RESUMO
Resumen Para la reconstrucción y el tratamiento de anomalías que comprometen la aorta torácica pueden emplearse diversas técnicas quirúrgicas abiertas, las cuales estarán determinadas por la patología que presente el paciente. La angiotomografía computada multicorte (ATCMC) es el método de elección para su control y seguimiento. El médico radiólogo debe estar familiarizado con las técnicas quirúrgicas empleadas (Wheat, Bentall de Bono, Cabrol, entre otras), con las reparaciones estructurales que se realizan y con los materiales protésicos utilizados con el fin de evitar una interpretación errónea de las imágenes. El fieltro espontáneamente hiperdenso, los conductos protésicos y sus anastomosis, tanto con la aorta como con los grandes vasos, puede generar errores en el informe final y en el diagnóstico.
Abstract Multiple surgical techniques can be used for the reconstruction and treatment of abnormalities that compromise the thoracic aorta, which will be determined by the patients pathology. Multislice computed tomography angiography is the method of choice for their control and monitoring. The radiologist should be familiar with the surgical techniques used (Wheat, Bentall de Bono, and Cabrol, among others), as well as with the structural repairs that are performed and the prosthetic materials used in order to avoid an erroneous interpretation of the images. Spontaneously hyperdense felt, the prosthetic ducts and their anastomosis, both with the aorta and the large vessels, can generate pitfalls in the final report and error in the diagnosis.
RESUMO
RESUMEN El pseudoaneurisma de aorta ascendente, como complicación en cirugía cardíaca, tiene una incidencia menor del 0,5%, pero una mortalidad que varía del 6,7 al 60%. La manipulación aórtica y la infección son los principales factores predisponentes. Su clínica puede ser variada y constituir un hallazgo casual en controles posteriores. Se presenta el caso de una paciente operada de cirugía valvular mitral que a los 11 meses del postoperatorio se le diagnostica un pseudoaneurisma de aorta ascendente, que requirió tratamiento quirúrgico de emergencia. La cirugía fue llevada a cabo con la utilización de canulación periférica extramediastínica, sin requerir parada circulatoria, ni hipotermia para su correcta disección. El caso muestra una variante técnica para enfrentar una enfermedad poco frecuente, pero altamente desafiante, por la necesidad de reintervención y una correcta estrategia quirúrgica.
ABSTRACT False ascending aortic aneurysm, as a complication in cardiac surgery, has an incidence of less than 0.5%, but a mortality that ranges from 6.7% to 60%. Aortic manipulation and infection are the main predisposing factors. Its clinical presentation is non-specific and may be found incidentally on subsequent check-ups. The case of a patient undergoing mitral valve surgery who was diagnosed with ascending aortic false aneurysm, eleven months after postoperative period, requiring emergency surgical treatment is presented. The surgery was performed using extra-mediastinal peripheral cannulation, without induced circulatory arrest or hypothermia for proper dissection. The case shows a technical version to face an uncommon but highly challenging disease as it needs re-interventions and successful surgical strategies.
Assuntos
Falso Aneurisma , Aorta , Complicações Pós-Operatórias , Cirurgia Torácica , Hipotermia InduzidaRESUMO
RESUMEN Introducción: Los aneurismas de aorta ascendente son lesiones que deben tratarse quirúrgicamente debido a sus complicaciones potencialmente mortales, como la ruptura y la disección. Objetivos: Revisar los resultados a corto y mediano plazo del tratamiento quirúrgico en pacientes con aneurisma de aorta ascendente. Método: Se revisaron retrospectivamente las historias clínicas de 78 pacientes que recibieron tratamiento quirúrgico debido a un aneurisma de aorta ascendente, entre agosto de 2006 y julio de 2018, en el hospital Erzurum Regional Training and Research Hospital. Resultados: La edad promedio de los pacientes fue de 51,7 ± 9,8 (rango 24-77 años). Hubo 54 (69,2%) hombres y 24 (30,8%) mujeres. Cincuenta y ocho pacientes (74,3%) tenían síndrome de Marfan. También se encontraron enfermedad coronaria (15,4%), estenosis mitral (3,8%), insuficiencia (11,5%), estenosis (8,9%) y coartación aórticas (2,6%). Se realizó tratamiento quirúrgico de emergencia en 41 pacientes (52,5%). Se reemplazó la aorta ascendente en 55 pacientes (70,5%). Se empleó la técnica de Bentall (17,9%) y sustitución valvular aórtica más reemplazo de aorta ascendente con injerto (11,5%). En 14 pacientes se utilizó paro anóxico (parada circulatoria total). La mortalidad operatoria fue de 3,8% (3 pacientes) con la técnica de Bentall y la mortalidad postoperatoria temprana fue de 1,3% (1 paciente con coartación aórtica). Conclusiones: Los pacientes con aneurisma de aorta ascendente deben tener un estrecho seguimiento para definir su momento quirúrgico, debido al riesgo de disección y rotura. Aunque se pueden aplicar varias técnicas quirúrgicas de acuerdo con el estado de la válvula aórtica, especialmente en pacientes con síndrome de Marfan, el procedimiento quirúrgico preferido debería ser el reemplazo de la raíz aórtica con injerto compuesto, con el uso de la técnica de Bentall modificada, con reimplantación de los ostium de las arterias coronarias en el injerto.
ABSTRACT Introduction: Ascending aortic aneurysms are lesions that should be surgically handled because of their life-threatening complications like rupture and dissection. Objectives: To examine the early and midterm outcomes of surgical treatment in patients with ascending aortic aneurysm. Method: We retrospectively examined the records of 78 patients who underwent surgical treatment due to ascending aortic aneurysm between August 2006 and July 2018 at Erzurum Regional Training and Research Hospital. Results: The patients' average age was 51.7 ± 9.8 (ranged 24-77 years). There were 54 (69.2%) men and 24 (30.8%) women. Fifty-eight (74.3%) patients had Marfan's Syndrome. They also presented coronary artery disease (15.4%), mitral stenosis (3.8%), aortic regurgitation (11.5%), aortic stenosis (8.9%), and aortic coarctation (2.6%). The emergency surgical treatment was required in 41 (52.5 %) patients. Only 55 (70.5 %) patients had performed ascending aortic replacement. Bentall procedure (17.9%) and aortic valve replacement + ascending aortic graft replacement (11.5%) were performed. In 14 patients totally circulatory arrest was used. The operative mortality occurred in 3 (3.8%) patients with Bentall procedure and the early postoperative mortality occurred in 1 (1.3%) patient with aortic coarctation. Conclusions: Patients with ascending aortic aneurysms should be closely monitored for the timing of surgery due to the risk of dissection and rupture. Although various surgical techniques can be applied according to the aortic valve status, especially in patients with Marfan's Syndrome, root replacement with composite graft, and Bentall modifications and button anastomosis of coronary arteries in composite graft applications should be the preferred surgical procedure.
Assuntos
Aorta , Aneurisma Aórtico , Cirurgia Geral , Síndrome de MarfanRESUMO
This paper describes a case of congenital aortic stenosis with eccentric left ventricular hypertrophy associated with hypothyroidism in a 1-year-old Bourdeaux Mastiff dog. The dog had ascites, apathy, alopecic and erythematous skin lesions in different parts of the body. A two-dimensional echocardiogram revealed aortic valve stenosis, with poststenotic dilation in the ascending aorta. The same exam showed eccentric hypertrophy and dilation of the left ventricle during systole and diastole. Aortic stenosis usually results in concentric left ventricular hypertrophy instead of eccentric hypertrophy; and therefore, this finding was very unusual. Hypothyroidism, which is uncommon in young dogs, may be incriminated as the cause of ventricular dilation, making this report even more interesting. Because hypothyroidism would only result in dilatation, the eccentric hypertrophy was attributed to pressure overload caused by aortic stenosis. Thus, cardiac alterations of this case represent a paradoxical association of both diseases.(AU)
Este trabalho descreve um caso de estenose aórtica congênita com hipertrofia excêntrica do ventrículo esquerdo associado ao hipotireoidismo em um cão Dogue de Bordeaux. O cão, de um ano de idade, apresentava ascite, apatia, lesões cutâneas alopécicas e eritematosas generalizadas. Na ecocardiografia bidimensional foi observada estenose da valva aórtica, com dilatação pós-estenótica em aorta ascendente. Foi detectado, no mesmo exame, hipertrofia excêntrica e dilatação do ventrículo esquerdo em sístole e diástole. Usualmente, como consequência, a estenose aórtica causa hipertrofia concêntrica do ventrículo esquerdo e não hipertrofia excêntrica, sendo este achado infrequente em tal cardiopatia. O hipotireoidismo, incomum em cães jovens, pode representar a causa da dilatação ventricular observada, o que torna mais relevante esse relato. Como no hipotireoidismo é esperado apenas dilatação, a hipertrofia excêntrica supostamente é atribuída à sobrecarga de pressão causada pela estenose aórtica. Dessa forma, as alterações cardíacas deste caso representam uma associação paradoxal das duas afecções.(AU)
Assuntos
Animais , Cães , Estenose da Valva Aórtica/veterinária , Ventrículos do Coração/anormalidades , Hipotireoidismo/complicações , Hipotireoidismo/veterinária , Aorta Torácica , Dilatação , Ecocardiografia/veterináriaRESUMO
This paper describes a case of congenital aortic stenosis with eccentric left ventricular hypertrophy associated with hypothyroidism in a 1-year-old Bourdeaux Mastiff dog. The dog had ascites, apathy, alopecic and erythematous skin lesions in different parts of the body. A two-dimensional echocardiogram revealed aortic valve stenosis, with poststenotic dilation in the ascending aorta. The same exam showed eccentric hypertrophy and dilation of the left ventricle during systole and diastole. Aortic stenosis usually results in concentric left ventricular hypertrophy instead of eccentric hypertrophy; and therefore, this finding was very unusual. Hypothyroidism, which is uncommon in young dogs, may be incriminated as the cause of ventricular dilation, making this report even more interesting. Because hypothyroidism would only result in dilatation, the eccentric hypertrophy was attributed to pressure overload caused by aortic stenosis. Thus, cardiac alterations of this case represent a paradoxical association of both diseases.
Este trabalho descreve um caso de estenose aórtica congênita com hipertrofia excêntrica do ventrículo esquerdo associado ao hipotireoidismo em um cão Dogue de Bordeaux. O cão, de um ano de idade, apresentava ascite, apatia, lesões cutâneas alopécicas e eritematosas generalizadas. Na ecocardiografia bidimensional foi observada estenose da valva aórtica, com dilatação pós-estenótica em aorta ascendente. Foi detectado, no mesmo exame, hipertrofia excêntrica e dilatação do ventrículo esquerdo em sístole e diástole. Usualmente, como consequência, a estenose aórtica causa hipertrofia concêntrica do ventrículo esquerdo e não hipertrofia excêntrica, sendo este achado infrequente em tal cardiopatia. O hipotireoidismo, incomum em cães jovens, pode representar a causa da dilatação ventricular observada, o que torna mais relevante esse relato. Como no hipotireoidismo é esperado apenas dilatação, a hipertrofia excêntrica supostamente é atribuída à sobrecarga de pressão causada pela estenose aórtica. Dessa forma, as alterações cardíacas deste caso representam uma associação paradoxal das duas afecções.
Assuntos
Animais , Cães , Aorta Torácica , Dilatação , Estenose da Valva Aórtica/veterinária , Hipotireoidismo/complicações , Hipotireoidismo/veterinária , Ventrículos do Coração/anormalidades , Ecocardiografia/veterináriaRESUMO
ABSTRACT: This paper describes a case of congenital aortic stenosis with eccentric left ventricular hypertrophy associated with hypothyroidism in a 1-year-old Bourdeaux Mastiff dog. The dog had ascites, apathy, alopecic and erythematous skin lesions in different parts of the body. A two-dimensional echocardiogram revealed aortic valve stenosis, with poststenotic dilation in the ascending aorta. The same exam showed eccentric hypertrophy and dilation of the left ventricle during systole and diastole. Aortic stenosis usually results in concentric left ventricular hypertrophy instead of eccentric hypertrophy; and therefore, this finding was very unusual. Hypothyroidism, which is uncommon in young dogs, may be incriminated as the cause of ventricular dilation, making this report even more interesting. Because hypothyroidism would only result in dilatation, the eccentric hypertrophy was attributed to pressure overload caused by aortic stenosis. Thus, cardiac alterations of this case represent a paradoxical association of both diseases.
RESUMO: Este trabalho descreve um caso de estenose aórtica congênita com hipertrofia excêntrica do ventrículo esquerdo associado ao hipotireoidismo em um cão Dogue de Bordeaux. O cão, de um ano de idade, apresentava ascite, apatia, lesões cutâneas alopécicas e eritematosas generalizadas. Na ecocardiografia bidimensional foi observada estenose da valva aórtica, com dilatação pós-estenótica em aorta ascendente. Foi detectado, no mesmo exame, hipertrofia excêntrica e dilatação do ventrículo esquerdo em sístole e diástole. Usualmente, como consequência, a estenose aórtica causa hipertrofia concêntrica do ventrículo esquerdo e não hipertrofia excêntrica, sendo este achado infrequente em tal cardiopatia. O hipotireoidismo, incomum em cães jovens, pode representar a causa da dilatação ventricular observada, o que torna mais relevante esse relato. Como no hipotireoidismo é esperado apenas dilatação, a hipertrofia excêntrica supostamente é atribuída à sobrecarga de pressão causada pela estenose aórtica. Dessa forma, as alterações cardíacas deste caso representam uma associação paradoxal das duas afecções.
RESUMO
This study aims at establishing whether transverse diameter (TD) and cross sectional-area (CSA) of the ascending aorta (AA), descending aorta (DA) and pulmonary trunk (PT) measured by computerized tomographic angiography (CTA) altered by sex, age, hypertension, smoking and diabetes. CTA examinations of the TD and CSA of the AA, DA and PT of 100 patients aged 49.5±16.9 years (range 1678 years) selected between January 2009 to May 2011 from those referred to Radiology Department, Jordan University Hospital, Faculty of Medicine, University of Jordan, Amman, Jordan for advanced evaluation. Measurements were made in the axial plane at the upper border of the six thoracic vertebrae. Patients were divided into three age groups. Significance of differences in parameters between age groups was calculated. Assessment ratios were considered. It was found that parameters of the three arteries were significantly larger in men than in women (P= < 0.05) and increased with age. Hypertension increased diameters of AA and DA in both genders (P= 0.001) and of PT in men (P= 0.01). Smoking significantly decreased parameters of PT in men (P= 0.01). Diabetes increased parameters of the three arteries in both genders, significantly increased parameters of PT in men (P= <0.05) and parameters of DA in women (P= <0.05). It is concluded that studied parameters were larger in men and increased with age of our patients. Distinctive differences in measurements appeared in hypertensive, smokers, and diabetic patients.
El objetivo fue determinar si el sexo, edad, hipertensión, tabaquismo y la diabetes alteran el diámetro transversal (DT) y área transversal (AT) de la parte ascendente de la aorta (AA), parte descendente de la aorta (AD) y tronco pulmonar (TP), medidos por angiografía por tomografía computadorizada (ATC). Exámenes de ATC de 100 pacientes de 49,5±16,9 años (rango 1678 años) fueron seleccionados entre enero del año 2009 a mayo del año 2011 por el Departamento de Radiología, Hospital de la Universidad de Jordania, Facultad de Medicina de la Universidad de Jordania, Amman, Jordania para una evaluación avanzada del DT y AT de la AA, AD y TP. Las mediciones se realizaron en el plano axial en el margen superior de las seis vértebras torácicas. Los pacientes fueron divididos en tres grupos según edad. Se determinó la existencia de significancia estadística de los diferentes parámetros entre los grupos etarios. La evaluación de las razones también fueron consideradas. Se encontró que los parámetros de las tres arterias fueron significativamente mayores en los hombres que en las mujeres (p= <0,05) y que aumentaron con la edad. La hipertensión aumentó los diámetros de la AA y AD en ambos sexos (p= 0,001) y del TP en los hombres (p= 0,01). En fumadores disminuyeron significativamente los parámetros del TP en los hombres (p= 0,01). La diabetes aumentó los parámetros de las tres arterias en ambos sexos. Ademas, aumentaron significativamente los parámetros del TP en los hombres (p= <0,05) y los parámetros de la AD en las mujeres (p = <0,05). Se concluye que los parámetros estudiados eran mayores en los hombres y aumentaron con la edad de nuestros pacientes. Diferencias distintivas en las mediciones aparecieron en hipertensos, fumadores y pacientes diabéticos.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Aorta/diagnóstico por imagem , Aorta/patologia , Artéria Pulmonar/patologia , Fatores Etários , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Angiografia por Tomografia Computadorizada , Diabetes Mellitus/patologia , Hipertensão/patologia , Artéria Pulmonar/diagnóstico por imagem , Fatores Sexuais , Tabagismo/patologiaRESUMO
Las enfermedades quirúrgicas de aorta ascendente constituyen afecciones cardiovasculares de interés creciente por su elevada tasa de morbimortalidad. Se realizó un estudio observacional longitudinal prospectivo en 22 pacientes con enfermedades de la aorta ascendente que recibieron tratamiento quirúrgico en el servicio de cirugía cardiovascular del Hospital Hermanos Ameijeiras, en el período comprendido entre octubre del 2006 y octubre del 2009. Se obtuvo como resultado que los grupos etéreos más afectados fueron entre 40 - 49 y 50 - 59 años con una media de edad de 48.83 ± 12 (intervalo, 25 - 67) años. Prevaleció el sexo masculino con una relación 4,5:1, respecto a las féminas. El dolor torácico fue el síntoma de presentación más usual referido por el 72.7% de los casos. La disección fue la entidad quirúrgica más frecuente con 14 pacientes, mientras que la HTA fue el factor de riesgo de mayor incidencia en el 45.5% de los casos. La cirugía de urgencia fue necesaria en el 81.8% de los pacientes. La técnica quirúrgica de mayor empleo fue la de Bentall De Bono (modificación de botón) realizada en el 54.5% de los operados. Las complicaciones cardiovasculares fueron las más frecuentes observadas en el 45.5% de los casos. La mortalidad hospitalaria fue de 22.7%. La mortalidad quirúrgica fue de 4,5% y la hospitalaria de 18,2% para un total de 22,7%; siendo la mortalidad esperada de nuestro pacientes de 30,3%. Las conclusiones evidenciaron que el dolor toráxico y la HTA se asociaron al síndrome aórtico agudo en un 92.9% y 71.4% respectivamente; mientras la cirugía cardíaca previa con manipulación de la aorta se vinculó a los pseudoaneurismas aórticos. Asimismo, la ocurrencia de complicaciones, principalmente las cardiovasculares y la mortalidad, estuvieron en correspondencia con el deterioro hemodinámico pre-quirúrgico de los pacientes.
As doenças cirúrgicas da aorta ascendente constituem afecções cardiovasculares de interesse crescente por sua elevada taxa de morbimortalidade. Realizou-se um estudo de observação longitudinal prospectivo em 22 pacientes com doenças da aorta ascendente que receberam tratamento cirúrgico no serviço de cirurgia cardiovascular do Hospital Hermanos Ameijeiras, no período compreendido entre outubro de 2006 e outubro de 2009. O resultado demonstrou que a faixa etárea mais afetada foi a de 40 - 49 e a de 50 -59 anos, com uma média de idade de 48.83 ± 12 (intervalo, 25 - 67) anos. Prevaleceu o sexo masculino com uma relação de 4,5:1, com relação ao feminino. A dor torácica foi o sintoma de apresentação mais usual, referido por 72.7% dos casos. A dissecção foi a entidade cirúrgica mais frequente, com 14 pacientes, enquanto que a HTA foi o fator de risco de maior incidència, 45.5% dos casos. A cirurgia de urgência foi necessária em 81.8% dos pacientes. A técnica cirúrgica de maior utilização foi a de Bentall & De Bono (modificação do botão) realizada em 54.5% dos operados. As complicações cardiovasculares foram as mais frequentes, observadas em 45.5% dos casos. A mortalidade hospitalar foi de 22.7%. A mortalidade cirúrgica foi de 4,5% e a hospitalar de 18,2% para um total de 22,7%, sendo a mortalidade esperada de nossos pacientes de 30,3%. As conclusões evidenciaram que a dor torácica e a HTA estão associadas à síndrome aórtica aguda em 92.9% e 71.4% dos casos respectivamente, enquanto a cirurgia cardiaca prévia com manipulação da aorta esteve vinculada aos pseudoaneurismas aórticos. De igual maneira, a ocorrência de complicações, principalmente as cardiovasculares e a mortalidade estiveram em correspondência com o deterioro hemodinâmico pré cirúrgico dos pacientes.
The surgical diseases of the ascending aorta are cardiovascular conditions of growing interest because of their high rate of mortality. A prospective observational study in 22 patients with diseases in the ascending aorta that have received surgical treatment in the Cardiovascular Service of the Hospital Hermanos Ameijeiras, from October, 2006 up to october, 2009. It was obtained as result that the most affected ethereal groups were between 40-49 and 50-59 years old with a mean average of 48.83 + 12 ( interval, 25 67 ) years. The male sex has prevailed with a relation 4, 5:1 with regard to the female ones. The thoracic pain was the most common symthom of presentation, referred to the 72.7% of the cases. The sisection was the most frequent surgical entity, with 14 patients, while the HTA was the risk factor with higher incidence in the 45.5% of the cases. The emergency surgery was necessary en the 81.1% of the patients. The surgical technique that was most permormed, was Bentals De Bono ( buttom change) which was carried out in the 54.5% of the operated patients. The cardiovascular complications were the most frequent and they were observed in the 45.5% of the cases. The hospitalary mortality was of about 22.7%. The surgical mortality was of 4.5% and the hospital ones of 18.2% for a total of 22.7%, being the expected mortality of our patients of 30.3%. The conclusions have shown that the thoracic pain and the HTA were associated to the severe aortic syndrome in a 92.9% and 71.4%, respectively, while the previous cardiac surgery with manipulation of the aorta was linked to the aortic pseudoaneurysms. Therefore, the occurrence of the complications, mainly the cardiovascular ones and the mortality were according to the pre surgical hemodynamic deterioration of the patients.
Assuntos
Humanos , Pessoa de Meia-Idade , Aorta/cirurgia , Aorta/patologia , Doenças da Aorta/cirurgia , Falso Aneurisma/diagnóstico , Aneurisma Aórtico/cirurgia , Complicações Pós-Operatórias , Estudos Observacionais como AssuntoRESUMO
Introducción: La enfermedad aneurismática de la aorta ascendente (EAAA) se caracteriza por su baja frecuencia, comportamiento heterogéneo, riesgo de rotura y disección, que conllevan elevada mortalidad, por lo que la cirugía electiva es fundamental. Se han desarrollado diversos procedimientos quirúrgicos, considerándose la técnica de Bentall el estándar de referencia. Se describe la mortalidad hospitalaria de la EAAA tratada quirúrgicamente mediante el procedimiento de Bentall. Material y métodos: Estudio descriptivo en el que se incluyeron 23 pacientes con EAAA operados entre el 1 de marzo de 2005 y el 30 de septiembre de 2008; la información fue obtenida de los expedientes clínicos. Resultados: Los 23 pacientes correspondieron a 1.2 % de las cirugías efectuadas. Edad media de 46 años (rango 16 a 74), sexo masculino 83 %. Etiología: degeneración inespecífica de la capa media con implicación valvular 43 %, aorta bivalva 22 %, síndrome de Marfán, de Turner y aneurismas posestenóticos, 9 % cada uno. Enfermedad de Takayasu y espondilitis anquilosante, 4 % cada uno. Enfermedad cardiaca asociada en seis (26 %): coartación aórtica (2), cardiopatía isquémica (1), comunicación interauricular (1), insuficiencia mitral severa (1) y rodete subaórtico (1). Procedimientos realizados: cirugía de Bentall 20 (87 %), aortoplastia con prótesis valvular tres (13 %). Complicaciones: sangrado anormal con reintervención 17 %, neumonía nosocomial 13 %, arritmias 13 %, choque séptico 9 %. Mortalidad tres (13 %): choque séptico y fibrilación ventricular. Conclusiones: La mortalidad hospitalaria para la cirugía de Bentall fue semejante a la registrada en otros centros especializados. Los eventos relacionados con la patología aórtica, técnica quirúrgica, prótesis valvular aórtica y la disfunción ventricular izquierda, obligan a realizar estudios de seguimiento a largo plazo.
BACKGROUND: Ascending aortic aneurysm disease (AAAD) shows a low frequency, heterogeneous behavior, high risk of rupture, dissection and mortality, making elective surgery necessary. Several procedures have been developed, and the Bentall technique is considered as the reference standard. The objective was to describe the hospital mortality of AAAD surgically treated using the Bentall procedure. METHODS: We carried out a descriptive study. Included were 23 patients with AAAD who were operated on between March 1, 2005 and September 30, 2008 at our hospital. Data were obtained from clinical files, and descriptive statistics were selected for analysis. RESULTS: The study population was comprised of 23 patients with an average age of 46 years; 83% were males. Etiology was nonspecific degeneration of the middle layer with valve implication in 43%, bivalve aorta in 22%, Marfan syndrome, Turner's syndrome and poststenotic aneurysms each represented 9%, and Takayasu disease and ankylosing spondylitis 4% each. Associated heart disease was reported in six (26%) patients as follows: aortic coarctation (2), ischemic cardiopathy (1), atrial septal defect (1), severe mitral insufficiency (1) and subaortic membrane (1). Procedures carried out were Bentall surgery in 20 (87%) patients and aortoplasty with valve prosthesis in three (13%) patients. Complications reported were abnormal bleeding with mediastinal exploration (17%), nosocomial pneumonia (13%), arrhythmia (13%), and septic shock (9%). Mortality was reported in three (13%) patients due to septic shock and ventricular fibrillation. CONCLUSIONS: Surgical mortality with the Bentall procedure is similar to published results by other specialized centers. Events related to the basic aortic pathology, surgical technique, aortic valve prosthesis and left ventricular dysfunction encourage longterm studies with follow-up.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/mortalidade , Dissecção Aórtica/etiologia , Dissecção Aórtica/mortalidade , Dissecção Aórtica/cirurgia , Arritmias Cardíacas/etiologia , Cardiopatias/complicações , Choque Séptico/etiologia , Choque Séptico/mortalidade , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Eletivos , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/mortalidade , Mortalidade Hospitalar , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Implante de Prótese de Valva Cardíaca , Infecção Hospitalar/etiologia , Pneumonia/etiologia , Síndrome de Marfan/complicaçõesRESUMO
Objetivo: Presentar nuestra experiencia en el diagnóstico ecocardiográfico del origen anómalo de una rama de la arteria pulmonar naciendo de la aorta ascendente (OAAP) y analizar su presentación clínica, tratamiento y evolución con especial énfasis en los aspectos ecocardiográficos. Método: Revisamos retrospectivamente los expedientes clínicos, estudios de gabinete y hallazgos transoperatorios de los pacientes con diagnóstico ecocardiográfico de OAAP estudiados en el Hospital Infantil de México "Federico Gómez" de 1991 al 2002. Resultados: El estudio incluye 12 niños con OAAP. Siete fueron hombres. La edad media de presentación fue de 2 meses. Cuatro pacientes se diagnosticaron en la etapa neonatal, 3 en el primer año y 5 después del año. El diagnóstico se estableció prospectivamente por ecocardiografía en todos y se confirmó al cateterismo en 8 y a la cirugía en 9. El origen aórtico de la rama derecha se encontró en 10 casos y de la izquierda en 2. Las anomalías asociadas fueron PCA en 6, CIV en 2 y ventana aortopulmonar, discordancia atrioventricular, doble vía de salida ventricular derecha y tetralogía de Fallot en 1 caso respectivamente. Se operaron 9 casos. Un paciente falleció en el 6o día postoperatorio. Los restantes se encuentran en buenas condiciones sin estenosis en el sitio de la anastomosis. La cirugía no fue aceptada en un caso. Un paciente no fue candidato a cirugía por enfermedad vascular pulmonar (EVP) avanzada y otro está en espera de cirugía. Conclusiones: El diagnóstico del OAAP puede establecerse con exactitud mediante ecocardiografía. El cateterismo cardiaco rara vez es necesario para confirmar la morfología, pero es obligado en niños mayores con sospecha de EVP.
Objective: To present our experience in the echocardiographic diagnosis of anomalous origin of one pulmonary artery from the ascending aorta (AOPA). To analyze its clinical presentation, treatment and outcomes with special emphasis in the echocardiographic data. Method: We reviewed restrospectively the clinical, hemodynamic data, and surgical findings of patients with an echocardiographic diagnosis of AOPA studied in the Hospital Infantil of Mexico "Federico Gomez" from 1991 to 2002. Results: The study includes 12 children with AOPA; Seven were males. The average age at diagnosis was two months; 4 in neonatal period, 3 under 1 year and 5 older than 1 year. The diagnosis was established prospectively by echocardiography in all patients and it was confirmed by angiography in 8 and at surgery in 9. Ten had anomalous origin of rigth pulmonary artery. The associated anomalies were patent ductus arteriosus in 6, ventricular septal defect in 2 and aortopulmonary window, atrioventricular discordance, double outlet right ventricle and tetralogy of Fallot in one case each. Nine underwent corrective surgery of all the anomalies. One patient died on the sixth postoperative day; the remaining are in good condition without stenosis at the site of the anastomosis. Surgery was refused in one. One patient was not candidate to surgery due to advanced obstructive pulmonary vascular disease (OPVD) and one case is awaiting surgery. Conclusion: The diagnosis of AOPA may be established with precision through echocardiography. Cardiac catheterization is seldom needed to confirm morphology but is mandatory in older children with suspected of OPVD. (Arch Cardiol Mex 2003; 73:115-123).
Assuntos
Adolescente , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Aorta/anormalidades , Cardiopatias Congênitas , Artéria Pulmonar/anormalidades , Aortografia , Aorta/cirurgia , Aorta , Cateterismo Cardíaco , Ecocardiografia Doppler , Cardiopatias Congênitas , Cardiopatias Congênitas/cirurgia , Artéria Pulmonar , Artéria Pulmonar , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
PURPOSE: To report our experience and results with the surgical treatment of aortic aneurysms and dissections of the ascending aorta as well as the techniques that have been used. METHODS: Between May 1982-May 1995, 54 patients were operated on and divided in two groups: group A was composed of 25 patients with aneurysms or chronic dissections of the ascending aorta. The Bentall and DeBonno procedure was performed in 18, five were submitted to prosthetic aortic graft associated with aortic valve replacement and two prosthetic aortic graft without aortic valve replacement. Group B had 29 patients with acute dissections of the ascending aorta (type A) who were submitted to 10 prosthetic graft alone, nine Bentall procedures, five prosthetic graft with aortic valve replacement, four aortic repair and one direct suture of the dissection. The survival curve was obtained by the Kaplan-Meier method. RESULTS: Total hospital mortality rate was 13 and the late was 18.5. Group A-immediate mortality rate was 8 (two patients): Low cardiac output and stroke; late mortality rate was five (20): sudden death in three, pulmonary embolism one and infectious endocardite one. Group B-hospital mortality rate was five (17.2) patients: low cardiac output three, multiple organs failure one and stroke with pneumonia one; late mortality rate was five (17.2), distal redissection in three, sudden death in two. The average survival time was 86 +/- 12 for group A and 75 +/- 13 months for group B. CONCLUSION: The surgery of the aneurysm and dissections of the ascending aorta has shown immediate favorable results and a thorough follow-up to get better late results is needed.