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1.
Ann Palliat Med ; 10(9): 10102-10107, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628930

RESUMO

Aortic dissection (AD) is a cardiovascular emergency that seriously endangers human health. It has acute onset, dangerous condition and many complications. The mortality without treatment is very high, and the mortality within 24 hours is 25%. AD combined with mesenteric artery malperfusion has an incidence of only 5%, but a hospital mortality rate of up to 33-100%. Mesenteric artery malperfusion increases the mortality of acute AD by 3-4 times. Even after complete revascularization, ischemia/reperfusion injury still leads to frequent postoperative deaths. In this paper, we describe the case of a 60-year-old man with type A aortic dissection and mesenteric artery malperfusion who developed refractory gastrointestinal bleeding postoperatively. He was cured after conservative, interventional, and surgical hemostasis, finally recovered and discharged. This case provides a certain reference value for clinical treatment of such diseases. Aortic dissection combined with mesenteric artery malperfusion is a significant surgical challenge. Ischemia/reperfusion injury may still occur after thoracotomy, even when the blood supply is normalized. Immediate surgery is recommended for preventing death from acute AD, but the strategy should be modified according to the specific symptoms and ischemic severity. In addition, interventional/surgical treatment should be performed more actively in patients with refractory gastrointestinal bleeding after cardiac surgery and a poor response to conservative treatment.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Doença Aguda , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Artérias Mesentéricas , Pessoa de Meia-Idade
2.
Braz J Cardiovasc Surg ; 36(4): 535-549, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34617429

RESUMO

Thoracic aortic diseases contribute to a major part of cardiac surgeries. The severity of pathologies varies significantly from emergency and life-threatening to conservatively managed conditions. Life-threatening conditions include type A aortic dissection and rupture. Aortic aneurysm is an example of a conservatively managed condition. Pathologies that affect the arterial wall can have a profound impact on the presentation of such cases. Several risk factors have been identified that increase the risk of emergency presentations such as connective tissue disease, hypertension, and vasculitis. The understanding of aortic pathologies is essential to improve management and clinical outcomes.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Aneurisma Aórtico , Procedimentos Cirúrgicos Torácicos , Aneurisma Dissecante/cirurgia , Aorta , Aneurisma da Aorta Torácica/cirurgia , Humanos
3.
BMC Genomics ; 22(1): 724, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620091

RESUMO

BACKGROUND: Many studies on long chain non-coding RNAs (lncRNAs) are published in recent years. But the roles of lncRNAs in aortic dissection (AD) are still unclear and should be further examined. The present work focused on determining the molecular mechanisms underlying lncRNAs regulation in aortic dissection on the basis of the lncRNA-miRNA-mRNA competing endogenous RNA (ceRNA) network. METHODS: This study collected the lncRNAs (GSE52093), mRNAs (GSE52093) and miRNAs (GSE92427) expression data within human tissue samples with aortic dissection group and normal group based on Gene Expression Omnibus (GEO) database. RESULTS: This study identified three differentially expressed lncRNAs (DELs), 19 differentially expressed miRNAs (DEmiRs) and 1046 differentially expressed mRNAs (DEGs) identified regarding aortic dissection. Furthermore, we constructed a lncRNA-miRNA-mRNA network through three lncRNAs (including two with up-regulation and one with down-regulation), five miRNAs (five with up-regulation), as well as 211 mRNAs (including 103 with up-regulation and 108 with down-regulation). Simultaneously, we conducted functional enrichment and pathway analyses on genes within the as-constructed ceRNA network. According to our PPI/ceRNA network and functional enrichment analysis results, four critical genes were found (E2F2, IGF1R, BDNF and PPP2R1B). In addition, E2F2 level was possibly modulated via lncRNA FAM87A-hsa-miR-31-5p/hsa-miR-7-5p or lncRNA C9orf106-hsa-miR-7-5p. The expression of IGF1R may be regulated by lncRNA FAM87A-hsa-miR-16-5p/hsa-miR-7-5p or lncRNA C9orf106-hsa-miR-7-5p. CONCLUSION: In conclusion, the ceRNA interaction axis we identified is a potentially critical target for treating AD. Our results shed more lights on the possible pathogenic mechanism in AD using a lncRNA-associated ceRNA network.


Assuntos
Aneurisma Dissecante , MicroRNAs , RNA Longo não Codificante , Redes Reguladoras de Genes , Humanos , MicroRNAs/genética , RNA Longo não Codificante/genética , RNA Mensageiro/genética
4.
Angiol Sosud Khir ; 27(3): 34-45, 2021.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-34528587

RESUMO

AIM: The study was aimed at assessing the in-hospital results of aortic arch endoprosthetic repair using different variants of endovascular supraaortic debranching. PATIENTS AND METHODS: The analysis included 27 patients subjected within the framework of aortic arch endoprosthetic repair to various types of supraaortic endobranching, including the technique of parallel prostheses and implantation of fenestrated stent grafts. We analysed the clinical and morphological status of patients prior to operation, peculiarities of the intervention (type of debranching and Ishimaru's classification zones in which the reconstruction was performed) and in-hospital results of treatment. RESULTS: The patients' mean age amounted to 66 years. The main nosology (70%) was an aortic aneurysm. Nearly in 30% of cases, the operation was performed emergently for acute aortic syndrome. The main causes of refusal from the traditional prosthetic repair included chronic kidney disease (22.5%), chronic obstructive pulmonary disease (11%), acute cerebral ischaemia within the previous 6 months (15%). The technical success rate of the operation was achieved in 100% of cases. The average duration of the intervention amounted to 226 min, with the mean blood loss equalling 355 ml. The majority of reconstructions were performed in zones 1 and 2 according to Ishimaru (59 and 33%, respectively), in 2 (7%) patients prosthetic repair was performed in zone 0. The total number of the aortic branches involved into reconstruction amounted to 45. Intervention-related complications included 3 (11%) cases of acute cerebral circulation impairment, 2 (7.4%) aortic branch occlusions, and 1 (3.7%) type II endoleak. The in-hospital and 30-day mortality rates amounted to 3.7 and 7.4%, respectively. CONCLUSION: Aortic arch endoprosthetic repair using supraaortic endobranching is considered to be an effective alternative method of treatment for patients with various pathology of the aortic arch and contraindications to traditional prosthetic repair involving artificial blood circulation.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
5.
Angiol Sosud Khir ; 27(3): 140-145, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528598

RESUMO

Total left-sided haemothorax is a rare and severe complication of acute DeBakey type III aortic dissection. The primary aim of treatment is immediate arrest of haemorrhage and stabilization of the haemodynamic status of the patient. Endovascular isolation of the ruptured thoracic portion of the aorta using a stent graft (TEVAR) has recently become the 'gold standard' in treatment of acute, rupture-complicated aortic dissections of this localization. Described in the article is a clinical case report concerning successful endovascular treatment of a seriously ill patient with dissection of the thoracoabdominal portion of the aorta, rupture and massive haemorrhage into the left pleural cavity. The patient underwent endoprosthetic repair of the descending aorta in the setting of a hybrid operating room under local anaesthesia, followed by drainage of the left pleural cavity. The postoperative period was uneventful with no complications. The patient was discharged in a satisfactory condition on day 10 after the emergency surgical intervention. An important advantage of TEVAR for aortic ruptures is a minimally invasive nature of the procedure, consisting in no need to perform either sternothoracotomy or to connect a heart-lung machine, thus decreasing surgical wound, reducing the risk of perioperative life-threatening haemorrhage, and contributing to early activation of the patient.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Hemotórax/diagnóstico , Hemotórax/etiologia , Hemotórax/cirurgia , Humanos , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento
6.
J Card Surg ; 36(11): 4238-4242, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34499373

RESUMO

BACKGROUND: To determine if racial disparities exist between African Americans (AA) and Non-Hispanic Whites (NHW) for patients undergoing repair of acute type A aortic dissection (ATAAD) at a rural tertiary academic medical center. METHODS: There were 215 consecutive AA and NHW patients who underwent ATAAD repair at our institution from 1999 to 2019 included in a retrospective analysis of our Society of Thoracic Surgeons Adult Cardiac Surgery Database. Statistical analysis was performed with a p value of less than .05 considered statistically significant. RESULTS: Patients undergoing ATAAD repair were 47% AA despite comprising only 27% of the total population in our region. AAs were significantly younger (54.0 vs. 61.2 years), were more likely to be hypertensive (94.1% vs. 79.7%), had higher creatinine levels (1.7 vs. 1.1 mg/dL), and higher body mass index (30.8 vs. 28.1 kg/m2 ) (all p values < .006). There were no significant differences in type of repair or intraoperative variables. A logistic regression analysis showed AAs had an increased rate of postoperative acute renal failure not requiring hemodialysis when compared to NHWs (20.8% vs. 10.6%, p value = .042). Thirty-day mortality was not significantly different (15.7% vs. 13.4%) nor was 1-year survival (78% vs. 79%) in AAs and NHWs, respectively. CONCLUSIONS: Despite AAs having more medical comorbidities at presentation, there were no differences in short- and intermediate-term survival. In our catchment of 1.8 million people, AAs appear to undergo ATAAD repair at a disproportionate rate versus NHWs. These findings may alter strategies for surveillance and prevention of aortic disease in this high-risk population.


Assuntos
Aneurisma Dissecante , Centros Médicos Acadêmicos , Adulto , Aneurisma Dissecante/cirurgia , Humanos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
7.
Medicina (Kaunas) ; 57(9)2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34577818

RESUMO

Acute type A aortic dissection (ATAAD) is an indisputable emergency with very poor outcomes without surgical treatment. Although the aortic arch is often involved in the aortic dissection, its optimal management during surgical therapy remains uncertain. A conservative tear-oriented approach has traditionally been adopted, limiting the procedure to the ascending aorta (or hemiarch) replacement. However, dilation of the residual dissected aorta and subsequent rupture may occur, requiring further intervention in the future. In the last two decades, the frozen elephant trunk (FET) technique has become a valid and attractive option to treat aortic disease when the arch and the thoracic aorta are involved, both in elective and in emergency settings. Here, we report a review of the contemporary literature regarding the short- and long-term outcomes of the FET technique in ATAAD repair.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Doença Aguda , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Humanos , Estudos Retrospectivos
8.
Medicina (Kaunas) ; 57(9)2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34577832

RESUMO

Background and Objectives: Aortic arch disease is still a high-risk surgical challenge despite major advances both in surgical and anesthesiological management. A combined surgical and endovascular approach has been proposed for aortic arch disease treatment to avoid hypothermia and circulatory arrest in high-risk patients. Materials and Methods: Between June 2004 and June 2021, 112 patients were referred to our department for aortic arch surgery; 38 (33.9%) patients underwent supra-aortic debranching and endovascular treatment. Of these, 21 (55%) patients underwent type I aortic arch hybrid debranching procedure and in 17 (45%) patients a type II aortic arch hybrid debranching procedure was performed. None of the patients were emergent. Results: No intra-operative deaths were recorded. In the type I aortic arch hybrid debranching patients' group, one patient died at home waiting the endovascular step, one developed ascending aortic dissection and another one developed a pseudoaneurysm at the site of the debranching at follow-up. In the type II aortic arch hybrid debranching patients' group, left carotid artery branch closure was detected at follow-up in one patient. Thirty day/in-hospital rates of adverse neurological events for both the surgical and endovascular procedures were 3% for minor stroke, with no permanent neurological deficit and 0% for permanent paraplegia/paraparesis. In 100% of the cases, the endovascular step succeeded and the type Ia endoleak rate was 0%. Conclusions: Hybrid arch surgery is a valuable option for aortic arch aneurysm treatment in patients with high surgical risk. The choice of aortic arch debranching between type I or type II is crucial and depends on anatomic and clinical patient characteristics. Further larger scale studies are needed to better define the advantages of these techniques.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Humanos , Estudos Retrospectivos , Fatores de Risco , Stents , Resultado do Tratamento
9.
BMJ Case Rep ; 14(9)2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521744

RESUMO

The standard endovascular treatment for ruptured dissecting aneurysm is a parent artery occlusion. However, this treatment is unsuitable when the artery of the lesion gives off perforating vessels that supply blood to critical regions or when the collateral flow cannot be expected due to the sacrifice of the parent artery. Here, we present an infrequent case of ruptured dissecting aneurysm on P1 segment of the posterior cerebral artery. The aneurysm had little sac for coiling and the artery of the lesion had some perforator branches; thus, we selected the monotherapy with three overlapping low-profile visualised intraluminal support stents as radical treatment, which resulted in prompt obliteration of the aneurysm. The patient was fully recovered at 3 months after the procedure. Previous studies have reported the effectiveness of multiple stents alone for dissecting aneurysms, whereas this case showed that overlapping stents may also be effective on the P1 segment.


Assuntos
Aneurisma Dissecante , Aneurisma Roto , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento
11.
Acta Clin Croat ; 60(1): 115-119, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34588730

RESUMO

Acute aortic dissection (AAD) is a serious medical emergency that requires early diagnosis and rapid treatment. Whether cardiac troponin could be an independent prognostic marker in patients with type A AAD is still unknown. We systematically searched Medline and Scopus to identify all observational cohort studies published before January 2020 that compared outcome (in-hospital mortality) in patients with type A AAD with and without troponin elevation on admission. Four studies with 412 patients were included in final analysis (median age 59 years, 65% of males). A total of 124 (30%) patients died during in-hospital stay, and 73% underwent surgery. Elevated troponins (39.6% of patients) were associated with an increased risk of short-term mortality (adjusted odds ratio 1.26; 95% confidence interval 1.08-1.47), with low heterogeneity among studies (I2 =29.81%). Elevated troponins on admission are independently associated with increased in-hospital mortality in type A AAD.


Assuntos
Aneurisma Dissecante , Doença Aguda , Aneurisma Dissecante/diagnóstico , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Troponina
12.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(8): 962-966, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34590564

RESUMO

OBJECTIVE: To investigate the clinical characteristics as well as short-term and long-term prognostic factors of patients with Stanford type B aortic dissection (TBAD) with hypertension. METHODS: Patients with TBAD who received thoracic endovascular aortic repair (TEVAR) admitted to Xiangyang Central Hospital from January 2014 to December 2018 were enrolled. The baseline data of patients admitted to the hospital were collected through the case management system, including gender, age, underlying diseases (hypertension, diabetes, coronary heart disease), smoking history, drinking history, duration of pain, vital signs at admission [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP)], laboratory results [white blood cell count (WBC), platelet count (PLT), neutrophil/lymphocyte ratio (NLR), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ascending aorta diameter], etc. The clinical characteristics of TBAD patients with hypertension were analyzed. Logistic regression model and Cox proportional risk model were used to analyze the impact of hypertension on the short-term and long-term all-cause deaths after TEVAR in TBAD patients. RESULTS: Among 227 TBAD patients, 160 cases (70.5%) were complicated with hypertension, while 67 cases (29.5%) were not. The average age, the proportion of diabetes and coronary heart disease, and the level of SBP, DBP and SCr at admission of TBAD patients with hypertension were higher than those of TBAD without hypertension [age (years old): 53.1±11.9 vs. 42.8±14.1, combined with diabetes: 8.8% vs. 1.5%, combined with coronary heart disease: 6.3% vs. 0%, SBP (mmHg, 1 mmHg = 0.133 kPa): 147.9±18.1 vs. 136.9±15.2, DBP (mmHg): 93.9±11.9 vs. 89.1±13.8, SCr (µmol/L): 97.8±25.4 vs. 89.8±23.6, all P < 0.05]. The short-term mortality of TBAD with hypertension group was significantly higher than that of TBAD without hypertension group [6.3% (10/160) vs. 0% (0/67), χ2 = 4.386, P = 0.036]. 227 patients with TBAD were followed up for 3-66 months, with a median follow-up time of 25 months. There was no significant difference in long-term mortality between TBAD patients with and without hypertensive during discharge follow-up [13.1% (21/160) vs. 9.0% (6/67), χ2 = 0.784, P = 0.376]. Further multivariate Logistic regression analysis and Cox regression analysis did not indicate that hypertension was an independent risk factor for short-term and long-term death in TBAD patients [odds ratio (OR) and 95% confidence interval (95%CI) were 13.477 (0.541-330.215), 1.012 (0.990-1.035), both P > 0.05]. Age and HR were independent risk factors for the short-term mortality of TBAD patients [OR and 95%CI were 15.287 (1.051-226.415), 0.026 (0.002-0.840), both P < 0.05]. Age, PLT and D-dimer were independent risk factors for the long-term mortality of TBAD patients [OR and 95%CI were 1.808 (1.205-2.711), 0.555 (0.333-0.924), 1.482 (1.035-2.122), respectively, all P < 0.05]. CONCLUSIONS: The TBAD patients with hypertension have older age, high rates of diabetes or coronary heart disease. However, hypertension is not an independent risk factor for short-term and long-term mortality in TBAD patients.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Hipertensão , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Humanos , Hipertensão/complicações , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
BMJ Case Rep ; 14(9)2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34580135

RESUMO

Spontaneous renal artery dissection is a rare condition with an often non-specific presentation, resulting in a challenging diagnosis for clinicians. This is the case of a 39-year-old man who presented with an acute-onset right flank pain, mild neutrophilia and sterile urine. CT of abdomen and pelvis showed a patchy hypodense area in the right kidney originally thought to represent infection. He was treated as an atypical pyelonephritis with antibiotics and fluids. When his symptoms failed to improve, a diagnosis of renal infarction was considered and CT angiogram of the aorta revealed a spontaneous renal artery dissection. He was managed conservatively with systemic anticoagulation, antihypertensive treatment and analgesia and discharged home with resolution of his symptoms and normal renal function.


Assuntos
Aneurisma Dissecante , Nefropatias , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Dissecação , Humanos , Infarto/diagnóstico por imagem , Masculino , Artéria Renal/diagnóstico por imagem
14.
Kyobu Geka ; 74(10): 775-780, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34548445

RESUMO

Redo or repetitive surgeries for residual distal dissection after the limited proximal aortic repair for Stanford type A acute aortic dissection remains challenging. Depending on targeted aortic segments, the strategy including a median or lateral approach and one or two-staged repairs would be determined with careful consideration for patient's age and conditions of the brain, heart, lung, liver, and kidney. Given the aortic arch involved, for young and low-risk patients, an aggressive one-stage repair of the entire arch to descending aorta through a left thoracotomy is attempted. In particular, with our left antero-axillary approach, it would be much easier with a better surgical field from the ascending aorta to the descending/thoracoabdominal aortic segments. Meanwhile, two-staged repairs are more beneficial for elderly higher-risk patients, which consists of the first total arch replacement (TAR) with elephant trunk (ET) through a median sternotomy followed secondly by an open descending/thoracoabdominal aortic repair through a left thoracotomy or by less-invasive thoracic endovascular aortic repair. In additions, TAR with a frozen ET (FET) has been a new option for downstream aortic remodeling. Consequently, in the initial repair, TAR with FET or ET has been more aggressively performed to prevent such troublesome behaviors of the residual aortic dissection.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Dilatação , Humanos
15.
Kyobu Geka ; 74(10): 781-786, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34548446

RESUMO

It is not uncommon for aortic regurgitation to occur after ascending aortic replacement. There are various causes of the aortic valve insufficiency after ascending aorta replacement. Among them, most common is a reoperation after open repair of Stanford type A acute aortic dissection. Although it is becoming safer to perform reoperative cardiac surgery, the risks of operative mortality and morbidity is still higher than those of non-reoperative cardiac surgeries. In order to improve the mortality and morbidity rate, we should select the best strategies with a thorough preoperative evaluation. Moreover, a careful observation after the operation is required to find the complications, especially the patients who have the risk of aortic valve insufficiency.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Insuficiência da Valva Aórtica , Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Humanos , Complicações Pós-Operatórias , Reoperação
16.
J Card Surg ; 36(10): 3977-3980, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34338328

RESUMO

Although acute aortic dissections with bilateral carotid artery involvement are rare, they have serious morbidity and mortality rates. The most important strategy in cases with carotid involvement is to provide adequate cerebral perfusion during cardiopulmonary bypass. In this case, we presented, aortic dissection with bilateral carotid involvement was detected in the patient who was admitted to the emergency department with severe chest pain, vision loss, and left arm monoplegia, and the decision for surgery was made urgently. Selective cerebral perfusion was provided throughout the operation with direct bilateral carotid cannulation, in terms of being the fastest method and providing adequate cerebral flow. During the discharge period, full recovery was achieved in neurological deficits without any sequelae. We think that the technique we have applied in such a difficult and complicated case is the best strategy because it is fast and effective.


Assuntos
Aneurisma Dissecante , Aneurisma Dissecante/cirurgia , Ponte Cardiopulmonar , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/cirurgia , Artéria Carótida Primitiva , Cateterismo , Humanos
17.
J Card Surg ; 36(10): 3963-3967, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34338352

RESUMO

We report first in man implantations of the newly designed Evita-open-NEO hybrid prosthesis for complex aortic arch disease from three different countries in Asia-Pacific including instructions on how to proceed with perioperative coagulation management.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Humanos , Implantação de Prótese
18.
J Card Surg ; 36(10): 3854-3856, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34338372

RESUMO

Staged repair of the aortic arch and downstream aorta using the elephant trunk technique is widely accepted for extensive aortic disease. However, elephant trunk retrieval is challenging in patients with unclampable descending aorta caused by extreme aneurysmal dilation or surrounding tissue adhesion. Here, we introduce a new elephant trunk retrieval technique using the step-by-step aortic clamping in descending aortic replacement of dissecting aortic aneurysm. This technique is a safe and feasible method of elephant trunk retrieval that consists of staged clamping and intraoperative ultrasound assessment of blood flow in the aorta.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Constrição , Humanos
19.
J Card Surg ; 36(10): 3968-3970, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34351022

RESUMO

We report the case of a young woman who underwent cardiac transplantation from systemic lupus erythematosus affected donor and who developed a type A aortic dissection limited only to the graft aortic wall 9 years after.


Assuntos
Aneurisma Dissecante , Transplante de Coração , Lúpus Eritematoso Sistêmico , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Aorta , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações
20.
BMJ Case Rep ; 14(8)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433533

RESUMO

We present a 54-year-old Caucasian woman, who presented with acute symptomatic type B aortic dissection with deteriorating renal function. She was a known smoker with a 2-year history of dysphagia. CT angiography documented the artery of lusoria arising from the mid-thoracic aorta, aneurysmal dilation of her descending aorta, and kinetic and static flaps around her visceral ostia. The patient was managed by staged hybrid single lumen reconstruction and bilateral subclavian to carotid transpositions. During follow-up, there was no aortic rupture or retrograde type A dissection. There were no renal, visceral, cardiac, pulmonary or spinal complications. The patient went off her antihypertensive medication with a normal estimated glomerular filtration rate and accelerated aortic modulation.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia
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