RESUMEN
Closure of adult patent ductus arteriosus (PDA) is difficult for its variation. We report a case of open stent-grafting for a 67-year-old woman who had PDA and a concomitant distal aortic arch aneurysm. The pulmonary/systemic flow ratio was 1.88, and the pulmonary arterial pressure was 34/21(25). The operation was done through a median sternotomy under hypothermic cardioplegic arrest. We opened the anterior wall of the arch just distal to the left subclavian artery and placed a stent-graft into the descending aorta. At 5 months after discharge, three-dimensional computed tomography showed disappearance of PDA and no endoleak of the stent-graft.
Asunto(s)
Aneurisma de la Aorta Torácica/epidemiología , Implantación de Prótesis Vascular/métodos , Conducto Arterioso Permeable/epidemiología , Conducto Arterioso Permeable/cirugía , Stents , Anciano , Comorbilidad , Conducto Arterioso Permeable/diagnóstico por imagen , Femenino , Paro Cardíaco Inducido , Humanos , Toracotomía/métodos , Tomografía Computarizada por Rayos XRESUMEN
A 35 year-old male with Marfan's syndrome was referred with a fortuitous echographic finding of an abdominal aorta flap. Transthoracic echocardiography showed moderate aortic regurgitation and an aneurysm in the sinus of Valsalva. Computed tomography demonstrated an aneurysm in the sinus of Valsalva 60 mm in size and a DeBakey type IIIb dissection extending from the left subclavian artery to the right common iliac artery. An aortic valve-sparing operation (reimplantation), total aortic arch replacement and the elephant trunk method were used in this patient. An aortic valve-sparing operation is preferable because the patient is young, and has no need for anticoagulant therapy after surgery. The extent of the aortic reconstruction, including the intact aortic arch, was appropriate to prohibit future dilatation of the aortic arch and retrograde dissection from a DeBakey type IIIb dissection.