Bronchial artery embolization for pulmonary arterial hypertension and recurrent hemoptysis?

Embolization of bronchial collaterals has been suggested as a means of controlling the recurrence of hemoptysis in patients with pulmonary arterial hypertension. In conclusion, the investigators present a patient in which this procedure failed to prevent further episodes of hemoptysis and discuss whether this procedure should be offered routinely, given the lack of sufficient data to support this approach.     

Stentless heterograft conduits for pulmonic ventricle to pulmonary artery connection: is it the right option?

BACKGROUND AND AIM OF THE STUDY: A variety of stentless heterograft conduits has been developed as alternatives for pulmonary outflow reconstruction. Herein are reported the authors' results with four different types of stentless heterograft conduit implanted during the past nine years. METHODS: Between January 1996 and March 2005, stentless heterograft conduits were used in 54 patients (mean age 9.9 +/- 7.5 years; median age 7 years; range: 1-32 years) to reconstruct the pulmonary outflow tract. The main pathologies were tetralogy of Fallot, transposition of the great arteries and aortic valve disease (Ross operation). A Baxter-Edwards Prima valve (EP) was used in three patients, a Medtronic Freestyle bioprosthesis (MF) in 27, a Cryolife Ross pulmonic heterograft (CR) in 14, and a Medtronic Contegra bovine jugular vein conduit (MC) in 10. The mean conduit diameter was 20.4 +/- 1.7 mm (range: 16-23 mm). RESULTS: Early mortality was 5.5%. Mean intensive care unit and hospital stays were 4.3 +/- 4.8 days and 11.7 +/- 7.2 days, respectively. Clinical follow up was complete for 92.1% of patients; the mean follow up period was 45.6 +/- 20 months. Excluding early deaths, the probability of patient survival (Kaplan-Meier) was 97.9% and 74.6% at one and five years, respectively. Transconduit gradients increased significantly in all conduit types during follow up. Conduit failure occurred in 15 patients (two EP, nine MF, three CR, one MC) at a median duration of 70 +/- 7 months (range: 56-84 months). To date, nine patients have undergone conduit re-replacement, without mortality and major morbidity. The probability of freedom from conduit failure was 91.6%, 66.4% and 27.9% at three, five and seven years, respectively. CONCLUSION: Stentless heterograft conduits are suitable alternatives to homografts, with acceptable early and mid-term results. However, they do not offer any significant advantage over homografts or other conventional Dacron or pericardial conduits.     

Adult type anomalous origin of the left coronary artery from the pulmonary artery: When should we be aware?

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a clinical entity characterized by myocardial ischemia which becomes symptomatic shortly after birth leading to left heart failure and death. It is rare for an ALCAPA patient to survive to adulthood. In this case, the diagnosis is sometimes missed because of atypical clinical presentation or of the unawareness of doctors. Here, we report a case of an 11-year-old boy with ALCAPA syndrome whose diagnosis took many years to be set-up.     

Anomalous origin of left coronary artery from the pulmonary artery does the management in the adult differ from that of the infant? Four cases of the Bland-White-Garland Syndrome

We report four adult patients with anomalous origin of left main coronary artery from the pulmonary artery that presented to us from 1995 to 2006. One died suddenly at the age of 21 years before undergoing surgery, two patients had ligation and left internal mammary artery (LIMA) grafting to the left anterior descending artery, and one had aortic implantation of the left main coronary artery. All three patients who had surgical treatment are doing well.     

Comprehensive intraoperative transesophageal echocardiography of anomalous left coronary artery from pulmonary artery: What to look for and where to look?

Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) accounts for 0.4% of the congenital heart diseases. Comprehensive 2D and 3D transesophageal echocardiographic imaging of a well‐collateralized subset of ALCAPA is described. A nonstandard short‐axis view of both aorta and pulmonary arteries showed the origin of left coronary artery from the posterior sinus of the pulmonary artery and right coronary artery in its usual position. Pulse‐wave interrogation of the coronary arteries showed the direction of flow in opposite directions. Using the real time‐3D, the en‐face views of the origins of both coronaries were also demonstrated.     

Is chronic obstructive pulmonary disease a risk factor for epistaxis after coronary artery bypass graft surgery?

Epistaxis is the most common otolaryngological emergency that affects up to 60% of the population in their lifetime. Six per cent of all epistaxis cases require medical attention.1Chronic obstructive pulmonary disease (COPD) is often considered a risk factor for postoperative morbidity and mortality after coronary artery bypass graft (CABG) surgery. Postoperative complications such as respiratory failure, re-intubation, sternal dehiscence, prolonged mechanical ventilation, rhythm disturbances and prolonged hospital stays are known complications of COPD in CABG patients.2Epistaxis is a rare complication that is not directly related to heart surgery.3 Many factors affect bleeding after cardiac surgery, such as thrombolytic agents, hypertension, trauma and nasal oxygen therapy. Data on the association between epistaxis and CABG surgery is less clear.4 There is a paucity of published data regarding the management of epistaxis in patients with COPD who undergo CABG. We conducted this study to determine whether there was a relationship between epistaxis and COPD after CABG surgery.