RESUMO
Few images are available in the literature of the Ross II procedure wherein the pulmonary valve is autotransplanted into the mitral position. These images are from a 33-year-old woman who underwent the procedure 18 years ago.
Assuntos
Valva Pulmonar , Adulto , Valva Aórtica , Autoenxertos , Feminino , Seguimentos , Humanos , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/cirurgia , Transplante Autólogo , Resultado do TratamentoAssuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Vasos Coronários/diagnóstico por imagem , Fístula/diagnóstico por imagem , Septos Cardíacos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ponte de Artéria Coronária , Humanos , Ultrassonografia , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/cirurgiaRESUMO
A 27-year-old male presented with a known history of congenital ventricular septal defect (VSD). A Gerbode-type defect was discovered intraoperatively that was originally misinterpreted as pulmonary hypertension. The case report will review the Gerbode defect and the transesophageal echocardiography findings. It is important, in patients with history of perimembranous VSD, to consider Gerbode-type defect when the tricuspid regurgitation jet velocity is high.
Assuntos
Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia , Adulto , Diagnóstico Diferencial , Humanos , Masculino , UltrassonografiaRESUMO
The coronavirus disease-19 (COVID-19) pandemic has prompted new interest among anesthesiologists and intensivists in controlling coughing and expectoration of potentially infectious aerosolized secretions during intubation and extubation. However, the fear of provoking laryngospasm may cause avoidance of deep or sedated extubation techniques which could reduce coughing and infection risk. This fear may be alleviated with clear understanding of the mechanisms and effective management of post-extubation airway obstruction including laryngospasm. We review the dynamic function of the larynx from the vantage point of head-and-neck surgery, highlighting two key concepts: 1. The larynx is a complex organ that may occlude reflexively at levels other than the true vocal folds; 2. The widely held belief that positive-pressure ventilation by mask can "break" laryngospasm is not supported by the otorhinolaryngology literature. We review the differential diagnosis of acute airway obstruction after extubation, discuss techniques for achieving smooth extubation with avoidance of coughing and expectoration of secretions, and recommend, on the basis of this review, a clinical pathway for optimal management of upper airway obstruction including laryngospasm to avoid adverse outcomes.
Assuntos
Insuficiência Cardíaca , Insuficiência da Valva Pulmonar , Estenose da Valva Pulmonar , Ecocardiografia , Humanos , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/complicações , Estenose da Valva Pulmonar/diagnóstico por imagemRESUMO
BACKGROUND: Myxomatous mitral valve insufficiency is traditionally repaired by posterior leaflet quadrangular resection and reconstruction. A simplified repair technique without leaflet resection is described, and our initial experience is reviewed. METHODS: Thirty-nine consecutive patients with significant mitral regurgitation underwent repair since January 2000 by placement of expanded polytetrafluoroethylene sutures between the leading (coapting) edge of the posterior leaflet and the corresponding papillary muscle. An annuloplasty ring was placed, and no leaflet tissue was resected. Patient medical records were obtained and retrospectively reviewed. RESULTS: Twenty-five men and 14 women (median age, 61 years; range, 40-88 years) had their mitral valve repaired by a variety of surgical approaches, including robotic (18 patients), right thoracotomy (6 patients), and sternal (15 patients). Three patients have required valve replacement: 1 at the initial operation, 1 because of dehiscence of the annuloplasty ring, and 1 after subsequent rupture of a previously normal native chorda. At follow-up (median, 12 months), 92% (33/36) of the remaining patients had an intact mitral repair with no to mild regurgitation, 8.3% (3/36) of patients had moderate regurgitation, and 92% of all patients (36/39) were in New York Heart Association class I. There were no deaths. CONCLUSIONS: Myxomatous mitral regurgitation due to posterior leaflet insufficiency can be repaired without leaflet resection by placement of neochordae. This repair technique is effective and is readily accomplished by traditional and minimally invasive surgical approaches.
Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/cirurgia , Ecocardiografia , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/epidemiologia , Prolapso da Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/epidemiologia , Morbidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Recidiva , Reoperação , Estudos Retrospectivos , Robótica , Índice de Gravidade de Doença , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/cirurgiaRESUMO
Surgeries in general and cardiac procedures in particular are increasingly performed using catheter-based or minimally invasive techniques, often with sedation or general anesthesia. These new approaches require close cooperation and communication between the cardiologist and anesthesiologist to ensure patient safety. Anesthesia-related respiratory complications arising in the catheterization laboratory are more frequent and more severe than are seen in the operating room. The principals of safe anesthetic practice as they apply to procedures performed outside the operating room and suggestions to improve safety and outcome are reviewed in this article.