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1.
Khirurgiia (Mosk) ; (11): 83-87, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34786920

RESUMO

Bleeding is a significant cause of complications and mortality in surgery for ascending aorta and aortic root disease. This is especially true after complex reconstructions associated with hypothermic circulatory arrest and long-standing cardiopulmonary bypass. The review is devoted to modern methods of hemostasis in reconstructive aortic root surgery.


Assuntos
Doenças da Aorta , Hemostáticos , Aorta/cirurgia , Ponte Cardiopulmonar/efeitos adversos , Parada Cardíaca Induzida , Hemostasia , Humanos
2.
J Int Med Res ; 49(11): 3000605211054438, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34738476

RESUMO

Anomalous aortic origin of a coronary artery (AAOCA) is a rare pathology that may cause episodic ischemia owing to possible vessel compression during systolic expansion of the aortic root. This anomaly can lead to myocardial infarction, malignant arrhythmias and sudden cardiac death (SCD). Several surgical techniques have been described; however, there are no defined guidelines regarding the treatment of AAOCA. We report the case of a 47-year-old woman with ectopic origin of the right coronary artery (RCA) from the left sinus of Valsalva, with an interarterial course of the proximal segment of the artery, running between the aorta and the pulmonary trunk. Revascularization was accomplished by harvesting the right internal mammary artery (RIMA) and anastomosing it to the anomalous RCA, given the small portion of the RCA following an intramural course and our familiarity with the procedure. The RCA was ligated proximal to the anastomosis to avoid the string sign phenomenon. This procedure is safe and fast and can be considered an alternative to coronary reconstruction.


Assuntos
Anomalias dos Vasos Coronários , Artéria Torácica Interna , Infarto do Miocárdio , Aorta/diagnóstico por imagem , Aorta/cirurgia , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Feminino , Humanos , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/cirurgia , Pessoa de Meia-Idade
3.
Medicina (Kaunas) ; 57(11)2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34833394

RESUMO

We present the case of a 50-year-old male, with no cardiovascular risk factors other than smoking, that presented with acute chest pain, revealed to be an acute myocardial infarction with a large thrombus located in the ascending aorta. Such findings are rare in a patient with no other afflictions, such as atherosclerosis, aortic aneurysm, or aortic wall injury (surgical or traumatic). There is no specific pathway regarding the management of ascending aorta thrombus in such a patient; therapeutic options include surgical, interventional, or medical methods. Surgical thrombectomy was performed in this case, considering the high risk of systemic embolism and stroke and the hemodynamic stability of the patient.


Assuntos
Doenças da Aorta , Infarto do Miocárdio , Trombose , Aorta/diagnóstico por imagem , Aorta/cirurgia , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Trombectomia , Trombose/diagnóstico por imagem , Trombose/cirurgia
4.
J Trauma Acute Care Surg ; 91(5): 781-789, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34695057

RESUMO

BACKGROUND: The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) is controversial. We hypothesize that REBOA outcomes are improved in centers with high REBOA utilization. METHODS: We examined the Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry over a 5-year period (2014-2018). Resuscitative endovascular balloon occlusion of the aorta outcomes were analyzed by stratifying institutions into low-volume (<10), average-volume (11-30), and high-volume (>30) deployment centers. A multivariable model adjusting for volume group, mechanism of injury, signs of life, systolic blood pressure at initiation, operator level, device type, zone of placement, and hemodynamic response to aortic occlusion was created to analyze REBOA mortality and REBOA-related complications. RESULTS: Four hundred ninety-five REBOA placements were included. High-volume centers accounted for 63%, while low accounted for 13%. High-volume institutions were more likely to place a REBOA in the emergency department (81% vs. 63% low volume, p = 0.003), had a lower mean systolic blood pressure at insertion (53 ± 38 vs. 64 ± 40, p = 0.001), and more Zone I deployments (64% vs. 55%, p = 0.002). Median time from admission to REBOA placement was significantly less in patients treated at high-volume centers (15 [7-30] minutes vs. 35 [20-65] minutes, p = 0.001). Resuscitative endovascular balloon occlusion of the aorta mortality was significantly higher at low-volume centers (67% vs. 57%; adjusted odds ratio, 1.29; adj p = 0.040), while average- and high-volume centers were similar. Resuscitative endovascular balloon occlusion of the aorta complications were less frequent at high-/average-volume centers, but did not reach statistical significance (adj p = 0.784). CONCLUSION: Resuscitative endovascular balloon occlusion of the aorta survival is increased at high versus low utilization centers. Increased experience with REBOA may be associated with earlier deployment and subsequently improved patient outcomes. LEVEL OF EVIDENCE: Therapeutic/Care Management, level IV.


Assuntos
Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Ressuscitação/métodos , Choque Hemorrágico/cirurgia , Traumatismos Torácicos/terapia , Adulto , Aorta/cirurgia , Oclusão com Balão/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/mortalidade , Resultado do Tratamento , Adulto Jovem
5.
J Cardiothorac Surg ; 16(1): 285, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627316

RESUMO

Penetrating aortic ulcer (PAU) is one of the three subtypes of acute aortic syndrome. PAUs occur at any point throughout the aorta, most commonly in the descending thoracic aorta and less frequently in the aortic arch. Open surgical repair and total/hybrid endovascular repair are currently available to treat aortic arch PAUs. Herein, we present a patient with aortic arch PAU who underwent transthoracic minimally invasive closure, which is a novel method for the treatment of PAU. We describe a 52-year old Asian man who presented with sudden chest and back pain for 8 h. Computed tomography angiography showed that the PAU occurred in the aortic arch and had a diameter of 16 mm and a depth of 6 mm. The opening was successfully closed via transthoracic minimally invasive closure with an atrial septal defect occluder.


Assuntos
Doenças da Aorta , Implante de Prótese Vascular , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Úlcera/diagnóstico por imagem , Úlcera/cirurgia
6.
Zentralbl Chir ; 146(5): 479-485, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34666362

RESUMO

Pathologies in the region of the aortic arch may occur in isolation, but adjacent segments of the thoracic aorta - the ascending or descending aorta - are much more commonly affected. The first surgical procedures to treat the aortic arch were performed nearly six decades ago. Despite numerous improvements and innovations in the 20th and early 21st centuries, these procedures are still associated with relevant operative mortality and neurological complication rates. Endovascular techniques and modern hybrid procedures are increasingly expanding the therapeutic spectrum in the aortic arch, although the open surgical approach is currently still the gold standard. Endovascular treatment of aortic aneurysm was first performed in the early 1990s in the infrarenal abdominal aorta. It was not long before the first attempts at endovascular therapy were made for the treatment of the aortic arch. In 1996, Inoue et al. reported the use of the first commonly used endoprosthesis to treat aneurysms in the aortic arch. Continuous improvements and refinements in implantation techniques and also implanted material have resulted in endovascular therapy now being an increasingly important option compared to open surgical procedures in the descending thoracic and abdominal aorta and has partially replaced them as the gold standard. This review article aims to provide an overview of the prerequisites, results, but also limitations of endovascular surgery of the aortic arch.


Assuntos
Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Humanos , Stents , Resultado do Tratamento
7.
J Cardiothorac Surg ; 16(1): 283, 2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-34602088

RESUMO

BACKGROUND: In our earlier study on the functional limits of the aneurysmal aortic root we determined the pig root is susceptible to failure at high aortic pressures levels. We established a pig rupture model using cardiopulmonary bypass to determine the most susceptible region of the aortic root under the highest pressures achievable using continuous flow, and what changes occur in these regions on a macroscopic and histological level. This information may help guide clinical management of aortic root and ascending aorta pathology. METHODS: Five pigs underwent 4D flow MRI imaging pre surgery to determine vasopressor induced wall sheer stress and flow parameters. All pigs were then placed on cardiopulmonary bypass (CPB) via median sternotomy, and maximal aortic root and ascending aorta flows were initiated until rupture or failure, to determine the most susceptible region of the aorta. The heart was explanted and analysed histologically to determine if histological changes mirror the macroscopic observations. RESULTS: The magnetic resonance imaging (MRI) aortic flow and wall sheer stress (WSS) increased significantly in all regions of the aorta, and the median maximal pressures obtained during cardiopulmonary bypass was 497 mmHg and median maximal flows was 3.96 L/m. The area of failure in all experiments was the non-coronary cusp of the aortic valve. Collagen and elastin composition (%) was greatest in the proximal regions of the aorta. Collagen I and III showed greatest content in the inner aortic root and ascending aorta regions. CONCLUSIONS: This unique porcine model shows that the aortic root is most susceptible to failure at high continuous aortic pressures, supported histologically by different changes in collagen content and subtypes in the aortic root. With further analysis, this information could guide management of the aortic root in disease.


Assuntos
Aneurisma da Aorta Torácica , Ruptura Aórtica , Animais , Aorta/diagnóstico por imagem , Aorta/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Ponte Cardiopulmonar , Suínos
8.
Artigo em Inglês | MEDLINE | ID: mdl-34662003

RESUMO

Traumatic aortic injury is potentially fatal. Although uncommon, involvement of the aortic arch and the ascending aorta can occur. This case shows concomitant dissection of the ascending and descending sections of the aorta after blunt chest trauma where the open surgical approach was successfully performed to treat both aortic injuries.


Assuntos
Aneurisma da Aorta Torácica , Doenças da Aorta , Implante de Prótese Vascular , Traumatismos Torácicos , Ferimentos não Penetrantes , Aorta/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Humanos , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/cirurgia
9.
Kyobu Geka ; 74(10): 763-769, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34548443

RESUMO

We presented our experiences of reoperative aortic root replacement and technical details. Between April 2000 and February 2021, 80 patients underwent reoperative aortic root replacement (60 male, mean age 59.3±14.4 years). The previous procedures were ascending or arch replacement in 36, aortic valve replacement (AVR) in 32, and aortic root replacement in 12. Surgical indications for reoperation included infective endocarditis or graft infection (n=31), root dilation/dissection (n=26), pseudoaneurysm(n=13), aortic valve regurgitation( n=7), and structural valve dysfunction( n=3). Mean interval from 1st operation was 6.7±6.1 years. Reoperative procedures were composed of modified Bentall( n=27), reimplantation technique (n=25), root replacement with stentless valve (n=16), partial remodeling/patch plasty( n=5), Commando operation( n=5), and Ross operation( n=2). In-hospital mortality was 8.8%(7/80 patients). The causes of mortality were sepsis in 3, pneumonia in 2, bowel perforation in 1, and anastmotic rupture with mediastinitis in 1. Freedom from 3rd time aortic root related opera tion was 90.8±4.8% at 10 years. Actuarial survival after reoperation was 67.3±6.6% at 10 years. In conclusion, the clinical short-and long-term outcomes of reoperative aortic root replacement were reasonable even in patients with complicated aortic pathologies.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Adulto , Idoso , Aorta/cirurgia , Valva Aórtica/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
10.
Kyobu Geka ; 74(10): 770-774, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34548444

RESUMO

Surgeries for non-dissected aortic arch diseases have been performed with increasing frequency in recent years. Accordingly, the awareness of the pitfalls in reoperation after a previous ascending aortic replacement is needed. Indications for redo total aortic arch replacement after a prior ascending aortic replacement include pseudoaneurysm formation at the distal anastomosis site and newly developed aortic arch aneurysms. At reoperation, we should take the assurance of safety during re-sternotomy into consideration. Cannulation sites should be strategically selected. The radiologic features of the high-risk re-sternotomy include a close approximation( <5 mm) between the sternum and the aorta or the previously placed vascular prosthesis and a presence of pseudoaneurysm underneath the sternum. In such cases, it is reasonable to establish partial cardiopulmonary bypass and selective cerebral perfusion via bilateral carotid artery cannulation prior to sternotomy to avoid disastrous neurological complications. Adhesions around a previously placed vascular prosthesis with innominate vein or main pulmonary artery can be troublesome;thus, care must be taken so as not to injure the surrounding vital organs. Liberal employment of hypothermia can be life-saving by preserving brain, heart and other vital end-organs at the expense of prolonged procedure time.


Assuntos
Aneurisma Aórtico , Doenças da Aorta , Implante de Prótese Vascular , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Doenças da Aorta/cirurgia , Humanos , Perfusão
11.
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
12.
Kyobu Geka ; 74(10): 804-808, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34548450

RESUMO

Pediatric patients with narrow aortic valve annulus are often forced to undergo repeated aortic valve surgery, and it is not uncommon to plan a treatment strategy from the beginning with the assumption of reoperation or staged surgery. This article describes the anatomical structure of the aorto-mitral curtain and presents an example case of the Yamaguchi method, a relatively infrequently performed aortic valve procedure, in anticipation of aortic annular enlargement as a third reoperation in a 15-year-old boy with critical aortic valve stenosis. In the Nicks procedure, the incision beyond the posterior annulus is limited to the fibrous tissue of the aorto-mitral curtain;in the Manouguian procedure on the other hand, the incision is extended beyond this point to the anterior leaflet of the mitral valve. In the Yamaguchi procedure, the Konno incision at the anterior annulus near the right-left commissure is added to the standard Nicks incision for posterior annular enlargement, and thus the narrow annulus is enlarged in two places using two separate patches. However, the anterior incision cannot be very deep because the area immediately below the anterior annulus is nearly muscular tissue. Usually the annulus is enlarged with four posterior pledgets and additional two anterior pledgets.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Adolescente , Aorta/diagnóstico por imagem , Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Criança , Humanos , Masculino , Valva Mitral , Reoperação
13.
Am J Physiol Heart Circ Physiol ; 321(4): H784-H797, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34533403

RESUMO

Coenzyme A (CoA) is an essential cofactor required for intermediary metabolism. Perturbations in homeostasis of CoA have been implicated in various pathologies; however, whether CoA homeostasis is changed and the extent to which CoA levels contribute to ventricular function and remodeling during pressure overload has not been explored. In this study, we sought to assess changes in CoA biosynthetic pathway during pressure overload and determine the impact of limiting CoA on cardiac function. We limited cardiac CoA levels by deleting the rate-limiting enzyme in CoA biosynthesis, pantothenate kinase 1 (Pank1). We found that constitutive, cardiomyocyte-specific Pank1 deletion (cmPank1-/-) significantly reduced PANK1 mRNA, PANK1 protein, and CoA levels compared with Pank1-sufficient littermates (cmPank1+/+) but exerted no obvious deleterious impact on the mice at baseline. We then subjected both groups of mice to pressure overload-induced heart failure. Interestingly, there was more ventricular dilation in cmPank1-/- during the pressure overload. To explore potential mechanisms contributing to this phenotype, we performed transcriptomic profiling, which suggested a role for Pank1 in regulating fibrotic and metabolic processes during the pressure overload. Indeed, Pank1 deletion exacerbated cardiac fibrosis following pressure overload. Because we were interested in the possibility of early metabolic impacts in response to pressure overload, we performed untargeted metabolomics, which indicated significant changes to metabolites involved in fatty acid and ketone metabolism, among other pathways. Collectively, our study underscores the role of elevated CoA levels in supporting fatty acid and ketone body oxidation, which may be more important than CoA-driven, enzyme-independent acetylation in the failing heart.NEW & NOTEWORTHY Changes in CoA homeostasis have been implicated in a variety of metabolic diseases; however, the extent to which changes in CoA homeostasis impacts remodeling has not been explored. We show that limiting cardiac CoA levels via PANK deletion exacerbated ventricular remodeling during pressure overload. Our results suggest that metabolic alterations, rather than structural alterations, associated with Pank1 deletion may underlie the exacerbated cardiac phenotype during pressure overload.


Assuntos
Metabolismo Energético , Miocárdio/enzimologia , Fosfotransferases (Aceptor do Grupo Álcool)/deficiência , Disfunção Ventricular Esquerda/enzimologia , Função Ventricular Esquerda , Remodelação Ventricular , Animais , Aorta/fisiopatologia , Aorta/cirurgia , Apoptose , Pressão Arterial , Coenzima A/metabolismo , Modelos Animais de Doenças , Feminino , Fibrose , Deleção de Genes , Humanos , Masculino , Metaboloma , Camundongos Endogâmicos C57BL , Camundongos Knockout , Miocárdio/patologia , Fosfotransferases (Aceptor do Grupo Álcool)/genética , Transcriptoma , Disfunção Ventricular Esquerda/genética , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/fisiopatologia
14.
Am J Physiol Heart Circ Physiol ; 321(5): H976-H984, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34559578

RESUMO

Heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF) often arises from a prolonged LV pressure overload (LVPO) and accompanied by abnormal extracellular matrix (ECM) accumulation. The E3 ubiquitin ligase WWP1 is a fundamental determinant ECM turnover. We tested the hypothesis that genetic ablation of Wwp1 would alter the progression of LVPO-induced HFpEF. LV echocardiography in mice with global Wwp1 deletion (n = 23; Wwp1-/-) was performed at 12 wk of age (baseline) and then at 2 and 4 wk following LVPO (transverse aortic banding) or surgery without LVPO induction. Age-matched wild-type mice (Wwp1+/+; n = 23) underwent identical protocols. LV EF remained constant and unchanged with LVPO and LV mass increased in both groups but was lower in the Wwp1-/- mice. With LVPO, the E/A ratio, an index of LV filling, was 3.97 ± 0.46 in Wwp1+/+ but was 1.73 ± 0.19 in the Wwp1-/- group (P < 0.05). At the transcriptional level, mRNA for fibrillar collagens (types I and III) decreased by approximately 50% in Wwp1-/- compared with the Wwp1+/+ group at 4 wk post-LVPO (P < 0.05) and was paralleled by a similar difference in LV fibrillar collagen content as measured by histochemistry. Moreover, mRNA levels for determinants favoring ECM accumulation, such as transforming growth factor (TGF), increased with LVPO, but were lower in the Wwp1-/- group. The absence of Wwp1 reduced the development of left ventricular hypertrophy and subsequent progression to HFpEF. Modulating the WWP1 pathway could be a therapeutic target to alter the natural history of HFpEF.NEW & NOTEWORTHY Heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF) often arises from a prolonged LV pressure overload (LVPO) and is accompanied by abnormal extracellular matrix (ECM) accumulation. It is now recognized that the ECM is a dynamic entity that is regulated at multiple post-transcriptional levels, including the E3 ubiquitin ligases, such as WWP1. In the present study, WWP1 deletion in the context of an LVPO stimulus reduced functional indices of HFpEF progression and determinants of ECM remodeling.


Assuntos
Insuficiência Cardíaca/enzimologia , Ventrículos do Coração/enzimologia , Hipertrofia Ventricular Esquerda/enzimologia , Ubiquitina-Proteína Ligases/deficiência , Disfunção Ventricular Esquerda/enzimologia , Função Ventricular Esquerda , Remodelação Ventricular , Animais , Aorta/fisiopatologia , Aorta/cirurgia , Diástole , Modelos Animais de Doenças , Progressão da Doença , Matriz Extracelular/metabolismo , Matriz Extracelular/patologia , Feminino , Colágenos Fibrilares/genética , Colágenos Fibrilares/metabolismo , Deleção de Genes , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Hipertrofia Ventricular Esquerda/genética , Hipertrofia Ventricular Esquerda/patologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , Fatores de Tempo , Ubiquitina-Proteína Ligases/genética , Disfunção Ventricular Esquerda/genética , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/fisiopatologia
15.
G Ital Cardiol (Rome) ; 22(10): 851-853, 2021 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-34570119

RESUMO

We describe the case of a patient with an ascending aorta and aortic root aneurysm who underwent aortic valve replacement, 14 years earlier, with a mechanical prosthesis, which was normally functioning at time of reoperation. We describe the "completion Bentall" technique - a modified Bentall technique -, a procedure for prosthesis-sparing aortic root replacement. This technique simplifies the original procedure in reinterventions, reducing complication rates and aortic cross-clamping and cardiopulmonary bypass times, with a good surgical result.


Assuntos
Aneurisma da Aorta Torácica , Aneurisma Aórtico , Implante de Prótese Vascular , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Valva Aórtica/cirurgia , Humanos , Reoperação , Resultado do Tratamento
16.
J Card Surg ; 36(12): 4546-4550, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34580925

RESUMO

BACKGROUND: Un-roofing is the most common technique utilized for repair of anomalous aortic origin of a coronary artery (AAOCA). There are very few publications directly comparing un-roofing to another surgical technique, like reimplantation. METHODS: The prospectively collected Children's Memorial Hermann Heart Institute Society of Thoracic Surgeon's Database was retrospectively reviewed from 2007 to 2021. Surgical patients were included if they underwent un-roofing or reimplantation of the AAOCA. The primary outcomes of this study were operative characteristics and postoperative outcomes. Secondary outcomes included angiographic outcomes, aortic regurgitation incidence, ventricular function, and symptom relief. RESULTS: From 2007 to 2021, there were 12 patients who underwent either a reimplantation (n = 9, 73%) or un-roofing (n = 3, 27%) for an AAOCA. The hospital length of stay was a median of 1.8 days longer for reimplantation compared to un-roofing. The last follow-up echocardiogram was a median of 52.2 days later in the reimplantation group. There was one patient (11%) in the reimplantation group that had more than or equal to mild aortic regurgitation and mild systolic ventricular dysfunction. Outpatient follow-up was incomplete and there was no postoperative computed tomographic angiography in the un-roofing cohort. CONCLUSIONS: Coronary artery reimplantation is a valuable alternative surgical technique to un-roofing for the repair of AAOCA. There are still some concerns with the creation of aortic regurgitation or incomplete symptom relief with any surgical technique. Longer-term follow-up and prospective studies will be needed to show an effective reduction of myocardial ischemia and risk of sudden cardiac death.


Assuntos
Anomalias dos Vasos Coronários , Vasos Coronários , Aorta/diagnóstico por imagem , Aorta/cirurgia , Criança , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Estudos Prospectivos , Estudos Retrospectivos
17.
J Card Surg ; 36(12): 4779-4782, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34590338

RESUMO

BACKGROUND: Circumferential calcification of the ascending aorta, known as porcelain aorta, in a patient candidate to a heart transplant, requires technically demanding and high-risk procedural adjustments. AIMS: This case report showed successful replacement of ascending aorta due to extensive calcification at time of heart transplantation. MATERIALS AND METHODS: In the operating theatre, after median sternotomy, cardiopulmonary bypass (CPB) was achieved via the right femoral artery and vein. Due to the impossibility of replacing the ascending aorta using safe aortic cross-clamping, a moderate hypothermia was established, and circulatory arrest was realized. According to Kazui protocol for selective anterograde cerebral perfusion via anonymous trunk and left carotid artery, ascending aorta was replaced with vascular prosthesis. RESULTS: Thanks to accurate pre-surgical planning, which included hypothermic circulatory arrest, ascending aorta replacement, before orthotopic heart implantation, we were able to perform the procedure successfully and prevent neurological events. DISCUSSION: Although different reports showed the feasibility of heart transplant combined to aortic replacement for aneurysmatic pathology, few cases were described for porcelain aorta, due to technically demanding procedure and prohibitive aortic cross-clamping. To avoid vascular embolization, dissection and mural laceration, aortic cross-clamping is not recommended. We performed aortic replacement at first, to reduce allograft ischemia. CONCLUSION: The use of hypothermic circulatory arrest technique with selective cerebral perfusion for aortic replacement, followed by vascular graft clamping to favour cardiac allograft implantation, could be considered a winning combination to guarantee procedural success and to reduce perioperative complications.


Assuntos
Porcelana Dentária , Transplante de Coração , Aorta/cirurgia , Aorta Torácica , Parada Cardíaca Induzida , Humanos
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