RESUMEN
Retroperitoneal fibrosis is best described as a chronic inflammatory process which may be idiopathic, but can rarely be brought about by medications, such as pergolide, used for treating Parkinson's disease. Pergolide can produce a fibrotic process in heart valves, resulting in valve insufficiency in up to 25% of cases. Herein we describe the case of a 68-year-old man who received pergolide for 2 years for Parkinson's disease. The patient developed retroperitoneal fibrosis resulting in renal failure from ureteral obstruction necessitating ureteral stenting, as well as significant aortic and mitral valve insufficiency. He successfully underwent surgery for combined aortic valve, mitral valve and ascending aorta replacement because of severe valve insufficiency and dilated (d = 5.8 cm) ascending aorta. Retroperitoneal fibrosis improved with pergolide cessation and corticosteroid treatment. This is the second case reported in the literature, of a patient who had double valve and ascending aorta replacement surgery because he suffered from this rare but serious adverse effect of dopamine agonists used for managing Parkinson's disease.
Asunto(s)
Insuficiencia de la Válvula Aórtica , Agonistas de Dopamina/efectos adversos , Insuficiencia de la Válvula Mitral , Enfermedad de Parkinson/tratamiento farmacológico , Pergolida/efectos adversos , Fibrosis Retroperitoneal , Anciano , Insuficiencia de la Válvula Aórtica/inducido químicamente , Insuficiencia de la Válvula Aórtica/cirugía , Humanos , Masculino , Insuficiencia de la Válvula Mitral/inducido químicamente , Insuficiencia de la Válvula Mitral/cirugía , Fibrosis Retroperitoneal/inducido químicamente , Fibrosis Retroperitoneal/cirugía , Resultado del TratamientoRESUMEN
Aortoesophageal fistula is a rare emergency that presents a real challenge for cardiothoracic surgeons. There have been few reports of survivors. We present the case of a 70-year-old man with aortoesophageal fistula, mediastinal abscess, and severe septicemia consequent to esophageal erosion and rupture of a chronic degenerative descending thoracic aortic aneurysm. The patient underwent successful surgical treatment by aorto-aortic bypass and bipolar esophageal exclusion in conjunction with a cervical esophagostomy and a feeding gastrostomy. The pleural cavity was copiously irrigated and drained. Three months later, a retrosternal gastric bypass operation was performed successfully. The patient's 6-month follow-up examination revealed no problems.
