1/61. clindamycin hypersensitivity appears to be rare.BACKGROUND: A patient developed a generalized confluent erythematous papular rash after a single injection of clindamycin preoperatively. The literature from two small studies suggested a 10% incidence of cutaneous eruptions to clindamycin which seemed too high. OBJECTIVE: Describe a patient with clindamycin hypersensitivity and determine the incidence of hospital-wide adverse drug reactions from clindamycin from 1995-1997. methods: At a tertiary care center, utilizing the Department of Pharmacy records, the incidence of adverse drug reactions was determined with (1) voluntary physician reporting, (2) health information management chart reviews and adverse drug reaction coding, and (3) chart reviews by the pharmacy and therapeutics committee of adverse drug reactions. RESULTS: (I) A 50-year-old patient developed a generalized raised, erythematous rash that worsened over 3.5 days until hydrocortisone was administered. Immediate skin tests with clindamycin were negative. (2) From 3,896 administrations of clindamycin from April 1995 to October 1997, 14 (0.47%) adverse drug reactions occurred but 7 were confounded by other medications also being administered. CONCLUSION: (1) Adverse drug reactions to clindamycin are much lower than reported 25 years ago with an incidence < 1%. (2) A patient who previously had experienced facial edema and a generalized rash after receiving clindamycin and a cephalosporin 6 years ago and who was considered allergic to cephalosporins, was found to be clindamycin allergic when she received a preoperative dose of clindamycin.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/61. Valve replacement for appetite suppressant-induced valvular heart disease.Valvular heart disease associated with the use of appetite-suppressant medication is a recently described clinical entity. Although the mechanism of valvular injury remains elusive pathologically, the valvular abnormalities resemble those observed in carcinoid syndrome. The incidence of clinically evident valvular heart disease is low with short-term (less than 3 months) exposure to appetite-suppressant drugs. Prolonged exposure to higher doses in addition to combination drug therapy confers an excess risk for valvular pathologic changes. We report the case of a patient with severe mitral regurgitation who had short-term exposure (3 weeks) to the combination of fenfluramine (20 mg) and phenteramine (15 mg).- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
3/61. Combined mitral and tricuspid valve repair in acute infective endocarditis.Combined repair of the mitral and tricuspid valves involved with acute infective endocarditis was carried out in a 38-year-old drug addict. Mitral valve repair included vegetectomy, closure of posterior leaflet perforation, and posterior annuloplasty with a patch and a strip of glutaraldehyde-tanned autologous pericardium, respectively, while the tricuspid valve was reconstructed with the use of artificial chordae and valve bicuspidalization. At five months follow up the patient is asymptomatic, with echocardiographic evidence of only trivial mitral and tricuspid incompetence, and no signs of recurrent infection. This case report supports the use of valve reconstruction as a valuable option in patients in whom there is simultaneous involvement of the mitral and tricuspid valves with infective endocarditis.- - - - - - - - - - ranking = 4.8563610953868keywords = closure, drug (Clic here for more details about this article) |
4/61. An unusual iatrogenic cause of right coronary air embolism.A 62-year-old woman undergoing redo mitral valve replacement was noted to have persistent intracardiac air following standard deairing procedures. Transesophageal echocardiography (TEE) identified air bubbles entering the left atrium from the right superior pulmonary vein. Exploration of the pleural cavity revealed a fistula between the pulmonary parenchyma and the right superior pulmonary vein caused by the atriotomy closure suture transfixing the edge of the lung, which was repaired with immediate disappearance of the air emboli. This demonstrates that transesophageal echocardiography is an invaluable aid to ensuring complete deairing after open heart procedures.- - - - - - - - - - ranking = 4.6896944287201keywords = closure (Clic here for more details about this article) |
5/61. Transcatheter closure of a patent foramen ovale following mitral valve replacement.We report the successful closure of a postoperative patent foramen ovale in a patient who underwent coronary artery bypass grafting and mitral valve replacement for severe mitral insufficiency. The postoperative course was complicated by severe hypoxemia due to a large patent foramen ovale. The patient underwent transcatheter closure with the Das Angel Wings transcatheter occluder (Microvena Corporation, White Bear Lake, MN) with immediate improvement.- - - - - - - - - - ranking = 28.138166572321keywords = closure (Clic here for more details about this article) |
6/61. Catheter entrapment by atrial suture during minimally invasive port-access cardiac surgery.PURPOSE: The port-access approach allows surgeons to perform heart operations through small intercostal openings, or "ports". This technique requires new skills for anesthesiologists. A pulmonary artery venting (PAV) catheter and, in some cases, a coronary sinus catheter (for administration of retrograde cardioplegia) are positioned with the aid of fluoroscopy and transesophageal echography (TEE). Both catheters have a wider diameter than the more commonly used conventional PA catheter and present distinctive features. We report a case in which a pulmonary artery venting catheter was entrapped by a suture during a port-access procedure. CLINICAL FEATURES: A 35-yr-old man with severe mitral valve insufficiency was scheduled for valve repair. After a successful bypass procedure, resistance was felt while attempting to withdraw the PAV catheter. On fluoroscopy, fixation of the catheter at the heart level was established and perforation by suture was confirmed after injection of a contrast agent. Because of the risk of cardiac wall rupture and tamponade, the thorax was reopened. After release of some atrial sutures, the catheter could be withdrawn easily. Transfixion by a suture was confirmed by visual examination. CONCLUSION: The more frequent use of a PAV catheter in minimally invasive cardiac surgery with the port-access technique should remind the anesthesiologist of the higher risk of entrapment by surgical sutures. Surgeons should be aware of the risk of accidentally transfixing this catheter during closure of the atriotomy via the port.- - - - - - - - - - ranking = 4.6896944287201keywords = closure (Clic here for more details about this article) |
7/61. Left ventricular pseudoaneurysm and mitral valve regurgitation. Conservative surgical therapy.A patient with posterolateral left ventricular pseudoaneurysm, severe mitral regurgitation and coronary artery disease is reported. mitral valve insufficiency was almost completely cured by simple closure of the left ventricular defect by edge to edge apposition along the long axis of the heart.- - - - - - - - - - ranking = 4.6896944287201keywords = closure (Clic here for more details about this article) |
8/61. cardiac tamponade complicating closure of a median sternotomy.A case of intraoperative cardiac tamponade manifested during closure of a median sternotomy is presented. We postulate that cardiac tamponade was caused by acute dilatation of the cardiac chambers as a result of intraoartic balloon pumping in a patient with aortic and mitral regurgitation. It has been shown experimentally that acute rises in ventricular end-diastolic pressure result in increased intrapericardial pressure and that if a certain point on the pericardial pressure-volume curve is reached, cardiac tamponade will occur. sternotomy closure was accomplished easily as soon as the need for intra-aortic balloon pumping diminished.- - - - - - - - - - ranking = 28.138166572321keywords = closure (Clic here for more details about this article) |
9/61. Entrapment of subvalvular mitral tissue causing intermittent failure of a St Jude mitral prosthesis.Frequently portions of the mitral valve and sub-valvular apparatus are left intact during mitral valve replacement to help preserve left ventricular function. We describe a patient with paroxysmal congestive heart failure caused by intermittent entrapment of the subvalvular apparatus in the prosthesis, preventing complete valve closure.- - - - - - - - - - ranking = 4.6896944287201keywords = closure (Clic here for more details about this article) |
10/61. Optimization of atrioventricular delay and follow-up in a patient with congestive heart failure with an implanted DDD pacemaker: case report.It has been reported that cardiac function can be improved by implanting a DDD pacemaker (PM) and setting a short atrioventricular (AV) delay in patients with impaired cardiac function. A previous report found that the critical AV delay that induces diastolic mitral regurgitation (MR) may represent the upper limit of the optimal AV delay. The optimal AV delay can be predicted by a simple method: slightly prolonged AV delay minus the interval between the end of the atrial kick and complete closure of the mitral valve (duration of diastolic MR) at the AV delay setting. The patient was a 84-year-old man with an old myocardial infarction. He had repeated admissions to hospital for congestive heart failure. ECG showed prolongation of the PQ interval (0.28 s) and complete left bundle branch block. Cardiac function was improved by AV sequential pacing when the AV delay was set at 120ms. After DDD-PM implantation, the cardiothoracic ratio decreased from 57 to 45% and cardiac function was improved from new york Heart association class III to I. The AV delay was optimized during follow-up. Four years after PM implantation, the patient was in good condition without further hospital admission.- - - - - - - - - - ranking = 4.6896944287201keywords = closure (Clic here for more details about this article) |
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