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Emergency Quadrido-Bentall Procedure for Aortic Rupture in a Patient with Behcet's Disease.

Park SJ, Lee JW, Kim JB - Korean J Thorac Cardiovasc Surg (2015)

Bottom Line: Cardiovascular involvement in cases of Behcet's disease is a rare but life-threatening condition, and prosthetic valve detachment is a frequent and serious complication attributable to Behcet's disease following the surgical repair of aortic regurgitation.The patient had previously undergone aortic valve surgery three times due to recurrent prosthetic valve detachment.ARR may be an appropriate surgical option for patients with Behcet's disease in order to prevent recurrence of the disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.

ABSTRACT
Cardiovascular involvement in cases of Behcet's disease is a rare but life-threatening condition, and prosthetic valve detachment is a frequent and serious complication attributable to Behcet's disease following the surgical repair of aortic regurgitation. We report the case of a patient with Behcet's disease presenting with contained aortic rupture around the aortic root. The patient had previously undergone aortic valve surgery three times due to recurrent prosthetic valve detachment. An emergency operation was performed, consisting of aortic root replacement (ARR) using a composite valved conduit and the replacement of the hemiarch. ARR may be an appropriate surgical option for patients with Behcet's disease in order to prevent recurrence of the disease.

No MeSH data available.


Related in: MedlinePlus

While inducing deep hypothermia, transapical left ventricular (LV) venting was achieved through a left-side mini-thoracotomy in order to prevent LV distension during cardiac arrest.
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f2-kjtcv-48-364: While inducing deep hypothermia, transapical left ventricular (LV) venting was achieved through a left-side mini-thoracotomy in order to prevent LV distension during cardiac arrest.

Mentions: Massive hemorrhage during the reopening of the sternum and consequent catastrophic events were anticipated; therefore, deep hypothermic circulatory arrest (DHCA) was implemented before opening the sternum, using femoral cardiopulmonary bypass (CPB) with direct trans-apical LV venting through a left-side mini-thoracotomy (Fig. 2). Once the nasopharyngeal temperature cooled to 18°C, sternal opening was attempted using an oscillating saw. As expected, a massive hemorrhage occurred from the ruptured aorta while the hematoma was being removed after sternal opening, at which point the CPB was stopped. Distal ascending aorta clamping was achieved securely within one minute of DHCA, and CPB was restarted. Two discrete rupture sites were found in the aorta: one at the distal anastomosis site of the previous Ross procedure and the other at the right coronary button site (Fig. 3). After complete adhesiolysis of the mediastinum and the removal of the previously implanted pulmonic autograft, several tiny pseudoaneurysms were identified at the level of the aorto-ventricular junction, and further resection of this area was therefore conducted. DHCA was then reimplemented (15 minutes) in order to conduct hemiarch replacement using a 28-mm Hemashield vascular graft (Boston Scientific, Boston, MA, USA), which was followed by the reimplementation of CPB and systemic rewarming. During this period, complete root replacement was carried out, using a 27-mm composite mechanical valved conduit (St. Jude Medical Inc., St Paul, MN, USA). The circulatory arrest and cardiac ischemic times were 16 minutes and 188 minutes, respectively. The patient failed to be weaned from CPB due to profound LV dysfunction, therefore, CPB was substituted with venous-arterial extracorporeal membrane oxygenation (ECMO). Massive hemorrhage from the surgical sites continued despite meticulous hemostatic maneuvers and massive blood product transfusions. The patient was transferred to the intensive care unit (ICU) with an open sternum. The transfusion of large quantities of blood products for two days resulted in adequate hemostasis. Follow-up echocardiography showed a significant recovery of LV function at this point, and the patient was successfully weaned off ECMO after four days of ECMO support, after which a delayed sternal closure was performed. The follow-up computed tomography images and echocardiogram were unremarkable in that neither paravalvular dehiscence nor leakage on the anastomosis site was observed. LV function was found to be normal, with an ejection fraction of 56% without any inotropic support. The patient was discharged on postoperative day 31 without any neurologic sequelae or residual complications. On the echocardiographic follow-up performed six months after the surgery, cardiac function was completely normal, with adequate function of the mechanical valve and no pathologic findings around the aortic root and ascending aorta. The patient has undergone 14 months of follow-up while prescribed an oral corticosteroid medication, and has exhibited no cardiovascular complications.


Emergency Quadrido-Bentall Procedure for Aortic Rupture in a Patient with Behcet's Disease.

Park SJ, Lee JW, Kim JB - Korean J Thorac Cardiovasc Surg (2015)

While inducing deep hypothermia, transapical left ventricular (LV) venting was achieved through a left-side mini-thoracotomy in order to prevent LV distension during cardiac arrest.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4622037&req=5

f2-kjtcv-48-364: While inducing deep hypothermia, transapical left ventricular (LV) venting was achieved through a left-side mini-thoracotomy in order to prevent LV distension during cardiac arrest.
Mentions: Massive hemorrhage during the reopening of the sternum and consequent catastrophic events were anticipated; therefore, deep hypothermic circulatory arrest (DHCA) was implemented before opening the sternum, using femoral cardiopulmonary bypass (CPB) with direct trans-apical LV venting through a left-side mini-thoracotomy (Fig. 2). Once the nasopharyngeal temperature cooled to 18°C, sternal opening was attempted using an oscillating saw. As expected, a massive hemorrhage occurred from the ruptured aorta while the hematoma was being removed after sternal opening, at which point the CPB was stopped. Distal ascending aorta clamping was achieved securely within one minute of DHCA, and CPB was restarted. Two discrete rupture sites were found in the aorta: one at the distal anastomosis site of the previous Ross procedure and the other at the right coronary button site (Fig. 3). After complete adhesiolysis of the mediastinum and the removal of the previously implanted pulmonic autograft, several tiny pseudoaneurysms were identified at the level of the aorto-ventricular junction, and further resection of this area was therefore conducted. DHCA was then reimplemented (15 minutes) in order to conduct hemiarch replacement using a 28-mm Hemashield vascular graft (Boston Scientific, Boston, MA, USA), which was followed by the reimplementation of CPB and systemic rewarming. During this period, complete root replacement was carried out, using a 27-mm composite mechanical valved conduit (St. Jude Medical Inc., St Paul, MN, USA). The circulatory arrest and cardiac ischemic times were 16 minutes and 188 minutes, respectively. The patient failed to be weaned from CPB due to profound LV dysfunction, therefore, CPB was substituted with venous-arterial extracorporeal membrane oxygenation (ECMO). Massive hemorrhage from the surgical sites continued despite meticulous hemostatic maneuvers and massive blood product transfusions. The patient was transferred to the intensive care unit (ICU) with an open sternum. The transfusion of large quantities of blood products for two days resulted in adequate hemostasis. Follow-up echocardiography showed a significant recovery of LV function at this point, and the patient was successfully weaned off ECMO after four days of ECMO support, after which a delayed sternal closure was performed. The follow-up computed tomography images and echocardiogram were unremarkable in that neither paravalvular dehiscence nor leakage on the anastomosis site was observed. LV function was found to be normal, with an ejection fraction of 56% without any inotropic support. The patient was discharged on postoperative day 31 without any neurologic sequelae or residual complications. On the echocardiographic follow-up performed six months after the surgery, cardiac function was completely normal, with adequate function of the mechanical valve and no pathologic findings around the aortic root and ascending aorta. The patient has undergone 14 months of follow-up while prescribed an oral corticosteroid medication, and has exhibited no cardiovascular complications.

Bottom Line: Cardiovascular involvement in cases of Behcet's disease is a rare but life-threatening condition, and prosthetic valve detachment is a frequent and serious complication attributable to Behcet's disease following the surgical repair of aortic regurgitation.The patient had previously undergone aortic valve surgery three times due to recurrent prosthetic valve detachment.ARR may be an appropriate surgical option for patients with Behcet's disease in order to prevent recurrence of the disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.

ABSTRACT
Cardiovascular involvement in cases of Behcet's disease is a rare but life-threatening condition, and prosthetic valve detachment is a frequent and serious complication attributable to Behcet's disease following the surgical repair of aortic regurgitation. We report the case of a patient with Behcet's disease presenting with contained aortic rupture around the aortic root. The patient had previously undergone aortic valve surgery three times due to recurrent prosthetic valve detachment. An emergency operation was performed, consisting of aortic root replacement (ARR) using a composite valved conduit and the replacement of the hemiarch. ARR may be an appropriate surgical option for patients with Behcet's disease in order to prevent recurrence of the disease.

No MeSH data available.


Related in: MedlinePlus