RESUMEN
Thoracic aortic aneurysm with fistulization into the trachea or the esophagus is usually a lethal complication. An unusual case of combined aortotracheal and aortoesophageal fistulae is presented here. The patient had a successful outcome after resection of the aneurysm with tracheal repair and esophageal resection. A review of literature on this subject is also included in this manuscript.
Asunto(s)
Aneurisma de la Aorta Torácica/complicaciones , Fístula Esofágica/cirugía , Esofagectomía/métodos , Toracotomía/métodos , Enfermedades de la Tráquea/cirugía , Fístula Vascular/cirugía , Anciano de 80 o más Años , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Aortografía , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Endoscopía Gastrointestinal , Fístula Esofágica/diagnóstico , Fístula Esofágica/etiología , Estudios de Seguimiento , Gastrostomía , Humanos , Masculino , Tereftalatos Polietilenos , Técnicas de Sutura , Enfermedades de la Tráquea/diagnóstico , Enfermedades de la Tráquea/etiología , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiologíaRESUMEN
The purpose of this paper is to describe the preoperative diagnosis and the surgical treatment of a symptomatic ductus arteriosus aneurysm in a 65-year-old adult. The diagnosis was made by CT scan of the chest and confirmed by aortic angiography. The aneurysm was stapled and resected uneventfully through a left posterolateral thoracotomy. Early diagnosis and treatment methods were reviewed in the literature; and simple operative interventions were recommended for the future.
RESUMEN
BACKGROUND: The peri-operative and long-term outcome of 211 consecutive patients at or above 75 years of age undergoing cardiac surgery between 1987-1990, was assessed. 79.6% of patients underwent CABG, 8.5% underwent both CABG and valvular surgery, 8.1% underwent only valvular surgery and 3.8% underwent other procedures. RESULTS: Survival curve analysis revealed no intra-operative deaths and a 30 day, 1,3, and 5 year overall survival rate of 93.3%, 89.2%, 77.8% and 64.6% respectively. 30.8% of patients had major peri-operative complications. Transient post-operative atrial fibrillation occurred in 47% of patients. There was a non-statistical trend towards increased risk of post-operative stroke in patients with transient post-operative atrial fibrillation. Early cardiothoracic re-operation was required in 8.5%. 91.9% of patients were followed up at a mean of 36.5Â+/-18.2 months post-operatively. 94.1% lived at home, 96.3% were ambulant, 96.3% were NYHA class I or II. Previously undetected malignancy was he cause of mortality in 10/45 (22%) patients who died after the thirtieth post-operative day, during the follow-up period. CONCLUSIONS: Chronologic age alone is not a contra-indication to cardiac surgery. Standard selection criteria with careful consideration of risk-benefit ratio, quality of life, presence of comorbid disease and health care costs should be factored in the decision process regarding cardiac surgery in the elderly. Particular attention should be paid to screening for malignancy and to management of transient post-operative atrial fibrillation.
