/10. Chronic false aneurysms of the left ventricle: management revisited.

    False aneurysms of the left ventricle are a rare complication of myocardial infarction. They pose a high risk of cardiac rupture and death in the immediate stages following infarction. The long term fate of these aneurysms is less clear. Based on early reports, the current practice is to resect all false aneurysms regardless of their age. Three patients were found to have false aneurysms several years (seven to 12) following their index infarction. Two of the patients were asymptomatic at presentation and their aneurysms were discovered by echocardiography. All three patients underwent successful surgical repair. The literature on false aneurysms is reviewed and analyzed. With the wide availability of high quality noninvasive imaging there has been an increase in the reporting of unsuspected false aneurysms in the past decade. The need for prophylactic aneurysectomy of stable asymptomatic chronic false ventricular aneurysms is not well supported by available data in the literature. A strategy of conservative management with noninvasive follow-up may be a more appropriate alternative.
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9/10. Pericardial patch repair of left ventricular aneurysm.

    Infectious complications associated with the use of Teflon felt buttresses in left ventricular aneurysm repair may result in serious morbidity. Use of an autologous pericardial patch is an alternative approach that should be considered. The technique, which we have used in 4 patients, is described.
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10/10. Surgical elimination of an atrial septal aneurysm causing cerebral embolism.

    Atrial septal aneurysms have been recognized as sources of arterial embolism. An intraatrial aneurysm was demonstrated in the fossa ovalis of a 45-year-old woman who suffered an episode of cerebral embolism. The disorder is rarely treated surgically. Most patients with this condition are given life-long anticoagulation, a treatment that may have serious complications. As an alternative treatment with possible lower risk, we removed the aneurysm surgically.
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