RESUMEN
A patient with an extensive type I left ventricular rupture after a redo mitral valve replacement was successfully treated using a patch of glutaraldehyde-preserved pericardium sutured to the endocardium around the tear.
Asunto(s)
Bioprótesis , Lesiones Cardíacas/cirugía , Prótesis Valvulares Cardíacas , Complicaciones Intraoperatorias/cirugía , Lesiones Cardíacas/etiología , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral , Pericardio , Reoperación , Técnicas de SuturaRESUMEN
We reviewed the entire experience in Hawaii with external wall reinforcement with Dacron graft material as a primary method of surgical treatment of aortic aneurysm. Over the past 11.5 years, 14 such procedures have been performed. Two of the aneurysms were located in the distal aortic arch, eight in the descending thoracic aorta, and four in the abdominal aorta. The operation was done in each instance as a safer alternative to resection and replacement in high-risk patients. There were two postoperative deaths, one unrelated to the surgery. To date, three of the 12 surviving patients have experienced aortic rupture at the graft site, 6 months to 3 years later. Two died of exsanguinating hemorrhage and a third survived corrective surgery. The rupture in each instance occurred through the entire wrap itself. Two of these developed aortobronchial fistulas and one an aortoesophageal fistula. The high incidence of late rupture of wrapped aneurysms, as reported here, has not been documented in the literature and raises serious questions as to the efficacy of this procedure.
Asunto(s)
Aneurisma de la Aorta/cirugía , Rotura de la Aorta/etiología , Tereftalatos Polietilenos/uso terapéutico , Complicaciones Posoperatorias/etiología , Anciano , Aorta Abdominal/cirugía , Aorta Torácica/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Factores de TiempoRESUMEN
In this study, 207 consecutive limbs with chronic venous insufficiency were evaluated with dynamic venous pressure studies and they were correlated with the clinical presentation and results of definitive radiologic studies with ascending and descending venography. Multiple methods of performing the pressure studies, by active exercise, passive manual compression, and tourniquet application at the calf and ankle, proved useful in distinguishing the severity and location of venous disease. The limits of confidence that can be ascribed to the dynamic venous pressure studies were also determined.