RESUMO
The presence of stroke in patients with type A acute aortic dissection confers worse clinical outcomes and represents a therapeutic dilemma. While emergency surgical repair is the ideal management strategy, the risk of further cerebral insult is a cause of concern, especially in the elderly moribund patient, where delayed repair or a conservative approach may be considered. A 67-year-old female presented with chest pain and left-sided hemiparesis and was diagnosed with extensive type A acute aortic dissection and ischaemic stroke secondary to right common carotid artery stenosis. She underwent two major operations (emergency dissection repair and hemicraniectomy) and sustained several complications. Despite her eventful postoperative recovery, she was discharged after 6 weeks to a neurorehabilitation unit with a mild neurological deficit. Due to subsequent pulmonary complications, the patient died 5 weeks later. The present report appraises the current evidence on the management of patients with type A acute aortic dissection presenting with neurological sequelae.
Assuntos
Dissecção Aórtica , Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/cirurgia , Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Feminino , Humanos , Acidente Vascular Cerebral/complicações , Procedimentos Cirúrgicos VascularesRESUMO
We present a case of a 70-year-old woman with exertional shortness of breath. A transthoracic echocardiogram showed a large mass on the ventricular side of the pulmonary valve. The anatomy of the mass was additionally investigated with a transesophageal echocardiogram, which delineated the anatomical details of the structure. The mass was surgically excised, and histopathology confirmed a cardiac papillary fibroelastoma.
Assuntos
Fibroelastoma Papilar Cardíaco , Fibroma , Neoplasias Cardíacas , Valva Pulmonar , Idoso , Ecocardiografia Transesofagiana , Feminino , Fibroma/diagnóstico por imagem , Fibroma/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/cirurgiaRESUMO
Accessory mitral valve (AMV) is an unusual congenital cardiac anomaly typically presenting with left ventricular outflow obstruction. We describe a patient with AVM presenting with transient ischemic attack.
Assuntos
Cardiopatias Congênitas/complicações , Ataque Isquêmico Transitório/etiologia , Valva Mitral/anormalidades , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Diagnóstico Diferencial , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Seguimentos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Humanos , Ataque Isquêmico Transitório/diagnóstico , MasculinoRESUMO
Percutaneous cardiovascular device implantation plays an important and increasing role in the treatment of congenital heart disease. Device related complications of malposition and embolisation are uncommon and can usually be retrieved by catheter. We present two interesting cases in which migrated devices resulted in thoracic aortic obstruction; both were refractory to percutaneous retrieval. Device retrieval was achieved by thoracotomy and utilising partial left heart bypass because of specific concerns of distal perfusion. Our experience is presented.
