Cerebral Thrombemboli with left ventricular origin are occasionally seen in patients with post-infarction left ventricular aneurysm or dilatativer cardiomyopathy of non-ischemic cause. Freedom of medical history of ca...Cerebral Thrombemboli with left ventricular origin are occasionally seen in patients with post-infarction left ventricular aneurysm or dilatativer cardiomyopathy of non-ischemic cause. Freedom of medical history of cardiac disease and corresponding symptoms may delay the proper diagnosis, particularly in patients with distinct neurological symptoms and normal findings in electrocardiogram or cerebral MRI. We report on a rare case of long standing neurological symptoms and late diagnosis of a left ventricular thrombus without clinical symptoms or medical history of cardiac disease. The patient underwent a thrombus extraction via left ventricular apical approach. He was discharged from hospital after an uneventful course in our clinic with remaining mild neurological symptoms that were partially recurrent under physiotherapy and logopedic therapy in the course of the following two years. An echocardiographical evaluation of cardiac function and exclusion of a cardiac source of emboli as a first line diagnostic tool may have led to an early diagnosis. Therefore, it should be implemented in the routine examination, independent of cardiac history or present cardiac symptoms.展开更多
Objective: Vein graft quality control had been traditionally done for more than 20 years with a roller-pump flow measurement (RPFM) in our institute until off-pump coronary artery bypass grafting was introduced as the...Objective: Vein graft quality control had been traditionally done for more than 20 years with a roller-pump flow measurement (RPFM) in our institute until off-pump coronary artery bypass grafting was introduced as the standard technique of myocardial revascularization in the year 2009 in our institute. In this study, the RPFM method was compared with the Transit-time flow measurement (TTFM). Patients and Methods: From February to September 2005, 31 patients (5 females) undergoing CABG in our institute were included into the study. All the patients were operated with cardiopulmonary bypass. In those patients, 27 distal anastomoses were done with the left internal thoracic artery and 99 anastomoses were done with vein grafts. Those 99 vein graft were assessed both, with the RPFM method and TTFM method. Results: CABG could be safely performed in all cases. In all target vessels, the RPFM method overestimated bypass flow compared to the TTFM method, and simple linear regression revealed no correlation between the TTFM measurement and the RPFM measurement (r = 0.08, p = 0.21). There were two cases in which a graft problem could be detected only with TTFM method, even in our small patient cohort. Conclusion: The present study suggests that the TTFM method is clearly superior to the traditional RPFM method and we believe now that TTFM should be performed routinely in all CABG to improve patient care and quality of surgical results.展开更多
文摘Cerebral Thrombemboli with left ventricular origin are occasionally seen in patients with post-infarction left ventricular aneurysm or dilatativer cardiomyopathy of non-ischemic cause. Freedom of medical history of cardiac disease and corresponding symptoms may delay the proper diagnosis, particularly in patients with distinct neurological symptoms and normal findings in electrocardiogram or cerebral MRI. We report on a rare case of long standing neurological symptoms and late diagnosis of a left ventricular thrombus without clinical symptoms or medical history of cardiac disease. The patient underwent a thrombus extraction via left ventricular apical approach. He was discharged from hospital after an uneventful course in our clinic with remaining mild neurological symptoms that were partially recurrent under physiotherapy and logopedic therapy in the course of the following two years. An echocardiographical evaluation of cardiac function and exclusion of a cardiac source of emboli as a first line diagnostic tool may have led to an early diagnosis. Therefore, it should be implemented in the routine examination, independent of cardiac history or present cardiac symptoms.
文摘Objective: Vein graft quality control had been traditionally done for more than 20 years with a roller-pump flow measurement (RPFM) in our institute until off-pump coronary artery bypass grafting was introduced as the standard technique of myocardial revascularization in the year 2009 in our institute. In this study, the RPFM method was compared with the Transit-time flow measurement (TTFM). Patients and Methods: From February to September 2005, 31 patients (5 females) undergoing CABG in our institute were included into the study. All the patients were operated with cardiopulmonary bypass. In those patients, 27 distal anastomoses were done with the left internal thoracic artery and 99 anastomoses were done with vein grafts. Those 99 vein graft were assessed both, with the RPFM method and TTFM method. Results: CABG could be safely performed in all cases. In all target vessels, the RPFM method overestimated bypass flow compared to the TTFM method, and simple linear regression revealed no correlation between the TTFM measurement and the RPFM measurement (r = 0.08, p = 0.21). There were two cases in which a graft problem could be detected only with TTFM method, even in our small patient cohort. Conclusion: The present study suggests that the TTFM method is clearly superior to the traditional RPFM method and we believe now that TTFM should be performed routinely in all CABG to improve patient care and quality of surgical results.
