scholarly journals Balloon coronary angioplasty and parenteral antiplatelet therapy for intraoperative myocardial infarction during general surgery: An attempt to balance benefits and risks - a case report

2020 ◽  
Vol 77 (4) ◽  
pp. 445-449 ◽  
Author(s):  
Vojislava Neskovic ◽  
Slobodan Obradovic ◽  
Ana Popadic ◽  
Nenad Nikolic ◽  
Dusica Stamenkovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Case Report ◽  
Balloon Angioplasty ◽  
Previous History ◽  
Hemodynamic Instability ◽  
Bleeding Complications ◽  
Perioperative Morbidity ◽  
Percutaneous Balloon ◽  
Profound Hypotension

Introduction. Cardiovascular complications remain one of the major risk factors for perioperative morbidity and bad outcome in non-cardiac surgery patients. Here we report a case of the patient suffering intraoperative ST-segment elevation acute myocardial infarction (STEMI) promptly treated with percutaneous balloon angioplasty and intravenous antiplatelet agents. Case report. A 62-year-old man, without previous history of cardiovascular morbidity, developed STEMI during abdominal surgery. Due to profound hypotension with mean arterial pressure of less than 40 mmHg, surgery was promptly ended and patient transferred to intensive care unit. Within one hour after the end of the surgery, coronary angiography and successful balloon angioplasty of occluded right coronary artery were performed. Tirofiban infusion was started in recommended dose. Developed hemodynamic instability was related to hypovolemia and excessive drainage, reaching 1,500 mL of blood in the following 15 hours. The following morning, drainage persisted (additional 600 mL of blood) which resulted in profound hypotension (65/40 mmHg). Overall, the patient received 1,970 mL of blood, 6 doses of thrombocytes and 840 mL of fresh frozen plasma. All together, the patient had a favorable outcome, despite the occurrence of bleeding complications and hemodynamic instability. Conclusion. The choice of treatment strategy for patients suffering perioperative STEMI during major non-cardiac surgery is challenging. After major non-cardiac surgery, characterized by both high bleeding risk and high risk of stent thrombosis, balloon angioplasty instead of stenting along with parenteral antiplatelet treatment may be a fair therapeutic choice. Clinical choices have to be made individually, according to the weighted risks and benefits.

scholarly journals Aspirin withdrawal in high risk cardiac patients before the operation of total colectomy with resection of ileum: Case report

2013 ◽  
Vol 60 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Tjasa Ivosevic ◽  
Nevena Kalezic ◽  
Svetlana Barovic ◽  
Ivan Palibrk ◽  
Vesna Karapandzic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Total Colectomy ◽  
Meta Analysis ◽  
Perioperative Period ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Cardiac Complications ◽  
Cardiac Events ◽  
Perioperative Bleeding

Coronary artery disease is one of the risk factors for myocardial infarction and it is present in 40% of patients who are undergoing noncardiac surgery. Despite evidence of the benefit of the antiplatelet therapy in patients at risk of cardiac complications, aspirin treatment is often discontinued before surgery due to the risk of perioperative bleeding. In many studies and meta-analysis it is shown that aspirin withdrawal in perioperative period was associated with three-fold higher risk of major adverse cardiac events. Perioperative continuation of aspirin increase the rate of bleeding by 1.5, but it doesn?t increase the level of the severity of bleeding complications. In perioperative periode aspirin is discontinued only if it is estimated that the bleeding risk is higher than the risk of thrombosis. In the paper authors present a case report of patient who developed a perioperative myocardial infarction as a consequence of aspirin withdrawal before total colectomy.

scholarly journals A case report of a complicated fatal percutaneous valve implantation

2020 ◽  
Author(s):  
Ana Sampaio ◽  
Gustavo Norte ◽  
Liliane Godinho ◽  
Ana Raimundo ◽  
Manuel Cuervo
Keyword(s):  
Cardiac Surgery ◽  
Case Report ◽  
Right Ventricle ◽  
Pulmonary Valve ◽  
Hemodynamic Instability ◽  
Valve Prosthesis ◽  
Safe Procedure ◽  
Percutaneous Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Valve

Pulmonary valve dysfunction, also called right ventricle outflow tract dysfunction, is one of the known anomalies in patients with congenital heart disease. Percutaneous pulmonary valve implantation (PPVI) has been developed as an alternative to surgical correction. Although it is largely considered a safe procedure, life-threatening complications can happen and institutions must be able to resolve these immediately and adequately. We present a case of pulmonary valve migration to the right ventricle during a PPVI. This complication needed immediate cardiac surgery due to resulting hemodynamic instability. The percutaneous valve prosthesis was removed and a bioprosthetic valve was surgically implanted in the correct position. This case emphasizes the need of prompt cardiac surgery support and the readiness of the anesthesia team to deal with emergency open cardiac surgery. Citation: Sampaio A, Norte G, Godinho L, Raimundo A, Cuervo M. A case report of a complicated fatal percutaneous valve implantation. Anaesth pain & intensive care 2019;23(4)__ Received: 24 September 2019, Reviewed: 24, 26 October 2019, Accepted: 22 November 2019

Review of safety in previous history of malignant hypertermia. Case report in cardiac surgery

2019 ◽  
Vol 33 ◽  
pp. S148-S149
Author(s):  
L.M. Santana Ortega ◽  
A. Rodríguez Pérez ◽  
G. Hernanz Rodríguez ◽  
O. Padrón Ruiz ◽  
L. Morales López
Keyword(s):  
Cardiac Surgery ◽  
Case Report ◽  
Previous History ◽  
History Of

Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Gruber-Szydlo ◽  
Poreba ◽  
Belowska-Bien ◽  
Derkacz ◽  
Badowski ◽  
...  
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Popliteal Artery ◽  
Doppler Ultrasonography ◽  
Histopathological Examination ◽  
Previous History ◽  
Plain Radiography ◽  
Artery Thrombosis ◽  
History Of ◽  
The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

Case report of Erdheim-Chester disease in a female cardiac surgery patient

2011 ◽  
Vol 59 (S 01) ◽  
Author(s):  
HR Mahoozi ◽  
A Zittermann ◽  
K Hakim-Meibodi ◽  
J Gummert ◽  
N Mirow
Keyword(s):  
Cardiac Surgery ◽  
Case Report ◽  
Cardiac Surgery Patient ◽  
Erdheim Chester Disease ◽  
Surgery Patient ◽  
Erdheim Chester ◽  
Chester Disease

Systemic Thrombin Generation and Activity Resistant to Low Molecular Weight Heparin Administered Prior to Streptokinase in Patients with Acute Myocardial Infarction

1997 ◽  
Vol 77 (01) ◽  
pp. 057-061 ◽  
Author(s):  
Dennis W T Nilsen ◽  
Lasse Gøransson ◽  
Alf-Inge Larsen ◽  
Øyvind Hetland ◽  
Peter Kierulf
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Molecular Weight ◽  
Body Weight ◽  
Low Molecular Weight Heparin ◽  
Troponin T ◽  
Bleeding Complications ◽  
Control Group ◽  
Low Molecular Weight ◽  
Creatine Kinase Mb

SummaryOne hundred patients were included in a randomized open trial to assess the systemic factor Xa (FXa) and thrombin inhibitory effect as well as the safety profile of low molecular weight heparin (LMWH) given subcutaneously in conjunction with streptokinase (SK) in patients with acute myocardial infarction (MI). The treatment was initiated prior to SK, followed by repeated injections every 12 h for 7 days, using a dose of 150 anti-Xa units per kg body weight. The control group received unfractionated heparin (UFH) 12,500 IU subcutaneously every 12 h for 7 days, initiated 4 h after start of SK infusion. All patients received acetylsalicylic acid (ASA) initiated prior to SK.Serial blood samples were collected prior to and during the first 24 h after initiation of SK infusion for determination of prothrombin fragment 1+2 (Fl+2), thrombin-antithrombin III (TAT) complexes, fibrinopeptide A (FPA) and cardiac enzymes. Bleeding complications and adverse events were carefully accounted for.Infarct characteristics, as judged by creatine kinase MB isoenzyme (CK-MB) and cardiac troponin T (cTnT), were similar in both groups of patients.A comparable transient increase in Fl+2, TAT and FPA was noted irrespective of heparin regimen. Increased anti-Xa activity in patients given LMWH prior to thrombolytic treatment had no impact on indices of systemic thrombin activation.The incidence of major bleedings was significantly higher in patients receiving LMWH as compared to patients receiving UFH. However, the occurrence of bleedings was modified after reduction of the initial LMWH dose to 100 anti-Xa units per kg body weight.In conclusion, systemic FXa- and thrombin activity following SK-infusion in patients with acute MI was uninfluenced by conjunctive LMWH treatment.

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