Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Realidade Virtual , Humanos , Correção Endovascular de Aneurisma , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares/métodos , Implante de Prótese Vascular/métodos , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate the outcomes of total arch replacement using the frozen elephant trunk technique with a FROZENIX® J Graft for patients with either acute or chronic aortic dissection, and to evaluate the late-phase outcomes. METHODS: Between January 2015 and December 2020, we used the frozen elephant trunk technique in 47 patients with acute aortic dissection and 12 patients with chronic aortic dissection. The primary endpoints were 30-day mortality, late aorta-related death and late aortic events. The secondary endpoints included early surgical complications and any aortic events (e.g. stent graft-induced new entry, frozen elephant trunk angle change). RESULTS: In the acute group, there were no aorta-related deaths, although 13 patients (27.7%) experienced an aortic event; stent graft-induced new entry occurred in 6 patients (12.8%). In the chronic group, 1 patient (9.1%) experienced aorta-related death, and 9 (81.8%) experienced an aortic event; stent graft-induced new entry occurred in 4 patients (36.4%). During the late phase after surgery, there was a significant increase in the frozen elephant trunk angle in both groups. In the AAD group, both the FET angle and spring-back angle were significantly enlarged in the late phase. There were no significant differences between groups in the degree of angle change, the overall survival, or aortic event-free survival. CONCLUSIONS: Total arch replacement using the frozen elephant trunk technique affords good early-stage results for both acute and chronic aortic dissection. During follow-up, careful monitoring for aortic events and appropriate therapeutic interventions are required. If surgeons are to use this device, they must have a thorough understanding of its spring back force and other features.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Humanos , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Prótese Vascular , Stents , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Isolated pulmonary valve infective endocarditis is rare and accounts for only 1.5% to 2.0% of all cases of infective endocarditis. We present a case of isolated pulmonary valve endocarditis, which was successfully treated by pulmonary valve replacement. A 69-year-old man presented with fever and was diagnosed with active pulmonary valve infective endocarditis. He had no apparent predisposing factors. Blood cultures were positive for Streptococcus viridans, and transesophageal echocardiography showed mobile vegetation. His condition improved transiently with intravenous antibiotic therapy;however, high fever and reduced oxygen saturation recurred. Computed tomography showed multiple infiltrative shadows suggesting septic pulmonary embolisms. Urgent surgery was indicated because antibiotic treatment was ineffective. During the operation, we found that vegetation had destroyed all pulmonary leaflets. We performed pulmonary valve replacement with a stented bioprosthetic valve as well as enlargement of the right ventricular outflow tract with a bovine pericardial patch. The postoperative course was uneventful. Antibiotic therapy was continued for six weeks after surgery. For two years since surgery, the patient has experienced no recurrence of infection.
Assuntos
Endocardite Bacteriana , Endocardite , Embolia Pulmonar , Valva Pulmonar , Idoso , Animais , Bovinos , Ecocardiografia Transesofagiana , Endocardite/complicações , Endocardite/diagnóstico por imagem , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/cirurgiaRESUMO
Massive pulmonary hemorrhage, although rare, is a potentially life-threatening complications during heart surgery. We herein present 1 such case successfully treated by selective bronchial occlusion using an Endobronchial Watanabe Spigot (EWS). The 82-year-old female underwent mitral valve replacement, tricuspid annuloplasty, and maze procedure. An hour and a half after cessation of cardiopulmonary bypass, the patient suffered a massive pulmonary hemorrhage. A subsequent bronchoscopy identified the hemorrhage site at the right middle lobe bronchus (B5b), and an EWS was then selectively deployed into this bronchus to block the hemorrhage. The following day, bronchial arterial embolization was performed, enabling the removal of the spigot on the next day. The patient's respiratory condition gradually improved, allowing for extubation on the 21st postoperative day. By preventing bleeding into neighboring bronchi, which, in turn, avoids the risk of exacerbating hypoxia, bronchial occlusion with EWSs is highly effective in managing massive pulmonary hemorrhage during heart surgery.
Assuntos
Broncopatias , Procedimentos Cirúrgicos Cardíacos , Idoso de 80 Anos ou mais , Brônquios , Broncoscopia , Feminino , Hemorragia , Humanos , Recém-NascidoRESUMO
We herein present a case of distal aortic arch aneurysm with an isolated left vertebral artery(LVA). In surgery, after establishing cardiopulmonary bypass, the LVA was anastomosed to the left common carotid artery (LCCA) while under moderate hypothermia. Selective cerebral perfusion (SCP) was then initiated by inserting catheters into the brachiocephalic artery( BCA), the LCCA and the left subclavian artery (LSA). The aorta was transected between the BCA and the LCCA, and an open stent graft was deployed into the descending aorta during circulatory arrest. After reconstructing the LSA, LCCA and BCA, the ascending aorta was replaced with a graft. The patient recovered well without any cerebral complications, and computed tomography confirmed the patency of the reconstructed LVA. Regarding the surgical treatment of an aortic arch aneurysm with an isolated LVA, reconstructing the isolated LVA before SCP makes the establishment of SCP straightforward, thereby helping protect the brain from ischemia.