RESUMEN
ABSTRACT: Intraoperative aortic dissection is a life-threatening emergency. The prognosis of patients with aortic dissection has markedly improved in recent years due to prompt diagnosis and the institution of effective medical and surgical therapy. Transesophageal echocardiography (TEE) is helpful in the evaluation of this life-threatening disorder.
Asunto(s)
Aorta , Disección Aórtica , Ecocardiografía Transesofágica , Complicaciones Intraoperatorias , Humanos , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Aorta/cirugía , Aorta/diagnóstico por imagen , Complicaciones Intraoperatorias/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana EdadAsunto(s)
Embolización Terapéutica , Defectos del Tabique Interatrial , Dispositivo Oclusor Septal , Humanos , Dispositivo Oclusor Septal/efectos adversos , Ecocardiografía Transesofágica , Complicaciones Posoperatorias , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interatrial/cirugía , Cateterismo Cardíaco , Resultado del TratamientoRESUMEN
BACKGROUND Patients with COVID-19 undergoing emergency or complex surgical procedures are at increased risk of developing perioperative complications. CytoSorb is a blood purification therapy used to remove circulating cytokines in conditions of hyperinflammation. This report is of a patient with COVID-19 requiring redo replacement of the aortic valve and aorta due to aortic aneurysm of the ascending aorta (Bentall procedure) associated with Marfan syndrome. The patient was successfully treated with extracorporeal cytokine hemoadsorption. CASE REPORT A 34-year-old man with Marfan syndrome, who had undergone a Bentall procedure in 2018, was admitted with symptoms of worsening dyspnea, tachycardia, fever, and confirmed COVID-19. Further diagnostic workup revealed dehiscence of the aortic root as well as moderate aortic regurgitation, in the context of a hyperinflammatory state. Anti-infective treatment was initiated. Given the severity of symptoms, COVID-19, echocardiography findings, and risk of aortic rupture, urgent Bentall surgery was performed. Additionally, a CytoSorb hemoadsorber was integrated into the cardiopulmonary bypass circuit to attenuate the anticipated systemic hyperinflammation. Intraoperatively, several blood products were administered due to excessive bleeding from the friable tissues and the pre-existing anemia and thrombocytopenia. Treatment was associated with marked improvements in vital parameters and inflammatory markers, and weaning from the ventilator and inotropes was possible after 48 hours. The remaining time in hospital was uneventful. CONCLUSIONS This report supports the findings from recent studies and reports that extracorporeal cytokine hemoadsorption has a role to play in reducing the systemic effects of cytokine storm associated with complex surgery involving cardiopulmonary bypass alongside severe infections, including COVID-19.
Asunto(s)
Insuficiencia de la Válvula Aórtica , COVID-19 , Síndrome de Marfan , Masculino , Humanos , Adulto , Síndrome de Marfan/complicaciones , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/cirugía , Aorta , CitocinasRESUMEN
We report a patient who after an uneventful coronary artery bypass graft surgery and left ventricular aneurysmorrhaphy developed intracerebral hemorrhage and subsequently required minitracheostomy. Chest X-ray showed misdirected minitracheostomy tube facing upward toward the laryngeal opening which was repositioned using bronchoscope.