Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.967
Filtrar
1.
Br J Radiol ; 93(1106): 20190017, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31899661

RESUMO

Paediatric aortic trauma is a rare injury which can be fatal if not identified and managed appropriately. Surgical repair remains the gold-standard in moderate to severe aortic injuries. In the last decade however, endovascular treatment has gained popularity in children who have suitable vascular anatomy for intervention and are either not fit for surgery or in whom, endovascular intervention is the only alternative that will make a difference in the clinical outcome. Children pose a unique set of challenges to endovascular therapy. In this article, we aim to illustrate the different endovascular options that are available for the treatment of acute traumatic aortic injury and visceral thromboembolisation through pictorial representation. We will also demonstrate the feasibility and the limitation of this technique.


Assuntos
Aorta Abdominal/lesões , Aorta Torácica/lesões , Procedimentos Endovasculares , Ferimentos não Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia , Acidentes de Trânsito , Adolescente , Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética , Masculino , Ferimentos não Penetrantes/diagnóstico , Ferimentos Perfurantes/diagnóstico
2.
Vasc Endovascular Surg ; 54(2): 162-164, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31707948

RESUMO

Hybrid thoracic endovascular aortic repair with surgical arch debranching is an accepted method for total arch reconstruction. Although off-pump arch debranching is increasingly used as a prophylactic adjunct to endovascular arch repair extending into landing zone 0, this technique is seldom performed with a ministernotomy due to a steep learning curve among surgeons. Herein, we report our standard technique for off-pump hybrid total aortic arch repair using a ministernotomy.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Esternotomia/métodos , Aneurisma Dissecante/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Khirurgiia (Mosk) ; (12): 5-12, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825337

RESUMO

The review is devoted to analysis of current trends in interdisciplinary approach to the differential diagnosis of patients' conditions on the first day after cardiac, ascending aortic and aortic arch surgery and repair of internal carotid arteries (neurological disorders, delirium, cognitive dysfunction, psycho-emotional disorders, postoperative sedation). This approach is valuable to determine the prognosis and timely treatment. The basic concepts reflecting the discussion between neurologists, cardiovascular surgeons, anesthetists, radiation diagnostics specialists and rehabilitators are summarized. The authors concluded that timely and correct differential diagnosis of the states on the first postoperative day using current tests and interdisciplinary approach to the treatment of patients with postoperative impaired consciousness or neurological/psycho-emotional dysfunction can improve their quality of life and efficiency of medical care.


Assuntos
Aorta/cirurgia , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Doenças do Sistema Nervoso/diagnóstico , Transtornos Neurocognitivos/diagnóstico , Aorta Torácica/cirurgia , Artéria Carótida Interna/cirurgia , Diagnóstico Diferencial , Humanos , Doenças do Sistema Nervoso/etiologia , Transtornos Neurocognitivos/etiologia , Prognóstico , Fatores de Tempo
4.
Medicine (Baltimore) ; 98(50): e18241, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852089

RESUMO

T helper 17 (Th17) cells are related to the progression of aortic dissection. This study aimed to determine whether circulating Th17 levels are associated with the prognosis of acute Stanford type B aortic dissection (STBAD) after thoracic endovascular aortic repair (TEVAR).A cohort study was performed and STBAD patients (n = 140) received TEVAR were enrolled, the circulating Th17 levels were measured and the patients were divided into low and high Th17 groups, and 36 months of follow-up was performed. The data for mortality, survival outcomes, heart structure and function changes, aortic regurgitation prevalence, and aortic remodeling outcomes were recorded.Lower mortality and fewer complications were observed in the low Th17 group than in the high Th17 group in the third year of follow-up. In addition, the low Th17 group exhibited better cardiac remodeling and cardiac function when compared with that in the high Th17 group in the second to third year after TEVAR. Aortic reflux was improved in both groups but was more pronounced in the low Th17 group. During follow-up, the true lumen of the proximal thoracic aorta at the level of the celiac trunk in both the low and high Th17 groups continuously enlarged and was more pronounced in the low Th17 group.Circulating Th17 cells were related to cardiac and aortic remodeling and prognosis during STBAD after TEVAR. Anti-inflammatory therapy may be useful for STBAD patients who have undergone TEVAR.


Assuntos
Aneurisma Dissecante/sangue , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/sangue , Procedimentos Endovasculares/métodos , Células Th17/patologia , Remodelação Vascular , Doença Aguda , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Angiografia por Tomografia Computadorizada , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo
5.
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
6.
Zhonghua Wai Ke Za Zhi ; 57(11): 848-852, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694134

RESUMO

Objective: To examine the results of surgical treatment for endograft infection after thoracic endovascular aortic repair (TEAVR). Methods: Clinical data of 7 patients underwent surgical treatment for endograft infection after TEAVR at Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University between January 2016 and December 2018 were analyzed retrospectively. There were 6 males and 1 female, aging (51.5±16.7) years (range: 25 to 68 years). The origin of the aortic disease was descending aortic aneurysm in 5 cases, and Stanford B aortic dissection in 2 cases. Abdominal aorta below the level of the diaphragm was not involved in all patients. Two patients received "chimney technology" for left subclavian artery procedures. Time to infection was 5(3) months (M(Q(R))) (range: 1 to 24 months). Aortic endograft infection was diagnosed with a combination of microbiology (positive blood cultures, except one with mycotic), radiological evidence and clinical evidence of sepsis. Two patients suffered from aorto-esophageal fistula received emergency surgery, others were treated with elective surgery. Extra-anatomic prosthetic graft bypass was used for reconstruction of aorta, infected endogarft and aorta was removed, sac drainage was performed. Aorto-esophageal fistula was procedured according to the degree of lesions. All patients received antibiotics with specialist advice for 6 to 8 weeks. Results: One patient died due to septic shock. In the follow-time (range: 6 to 24 months), 1 patient suffered from thoracic infection in 3 months after surgery, an other patient got iliac abscess after a month. Conclusions: Endograft infection after TEAVR is high risk but may be curative. Appropriate selection of patients for infected endograft explantation could get a satisfied results.


Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Adulto , Idoso , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Stents , Resultado do Tratamento
7.
Heart Surg Forum ; 22(5): E380-E384, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31596716

RESUMO

OBJECTIVE: To explore the feasibility of endovascular reconstruction of aortic root including aortic valve, sinus of valsalva and ascending aorta by a single stent-graft, a novel valved stent-graft with two fenestrae for preserving the coronary arteries was designed and performed in-vitro on a pig heart based circulation simulating system. METHODS: Pig hearts were harvested from 30 healthy adult female pigs weighing between 60-65 kilograms. Before sacrifice, all the pigs received aortic computed tomography angiography (CTA) examinations and morphologic parameters of aortic root were measured. Then we customized the valved stent-grafts according to the CTA measurements. After the pig heart was fixed on the special platform according to the original orientation and connected to the circulation system, the stent graft was delivered through transapical access and covered the segment from aortic annulus to proximal part of aortic arch under DSA (digital subtraction angiography) guidance. Then changes of coronary flow before and after the procedure and fenestration alignment with coronary ostia were analyzed. RESULTS: The overall technical success rate was 100%. The valve functions tested by ultrasound were in good condition under 120 mmHg circulation pressure. The flow of left coronary artery (LCA) did not decrease, but increased after the stent-graft implantation (340 ± 2.06 mL/min versus 288 ± 5.29 mL/min, P < .05). Similarly, the flow of right coronary artery (RCA) also increased (392 ± 9.17 mL/min versus 348 ± 8.01 mL/min; P < .05). The final angiography confirmed that both coronary arteries were patent. When generally observed from outer wall of valsalva sinus, both RCA and LCA orifices were aligned with the fenestrae. In 4 cases, the autologous valve leaflets blocked nearly 20% of the LCA fenestra's area, but the flow did not significantly decrease in these cases. CONCLUSION: Stimulated on a pig heart-based circulation simulation system, the one-piece valved-fenestrated stent graft with a branch could be delivered via the transapical access and deployed accurately, which achieved endovascular reconstruction of aortic valve, sinus of valsalva and ascending aorta while preserving the coronary artery perfusion by fenestrations. More in-vivo experiments on animal models are mandatory to further verify its efficacy and safety.


Assuntos
Aorta Torácica/cirurgia , Valva Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Stents , Angiografia Digital , Animais , Angiografia por Tomografia Computadorizada , Circulação Coronária , Vasos Coronários/cirurgia , Estudos de Viabilidade , Feminino , Técnicas In Vitro , Tratamentos com Preservação do Órgão/métodos , Estudo de Prova de Conceito , Procedimentos Cirúrgicos Reconstrutivos/métodos , Seio Aórtico/cirurgia , Técnicas de Sutura , Suínos
9.
Medicine (Baltimore) ; 98(38): e17173, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567956

RESUMO

BACKGROUND: Serum alkaline phosphatase (ALP) is related to vascular calcification and is known to have a prognostic impact in various cohorts. However, evidence in patients undergoing thoracic endovascular aortic repair (TEVAR) is lacking. Thus, we hypothesized that preoperative serum ALP level could be used for predicting adverse events after TEVAR. METHODS: We retrospectively reviewed 167 patients who underwent TEVAR between February 2013 and December 2016. Patients were classified into tertiles according to preoperative ALP level (<69, 69-92, and >92 IU/L). The composite of morbidity and mortality (composite MM) was defined as the presence of one or more of the following: myocardial infarction, cerebrovascular accident, dialysis requirement, pulmonary complication, infection, and mortality within 1 year after TEVAR. The incidence of composite MM was compared among the 3 tertiles, and stepwise logistic regression analysis was performed to evaluate the predictors for composite MM. RESULTS: The incidence of composite MM was 14.5% in the first tertile group, 17.9% in the second tertile group, and 35.7% in the third tertile group (P = .016). The third tertile of ALP level (odds ratio [OR] 1.766, 95% confidence interval [CI] 1.074-2.904, P = .025) and emergency TEVAR (OR 2.369, 95% CI 1.050-5.346, P = .038) remained as independent predictors of composite MM. CONCLUSIONS: Our data showed an independent relationship between high preoperative ALP levels and adverse outcomes in patients undergoing TEVAR. This finding might suggest a potential role of ALP level as a risk stratification marker.


Assuntos
Fosfatase Alcalina/sangue , Aorta Torácica/cirurgia , Procedimentos Endovasculares/efeitos adversos , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(37): e17159, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517864

RESUMO

RATIONALE: Penetrating aorta ulcer (PAU) with isolated left vertebral artery (ILVA) is a rare condition, accounting for no more than 1% of all kinds of aorta diseases. And traditional treatment was open surgery with total arch replacement by elephant trunk. Here, we report a case of PAU combined with ILVA managed by thoracic endovascular aortic repair (TEVAR) technique. PATIENT CONCERNS: A 65-year-old male with chronic hypertension and Nicotine abuse underwent intermittent back pain for 2 years and aggravated a bit for 1 week. DIAGNOSES: Preoperative computed tomography angiogram (CTA) indicated PAU combined with ILVA. INTERVENTIONS: TEVAR was performed for PAU following with retrograde in situ fenestration and chimney technique for revascularization of ILVA and left subclavian artery (LSA), respectively. OUTCOMES: The operation was successfully and the patient was discharged from hospital after 1 week of treatment. Postoperatively, the images of CTA illustrated the patency of aorta, ILVA, and LSA without obvious endoleak. Besides, no ischemia attack or other relative syndromes were detected at 6-months follow-up. LESSONS: This case demonstrates that TEVAR is an alternative to elephant trunk especially for PAU with ILVA. And it also showed the precise exposure of ILVA and necessity to reconstruct ILVA during TEVAR operation in order to reduce the occurrence of ischemia attack.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Procedimentos Endovasculares , Úlcera/cirurgia , Artéria Vertebral/cirurgia , Idoso , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico , Diagnóstico Diferencial , Procedimentos Endovasculares/métodos , Humanos , Masculino , Úlcera/diagnóstico , Artéria Vertebral/diagnóstico por imagem
11.
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
12.
Cardiovasc Intervent Radiol ; 42(11): 1522-1529, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31482337

RESUMO

PURPOSE: To compare the accuracy of two-dimensional (2D) versus three-dimensional (3D) image fusion for thoracic endovascular aortic repair (TEVAR) image guidance. MATERIALS AND METHODS: Between December 2016 and March 2018, all eligible patients who underwent TEVAR were prospectively included in a single-center study. Image fusion methods (2D/3D or 3D/3D) were randomly assigned to guide each TEVAR and compared in terms of accuracy, dose area product (DAP), volume of contrast medium injected, fluoroscopy time and procedure time. RESULTS: Thirty-two patients were prospectively included; 18 underwent 2D/3D and 14 underwent 3D/3D TEVAR. The 3D/3D method allowed more accurate positioning of the aortic mask on top of the fluoroscopic images (proximal landing zone error vector: 1.7 ± 3.3 mm) than was achieved by the 2D/3D method (6.1 ± 6.1 mm; p = 0.03). The 3D/3D image fusion method was associated with significantly lower DAP than the 2D/3D method (50.5 ± 30.1 Gy cm2 for 3D/3D vs. 99.5 ± 79.1 Gy cm2 for 2D/3D; p = 0.03). The volume of contrast medium injected was significantly lower for the 3D/3D method than for the 2D/3D method (50.6 ± 22.9 ml vs. 98.4 ± 47.9 ml; p = 0.002). CONCLUSION: Higher image fusion accuracy and lower contrast volume and irradiation dose were observed for 3D/3D image fusion than for 2D/3D during TEVAR. LEVEL OF EVIDENCE: II, Randomized trial.


Assuntos
Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Imagem Tridimensional/métodos , Imagem Multimodal/métodos , Radiografia Intervencionista/métodos , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Estudos Prospectivos , Doses de Radiação , Reprodutibilidade dos Testes , Resultado do Tratamento
13.
J Cardiothorac Surg ; 14(1): 159, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492164

RESUMO

BACKGROUND: Aortic erosion is a serious complication that usually occurs shortly after Amplazter Septal Occluder (ASO) implantation for atrial septal defect (ASD). CASE PRESENTATION: A seven-year-old girl was diagnosed with secundum ASD without symptoms. Transesophageal echocardiography (TEE) showed a defect of 20 mm in diameter in the fossa ovalis without aortic rim. An ASO device of 24 mm in diameter was selected and electively implanted. The "A-shape" of the device was confirmed by intraoperative TEE, a landmark finding indicating the proper implantation of ASO in patients without aortic rim. After an uneventful postoperative course of 5 years and 10 months, she was transferred to our unit due to cardiogenic shock. Her echocardiogram in emergency room showed pericardial effusion with collapsed right ventricle. Given her history of ASO and the observation of the sequentially increasing pericardial effusion, we diagnosed her with acute cardiac tamponade due to aortic erosion. Emergency pericardiotomy was then performed to improve the hemodynamic condition. Fresh clots were found, so we immediately prepared the cardiopulmonary bypass circuit and explored the damage to the aorta, in which the clots had accumulated. Bleeding suddenly started when the clots were removed. We then inserted the cannulae for perfusion and venous drainage. The clots were removed, and tears were found in both the lateral side of the ascending aorta and the right atrial wall. Intraoperative TEE showed that an edge of the ASO device was directly touching the aortic wall and the Doppler color-flow imaging showed blood flow through this lesion. The erosive lacerations of both the ascending aorta and right atrium were detected from the inside after achieving cardioplegic cardiac arrest. The ascending aorta was obliquely incised, and the laceration was closed from inside the aortic root. The postoperative course was uneventful. She has been doing well for 5 years since the surgery. CONCLUSIONS: We experienced and successfully treated a rare case of acute cardiac tamponade caused by aortic erosion 5 years and 10 months after ASO implantation.


Assuntos
Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/etiologia , Comunicação Interatrial/cirurgia , Complicações Pós-Operatórias/etiologia , Dispositivo para Oclusão Septal/efeitos adversos , Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Cateterismo Cardíaco/métodos , Criança , Remoção de Dispositivo , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Comunicação Interatrial/diagnóstico , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares/métodos
14.
J Cardiothorac Surg ; 14(1): 147, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370864

RESUMO

BACKGROUND: The frozen elephant trunk (FET) technique was developed to facilitate the two-stage surgery of extensive pathologies of the thoracic aorta and is now routinely applied in acute and chronic aortic syndromes. METHODS: From 11/2006 to 07/2017, 68 patients underwent aortic arch repair using the FET technique. Patients received either the Jotec E-vita Open graft (n = 57) or the Vascutek Thoraflex hybrid prosthesis (n = 11). Both, group 1 (acute aortic dissection type A and B; symptomatic penetrating aortic ulcer) and group 2 (aortic aneurysm; chronic aortic dissection) included 34 patients each. RESULTS: Early mortality was 13.2% (14.7% in group 1 vs. 11.7% in group 2, p = 0.720). Neurological complications occurred in 12 patients (17.6%) (stroke: 8.8 vs. 11.7%; p = 0.797 and spinal cord injury: 8.8 vs. 5.9%; p = 0.642 in groups 1 vs. 2 respectively). Cardiopulmonary bypass time and cross clamp time were significantly longer in group 1 (252.2 ± 73.5 and 148.3 ± 34 min vs. 189.2 ± 47.8 and 116.3 ± 34.5 min; p <  0.001). The overall 1-, 3- and 7-year-survival was 80.9, 80.9 and 74.2% with no significant differences between groups 1 and 2. Expansion of true lumen after FET implantation was significant at all levels in both groups for patients with aortic dissection. One-, 3-, and 7-year-freedom from secondary (re-)intervention for patients for aortic dissection was 96.9, 90.2 and 82.7% with no significant differences between groups 1 and 2; p = 0.575. CONCLUSION: The FET technique can be applied in acute aortic syndromes with similar risks regarding adverse events or mortality when compared to chronic degenerative aortic disease. Postoperative increase in true lumen diameter mirrors decrease of false lumen diameter, goes along with favorable midterm outcome and prolongs freedom from secondary interventions in acute aortic dissection.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Úlcera/cirurgia , Doença Aguda , Adulto , Idoso , Prótese Vascular , Ponte Cardiopulmonar/efeitos adversos , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Reoperação , Estudos Retrospectivos , Doenças da Medula Espinal/etiologia , Acidente Vascular Cerebral/etiologia , Taxa de Sobrevida , Fatores de Tempo
15.
Artigo em Inglês | MEDLINE | ID: mdl-31347798

RESUMO

The Konno-Rastan procedure is an anterior aortoventriculoplasty that has  the aim of relieving subvalvar, valvar, and supravalvar stenosis. It can be helpful for patients with aortic stenosis at any level and also for those with a prior implanted aortic and/or mitral prosthesis.  The patient presented in this video tutorial had a history of rheumatic heart disease with previously implanted mechanical prostheses in the aortic as well as the mitral position. We provide detailed insight on how to perform the Konno incision safely and demonstrate the reconstruction of the aortic root, as well as the ventricular septum and the right ventricular outflow tract using a patch of bovine pericardium.


Assuntos
Aorta Torácica/cirurgia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Próteses Valvulares Cardíacas , Animais , Bovinos , Feminino , Humanos , Pessoa de Meia-Idade
17.
Diagn Interv Radiol ; 25(4): 328-330, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31295145

RESUMO

Aortic arch pseudoaneurysms are rare but quite fatal when ruptured. Owing to its less morbidity and mortality compared with the surgical approach, endovascular and hybrid treatment methods are increasingly preferred. In this report, we present a 58-year-old male patient who has a ruptured saccular aortic arch pseudoaneurysm treated by endovascular approach using parallel grafts.


Assuntos
Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Falso Aneurisma/complicações , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Aorta Torácica/transplante , Ruptura Aórtica/diagnóstico por imagem , Prótese Vascular , Angiografia por Tomografia Computadorizada/métodos , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
18.
Gen Thorac Cardiovasc Surg ; 67(9): 751-757, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312983

RESUMO

BACKGROUND: Thoracic and thoracoabdominal aortic diseases are treated using operative procedures like open aortic repair (OAR), thoracic endovascular aortic repair (TEVAR), or hybrid aortic repair (HAR), or a combination of OAR and TEVAR. The surgical approach to aortic repair has evolved over the decades. The purpose of this study was to examine the current trends in treatment. METHODS: We extracted nationwide data of aortic repair procedures performed in 2015 and 2016 from the Japan Cardiovascular Surgery Database (JCVSD). In addition to estimating the number of cases, we also reviewed the respective operative mortalities and associated major morbidities (e.g., stroke, spinal cord insufficiency, and renal failure) according to disease pathology (e.g., acute dissection, chronic dissection, ruptured aneurysm, and unruptured aneurysm), site of operative repair (i.e., aortic root, ascending aorta, aortic root to arch, aortic arch, descending aorta, and thoracoabdominal aorta), and the preferred surgical approach (i.e., OAR, HAR, or TEVAR). RESULTS: The total number of cases studied was 35,427, with an overall operative mortality rate of 7.3%. Among the 3 procedures, 64% of patients were treated with OAR. Compared to the data from our previous report (also derived from the JCVSD in 2013 and 2014), the total number of cases and number of OAR, HAR, and TEVAR procedures have increased by 17.0%, 2.4%, 126.1%, and 34.9%, respectively. While the overall stroke rates following aortic arch surgical repair with HAR, OAR, and TEVAR were 10.1%, 8.4%, and 7.3%, respectively, OAR was found to have the lowest stroke rate when limited to cases presenting with a non-dissected/unruptured aorta. The incidence rates of paraplegia following descending/thoracoabdominal aortic surgical repair using HAR, OAR, and TEVAR were 6.3%/10.4%, 4.3%/8.9%, and 3.4%/4.6%, respectively. TEVAR was found to be associated with the lowest incidence of postoperative renal failure. CONCLUSIONS: The number of operations for thoracic and thoracoabdominal aortic diseases has increased, though the rate of operations using an OAR approach has decreased. While TEVAR showed the lowest mortality and morbidity rates, OAR demonstrated the lowest postoperative stroke rate for non-dissecting aortic arch aneurysms.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Idoso , Aneurisma Dissecante , Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/tendências , Cardiologia/métodos , Cardiologia/tendências , Bases de Dados Factuais , Procedimentos Endovasculares/tendências , Feminino , Humanos , Incidência , Japão , Masculino , Pessoa de Meia-Idade , Morbidade , Paraplegia/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
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
20.
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
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA