RESUMO
A 67-year-old man presented with chest pain. Clinical examination revealed hypertension (160/90 mm Hg). Electrocardiogram indicated no acute coronary syndrome and cardiac enzymes were normal. Catheterization was performed owing to the patient's continuing chest pain and ascending aortogram revealed irregular aortic wall. A computed tomography image showed the shape of penetrating ulcer. The patient was taken to the operating room and intraoperative examination confirmed the diagnosis of penetrating atherosclerotic ulcer (PAU). Coronary artery bypass graft and bovine pericardial patch repair of PAU was performed. A bovine pericardial patch was done as aortic root was heavily calcified and was easy to handle and more hemostatic.
Assuntos
Aorta/cirurgia , Aterosclerose/cirurgia , Úlcera Varicosa/cirurgia , Doença Aguda , Idoso , Angioplastia/métodos , Animais , Aorta/diagnóstico por imagem , Aorta/patologia , Aortografia , Aterosclerose/diagnóstico por imagem , Aterosclerose/patologia , Implante de Prótese Vascular/métodos , Bovinos , Dor no Peito/etiologia , Ponte de Artéria Coronária , Xenoenxertos , Humanos , Masculino , Pericárdio/transplante , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Úlcera Varicosa/diagnóstico por imagem , Úlcera Varicosa/patologiaRESUMO
Mitral valve repair is the ideal intervention for mitral valve disease with excellent long-term survival comparable to the age-matched general population. When the mitral valve is not repairable, mechanical prostheses may be associated with improved survival as compared with biological prostheses. Newer mechanical and biological valve prostheses have the potential to improve outcomes following mitral valve replacement in young patients. Patients presenting for mitral valve surgery after failed transcatheter mitral valve-in-valve have high rates of postoperative mortality and morbidity, exceeding those seen with reoperative mitral valve surgery, which poses issues in young patients who have a higher cumulative incidence of reintervention.
Patients presenting with mitral valve disease, the most common type of heart valve disease, have a survival advantage when they undergo mitral valve repair as opposed to replacement, and this is particularly true for young patients. When the mitral valve is not repairable, mechanical prostheses (prosthetic implants) may be associated with improved survival as compared with biological prostheses, and this difference is mostly observed until the age of 70 years. Newer techniques of treating mitral valve disease without requiring open heart surgery have not yet been shown to be superior or even equivalent to traditional open heart surgery in the general population. Patients presenting for mitral valve surgery after failure of these newer techniques have high rates of death, exceeding those seen with mitral valve reoperation, which has important implications for young patients with mitral valve disease.