Percutaneous treatment of an occlusive left main pseudoaneurysm: A role for multimodality imaging

A pseudoaneurysm with compression of the left main coronary artery causing significant ischaemia was successfully treated with a covered stent. We report this rare complication of cardiac surgery for infective endocarditis with a large root abscess. The patient developed a pseudoaneurysm arising from the body of the left main and causing compression of this vessel following his fourth redo aortic valve replacement for staphylococcal endocarditis. The endocarditis had been successfully managed and ongoing infection was excluded. The patient was then treated percutaneously with a covered stent that excluded the aneurysm and relieved the stenosis in the vessel. © 2011 Elsevier Inc

Determinants of in-hospital and long-term surgical outcomes after repair of postinfarction ventricular septal rupture

ObjectivesSurgical repair of post–myocardial infarction ventricular septal rupture is challenging with reported early mortality being substantial. In addition, congestive cardiac failure and ventricular tachyarrhythmia frequently occur long term after the operation, although frequency and predictive factors of these events have been poorly identified.MethodsA consecutive series of 68 patients who underwent repair of postinfarction ventricular septal rupture by 14 surgeons between 1988 and 2007 was studied. Fifty-eight (85%) patients underwent repair in an urgent setting (<48 hours after diagnosis). Coronary artery bypass grafting was concomitantly performed in 48 (71%) patients. Mean follow-up period was 9.2 ± 4.9 years.ResultsThirty-day mortality was 35%, with previous myocardial infarction, previous cardiac surgery, preoperative left ventricular ejection fraction less than 40%, and urgent surgery being independent risk factors. Actuarial survival of 30-day survivors was 88% at 5 years, 73% at 10 years, and 51% at 15 years. Actuarial freedom from congestive cardiac failure and ventricular tachyarrhythmia was 70% and 85% at 5 years, 54% and 71% at 10 years, and 28% and 61% at 15 years, respectively. Independent predictors for congestive cardiac failure included hypertension, posterior septal rupture, residual interventricular communication, and preoperative left ventricular ejection fraction less than 40%, whereas concomitant ventricular aneurysmectomy and preoperative occlusion of the left anterior descending artery were independent predictors of ventricular tachyarrhythmia.ConclusionsLong-term outcomes after surgical repair of postinfarction ventricular septal rupture was favorable, despite infrequent exposure by individual surgeons to the pathologic features, indicating that an aggressive surgical approach is warranted. Predictors of congestive cardiac failure and ventricular arrhythmia long term varied

Fistula between subclavian arterial graft and oesophagus

This is the first reported case of an oesophageal fistula arising from a subclavian arterial graft. A 28 year-old woman presented with massive haematemesis in severe haemorrhagic shock, three months after surgery to detach and relocate an aberrant right subclavian artery. Acutely, she was haemodynamically unstable and required transfusion of 45 units of blood. The fistula was identified with angiography (via the right brachial artery) after endoscopic and open visualisation were unsuccessful because of the torrential haemorrhage. The patient was stabilised and the fistula was managed with an endovascular covered stent. She had further surgery subsequently to remove the infected graft and to salvage the right arm

Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft

Background: Although the frequency of biological valve use in treating aortic valve disease is increasing, the critical limiting factor, "structural deterioration,'' remains unresolved. Analysis of long-term outcomes after implantation of cryopreserved aortic allografts will yield further information related to the durability of the aortic allograft, possibly suggesting mechanisms underlying or strategies to prevent or treat the structural deterioration of biological valve substitutes

Perioperative predictors of developmental outcome following cardiac surgery in infancy

7 page(s