Humans ; Infant ; Mucocutaneous Lymph Node Syndrome/surgery* ; Coronary Artery Bypass/adverse effects* ; Coronary Aneurysm/surgery* ; Coronary Artery Disease/surgery*

Although perioperative stroke is uncommon during low-risk non-vascular surgery, if it occurs, it can negatively impact recovery from the surgery and functional outcome. Based on the Society for Neuroscience in Anesthesiology and Critical Care Consensus Statement, perioperative stroke includes intraoperative stroke, as well as postoperative stroke developing within 30 days after surgery. Factors related to perioperative stroke include age, sex, a history of stroke or transient ischemic attack, cardiac surgery (aortic surgery, mitral valve surgery, or coronary artery bypass graft surgery), and neurosurgery (external carotid-internal carotid bypass surgery, carotid endarterectomy, or aneurysm clipping). Concomitant carotid and cardiac surgery may further increase the risk of perioperative stroke. Preventive strategies should be individualized based on patient factors, including cerebrovascular reserve capacity and the time interval since the previous stroke.
Anesthesiology ; Aneurysm ; Consensus ; Coronary Artery Bypass ; Critical Care ; Embolism ; Endarterectomy, Carotid ; Hemorrhage ; Humans ; Ischemia ; Ischemic Attack, Transient ; Mitral Valve ; Neurosciences ; Neurosurgery ; Stroke ; Thoracic Surgery ; Transplants

Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting ; complications ; Aortic Aneurysm, Thoracic ; complications ; Coronary Artery Bypass ; Coronary Artery Disease ; surgery ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo compare the mid- to long-term outcomes of patients receiving isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) plus CABG for left ventricular aneurysms.

METHODSThe clinical data were retrospectively analyzed in 205 patients with left ventricular aneurysms admitted to our hospital between January, 1997 and December, 2012, including 115 patients receiving SVR plus CABG and 90 undergoing isolated CABG. By matching preoperative echocardiographic parameters including aneurysm size, left ventricular ejection fraction (LVEF), left ventricular end-systolic volume index (LVESVI) and EuroSCORE risk factors, 32 patients receiving SVR plus CABG and another 32 with isolated CABG were enrolled in this study. The patients were compared for survival rates, major adverse cardiac or cerebrovascular events (MACCEs), left ventricular geometry and function at 1, 3 and 5 years of follow-up.

RESULTSCompared with the patients receiving isolated CABG, those receiving SVR and CABG showed greater improvements in echocardiographic parameters and NYHA functional class. The differences in the echocardiographic parameters between the two groups gradually reduced with time and became comparable at 5 years after the operation (P>0.05). No significant difference was found in the mid- to long-term survival or the incidence of MACCEs between the two groups (P>0.05).

CONCLUSIONCompared with isolated CABG, SVR plus CABG does not reduce the incidence of MACCEs or improve the mid- to long-term survival rate of patients with left ventricular aneurysm with a LVESVI <60 mL/m(2).

Aneurysm ; surgery ; Coronary Artery Bypass ; Echocardiography ; Heart Ventricles ; surgery ; Humans ; Incidence ; Retrospective Studies ; Risk Factors ; Stroke Volume ; Survival Rate ; Treatment Outcome ; Ventricular Function, Left

Aortic Aneurysm, Thoracic ; complications ; diagnostic imaging ; Aortography ; Contrast Media ; adverse effects ; Coronary Artery Bypass ; Cross Infection ; diagnostic imaging ; Fatal Outcome ; Female ; Humans ; Iohexol ; adverse effects ; Kidney Failure, Chronic ; complications ; Male ; Middle Aged ; Postoperative Complications ; diagnostic imaging ; ST Elevation Myocardial Infarction ; surgery ; Sepsis ; etiology ; Stevens-Johnson Syndrome ; etiology ; Surgical Wound Dehiscence ; diagnostic imaging ; Tomography, X-Ray Computed

INTRODUCTIONThe incidence of coronary artery anomalies (CAAs) varies from 0.2% to 8.4%. Knowledge of such anatomical variations is important as coronary procedures are regularly performed these days. We aimed to find the coronary dominance pattern, intermediate artery (IMA) frequency and CAA incidence in our clinic, and compare them to those in the literature.

METHODSThe medical reports of 5,548 patients who had undergone coronary angiography (CAG) between 2005 and 2009 were retrospectively investigated. Dominance pattern and presence of IMA and CAA were recorded. CAAs were described using two different classifications: Angelini and Khatami's classification, and a new modified classification that was derived from Angelini and Khatami's classification. Some procedural details and clinical features of the patients with CAA were also investigated.

RESULTSCoronary dominance pattern was: 81.6% right coronary artery, 12.2% circumflex artery and 6.2% co-dominant. IMA was present in 613 (11.0%) patients. The incidences of overall anomaly were 2.7% and 1.4%, according to the different classifications. Absent left main coronary artery, which was the most common anomaly in the present study, was found in 51 (0.9%) patients. Incidences of myocardial bridge, coronary arteriovenous fistulae and aneurysms were 1.1%, 0.2% and 0.3%, respectively.

CONCLUSIONCAAs are generally asymptomatic, isolated lesions. Some may lead to anginal symptoms, myocardial infarction or sudden death. We found that CAA was associated with increased radiation and contrast exposure in patients who underwent CAG. This risk could be reduced if appropriate catheters were designed and training programmes on ostial cannulation were developed.

Adult ; Aged ; Anatomic Variation ; Aneurysm ; Arteriovenous Fistula ; Coronary Angiography ; methods ; Coronary Artery Disease ; diagnosis ; Coronary Vessel Anomalies ; diagnosis ; surgery ; Coronary Vessels ; anatomy & histology ; surgery ; Death, Sudden ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction ; Myocardium ; pathology ; Retrospective Studies

A 62-year-old man was admitted, and thoracic endovascular aortic repair (TEVAR) procedure was performed to treat an accidentally detected aortic aneurysm, which was 63 mm in diameter. While performing TEVAR, the passage of the stent-graft introducer system was impossible due to the prolapse of the introducer system into a wide-necked aneurysm; this aneurysm was located at the greater curvature of the proximal descending thoracic aorta. In order to advance the introducer system, a compliant balloon was inflated. Thus, we created an artificial wall in the aneurysm with this inflated balloon. Finally, we were able to advance the introducer system into the target zone.
*Angioplasty, Balloon ; Angioplasty, Balloon, Coronary/*methods ; Aortic Aneurysm, Thoracic/radiography/*surgery ; Blood Vessel Prosthesis Implantation/*methods ; Endovascular Procedures/*methods ; Humans ; Male ; Middle Aged ; *Stents ; Tomography, X-Ray Computed

BACKGROUNDA number of studies have demonstrated the rates of overall and aneurysm-related mortality and morbidity in Western populations. The cardiovascular risk factors influencing postoperative outcome have been also reported. Until recently, little has been known about the prognosis in this patient cohort in the Chinese population. We evaluated the independent predictors of mortality and morbidity in abdominal aortic aneurysm (AAA) patients undergoing elective surgical treatment and emphasized whether the coronary artery revascularization could have any effect on the overall mortality and morbidity in patients following the current guideline recommendation.

METHODSA total of 386 patients (174 women) undergoing surgery in Beijing Anzhen Hospital from January 2008 to June 2010 were enrolled (mean age (70.6±10.5) years). Kaplan-Meier curves were constructed to compare the mortality and morbidity of AAA patients with coronary artery revascularization and those without. A Cox proportional hazards model was constructed to identify clinical factors associated with two-year outcomes. The primary outcomes were death from any cause, the pre-specified morbidity was re-hospitalization for pulmonary conditions, congestive heart failure, angina, ischemic/hemorrhagic stroke.

RESULTSDuring the two-year follow-up, 34 patients died and 65 experienced re-hospitalization with pulmonary conditions, congestive heart failure, angina, or ischemic/hemorrhagic stroke. Kaplan-Meier survival analysis showed that the AAA patients with cardiac revascularization had no higher incidence of overall mortality and major morbidity than those without (log-rank test P = 0.35 and P = 0.40, respectively). Cox proportional hazards regression analysis showed that level of lowdensity lipoprotein (HR, 4.06; 95% CI: 1.19-18.7, P = 0.027) and AAA size (HR, 2.18; 95% CI: 1.28-11.65, P = 0.036) were independently associated with the incidence of overall mortality. Long-term use of angiotensin converting enzyme inhibitors, statins, AAA size and systolic blood pressure were independent predictors of the secondary pre-specified outcomes.

CONCLUSIONSCoronary artery revascularization following the guideline recommendations did not increase the mortality and morbidity of Chinese with AAA who were undergoing repair. Absence of angiotensin converting enzyme inhibitors and statins, AAA size, and systolic blood pressure were powerful predictors of the clinical events.

Adult ; Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; surgery ; Coronary Artery Bypass ; adverse effects ; Coronary Artery Disease ; surgery ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Child ; Coronary Aneurysm ; diagnosis ; etiology ; surgery ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome ; complications

Epistaxis is commonly encountered in otorhinolaryngologic practice. However, severe and recurrent epistaxis is rarely seen, especially that originating from a pseudoaneurysm of the intracavernous internal carotid artery (ICA). We herein present the case of a 32-year-old man who was involved in a motor vehicle accident and subsequently developed recurrent episodes of profuse epistaxis for the next three months, which required blood transfusion and nasal packing to control the bleeding. Computed tomography angiography revealed a large intracavernous ICA pseudoaneurysm measuring 1.7 cm × 1.2 cm × 1.0 cm. The patient underwent emergent four-vessel angiography and coil embolisation and was discharged one week later without any episode of bleeding. He remained asymptomatic after three-month and one‑year intervals. This case report highlights a large intracavernous ICA pseudoaneurysm as a rare cause of epistaxis, which requires a high index of suspicion in the right clinical setting and emergent endovascular treatment to prevent mortality.
Accidents, Traffic ; Adult ; Aneurysm, False ; diagnostic imaging ; etiology ; surgery ; Carotid Artery Injuries ; Carotid Artery, Internal ; diagnostic imaging ; pathology ; surgery ; Coronary Angiography ; methods ; Embolization, Therapeutic ; Epistaxis ; etiology ; Humans ; Male ; Tomography, X-Ray Computed