Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.827
Filtrar
1.
Kyobu Geka ; 73(10): 744-748, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130759

RESUMO

Severe atherosclerosis of the ascending aorta frequently causes difficulties during heart operations, hindering surgical maneuvers and potentially leading to systemic embolism. There have been several methods to solve these problems but the best way to treat patients requiring aortic valve replacement (AVR) has not been established yet. Surgical techniques for AVR in these patients include AVR under deep hypothermic circulatory arrest with or without endarterectomy of the ascending aorta or replacement of the ascending aorta. Endovascular clamping using a balloon is another approach but require manipulation of the heavily calcified aorta that may result in a certain risk for stroke. Another option to avoid the ascending aorta and cross-clamping is the apico-aortic conduit. Trans-catheter AVR( TAVR),especially trans-apical AVR, has been shown to be feasible in such patients. Large studies and longer follow-up will be required to scientifically prove the superiority of trans-apical AVR over conventional surgical strategies in patients with porcelain aorta requiring AVR.


Assuntos
Doenças da Aorta , Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Aorta/diagnóstico por imagem , Aorta/cirurgia , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Humanos
2.
Kyobu Geka ; 73(10): 778-782, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130765

RESUMO

Arteritis is an inflammatory disease of the vessel walls, resulting in vascular damage and a wide variety of clinical symptoms and multisystem disorders. Because aneurysmal disease, coronary disease, and aortic insufficiency affect patient prognosis, surgical intervention plays an important role. Preoperatively, systemic vessels, cardiac function, and other major organs should be evaluated. Regarding the surgical technique, reinforcement of the anastomosis to the fragile aortic wall is important to prevent pseudoaneurysmal formation and prosthetic valvular detachment. As aortic root replacement, we have been applying the modified Bentall procedure with a "double fixation technique" and obtained desirable outcomes. Although endovascular repair for aneurysmal disease is one of the treatment options, its longterm efficacy remains uncertain. Postoperative control of inflammation with corticosteroids and/or immunosuppressive agents is also important for long-term management. Pseudoaneurysmal formation and prosthetic valvular detachment may occur progressively over a long period of time. To prevent these complications, strict follow-up with imaging and inflammation control should be performed.


Assuntos
Falso Aneurisma , Insuficiência da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Arterite de Takayasu , Aorta/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Humanos , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico por imagem , Arterite de Takayasu/cirurgia
4.
Angiol Sosud Khir ; 26(3): 158-161, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063762

RESUMO

Elderly and aged patients appear to have a significantly increased risk from a cardiosurgical intervention combining three-valve reconstruction and prosthetic repair of the ascending portion of the aorta. Triple-valve pathology in pronounced mitral insufficiency is often accompanied by concomitant dilatation of the left atrium, i. e., atriomegaly. With the aim to eliminate the syndrome of compression of surrounding tissues and normalize intracardiac haemodynamics, reduction of the left atrium should become an inherent procedure for atriomegaly in patients with multiple-valve pathology.


Assuntos
Aorta , Átrios do Coração , Idoso , Aorta/diagnóstico por imagem , Aorta/cirurgia , Dilatação Patológica , Humanos , Estudos Retrospectivos
5.
J Vis Exp ; (163)2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32986029

RESUMO

Based on twice transverse aortic constrictions (TACs) in mice, it is proved that myocardial hypertrophic preconditioning (MHP) could attenuate cardiomyocyte hypertrophy and slow down progression to heart failure. For novices, however, the MHP model is usually quite difficult to establish because of the technical obstacles in ventilator operation, opening the chest repeatedly, and bleeding caused by debanding. To facilitate this model, to increase the surgical success rate and to reduce the incidence of bleeding, we switched to absorbable sutures for the first TAC combing with a ventilator-free technique. Using a 2-week absorbable suture, we demonstrated that this procedure could cause significant myocardial hypertrophy in 2 weeks; and 4 weeks after surgery, myocardial hypertrophy was almost completely regressed to the baseline. Using this protocol, the operators could master the MHP model easily with a lower operation mortality.


Assuntos
Aorta/patologia , Aorta/cirurgia , Cardiomegalia/etiologia , Miocárdio/patologia , Suturas , Anestesia , Animais , Aorta/diagnóstico por imagem , Cardiomegalia/diagnóstico por imagem , Cardiomegalia/fisiopatologia , Constrição , Modelos Animais de Doenças , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Ligadura , Masculino , Camundongos Endogâmicos C57BL , Pressão , Sístole
6.
Khirurgiia (Mosk) ; (8): 49-54, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869615

RESUMO

OBJECTIVE: To compare various approaches to revascularization of aortoiliac-femoral segment. MATERIAL AND METHODS: Data were collected prospectively for retrospective analysis. There were 192 patients with atherosclerotic lesion of the aortoiliac-femoral segment who underwent reconstructive surgeries. All patients were divided into 3 groups depending on the type of reconstruction: 85 patients underwent open surgical interventions, 63 patients - endovascular interventions, 44 patients - hybrid techniques. Between-group differences were considered significant at p-value <0.05. RESULTS: Hybrid revascularization is characterized by less duration of surgery, blood loss and morbidity. Hybrid interventions ensured favorable primary patency compared to open surgery within the follow-up period. CONCLUSION: Hybrid revascularization of aortoiliac-femoral segment is characterized by less duration of surgery, blood loss and morbidity.


Assuntos
Aorta/cirurgia , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Doença Arterial Periférica/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Endovasculares , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
7.
J Thorac Cardiovasc Surg ; 160(3): 757-771.e5, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32800265

RESUMO

OBJECTIVES: It remains unclear when sudden cardiac event risk outweighs surgical risk for patients with anomalous aortic origin of a coronary artery. The Congenital Heart Surgeons' Society sought to characterize the surgical risks by determining the techniques, complications, and outcomes of repair. METHODS: Between January 2000 and September 2018, 682 patients with anomalous aortic origin of a coronary artery aged 30 years or less were enrolled. Demographic, morphologic, operative, imaging, and ischemia-related data were analyzed. RESULTS: There were 395 of 682 (57%) surgical patients (45 centers, median follow-up 2.8 years). In addition to primary repair (87% unroofing, 26% commissural manipulation), 13 patients had 15 coronary-related reoperations. Of 358 patients with pre/postoperative aortic insufficiency assessment, 27 (8%) developed new mild or greater aortic insufficiency postoperatively, and 7 (2%) developed new moderate or greater aortic insufficiency. Freedom from mild aortic insufficiency differed in those with versus without commissural manipulation (85%/91% at 6 months, 83%/90% at 1 year, and 77%/88% at 3 years, respectively) (P = .05). Of 347 patients with preoperative/postoperative ejection fraction, 6 (2%) developed new abnormal ejection fraction (<50%) within 30 days of surgery which persisted. Although 64 of 395 patients (16%) had preoperative ischemia, after surgery 51 of 64 patients (80%) no longer had ischemia (13 = new postoperative ischemia, P < .0001). Four patients died postoperatively (preoperatively 2 asymptomatic, 1 symptomatic, 1 in extremis). Composite surgical adverse event rates were 7% to 13% in the entire cohort (increasing/decreasing by presentation/anatomy/repair strategy). CONCLUSIONS: Anomalous aortic origin of a coronary artery surgery may relieve ischemia with low mortality; however, it can result in a variety of important morbidities, varying by the group evaluated. Strategies avoiding commissural manipulation may decrease the risk of developing aortic insufficiency. Understanding these risks should inform surgical decision-making and support the need for standardized assessment and management.


Assuntos
Aorta/cirurgia , Procedimentos Cirúrgicos Cardíacos , Anomalias dos Vasos Coronários/cirurgia , Complicações Pós-Operatórias , Adolescente , Adulto , Insuficiência da Valva Aórtica/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Adulto Jovem
8.
J Trauma Acute Care Surg ; 89(2): 320-328, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740640

RESUMO

BACKGROUND: Noncompressible hemorrhage remains a high-mortality injury, and aortic balloon occlusion poses limitations in terms of distal ischemic injury. Our hypothesis was that a retrievable Rescue stent would confer improved outcome over aortic balloon occlusion. METHODS: A three-tier, retrievable stent graft was laser welded from nitinol and polytetrafluoroethylene to provide rapid thoracic and abdominal coverage with an interval bare metal segment to preserve visceral flow. Anesthetized swine had injury of the thoracic or abdominal aorta followed by balloon occlusion or a Rescue stent. A 1-hour long damage-control phase with blood repletion was used to simulate the prolonged interval between injury and repair, especially in the battlefield setting. Following the damage-control phase, the balloon or stent were retrieved followed by vascular repair and recovery to 48 hours. Animals were compared in terms of hemodynamics, blood loss, neurophysiologic spinal cord ischemia, ischemic organ injury, and survival. RESULTS: Despite antegrade hemorrhage control, balloon occlusion averaged 3.5 L of retrograde hemorrhage, loss of visceral perfusion, and permanent spinal cord ischemia by neurophysiology in six of seven animals. After permanent repair, all balloon occlusion animals died with only a single short term (5 hours) survivor. Conversely, Rescue stent animals revealed rapid hemorrhage control (in under 2 minutes) whether the injury was thoracic or abdominal with improved hemodynamics, preserved visceral flow, reduced spinal cord ischemia, negligible histologic organ injury and survival to end of study in all abdominal injured animals (n = 6) and four of six thoracic injured animals, with two deaths related to arrhythmia. CONCLUSION: Compared with aortic balloon occlusion, a Rescue stent offers superior hemorrhage control and survival by virtue of reduced ischemic injury and direct control of the hemorrhagic injury. The Rescue stent may become a useful tool for damage control, especially on the battlefield where definitive repair presents logistical challenges.


Assuntos
Aorta/lesões , Aorta/cirurgia , Oclusão com Balão , Procedimentos Endovasculares , Hemorragia/cirurgia , Stents , Animais , Hemodinâmica , Hemorragia/etiologia , Hemorragia/fisiopatologia , Hemorragia/prevenção & controle , Isquemia/etiologia , Isquemia/prevenção & controle , Modelos Animais , Medula Espinal/irrigação sanguínea , Suínos , Resultado do Tratamento , Vísceras/irrigação sanguínea , Lesões Relacionadas à Guerra/complicações , Lesões Relacionadas à Guerra/cirurgia
10.
J Card Surg ; 35(10): 2725-2733, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32840925

RESUMO

INTRODUCTION: This study evaluated surgical outcomes of infective endocarditis (IE), with particular attention to the impact of intravenous drug use (IVDU). METHODS: Adult patients undergoing surgery for IE between 2011 and 2018 at a single center were included and stratified by IVDU. The primary outcome was overall survival. Secondary outcomes included postoperative complications and hospital readmissions. Kaplan-Meier and multivariable Cox regression were utilized for unadjusted and risk-adjusted survival analyses, respectively. Cumulative incidence function curves were compared for hospital readmissions. RESULTS: A total of 831 patients (mean age 55 years, 34.4% female) were operated on for IE, including 318 (38.3%) with IVDU. Cultures were most commonly positive for streptococcus (25.2%), methicillin-sensitive Staphylococcus aureus (17.7%), enterococcus (14.3%), or methicillin-resistant Staphylococcus aureus (8.4%). The most common procedures included isolated aortic valve repair/replacement (18.8%), aortic root replacement (15.9%), mitral valve repair/replacement (26.7%), aortic and mitral valve replacement (8.4%), and tricuspid valve repair/replacement (7.6%). Mean follow-up was 3.4 ± 2.4 years. Overall 5-year survival was 64% and was similar between IVDU and non-IVDU. Multivariable analysis demonstrated that IVDU was not associated with mortality risk. IVDU patients displayed higher rates of all-cause readmission (61.6% vs 53.9%; P = .03), drug-use readmission (15.4% vs 1.4%; P < .001), and recurrent endocarditis readmission (33.0% vs 13.0%; P < .001). CONCLUSIONS: The majority of patients undergoing surgical treatment of IE are alive at 5-years although readmission rates are high. IVDU is not a risk factor for longitudinal mortality although patients with IVDU are at higher overall readmission risk, driven largely by greater readmissions for drug-use and recurrent endocarditis.


Assuntos
Endocardite/cirurgia , Adulto , Idoso , Aorta/cirurgia , Implante de Prótese Vascular , Anuloplastia da Valva Cardíaca , Endocardite/microbiologia , Endocardite/mortalidade , Feminino , Implante de Prótese de Valva Cardíaca , Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa , Taxa de Sobrevida , Resultado do Tratamento
11.
J Card Surg ; 35(8): 2044-2046, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652640

RESUMO

Mediastinal paragangliomas are exceedingly rare neuroendocrine tumors of chromaffin cell origin. They are rarely endocrinologically functional, but complications often arise due to mass effect within the mediastinal cavity. We present a case of a 67-year-old gentleman referred to our unit for excision of a large mediastinal mass, thought to be thymic in origin, but without confirmatory preoperative histological diagnosis. Intra-operatively it became clear that the tumor was intra-pericardial, originating from aortic tissue, mandating pericardectomy, and ascending aortic replacement on cardiopulmonary bypass for its complete excision. Histopathological evaluation later confirmed the mass to be an aorticopulmonary paraganglioma.


Assuntos
Aorta/cirurgia , Paraganglioma/diagnóstico , Paraganglioma/cirurgia , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/cirurgia , Idoso , Aorta/patologia , Implante de Prótese Vascular/métodos , Ponte Cardiopulmonar , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias do Mediastino , Paraganglioma/patologia , Pericardiectomia , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/patologia
12.
J Card Surg ; 35(8): 2059-2063, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652648

RESUMO

Iatrogenic aortocoronary dissection is a rare but potentially fatal complication of coronary catheterizations. Although the incidence is comparatively low, dissection often leads to procedure failure with increased risk of myocardial infarction and death. Iatrogenic aortocoronary dissection is principally caused by disruption of intima at the ostia of the right or left coronary artery during interventional procedures and appears as luminal filling defects, the persistence of contrast or intimal tear outside the coronary lumen. We present a case of right coronary artery dissection leading to type-A aortic dissection suffered during diagnostic coronary catheterization. This required emergency supracoronary replacement of the ascending aorta with an aortic interposition tube graft and venous grafts to coronary arteries.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Valva Aórtica , Implante de Prótese Vascular/métodos , Cateterismo Cardíaco/efeitos adversos , Doença Iatrogênica , Tratamentos com Preservação do Órgão/métodos , Vasos Coronários , Feminino , Humanos , Pessoa de Meia-Idade
15.
J Card Surg ; 35(8): 2084-2086, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652658

RESUMO

Primary benign schwannomas of the heart are very rare. We report the case of a patient with a huge schwannoma of unique aortic origin. The complete resection of the rare tumor has been successfully performed. There is no recurrent tumor in the 5 years follow-up. We focus our attention on the surgical technique.


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular/métodos , Neurilemoma/cirurgia , Neoplasias Vasculares/cirurgia , Aorta/diagnóstico por imagem , Aorta/patologia , Ponte Cardiopulmonar , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Procedimentos Cirúrgicos Reconstrutivos , Esternotomia/métodos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologia
16.
J Card Surg ; 35(8): 2087-2088, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652665

RESUMO

A 58-year-old man with a history of hypertension, dyslipidemia, and an obtuse marginal branch coronary stent developed the sudden onset of chest pain. A contrast computed tomography demonstrated a penetrating ulcer of nondilating ascending aorta and a small pericardial effusion. Coronary angiography showed three-vessel disease. At emergency surgery, there was blood in the pericardial sac and the whole of the ascending aorta had hematoma with no evidence of tamponade. We performed a hemiarch replacement under circulatory arrest and concomitant coronary artery bypass grafting. The left side of the proximal arch had ruptured just beyond the pericardial reflection.


Assuntos
Aorta/cirurgia , Ruptura Aórtica/cirurgia , Aorta/diagnóstico por imagem , Ruptura Aórtica/complicações , Ruptura Aórtica/diagnóstico por imagem , Implante de Prótese Vascular/métodos , Dor no Peito/etiologia , Ponte de Artéria Coronária/métodos , Emergências , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/complicações , Derrame Pericárdico/diagnóstico por imagem , Ruptura Espontânea , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Ann Vasc Surg ; 69: 451.e5-451.e10, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32615204

RESUMO

BACKGROUND: Acute aortic dissection rarely results in circumferential dissections of the aortic intima that may lead to intimo-intimal intussusception (IIS) with complete separation from the aortic wall. Circumferential dissection may then result in distal embolization of the involved intima and media, adding considerable complexity to the management of such cases. Despite the severity of this complication, the natural history of aortic disease following extensive intimal denuding and IIS is not well documented in the literature. Here we present a case with long-term follow-up of type B aortic dissection (TBAD) complicated by IIS and embolization of the intima into the distal aorta following thoracic endovascular aortic repair. METHODS: Medical records and imaging studies were retrospectively reviewed with the approval of the Institutional Review Board. A single patient underwent repair of a TBAD that was complicated by IIS, with follow-up for 6 years. Aortic recovery was monitored with serial computerized tomography scans. RESULTS: During endovascular stent deployment, the patient's dissection progressed circumferentially, leading to distal embolization of the intima and aortic occlusion. An open transabdominal aortic exploration was performed to extract the embolized intima. Despite this severe aortic structural disruption, the patient recovered well postoperatively and exhibited favorable aortic remodeling over long-term follow-up. The denuded aorta did not rupture or develop progressive worsening aneurysmal dilation and the diameter of the involved aortic segment remained stable during follow-up. CONCLUSIONS: Acute TBADs can progress to circumferential intimal separation and IIS when managed with endovascular stenting and balloon dilation. Continued endovascular management once IIS has occurred may lead to further intimal damage, resulting in distal embolization of the intima and aortic occlusion. Thus, IIS may require conversion to open repair. However, in the event that loss of the aortic intima does occur following IIS, it is possible for the denuded aorta to recover well and remain stable with favorable remodeling over long-term follow-up.


Assuntos
Aneurisma Dissecante/cirurgia , Angioplastia com Balão/efeitos adversos , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Embolia/cirurgia , Lesões do Sistema Vascular/cirurgia , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Angioplastia com Balão/instrumentação , Aorta/diagnóstico por imagem , Aorta/lesões , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Embolia/diagnóstico por imagem , Embolia/etiologia , Humanos , Masculino , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
20.
J Card Surg ; 35(8): 1840-1847, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32643831

RESUMO

BACKGROUND: Porcine aortic roots (PAR) have been reported in the literature with acceptable short- and long-term outcomes for the treatment of aortic root aneurysms. However, their efficacy in type A aortic dissection (TAAD) is yet to be defined. METHODS: Using data from a locally collated aortic dissection registry, we compared the outcomes in patients undergoing aortic root replacement for TAAD using either of two surgical options: (a) PAR or (b) composite valve grafts (CVG). A retrospective analysis was conducted for all procedures in the period from 2005 to 2018. RESULTS: A total of 252 patients underwent procedures for TAAD in the time period. Sixty-five patients had aortic root replacements (PAR n = 30, CVG n = 35). Between-group comparisons identified a younger CVG group (50.5 vs 64.5, P < .05) although all other covariates were comparable. Operative parameters were comparable between the two groups. The use of PAR did not significantly impact operative mortality (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.22-3.61; P = .992), stroke (OR, 2.91, 0.25-34.09, P = .395), reoperation (OR, 0.91; 95% CI, 0.22-3.62; P = .882) or length of stay (coeff 2.33, -8.23 to 12.90; P = .659) compared to CVG. Five-year survival was similar between both groups (PAR 59% vs CVG 69%; P = .153) and reoperation was negligible. Echocardiography revealed significantly lower aortic valve gradients in the PAR group (8.69 vs 15.45mm Hg; P < .0001), and smaller left ventricular dimensions both at 6-week and 1-year follow-up (P < .05). CONCLUSIONS: This study highlights the comparable short- and midterm outcomes of PAR in cases of TAAD, in comparison to established therapy.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Implante de Prótese de Valva Cardíaca/métodos , Animais , Humanos , Estudos Retrospectivos , Suínos , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA