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Redo cardiac surgery for active prosthetic valve endocarditis associated with hereditary hemorrhagic telangiectasia: report of a case.

Nakamura Y, Shikata F, Ryugo M, Okamura T, Yasugi T, Izutani H - Surg. Today (2014)

Bottom Line: Hereditary hemorrhagic telangiectasia (HHT) is caused by an autosomal dominant gene and characterized by multiple arteriovenous malformations in several organs, leading to bleeding or shunting.These patients often suffer severe infections and heart failure, which should be managed in the perioperative period, when open heart surgery is indicated.We report a case of successful aortic root replacement for active prosthetic valve endocarditis and ventricular septal perforation in a patient with HHT, who had severe heart failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Ehime University Hospital, Shitsukawa, Toon, Ehime, 791-0295, Japan, yukihtky@yahoo.co.jp.

ABSTRACT
Hereditary hemorrhagic telangiectasia (HHT) is caused by an autosomal dominant gene and characterized by multiple arteriovenous malformations in several organs, leading to bleeding or shunting. These patients often suffer severe infections and heart failure, which should be managed in the perioperative period, when open heart surgery is indicated. We report a case of successful aortic root replacement for active prosthetic valve endocarditis and ventricular septal perforation in a patient with HHT, who had severe heart failure.

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Related in: MedlinePlus

This operative schema shows how we repaired the ventricular septal perforation. RCA right coronary artery, LCA left coronary artery, RV right ventricle, LV left ventricle, MV mitral valve
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Related In: Results  -  Collection


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Fig5: This operative schema shows how we repaired the ventricular septal perforation. RCA right coronary artery, LCA left coronary artery, RV right ventricle, LV left ventricle, MV mitral valve

Mentions: After inserting a tracheal tube carefully, but not a nasogastric tube, median sternotomy was performed. Systemic heparinization was delivered, and the patient’s activated clotting time was maintained at above 400 s throughout the surgery. Her primary otolaryngologist had waited until the operation was finalized to observe her nasal condition and stop any bleeding. An aortic cannula was inserted from the ascending aorta and cardiopulmonary bypass was established with bicaval cannulation. The ascending aorta was opened and trimmed just below the brachiocephalic artery under moderate hypothermic circulation arrest (28 °C) and retrograde cerebral perfusion. A 24-mm tube graft (GelweaveDacron graft, Vascutek USA, Inc., Ann Arbor, MI) with a side branch was anastomosed to the distal ascending aorta. We observed vegetation on the leaflet of the degenerated bioprosthesis. The prosthesis was partially detached from the annulus (Fig. 4). There was ventricular septal perforation below the valve along the muscular and membranous septum and the annulus, which was severely damaged by the endocarditis. The fragile tissue was removed carefully, following which the damaged annulus was reconstructed, and the perforated septum was repaired with a xenopericardial patch. A 27-mm Freestyle aortic root bioprosthesis (Medtronic Inc., Minneapolis, MN, USA) was placed in the supra-annular position and the left and right coronary arteries were reconstructed. Finally, the proximal end of the graft was anastomosed to the distal end of the bioprosthesis (Fig. 5).Fig. 4


Redo cardiac surgery for active prosthetic valve endocarditis associated with hereditary hemorrhagic telangiectasia: report of a case.

Nakamura Y, Shikata F, Ryugo M, Okamura T, Yasugi T, Izutani H - Surg. Today (2014)

This operative schema shows how we repaired the ventricular septal perforation. RCA right coronary artery, LCA left coronary artery, RV right ventricle, LV left ventricle, MV mitral valve
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4231213&req=5

Fig5: This operative schema shows how we repaired the ventricular septal perforation. RCA right coronary artery, LCA left coronary artery, RV right ventricle, LV left ventricle, MV mitral valve
Mentions: After inserting a tracheal tube carefully, but not a nasogastric tube, median sternotomy was performed. Systemic heparinization was delivered, and the patient’s activated clotting time was maintained at above 400 s throughout the surgery. Her primary otolaryngologist had waited until the operation was finalized to observe her nasal condition and stop any bleeding. An aortic cannula was inserted from the ascending aorta and cardiopulmonary bypass was established with bicaval cannulation. The ascending aorta was opened and trimmed just below the brachiocephalic artery under moderate hypothermic circulation arrest (28 °C) and retrograde cerebral perfusion. A 24-mm tube graft (GelweaveDacron graft, Vascutek USA, Inc., Ann Arbor, MI) with a side branch was anastomosed to the distal ascending aorta. We observed vegetation on the leaflet of the degenerated bioprosthesis. The prosthesis was partially detached from the annulus (Fig. 4). There was ventricular septal perforation below the valve along the muscular and membranous septum and the annulus, which was severely damaged by the endocarditis. The fragile tissue was removed carefully, following which the damaged annulus was reconstructed, and the perforated septum was repaired with a xenopericardial patch. A 27-mm Freestyle aortic root bioprosthesis (Medtronic Inc., Minneapolis, MN, USA) was placed in the supra-annular position and the left and right coronary arteries were reconstructed. Finally, the proximal end of the graft was anastomosed to the distal end of the bioprosthesis (Fig. 5).Fig. 4

Bottom Line: Hereditary hemorrhagic telangiectasia (HHT) is caused by an autosomal dominant gene and characterized by multiple arteriovenous malformations in several organs, leading to bleeding or shunting.These patients often suffer severe infections and heart failure, which should be managed in the perioperative period, when open heart surgery is indicated.We report a case of successful aortic root replacement for active prosthetic valve endocarditis and ventricular septal perforation in a patient with HHT, who had severe heart failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Ehime University Hospital, Shitsukawa, Toon, Ehime, 791-0295, Japan, yukihtky@yahoo.co.jp.

ABSTRACT
Hereditary hemorrhagic telangiectasia (HHT) is caused by an autosomal dominant gene and characterized by multiple arteriovenous malformations in several organs, leading to bleeding or shunting. These patients often suffer severe infections and heart failure, which should be managed in the perioperative period, when open heart surgery is indicated. We report a case of successful aortic root replacement for active prosthetic valve endocarditis and ventricular septal perforation in a patient with HHT, who had severe heart failure.

Show MeSH
Related in: MedlinePlus