RESUMEN
Small-diameter vascular substitutes remain necessary, especially in the absence of an available autologous vein. Using a completely autologous approach termed "in-body tissue architecture," a small-diameter, long, tissue-engineered vascular graft, a "Biotube," was developed. A below-the-knee distal bypass using the Biotube as a composite with expanded polytetrafluoroethylene grafts was performed to treat a patient with chronic limb-threatening ischemia without a venous graft available. The wound on the foot had completely healed 3 months after the bypass surgery, and limb salvage and walking without claudication were achieved. At the 1-year postoperative follow-up examination, duplex ultrasound scans demonstrated graft patency without thrombus or stenosis.
RESUMEN
Kommerell's diverticulum causes compression of the esophagus between the aberrant origin of the left subclavian artery and ascending aorta, leading to dysphagia or dyspnea. We describe 3 cases of successful surgical treatment of right aortic arch with Kommerell's diverticulum and aberrant origin of the left subclavian artery, using a right anterolateral partial sternotomy. This allows both resection of the Kommerell's diverticulum as well as reconstruction of the aberrant origin of the left subclavian artery anatomically.
Asunto(s)
Aneurisma/cirugía , Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Anomalías Cardiovasculares/cirugía , Trastornos de Deglución/cirugía , Divertículo/cirugía , Procedimientos de Cirugía Plástica , Arteria Subclavia/anomalías , Anciano , Aneurisma/diagnóstico , Aorta Torácica/anomalías , Aortografía/métodos , Anomalías Cardiovasculares/diagnóstico , Trastornos de Deglución/diagnóstico , Divertículo/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Esternotomía , Arteria Subclavia/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Aorto-esophageal fistula (AEF) is a rare complication of esophageal carcinoma. Left untreated, it may be lethal due to massive upper gastrointestinal bleeding, while open thoracic surgery is associated with high operative mortality and morbidity. In contrast, thoracic endovascular aortic repair (TEVAR) for AEF is less invasive than open thoracic surgery. Here, we report 3 successful cases of AEF with esophageal carcinoma treated using TEVAR under local anesthesia in the emergent or urgent phase. General condition of all the patients was dramatically improved, but 1 patient with exsanguinations developed infection of the implanted stent-graft and died due to sepsis. The other 2 patients were treated before esophageal bleeding and remained alive for 1 year without infection. The TEVAR should be considered as early as possible in patients with advanced esophageal carcinoma receiving radiation or chemotherapy who develop early signs of AEF such as symptoms of chest discomfort or descending aortic irregularity on computed tomography scan.
Asunto(s)
Aorta Torácica/cirugía , Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular , Carcinoma/complicaciones , Procedimientos Endovasculares , Fístula Esofágica/cirugía , Neoplasias Esofágicas/complicaciones , Fístula Vascular/cirugía , Anciano , Anciano de 80 o más Años , Enfermedades de la Aorta/etiología , Aortografía/métodos , Carcinoma/patología , Carcinoma/terapia , Fístula Esofágica/etiología , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/terapia , Esofagoscopía , Resultado Fatal , Femenino , Humanos , Masculino , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Fístula Vascular/etiologíaRESUMEN
OBJECTIVES: Surgical strategies for patients with aortic arch aneurysm extending to the descending aorta remain controversial. The antero-lateral partial sternotomy (ALPS) approach has been developed as a less invasive alternative single-stage strategy for extensive thoracic arch aneurysm (ETAA). METHODS: From September 2007 to April 2011, 18 patients underwent elective total arch replacement for ETAA by the ALPS approach (ALPS group). In this approach, a skin incision was made from the bottom of the xiphoid to the anterior axillary line at the third intercostal space with a convex curved line. The thorax was entered through the third intercostal space and a partial lower sternotomy was done. Surgical outcomes were compared with those of 22 patients with ETAA who underwent elective total arch replacement by median sternotomy alone (MS) with regard to the level of distal anastomosis, postoperative complications and mortality. RESULTS: In the ALPS group, no hospital mortality occurred and one patient experienced pneumonia. No significant difference between the ALPS and MS groups was seen in operative time (384.1 ± 41.6 min vs 402.3 ± 85.3 min P = 0.423) and cardiopulmonary bypass time (220.8 ± 47.1 min vs 236.9 ± 45.4 min P = 0.286). In contrast, distal anastomosis was at a significantly lower vertebral level in the ALPS than in the MS group (5.5 ± 0.4 vs 4.3 ± 0.9, respectively: P < 0.0001). CONCLUSIONS: The ALPS approach provides good surgical exposure for distal aortic arch aneurysms extending to the descending aorta and ensures the accurate reconstruction of the distal anastomosis without major complications.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Esternotomía/métodos , Anciano , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/mortalidad , Aortografía/métodos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Puente Cardiopulmonar , Distribución de Chi-Cuadrado , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía/etiología , Estudios Retrospectivos , Esternotomía/efectos adversos , Esternotomía/mortalidad , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The elephant trunk technique is a well-established procedure, but aortic wall injury or aneurysmal rupture may occur if the graft is forcibly pushed to insert it into the distal aorta. We have developed simple and safe insertion technique using a syringe.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Humanos , Diseño de Prótesis , Resultado del TratamientoRESUMEN
We report on a successful mitral valve (MV) repair and modified Cox maze procedure in a 35-year-old male patient with acromegaly, associated with severe mitral regurgitation and atrial fibrillation. He underwent a transsphenoidal adenomectomy, 7 months after the cardiac operation, and IGF-I level was normalized postoperatively. Valvular disease in patients with acromegaly is associated with hormonal activity, and control of growth hormone and insulin-like growth factor I excesses is important in the long-term durability of mitral valve repair.
Asunto(s)
Acromegalia/etiología , Adenoma/complicaciones , Procedimientos Quirúrgicos Cardíacos , Adenoma Hipofisario Secretor de Hormona del Crecimiento/complicaciones , Insuficiencia de la Válvula Mitral/cirugía , Acromegalia/sangre , Acromegalia/cirugía , Adenoma/sangre , Adenoma/cirugía , Adulto , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/etiología , Fibrilación Atrial/cirugía , Biomarcadores/sangre , Ablación por Catéter , Ecocardiografía Doppler en Color , Adenoma Hipofisario Secretor de Hormona del Crecimiento/sangre , Adenoma Hipofisario Secretor de Hormona del Crecimiento/cirugía , Hormona de Crecimiento Humana/sangre , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Insuficiencia de la Válvula Mitral/sangre , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/etiología , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Cerebrospinal fluid (CSF) drainage is a routinely used adjunct in operation of thoracoabdominal aortic aneurysm (TAAA), which may reduce the incidence of perioperative paraplegia by improving spinal cord perfusion. Neurological complications of CSF drainage have been reported, possibly due to excessive CSF drainage, and acute subdural hematoma (SDH) in particular may lead to catastrophic complications. We present a rare case of acute SDH due to CSF drainage that was not excessive, after TAAA repair in a patient with Marfan syndrome, who recovered without invasive treatment.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Líquido Cefalorraquídeo , Drenaje/efectos adversos , Hematoma Subdural Agudo/etiología , Síndrome de Marfan/cirugía , Adulto , Disección Aórtica/complicaciones , Aneurisma de la Aorta Torácica/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Síndrome de Marfan/complicaciones , Resultado del TratamientoRESUMEN
Mitral valve repair is preferred to replacement in infective endocarditis, but in the active phase, it often requires extensive debridement of infected tissue and complex reconstruction. We investigated 22 consecutive native mitral valve operations during active-phase infective endocarditis. The time from initiation of medical treatment to operation was 16.8 ± 16.4 days. Mitral valve repair was performed in 15 (68.2%) patients, using prosthetic annuloplasty in 14, an autologous pericardial patch in 11, and artificial chordal replacement in 9. Hospital mortality was 9.1% (2 patients), due to subarachnoid hemorrhage and pneumonia. One patient died 26 months after valve replacement due to congestive heart failure. The postoperative left ventricular end-diastolic dimension was significantly smaller (45.7 ± 5.6 vs. 53.3 ± 10.2 mm) and ejection fraction was significantly higher (57.0% ± 14.7% vs. 40.1% ± 8.2%) in patients who underwent valve repair compared to those who had valve replacement. Mitral regurgitation requiring reoperation occurred in 3 patients during follow-up. Mitral valve repair is feasible in active-phase infective endocarditis, and results in improved regression of left ventricular dimensions compared to valve replacement. However, complex mitral valve repair with extensive leaflet resection may not have long-term durability.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Endocarditis Bacteriana/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Anuloplastia de la Válvula Mitral , Válvula Mitral/cirugía , Adulto , Anciano , Antibacterianos/uso terapéutico , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Desbridamiento , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Endocarditis Bacteriana/fisiopatología , Estudios de Factibilidad , Femenino , Enfermedades de las Válvulas Cardíacas/microbiología , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/fisiopatología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Mortalidad Hospitalaria , Humanos , Japón , Masculino , Persona de Mediana Edad , Válvula Mitral/microbiología , Válvula Mitral/fisiopatología , Anuloplastia de la Válvula Mitral/efectos adversos , Anuloplastia de la Válvula Mitral/mortalidad , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Reoperación , Volumen Sistólico , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
Echocardiographic examination of patients with granulomatous endocarditis in patients with Wegener's granulomatosis (WG) reveals vegetation-like lesions that may be misdiagnosed as infective endocarditis resulting in inappropriate therapy. Three-dimensional transesophageal echocardiography aids differential diagnosis. Here, we report the case of a WG patient with associated mitral and aortic granulomatous endocarditis. Although the patient was treated with prednisolone and cyclophosphamide, serial echocardiography did not reveal any significant changes in disease course.
RESUMEN
A case of a large primary cardiac sarcoma on the left ventricular free wall is reported. Although the definitive diagnosis of this tumor was not made preoperatively, total excision was planned for rapid diagnosis and optimal procedure. However, the operation was discontinued due to intraoperative diagnosis of malignancy. As a result, the patient suffered from the symptoms of cardiac tamponade caused by the large tumor. We discuss the surgical strategy to provide therapeutic benefit for possible patients in the future. In conclusion, an aggressive attempt at volume reduction such as cardiac autotransplantation may relieve the symptoms, even though such surgery would only be palliative.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Neoplasias Cardíacas/cirugía , Ventrículos Cardíacos/cirugía , Sarcoma/cirugía , Anciano , Antineoplásicos Alquilantes/uso terapéutico , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Quimioterapia Adyuvante , Contraindicaciones , Ecocardiografía , Resultado Fatal , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/patología , Ventrículos Cardíacos/patología , Humanos , Ifosfamida/uso terapéutico , Masculino , Cuidados Paliativos , Sarcoma/complicaciones , Sarcoma/patología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Cardiac valve disease resulting from elastic tissue defects has been demonstrated in patients with beta-thalassemia; however, valve disorders of patients with alpha-thalassemia have been rarely discussed. We present the case of a patient with alpha-thalassemia and severe aortic regurgitation with left ventricular dysfunction. The patient underwent successful aortic valve replacement with mechanical prosthesis. Histopathology of the excised valve showed elastic tissue disruption and chronic thrombus on the ventricular side. Hypercoagulative states have been observed in patients with alpha-thalassemia as beta-thalassemia; therefore special attention should be taken in perioperative anticoagulation therapy.
Asunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Talasemia alfa/complicaciones , Adulto , Válvula Aórtica , Insuficiencia de la Válvula Aórtica/etiología , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Trombosis , Disfunción Ventricular Izquierda/etiologíaRESUMEN
A successful apico-aortic bypass for a patient with a porcelain aorta suffering from aortic stenosis is reported. A sewing cuff with an outflow graft to the apex and a hand-made composite graft were used instead of a rigid apical connector.
Asunto(s)
Enfermedades de la Aorta/cirugía , Estenosis de la Válvula Aórtica/cirugía , Bioprótesis , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Calcinosis/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Anciano , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/fisiopatología , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Calcinosis/complicaciones , Calcinosis/diagnóstico por imagen , Calcinosis/fisiopatología , Puente Cardiopulmonar , Hemodinámica , Humanos , Masculino , Diseño de Prótesis , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Moderate hypothermic circulatory arrest with selective cerebral perfusion has been developed for cerebral protection during thoracic aortic surgery. However, visceral organs, particularly the kidneys, suffer greater tissue damage under moderate hypothermic circulatory arrest, and acute renal failure after hypothermic circulatory arrest is an independent risk factor for early and late mortality. This study investigated whether atrial natriuretic peptide could prevent the reduction in renal perfusion and protect renal function after moderate hypothermic circulatory arrest. Twelve pigs cooled to 30 degrees C during cardiopulmonary bypass were randomly assigned to a peptide-treated group of 6 and a control group of 6. Moderate hypothermic circulatory arrest was induced for 60 min. Systemic arterial mean pressure and renal artery flow did not differ between groups during the study. However, renal medullary blood flow increased significantly in the peptide-treated group after hypothermic circulatory arrest. Myeloperoxidase activity was significantly reduced in the medulla of the peptide-treated group. Renal medullary ischemia after hypothermic circulatory arrest was ameliorated by atrial natriuretic peptide which increased medullary blood flow and reduced sodium reabsorption in the medulla. Atrial natriuretic peptide also reduced the release of an inflammatory marker after ischemia in renal tissue.