Incipient left ventricular rupture complicating anomalous left coronary artery

A 4-month-old girl presented with 2 weeks of symptoms and physical signs of heart failure. Echocardiography demonstrated marked left ventricular dilation, thinning of the myocardium with anterolateral akinesis, mitral regurgitation, a moderate pericardial collection, and an anomalous left coronary artery from the pulmonary artery. At operation there was a tense hemopericardium and a site of imminent rupture through a transmural anterior infarction. The anomalous artery was reimplanted in the ascending aorta, and an extensive infarct resection and ventricular repair performed. Support with a left ventricular assist device was required for 3 days, but the infant subsequently made a satisfactory recovery. Left ventricular rupture is a very rare complication of this lesion, but should be considered if there is evidence of a pericardial collection.     

Congenital left circumflex artery fistula drainage into left ventricle

Congenital communication between left coronary artery to left ventricle is a rare anomaly. A 52-year-old male patient visited our institution complaining of paroxysmal palpitation and echocardiography revealed a large fistula draining into the left ventricle. Coronary angiography and computed tomography (CT) scanning confirmed the fistula located between the left circumflex coronary artery (LCX) and left ventricle (LV). A simple fistula ligation was performed, and postoperative three-dimensional coronary CT scanning confirmed the patient got a complete cure.     

Thorn-induced non-specific granulomatous left biceps myositis with left subareolar lymphadenopathy

In surveying the pediatric and orthopedic literature, very little has been written about foreign bodies in skeletal muscle or muscle tissue inflammation in response to foreign bodies. When it is known that a foreign body has penetrated the muscle or if it is externally visible, there is no diagnostic problem. However, this can become a perplexing problem when history and physical examination are not clearly diagnostic. We present a case in which a thorn penetrated the left biceps muscle of a 10-year-old girl. The thorn remained there for 3 weeks without disturbing the child. It produced a local sterile granulomatous reaction in the muscle. Two weeks later, left subareolar lymphadenopathy appeared with no involvement of the axillary lymph nodes.     

Ruptured left ventricular pseudoaneurysm penetrating into the left pleural cavity

We experienced a rare case of ruptured left ventricular pseudoaneurysm penetrating into the left pleural cavity. A 77-year-old woman was first diagnosed with unstable angina due to sudden chest pain onset and abnormal electrocardiographic findings. In 2 days, massive left pleural effusion was recognized by chest X-ray, though subsequent computed tomographic scans did not show any aortic pathology. We observed her with left thoracentesis alone. Two days later, cardiac arrest suddenly occurred and emergency surgery was undertaken after resuscitation by percutaneous cardiopulmonary support. In surgery, a moderate amount of intrapericardial hematoma caused by rupture of a left ventricular pseudoaneurysm penetrating into the left pleural cavity was found and successfully repaired. This rare rupture of a left ventricular pseudoaneurysm penetrating into the left pleural cavity generated massive hemo-hydrothorax.     

Multiple myxoma in the left ventricle and the left atrium

Left ventricular myxoma is particulary rare. Our case is a 77-year-old female. Transesophageal echocardiography showed a giant tumor in the left atrium. An urgent operation was performed. A giant mass was excised en bloc via a transinteratrial septal approach. Histopathologically it was myxoma. As a transthoracic echocardiography at 1-year postoperation showed a tumor in the left ventricle. A mass was excised en bloc via a vertical approach. Histopathologically it was diagnosed again as myxoma. We looked at the earliest transesophageal echocardiogram again, and found the small tumor on the same area under the posterior mitral leaflet. At the diagnose of cardiac tumor, possibility of multiple formation should be always considered.     

选择性左半肝血流阻断在腹腔镜左半肝切除术中的应用

目的探讨选择性左半肝血流阻断在腹腔镜左半肝切除术中的安全性和可行性。方法回顾性分析2014年1月至2015年12月广东省梅州市人民医院26例腹腔镜左半肝切除术和25例开腹左半肝切除术治疗左肝胆管结石病人的临床资料,术中均采取选择性左半肝入肝血流阻断。对比二组病人的手术时间、术中出血量和术后住院时间。结果腹腔镜组与开腹组相比手术时间短,分别为(338.9±53.6)min比(373.8±54.4)min,两组比较差异有统计学意义(t=-2.311,P=0.025);术中出血量少,分别为(303.8±155.5)ml比(450.2±259.0)ml,差异有统计学意义(t=-2.458,P=0.020);术后住院时间短,分别为(8.5±2.6)d比(11.3±2.3)d,差异有统计学意义(t=-4.223,P=0.000)。术后均未发生肝衰竭。结论选择性左半肝血流阻断在左腹腔镜半肝切除术中的应用安全可行。     

Migration of left hip pin with involvement of left ureter

This patient had hematuria and a history of hip fusion many years before. It was found that a left hip pin had broken, and its sharpened portion had migrated through the head of the femur into the adventitia of the left ureter. During exploratory surgery, a bonecutter was employed to cut off the tip of the pin flush with the pelvic wall. The patient has had no recurrence of hematuria. Review of the literature disclosed no report of a similar case.     

Double-outlet left ventricle

Origin of both great vessels from the left ventricle is an uncommon congenital cardiac anomaly. When there is an associated ventricular septal defect and pulmonary stenosis, the preoperative diagnosis has usually been that of tetralogy of Fallot. Operative repair was accomplished successfully in a 12-year-old boy with such a combination of defects. This involved patch closure of the ventricular septal defect, interruption of blood flow from the left ventricle to the pulmonary artery by suture closure of the pulmonary valve and annulus, and restoration of blood flow to the lung by using a Dacron tube conduit between the right ventricle and the distal main pulmonary artery. This represents the third successful operative repair of double-outlet left ventricle.     

Thorn-induced non-specific granulomatous left biceps myositis with left subareolar lymphadenopathy

Summary In surveying the pediatric and orthopedic literature, very little has been written about foreign bodies in skeletal muscle or muscle tissue inflammation in response to foreign bodies. When it is known that a foreign body has penetrated the muscle or if it is externally visible, there is no diagnostic problem. However, this can become a perplexing problem when history and physical examination are not clearly diagnostic. We present a case in which a thorn penetrated the left biceps muscle of a 10-year-old girl. The thorn remained there for 3 weeks without disturbing the child. It produced a local sterile granulomatous reaction in the muscle. Two weeks later, left subareolar lymphadenopathy appeared with no involvement of the axillary lymph nodes.

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Zusammenfassung Über Fremdkörper im Muskelgewebe und deren nachfolgenden entzündlichen Reaktion ist in der Literatur kaum berichtet worden. Wenn bekannt oder gesichert ist, daß ein Fremdkörper das Muskelgewebe penetriert hat, besteht in der Regel kein diagnostisches Problem. Anders verhält es sich, wenn die Anamnese unbekannt ist und bei der Untersuchung ein unklarer Befund besteht. Dies soll an einem 10jährigen Mädchen demonstriert werden, bei welchem ein Dorn in den linken Bizepsmuskel eingedrungen ist. In den ersten 3 Wochen führte dies zu keinerlei Symptomatik, darn kam es zu eingr lokalen abakteriellen granulomatösen Reaktion, und 2 Wochen später fand sich eine subareoläre Lymphadenopathie ohne Mitbeteiligung der axillären Lymphknoten.

     

Partial left ventriculectomy

OBJECTIVE: Partial left ventriculectomy has been performed without standardized inclusion/exclusion criteria. A registry has been established to accumulate experience with this procedure to identify indications, risks and benefits. METHODS: In response to a mailed inquiry, 90 cases were voluntarily registered from 28 Japanese institutions. RESULTS: Males (n = 67, 74.4%) predominated, and 29 (32.2%) patients were over 60 years old. The underlying cardiac pathologies included dilated cardiomyopathy (n = 75, 83.3%), valvular disease (n = 8, 8.9%), the dilated phase of hypertrophic cardiomyopathy (n = 4, 4.5%), and others (n = 3, 3.3%). Gender, age, etiology, papillary muscle excision and absent transplant indication did not significantly affect survival. Poorer preoperative condition, reduced contraction and decompensation necessitating emergency operation were each associated with a significantly higher risk. Hospitals performing less than 5 cases had poorer results than more experienced institutions (p = .0019), which showed a tendency towards improved survival in the second half of their experience (p = .096). Hospital mortality (n = 29, 32.6%) and late death (n = 10, 11.2%) were mainly from ventricular failure with few sudden deaths over a period of 63.6 patient years follow-up. Late mortality was equally distributed in the first year and leveled off with significantly improved cardiac functional class in survivors. CONCLUSION: Partial left ventriculectomy was associated with better survival in less symptomatic patients with better contractile reserve undergoing an elective operation preserving the papillary muscles. Avoidance of identified risk factors may allow better patient selection and improved survival in the current environment where rescue transplantation is not readily available. Long-term follow-up is warranted with more registry data.     

Inverted left atrial appendage presenting as a large left atrial mass

Inverted left atrial appendage (ILAA) is a rare phenomenon. We describe a patient with mitral stenosis who presented with a homogenous mass in the left atrium, mimicking a large thrombus. The patient was sent to surgery and no thrombus was found; intraoperative examination by the surgeon revealed an ILAA. We briefly discuss the main features of this entity and also some aspects of the differential diagnosis.     

Intraoperative left subclavian artery occlusion with left hand ischaemia and steal syndrome in the left internal thoracic artery

We present a case of a 62-year old man with a left main stenosis, left coronary artery dominance, normal ejection fraction and no valvular pathology, and status post right carotid artery stenting, who was scheduled for elective coronary revascularization. We performed off-pump coronary revascularization, anastomosing the left internal thoracic artery to the left anterior descending artery, and three separate saphenous vein grafts to the intermediate artery and the first and second obtuse marginals, respectively. Proximally, the right internal thoracic artery was used as the inflow for all three venous grafts due to a heavily calcified ascending aorta. During the construction of the distal anastomoses to the obtuse marginals, the arterial pressure in the left radial artery suddenly dropped. The left hand was found to be pale and pulseless. A femoral artery catheter was placed for pressure monitoring and the anastomoses were completed as planned. Intraoperative transit-time graft flow measurement showed a reversed flow in the left internal thoracic artery. Postoperatively, angiography was performed showing a subtotal stenosis of the proximal left subclavian artery. The artery was dilated and stented. The postoperative course was uneventful and the patient was discharged on the 12th postoperative day.     

Traumatic rupture of the left lobe of the liver and rupture of the left diaphragm with left chylothorax

Reports of traumatic ruptures of the liver are not common and this case is most unusual, in that the original injury was a true rupture of the left lobe of the liver and rupture of the left diaphragm. The bile leaked down into the lesser omental sac as well as into the left chest. The bile and exudate continued to collect in the lesser omental sac, forming a large tumor mass in the upper abdomen. The patient was discharged from the hospital on the one hundred fourteenth day and had apparently recovered. He was readmitted thirty-nine days later and died from operative shock during an exploratory laparotomy.     

Partial left ventriculectomy

Objective: Partial left ventriculectomy has been performed without standardized inclusion/exclusion criteria. A registry has been established to accumulate experience with this procedure to identify indications, risks and benefits.Methods: In response to a mailed inquiry, 90 cases were voluntarily registered from 28 Japanese institutions.Results: Males (n=67, 74.4%) predominated, and 29 (32.2%) patients were over 60 years old. The underlying cardiac pathologies included dilated cardiomyopathy (n=75, 83.3%), valvular disease (n=8, 8.9%), the dilated phase of hypertrophic cardiomyopathy (n=4, 4.5%), and others (n=3, 3.3%). Gender, age, etiology, papillary muscle excision and absent transplant indication did not significantly affect survival. Poorer preoperative condition, reduced contraction and decompensation necessitating emergency operation were each associated with a significantly higher risk. Hospitals performing less than 5 cases had poorer results than more experienced institutions (p=.0019), which showed a tendency towards improved survival in the second half of their experience (p=.096). Hospital mortality (n=29, 32.6%) and late death (n=10, 11.2%) were mainly from ventricular failure with few sudden deaths over a period of 63.6 patient years follow-up. Late mortality was equally distributed in the first year and leveled off with significantly improved cardiac functional class in survivors.Conclusion: Partial left ventriculectomy was associated with better survival in less symptomatic patients with better contractile reserve undergoing an elective operation preserving the papillary muscles. Avoidance of identified risk factors may allow better patient selection and improved survival in the current environment where rescue transplantation is not readily available. Long-term follow-up is warranted with more registry data.     

Fistularized large pseudoaneurysm of left valsalva sinus to the left ventricle

Left sinus of Valsalva aneurysms particularly acquired type are rare reported cases in the literature. We present a fistularized large pseudoaneurysm of the left sinus of Valsalva into the left ventricle caused by atherosclerotic changes in a 61-year-old man presenting with dyspenea and three episodes of chest pain since one month prior to surgery. We describe its characteristics, surgical approach and associated lesions.     

Partial left pericardial defect with herniation of the left atrial appendage

A case is reported of herniation of the left atrial appendage through a partial pericardial defect, probably congenital. The diagnosis was suggested by the history of chest pain and bulging of the middle segment of the left heart border on the plain chest film, without other signs. Angiography revealed a dilated left atrial appendage. An artificial left pneumothorax confirmed the presence of a pleuropericardial defect. The surgical procedure included excision of the appendage and closure of the defect.     

Occlusion of left coronary artery ostium by left coronary cusp fusion

We report two cases of adults who had occlusion of the left coronary artery ostium by the left coronary cusp. Both patients were treated with the Bentall procedure, and both revealed a good, long-term course. We offer proper strategy of perioperative management consisting of precise preoperative diagnosis with a multimodality imaging study and adequate operative technique.     

气动泵的不同流量对急性左心衰竭辅助作用的实验研究

目的 用血液动力学、心肌超微结构及神经体液指标评价左室辅助装置（ＬＶＡＤ）的有效性。方法 ,对２０条急笥左心衰犬进行高,中、低流量的１８０ｍｉｎ左室辅助,观察其对上述指标的影响。结果 ＬＶＡＤ可使急性左心衰犬各项血流动力学指标迅速趋于稳定,血浆肾素,血管紧张素Ⅱ,内皮素下降,一氧化氮升高,与心力衰竭时差异有显著意义;使心肌细胞水肿和线粒体肿胀减轻。结论 不同辅助流量对急性左心衰时支持均有效,但以中     

The left lateroportal lamina of the pancreas or left retropancreatic lamina

Findings on 100 cadaver dissections after lymphatic injections of fetuses and infants demonstrated the presence of the left posterior attachment of the pancreas corresponding to the left mesopancreatico-duodeno-umbilical contingent described by Couinaud. In adults, this hand, known initially as the left lateroportal process in no way constitutes a surgical obstacle to excision, but its pathologic role and embryologic significance cannot be disputed. As a result of the article by H. Richelme, the author is in entire agreement with the term left retropancreatic process.     

Staged hybrid left pulmonary artery rehabilitation in post-fontan left pulmonary artery hypoplasia

Left pulmonary artery hypoplasia in the setting of Fontan circulation predisposes to pulmonary artery discontinuity. We describe a novel approach to correct post-Fontan left pulmonary artery discontinuity by a strategy to produce isolated left pulmonary artery growth, followed by a catheter-based reincorporation of the left pulmonary artery into the Fontan circuit.