Huge ascending aortic pseudoaneurysm 13 years after Bental surgery with tube graft

Pseudoaneurysms of the ascending aorta are rare, disastrous complications of surgical manipulation of the aorta and its surroundings. They frequently require emergency surgical intervention due to a high risk of sudden rupture and hemorrhage. We herein present the case of a pseudoaneurysm (130 mm in diameter) of the ascending aorta with a compressive effect on the left atrium and right coronary artery ostium at the site of a tube graft implanted 13 years previously via the Bental procedure in a 34 year-old man. The susceptibility of these pseudoaneurysms to silently increase in size through the years leads to a delayed diagnosis, with an increased risk of rupture and mortality, necessitating long-term follow-ups with a view to detecting it in the initial stages, when it is easier to perform surgical or endovascular interventions with a lower risk of mortality. (Cardiol J 2011; 18, 2: 185-188

Total myocardial revascularization for situs inversus totalis with dextrocardia: a case report

We report our experience of two patients suffering from severe coronary artery disease and situs inversus totalis with dextrocardia. The surgeon, standing on the right side of the patients, performed coronary artery bypass grafting by harvesting the right internal mammary artery in lieu of the left one

Ogromny tętniak rzekomy aorty wstępującej po 13 latach od operacji Bentalla z wszczepieniem cylindrycznego konduitu

Tętniaki rzekome aorty wstępującej są rzadkimi, katastrofalnymi powikłaniami zabiegów chirurgicznych przeprowadzanych na aorcie i w jej okolicy. Wymagają one często interwencji chirurgicznej w trybie nagłym ze względu na duże ryzyko nagłego pęknięcia i krwotoku. W pracy przedstawiono przypadek tętniaka rzekomego (o średnicy 130 mm) aorty wstępującej u 34- -letniego mężczyzny, który uciskał lewy przedsionek i miejsce odejścia prawej tętnicy wieńcowej, a znajdował się w miejscu cylindrycznego konduitu wszczepionego 13 lat wcześniej podczas operacji Bentalla. Skłonność tych tętniaków rzekomych do niemego klinicznie powiększania się w ciągu wielu lat prowadzi do opóźnienia rozpoznania, co wiąże się ze zwiększonym ryzykiem pęknięcia i zgonu. Konieczna jest więc długoterminowa obserwacja takich chorych, aby można było wykrywać opisane zmiany w początkowych stadiach, kiedy łatwiej wykonywać interwencje chirurgiczne lub wewnątrznaczyniowe z mniejszym ryzykiem zgonu. Folia Cardiologica Excerpta 2011; 6, 2: 135–13

Delayed-onset heparin-induced thrombocytopenia presenting with multiple arteriovenous thromboses: case report

<p>Abstract</p> <p>Background</p> <p>Delayed-onset heparin-induced thrombocytopenia with thrombosis, albeit rare, is a severe side effect of heparin exposure. It can occur within one month after coronary artery bypass grafting (CABG) with manifestation of different thrombotic events.</p> <p>Case presentation</p> <p>A 59-year-old man presented with weakness, malaise, bilateral lower limb pitting edema and a suspected diagnosis of deep vein thrombosis 18 days after CABG. Heparin infusion was administered as an anticoagulant. Clinical and paraclinical work-up revealed multiple thrombotic events (stroke, renal failure, deep vein thrombosis, large clots in heart chambers) and 48 ×10³/μl platelet count, whereupon heparin-induced thrombocytopenia was suspected. Heparin was discontinued immediately and an alternative anticoagulant agent was administered, as a result of which platelet count recovered. Heparin-induced thrombocytopenia, which causes thrombosis, is a serious side effect of heparin therapy. It is worthy of note that no case of delayed-onset heparin-induced thrombocytopenia with thrombosis associated with cardiopulmonary bypass surgery has thus far been reported in Iran.</p> <p>Conclusion</p> <p>Delayed-onset heparin-induced thrombocytopenia should be suspected in any patient presenting with arterial or venous thromboembolic disorders after recent heparin therapy, even though the heparin exposure dates back to more than a week prior to presentation; and it should be ruled-out before the initiation of heparin therapy.</p

Characterization of Suitability of Coronary Venous Anatomy for Targeting Left Ventricular Lead Placement in Patients Undergoing Cardiac Resynchronization Therapy

Background: Differences in the quantity and distribution of coronary veins between patients with ischemic and non-ischemic cardiomyopathy might affect the potential for the left ventricular (LV) lead targeting in patients undergoing cardiac resynchronization therapy (CRT). In the current study, we assessed and compared the suitability of the coronary venous system for the LV lead placement in ischemic and dilated cardiomyopathy. Methods: This single-centre study, performed at our hospital, retrospectively studied 173 patients with the New York Heart Association class III or IV who underwent CRT. The study population was comprised of 74 patients with an ischemic underlying etiology and 99 patients with a non-ischemic etiology. The distribution of the veins as well as the final lead positions was recorded. Results: There was no significant difference between the two groups in terms of the position of the available suitable vein with the exception of the posterior position, where the ischemic group had slightly more suitable veins than did the dilated group (48.4% versus 32.1%, p value = 0.049). There was also no significant difference with respect to the final vein, through which the LV lead was inserted. Comparative analysis showed that the patients with previous coronary artery bypass grafting surgery (CABG) had significantly fewer suitable veins in the posterolateral position than did the non-CABG group (16.3% versus 38.7%, p value = 0.029). There was, however, no significant difference between the two subgroups regarding the final vein position in which the leads were inserted. Conclusion: The final coronary vein position suitable and selected for the LV lead insertion was not different between the cases with cardiomyopathy with different etiologies, and nor was it different between the ischemic cases with and without a history of CABG. Patients with a history of procedures around the coronary vessel may have an intact or recovered venous system and may, therefore, benefit from transvenous LV lead placement for CRT