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Biomedical subjects

Torsten Bossert

Publications and source records attributed to Torsten Bossert.

13 recordsLinked to original sources
PubMed2006

Coronary artery spasm of the native right coronary artery during off-pump coronary surgery of the left coronary artery system.

Native coronary artery spasm is a very rare complication during off-pump coronary artery bypass grafting. We report the case of a 74-year-old man who experienced angiographically documentated right coronary artery spasm while undergoing off-pump coronary artery bypass grafting on the diseased left coronary system. Despite two episodes of ventricular fibrillation and persistent ST segment elevation of the posterior wall, the off-pump procedure was successfully completed by grafting the left internal thoracic artery to the left anterior descending artery and a saphenous vein graft to the Ramus intermedius. The immediate postoperatively performed coronary angiography demonstrated patent anastomoses and two areas of significant spasticity within the course of the right coronary artery. Intracoronary nitroglycerin infusion into the ostium of the right coronary artery resolved the spasms of this nondiseased vessel as well as the associated ST segment elevations.

Aged↗
PubMed2006

Cardiac fibroma as an inherited manifestation of nevoid basal-cell carcinoma syndrome.

We report the case of an 8-month-old male infant presenting with life-threatening ventricular tachycardia. Echocardiography revealed a left ventricular tumor. The tumor was resected through a left ventriculotomy, and the left ventricle was reconstructed after a partial ventriculectomy Histologic investigation showed a completely resected benign fibroma. The 30-year-old mother was known to have nevoid basal-cell carcinoma syndrome, which can be associated with cardiac fibromas. We believe that this is an interesting addition to the medical literature.

Basal Cell Nevus Syndrome↗
PubMed2005

Anomalous origin of the right coronary artery from the pulmonary artery combined with aortic valve stenosis.

We report the case of a 41-year-old patient presenting with anomalous of origin of the right coronary artery from the pulmonary artery (ARCAPA) and severe aortic valve stenosis. Surgical correction was performed by partial (T-shaped) sternotomy. After replacing the bicuspid aortic valve, the right coronary artery ostium was directly reimplanted into the aortic root. The main pulmonary artery was reconstructed using an autologous pericardial patch. Postoperative recovery was uneventful. Four cases involving an association of the bicuspid aortic valve and ARCAPA have been reported in the literature. This potential relationship should be considered whenever diagnosing a bicuspid aortic valve.

Abnormalities, Multiple↗
PubMed2005

Successful management of two heart transplant recipients with mycobacterial pulmonary infections.

We report two cases of pulmonary tuberculosis in heart transplant recipients: a 46-year-old man with pulmonary tuberculosis due to Mycobacterium tuberculosis and a 64-year-old man with nontuberculous mycobacterial infection with pulmonary infiltrates due to Mycobacterium xenopi. The time intervals from transplantation to diagnosis were 3 and 4 years, respectively. The patient with tuberculosis underwent standard treatment with isoniazid, rifampin, ethambutol, and pyrazinamide. The patient with the nontuberculous mycobacterial infection received treatment with clarithromycin and ciprofloxacin for 18 months in addition to rifampin for the first 3 months. Both patients responded well to treatment. No recurrences were observed during follow-up. The interactions between antibiotic treatment and cyclosporine therapy should be observed closely in organ transplant recipients, requiring frequent level determinations and dosing changes.

Anti-Infective Agents↗
PubMedDate not supplied

The use of an aortic connector system in a patient with severe calcified ascending aorta.

Patients with severe calcified ascending aorta ("porcelain aorta") present a surgical challenge. Off-pump coronary artery bypass grafting (OPCAB), using new automated proximal anastomotic devices, provide a surgical alternative for patients who are not candidates for in situ arterial grafting. We present a 74-year-old male with double-vessel disease and a large calcified aneurysm of the left anterior wall. Left ventricular function was poor with an ejection fraction of 24%. The beating heart technique was used for the distal anastomosis and ventriculoplasty. The proximal anastomosis was constructed with an automated aortic connector system, thereby avoiding clamping of the severely diseased aorta.

Aged↗
PubMedDate not supplied

Ruptured giant syphilitic aneurysm of the descending aorta in an octogenarian.

Syphilis can lead to saccular aneurysms of the thoracic aorta. Today syphilitic aortic aneurysms are rare. The average time from primary infections to the development of aortic aneurysms is 10 to 15 years. An 83-year-old man was admitted with a giant aneurysm of the descending thoracic aorta. The patient had first experienced subacute pain in the left hemithorax some weeks previously. Computer tomography scan detected an 11 x 11 cm aneurysm of the descending aorta. Serodiagnostic tests for syphilis were highly positive. Femoro-femoral bypass was initiated and a tube graft was interposed. The postoperative course was uneventful, the patient was discharged at the twentieth postoperative day. Histological examination of the aneurysmal wall showed typical syphilitic changes. Postoperatively, Penicillin G was given for 6 months. Three years later the patient remains asymptomatic. Although extremely rare today, tertiary syphilis should be considered in the differential diagnosis of thoracic aneurysms. In selected octogenarians replacement of the descending aorta is possible.

Aged↗
PubMedDate not supplied

Swan-Ganz catheter-induced severe complications in cardiac surgery: right ventricular perforation, knotting, and rupture of a pulmonary artery.

BACKGROUND: The role of Swan-Ganz catheterization for cardiac surgery and perioperative management has recently been scrutinized. METHODS: Prospective observational study for serious complications related to Swan-Ganz catheterization. 7150 patients undergoing cardiac operations at a major European heart center and academic setting. 3730 Swan-Ganz catheter placements for cardiac surgery (7.5 French Swan-Ganz Catheter Baxter, heparin coated). RESULTS: We observed four serious complications related to Swan-Ganz catheterization and placement (0.1%): A right ventricular free wall perforation occurred, one trouble with knotting, and two pulmonary artery ruptures. The right ventricular perforation was controlled with a suture, the knot was tightened, and the catheter withdrawn through insertion. The first case of pulmonary artery rupture was treated conservatively. All of these patients survived. The other pulmonary artery rupture occurred during coronary artery bypass grafting. Emergency lobectomy was performed. This patient died due to bleeding during the early postoperative course. CONCLUSION: The incidence of serious Swan-Ganz catheter complications in our patient population is comparable to the incidence reported in the literature. Based on these results the use of Swan-Ganz catheters in cardiac surgery is still justified since the rate of associated serious complications is extremely low. Despite the rare occurrence of serious complications and the infrequent fatal outcomes, the benefit of its use in selected cases of cardiac surgery overweight its associated complications.

Aged, 80 and over↗