Repeat coronary artery bypass in a patient with liver cirrhosis.
Sakakibara Y. Imazuru T. Watanabe K. Matsuzaki K. Mitsui T. Unno H. Doi T.
Department of Surgery, University of Tsukuba, Japan.
The case of a 69-year-old man with liver cirrhosis, thrombocytopenia, unstable angina, and a history of previous coronary artery bypass grafting (CABG) is presented. The patient under-went successful repeat CABG through lateral thoracotomy on the beating heart without extracorporeal circulatory support.
Resection for CMV ileitis in a patient supported by a left-ventricular assist device.
Aleksic I. Baryalei MM. Schorn B. Stohr G. Busch T. Zenker D. Strauch J. Dalichau H.
Department of Thoracic and Cardiovascular Surgery, Gottingen, Germany.
We describe a patient requiring a HeartMate 1000 IP left-ventricular assist device (LVAD) due to cardiogenic shock. After prolonged gastrointestinal bleeding without identifying the source of bleeding technetium scintigraphy pointed to the right lower abdomen. The patient underwent a laparotomy and inflamed ileum was resected. Pathologic examination revealed cytomegalovirus ileitis. This was treated with ganciclovir and acyclovir. The patient is now (14 months later) awaiting heart transplantation since she could not be weaned from LVAD. The diagnostic and management problems are discussed as well as the relevance for future transplantation.
De-epithelialization for esophageal cyst by video-assisted thoracoscopic surgery monitored by esophagoscopy.
Nomori H. Horio H. Imazu Y. Morinaga S. Suemasu K.
Department of Surgery, Saiseikai Central Hospital, Tokyo, Japan.
In a 26-year-old male a congenital esophageal cyst was de-epithelialized using electro-cauterization via video-assisted thoracoscopic surgery (VATS) together with esophagoscopy. As the cyst adhered firmly to the esophageal muscle layer and mucosa, partial excision of the cyst and burning up of the cystic mucosa by electro-cauterization was performed to prevent esophageal mucosal perforation and postoperative esophageal dysmotility. Intraoperative video esophagoscopic monitoring enabled esophageal mucosal perforation to be avoided. Postoperative barium esophagography revealed good esophageal motility, and the patient showed no symptoms of esophageal dysmotility. We conclude that de-epithelialization for congenital esophageal cysts using VATS together with esophagoscopy is a minimally damaging and reasonable curative procedure without postoperative complications.