RESUMEN
Endovascular stent-grafting of the aorta, as an alternative to open surgical techniques, is gaining in popularity everyday, especially in high-risk patients. Acute or chronic traumatic lesions of the descending aorta, especially after motor vehicle accidents, constitute such a group with a high-risk of morbidity and mortality. Here, we report the successful endovascular repair of acute and chronic traumatic thoracic aortic aneurysms after motor vehicle accidents in five patients.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Accidentes , Accidentes de Tránsito , Adulto , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motocicletas , Radiografía , StentsRESUMEN
Penetrating injuries to the neck have high morbidity and mortality rates because of the multiple vital structures present within this anatomic region. Endovascular treatment of an AV fistula of left common carotid artery and left subclavian vein subsequent to stab injury of the left supraclavicular region is presented in this case report.
Asunto(s)
Fístula Arteriovenosa/diagnóstico , Traumatismos de las Arterias Carótidas/diagnóstico , Lesiones del Hombro , Vena Subclavia/lesiones , Heridas Punzantes/complicaciones , Adulto , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/cirugía , Traumatismos de las Arterias Carótidas/complicaciones , Traumatismos de las Arterias Carótidas/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Procedimientos Quirúrgicos VascularesRESUMEN
Tuberculous pseudoaneurysm of the aorta is a rare disease that is uniformly fatal if not treated properly. The authors present a case of a recurrent tuberculous false aneurysm of the descending thoracic aorta that was treated surgically with excision and primary repair of the lesion. To their knowledge, this is the first reported case of recurrent disease after a successful surgical treatment.
Asunto(s)
Aneurisma Falso/microbiología , Aneurisma Infectado/microbiología , Aneurisma de la Aorta Torácica/microbiología , Tuberculosis Cardiovascular/microbiología , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/cirugía , Aorta Torácica/microbiología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Aortografía , Implantación de Prótesis Vascular , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Toracotomía , Tomografía Computarizada por Rayos X , Tuberculosis Cardiovascular/diagnóstico por imagen , Tuberculosis Cardiovascular/cirugíaAsunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Enfermedad de la Arteria Coronaria/terapia , Vasos Coronarios , Cuerpos Extraños , Angina de Pecho/etiología , Enfermedad de la Arteria Coronaria/complicaciones , Remoción de Dispositivos , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Esternón/cirugíaRESUMEN
A 67-year-old man operated on 8 years previously for type B aortic dissection presented with two episodes of massive hemoptysis. An aortobronchial fistula was suspected with spiral computed tomography angiography, and showed a small pseudoaneurysm corresponding to the distal anastomotic site. The patient underwent endovascular stent-graft implantation and is asymptomatic 8 months after the procedure.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Fístula Arterio-Arterial/cirugía , Hemoptisis/cirugía , Anciano , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Fístula Arterio-Arterial/diagnóstico por imagen , Implantación de Prótesis Vascular , Hemoptisis/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Stents , Tomografía Computarizada por Rayos XAsunto(s)
Angioplastia Coronaria con Balón , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/terapia , Disección Aórtica/diagnóstico , Disección Aórtica/terapia , Stents , Enfermedad Aguda , Anciano , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/patología , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/patología , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Intraoperative coronary angiography has always been favoured by cardiac surgeons. Thermal coronary angiography (TCA) is a useful method for intraoperative control of graft patency. It detects heat differences between tissues, provides easy-to-interpret angiographic images and even measures the flow of the grafts quantitatively. METHODS: Between January 2000 and January 2002, TCA has been used in scheduled coronary bypass operations. Upon completion of each distal anastomosis, the perfusion of the distal arterial tree from the graft was evaluated with a thermal camera. RESULTS: TCA was applied to 1401 patients, mean age 60.97+/-9.61 years, who underwent simple coronary artery bypass grafting (CABG) procedures. A total of 4105 thermal images were obtained including 2161 venous, 1355 single internal thoracic artery (ITA), 56 bilateral ITA and 477 radial artery grafts. Image quality was not sufficient in 34 grafts (1.57%) due to either deep intramyocardial vessels or excessive epicardial fat tissue. Technical failures in three ITA anastomoses were detected and revised before the cross-clamp was removed. Flow-restricting lesions distal to the anastomosis on the left anterior descending artery (LAD) in nine patients were managed with a secondary distal bypass graft (five patients) or plaque splitting and anastomotic revision (four patients). Endarterectomy was combined in seven patients since the graft flow and the distal visualization was not satisfactory, although the anastomoses were performed on a good lumen. Angiographically undetected diagonal arteries were revascularized in 11 patients with totally occluded LAD vessels. CONCLUSION: Thermal imaging provides decisive coronary angiographies, and detects the perfusion area and flow of the implanted graft. It allows real-time detection of technical failures, reveals unexpected occluding plaques or any kind of flow-restricting lesions, and gives the chance of refinement of the anastomosis during the arrest period. We believe that the thermal imaging technique is a safe, noninvasive and feasible method to document the quality of the myocardial revascularization intraoperatively.
Asunto(s)
Angiografía Coronaria/métodos , Puente de Arteria Coronaria/métodos , Oclusión de Injerto Vascular/diagnóstico , Cuidados Intraoperatorios/métodos , Termografía/métodos , Grado de Desobstrucción Vascular , Anciano , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/cirugía , Endarterectomía/métodos , Oclusión de Injerto Vascular/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Termografía/instrumentaciónRESUMEN
Treatment of chronic atrial fibrillation with intraoperative radiofrequency ablation is gaining more acceptance in patients with rheumatic valve disease. This article reports a case of fatal atrio-esophageal fistula after radiofrequency ablation in a patient with rheumatic mitral and aortic valve disease with chronic atrial fibrillation.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Fibrilación Atrial/cirugía , Ablación por Catéter/efectos adversos , Fístula Esofágica/etiología , Prótesis Valvulares Cardíacas , Estenosis de la Válvula Mitral/cirugía , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Ablación por Catéter/métodos , Enfermedad Crónica , Terapia Combinada , Electrocardiografía , Fístula Esofágica/diagnóstico , Esofagoscopía , Resultado Fatal , Femenino , Atrios Cardíacos/patología , Humanos , Persona de Mediana Edad , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: Endovascular treatment of aortic aneurysms is getting popular in our country due to its less invasive nature and shortened hospital stay. The initial experience with endovascular stent-graft implantation procedures to treat abdominal aortic aneurysms and their results were evaluated retrospectively in this study. METHODS: Eight patients with abdominal aortic aneurysms were treated with endovascular stent grafts. Seven patients were male and 1 was female with the mean age of 63.13+/-9.23 (48-72) years. Six patients were considered not proper for conventional surgical treatment. RESULTS: The procedure was converted to conventional surgery in one patient due to traumatic rupture of the iliac artery during the intervention. Type I endoleak was detected in 1 patient in the first month and was treated successfully by balloon dilatation of the proximal neck. Type II endoleak in two patients resolved spontaneously in the postoperative follow-up. No mortality was occurred. The mean intensive care unit stay was 24.57+/-10.37 (20-48) hours, mean hospital stay was 4.00+/-1.83 (3-8) days, and mean use of blood and blood products was 456.25+/-722.81 ml, excluding the patient treated by conventional surgery. The mean follow-up period was 9.36+/-3.75 (4-15) months. CONCLUSION: Endovascular treatment of abdominal aortic aneurysms is a good therapeutic alternative with low morbidity even in complicated cases. More studies are needed to enlighten the safety, effectiveness and durability of this therapeutic modality.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Stents , Procedimientos Quirúrgicos Vasculares , Anciano , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Recurrence of ductal patency is a rarely encountered complication in surgical repair of patent ductus arteriosus (PDA). An adult patient with ductal recurrency underwent closure of ductus by using cardiopulmonary bypass via transpulmonary approach. She had significant improvement of symptoms and no residual shunt or pseudoneurysm seven months after surgery.
Asunto(s)
Puente Cardiopulmonar , Conducto Arterioso Permeable/cirugía , Adulto , Oclusión con Balón , Conducto Arterioso Permeable/diagnóstico por imagen , Ecocardiografía Transesofágica , Femenino , Humanos , Recurrencia , ReoperaciónRESUMEN
BACKGROUND: Repetitive procedures usually take place in the natural course of coronary heart disease. The aim of this study was to evaluate the risk factors, which affect coronary bypass reoperations, and to compare them with the postoperative results of the coronary first operations and the reoperations. METHODS: Between January 1995 and January 2000, coronary reoperations were performed in 104 cases (Coronary reoperations group) by the same surgical team. Ninety-nine of them were the first, 3 were the second and 2 were the third reoperations in this group. At the same period of time, 3609 patients underwent coronary bypass procedure as the first operation (Coronary 1. operation group). Eighty-seven patients were male (83.65%), 17 were female (16.35%) and the mean age was 60.82 +/- 9.49 in reoperation group; while among 2916 patients 2223 were male (80.8%), 693 were female (19.2%) and the mean age was 60.37 +/- 9.58 in the first operation group. RESULTS: Incidence of prolonged ventilation (p = 0.0001), renal dysfunction requiring dialysis (p = 0.01), need for intraaortic balloon pump (p = 0.0001) and prolonged intensive care unit (p = 0.01) and hospital stay (p = 0.01) were significantly higher in reoperation group. The mortality rate was 9.62% in the reoperation group while it was 2.2% in the first operation group (p = 0.0001). CONCLUSIONS: The high morbidity and mortality of coronary bypass reoperations can be reduced to acceptable levels accordingly with early therapy prior to ventricular dysfunction and clinical deterioration that will improve the outcome in these patients.