RESUMEN
The surgical repair of descending thoracic aortic (DTA) and thoracoabdominal aortic aneurysms (TAAAs) presents one of the greatest challenges for anaesthesiologists. The challenge comes from the fine balance of complex medical issues in the setting of altered physiology that occurs during the perioperative period. Patients presenting for TAAA repair usually have multiple pre-existing comorbid conditions involving their cardiac, pulmonary and renal systems; and aneurysm repair poses a direct and immediate threat to these systems in addition to that to the gastrointestinal and neurologic systems. Operative mortality in thoracoabdominal aortic surgery is quite high to the extent of 5%-12% with a 5-year survival rate of 70%-79% for DTA aneurysm and 59% for thoracoabdominal aortic aneurysm surgeries. Complex haemodynamic changes associated with the clamping and declamping of aorta requires thorough knowledge and expertise for the management of TAAA. We present a brief review on the anaesthetic management and possible complications that anaesthetists should be aware of during TAAA repair.
RESUMEN
Reported here is a case of 1-year-old male child who presented with huge abdominal mass, which on radiological investigation was diagnosed as retroperitoneal pseudoaneurysm of the aorta. On exploration, it was found to be a true aneurysm of infrarenal abdominal aorta with inflow agenesis. Aneurysm was excised, and aorta was reconstructed with 10 mm Dacron graft. Postoperative computed tomography angiography showed patent graft with good distal runoff. Literature review revealed that only 26 cases of congenital abdominal aortic aneurysm had been reported so far. None of them had inflow agenesis which can give false impression of pseudoaneurysm on preoperative evaluation. The case highlights the utility of additional complimentary investigations such as Doppler study in clinching diagnosis and helping plan and execute successful treatment in the difficult diagnostic scenario.
RESUMEN
OBJECTIVES: The purpose of this study was to examine the outcome after the Fontan operation in patients with congenitally corrected transposition of great arteries with ventricular septal defect and pulmonary stenosis (ccTGA-VSD-PS). METHODS: Patient- and procedure-related variables were analysed in 23 patients with ccTGA-VSD-PS operated between April 2003 and April 2015. RESULTS: The mean age was 14.07 ± 6.38 years (range 4-23, median 11 years), with 82% patients being male (19/23). Dextrocardia was present in 52% (12/23) of patients and left superior vena cava was present in 26% (6/23) of patients. Most patients underwent extracardiac Fontan (n = 18), whereas in 5 patients lateral tunnel Fontan was performed. All patients received polytetrafluoroethylene grafts of size 18-22 mm for extracardiac Fontan. In 8 patients, conduits were fenestrated to reduce the intraconduit pressure. The mean hospital stay was 15.7 ± 11.24 days (5-60, median 14 days). The most common cause for prolonged hospital stay was pleural effusion in 5 patients (21.7%). One 7-year old patient developed conduit thrombosis, intracranial bleed, seizures and died. The mean follow-up was 46.4.4 ± 32.2 months (range 8-142, median 42 months) and was available for 21 patients (91.3%). There was 1 mid-term non-cardiac death after 3 years of operation. Of the total, 85.7% (18/21) patients in follow-up are in NYHA class I, whereas 3 patients are in class II. The actuarial event-free survival rate was 81.8 ± 13.2% at 10 years. CONCLUSIONS: In ccTGA-VSD-PS patients with non-routable VSD and in those with difficult options for biventricular repair, the Fontan approach provides satisfactory mid-term palliation.
