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Rupture of the Renal Artery After Cutting Balloon Angioplasty in a Young Woman With Fibromuscular Dysplasia

A 24-year-old woman with uncontrollable high blood pressure for 3 months had significant stenosis of the left renal artery caused by fibromuscular dysplasia (FMD). The lesion was resistant to percutaneous transluminal angioplasty at 18 atm with a semicompliant balloon. Angioplasy with a 6 × 10 mm cutting balloon (CB) caused rupture of the artery. Low-pressure balloon inflation decreased but did not stop the leak. An attempt to place a stent-graft (Jostent; Jomed, Rangendingen, Germany) failed, and a bare, 6-mm balloon-expandable stent (Express SD; Boston Scientific, MN) was deployed to seal the leak, which had decreased considerably after long-duration balloon inflation. The bleeding continued, and the patient underwent emergent surgical revascularization of the renal artery with successful placement of a 6-mm polytetrafluoroethylene bypass graft. CBs should be used very carefully in the treatment of renal artery stenosis, particularly in patients with FMD.

A Prospective Randomized Double-Blind Study to Determine the Effect of Thoracic Epidural Neostigmine on Postoperative Ileus After Abdominal Aortic Surgery

BACKGROUND: Postoperative ileus is a major gastrointestinal complication of abdominal aortic surgery leading to increased rates of morbidity and mortality, longer lengths of hospital stay, and higher costs. In this study, we evaluated the effect of epidurally administered neostigmine on postoperative ileus after abdominal aortic surgery. METHODS: We enrolled 45 patients who were scheduled for elective abdominal aortic surgery at our institution. All patients received identical general and epidural anesthesia. Before the induction of general anesthesia, an epidural catheter was placed at the T7–T8 intervertebral space, and 20 mL bupivacaine (0.5%) was injected over 15 min. Patients were randomized into two groups. Patients received a 5 mL bolus of neostigmine (1 &mgr;g/kg) diluted with normal saline (Group 1) or a 5 mL bolus of normal saline (Group 2) via an epidural catheter at the end of surgery and 8 h postoperatively. Times of bowel sounds were recorded postoperatively in the intensive care unit. Times of daily passage of flatus and defecation also were recorded. RESULTS: Times to the first bowel sounds and the first flatus were significantly shorter in Group 1 than they were in Group 2 (11.6 ± 11.2 h vs 22.6 ± 12.8 h and 21.8 ± 15.6 h vs 36.6 ± 19.1 h, respectively, P < 0.05). The times to first defecation were similar in both groups (P > 0.05). Nausea was more frequent in patients in Group 2 than in Group 1 (P < 0.05). The incidence of postoperative complications was similar between the groups (P > 0.05). CONCLUSIONS: Thoracic epidural neostigmine enables faster restoration of bowel sounds and shortens duration of postoperative ileus after abdominal aortic surgery.

On-pump/beating-heart myocardial protection for isolated or combined coronary artery bypass grafting in patients with severe left ventricle dysfunction : assessment of myocardial function and clinical outcome

BACKGROUND Myocardial protection in coronary artery bypass grafting (CABG) with severe left ventricular (LV) dysfunction is still a surgical dilemma. Preoperative myocardial infarction (MI) and postoperative low output syndrome are serious complications in cases of inadequate protection of the heart, which has limited myocardial reserve. The aim of this study was to evaluate myocardial function and clinical outcome after on-pump/beating-heart CABG in patients with severe LV dysfunction. METHODS Between March 2001 and March 2004, clinical, operative, and postoperative data were prospectively collected from patients with LV ejection fraction (EF) < 30% who underwent on-pump/beating-heart CABG and associated procedures. RESULTS There were 46 patients and the mean patient age was 58.38 +/- 9.23. The mean EF was 25.6 +/- 2.8%. Operating time was 275 +/- 63 minutes. The frequency of distal anastomosis was 3.06 +/- 1.04. Twenty-four patients required aneurysmectomy in addition to CABG, and 2 of the 24 required mitral repairs. Inotropic support was required in 14 patients (30%) and 5 of them (10.9%) also required IABP. The LV EF improved significantly after the operation when compared to preoperative measurements (25.6 +/- 2.8 versus 33.64 +/- 4.69, P < .05). Hospital mortality rate was 4.3% (2 of the 46 patients). No mortality was observed at a mean followup of 16 months after discharge from the hospital. CONCLUSIONS On-pump/beating-heart CABG technique is effective in protecting myocardial functions in patients with severe LV dysfunction. The main advantage of the on-pump/beating-heart technique is the ability it provides one to perform complete revascularization, and intracavitary procedures with low morbidity and mortality even in impaired LV function.

Delayed Sternal Closure After Pediatric Cardiac Operations; Single Center Experience: a Retrospective Study

BackgroundDelayed sternal closure (DSC) after cardiac surgery is a therapeutic option in the treatment of the severely impaired heart in pediatric cardiac surgery. The results with the technique of DSC over a 4-year period are examined with regard to mortality and morbidity.MethodsWe retrospectively reviewed records of 38 patients who had undergone DSC among 1100 congenital cardiac operations. Indication of DSC, time to sternal closure, pre and post closure cardiopulmonary and metabolic status, mortality, rate of wound and bloodstream infections were recorded.ResultsThe mean sternal closure time was 2.9 days. The mortality rate was 34.2% (n = 13). Twenty (52.6%) patients required prolonged antibiotic use due to postoperative infection. There was gram negative microorganism predominance. There were 4 (10.5%) patients with postoperative mediastinitis. Postoperative infection rate statistically increased with cardiopulmonary bypass time (CPBT), sternal closure time (SCT) and intensive care unit (ICU) stay time (p = 0.039;p = 0.01;p = 0.012). On the other hand, the mortality rate significantly increased with increased cross clamp time (CCT), SCT, and extracorporeal membrane oxygenation (ECMO) use (p = 0.017; p = 0.026; p = 0.03). Single ventricular physiology was found to be risk factor for mortality in delayed sternal closure (p < 0.007).ConclusionsElective DSC does not reduce the morbidity. The prolonged sternal closure time is associated with increased rate of postoperative infection rate; therefore early closure is strongly advocated.

Does Ischemia-Induced Prostate Damage during Cardiac Surgery Involving Cardiopulmonary Bypass Cause Bladder Outlet Obstruction?

Objective: This study sought to investigate whether ischemia-induced prostate damage during cardiac surgery involving cardiopulmonary bypass causes bladder outlet obstruction. Materials and Methods: The study involved 37 men who underwent elective cardiac surgery involving cardiopulmonary bypass. Prostate-specific antigen (PSA) levels were determined preoperatively (baseline) and on postoperative days 1, 5, and 30. In 4 cases, the PSA level after the operation was unchanged from the preoperative level, so these 4 men were excluded from the study. In the remaining 33 patients, symptoms of bladder outlet obstruction were assessed using the International Prostate Symptom Score. Each subject completed this test preoperatively and 3, 6 and 9 months postoperatively, and the means scores at these time points were compared. The effects of patient age, operative time, CPB time, and aortic clamping time on postoperative increases in PSA levels were investigated. Results: Thirty-three (89.2%) of the 37 men exhibited increased postoperative PSA levels compared to baseline. The mean PSA level for the 33 cases on day 5 was significantly higher than the baseline mean, but the mean levels on postoperative days 1 and 30 were comparable to baseline. Nine (24.3%) of the 33 men had postoperative PSA levels greater than 4.0 ng/dl (the upper normal limit). There was no significant difference between preoperative and postoperative International Prostate Symptom Scores. Conclusion: The study indicates that men’s PSA levels are, indeed, increased after cardiac surgery with cardiopulmonary bypass. However, in 9 months of follow-up, there was no association between this PSA rise and development of BOO, according to International Prostate Symptom Scores.

Cutting Balloon Angioplasty of Bilateral Renal Artery Stenosis Due to Takayasu Arteritis in a 5-Year-Old Child with Midterm Follow-Up

The aim of this report is to demonstrate the successful endovascular treatment of bilateral renal artery stenosis due to Takayasu arteritis by cutting balloon angioplasty in a 5-year-old child with mid-term follow-up.

Endovascular treatment of huge saccular abdominal aortic aneurysm in a young Behcet patient: mid-term result

BackgroundAbdominal aortic aneurysm formation is among the arterial complications of Behcets disease. Weakness and fragility of aortic walls leads to the development of arterial complications like pseudoaneurysms.Case PresentationA case of huge saccular abdominal aortic aneurysm in a young Behcet patient who was successfully treated with endovascular stent graft placement is reported, diagnostic and interventional procedures are discussed, and mid-term follow-up results are presented.ConclusionsEndovascular treatment of abdominal aortic aneurysm complications of young Behcet patients who are not suitable for open surgery and need intervention could be an alternative treatment modality even without performing preprocedural angiography.

Valve-sparing replacement of the ascending aorta and aortic arch in a child with Loeys–Dietz syndrome

We describe a successful surgical treatment in a 2.5-year old boy with Loeys-Dietz syndrome, in whom we performed aortic arch and ascending aorta replacement with a valve-sparing operation (VSO) of the aortic root because of significant aortic insufficiency and dilation of the aortic root. We believe that VSO is ideal for treating young patients with aortic root aneurysm with normal or minimally diseased aortic cusps to avoid the disadvantages of prosthetic valve replacements.

Anesthesia management with single injection paravertebral block for aorta coarctation in infant

Thoracotomy causes severe pain in the postoperative period. Perioperative thoracic paravertebral block reduces pain score and may improve outcome after pediatric cardiac surgery. This prospective study was designed for the efficacy and duration of a single level, single injection ultrasound–guided thoracic paravertebral block (TPVB) for fifteen infants undergoing aortic coarctation repair.

Outcomes of the Eighth International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion

The Eighth International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion was held at the Galatasaray University, Istanbul, Turkey, June 13–16, 2012 (Fig. 1).Atif Akcevin, MD, was the local chair of the conference. The scientific co-chairs of the eighth event were Atif Akcevin, Tijen Alkan-Bozkaya, Ihsan Bakir, Hakan Ceyran, Yves Durandy, Huriyet Ersayin-Kantas, Colleen E. Gruenwald, David Palanzo, Linda Pauliks, Kerem Pekkan, Chitra Ravishankar, Eugen Sandica, Kyung Sun, Riza Turkoz, Akif Undar, Bonnie Weaver, and John L. Myers. As we stated in the past seven editorials, the overall objective of the meeting was and still is to bring together internationally known clinicians, bioengineers, and basic scientists involved in research on pediatric mechanical circulatory support systems and pediatric cardiopulmonary bypass procedures. Primarily, we focus to explicitly describe the problems with current pediatric mechanical circulatory support systems, methods, and techniques during acute and chronic support and to suggest solutions and future directions for research (1–3). Over 200 participants from 20 countries participated at the eighth annual event. One hundred one formal presentations including a keynote lecture, 40 invited lectures, 29 oral, and 32 poster presentations began on Thursday morning June 14, 2012 and continued through Saturday evening June 16, 2012. To date, over 800 presentations (320 invited lectures, 220 slide, and 260 poster presentations) and 400 peer-reviewed articles were published based on this unique event (http://pennstatehershey.org/web/ pedscpb/home). It was a great honor to have William S. Pierce, MD, from Penn State Hershey College of Medicine, as the keynote lecturer. His lecture entitled “A 40-Year Odyssey in Mechanical Circulatory Support” was a great historic lecture and it was a privilege to listen to his talk (Figs. 2 and 3a,b). In addition, platform presentations took place in 2-h blocks during the morning and afternoon sessions on Thursday, Friday, and Saturday. Plenary sessions were held throughout the conference focusing on key topics including “Managing the Single Ventricle Patient from Fetus to Definite Treatment” (led by co-chairs David Anderson, MD, and John L. Myers, MD), “Pediatric MCS—Devices & Outcomes” (led by co-chairs William S. Pierce, MD, and Kyung Sun, MD, PhD, MBA), “Bioengineering Approaches in Pediatric Cardiovascular Medicine” (led by Akif Undar, PhD, and Jeffrey D. Zahn, PhD), “Extracorporeal Life Support” (led by Chitra Ravishankar, MD, and Bonnie Weaver, RN, CCRN), “Multi-Disciplinary Team Approach to Solve the Complex Problems in Neonatal and Pediatric Cardiac Surgery” (led by Ihsan Bakir, MD [Turkey], and Tayyar Sarioglu, MD), “Cardiopulmonary Perfusion” (led by Colleen E. Gruenwald, PhD, and David Palanzo, CCP), “Myocardial Protection during CPB” doi:10.1111/j.1525-1594.2012.01562.x FIG. 1. Halil Tűrkoglu, William S. Pierce, PeggyJayne Pierce, Akif Undar, Ihsan Bakir, and John L. Myers. bs_bs_banner