Computer tomography guided transthoracic periaortic abscess needle biopsy in late mediastinitis after heart surgery

Mediastinitis is a well-known complication of open heart surgery. Abscess as late complication, presenting years after heart surgery, is adegnotical. Transthoracic needle biopsies of lung parenchyma guided by computer tomography are widely accepted. The puncture of periaortic masses is not routinely performed. We report the case of an encapsulated mediastinal abscess localized next to ascending vascular graft. The febrile 47-year-old white male patient with history of Bentall operation was admitted to Cardiac Surgery Department. He was transferred for urgent chest tomography after International Normalization Ratio was reversed by prothrombin complex concentrate. Tomography revealed 7 × 5 × 4 cm mass between the sternum and ascending aorta, that was punctured by the needle. After biopsy specimen was sent for microbiology, the patient was transferred for surgery. There was no vascular graft invasion by the mass. The surgery was limited to abscess removal with postoperative drainage of periaortic area. The 6-week antibiotic therapy was applied. Patient recovered uneventfully

Zwężenie pnia lewej tętnicy wieńcowej w badaniu koronarograficznym — ostre rozwarstwienie aorty w rozpoznaniu śródoperacyjnym

Acute aortic dissection occurs in 0.5–2.95 cases per 100,000 citizens-year. Although the modern diagnostic tools help in more accurate diagnosis, the missleading findings still occure. We present a case of a 72-year-old man who was admitted to cardiology ward due to persistent chest pain. Initial diagnosis of acute coronary syndrome was confirmed by electrocardiography (ST segment depression in V1–V5 leads), transthoracic echocardiography (anterior wall dyskinesis) and laboratory tests (Tn-I: 6.92 μ/L, CK-MB: 226.24 ng/mL). Due to aortic aneurysm history, computer tomography (CT) was performed. Neither CT nor transthoracic echocardiography were negative for aortic dissection. Intraoperatively aortic dissection limited to Valsalva sinuses was found. Left main orifice was blindly closed followed by Bentall procedure and coronary artery revascularisation.Acute aortic dissection occurs in 0.5–2.95 cases per 100,000 citizens-year. Although the modern diagnostic tools help in more accurate diagnosis, the missleading findings still occure. We present a case of a 72-year-old man who was admitted to cardiology ward due to persistent chest pain. Initial diagnosis of acute coronary syndrome was confirmed by electrocardiography (ST segment depression in V1–V5 leads), transthoracic echocardiography (anterior wall dyskinesis) and laboratory tests (Tn-I: 6.92 μ/L, CK-MB: 226.24 ng/mL). Due to aortic aneurysm history, computer tomography (CT) was performed. Neither CT nor transthoracic echocardiography were negative for aortic dissection. Intraoperatively aortic dissection limited to Valsalva sinuses was found. Left main orifice was blindly closed followed by Bentall procedure and coronary artery revascularisation

Potentially positive ageing-related variations of medial smooth muscle cells in the saphenous veins used as aortocoronary bypass grafts

Introduction. Currently, elderly people constitute a large proportion of patients undergoing coronary artery bypass grafting (CABG). Activated smooth muscle cells in the tunica media of saphenous vein (SV) grafts are thought to play a key role in the formation of neointima and development of occluding atherosclerotic plaques. The aim of this study was to identify ageing-related variations in the expression of the smooth muscle cells pro­teins that may impact on patency rate of the grafts and the CABG outcomes. Material and methods. The study involved 216 consecutive patients with the mean of 62.7 ± 8.4 years who underwent isolated CABG with at least one SV aortocoronary bypass graft. Expression of a-smooth muscle actin (a-SM actin), smooth muscle-myosin heavy chain (SM-MHC), calponin (CALP), cytokeratin 8 (CK-8), metalloproteinase-2 (MMP-2) and tissue inhibitors of metalloproteinases-2 and -3 (TIMP-2, TIMP-3) in the SV wall was assessed by immunohistochemistry and correlated with the age of patients. Results. Calponin and a-SM actin were expressed in all studied SV transplants. SM-MHC immunoreactivity was observed in SV segments in 68.5% of patients, whereas MMP-2a and TIMPs expression was found in 75% of cases. In more than 50% of analyzed SV transplants, no expression of cytokeratin-8 was found. Moderate correlations between preexisting expressions of either cytoskeletal or hemostatic proteins in the tunica media of the SV grafts and the age of CABG patients were demonstrated. They were positive for SM-MHC (r = 0.494), CALP (r = 0.548), TIMP-2 (r = 0.413) and TIMP-3 (r = 0.406) whereas negative for CK-8 (r = –0.528) and MMP-2 (r = –0.417). Conclusions. Age-dependent decreases in the expression of MMP-2 and CK-8 accompanied by increases in expression of SM-MHC, TIMP-2 and TIMP-3 may promote SV graft patency and, thus, suggest a rationale for common use of SV grafts in the elderly