Carotid shunt provides cerebral protection during emergency coronary artery bypass grafting in a patient with bilateral high grade carotid stenosis: a case report

<p>Abstract</p> <p>Background</p> <p>Management of patients with co-existent coronary and carotid disease is a controversial and challenging issue. The risk for stroke after coronary artery bypass grafting (CABG) in patients with hemodynamically significant carotid stenosis is up to 30%. In these patients a common practice is to proceed first with the restoration of cerebral perfusion and then perform the coronary revascularization. The rationale is that this strategy will reduce perioperative neurological morbidity and mortality. However, what happens when the carotid procedure is acutely complicated by cardiac instability which necessitates the interruption of the carotid procedure?</p> <p>Case report</p> <p>We describe a case of a patient with unstable angina and high grade asymptomatic bilateral carotid stenosis who underwent emergency combined CABG and carotid endarterectomy (CEA). Due to hemodynamic instability, ST-T changes, hypotension and bradycardia, upon completion of endarterectomy we placed a carotid shunt and the patient was put on cardiopulmonary bypass through median sternotomy. After triple CABG (duration of 90 minutes) we concluded the interrupted CEA procedure with primary closure of the carotid arteriotomy with the shunt in place. The postoperative course was uneventful and the patient was discharged after a week. In extreme cases with bilateral severe carotid stenosis and coronary artery disease where the carotid procedure should be interrupted, we suggest the use of carotid shunt which can provide adequate cerebral perfusion giving time to cardiac surgeon to perform the life saving cardiac procedure first.</p

Hamartomatous polyp of the small bowel with cyst formation and intestinal perforation: A rare complication

We present an unusual complication of a rare type of a small bowel polyp. The patient presented with acute abdomen and underwent emergency laparotomy. The small bowel was perforated. The site of perforation was a single hamartomatous polyp, which manifested intraluminal and exophytic growth. © 1993 S. Karger AG, Basel

Seclusion of an abdominal aortic aneurysm in the presence of an unusual horseshoe kidney - A case report

The coexistence of horseshoe kidney and abdominal aortic aneurysm is rare, and technical challenges during aneurysm repair are significant. This is a report of a case of an infrarenal aortic aneurysm associated with a horseshoe kidney with a parenchymatous isthmus draining to a third ureterocaliceal system and an anomalous vascular supply. Surgical management consisted of aneurysm exclusion and use of a bifurcation graft to the common iliac arteries. Arterial supply to the isthmus remained intact during operation and the postoperative clinical outcome was satisfactory