Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Hipotermia Induzida/métodos , Doença Aguda , Dissecção Aórtica/classificação , Aneurisma da Aorta Torácica/classificação , Isquemia Encefálica/etiologia , Isquemia Encefálica/prevenção & controle , Doença Crônica , Humanos , Hipotermia Induzida/efeitos adversos , Hipotermia Induzida/tendências , Seleção de Pacientes , ReoperaçãoRESUMO
Coexisting arterial diseases and endoprosthesis to peripheral-vessel mismatch may impair conventional femoral access for endovascular treatment of descending aorta aneurysms. Furthermore, previous abdominal operations can make an optional aortic-iliac approach more difficult. We introduced a new minimally invasive access through the aortic arch, which completely avoids the aortic-iliac access and minimizes surgical trauma.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Idoso , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Feminino , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , StentsRESUMO
BACKGROUND: Different methods of replacing the aortic valve via a minimally invasive access have been reported in the recent literature. Although these strategies have clear advantages in terms of reduced surgical trauma, no further refinements in terms of cosmetic results have been made for women. METHODS: Aortic valve replacement was performed in 4 women via a right anterior submammary minithoracotomy without rib resection. The incision was made along the breast fold. The extracorporeal circulation was connected through the same access. Standard surgical technique and equipment were employed. RESULTS: No intraoperative complications or hospital deaths occurred. The 4 patients could be discharged home on the sixth postoperative day. The cosmetic result was excellent and the wound completely disappeared within the breast fold. CONCLUSIONS: The advantages of the present method include the preservation of sternal integrity, early mobilization and rehabilitation and an excellent cosmetic result for women.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Toracotomia/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Coronary ostial stenosis is a life-threatening complication of aortic valve replacement. We describe the case of a patient who developed symptoms and signs related to coronary insufficiency 4 months after aortic valve replacement. In view of a coronary angiogram revealing a 99% left main stem stenosis, an urgent revascularization procedure was performed. Intraoperative inspection revealed a dense fibrous reaction of the aortic root involving the left coronary ostium. The postoperative course was uneventful and since the operation the patient remained asymptomatic. The possible mechanisms involved in the pathogenesis of coronary ostial stenosis after aortic valve replacement and the surgical strategy to be employed for the treatment of this complication are discussed.