摘要
Abstract Introduction: Iatrogenic acute aortic dissection (IAAD) type A is a rare but potentially fatal complication of cardiac surgery. Methods: The purpose of this article is to review the literature since the first reports of IAAD in 1978, examining its clinical characteristics and describing operative details and surgical outcomes. Moreover, we reviewed the recent literature to identify current trends and risk factors for IAAD in minimally invasive cardiac surgery procedures, often related to femoral artery cannulation for retrograde perfusion. Results: We found that IAAD ranges from 0.04 to 0.29% of cardiac patients in overall trials and ranged from 0.12 to 0.16% between 1978-1990, before the minimally invasive surgical era. And we concluded that since the first cases to the recent reports, the incidence of IAAD has not significantly changed. As minimally invasive procedures are on the rise, some authors think that the incidence of IAAD could increase in the future; we think that using all the precaution - such a strict monitoring of perfusion pressure throughout the intervention, avoiding extremely high jet pressures using vasodilators, repositioning of arterial cannula, or splitting perfusion in both femoral arteries -, this complication can be extremely reduced. Finally, we describe a very singular case occurring during mitral valve replacement followed by spontaneous dissection of left anterior descending artery one month later. Conclusion: The present article adds to the literature a more detailed clinical picture of this entity, including patients' characteristics, the mechanism, timing, and localization of the tear, and mortality details.
Subject(s)
Humans , Cardiac Surgical Procedures/adverse effects , Aortic Dissection/surgery , Aortic Dissection/etiology , Aortic Dissection/diagnostic imaging , Minimally Invasive Surgical Procedures , Iatrogenic Disease , Mitral Valve摘要
Abstract According to the most recent guidelines, the use of intraoperative transesophageal echocardiography in valvular surgeries is well established, as well as its use in the diagnosis, management, and rescue of perioperative complications. The aim of this case report is to illustrate a condition in which its intraoperative use had a positive influence on the outcome.
Resumo O uso da ecocardiografia transesofágica no intraoperatório em cirurgias valvulares é bem estabelecido de acordo com os guidelines mais recentes, assim como o seu uso no diagnóstico, manuseio e resgate de complicações perioperatórias. O objetivo deste relato de caso é ilustrar uma situação em que o seu uso no intraoperatório influenciou de maneira positiva o seu desfecho.
Subject(s)
Humans , Male , Aged , Echocardiography, Transesophageal/methods , Heart Valve Prosthesis Implantation/methods , Aortic Dissection/diagnostic imaging , Intraoperative Care/methods , Intraoperative Complications/diagnostic imaging , Aortic Dissection/etiology , Mitral Valve/surgery摘要
El síndrome de Turner (ST) resulta de la ausencia completa o parcial del segundo cromosoma sexual en fenotipos femeninos. Tiene una incidencia de 1:2000- 2500 nacidas vivas. Recién en la última década se ha puesto atención a la salud de las adultas con ST. La mortalidad es 3 veces superior respecto de la población general debido al riesgo de disección aórtica por anomalías cardiovasculares estructurales y aterosclerosis vinculada a hipertensión arterial, diabetes, dislipidemia y obesidad. También presentan elevada prevalencia de enfermedades autoinmunitarias. Objetivo: evaluar la calidad del seguimiento clínico de pacientes adultas con ST, comparando los controles de salud preconformación y posconformación del Registro y de la Unidad Interdisciplinaria. En el año 2017 fuimos convocados para integrar el Programa de Enfermedades Raras del Hospital Italiano de Buenos Aires. A partir de la creación del Registro Institucional y del equipo multidisciplinario obtuvimos mejoría significativa en los controles por las especialidades de cardiología, endocrinología y otorrinolaringología, en los controles bioquímicos del metabolismo lipídico, hidrocarbonado, hepatograma, TSH y anticuerpos para celiaquía e imágenes cardiovasculares y densitometría ósea. En conclusión, el seguimiento sistematizado e institucional, mediante el Registro y la creación de la Unidad Interdisciplinaria de Síndrome de Turner, permitió encontrar las falencias del sistema de atención y optimizar el seguimiento de esta población. (AU)
Turner syndrome (TS) results from the complete or partial absence of the second sex chromosome in female phenotypes. It has an incidence of 1: 2000-2500 girls born alive. Only in the last decade has been paid attention to the health of adults women with TS. Mortality is 3 times higher than in the general population due to the risk of aortic dissection cause to structural cardiovascular anomalies and atherosclerosis related to hypertension, diabetes, dyslipidemia and obesity. They also have a high prevalence of autoimmune diseases. Until nowadays in Argentina do not exist a national registry of this disease that complies with the international follow-up recommendations for these patients. We proposed to develop the institutional register at 2014 and a multidisciplinary team was created to care and follow up girls and women with TS during 2015. It was indexed to Italian Hospital of Buenos Aires' Rare Diseases Program since 2017. After the creation of the institutional registry and the multidisciplinary team we obtained a significant improvement in cardiology, endocrinology and otorhinolaryngology schedule visits, in lipids and hydrocarbon metabolism, liver, thyroid and celiac diseases biochemical controls and in the performance of cardiovascular MNR and bone densitometry. In conclusion, the systematized and institutional follow-up, through the registry and the creation of the Interdisciplinary Unit of Turner Syndrome, allowed us to find the flaws of the care system and to optimize the follow up of this population. (AU)
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Young Adult , Quality of Life , Turner Syndrome/prevention & control , Aftercare/statistics & numerical data , Aortic Dissection/etiology , Autoimmune Diseases/epidemiology , Turner Syndrome/complications , Turner Syndrome/etiology , Turner Syndrome/mortality , Turner Syndrome/epidemiology , Aftercare/methods , Cardiovascular Abnormalities/complications , Human Growth Hormone/therapeutic use , Diabetes Mellitus , Atherosclerosis/complications , Dyslipidemias/complications , Estrogens/therapeutic use , Gonadal Disorders/etiology , Hypertension/complications , Infertility, Female/etiology , Obesity/complicationsSubject(s)
Humans , Male , Female , Middle Aged , Coronary Aneurysm/etiology , Angioplasty, Balloon, Coronary/adverse effects , Stents , Percutaneous Coronary Intervention/adverse effects , Aortic Dissection/therapy , Coronary Aneurysm/therapy , Coronary Aneurysm/diagnostic imaging , Coronary Angiography , Iatrogenic Disease , Aortic Dissection/etiology , Aortic Dissection/diagnostic imaging摘要
Objective: To describe and analyze five cases of symptomatic intracranial spontaneous cortical dissections and a review of the literature relating to this disorder. Method: Retrospective analysis of patients undergoing investigation for intracranial hemorrhage. Data were compiled from the medical file and PACS of the Nancy University Hospital. Results: Of 350 patients who underwent investigation for spontaneous intracranial hemorrhage, five patients (four women) harbored intracranial distal dissections, with no evidence of infection, trauma, arterial hypertension, vasculitis. The patients age ranged from 35 to 77 years (mean age 50.8 years). No patient presented with a poor grade SAH (Hunt and Hess grade IV or V). All patients presented with headache. The localization of the vessel abnormality was equally distributed between the anterior and posterior circulation. All patients, except one, harbored an aneurysmal sac angiographically detectable. Conclusion: Dissecting aneurysms of the intracranial distal/cortical arteries are exceedingly rare vascular lesions that produce neurologic symptoms related to their topography and hemorrhagic or ischemic nature. In the aneurysmal forms, the treatment in an urgent fashion may be considered if we consider the risk of re-hemorrhage. The first-choice treatment is coil occlusion of the involved artery at the level of the dissection.
Objetivo: Descrever e analisar 5 casos de dissecção intracraniana de artérias distais espontâneas sintomáticas, com revisão da literatura. Métodos: Análise retrospectiva dos prontuários e imagens de tomografia, ressonância e angiografia. Os dados foram compilados do arquivo de imagens eletrônicas em formato DICOM através do sistema PACS do Hospital Universitário de Nancy, França. Resultados: De 350 pacientes investigados por hemorragia intracraniana espontânea, foram identificados 5 pacientes (4 do sexo feminino) com aneurismas intracranianos distais, onde foram descartadas as etiologias habituais (infecção, trauma, hipertensão arterial, vasculite). A média de idade foi de 50,8 anos, com mínima de 35 e máxima de 77 anos. Nenhum paciente estava com hemorragica de alto grau (Hunt-Hess grau 4 ou 5). Todos tiveram cefaléia súbita como sintoma inicial. A localização da anormalidade vascular foi igualmente distribuida entre a circulação anterior e posterior. Todos os pacientes, exceto um, apresentavam aneurisma angiograficamente detectável. Conclusão: Pequenas hemorragias intracranianas em vasos corticais são frequentemente encontradas, mas raramente investigadas. Aneurismas dissecantes das artérias distais/corticais são lesões extremamente raras que produzem sintomas relacionados a sua topografia e natureza isquêmica ou hemorrágica. A história natural destas lesões é pouco conhecida ou documentada. Aneurismas devem ser ocluidos preferencialmente com micromolas, evitando ressangramento.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Intracranial Hemorrhages/diagnostic imaging , Aortic Dissection/surgery , Aortic Dissection/complications , Aortic Dissection/etiology , Aortic Dissection/pathology , Aortic Dissection/epidemiology , Medical Records , Retrospective Studies , Dissection/methods , Endovascular Procedures/methods摘要
Introduction: Spontaneous dissection of the iliac artery (SDIA) is an extremely rare clinical manifestation, associated to different etiologies, and it usually shows an ischemia of the involved lower extremity. Clinical case: We report a case of a 48-year-old man, with past medical history of chronicle consumption of ergotamine, which presented left lower limb ischemia, while practicing physical exercise. An emergent contrast-enhanced computed tomography scan showed a spontaneous dissection of the common and the external left iliac artery. An endovascular therapy of the lesion was performed with self-expanding stents, achieving the reconstruction of the lesion, the recovery of the blood flow and of the lower limb ischemia. Conclusions: There are no previous descriptions of the association between ergotamine consumption, sport and this very rare pathology. Endovascular treatment represents a less invasive and, such as in our case report, successful management of the SDIA, and it should be considered among the alternative therapies.
Introducción: La disección espontánea de la arteria ilíaca es un cuadro muy poco frecuente asociado a diferentes etiologías que habitualmente se presenta como isquemia de la extremidad comprometida. Caso clínico: Se reporta el caso de un paciente masculino de 48 años con antecedente de consumo crónico de ergotamina, quien mientras practicaba deporte presenta cuadro de isquemia aguda de la extremidad inferior izquierda. Angio tomografía computada demostró disección espontánea de la arteria ilíaca común y externa izquierda. Se realizó terapia endovascular de la lesión con stents auto expandibles, logrando la reparación de la lesión, el restablecimiento del flujo y la recuperación de la isquemia de la extremidad. Discusión y conclusiones: No existen reportes previos de esta patología poco frecuente, en que se asocie en forma conjunta la práctica de deporte y el uso de ergotamina. Dentro de las alternativas terapéuticas, la reparación endovascular representa una opción menos invasiva y, como en este caso, con óptimos resultados.
Subject(s)
Humans , Male , Middle Aged , Aortic Dissection/surgery , Iliac Aneurysm/surgery , Exercise , Ergotamine/adverse effects , Aortic Dissection/etiology , Iliac Aneurysm/etiology , Endovascular Procedures/methods , Stents , Treatment Outcome摘要
Introducción: La enfermedad aneurismática de la aorta ascendente (EAAA) se caracteriza por su baja frecuencia, comportamiento heterogéneo, riesgo de rotura y disección, que conllevan elevada mortalidad, por lo que la cirugía electiva es fundamental. Se han desarrollado diversos procedimientos quirúrgicos, considerándose la técnica de Bentall el estándar de referencia. Se describe la mortalidad hospitalaria de la EAAA tratada quirúrgicamente mediante el procedimiento de Bentall. Material y métodos: Estudio descriptivo en el que se incluyeron 23 pacientes con EAAA operados entre el 1 de marzo de 2005 y el 30 de septiembre de 2008; la información fue obtenida de los expedientes clínicos. Resultados: Los 23 pacientes correspondieron a 1.2 % de las cirugías efectuadas. Edad media de 46 años (rango 16 a 74), sexo masculino 83 %. Etiología: degeneración inespecífica de la capa media con implicación valvular 43 %, aorta bivalva 22 %, síndrome de Marfán, de Turner y aneurismas posestenóticos, 9 % cada uno. Enfermedad de Takayasu y espondilitis anquilosante, 4 % cada uno. Enfermedad cardiaca asociada en seis (26 %): coartación aórtica (2), cardiopatía isquémica (1), comunicación interauricular (1), insuficiencia mitral severa (1) y rodete subaórtico (1). Procedimientos realizados: cirugía de Bentall 20 (87 %), aortoplastia con prótesis valvular tres (13 %). Complicaciones: sangrado anormal con reintervención 17 %, neumonía nosocomial 13 %, arritmias 13 %, choque séptico 9 %. Mortalidad tres (13 %): choque séptico y fibrilación ventricular. Conclusiones: La mortalidad hospitalaria para la cirugía de Bentall fue semejante a la registrada en otros centros especializados. Los eventos relacionados con la patología aórtica, técnica quirúrgica, prótesis valvular aórtica y la disfunción ventricular izquierda, obligan a realizar estudios de seguimiento a largo plazo.
BACKGROUND: Ascending aortic aneurysm disease (AAAD) shows a low frequency, heterogeneous behavior, high risk of rupture, dissection and mortality, making elective surgery necessary. Several procedures have been developed, and the Bentall technique is considered as the reference standard. The objective was to describe the hospital mortality of AAAD surgically treated using the Bentall procedure. METHODS: We carried out a descriptive study. Included were 23 patients with AAAD who were operated on between March 1, 2005 and September 30, 2008 at our hospital. Data were obtained from clinical files, and descriptive statistics were selected for analysis. RESULTS: The study population was comprised of 23 patients with an average age of 46 years; 83% were males. Etiology was nonspecific degeneration of the middle layer with valve implication in 43%, bivalve aorta in 22%, Marfan syndrome, Turner's syndrome and poststenotic aneurysms each represented 9%, and Takayasu disease and ankylosing spondylitis 4% each. Associated heart disease was reported in six (26%) patients as follows: aortic coarctation (2), ischemic cardiopathy (1), atrial septal defect (1), severe mitral insufficiency (1) and subaortic membrane (1). Procedures carried out were Bentall surgery in 20 (87%) patients and aortoplasty with valve prosthesis in three (13%) patients. Complications reported were abnormal bleeding with mediastinal exploration (17%), nosocomial pneumonia (13%), arrhythmia (13%), and septic shock (9%). Mortality was reported in three (13%) patients due to septic shock and ventricular fibrillation. CONCLUSIONS: Surgical mortality with the Bentall procedure is similar to published results by other specialized centers. Events related to the basic aortic pathology, surgical technique, aortic valve prosthesis and left ventricular dysfunction encourage longterm studies with follow-up.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Middle Aged , Aortic Aneurysm/surgery , Blood Vessel Prosthesis Implantation/methods , Aortic Aneurysm/etiology , Aortic Aneurysm/mortality , Aortic Dissection/etiology , Aortic Dissection/mortality , Aortic Dissection/surgery , Arrhythmias, Cardiac/etiology , Heart Diseases/complications , Shock, Septic/etiology , Shock, Septic/mortality , Postoperative Complications/epidemiology , Elective Surgical Procedures , Ventricular Fibrillation/etiology , Ventricular Fibrillation/mortality , Hospital Mortality , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Heart Valve Prosthesis Implantation , Cross Infection/etiology , Pneumonia/etiology , Marfan Syndrome/complications摘要
A dissecção de aorta pode ocorrer tardiamente após cirurgia de troca de valva aórtica e raramente no primeiro mês pós-operatório. A dissecção de artéria coronariana é rara e normalmente ocorre depois de angiografia coronariana. Relata-se um caso raro de dissecção de artéria coronária, seguido de infarto do miocárdio, no pós-operatório imediato de troca de valva aórtica com correção e evolução bem-sucedidas.
Late aortic dissection can occur after aortic valve replacement surgery, but rarely in the first postoperative month. Coronary artery dissection is rare and usually occurs after coronary angiography. We report a rare case of coronary artery dissection followed by myocardial infarction in the immediate postoperative period of a successful aortic valve replacement with a good postoperative evolution.
La disección de aorta puede ocurrir tardíamente tras cirugía de reemplazo de válvula aórtica y raramente en el primer mes postoperatorio. La disección de arteria coronaria es rara y normalmente ocurre después de angiografía coronaria. Se relata un caso raro de disección de arteria coronaria, seguido de infarto de miocardio, en el postoperatorio inmediato de reemplazo de válvula aórtica con corrección y evolución exitosas.
Subject(s)
Aged , Female , Humans , Aortic Dissection , Aortic Valve/surgery , Coronary Aneurysm , Heart Valve Prosthesis Implantation , Postoperative Complications , Aortic Dissection/etiology , Coronary Aneurysm/etiology , Hypertension/complications , Myocardial Infarction , Postoperative Period摘要
A obesidade e as comorbidades desencadeadas ou agravadas pela mesma têm se tornado um problema de saúde pública. Diversas terapêuticas buscaram métodos capazes de reduzir de modo efetivo a massa dos indivíduos obesos e, conseqüentemente, atenuar as complicações a ela relacionadas. Dentre essas abordagens, nos últimos anos, os procedimentos bariátricos têm crescido de forma significativa, sendo capazes de promover reduções de massa expressivas e duradouras. Diversas complicações precoces e tardias são descritas e relacionadas aos procedimentos bariátricos restritivos e malabsortivos. Neste relato, descrevemos dois casos de complicações cardiovasculares (dissecção e aneurisma) no pósoperatório tardio de procedimentos bariátricos.
Obesity and its correlated comorbidities are nowadays considered a public health concern. In the last few years, a myriad of strategies searched an effective procedure to reduce weight and decreases related comorbidities. Among these strategies, the bariatric procedures have been achieved a significantly increase, being able to promote an expressive and lasting weight reduction. Diverse early and late complications are described and related to restrictive and malabsortive bariatric procedures. In this report we describe two cases of cardiovascular complications (aortic dissection and aneurysm) in the late postoperative period of the bariatric procedures.
Subject(s)
Humans , Male , Middle Aged , Aortic Dissection/etiology , Aortic Aneurysm/etiology , Bariatric Surgery/adverse effects , Aortic Dissection , Aortic Aneurysm , Postoperative Period摘要
As dissecções da artéria carótida devem ser consideradas como possível etiologia de acidentes vasculares cerebrais e acidentes isquêmicos transitórios em pacientes jovens e de meia-idade e em geral têm bom prognóstico. Técnicas não-invasivas, em particular a ressonância magnética (ponderadas em T1 e T2, supressão de gordura em T1) e a angiografia por ressonância magnética de cabeça e pescoço com e/ou sem gadolino, devem ser usadas rotineiramente para triagem de pacientes com dissecção da artéria carótida interna. A angiografia por tomografia computadorizada pode ser também uma técnica diagnóstica alternativa ou complementar usada para avaliação da dissecção. A angiografia convencional deve ser reservada para casos selecionados, em que ainda não foi possível chegar a um diagnóstico depois dos primeiros exames. Outros estudos são necessários para avaliar as melhores opções de tratamento para pacientes com dissecção arterial.
Carotid artery dissections usually have a good prognosis and should be thought as a potential etiology of stroke and transient ischemic attacks (TIAs) in young patients. Noninvasive imaging techniques, in particular magnetic resonance imaging (MRI) (T1- and T2-weighted, fat-suppressed T1) and magnetic resonance angiography (MRA) of head and neck with and/or without gadolinium, should be used routinely for screening of patients with internal carotid artery (ICA) dissection. Computed tomographic angiography (CTA) can be an alternative or adjunctive diagnostic technique used for evaluation of dissection. Conventional angiography should be reserved for selected cases where the diagnosis remains indeterminate after initial studies have been performed. Further studies arenecessary to evaluate the best therapeutic options for patients with arterial dissection.
Subject(s)
Humans , Aortic Dissection/etiology , Aortic Dissection/pathology , Carotid Artery, Internal, Dissection/etiology , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnosis , Heparin/administration & dosage , Tomography摘要
A dissecção coronária iatrogênica apresenta alta morbidade e mortalidade. Diante da oclusão aguda do fluxo coronariano, é fundamental a restauração imediata da perviabilidade do vaso para limitar a extensão e duração da isquemia. Nesta situação, pode estar indicada a revascularização cirúrgica do miocárdio de emergência. Os autores apresentam caso de um paciente com dissecção iatrogênica do tronco de coronária esquerda durante angioplastia transluminal percutânea, que foi solucionada pela realização de revascularização completa do miocárdio, com resultado satisfatório.
Coronary dissection has a significant morbity and mortality. The ideal management of acute coronary occlusion is the prompt restoration of the vessel patency to limit the extent and duration of ischemia. In the setting of dissection during percutaneous procedure, the usual approach has been emergency aortocoronary bypass surgery. The authors present a case of a patient with left main dissection during percutaneous transluminal coronary angioplasty. This problem was successfully managed with emergent aortocoronary bypass surgery.
Subject(s)
Aged , Humans , Male , Aortic Dissection/etiology , Angioplasty, Balloon, Coronary/adverse effects , Coronary Artery Bypass , Coronary Aneurysm/etiology , Coronary Occlusion/therapy , Aortic Dissection , Aortic Dissection/surgery , Coronary Aneurysm , Coronary Aneurysm/surgery , Emergencies , Iatrogenic Disease摘要
Arterial and cardiac involvement of Behcet's disease is a rare but life threatening complication. The rupture of an arterial aneurysm might result in sudden death. We report a 54-year-old man with an established diagnosis of Behcet's disease who presented with multiple cardiovascular complications that eventually lead to his death. He presented with extensive venous occlusions, and sequentially developed right ventricular thrombosis with multiple pulmonary thromboembolisms, and a pulmonary artery aneurysm. We report this unusual sequence of cardiovascular complications in a patient with Behcet's disease.
Subject(s)
Humans , Male , Middle Aged , Aortic Dissection/etiology , Behcet Syndrome/complications , Cardiovascular Diseases/diagnosis , Fatal Outcome , Hemoptysis , Pulmonary Artery/pathology , Pulmonary Embolism/etiology , Risk Factors , Rupture/etiology , Tomography, X-Ray Computed摘要
Bleeding in patients with liver cirrhosis is primarily caused by gastroesophageal varix in association with extensive collateral circulation, portal hypertensive gastropathy, a Mallory-Weiss tear and peptic ulcer disease. The spontaneous rupture of an artery, as a result of coagulopathy, is extremely rare in patients with liver cirrhosis; however, we recently observed a case of a spontaneous rupture of the lateral thoracic artery in a 47 year-old male patient with alcoholic liver cirrhosis. The patient expired despite repeated transcatheter arterial embolization of the lateral thoracic artery and best supportive care. This is, to our knowledge, the first documented case of the spontaneous rupture of the lateral thoracic artery in a patient with liver cirrhosis.
Subject(s)
Humans , Male , Middle Aged , Aortic Dissection/etiology , Fatal Outcome , Liver Cirrhosis/complications , Rupture, Spontaneous/etiology , Thoracic Arteries/pathology , Time Factors摘要
A case of dissecting aneurysm in a 5-year-old girl without a pre-existing predisposing factor is presented. Her clinical presentation in spite of being typical, did not progress to severe deficit. The diagnosis was achieved by 2D and 3D-TOF MRI studies after the indirect indications of the CT studies after the accident. This case study emphasizes the possible presentation s in children. This diagnosis in the pediatric age-group is difficult and is probably the reason for the very few cases reported
Subject(s)
Humans , Female , Carotid Artery, Internal , Neck Injuries/complications , Child , Aortic Dissection/etiology摘要
Dissections after percutaneous transluminal coronary angioplasty (PTCA) are risk factors for acute or subacute vessel closures. Intracoronary stenting was developed to avoid these complications by pressing the intimal and medial flaps against the vessel wall, thus reducing the risk of acute closure from thrombus formation. Thirty three coil (Gianturco-Roubin) stents were implanted into the coronary arteries of 32 patients with dissections after PTCA during the period of March 1993 to December 1993. The indications for stent implantation were acute closure in 6 (18.8%), threatened closure in 6 (18.8%) and suboptimal result in 20 (62.4%) patients. Stent insertion were successful in 30 (94%) patients. The diameter stenosis in an immediate angiographic findings after stenting was decreased from 87% to 18% by caliper estimation. Emergency coronary artery bypass graft surgery was required in 1 (3%) patient. A non-Q wave myocardial infarction occurred in 1 (3%) patient. Complications included hematoma of the arterial access site requiring blood transfusion in 4 (12.5%) patients and hemopericardium in 1 (3%) patient. Our initial clinical experience of flexible coil coronary stent imply that stenting is efficacious treatment for acute dissections that are causing acute or threatened closure following angioplasty. The long term follow-up result in all groups of patient who received coronary stents is needed for better evaluation of new devices and prognosis.
Subject(s)
Adult , Aged , Female , Humans , Male , Acute Disease , Aortic Dissection/etiology , Angioplasty, Balloon, Coronary/adverse effects , Coronary Aneurysm/etiology , Coronary Vessels , Middle Aged , Stents摘要
Mulher de 33 anos, com história de hipertensão arterial sistêmica (HAS) há 4 anos e diagnóstico de lupus eritematoso sistêmico (LES) há 3 anos, em uso de doses elevadas de corticóides, há 8 meses apresentando infecções respiratórias de repetição e insuficiência cardíaca congestiva. O estudo hemodinâmico confirmou o diagnóstico de insuficiência aórtica (IA o) com dilatação aneurismática do seio posterior de Valsalva, aorta ascendente de calibre normal e artérias coronárias normais. Foi levada à cirurgia onde foi encontrada dissecção da aorta com desabamento das cúspides aórticas levando à IAo, corrigido através de implante de tubo de pericárdio bovino e suspensão da valva aórtica. No pós-operatório (PO) evoluiu com convulsão focal em hemicorpo esquerdo seguido por hemiparesia à esquerda e infecção respiratória, recebendo alta no 25° dia PO com discreta hemiparesia à E e do ponto de vista cardiovascular em classe funcional I (NYHA), em uso de medicação. Enfatizamos a necessidade de se pensar no diagnóstico de dissecção de aorta em pacientes portadores de LES e IAo, principalmente aqueles que tenham história de HAS e uso de corticosteróides por tempo prolongado
A 33 year-old female patient, with a 4-year history of hypertension plus a 3-year history of systemic lupus erythematosus, who had been taking high dosages of corticosteroids, has shown repetitive respiratory infections and congestive heart failure for the past 8 months. Angiocardiography confirmed the diagnosis of aortic insufficiency with aneurismatic dilation of Valsalva's posterior sinus, ascending aorta of normal diameter and normal coronary arteries. Aortic dissection causing aortic insufficiency due to collapse of aortic leaflets was spotted during the surgery and was corrected by a bovine pericardial tube and suspension of aortic valve. The postoperative (PO) period was complicated by leftsided seizures followed by left hemiparesis and respiratory infection. She was discharged on the 25th PO day with mild left hemiparesis and in functional class I (NYHA), using medicines. We emphasize the need to consider the diagnosis of aortic dissection in patients with systemic lupus erithematosus and aortic insufficiency, specially in those who have a history of systemic arterial hypertension and long-term corticosteroid therapy