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1.
Acta Chir Belg ; 121(2): 144-151, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33146588

RESUMO

Leiomyosarcoma is a rare malign neoplasm, representing about 5-7% of all tissue sarcomas while inferior vena cava leiomyosarcomas accounts for only 1%. This paper presents the case of a 74 years old patient that was diagnosed with an abdominal venous leiomyosarcoma involving the inter-renal segment of the inferior vena cava. Tumor was treated by complete in bloc resection. Reconstruction of the vascular axis was performed with an autologous venous tube graft achieved with segments of the right superficial femoral vein. Recurrent free survival and freedom from local or systemic recurrence was observed at 2 years after the intervention thanks to the aggressive radical surgical management.


Assuntos
Leiomiossarcoma , Neoplasias Vasculares , Idoso , Veia Femoral/cirurgia , Humanos , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Recidiva Local de Neoplasia , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
5.
Interact Cardiovasc Thorac Surg ; 12(4): 605-8, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21252209

RESUMO

OBJECTIVES: Ascending aorta false aneurysms after cardiac surgery are uncommon. Resternotomy is hazardous and may result in massive and uncontrollable hemorrhage if the false aneurysm is entered. Here we report our experience with the use of deep hypothermia and circulatory arrest to avoid this risk. METHODS: From March 2000 to December 2007, seven patients (mean age 50 years) were reoperated for an ascending aorta false aneurysm. Three patients had undergone an aortic valve replacement (n=2) or an aortic valve repair (n=1). Three had undergone an ascending aorta replacement with a valved conduit (n=2) or an aortic valve repair (n=1) for type A dissection. One had undergone a coronary artery bypass grafting. Mean delay to reoperation was 133 months (range 22-324 months). Two patients had positive blood cultures (Staphylococcus species). Cardiopulmonary bypass was established by extramediastinal access. Patients were cooled to 18 °C. RESULTS: Resternotomy was performed uneventfully under total circulatory arrest in all patients. Four patients underwent an ascending aorta replacement with a valved conduit (n=2) or a dacron conduit (n=2) associated with a mitral valve replacement in one patient. Direct suture was performed in two patients and in one patient the aorta was repaired using a saphenous vein patch. There was one hospital death. Mean follow-up was 53 months (range 14-90 months). CONCLUSION: Resternotomy under circulatory arrest and deep hypothermia is a safe technique well-adapted to patients with an ascending aorta false aneurysm.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Aneurisma Aórtico/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Parada Circulatória Induzida por Hipotermia Profunda , Esternotomia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/mortalidade , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/etiologia , Aneurisma Infectado/mortalidade , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/mortalidade , Aortografia/métodos , Bélgica , Procedimentos Cirúrgicos Cardíacos/mortalidade , Parada Circulatória Induzida por Hipotermia Profunda/efeitos adversos , Parada Circulatória Induzida por Hipotermia Profunda/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
6.
Ann Thorac Surg ; 87(2): 440-6, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19161756

RESUMO

BACKGROUND: The benefit of the Cox Maze procedure combined with heart surgery was evaluated at long-term follow-up. METHODS: The outcome for 37 patients who underwent a Cox Maze III procedure combined with heart surgery (Maze group) was compared with that of 66 patients who had heart surgery alone (control group). All patients were in persistent atrial fibrillation preoperatively. The two groups had similar preoperative characteristics and were operated upon during the same era (1996 to 2004). RESULTS: Five-year survival, including hospital deaths, was 89% +/- 5% in the Maze group and 60% +/- 7% in the control group (log rank p = 0.008). Causes of death were predominantly related to heart failure (1 of 37 in the Maze group and 12 of 66 in the control group; p = 0.02) and to sudden death (0 of 37 in the Maze group and 9 of 66 in the control group; p = 0.02). After correction for preoperative variables, Cox regression analysis showed that the Maze procedure improved survival independently (p = 0.019). In a subgroup of patients with left atrial diameter of more than 60 mm preoperatively, the 5-year survival estimate was 92% +/- 6% in the Maze group versus 59% +/- 9% in the control group (log rank p = 0.012). The 5-year estimate of conversion to sinus rhythm was 91% +/- 7% in the Maze group and 33% +/- 7% in the control group (log rank p < 0.001). CONCLUSIONS: The restoration of sinus rhythm by a Maze procedure combined with heart surgery markedly improved long-term survival in this series.


Assuntos
Fibrilação Atrial/mortalidade , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ablação por Cateter/mortalidade , Mortalidade Hospitalar/tendências , Idoso , Análise de Variância , Fibrilação Atrial/diagnóstico , Procedimentos Cirúrgicos Cardíacos/métodos , Estudos de Casos e Controles , Ablação por Cateter/métodos , Causas de Morte , Terapia Combinada , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Probabilidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento
7.
Ann Thorac Surg ; 87(1): 95-102, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19101277

RESUMO

BACKGROUND: Dilatation of the pulmonary autograft is a major concern after root replacement for the Ross operation. The inclusion technique would avoid this drawback, but few data are available on the long-term results of this technique. We retrospectively analyze long-term results of both techniques. METHODS: Of 218 patients undergoing the Ross operation between 1991 and 2006, 148 (68%) had root replacement and 70 (32%) underwent the inclusion technique. The mean age of the patients was 40 +/- 10 years (range, 16 to 64). Mean follow-up was 94 +/- 44 months (range, 13 to 196). Echocardiographic controls were available in 197 patients. Proximal aorta dilatation was defined as diameter > 40 mm. RESULTS: In the root and inclusion groups, 10-year overall survival was 94% +/- 4% and 97% +/- 4%, respectively. Freedom from autograft reoperation was 81% +/- 10% and 84% +/- 13%, respectively. Main cause of reoperation was autograft dilatation in the root group (13 of 16) and valve prolapse in the inclusion group (5 of 6). Freedom from proximal aorta dilatation was 57% +/- 12% and 80% +/- 15%, respectively. In the root group, dilatations (n = 48) affected systematically the autograft sinuses or sinotubular junction, whereas in the inclusion group, dilatations (n = 10) affected principally the ascending aorta (8 of 10). Freedom from severe autograft regurgitation was 86% +/- 9% and 83% +/- 13%, respectively. Root technique, follow-up length, and preoperative aortic valve regurgitation were predictors of proximal aorta dilatation. CONCLUSIONS: In the long term, both techniques showed excellent survival and similar rates of autograft failure. For root replacement, autograft dilatation was the main cause of failure. For the inclusion technique, the autograft, but not the ascending aorta, was protected against dilatation and autograft valve prolapse was the main cause of failure.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Valva Pulmonar/transplante , Adolescente , Adulto , Análise de Variância , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/mortalidade , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estudos de Coortes , Intervalos de Confiança , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/cirurgia , Ecocardiografia Doppler , Feminino , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Reoperação , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Análise de Sobrevida , Transplante Autólogo/efeitos adversos , Resultado do Tratamento , Adulto Jovem
8.
Ann Thorac Surg ; 83(6): 2244-5, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17532447

RESUMO

A simplified technique to treat patients in stand-alone atrial fibrillation with a right thoracoscopic approach is described. An electrical isolation of the four pulmonary veins (box lesion) is achieved with a microwave antenna.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Veias Pulmonares/cirurgia , Toracoscopia/métodos , Humanos , Micro-Ondas/uso terapêutico
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