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Infection with the novel coronavirus, SARS-CoV2, produces the clinical syndrome COVID-19. COVID-19 is a systemic illness inducing hyperinflammation and cytokine storm affecting multiple organs including the myocardium which is reflected in elevated cardiac biomarkers such as troponin, lactate dehydrogenase, and creatinine kinase MB. Furthermore, COVID-19 has been implicated in increased predilection to thromboembolic phenomena. Hence, mortality in patients with associated cardiovascular disease has been higher compared with the cohort with no cardiovascular comorbidity. It is entirely unknown how remdesivir will change the facet of cardiovascular medicine and surgery. In the present constantly changing climate, this review of remdesivir and its association with cardiovascular disease is comprehensive as of June 17, 2020 and it highlights the science behind this drug and its potential implications to cardiovascular practice.
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OBJECTIVES: Only limited data is available on prosthetic valve sparing aortic root replacement after aortic valve replacement. The aim of the present study was to assess the short- and midterm outcomes of the patients who underwent such procedures. METHODS: From June 2004 to March 2018, 21 patients underwent this procedure. The mean age was 51.2 ± 10.2 years with a male predominance (85.7%). The mean time interval from aortic valve replacement to the present surgery was 10.62 years. RESULTS: One patient died in immediate postoperative period who was taken up for emergency surgery-acute type A aortic dissection. Kaplan-Meier estimates of 1, 3, and 5 year survival were 95.2% ± 0.04%, 85.7% ± 0.07% and 85.7% ± 0.07%, respectively. No cardiac or aortic reinterventions were performed during follow up with a 100% freedom from reoperation at 5 years. Fifteen patients (71.43%) had aortopathy and had borderline pathology at the time of first surgery, with all of them having a tear either in the aortic sinuses or pervious aortotomy site. CONCLUSION: The favorable short and midterm results suggests that prosthetic valve sparing aortic root replacement is a valid option when possible. Utmost care has to be taken at the primary surgery especially in patients with aortopathy, trying to avoid the need for a second surgery.
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Disección Aórtica , Implantación de Prótesis Vascular , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Adulto , Disección Aórtica/cirugía , Aorta/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Acute type A aortic dissection remains one of the most challenging condition in cardiothoracic surgery, with a high mortality rate. Various improvements and innovations have happened over the years to better the outcome of this lethal condition. The frozen elephant trunk prosthesis has been developed to negate the long-term complications of acute type A aortic dissection, but at the cost of increased morbidity compared to hemiarch replacement. Although hemiarch and total arch replacement seem have less morbidity than the frozen elephant trunk technique, they do not address the long-term complications of the distal dissected aorta. Few surgeons now suggest hybrid aortic arch repair as a solution for acute type A aortic dissection. The long-term results need to be studied in all procedures before standardizing them. Although multiple strategies are evolving, the short-term goal of acute type A aortic dissection has not changed: to save the patient's life. The surgical strategy has to be tailored according to the patient's condition and the surgeon's experience.
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Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , HumanosAsunto(s)
Insuficiencia de la Válvula Aórtica , Seno Aórtico , Válvula Aórtica , Humanos , MasculinoRESUMEN
Left main coronary artery disease (LMCAD) has low incidence but foreshadow a high prognostic risk merely due to the myocardial territory it supplies. Coronary artery bypass grafting (CABG) has been the standard of treatment for LMCAD. Recently, two major trials-NOBEL and EXCEL-with contradicting results have been published. I will not wade into the accusations of malfeasance, but the bottom line is that, superiority of percutaneous coronary interventions (PCI) to CABG is yet to be proved. Heart-team approach has been discussed in every aspect, but in real-world scenario, to what extent, and in what manner the same is practised, remains a question. We need an objective type of heart-team approach than a subjective heart-team approach.
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Malperfusion syndrome results from end-organ ischemia in the setting of an aortic dissection. Malperfusion syndrome can affect any vascular bed with mesenteric malperfusion (MMP) being the most challenging associated with a 3- to 4-fold increase in mortality in both acute type A and B aortic dissections. The incidence MMP is between 66% and 100% in different literature. The insidious onset of MMP, among the different ischemic end-organ complications, makes it a challenge for diagnosis and management. The management of MMP is still a polemic, as to whether initially the aortic repair to be done or to restore the mesenteric perfusion. The approach for acute type A aortic dissection with MMP includes initial central repair, endovascular repair followed by central repair or simultaneous repair. Endovascular remains the main mode of treatment for acute type B aortic dissection with MMP. With respect to the variation in presentation and degree of ischemia, a patient-specific approach is required for treating this condition.
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Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Hemodinámica , Isquemia Mesentérica/cirugía , Oclusión Vascular Mesentérica/cirugía , Circulación Esplácnica , Procedimientos Quirúrgicos Vasculares , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/mortalidad , Disección Aórtica/fisiopatología , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/fisiopatología , Humanos , Incidencia , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/mortalidad , Isquemia Mesentérica/fisiopatología , Oclusión Vascular Mesentérica/diagnóstico por imagen , Oclusión Vascular Mesentérica/mortalidad , Oclusión Vascular Mesentérica/fisiopatología , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Síndrome , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidadRESUMEN
Aorto-oesophageal fistulae represent <10% of all aortoenteric fistulae and occur in 1.9% of patients who undergo thoracic endovascular aortic repair for treatment of thoracic aortic aneurysms. Untreated patients have a mortality close to 100%. A 74-year-old man had aorto-oesophageal fistulae secondary to thoracic endovascular aortic repair. He had a functioning left internal thoracic artery graft to the left anterior descending artery and a calcific distal aortic arch. He underwent replacement of the thoracic aorta and sealing of the fistulous tract with omentum, and the latter was used to wrap the neoaorta.
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Aneurisma de la Aorta Torácica/cirugía , Enfermedades de la Aorta/cirugía , Procedimientos Endovasculares/efectos adversos , Fístula Esofágica/cirugía , Epiplón/trasplante , Complicaciones Posoperatorias/cirugía , Anciano , Aorta Torácica , Enfermedades de la Aorta/complicaciones , Fístula Esofágica/etiología , Humanos , Masculino , Complicaciones Posoperatorias/etiología , StentsRESUMEN
When the ascending aorta and aortic arch must be replaced with a vascular graft, two separate grafts are often required to reconstruct a more anatomically configured aorta. We describe a method of graft tailoring that will result in a more natural shape of the neoaorta, avoiding kinking at the junction of the ascending aorta and the aortic arch.
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Anastomosis Quirúrgica/métodos , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Prótesis Vascular , HumanosRESUMEN
Entrapment of a guidewire during coronary artery interventions is rare and requires prompt treatment. A 52-year-old man underwent a primary percutaneous transluminal coronary angioplasty to the left anterior descending artery. A fractured guidewire was retained in the distal left anterior descending artery, which caused left ventricular dysfunction and total occlusion of the left anterior descending artery. He underwent endarterectomy with removal of the guidewire and bypass grafting. He had a normal postoperative period. The modalities for management of an entrapped guidewire are discussed.
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Catéteres Cardíacos , Puente de Arteria Coronaria , Oclusión Coronaria/cirugía , Remoción de Dispositivos/métodos , Endarterectomía , Intervención Coronaria Percutánea/instrumentación , Disfunción Ventricular Izquierda/cirugía , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/etiología , Oclusión Coronaria/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular IzquierdaAsunto(s)
Aneurisma Infectado/microbiología , Aneurisma Infectado/cirugía , Aneurisma de la Aorta Torácica/microbiología , Aneurisma de la Aorta Torácica/cirugía , Tuberculosis Cardiovascular/cirugía , Adolescente , Aneurisma Infectado/tratamiento farmacológico , Antituberculosos/uso terapéutico , Aneurisma de la Aorta Torácica/tratamiento farmacológico , Terapia Combinada , Humanos , Masculino , Tuberculosis Cardiovascular/tratamiento farmacológicoRESUMEN
A 14-year-old girl underwent classical Blalock-Taussig shunt at 5 months of age. Computed tomography evaluation showed "Adachi type H" pattern of aortic arch vessels with the right common carotid artery being anastomosed to the right pulmonary artery mistaking it for the right subclavian artery.
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Origin of a common carotid artery from a pulmonary artery is extremely rare, but isolated origin of an internal carotid artery from a pulmonary artery with intracardiac anomaly has not been reported before. We report a case of the left internal carotid artery arising from the left pulmonary artery in a case of tetralogy of Fallot. The possible embryologic mechanism and the surgical management of this unique lesion are described.
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Arteria Carótida Interna/anomalías , Arteria Pulmonar/anomalías , Tetralogía de Fallot/complicaciones , Anomalías Múltiples/diagnóstico , Femenino , Humanos , Adulto JovenRESUMEN
Calcific aorta is a disease of old age and is an independent risk factor for morbidity and mortality. Here, we present two patients with calcific aorta at different levels. One with a descending porcelain aorta, and modified Bentall's procedure was done. Second is a patient who is having a calcific ascending aorta and coronary artery. Coronary artery bypass grafting from left internal mammary artery to left anterior descending was done for the patient. The calcification and its morbidity had been discussed briefly.
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Modified Bentall's procedure done as part of the primary repair in Laubry-Pezzi syndrome is very rarely described in the literature. We present a case of a 33-year-old man with a subpulmonic venticular septal defect, aneurysmal dilatation of the aortic root and ascending aorta, with an associated patent ductus arteriosus, corrected by the incorporation of Yacoub's techique for ventricular septal defect closure with a modified Bentall's procedure and transpulmonary patent ductus arteriosus ligation. The postoperative course was unremarkable. Early follow-up reports show good biventricular function without residual ventricular septal defect or iatrogenic ventricular outflow tract obstructions.