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1.
Tex Heart Inst J ; 46(3): 225-228, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708710

RESUMO

Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. Four months after corrective surgery, she was doing well. We discuss the reperfusion phenomenon in our patient's case, as well as other considerations in this combination of congenital defects.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Síndrome de Turner/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Cateterismo Cardíaco , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Ecocardiografia , Feminino , Fluoroscopia , Humanos , Recém-Nascido , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia
2.
Pan Afr Med J ; 33: 312, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692927

RESUMO

Congenital malformations of the aortic arches are a heterogeneous group of diseases associated with developmental disorders of the primitive branchial arches during fetal life. The coarctation of the aorta is a common congenital vascular malformation which is a congenital narrowing of the aortic isthmus, a segment of the aorta between the left subclavian artery and the ductus arteriosus. The interruption of the aortic arch is considered by some authors as an extreme coarctation of the aorta, characterized by discontinuity between ascending and descending aorta. These abnormalities are integrated, in most cases, in the context of cardiac malformations from which they are indivisible. CT angiogram plays an essential role in the examination of these abnormalities, their preoperative assessment and their follow-up in the long term. We conducted a retrospective study of 42 patients undergoing CT angiogram following the detection of heart disease on echocardiography. CT angiogram was performed in 6 cases. The average age of patients was 2 years, ranging from 6 days to 14 years; a male predominance was reported with a sex ratio of 1,6. The main diseases were: coarctation of the aorta: 18 cases; hypoplasies of the aortic arch: 8 cases; interruptions of the aortic arch: 7 cases; abnormalities of the aortic arches: 9 cases. Some of these abnormalities were associated. Extracardiac abnormalities associated with congenital heart diseases are relatively frequent; multislice scanner allows for good analysis of the cardiac afferent and efferent pathways. CT complements echocardiogram for pre-treatment assessment of the main malformative diseases, especially for the detection of the associated extra-cardiac vascular abnormalities, thanks to its satisfactory tridimensional multiplanar exploration. It tends to supplant angiography in many pathological malformations for several reasons: it is less invasive; it provides high-resolution 3D images useful to surgeons; it established the anatomical diagnosis, assesses tracheal compression and any associated malformation; it guides surgical treatment.


Assuntos
Aorta Torácica/diagnóstico por imagem , Coartação Aórtica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Adolescente , Aorta Torácica/anormalidades , Criança , Pré-Escolar , Ecocardiografia/métodos , Feminino , Humanos , Imagem Tridimensional/métodos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
3.
Med Clin North Am ; 103(6): 1005-1019, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582001

RESUMO

Heritable thoracic aortic disease (HTAD) can have life-threatening consequences if not diagnosed early. Affected individuals and at-risk family members benefit from both cardiology and genetic evaluations, including genetic testing. Important information can be obtained through family history, medical history, and genetic testing to help guide management and assess risk. A genetic diagnosis can guide cardiovascular management (type and frequency of vascular imaging, timing of surgical intervention), risk assessment for arterial aneurysm/dissection, evaluation of nonvascular features, and familial testing.


Assuntos
Aorta Torácica/anormalidades , Doenças da Aorta , Testes Genéticos/métodos , Administração dos Cuidados ao Paciente/métodos , Doenças da Aorta/genética , Doenças da Aorta/terapia , Humanos , Medicina de Precisão/métodos
4.
J Cardiothorac Surg ; 14(1): 160, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500640

RESUMO

OBJECTIVES: Double aortic arch (DAA) is a rare congenital vascular malformation. This study aims to summarize the experience of diagnosis and surgical treatment for congenital double aortic arch. METHODS: The clinical data of 24 cases with double aortic arch (DAA) from January 2008 to January 2018 in our hospital was reviewed retrospectively. RESULTS: A total of 24 cases, including 12 patients with isolated DAA and 12 patients with DAA and associated intracardiac defects were identified. There were 14 males and 10 females, with an average age of 11 months. The associated intracardiac malformations included ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), tetralogy of Fallot (TOF), transposition of the great arteries (TGA), pulmonary stenosis (PS), and patent foramen ovale (PFO). Of the 12 patients with DAA and intracardiac malformations, 7 patients underwent intracardiac repair simultaneously, however, 3 patients underwent isolated double aortic arch correction. One patient with DAA and TGA underwent surgical correction of congenital vascular ring at the first stage, and the arterial switch operation was performed at the second stage. The clinical outcomes of 23 patients were promising, however, in one patient, parents decided not to do the surgery due to personal reasons. The average follow-up time was 35 months. CONCLUSIONS: Tracheal and esophageal compression are commonly seen in patients with DAA, however could be relieved significantly after surgery. In particular cases, the simultaneous intracardiac defects repair could be performed. Misdiagnosis was easily established with isolated echocardiography. Fortunately, the correct diagnosis of DAA and associated intracardiac defects could be established with the use of combined chest computed tomography.


Assuntos
Aorta Torácica/anormalidades , Imagem Tridimensional/métodos , Anel Vascular/diagnóstico , Procedimentos Cirúrgicos Vasculares/métodos , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Ecocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Anel Vascular/cirurgia
5.
Pediatr Cardiol ; 40(6): 1304-1313, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31338561

RESUMO

This study aimed to evaluate fetal echocardiographic parameters associated with neonatal intervention and single-ventricle palliation (SVP) in fetuses with suspected left-sided cardiac lesions. Initial fetal echocardiograms (1/2002-1/2017) were interpreted by the contemporary fetal cardiologist as coarctation of the aorta (COA), left heart hypoplasia (LHH), hypoplastic left heart syndrome (HLHS), mitral valve hypoplasia (MVH) ± stenosis, and aortic valve hypoplasia ± stenosis (AS). The cohort comprised 68 fetuses with suspected left-sided cardiac lesions (COA n = 15, LHH n = 9, HLHS n = 39, MVH n = 1, and AS n = 4). Smaller left ventricular (LV) length Z score, aortic valve Z score, ascending aorta Z score, and aorta/pulmonary artery ratio; left-to-right shunting at the foramen ovale; and retrograde flow in the aortic arch were associated with the need for neonatal intervention (p = 0.005-0.04). Smaller mitral valve (MV) Z score, LV length Z score, aortic valve Z score, ascending aorta Z score, aorta/pulmonary artery ratio, and LV ejection fraction, as well as higher tricuspid valve-to-MV (TV/MV) ratio, right ventricular-to-LV (RV/LV) length ratio, left-to-right shunting at the foramen ovale, abnormal pulmonary vein Doppler, absence of prograde aortic flow, and retrograde flow in the aortic arch were associated with SVP (p < 0.001-0.008). The strongest independent variable associated with SVP was RV/LV length ratio (stepwise logistical regression, p = 0.03); an RV/LV length ratio > 1.28 was associated with SVP with a sensitivity of 76% and specificity of 96% (AUC 0.90, p < 0.001). A fetal RV/LV length ratio of > 1.28 may be a useful threshold for identifying fetuses requiring SVP.


Assuntos
Ecocardiografia/métodos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Diagnóstico Pré-Natal , Adulto , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Valva Mitral/anormalidades , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Gravidez , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
6.
World J Pediatr Congenit Heart Surg ; 10(4): 464-468, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307306

RESUMO

OBJECTIVES: To review the outcomes of direct innominate artery cannulation for continuous cerebral perfusion used for repair of interrupted aortic arch (IAA) in a consecutive cohort of neonates regardless of weight. METHODS: Between September 1999 and April 2016, forty-four children with IAA (18 type A and 26 type B) underwent repair using continuous, hypothermic (18°C) low-flow cerebral perfusion via direct innominate artery cannulation. Associated cardiac lesions were truncus arteriosus (TA; 5), ventricular septal defect (VSD; 30), transposition of the great arteries (TGA; 1), unbalanced atrioventricular septal defect (1), double-inlet left ventricle (1), double-outlet right ventricle (3), and aortopulmonary window (APW; 5). Truncus arteriosus, single VSD, TGA, and APW were corrected while the other patients were palliated. RESULTS: Age at the time of surgery was 7 days (4-120 days) and weight 3.1 kg (2.1-5.8 kg). Selective cerebral perfusion was maintained in all patients. During the selective cerebral perfusion, perfusion flow rate was maintained at 30 mL/kg/min. Aortic cross-clamp time, low-flow, and total cardiopulmonary bypass time were 63 (40-116), 28 (17-41), and 108 (80-217) minutes, respectively. There were no deaths nor clinical evidence of neurological injury. Postoperative ventilation time, length of intensive care unit, and hospital stay were 3 (2-14), 5 (3-21), and 13 (6-27) days, respectively. Follow-up, complete at 84 months (24-221), revealed no late clinically evident neurologic sequelae nor innominate artery complications. CONCLUSIONS: Direct innominate arterial cannulation with continuous selective cerebral perfusion can be safely applied for repair of IAA even in low birth weight neonates. It is technically simple and associated with excellent clinical outcomes.


Assuntos
Aorta Torácica/anormalidades , Cateterismo/métodos , Circulação Cerebrovascular/fisiologia , Recém-Nascido de Baixo Peso , Perfusão/métodos , Malformações Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Angiografia , Aorta Torácica/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Resultado do Tratamento , Malformações Vasculares/fisiopatologia
7.
World J Pediatr Congenit Heart Surg ; 10(4): 469-474, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307310

RESUMO

BACKGROUND: We sought to evaluate the relationship between proximal arch hypoplasia and reintervention for left thoracotomy repair of coarctation of the aorta. METHODS: This was a retrospective review of 153 consecutive neonates and infants undergoing left thoracotomy and extended end-to-end repair of coarctation from January 1, 2000, to January 1, 2014, at a single center with exclusion of single ventricle-palliated patients. Primary outcome was reintervention evaluated with respect to five definitions of proximal arch hypoplasia. RESULTS: Median follow-up was 7.2 years. Reintervention occurred in eight (5.2%) patients, with 50% of patients undergoing re-intervention in the first six months after their index operation. Using Kaplan-Meier analysis and log-rank test, with hypoplasia defined by weight, hypoplasia was not associated with increased reintervention for arch size < patient weight (in kilograms; P = .24) or for arch size < patient weight (in kilograms) +1 (P = .02, higher freedom from reintervention in hypoplasia group). For each of the five comparison groups, freedom from reintervention was similar between the groups with and without proximal arch hypoplasia: (1) z-score < -2 versus ≥-2 (P = .72), (2) z-score < -3 versus ≥-3 (P = .95), and (3) z-score < -4 versus ≥-4 (P = .17). CONCLUSION: In our cohort of patients with left thoracotomy and extended end-to-end repair of coarctation, proximal arch hypoplasia, defined by various weight-based or z-score thresholds, was not associated with reintervention. While this may imply value to a more liberal use of thoracotomy, confirmation requires longer term follow-up with a more comprehensive evaluation of the patients and their arches.


Assuntos
Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Toracotomia/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Aorta Torácica/anormalidades , Peso Corporal , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Tempo
8.
Medicine (Baltimore) ; 98(27): e16220, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277133

RESUMO

Pulmonary sequestrations (PS) are typically supplied by a vessel originating from thoracic aorta, or abdominal aorta. Differences in imaging features between these PS subtypes have not been described.To analyze the imaging features of PS with arterial supply from the thoracic and abdominal aorta.Retrospectively, 23 pathologically proven cases of pulmonary sequestration were analyzed and compared based on the site of feeding artery origin.In 21 cases (21/23), the PS was soft tissue density. 1 (1/23) PS was purely cystic and another heterogeneous with both cystic and solid components (1/23). In 16/23 cases, the feeding vessel(s) arose from the thoracic aorta (male:female ratio 1:7) and in 7/23 cases from the abdominal aorta (male:female ratio 4:3). Feeding vessels from the thoracic aorta were duplicated in 7/16 cases. PS location (P <.05) and size (P <.001) differed based on the origin of the feeding vessel (thoracic aorta: 14/16 left lower lobe, mean volume 962.97 mL; abdominal aorta: 3/7 left lower lobe, mean volume 1120.89 mL). The feeding arteries themselves differed in size depending on their site of origin (thoracic aorta: mean diameter 7.0mm ±â€Š2.7 mm, mean length 44.6mm ±â€Š10.9 mm; abdominal aorta: mean diameter 3.3mm ±â€Š0.6 mm, mean length 103.6mm ±â€Š34.5 mm).PS size and distribution differ depending upon the site of feeding vessel origin as does the size of the feeding vessel itself.


Assuntos
Aorta Abdominal/anormalidades , Aorta Torácica/anormalidades , Sequestro Broncopulmonar/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Pulmão/irrigação sanguínea , Tomografia Computadorizada Multidetectores/métodos , Adolescente , Adulto , Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
9.
Genesis ; 57(7-8): e23326, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31299141

RESUMO

While common in the general population, the developmental origins of "normal" anatomic variants of the aortic arch remain unknown. Aortic arch development begins with the establishment of the second heart field (SHF) that contributes to the pharyngeal arch arteries (PAAs). The PAAs remodel during subsequent development to form the mature aortic arch and arch vessels. Retinoic acid signaling involving the biologically active metabolite of vitamin A, plays a key role in multiple steps of this process. Recent work from our laboratory indicates that the E3 ubiquitin ligase Hectd1 is required for full activation of retinoic acid signaling during cardiac development. Furthermore, our study suggested that mild alterations in retinoic acid signaling combined with reduced gene dosage of Hectd1, results in a benign aortic arch variant where the transverse aortic arch is shortened between the brachiocephalic and left common carotid arteries. These abnormalities are preceded by hypoplasia of the fourth PAA. To further explore this interaction, we investigate whether reduced maternal dietary vitamin A intake can similarly influence aortic arch development. Our findings indicate that the incidence of hypoplastic fourth PAAs, as well as the incidence of shortened transverse arch are increased with reduced maternal vitamin A intake during pregnancy. These studies provide new insights as to the developmental origins of these benign aortic arch variants.


Assuntos
Aorta Torácica/embriologia , Síndromes do Arco Aórtico/etiologia , Fenômenos Fisiológicos da Nutrição Materna , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Deficiência de Vitamina A/metabolismo , Vitamina A/metabolismo , Animais , Aorta Torácica/anormalidades , Aorta Torácica/anatomia & histologia , Feminino , Camundongos , Gravidez , Ubiquitina-Proteína Ligases/genética , Ubiquitina-Proteína Ligases/metabolismo
10.
J Cardiothorac Surg ; 14(1): 117, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242919

RESUMO

BACKGROUND: A strategy for the surgical repair of ruptured Kommerell diverticulum has not yet been established. The aim of this study is to demonstrate that this entity could be associated with a number of other cardiac anomalies and this lesion can be successfully treated by a hybrid approach. CASE PRESENTATION: The patient, with a combination of ruptured Kommerell diverticulum, dextrorotation, bovine arch, and bicuspid aortic valve, underwent emergency surgery. A single stage hybrid surgical/endovascular repair including subclavian artery revascularization, aortic resection with open proximal anastomosis under circulatory arrest, endovascular stenting, and valve repair was performed. Histological studies indicated the presence of the aortic wall media degeneration. Postoperative course was uneventful and patient is free of symptoms during 2-year follow up. CONCLUSIONS: Less invasive hybrid technique is safe and effective treatment option. Accumulated knowledge of Kommerell diverticulum has lead to understanding the best clinical treatment for this complicated aortic anomaly.


Assuntos
Aorta Torácica/anormalidades , Ruptura Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Divertículo/cirurgia , Procedimentos Endovasculares/métodos , Doenças das Valvas Cardíacas/cirurgia , Stents , Adulto , Anastomose Cirúrgica/métodos , Aorta Torácica/cirurgia , Valva Aórtica/cirurgia , Humanos , Masculino , Artéria Subclávia/cirurgia
11.
Anticancer Res ; 39(6): 3207-3211, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177169

RESUMO

BACKGROUND/AIM: Right aortic arch (RAA) is a rare abnormality of the aortic arch that forms a vascular ring. Oesophageal cancer (EC) accompanied with RAA is even rarer, and in such cases, it is very important to understand the anatomical structure in the upper mediastinum in order to perform a safe and curative operation. PATIENTS AND METHODS: A 67-year-old man who presented with pharyngeal discomfort was admitted to our hospital. Further examinations revealed advanced thoracic EC accompanied with RAA and aortic diverticulum. RESULTS: After neoadjuvant chemotherapy, we successfully and safely performed thoracoscopic oesophagectomy and lymphadenectomy using the prone positioning. CONCLUSION: There exist only a few reports of thoracoscopic oesophagectomy for EC with RAA. Sufficient preoperative preparation and sharing an adequate strategy for the surgical approach with the surgical team are definitely necessary. Although the thoracoscopic approach for EC with RAA is useful, more considerations are needed for some issues.


Assuntos
Aorta Torácica/anormalidades , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Posicionamento do Paciente/métodos , Decúbito Ventral , Toracoscopia , Idoso , Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Quimioterapia Adjuvante , Angiografia por Tomografia Computadorizada , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Humanos , Excisão de Linfonodo , Masculino , Terapia Neoadjuvante , Resultado do Tratamento
12.
Ann Vasc Surg ; 60: 477.e11-477.e13, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200064

RESUMO

Congenital aortic arch anomalies are rare and may be associated with other congenital cardiovascular malformations. The authors report a rare case of anomaly in the aortic arch embryogenesis, presenting with a right aortic arch and an isolated innominate artery, associated with the subclavian steal phenomenon. This condition is discussed considering the Edwards hypothetical double embryonic arch and its clinical aspects.


Assuntos
Aorta Torácica/anormalidades , Tronco Braquiocefálico/anormalidades , Síndrome do Roubo Subclávio/etiologia , Malformações Vasculares/complicações , Adolescente , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/fisiopatologia , Feminino , Humanos , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/fisiopatologia , Síndrome do Roubo Subclávio/terapia , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Malformações Vasculares/terapia
14.
Cardiol Young ; 29(5): 717-719, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31094309

RESUMO

Isolation of the left innominate artery from the right aortic arch is a rare anomaly. Herein, we present an even rarer case of incomplete isolation of the proximal left innominate artery with the right aortic arch in a 3-month-old female infant with a double-outlet right ventricle and pulmonary stenosis. Surgical repair at 6 months of age was successful, leading to the restoration of adequate flow in the left arm.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Tronco Braquiocefálico/anormalidades , Dupla Via de Saída do Ventrículo Direito/cirurgia , Estenose da Valva Pulmonar/etiologia , Aorta Torácica/cirurgia , Tronco Braquiocefálico/cirurgia , Feminino , Humanos , Lactente
15.
Cardiol Young ; 29(5): 699-700, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31122308

RESUMO

We describe the case of a newborn girl who displayed association of aortic atresia and interrupted aortic arch, with retrograde flow in ascending aorta, through extracranial anastomoses between vertebral arteries (arisen from descending aorta) and external carotids.


Assuntos
Anastomose Cirúrgica , Aorta/anormalidades , Doenças da Aorta/cirurgia , Malformações Vasculares/cirurgia , Aorta Torácica/anormalidades , Doenças da Aorta/congênito , Feminino , Humanos , Recém-Nascido , Procedimentos Cirúrgicos Vasculares
16.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-46423

RESUMO

Aneurisma é a dilatação anormal de uma artéria. Um aneurisma pode se romper e causar uma hemorragia ou permanecer sem estourar durante toda a vida. Os aneurismas podem ocorrer em qualquer artéria do corpo, como as do cérebro, do coração, do rim ou do abdômen. Os do tipo cerebral e da aorta torácica e abdominal apresentam altas taxas de mortalidade.


Assuntos
Aneurisma , Hemorragia Cerebral , Aorta Torácica/anormalidades , Aorta Abdominal/anormalidades , Hipertensão/complicações , Tabagismo/complicações , Ferimentos e Lesões/complicações , Doenças e Anormalidades Congênitas, Hereditárias e Neonatais , Aneurisma da Aorta Abdominal , Aneurisma Intracraniano , Aterosclerose/complicações
17.
J Cardiothorac Surg ; 14(1): 65, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940154

RESUMO

BACKROUND: The right aortic arch and aortic coarctation are rare congenital anomalies with the incidence of 0.1% and 0.03-0.04%. We present a case report of a 51-year-old woman with the right aortic arch with aberrant left subclavian artery and coarctation of the aorta with post-stenotic aneurysm. CASE PRESENTATION: Resection of the coarctation and aneurysm with replacement by tubular prosthesis was performed on partial cardiopulmonary bypass via femoral vessels. CONCLUSION: Partial cardiopulmonary bypass is an applicable method for ensuring the perfusion of the distal part of the body and an aberrant left subclavian artery is not a contraindication of this technique.


Assuntos
Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Coartação Aórtica/cirurgia , Anormalidades Cardiovasculares/cirurgia , Artéria Subclávia/anormalidades , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Coartação Aórtica/diagnóstico por imagem , Implante de Prótese Vascular , Ponte Cardiopulmonar , Anormalidades Cardiovasculares/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Tomografia Computadorizada por Raios X
18.
Artigo em Inglês | MEDLINE | ID: mdl-31027557

RESUMO

Aortic coarctation/arch hypoplasia is a relatively common congenital heart disease that leads to severe cardiovascular complications if left untreated. During the modern era, the mortality of the primary surgical repair is very low but the long-term issues, such as recurrent coarctation/arch reobstruction and hypertension, are still significant challenges. The former is related to the surgical repair performed particularly in the management of the smallish distal aortic arch, and for the latter, despite the "successful" repair of the aortic coarctation, the intrinsic vascular anomaly remains a significant long-term morbidity.


Assuntos
Aorta Torácica/anormalidades , Coartação Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos , Humanos , Recém-Nascido , Seleção de Pacientes
19.
Artigo em Inglês | MEDLINE | ID: mdl-31027560

RESUMO

Interrupted aortic arch is commonly associated with a posterior malalignment ventricular septal defect (VSD) and left ventricular outflow tract (LVOT) hypoplasia. Standard repair is carried out in the neonatal period and includes re-establishing arc continuity and VSD closure. Reintervention on the LVOT for obstruction is a common and an ongoing source of morbidity and mortality. A variety of preoperative echocardiographic measurements have been identified to identify patients at risk for developing LVOT obstruction but an aortic valve annulus dimension (mm) < patient's weight (kg) + 1 mm is a reasonable threshold to identify a patient at increased risk for future LVOT reintervention. Prophylactic direct approaches to prevent future LVOT obstruction include myectomy/myotomy and left-sided placement of the VSD patch but do not reliably prevent late LVOT obstruction. Patients amendable to a biventricular repair but with important LVOT hypoplasia are probably best served with a Yasui operation, either as a primary operation or staged with a Norwood procedure. In the case of complex redo operations, a Ross-Konno provides another valuable option for a durable repair. Though smaller preoperative LVOT structures predict the need for reoperation, careful preoperative planning may minimize the need for LVOT reintervention and improve long-term survival.


Assuntos
Aorta Torácica/anormalidades , Coartação Aórtica/cirurgia , Tomada de Decisão Clínica , Comunicação Interventricular/cirurgia , Seleção de Pacientes , Obstrução do Fluxo Ventricular Externo/cirurgia , Humanos , Recém-Nascido
20.
Can J Cardiol ; 35(4): 438-445, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30935634

RESUMO

BACKGROUND: This study describes the different types of congenital vascular rings according to their anatomy, symptoms, and age at clinical onset and reports the surgical outcomes. METHODS: A retrospective observational database study was conducted, reviewing the medical charts of 69 adult survivors with a history of a vascular ring, identified from the Dutch Congenital Cor vitia database. RESULTS: Median age at presentation was 8.5 years (0-53.0 years). Thirty patients (43.5%) had a "left aortic arch with aberrant right subclavian artery," 21 patients (30.4%) a "double aortic arch," and 16 patients (23.2%) a "right aortic arch with aberrant left subclavian artery." The main symptomatology at presentation comprised respiratory symptoms (82.9%). Almost three-quarters of patients were also diagnosed with asthma/bronchial hyperreactivity. Patients with a double aortic arch had more symptoms than patients with a left aortic arch with aberrant right subclavian artery and right aortic arch with aberrant left subclavian artery (P < 0.001), requiring surgery most often (P < 0.001). In patients with childhood onset of symptoms, preoperative spirometry (ie, peak expiratory flows) was more often abnormal as compared with adult patients (P = 0.007). Surgery was performed in 42.0% of all patients at a median age of 17 years (0-63.0 years). Twenty-four (92.3%) of the operated patients showed improvement or complete relief of symptoms shortly after surgery. Of 26 asymptomatic nonoperated patients, 3 patients (11.5%) eventually developed symptoms. CONCLUSIONS: The low incidence of vascular rings, their anatomic heterogeneity, and a wide range of common symptoms often lead to misdiagnosis. Clinical awareness is warranted as a large subset of patients could benefit from surgery, even at an adult age.


Assuntos
Aorta Torácica/anormalidades , Artéria Subclávia/anormalidades , Sobreviventes , Anel Vascular/epidemiologia , Adolescente , Adulto , Idoso , Asma/epidemiologia , Hiper-Reatividade Brônquica/epidemiologia , Procedimentos Cirúrgicos Cardiovasculares/estatística & dados numéricos , Dor no Peito/epidemiologia , Criança , Pré-Escolar , Cianose/epidemiologia , Transtornos de Deglutição/epidemiologia , Dispneia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Sons Respiratórios , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Espirometria , Anel Vascular/cirurgia , Adulto Jovem
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