Intra-abdominal pectus bar migration – a rare clinical entity: case report

We present the case of a 20-year-old male who underwent successful surgical correction of pectus excavatum with the Highly Modified Ravitch Repair (HMRR). At 29 months the attempted operative removal of the Ravitch bar was unsuccessful despite the impression of adequate bar location on chest x-ray. Subsequent imaging with computed tomography was unclear in determining whether the bar was supra or infra-diaphragmatic due to the tissue distortion subsequent to initial surgery. Video assisted thoracoscopic surgery (VATS) successfully retrieved the bar and revealed that it was not in the thorax, but had migrated to the intra-abdominal bare area of the liver, with no evidence of associated diaphragmatic defect or hernia. Intra-abdominal pectus bar migration is a rare clinical entity, and safe removal can be facilitated by the use of the VATS technique

Intrapericardial migration of dislodged sternal struts as late complication of open pectus excavatum repairs

<p>Abstract</p> <p>We present a case of sternal steel strut dislodgement and migration in a patient undergoing Ravitch repair for pectus excavatum (PE) 37 years ago. Broken struts perforated the right ventricle and right ventricular outflow tract (RVOT) and additionally migrated into the left upper lobar bronchus.</p> <p>Dislodged sternal struts represent rare complications after surgical repair of patients suffering from pectus excavatum. Reviewing the literature, only five cases of intrapericardial migration of dislodged sternal struts or wires have been reported so far.</p> <p>In our case, the first strut was removed from the airways through a left antero-lateral thoracotomy. Using cardiopulmonary bypass, a second strut was removed via ventriculotomy. These life-threatening sequelae underscore the importance of postoperative follow-up and early removal of osteosynthetic materials used in open PE repair. Accurate preoperative localization of migrated materials and availability of CPB support are crucial for successful surgical removal.</p> <p>Introduction</p> <p>The migration of dislodged sternal steel struts or wires into the pericardium and cardiac cavities is a rare but life-threatening complication of open pectus excavatum (PE) repair <abbrgrp><abbr bid="B1">1</abbr></abbrgrp>. Removal of these materials poses a challenge for cardiothoracic surgeons. Herein, the authors report a case of migration of dislodged steel struts through the right ventricle and right ventricular outflow tract (RVOT) into the left upper lobar bronchus in a patient who underwent Ravitch repair 37 years ago.</p

Management and Outcome of Cardiac and Endovascular Cystic Echinococcosis

Cardiac and vascular involvement are infrequent in classical cystic echinococcosis (CE), but when they occur they tend to present earlier and are associated with complications that may be life threatening. Cardiovascular CE usually requires complex surgery, so in low-income countries the outcome is frequently fatal. This case series describes the characteristics of cardiovascular CE in patients diagnosed and treated at a Tropical Medicine & Clinical Parasitology Center in Spain. A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995–2009) is reported. The main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. The clinical picture and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas. CE is a neglected disease and further studies are necessary in order to make more definite management recommendations for this rare and severe form of the disease. The authors propose a general approach based on cyst location: exclusively cardiac, endovascular or both

Pituitary Apoplexy Following Coronary Artery Bypass Grafting Report of a Case

Pituitary apoplexy can rarely occur after surgical procedures, mainly due to severe haemorrhage or hypotension. It is a serious condition that may lead to devastating complications and even to death. We present a 60-year-old male patient in whom pituitary apoplexy developed due to protamine anaphylaxis during coronary artery bypass surgery

Pituitary Apoplexy Following Coronary Artery Bypass Grafting Report of a Case

Pituitary apoplexy can rarely occur after surgical procedures, mainly due to severe haemorrhage or hypotension. It is a serious condition that may lead to devastating complications and even to death. We present a 60-year-old male patient in whom pituitary apoplexy developed due to protamine anaphylaxis during coronary artery bypass surgery

Idiopathic aneurysm of the inferior caval vein

Idiopathic aneurysms of the inferior caval vein are uncommon in children and adults. We describe a 14 year old boy with a saccular aneurysm of the inferior caval vein, in whom no surgical intervention was required to repair the aneurysm. The patient is being followed-up periodically for the evaluation of any increase in the diameter of the inferior caval vein

Ischemic spinal cord injury after aortocoronary bypass operation - A case report

Although spinal ischemia is a very well recognized complication after operation on the thoraco-abdominal and abdominal aorta, it is very rare following coronary artery bypass surgery. A case of a 56-year-old man, who had juxtarenal aortic occlusion and became paraplegic after internal mammary artery grafting for ischemic heart disease is reported. The complete paraplegia was thought to be due to interruption of critical collateral blood supply to the spinal cord

Congenital subclavian aortic steal syndrome: Hypoplastic aortic arch with severe coarctation of the aorta of unusual location

An unusual case of subclavian-aortic steal syndrome in a pediatric patient with hypoplastic aortic arch with coarctation of the aorta of unusual location is described. Aortography showed hypoplasia of the arcus aorta and severe coarctation proximal to the left subclavian artery associated with an aneurysm formation on the isthmus and descending aorta. The enlargement of the arcus aorta was accomplished by prosthetic patch aortoplasty extending from the ascending to descending aorta via median sternotomy using cardiopulmonary bypass and moderate hypothermia. Postoperatively, the patient is doing well with equalized blood pressure. (Ann Thorac Surg 2000;70:291-2) (C) 2000 by The Society of Thoracic Surgeons

CONGENITAL CORONARY ARTERIOVENOUS-FISTULA IN A 10-YEAR-OLD BOY WITH ANGINA-PECTORIS

Congenital arteriovenous fistula (CAVF) is a rare cardiac lesion. Angina pectoris is uncommon in younger patients with CAVF Fistula-related symptoms, complications of this anomaly and surgical complications have a strong correlation with the age of the patient. A ten-yer-old male patient with angina pectoris in whom the diagnosis of CAVF was established, and who, following surgical ligation recovered, is presented