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1.
J Thorac Cardiovasc Surg ; 160(3): 796-804, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32616349

RESUMO

OBJECTIVE: Aortic uncrossing is an effective procedure for relieving the external airway compression from a circumflex aortic arch by transferring the aortic arch to the same side as the descending aorta. However, patients frequently have residual tracheobronchomalacia (TBM), which may result in persistent postoperative symptoms. We review a series of patients who underwent an aortic uncrossing and concomitant tracheobronchopexy to correct the airway compression and residual TBM. METHODS: Retrospective review of all patients who underwent aortic uncrossing and concomitant tracheobronchopexy at a single institution between September 2016 and March 2019. Preoperative evaluation included computed tomography angiography and rigid 3-phase dynamic bronchoscopy. RESULTS: Eight patients who ranged in age from 4 months to 15 years with significant respiratory symptoms underwent an aortic uncrossing procedure with concomitant tracheobronchial procedures. Mild hypothermic cardiopulmonary bypass (mean time, 105.6 ± 39.4 min) and regional perfusion (mean time, 44 ± 10 min) were used without circulatory arrest. Intraoperative bronchoscopy demonstrated no patients had residual TBM. There were no postoperative mortalities, neurologic complications, chylothoraces, coarctations, or obstructed aortic arches. Two patients required tracheostomy and gastrostomy for bilateral recurrent laryngeal nerve paresis (patients 2 and 3). One patient with bronchial stenosis after concomitant slide bronchoplasty required stenting. At a median follow-up of 22 months (range, 5-34 months), all patients were alive without evidence of significant respiratory symptoms. CONCLUSIONS: The aortic uncrossing procedure can be performed safely in pediatric patients of all ages without circulatory arrest. Concomitant procedures addressing associated TBM can significantly improve respiratory symptoms.


Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Traqueobroncomalácia/complicações , Traqueobroncomalácia/cirurgia , Adolescente , Anastomose Cirúrgica , Aorta Torácica/diagnóstico por imagem , Broncoscopia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Traqueobroncomalácia/diagnóstico por imagem
2.
Magy Seb ; 73(2): 61-68, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32609633

RESUMO

Incidence of anomalies of the aortic arch is estimated 1-2 per cent in newborn babies. Lusory artery may arise either from left sided aortic arch in 0.7-2 per cent, or from right sided aortic arch in 0.4 per cent. Leading symptoms develop from compression of the oesophagus or trachea, or both. If lusory artery dilates conically over the time reaching 3 cm or more we call it Kommerell diverticulum. Very rare complications of this are the Type B aortic dissection, which may turn into chronic thoracoabdominal aneurysm, or its shaggy inner surface can be the source of upper extremity embolism. Rupture is extremely rare complication. In our report we focus on five cases of the mentioned complications with their clinical workups and technical solutions. In a female patient with right sided arch transection of the lusory artery was followed by transposition into the right common carotid artery. The central stump 10 years later gradually expanded and the saccular aneurysm indicated intervention. After complete arch debranching thoracic endograft was implanted. In this group of patients with variable surgical and hybrid procedures neither complication nor mortality occurred.


Assuntos
Aneurisma Dissecante , Aorta Torácica/cirurgia , Anormalidades Cardiovasculares/cirurgia , Divertículo/cirurgia , Artéria Subclávia/anormalidades , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Anormalidades Cardiovasculares/diagnóstico por imagem , Pré-Escolar , Divertículo/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Reimplante , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do Tratamento
4.
J Card Surg ; 35(8): 2035-2036, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652780

RESUMO

We present a case of a 4-year-old child operated previously for cyanotic congenital heart disease where the follow-up computed tomography (CT) angiography revealed anomalous origin of the left vertebral artery from the descending thoracic aorta. This case also highlights the potential implications of this variant and the value of CT angiography in diagnosing this anomaly.


Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Anormalidades Cardiovasculares/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Artéria Vertebral/anormalidades , Artéria Vertebral/diagnóstico por imagem , Pré-Escolar , Humanos , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem
5.
J Cardiothorac Surg ; 15(1): 136, 2020 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-32527284

RESUMO

Transposition of the great arteries (TGA) and interruption of the aortic arch (IAA) are uncommon congenital heart diseases. The association between TGA and IAA is rare. The aim of this study is to present a case with combined TGA and IAA, who underwent the primary repair and review the literature with similar cases. The one-month-old patient was admitted with tachypnea and cyanosis. Delayed diagnosis was caused due to the absence of prenatal examination. Echocardiography and computed tomography angiography confirmed TGA with anterior-posterior-oriented great arteries, wide patent ductus arteriosus, type B IAA, ventricular septal defect (VSD) and pulmonary arterial hypertension. The patient underwent a single-stage primary surgical repair process leading to VSD closure, reconstruction of the aortic arch and arterial switch operation in October 2019. The patient is doing well at a 3-month follow-up post-surgery. The echocardiogram suggests a normal systolic function of the ventricles and trivial regurgitation for both aortic and pulmonary valves. CONCLUSIONS: The single-stage repair with VSD closure, reconstruction of aortic arch and arterial switch operation might be an applicable approach for most of the patients with combined TGA and IAA. Long term follow-up is required as a high re-intervention rate for recurrent coarctation, supravalvular aortic stenosis, neoaortic valve regurgitation, obstruction of the right heart system and coronary stenosis has been reported.


Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Permeabilidade do Canal Arterial/cirurgia , Comunicação Interventricular/cirurgia , Transposição dos Grandes Vasos/cirurgia , Transposição das Grandes Artérias , Humanos , Lactente , Masculino , Hipertensão Arterial Pulmonar/complicações , Valva Pulmonar
6.
J Endovasc Ther ; 27(5): 785-791, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32495679

RESUMO

Purpose: To analyze the structural variation of the aortic arch and the supra-aortic arteries and establish an average spatial configuration that would be a pattern for a "universal double fenestration" design for physician-modified endovascular grafts (PMEGs) used in total thoracic endovascular aortic repair (TEVAR). Materials and Methods: Aortic arch morphology was retrospectively analyzed by reviewing the preoperative thoracic computed tomography angiography scans in 33 consecutive patients (mean age 68 years; 27 men) treated between January 2017 and March 2019 using double-fenestrated PMEGs for zone 0 TEVAR. Image analysis was completed according to a standardized technique on a vascular workstation with center lumen line reconstruction for all measurements. Variations in branching pattern of the aortic arch were classified into 8 types. Results: The arch trunk configuration was type I in 26 patients (79%), type II in 5 (15%), type III in 1, and type IV in 1. Mean aortic diameters at the level of mid ascending aorta, innominate artery (IA), left common carotid artery (LCCA), and left subclavian artery (LSA) were 35.7±3.7, 34.2±4.5, 33.3±6.7, and 33.7±4.7 mm, respectively. Mean diameters of the trunk were 12.2±1.7, 7.5±1.4, and 8.0±0.8 mm, respectively. Mean longitudinal center to center lengths were 15.9±2.5 mm between the LSA and LCCA and 12.1±3.0 mm between the LCCA and IA. Mean clock positions using the LSA as reference were 12:50 for the IA and 12:05 for the LCCA. In 32 patients (97%) all the supra-aortic branch vessels fit perfectly inside two delimited areas defined by a proximal common square area of 30×30 mm for the IA and LCCA and a second distal 8-mm-diameter circle for the LSA. Conclusion: Variations of the aortic arch anatomy are numerous and common. A general morphological pattern is described that delimits the aortic area where these variations occur. This information can be utilized for the design of an off-the-shelf double-fenestrated stent-graft for zone 0 TEVAR.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Desenho de Prótese , Stents , Idoso , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
BMC Surg ; 20(1): 86, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366237

RESUMO

BACKGROUND: Double aortic arch (DAA) is a congenital anomaly of the aorta. Esophageal cancer with DAA is rare, and consequently, the appropriate surgical approach has not been standardized. Herein, we report the utilization of intraoperative neurological monitoring (IONM) system to preserve the function of the recurrent laryngeal nerve. CASE PRESENTATION: A 79-year-old man with esophageal cancer was diagnosed with DAA incidentally. The descending aorta was located on the right side of the thoracic vertebrae. Safe dissection of the mediastinal lymph nodes was difficult using the right transthoracic approach because of the anatomical abnormalities. During surgery, we used cervical mediastinoscopy combined with the IONM system to preserve the bilateral recurrent laryngeal nerves. Severe complications, including recurrent nerve palsy, were not observed postoperatively. CONCLUSION: IONM may be useful for evaluation of the function of the recurrent laryngeal nerve, and it would be suitable for atypical cases of esophageal cancer.


Assuntos
Neoplasias Esofágicas/cirurgia , Monitorização Intraoperatória/métodos , Anel Vascular/diagnóstico , Idoso , Aorta/anormalidades , Aorta Torácica/anormalidades , Humanos , Linfonodos/patologia , Masculino , Mediastinoscopia , Nervo Laríngeo Recorrente/fisiologia
8.
J Endovasc Ther ; 27(5): 792-800, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32431247

RESUMO

PURPOSE: To describe the implantation steps and tips and tricks for the Inner Branch Arch Endograft designed to treat aortic arch aneurysm and chronic type A aortic dissection. TECHNIQUE: Anatomical suitability criteria should be met in order to use this device. The proximal segment of the graft lands in the ascending aorta distally to the sinotubular junction and the distal segment lands in the descending aorta. The device includes 2 inner branches; the proximal branch is used for a connection to the innominate artery (positioned slightly posterior at 12:30 o'clock), while the second branch is positioned slightly anterior at 11:30 o'clock and is used as a connection to the left common carotid artery. Access, implantation technique, deployment of the device, and catheterization of the branches are described thoroughly. CONCLUSION: This Inner Branch Arch Endograft is an appealing alternative to treat aortic arch pathology, especially in patients unsuitable for open repair. Nevertheless, complex aortic arch repair is associated with a learning curve. Meticulous preoperative planning and a high level of concentration intraoperatively are mandatory.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Desenho de Prótese , Stents , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
Vasc Endovascular Surg ; 54(4): 375-377, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32270759

RESUMO

Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic arch anomaly. Patients with KD have a high risk of rupture, dissection, compression of adjacent structures, as well as distal embolization symptoms. Several treatment options have been proposed (surgical, hybrid, endovascular), however, a consensus regarding optimal surgical management has not been established yet. We present a successful single-stage hybrid repair of distal aortic arch dissection aneurysm with dissecting KD and ARSA with debranching of innominate and left common carotid artery, bilateral carotid-subclavian bypass, and stent grafting.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Anormalidades Cardiovasculares/cirurgia , Divertículo/cirurgia , Procedimentos Endovasculares , Artéria Subclávia/anormalidades , Aneurisma Dissecante/diagnóstico por imagem , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Anormalidades Cardiovasculares/diagnóstico por imagem , Divertículo/diagnóstico por imagem , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do Tratamento
12.
Ann Thorac Surg ; 110(4): e257-e259, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32240646

RESUMO

Anomalous aortic origin of a coronary artery is a congenital condition associated with sudden cardiac death. There are no current recommendations for the acute management and urgency for this patient population. This manuscript describes and discusses two patients who presented with an acute coronary event and needed emergent intervention despite initial clinical stabilization and improvement.


Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Adolescente , Criança , Emergências , Feminino , Humanos , Masculino
14.
J Card Surg ; 35(4): 957-960, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115762

RESUMO

BACKGROUND: A complex and rare form of persistent truncus arteriosus needs careful attention when choosing the optimal strategy for repair. AIM OF THE STUDY: We herein describe our surgical strategy of a small infant having this malformation concomitantly with right aortic arch, unusual pulmonary artery branching and a left superior vena cava. METHODS: The patient underwent initially bilateral pulmonary arterial banding followed by the Rastelli type definitive repair. The pulmonary arteries were unified in front of the left superior vena cava, and the right ventricular outflow tract was readily reconstructed. RESULTS: The patient is doing well with an excellent hemodynamic status. CONCLUSIONS: We considered the two-stage approach was sensible in this particular patient.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/métodos , Artéria Pulmonar/cirurgia , Persistência do Tronco Arterial/cirurgia , Anormalidades Múltiplas , Aorta Torácica/anormalidades , Hemodinâmica , Humanos , Recém-Nascido , Masculino , Artéria Pulmonar/anormalidades , Resultado do Tratamento , Persistência do Tronco Arterial/complicações , Persistência do Tronco Arterial/fisiopatologia , Veia Cava Superior/anormalidades , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Obstrução do Fluxo Ventricular Externo/cirurgia
15.
J Card Surg ; 35(5): 1085-1089, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32207192

RESUMO

Hypoplastic ascending aorta and interrupted aortic arch (IAA) are rarely associated with dextro-transposition of the great arteries (D-TGA). Severe hypoplastic ascending aorta may preclude coronary artery transfer making arterial switch operation problematic. We report a case of D-TGA with a large subpulmonic ventricular septal defect, IAA, and hypoplastic ascending aorta that underwent successful biventricular surgical repair without coronary artery transfer.


Assuntos
Aorta/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Transposição dos Grandes Vasos/cirurgia , Anormalidades Múltiplas , Aorta/patologia , Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Transposição das Grandes Artérias , Vasos Coronários/cirurgia , Feminino , Comunicação Interventricular/cirurgia , Humanos , Recém-Nascido
17.
J Card Surg ; 35(3): 716-720, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32027400

RESUMO

BACKGROUND: Challenging surgical cases are becoming more and more frequent, making the optimization of decision making process and an accurate preoperative planning mandatory in order to improve postoperative outcomes. AIMS: Here we present an original multidisciplinary approach aimed at optimizing decision making in a peculiar case of double aortic arch (DAA) presenting in an adult patient. MATERIALS AND METHODS: Following the diagnosis of DAA, based on conventional exams, a three steps engineering simulation was adopted including: a) three-dimensional (3D) rapid prototype simulation; b) computational fluid-dynamic analysis; c) 3D virtual simulation of surgical exposure. RESULTS: Based on careful evaluation of such simulations we were able to identify optimal anatomical and functional surgical options, along with the optimal surgical approach. DISCUSSION: In peculiar clinical case, a significant step forward to optimize preoperative surgical planning could be obtained applying current available engineering techniques. CONCLUSION: We do believe that a multidisciplinary approach could become mandatory, in challenging cases, to optimize preoperative planning and outcomes.


Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Simulação por Computador , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Adulto , Aorta Torácica/diagnóstico por imagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Impressão Tridimensional , Resultado do Tratamento , Adulto Jovem
18.
J Card Surg ; 35(4): 912-915, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32092176

RESUMO

BACKGROUND AND AIM: Over the past years, three-dimensional (3D) models of patient-specific anatomical conditions are being used to improve the comprehension and surgical management of a variety of diseases. It is an additional diagnostic tool that aids clinical decision-making. Furthermore, this technology is still not routinely used in the medical field since its availability is limited by cost and complex process. METHODS AND RESULTS: We describe a patient with a balanced-type double aortic arch encircling trachea and esophagus. Considering the clinical symptoms, surgical decompression of these structures and defined aortic arch reconstruction was indicated. The 3D printed model revealed narrowing of the left aortic arch at the junction of the descending thoracic aorta that did not clearly appear on the conventional images reconstruction. The left aortic arch was divided and the symptoms completely disappeared. No immediate or late complications occurred. CONCLUSION: 3D printed models can be helpful in surgical planning of congenital heart malformations. It should be strongly considered as an additional tool in complex cases.


Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Modelos Anatômicos , Planejamento de Assistência ao Paciente , Impressão Tridimensional , Tomada de Decisões , Descompressão Cirúrgica/métodos , Esôfago/irrigação sanguínea , Humanos , Lactente , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/irrigação sanguínea , Anel Vascular/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
20.
Ann Thorac Surg ; 109(5): e379-e381, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31987822

RESUMO

Arterial cannulation with a chimney polytetrafluoroethylene graft to the innominate artery is commonly used for antegrade cerebral perfusion during neonatal aortic arch surgery. When properly retained and prepared before sternal closure, resuscitation of the polytetrafluoroethylene graft to innominate artery can be performed months later during sternal reentry. It is a safe and reproducible technique for expeditious arterial cannulation at stage II palliation in single-ventricle patients or complete intracardiac repair of biventricular lesions. We report our experience utilizing this technique successfully during reoperation in 90 of 92 patients, with no adverse thromboembolic events identified.


Assuntos
Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Tronco Braquiocefálico/cirurgia , Encéfalo/irrigação sanguínea , Cateterismo/métodos , Procedimentos de Norwood , Politetrafluoretileno , Aorta Torácica/anormalidades , Humanos , Recém-Nascido , Cuidados Paliativos , Complicações Pós-Operatórias/prevenção & controle , Reoperação , Tromboembolia/prevenção & controle
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