RESUMEN
Introduction: Acute aortic dissection is the most common cause of death in patients with Marfan syndrome and untreated aortic root enlargement. Emergency surgery for replacement of the ascending aorta has the potential of life saving procedure, but is associated with high morbidity and mortality. Long-term outcomes after surgical repair of acute aortic dissection type A in patients with Marfan syndrome are limited. Material and methods: We made a retrospective study concerning emergency surgical intervention for acute aortic dissection type A, by Bentall procedure, performed in Emergency Institute for Cardiovascular Diseases "Prof dr. C. C. Iliescu" Bucharest between January 2005 and July 2014. We included 332 patients with type a acute aortic dissection divided into two groups: group A - 16 patients with Marfan syndrome and group B - 316 patients with other etiologies. We analyzed differences between these two groups regarding perioperative characteristics, surgical technique and short and long-term morbidity and mortality. Results: The patients from group A were significantly younger than those in group B (35.1±12.7 years vs. 56.8±7.1 years; p<0.001). Arterial hypertension was three times more common in group B as compared to group A (p<0.001). The incidence of postoperative morbidity, and intraoperative and 30-days mortality death rates were similar between groups, but overall mortality at 10 years was lower in group A (31.3%) vs. group B (44.9 %). Conclusions: Emergency surgical in Marfan syndrome, by Bentall procedure could improve perioperative morbidity and mortality of patients with acute aortic dissection, but need an early diagnosis, proper medical therapy and imagistic surveillance.
Asunto(s)
Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Síndrome de Marfan/complicaciones , Adulto , Disección Aórtica/etiología , Disección Aórtica/mortalidad , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/mortalidad , Urgencias Médicas , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Quadricuspid aortic valve is a rare variant of aortic semilunar valve, often being an unexpected discovery during cardiac surgery. We present the case of a 59 years old patient, who was admitted for dyspnea on light exertion and palpitations. The transthoracic echocardiography revealed severe aortic valve regurgitation due to a quadricuspid aortic valve, the result being confirmed by the transesophageal echo examination. The patient had a first class indication for aortic valve replacement and the surgical intervention was uneventful. The operative technique and case particularities are discussed in view of the literature published so far regarding this uncommon condition.
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Insuficiencia de la Válvula Aórtica/congénito , Insuficiencia de la Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Disnea/etiología , Ecocardiografía Transesofágica , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
We report a rare case of a 23-year-old woman in who recurrent multiple cardiac myxomas were resected first time 4 years after the initial operation and second time three years after the second operation. In February 2000, she was diagnosed with right ventricular myxoma. The initial cardiac tumor was successfully resected through a right atrium approach and the tricuspid valve was changed with a biological prosthesis; the patient has been followed-up by ultrasound echocardiography every 6-month after discharge. Four years after, the echocardiography revealed one masse in the left atrium, which was resected using a trans-septal approach. Due to malfunction of the tricuspid prosthesis, this was changed with a biological one. After another three years, the echocardiography revealed once again two masses, this time in the right atrium and left ventricle. The third surgery was performed and all 2 myxomas were successfully resected through a combined right atrial and left ventricle approach. One year after the third operation, she has been doing well without any sign of recurrence of myxoma. A long-term follow-up is mandatory in patients after the resection of a cardiac myxoma.
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Neoplasias Cardíacas/cirugía , Mixoma/cirugía , Recurrencia Local de Neoplasia/cirugía , Adulto , Femenino , Atrios Cardíacos , Neoplasias Cardíacas/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Ventrículos Cardíacos , Humanos , Mixoma/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Reoperación , Resultado del Tratamiento , Válvula Tricúspide/cirugía , UltrasonografíaRESUMEN
To evaluate a different technique for the treatment of the left main coronary artery ostial stenosis, the coronary ostial surgical angioplasty. Three patients underwent this operation. After placing the patient on cardiopulmonary bypass and aortic cross clamping, the main pulmonary trunk was retracted laterally. The left main coronary artery was approached anteriorly through a curved aortotomy. Reconstruction was performed using fresh or treated with glutaraldehyde pericardial patch. There were no in-hospital deaths. In one case, the aortic suture had to be reconstructed with a GoreTex patch. We didn't note other complications. The patch plasty of the left main coronary trunk is a safe procedure, with no important complications, despite its technical difficulty.
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Angioplastia , Estenosis Coronaria/cirugía , Puente Cardiopulmonar , Humanos , Masculino , Persona de Mediana Edad , Pericardio/trasplante , Factores de Riesgo , Trasplante Autólogo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
The fungal etiology of the native aortic endocarditis is a rare situation. Most often the etiologic factors are medical manoeuvres like cardiovascular surgery (cardiac prosthesis), cardiac defibrillators or stimulators, the prolonged use of the intravenous catheters, antibiotics, immunosuppressors, etc. We are presenting the case of a patient with cardiac stimulator, with rare fungal native aortic endocarditis, complicated with cerebral embolization, in which we have chosen a combined therapy: aortic replacement with biologic prosthesis and pre and post operative anti fungal therapy. We are considering that in this case the combined medico-surgical therapy was the right choice.
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Válvula Aórtica/microbiología , Válvula Aórtica/cirugía , Candidiasis/complicaciones , Candidiasis/terapia , Endocarditis/microbiología , Endocarditis/terapia , Anciano , Antifúngicos/uso terapéutico , Candidiasis/tratamiento farmacológico , Candidiasis/cirugía , Endocarditis/tratamiento farmacológico , Endocarditis/cirugía , Humanos , Masculino , Marcapaso Artificial/efectos adversos , Resultado del TratamientoRESUMEN
PURPOSE: This study aimed to report our experience in the creation of brachio-brachial arteriovenous fistulas (AVFs) in patients without adequate superficial venous circulation at the upper limb. METHODS: A retrospective study of 33 patients, operated on between 2004-2005, in whom we created a brachio-brachial fistula between the brachial artery and the brachial vein. After dissection and adequate mobilization, the brachial vein was anastomized to the brachial artery in an end-to-side fashion. After the maturation period (1 month) the brachial vein was transposed into the subcutaneous tissue. RESULTS: Thirty-three patients underwent 33 brachio-brachial fistula constructions. Primary patency was achieved in all patients. After 1 month, 27 fistulas (81.8%) were functional. Six patients developed fistula occlusion. The 27 remaining patients had subsequently good fistulas for hemodialysis (HD) afterwards. Discrete edema of the forearm was noted in 12 patients (36%); in one of these patients the edema was extended to the entire arm. No other complications were noted. A follow-up study, extended from 3-26 months (mean 14 +/- 6.6 months), was performed. The overall patency rate of the brachio-brachial fistula at the end of the follow-up was 85.2%. CONCLUSIONS: The brachio-brachial fistula can represent a viable choice in patients with an inadequate superficial venous system in the upper limb.
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Derivación Arteriovenosa Quirúrgica/métodos , Arteria Braquial/cirugía , Extremidad Superior/irrigación sanguínea , Venas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Derivación Arteriovenosa Quirúrgica/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diálisis Renal/métodos , Estudios Retrospectivos , Análisis de Supervivencia , Trombosis , Grado de Desobstrucción VascularRESUMEN
We have chosen this case of sporadic atrial myxoma for our presentation because it had a particular evolution, with recurrence at 8 years after surgical excision (echocardiography was performed every year) and a particular diagnostic means - at echocardiographic follow-up, the patient being asymptomatic. This presentation, together with a review of literature included in the article, emphasizes the importance of a careful postoperative follow-up of the patients and the existence of some particular aspects of the evolution and symptomatology of recurrent atrial myxoma.