Attempted Cardiopulmonary Bypass Venous Cannula Extraction Catheter Extraction of a Rare Intracardiac Myoepithelioma

Myoepithelioma of the soft tissue is a rare entity that can mimic myxoma when presenting within the heart. We present a case where cardiopulmonary bypass venous cannula extraction catheter removal of an intracardiac myoepithelioma was attempted with minimal debulking and subsequently required minimally invasive open-heart surgery with cardiopulmonary bypass. (Level of Difficulty: Advanced.).

Aorto-right ventricular fistula: a late complication of aortic valve replacement

We report the case of a patient who was found to have an aorto-right ventricular fistula 17 years after receiving a Björk-Shiley prosthetic aortic valve. A pseudoaneurysm had formed at the aortotomy suture line, and it had extended into the interventricular septum and had eventually opened into the right ventricle. Using transesophageal echocardiography, we identified the defect in the ascending aorta, and a left-to-right shunt. Aortography was used to confirm these findings. The pseudoaneurysm was successfully resected and the ascending aorta was replaced with a Dacron graft. To the best of our knowledge, no similar late complication of aortic valve replacement has been reported in the medical literature.

Intraoperative angiography to assess graft patency after minimally invasive coronary bypass

BACKGROUND

Intraoperative angiography was performed to confirm graft patency immediately after minimally invasive coronary bypass operations.

METHODS

In 26 patients who had internal mammary artery grafting, intraoperative coronary angiography was performed with a portable digital fluoroscope.

RESULTS

High-resolution angiograms were obtained in all cases. Angiography documented vasospasm of the graft or native vessel in 9 patients (graft in 3, native in 2, graft and native in 4 others), which responded promptly to intracoronary vasodilators in all. Angiography identified technically unsuspected and clinically silent fixed stenoses (>50%) in 11 patients, attributable to graft kinking in 2, anastomotic obstruction in 6 (total occlusion in 4), and stenosis of the left anterior descending artery just distal to the anastomosis in three cases (total occlusion in one). In 9 of 11 patients, fixed stenoses were sufficiently severe to warrant intraoperative intervention by surgical revision (n = 5) or angioplasty via the graft (n = 4).

CONCLUSIONS

Intraoperative angiography after minimally invasive coronary artery bypass operations can immediately identify dynamic and fixed obstructions and facilitate their prompt treatment, thereby ensuring that each patient leaves the operating room with an optimal surgical result.

Acute occlusion of a left internal mammary artery graft immediately after redo coronary artery bypass surgery: successful rescue PTCA

A patient with a patent left internal mammary artery (LIMA) to the left anterior descending (LAD) artery required repeat bypass grafting to the distal right coronary artery (RCA). Intraoperative injury to the LIMA resulted in acute anterior myocardial infarction, which was managed by successful rescue percutaneous transluminal coronary angioplasty (PTCA).

Seroepidemiology of human immunodeficiency virus infection in Borno State of Nigeria by sentinel surveillance

A serosurvey for human immunodeficiency virus (HIV) infection was carried out in three well-separated population centers in Borno State of Nigeria in 1989-1990. The study subjects were 1,259 made up of sexually transmitted disease (STD) clinic attenders, pregnant women, female prostitutes, and blood donors. Sera were screened by enzyme-linked immunosorbent assay and confirmation was done by Western blotting. The overall seroprevalence was 1.67% (21/1,259), with no significant differences from one population center to another. There were, however, significant differences among the population groups studied: prostitutes, 4.24%; STD clinic attenders, 1.67%; blood donors, 0.71%; and pregnant women, 0.24%. Of the 21 seropositives, 18 were positive for HIV-1 only; 1 was positive for HIV-2 only; and 2 were positive for both HIV-1 and HIV-2. All three HIV-2-positive sera were from prostitutes. Prevalence rates found in this study showed marked increases from 2 to 3 years earlier. There is therefore the need for a vigorous and sustained intervention program.

Hemodynamic and metabolic effects of venoarterial cardiopulmonary support in coronary artery disease

Coronary angioplasty was performed on 14 high-risk patients supported with venoarterial partial cardiopulmonary bypass. Hemodynamic, metabolic and physiologic parameters were monitored to assess the effect of cardiopulmonary support in conscious patients. Cardiopulmonary support caused a decrease in systolic (45 +/- 17 to 27 +/- 14 mm Hg, p less than 0.001), diastolic (23 +/- 12 to 14 +/- 8 mm Hg, p less than 0.005) and mean (29.7 +/- 13.2 to 18 +/- 9 mm Hg, p less than 0.001) pulmonary artery pressures. Aortic systolic (129 +/- 18 to 106 +/- 17 mm Hg, p less than 0.001), mean (89 +/- 19 to 84 +/- 19 mm Hg, p less than 0.05) and pulse (64 +/- 17 to 37 +/- 16 mm Hg, p less than 0.00001) pressures also decreased. Heart rate and aortic diastolic pressures were unchanged. End-systolic wall stress (122 +/- 48 x 10(3) to 96 +/- 44 x 10(3) dynes/cm2, p less than 0.001) and left ventricular end-diastolic diameter (5.7 +/- 0.8 to 5.5 +/- 0.9 cm, p less than 0.05) were reduced during partial cardiopulmonary bypass. After initiation of cardiopulmonary support, normal lactate extraction across the coronary circulation was diminished or converted to lactate production (38 +/- 23 to 2 +/- 29%, p less than 0.005). There was a marked reduction in hematocrit (41 +/- 4 to 28 +/- 5%, p less than 0.0001) and platelet count (259,000 +/- 57,600/ml to 145,900 +/- 46,000/ml, p less than 0.0001) after bypass. Cardiopulmonary bypass successfully supported all patients during balloon inflation, for an optimal angioplasty result.(ABSTRACT TRUNCATED AT 250 WORDS)

Colorectal carcinoma in patients under age 40

Patients under the age of 40 with colorectal cancer (29 females, 18 males) were compared with similar patients in our general hospital population and analyzed for patterns of presentation, stage at diagnosis, degree of tumor differentiation, and survival. There was a higher incidence of poorly differentiated tumors in the young patients (21% vs. 8% in the general population). Colon cancer in young adults was in a more advanced stage at presentation. The survival rate for young patients was 23% vs. 61% for the general population (p = 0.02). Stage C patients treated for cure had a survival rate of 56% in the general population compared with 34% in young adults (p = 0.05). The degree of tumor differentiation did not affect survival in those young patients undergoing curative resections (41% for well-differentiated and 30% for poorly differentiated cancers, p = 0.09). The median survival time by stage was: Stage A and B (N = 3) 36 months, Stage C (N = 26) 32 months, and Stage D (N = 18) 15.8 months. The need for early recognition of colorectal cancer in young adults is emphasized by the greater incidence of advanced disease and the high failure rate.