Atrial fibrillation occurring early after cardiovascular surgery: impact of the surgical procedure

Purpose

Postoperative atrial fibrillation/flutter (AF) is still the most common complication after cardiovascular surgery, and it is important to determine the risk factors in order to establish effective management for recent postoperative AF. This study investigated the clinical predictors of postoperative AF using a prospectively collected database.

Methods

A total of 418 patients underwent cardiovascular surgery and were enrolled in this study. The relationship between postoperative AF and perioperative factors was examined.

Results

Postoperative AF occurred in 134 patients (32.1 %). A univariate analysis showed that an older age, hypertension, perioperative transfusion, use of cardiopulmonary bypass and thoracic aortic surgery were significantly associated with postoperative AF. The incidence of fibrillation was 49.4 % (39/79) in patients having aortic surgery. A multivariate analysis revealed that an older age, transfusion, and aortic surgery were all independent predictors of postoperative AF.

Conclusions

An older age, transfusion, and aortic surgery are strong independent predictors of postoperative AF. These findings help to identify high-risk patients for AF after cardiovascular surgery. Careful perioperative management is required for older patients undergoing aortic surgery with cardiopulmonary bypass.     

Traumatic aneurysm complicating EC-IC bypass: Successful surgical clipping

A patient with an aneurysm developing at the site of an extracranial-intracranial (EC-IC) bypass is described. After the aneurysm was observed enlarging over a course of three months, it was clipped, preserving the anastomosis. The patient has done well postoperatively, and to our knowledge this is the first report of such an occurrence.     

Traumatic intracranial aneurysm after blunt trauma.

Traumatic intracranial aneurysms are rare and represent less than 1% of all cerebral aneurysms. This type of aneurysm develops after blunt or penetrating head trauma. Surgical clipping and/or endovascular occlusion are the definitive treatments. This report describes the very unusual case of a patient who has survived for 2 years with conservative management alone.     

Effects of Milrinone continuous intravenous infusion on global cerebral oxygenation and cerebral vasospasm after cerebral aneurysm surgical clipping

BackgroundCerebral vasospasm (CVS) is a disabling disease with high morbidity and mortality risk. Milrinone (phosphodiesterase III inhibitor) has inotropic and vasodilator effects, noninvasive transcranial cerebral oximetry (rSO2%) useful in estimating the effect of triple-H therapy preventive measures against CVS.ObjectiveThe objective of the study is to clarify the value of the use of Milrinone continuous IV infusion as a cerebral vasodilator in post-clipping spasm prevention during the period of maximum vasospasm incidence, guided by noninvasive rSO2%.MethodsPost-clipping all patients extubated in the operative room, shifted to Neurosurgical ICU, and fully monitored. Then, in the period from 4th till the 11th day post-clipping, they were divided into two groups 15 patients each: Group 1: control group, given Norepinephrine continuous IV infusion alone in a dose ranges from 0.05 to 0.2 μg/kg/min. Group 2: given Norepinephrine continuous IV infusion 0.05–0.2 μg/kg/min, Plus Milrinone starting with 50 μg/kg bolus dose, followed by IV infusion at a rate of [0.5–0.75 μg/kg/min]. IMAP, ICP and CPP, GCS, Norepinephrine dose, rSO2%, were recorded every 6 h for the next 168 h. Any attack of cerebral vascular spasm recorded as number and % in each group as an incident.ResultsMBP, rSO2%, ICP, CPP, Norepinephrine Infusion dose, and GCS were significantly increased in Group (2) in comparison with Group (1) mostly during the period of the study. CVS occurrence was significantly lower in group (2), i.e., (20%) cases compared to (46.6%) in group (1).ConclusionsMilrinone improved significantly the global cerebral oxygenation and reduced the incidence of cerebral vasospasm during the dangerous period of cerebral spasm after cerebral aneurysm clipping.     

Intra-mural propagation of a large cavernous internal cerebral artery aneurysm after parent artery sacrifice

The mechanism of aneurysm growth after isolation from the circulation is not well known. We report a case of a woman who presented with mass effects of a large cavernous internal carotid artery (ICA) aneurysm. The parent vessel harboring the aneurysm was sacrificed but the aneurysm continued to enlarge with propagation of the disease along the vessel wall progressively extending to the middle cerebral artery (MCA) leading to ischemic stroke. This case provides imaging evidence of the role of mural inflammation in the development of certain aneurysms.     

Traumatic aneurysm of the intrathoracic left carotid artery with cerebral embolization

The presentation and management of a young male patient with a traumatic aneurysm of the intrathoracic portion of the left common carotid artery from a football injury, complicated by cerebral embolization, is detailed. At operation 6 weeks afterward the aneurysm was isolated and ligated and the patient was discharged 19 days postoperation with plans for physical and speech rehabilitation. At 14 months a chronic subdural hematoma which caused some seizures was removed, and the patient's neurologic status is continuing to improve. This appears to be the first report of an isolated blunt injury to this branch of the aortic arch.     

Dor法治疗左心室室壁瘤

目的总结Dot法治疗左心室室壁瘤的临床疗效。方法 1999年1月至2006年2月应用Dor法治疗69例冠心病心肌梗死室壁瘤病人，比较其术前、术后心功能、射血分数等指标的变化。结果 手术死亡5例（7．2％）。随访1-68个月，平均（52．6±23．2）个月，死亡6例（8．6％），失访3例（4．3％）。心功能（NYHA）从术前平均（3．19±0．69）级改善到术后平均（1．71±1．07）级（P〈0．01），射血分数从术前的0．37±0．08提高到术后的0．47±0．10（P〈0．01）。左心室容积较术前明显减少。舒张末容积指数从术前（123．54±52．49）ml／m^2降至术后（74．28±28．49）ml／m^2（P〈0．01），收缩末容积指数从术前（83．47±43．78）ml／m^2降至术后（41．25±17．99）ml／m^2（P〈0．01）。结论 Dot法能有效改善左心室室壁瘤病人的心功能。     

Combined endovascular-open surgical procedure in a great hepatic artery aneurysm

Visceral artery aneurysms are rare lesions. They involve the hepatic artery in approximately 20% of cases. Various therapeutic options are available for patients with hepatic artery aneurysms (HAAs). Dictated predominately by the need to maintain distal end-organ perfusion, potential therapies include traditional surgical techniques and laparoscopic surgery, endovascular methods of embolization, and stenting of the lesions. There is still a lack of studies demonstrating the comparative efficacy or inefficacy of any particular treatment, so there are currently no precise indications for determining which type of treatment should be used. In this paper, we present a case of great HAA in a 59-year-old man. He was preoperatively diagnosed and treated with a combined surgical and endovascular approach. The clinical presentation, management, and therapy of patients with HAAs are discussed. In addition to that, we reviewed the literature dealing with HAAs. This case report lays emphasis on the aspect that the treatment strategy in HAAs has to be determined individually in each case due to the high anatomic variability of the arterial supply of the liver. Treatment with a combined surgical and endovascular approach may reduce the risk of liver ischemia and morbidity.     

Combined endovascular and surgical procedure for recurrent thoracoabdominal aortic aneurysm

We report the case of an 85-year-old man with a recurrent thoracoabdominal aortic aneurysm who underwent two-staged combined endovascular and surgical procedure. First, two retrograde bypasses using saphenous vein grafts were implanted from the right common iliac artery to the celiac artery and superior mesenteric artery. Two weeks later the aneurysm was successfully excluded with a stent-graft. The postoperative course was uneventful. This two-staged combined endovascular and surgical approach may be a safe and effective alternative to open surgical repair of thoracoabdominal aortic aneurysm in high-risk patients.     

Traumatic innominate artery aneurysm 26 years after stab injury

We report the case history of a 46-year-old African man with a false aneurysm of the innominate artery subsequent to a stab wound in the right supraclavicular area 26 years previously, presenting with stridor.     

Coiling of cerebral aneurysm remnants after clipping

OBJECTIVE: During the past decade, options for the management of aneurysm remnants after clipping have expanded. Advances in aneurysm coiling techniques and technology have allowed for more remnants to be treated safely. We present our experience with this approach and discuss its indications, limitations, and results. METHODS: We retrospectively reviewed the Northwestern Memorial Hospital experience with aneurysm coiling between January 1996 and June 2001. We identified five patients who underwent coiling for aneurysm remnants after clipping. We reviewed the clinical history, all follow-up notes, and all relevant imaging studies. We also reviewed MEDLINE for all articles published in the English language between 1990 and September 2001 that included patients treated with this approach. RESULTS: Complete to near-complete aneurysm occlusion was achieved in all five patients in our study. There was no permanent morbidity or mortality associated with the procedure in any of these patients. In the literature, we found seven articles that discuss 21 patients who were treated with coiling for their remnants. There were no permanent complications reported for these 21 patients. Adequate long-term follow-up in these 21 patients, however, is lacking. CONCLUSION: Complete aneurysm occlusion is the goal of aneurysm clipping. When this goal cannot be achieved safely, coiling of the remnant, if size and morphology are amenable, is a safe option that should be considered. Clinical and angiographic long-term follow-up of patients treated in this manner should be studied and reported.     

Traumatic middle cerebral artery aneurysm: case report and review of the literature

Traumatic intracranial aneurysms are rare. A case of traumatic middle cerebral artery aneurysm was presented. A 66-year-old man sustained a severe head injury in a bicycle accident. Serial computed tomography and angiography showed the delayed intracerebral hemorrhage caused by the traumatic middle cerebral artery aneurysm. The aneurysm was trapped and removed. Histological examination clearly revealed the pseudoaneurysm. Traumatic middle cerebral aneurysms were reviewed.