RESUMO
Continued enlargement of the aneurysm sac after thoracic endovascular aortic repair (TEVAR) is a known risk after endovascular treatment of thoracic aortic aneurysms. For this reason, periodic outpatient follow-up is required to identify situations that require repair. Here, we describe an aortobronchial fistula (ABF) in a patient lost to follow-up, that presented 3 years after an elective TEVAR done for a primary, descending thoracic aortic aneurysm. Our patient arrived in extremis and suffered massive hemoptysis leading to her demise. Computed tomography (CT) angiogram near the time of her death demonstrated a bleeding ABF immediately distal to her previous TEVAR repair. Aortic aneurysmal disease remains life threatening even after repair. Improved endovascular techniques and devices have resulted in decreased need for reintervention. However, this case demonstrates the risk of thoracic aortic disease progression and highlights the importance of establishing consistent, long-term follow-up after TEVAR.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/etiologia , Implante de Prótese Vascular/efeitos adversos , Fístula Brônquica/etiologia , Procedimentos Endovasculares/efeitos adversos , Fístula Vascular/etiologia , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Aortografia/métodos , Fístula Brônquica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Evolução Fatal , Feminino , Hemoptise/etiologia , Humanos , Fatores de Tempo , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagemAssuntos
Tamponamento Cardíaco/etiologia , Vasos Coronários/lesões , Fundoplicatura/efeitos adversos , Laparoscopia , Complicações Pós-Operatórias/etiologia , Grampeamento Cirúrgico/efeitos adversos , Lesões do Sistema Vascular/etiologia , Tamponamento Cardíaco/diagnóstico , Feminino , Fundoplicatura/instrumentação , Fundoplicatura/métodos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Grampeamento Cirúrgico/instrumentação , Suturas/efeitos adversos , Lesões do Sistema Vascular/diagnósticoRESUMO
We present a rare late complication after inferior vena cava filter (IVC) placement. A 52-year-old woman with an IVC presented with sudden onset of chest pain. Cardiac catheterisation and echocardiography revealed an embolised IVC filter strut penetrating the right ventricle. Endovascular retrieval was considered but deemed unsafe due to proximity to the right coronary artery and concern for migration to pulmonary circulation. Urgent removal of the strut was performed via sternotomy. The postoperative course was uneventful. Two weeks later, she was asymptomatic. Minimally invasive approaches have been described for retrieval of intact IVC filters that have migrated to the right heart but not for embolised filter fragments. We recommend traditional sternotomy as the preferred method of retrieval as it limits the likelihood of further migration or trauma.
Assuntos
Síndrome Coronariana Aguda , Ventrículos do Coração/cirurgia , Perfuração Espontânea , Filtros de Veia Cava/efeitos adversos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Perfuração Espontânea/diagnóstico , Perfuração Espontânea/cirurgiaRESUMO
Iatrogenic intraoperative tracheal injuries are rare in cardiac operations. Management of this complication is not well described because of the low incidence and lack of reported cases. We present an 82-year-old woman who sustained a tracheal injury during aortic valve replacement. Soft tissue coverage of the trachea was obtained, the original cardiac operation was completed, and she was otherwise managed conservatively. She recovered without further complication and was discharged home 1 week after the surgical procedure.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Complicações Intraoperatórias/terapia , Traqueia/lesões , Idoso de 80 Anos ou mais , Feminino , HumanosRESUMO
OBJECTIVES: To describe the preoperative, intraoperative and postoperative characteristics of patients with left-sided heart valve disease treated in the thoracic and cardiovascular surgery service of a national reference hospital; as well as to describe the occurrence of thromboembolic and bleeding events in these patients. MATERIALS AND METHODS: A retrospective longitudinal study was carried out, which included 185 patients who underwert surgery between 1999 and 2006 at the Hospital Nacional Dos de Mayo (Lima, Peru). The patients were divided into 4 groups: patients with mitral commissurotomy; with aortic valve replacement; with mitral valve replacement and with double valve replacement. T-student test, Chi-square test, analysis of variance and Bonferroni test were used. The survival analysis took into account the severe thromboembolic and bleeding events and a follow-up period of 7 years was set. RESULTS: The average durations of disease was 4.6 years. The most frequent etiology was rheumatic valve disease (74.6%). Hospital mortality was 3.8%, the most frequent cause of death was low cardiac output syndrome associated to multiple organ failure. The incidence of ischemic events (thrombosis or embolization) in patients who had a long-term valve replacement (more than 6 months) was 3.2%, and the incidence of bleeding events was 4.3%. CONCLUSIONS: The results of surgical treatment for left-sided heart valve disease in Peru are favorable. The rate of complications and hospital mortality rate, as well as the long-term thromboembolic and bleeding events are comparable to those reported in the world literature.
Assuntos
Doenças das Valvas Cardíacas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Tromboembolia/epidemiologia , Adolescente , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Peru , Encaminhamento e Consulta , Estudos Retrospectivos , Adulto JovemRESUMO
Objetivos. Describir las características preoperatorias, intraoperatorias y posoperatorias de los pacientes con enfermedad valvular cardiaca de predominio izquierdo (EVCPI) tratados en un servicio de cirugía de tórax y cardiovascular de un hospital de referencia nacional; así como describir la ocurrencia de eventos tromboembólicos y hemorrágicos en estos pacientes. Materiales y métodos. Se realizó un estudio longitudinal retrospectivo en el que se incluyeron 185 pacientes operados entre 1999 y 2006 en el Hospital Nacional Dos de Mayo (Lima, Perú). Los pacientes fueron divididos en cuatro grupos: con comisurotomía mitral; con reemplazo valvular aórtico; con reemplazo valvular mitral y con doble reemplazo valvular. Se empleó la prueba t de student, la prueba chi cuadrado, el análisis de varianza y la prueba de Bonferroni. El análisis de supervivencia tomó en cuenta los eventos tromboembolicos y hemorrágicos serios y se fijó un tiempo de seguimiento de seis años. Resultados. El tiempo de enfermedad promedio fue 4,6 años. La etiología más frecuente fue enfermedad reumática valvular (74,6%). La mortalidad hospitalaria fue 3,8%, siendo la causa de muerte más frecuente el síndrome de bajo gasto cardiaco con falla multiorgánica asociada. La incidencia de eventos isquémicos (trombosis o embolización) en pacientes que tuvieron reemplazo valvular a largo plazo (más de 6 meses) fue 3,2%, y de eventos hemorrágicos fue 4,3%. Conclusiones. Los resultados del tratamiento quirúrgico de EVCPI en el Perú son favorables. La tasa de complicaciones y mortalidad hospitalaria, así como los eventos tromboembólicos y hemorrágicos a largo plazo son comparables con los reportados en la literatura mundial.
Objectives. To describe the preoperative, intraoperative and postoperative characteristics of patients with left-sided heart valve disease treated in the thoracic and cardiovascular surgery service of a national reference hospital; as well as to describe the occurrence of thromboembolic and bleeding events in these patients. Materials and methods. A retrospective longitudinal study was carried out, which included 185 patients who underwert surgery between 1999 and 2006 at the Hospital Nacional Dos de Mayo (Lima, Peru). The patients were divided into 4 groups: patients with mitral commissurotomy; with aortic valve replacement; with mitral valve replacement and with double valve replacement. T-student test, Chi-square test, analysis of variance and Bonferroni test were used. The survival analysis took into account the severe thromboembolic and bleeding events and a follow-up period of 7 years was set. Results. The average durations of disease was 4.6 years. The most frequent etiology was rheumatic valve disease (74.6%). Hospital mortality was 3.8%, the most frequent cause of death was low cardiac output syndrome associated to multiple organ failure. The incidence of ischemic events (thrombosis or embolization) in patients who had a long-term valve replacement (more than 6 months) was 3.2%, and the incidence of bleeding events was 4.3%. Conclusions. The results of surgical treatment for left-sided heart valve disease in Peru are favorable. The rate of complications and hospital mortality rate, as well as the long-term thromboembolic and bleeding events are comparable to those reported in the world literature.
Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Doenças das Valvas Cardíacas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Tromboembolia/epidemiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Estudos Longitudinais , Peru , Encaminhamento e Consulta , Estudos RetrospectivosRESUMO
Patients with central venous occlusion who are ''tunneled catheter dependent'' are a challenge for hemodialysis access. A relatively new option for them is the hemodialysis reliable outflow (HeRO) device that can be totally implanted subcutaneously. However, patients still require a tunneled hemodialysis catheter that is used until the HeRO device is mature, 4 to 6 weeks later. Here, we describe a conversion of an existing tunneled hemodialysis catheter into a HeRO device, which was combined with a ''self-sealing'' Flixene graft. This allowed almost immediate use of the HeRO device without the need for placement of a catheter.
Assuntos
Implante de Prótese Vascular/instrumentação , Prótese Vascular , Cateteres de Demora , Falência Renal Crônica/terapia , Diálise Renal/instrumentação , Adulto , Desenho de Equipamento , Humanos , Masculino , Desenho de Prótese , Resultado do TratamentoRESUMO
The Hemodialysis Reliable Outflow (HeRO) device is a novel alternative for dialysis access in patients with no suitable veins in the upper extremities. We placed a HeRO device in a 67-year-old woman with end-stage renal disease and 2 months later, it was being used for hemodialysis. After 1 month of uneventful use, the device thrombosed and it was rescued with a percutaneous endovascular approach. The device remains patent 6 months after the intervention.
Assuntos
Angioplastia com Balão/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Oclusão de Enxerto Vascular/terapia , Falha de Prótese , Diálise Renal/instrumentação , Stents , Trombose/terapia , Idoso , Anastomose Cirúrgica , Implante de Prótese Vascular/efeitos adversos , Artéria Braquial/cirurgia , Constrição Patológica , Desenho de Equipamento , Feminino , Fibrinolíticos/administração & dosagem , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Veias Jugulares/cirurgia , Falência Renal Crônica/terapia , Politetrafluoretileno , Desenho de Prótese , Radiografia , Diálise Renal/efeitos adversos , Trombectomia , Terapia Trombolítica , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
Aneurysms of the iliac vein are rare. They can occur in association with arteriovenous fistulae located elsewhere. Here, we present a 30-year-old man who developed a large left external iliac vein aneurysm in association with a chronic traumatic arteriovenous fistula in the left thigh. Less than 25 cases of iliac vein aneurysms have been reported in the last 40 years. The presentation and treatment of this condition has been heterogeneous. We suggest that adequate surgical treatment can be offered in a staged approach: aneurysm resection with reconstruction should be done first, followed by closure of the arteriovenous fistula 6 months later.
Assuntos
Aneurisma/cirurgia , Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular , Artéria Femoral/cirurgia , Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Ferimentos Perfurantes/complicações , Adulto , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/lesões , Veia Femoral/diagnóstico por imagem , Veia Femoral/lesões , Humanos , Veia Ilíaca/diagnóstico por imagem , Masculino , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Fístula Cutânea/etiologia , Hérnia Diafragmática/cirurgia , Hérnias Diafragmáticas Congênitas , Complicações Pós-Operatórias , Fístula do Sistema Respiratório/etiologia , Abscesso Abdominal/complicações , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/terapia , Criança , Fístula Cutânea/diagnóstico , Fístula Cutânea/cirurgia , Humanos , Recém-Nascido , Masculino , Fístula do Sistema Respiratório/diagnóstico , Fístula do Sistema Respiratório/cirurgia , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapia , CicatrizaçãoRESUMO
Hydatid cyst can simultaneously affect the liver and lung. Some patients might have additional comorbidities that can make management more challenging. Here, we present a 10-year-old boy with hepatopulmonary hydatid cysts and severe mitral regurgitation, who was successfully managed with a staged surgical approach treating the lung first, followed by the liver and finally, the heart.
Assuntos
Equinococose Hepática/cirurgia , Equinococose Pulmonar/cirurgia , Insuficiência da Valva Mitral/cirurgia , Criança , Equinococose Hepática/complicações , Equinococose Hepática/diagnóstico por imagem , Equinococose Pulmonar/complicações , Equinococose Pulmonar/diagnóstico por imagem , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
A prospective series of 65 patients with surgically confirmed lung cystic hydatid disease was evaluated in terms of their radiologic characteristics, serologic response, and presence of cysts in other organs. Cysts were mostly single and located in lower lung lobes. Liver compromise was found in 34% of the patients. Despite a systematic search, no patient showed brain cysts in this series. Twelve patients had previous hydatid disease: six in the liver and eight in the lung (two had involvement of both organs in the past). Serology using bovine cyst fluid in an immunoblot assay was 85% sensitive. Serologic response was not associated with number or cyst or compromise of other organs but was clearly associated to the presence of at least one complicated cyst. Cyst status in terms of complications should be described to allow appropriate assessment of serologic evaluations.
Assuntos
Equinococose Pulmonar/diagnóstico por imagem , Equinococose Pulmonar/cirurgia , Equinococose/diagnóstico , Pulmão/cirurgia , Encéfalo/diagnóstico por imagem , Equinococose Pulmonar/patologia , Humanos , Fígado/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Estudos Prospectivos , RadiografiaRESUMO
A molecular PCR study using DNA from 21 hydatid cysts was performed to determine which strain type is responsible for human infection in Peru. The mitochondrial cytochrome c oxidase subunit 1 (CO1) gene was amplified in 20 out of 21 samples, revealing that all but 1 sample (19/20, 95%) belonged to the common sheep strain (G1). The remaining samples belonged to the camel strain (G6). The G1 genotype was most frequently found in human cases of cystic hydatid disease (CHD) in Peru. Local control measures should focus primarily on decreasing dog and sheep infection rather than intermediate reservoirs.
Assuntos
Camelus/parasitologia , DNA de Helmintos/química , DNA Mitocondrial/química , Echinococcus granulosus/classificação , Complexo IV da Cadeia de Transporte de Elétrons/genética , Zoonoses/parasitologia , Animais , DNA de Helmintos/análise , DNA Mitocondrial/análise , Cães , Equinococose , Echinococcus granulosus/enzimologia , Echinococcus granulosus/genética , Genótipo , Humanos , Peru/epidemiologia , Reação em Cadeia da Polimerase , Ovinos , Doenças dos Ovinos/parasitologia , Zoonoses/epidemiologia , Zoonoses/transmissãoRESUMO
Colonization with Aspergillus sp. usually occurs in previously formed lung cavities. Cystectomy is a widely used surgical technique for hydatid lung disease that can also leave residual cavities and potentially result in aspergilloma. We present two cases of this rare entity and a case with Aspergillus sp. colonization of an existing ruptured hydatid cyst.
Assuntos
Aspergilose/complicações , Aspergilose/cirurgia , Equinococose Pulmonar/microbiologia , Adulto , Aspergilose/diagnóstico por imagem , Equinococose Pulmonar/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
We report a case of a large mobile myxoma of the left ventricle that caused obstruction of the outflow tract. Transthoracic and transesophageal echocardiography defined the extent and location of the mass providing crucial information for surgical treatment, which was successful.
Assuntos
Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/complicações , Mixoma/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/etiologia , Adulto , Humanos , Masculino , UltrassonografiaRESUMO
The superior mesenteric artery (SMA) is an uncommon location of aneurysm formation. This entity is potentially lethal and should be treated once a diagnosis is made. When the aneurysm reaches a large size, there is a high risk of rupture and surgical treatment should not be delayed, although it can be technically demanding because there is a significant portion of bowel at risk for ischemia. Here, we describe our approach for the management of a giant SMA aneurysm.
Assuntos
Aneurisma/cirurgia , Artéria Mesentérica Superior/cirurgia , Procedimentos Cirúrgicos Vasculares , Aneurisma/diagnóstico por imagem , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Ligadura , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Presentamos 3 casos consecutivos de perforación del esófago por espina de pescado que ocasionó mediastinitis aguda. Todos los pacientes fueron satisfactoriamente manejados con drenaje y debridamiento del mediastino y cavidad pleural. Sin embargo, se realizó exclusión esofágica temporal mediante ligadura externa en un paciente, con recanalización espontánea 2 semanas más tarde. Discutimos el posible rol de esta maniobra quirúrgica en el manejo de perforación esofágica.
We present 3 consecutive cases of fishbone perforation of the esophagus that resulted in acute mediastinitis. All patients were successfully managed with drainage and debridement of the mediastinum and pleural cavity. However, temporary exclusion with external ligation of the esophagus was also performed in one patient, withspontaneous recanalization two weeks later. We discuss the possible role of thissurgical maneuver in the management of esophageal perforation.
Assuntos
Humanos , Masculino , Adulto , Feminino , Mediastinite , Perfuração Esofágica/terapia , Perfuração EsofágicaAssuntos
Angina Pectoris/etiologia , Estenose Coronária/etiologia , Traumatismos Cardíacos/complicações , Ventrículos do Coração/lesões , Ferimentos Perfurantes/complicações , Adulto , Angiografia Coronária , Ponte de Artéria Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Ferimentos Perfurantes/cirurgiaRESUMO
The standard incision for a cardiac operation is a median sternotomy. In special situations, alternative approaches are needed. We report a 53-year-old woman who required coronary artery bypass grafting 10 days after chest wall reconstruction with a transverse rectus abdominis myocutaneous flap. We describe our technique, which allowed us to preserve the flap and resulted in good functional and aesthetic outcome.
Assuntos
Ponte de Artéria Coronária , Retalhos Cirúrgicos , Parede Torácica/cirurgia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica , Resultado do TratamentoRESUMO
We present 3 consecutive cases of fishbone perforation of the esophagus that resulted in acute mediastinitis. All patients were successfully managed with drainage and debridement of the mediastinum and pleural cavity. However, temporary exclusion with external ligation of the esophagus was also performed in one patient, with spontaneous recanalization two weeks later. We discuss the possible role of this surgical maneuver in the management of esophageal perforation.