RESUMO
BACKGROUND: Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma mainly treated via surgical resection. Herein, we report a case of MPNST wherein a massive tumor thrombus extended to the major veins and heart. CASE PRESENTATION: A 39-year-old female with a history of neurofibromatosis type 1 developed MPNST from the right radial nerve. In addition to adjuvant chemotherapy, she underwent wide tumor resection and concomitant radial nerve resection, followed by postoperative radiotherapy. Histological evaluation revealed marked venous invasion. The 2-year follow-up CT revealed an asymptomatic recurrent tumor thrombus extending from the right subclavian vein to the heart. An urgent life-saving operation was performed to ligate the base of the right subclavian vein and remove the entire intravenous thrombus that extended to the right ventricle. The remaining tumor in the right subclavian vein increased in size 3 months after thrombectomy. After confirming the absence of any metastatic lesions, the patient underwent extended forequarter amputation to achieve surgical remission. One year later, a new metastasis to the right diaphragm was safely resected. The patient remains alive without any evidence of disease 2 years after the extended forequarter amputation. CONCLUSIONS: In cases of a previous history of microscopic venous invasion, recurrence can occur as a massive tumor thrombus that extends to the great vessels.
Assuntos
Neurofibromatose 1 , Neurofibrossarcoma , Neoplasias de Tecidos Moles , Trombose , Adulto , Feminino , Humanos , Recidiva Local de Neoplasia/cirurgia , Trombose/etiologia , Trombose/cirurgiaRESUMO
Dysphagia aortica is a rare pathology primarily caused by an aortic aneurysm or Kommerrell's diverticulum. Herein, we describe an extremely rare case of dysphagia aortica due to a congenitally angulated descending aorta in a 50-year-old woman successfully treated by open surgery. The woman underwent David procedure for aortic regurgitation 5 years previously, with the same anatomy of an angulated descending aorta without symptoms. She has difficulty in swallowing solid food from 1 month. Total aortic arch replacement using the elephant trunk technique and secondary descending aortic replacement released the esophageal compression by the abnormal aorta and completely improved her symptom.
Assuntos
Aorta Torácica/anormalidades , Transtornos de Deglutição/etiologia , Deglutição , Malformações Vasculares/complicações , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Implante de Prótese Vascular , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/cirurgiaRESUMO
BACKGROUND: Excellent results have been reported regarding pulmonary valve replacement (PVR) for pulmonary valve regurgitation (PR) after intracardiac repair (ICR) in patients with tetralogy of Fallot (TOF). However, there are apparently no reports comparing the following procedures: PVR using a bioprosthetic valve and PVR using a polytetrafluoroethylene (PTFE) bicuspid valve. Herein, we retrospectively analyzed the outcomes of PVR for PR after ICR of TOF in our institution and assessed which of the two PVR procedures was better. METHODS: From June 2008 to December 2017, we performed PVR for PR after ICR of TOF in 34 patients. Patients with the right ventricle to the pulmonary artery conduits were excluded. Preoperative and postoperative cardiac magnetic resonance imagings (cMRIs) were performed in all patients. The patients were divided into the bioprosthetic valve group (BV group, n = 17) and the PTFE bicuspid valve group (PTFE group, n = 17). RESULTS: There were no significant differences in the preoperative cMRI data and perioperative factors between the two groups. There were no deaths in either group. Postoperative cMRI showed that the PR fraction and the right ventricular end-diastolic volume index (RVEDVI)/left ventricular end-diastolic volume index ratio were significantly improved in both groups. However, RVEDVI was significantly improved only in the BV group. Re-PVR was required in four patients in the PTFE group. CONCLUSION: PVR using a bioprosthetic valve was more effective for PR treatment after ICR of TOF than PVR using a PTFE bicuspid valve.
Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Pulmonar , Valva Pulmonar , Tetralogia de Fallot , Humanos , Valva Mitral , Politetrafluoretileno , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/cirurgia , Estudos Retrospectivos , Tetralogia de Fallot/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: Conventional mitral valve replacement is associated with the loss of natural continuity of the mitral valve complex. This study evaluated the morphologic/histological characteristics and function of a decellularized mitral valve used as a transplantable graft. METHODS: Hearts excised from pigs were decellularized by perfusion using detergent. Grafts with the mitral annulus, valve, chordae, and papillary muscle isolated from the decellularized heart were then transplanted into recipient pigs. After transplantation, the function of the graft was analyzed through echocardiography. A histological analysis was performed to evaluate the postoperative features of the decellularized graft. RESULTS: The decellularized graft was successfully transplanted in all cases but one. The remaining grafts maintained their morphology and function. They did not exhibit mitral regurgitation or stenosis. Only one animal survived for 3 weeks, and a histological analysis was able to be performed in this case. The transplanted valve was re-covered with endothelial cells. The microvessels in the papillary muscle were recellularized with vascular endothelial cells, and the papillary muscle was completely attached to the papillary muscle of the recipient. CONCLUSION: The early outcome of decellularized mitral graft transplantation was acceptable. This native organ-derived acellular scaffold is a promising candidate for the replacement of the mitral valve complex.
Assuntos
Valva Mitral/transplante , Animais , Sobrevivência de Enxerto , Implante de Prótese de Valva Cardíaca , Perfusão/métodos , Suínos , Alicerces TeciduaisRESUMO
Minimally invasive mitral valve surgery (MIMVS), despite its challenges, is not a rare procedure. However, MIMVS via a right small thoracotomy must be performed using long-shafted surgical instruments and thoracotomy instruments specialized for minimally invasive cardiac surgeries. We have performed 12 cases of MIMVS via right small thoracotomy using the superior trans-septal approach and secured a surgical visual field that easily allows a finger to reach the mitral valve annulus without using special instruments for minimally invasive cardiac surgery. We named this technique the "drawer-case technique." In conclusion, MIMVS via right thoracotomy using the superior trans-septal approach can be performed easily and safely, similar to mitral valve surgery performed via median sternotomy.
Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Toracotomia/métodos , Septos Cardíacos/cirurgia , HumanosRESUMO
As transcatheter aortic valve implantation (TAVI) requires multidisciplinary collaboration, operators and the entire heart team must overcome a steep learning curve. A web-based screening and traditional on-site proctoring system were developed for the introduction of TAVI in Japan. To assess the learning curve involved with the introduction of TAVI under the supervision of a novel proctoring system. We divided 749 consecutive patients enrolled in the OCEAN-TAVI study between October 2013 and August 2015 into the trans-femoral (TF, n = 608) and transapical (TA, n = 141) approach groups to compare outcomes in patients who underwent TAVI during the early proctoring period (proctoring group) and after the procedures began to be performed independently (independent group). The primary endpoint was the rate of composite events regarding early safety (at 30 days) according to the valve academic research consortium-2 criteria. For TF-TAVI, the logistic EuroSCORE and the rate of peripheral artery disease were significantly lower during the independent period. The rate of device success significantly increased during the independent period (90.5 vs. 81.8%, p = 0.005). The rate of the primary endpoint was significantly reduced during the independent period compared to that during the proctoring period for TA-TAVI (21.3 vs. 37.9%, p = 0.031); however, no difference was observed for TF-TAVI (16.8 vs. 13.1%, p = 0.283). No deaths occurred within 30 days during the proctoring period for TF-TAVI. After adjustment using propensity score matching, the procedure time for TF-TAVI (88 ± 43 vs. 102 ± 36 min, p = 0.004) and the rate of life-threatening bleeding for TA-TAVI (3.6 vs. 25%, p = 0.026) reduced during the independent period compared to the values during the proctoring period. During the introduction of TAVI under the supervision of a new proctoring system in Japan, clinical outcomes and technical aspects improved significantly. There are differences in the steepness of the learning curve between TF-TAVI and TA-TAVI.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Curva de Aprendizado , Complicações Pós-Operatórias/epidemiologia , Medição de Risco , Substituição da Valva Aórtica Transcateter/educação , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico , Educação de Pós-Graduação em Medicina , Feminino , Fluoroscopia , Humanos , Incidência , Japão/epidemiologia , Masculino , Estudos Prospectivos , Taxa de Sobrevida/tendências , Substituição da Valva Aórtica Transcateter/métodosRESUMO
Peripheral artery disease plays a pivotal role for access site selection in transcatheter aortic valve replacement (TAVR). Abnormal ankle-brachial index (ABI) is a generalized mortality marker in many cardiovascular scenarios. However, the long-term outcomes in high-risk TAVR populations remain unclear. We investigated the association between low ABI and 2-year outcome after TAVR. Of 1613 patients enrolled in the OCEAN-TAVI registry, 1458 (90.4%) who underwent ABI before TAVR were divided into groups: patients with (1) ABI ≥ 0.9 in both legs and (2) ABI < 0.9 in either leg. Primary endpoint was all-cause death within 2 years. ABI < 0.9 was noted in 304 patients (20.8%). ABI < 0.9-group had more frequent and severe comorbidities. Primary endpoint in ABI < 0.9-group was significantly higher than that in ABI ≥ 0.9-group (15.8 vs. 8.7%, p < 0.001). This trend continued in the transfemoral (TF)-approach (14.9 vs. 7.5%, p < 0.001), but not in the alternative approach (17.2 vs. 15.8%, p = 0.815). Within 30 days, ABI < 0.9-group had a higher cardiac death rate (3.1 vs. 1.0%, p = 0.033), whereas between 31 days and 2 years, non-cardiovascular death was more frequently observed (9.2 vs. 5.1%, p = 0.003). In ABI < 0.9-group, in-hospital vascular complications (11.9 vs. 4.9%, p < 0.001) and acute kidney injury (10.8 vs, 5.7%, p = 0.009) were more frequently found when using the transfemoral-approach. In multivariate analysis, ABI < 0.9 was an independent predictor of 2-year mortality (adjusted hazard ratio 1.495, 95% CI 1.007-2.220, p = 0.046). Pre-procedure ABI < 0.9 is a useful prognostic marker for all-cause mortality, even in high-risk TAVR populations.
Assuntos
Índice Tornozelo-Braço/métodos , Estenose da Valva Aórtica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Substituição da Valva Aórtica Transcateter/métodos , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Tomografia Computadorizada Multidetectores , Complicações Pós-Operatórias/diagnóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências , Fatores de TempoRESUMO
Patients with tracheostomy who undergo a full sternotomy have an increased risk of mediastinitis and sternal infection. This report describes a reoperative aortic valve replacement (re-AVR) for structural valve deterioration (SVD) through a lower hemisternotomy. This procedure was performed on a 71-year-old man with a tracheostomy who had previously undergone a Bentall procedure with a bioprosthetic valve to replace an enlarged ascending aortic aneurysm. Comorbidities included chronic renal failure requiring hemodialysis. Fourteen months after the Bentall procedure, the patient presented with sudden dyspnea and was transferred to another hospital. Upon suffering acute heart failure, the patient required mechanical ventilation and was transferred to our hospital for intubation. The patient subsequently developed severe pneumonia. As a result of prolonged ventilation, the patient underwent tracheostomy and was administered antibiotic medication (piperacillin/tazobactam) for pneumonia. Echocardiography revealed severe aortic regurgitation caused by SVD. There was a risk that a full sternotomy in a patient with tracheostomy could cause mediastinitis; therefore, we performed a re-AVR through a lower hemisternotomy (second T incision). The re-AVR surgery proceeded without complications, and the bioprosthetic valve was removed while preserving the vascular graft from the previous Bentall procedure. The postoperative course was uneventful, and the patient was discharged from hospital 31 days after the tracheostomy was closed. The success of this procedure demonstrates the viability of re-AVR through a lower hemisternotomy in patients with SVD who are at risk of additional surgical complications.
Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Mediastinite , Masculino , Humanos , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Mediastinite/cirurgia , Traqueostomia/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Resultado do Tratamento , Estudos RetrospectivosAssuntos
Aorta Torácica/anormalidades , Aneurisma da Aorta Torácica/complicações , Malformações Vasculares/complicações , Idoso , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Malformações Vasculares/diagnóstico por imagemRESUMO
A 58-year-old man was admitted for sudden numbness of the right leg and abdominal pain 6 months following late open conversion for endotension after endovascular aortic repair. Computed tomography demonstrated residual endograft collapse due to Stanford type B dissection. Emergent right axillobifemoral bypass was performed to perfuse the lower extremities. We performed subsequent total arch replacement with secondary thoracic endovascular aortic repair.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/etiologia , Dissecção Aórtica/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Resultado do TratamentoRESUMO
This article presents a method for trend clustering from tweets about coronavirus disease (COVID-19) to help us objectively review the past and make decisions about future countermeasures. We aim to avoid detecting usual trends based on seasonal events while detecting essential trends caused by the influence of COVID-19. To this aim, we regard daily changes in the frequencies of each word in tweets as time series signals and define time series signals with single peaks as target trends. To successfully cluster the target trends, we propose graphical lasso-guided iterative principal component analysis (GLIPCA). GLIPCA enables us to remove trends with indirect correlations generated by other essential trends. Moreover, GLIPCA overcomes the difficulty in the quantitative evaluation of the accuracy of trend clustering. Thus, GLIPCA's parameters are easier to determine than those of other clustering methods. We conducted experiments using Japanese tweets about COVID-19 from March 8, 2020, to May 7, 2020. The results show that GLIPCA successfully distinguished trends before and after the declaration of a state of emergency on April 7, 2020. In addition, the results reveal the international argument about whether the Tokyo 2020 Summer Olympics should be held. The results suggest the tremendous social impact of the words and actions of Japanese celebrities. Furthermore, the results suggest that people's attention moved from worry and fear of an unknown novel pneumonia to the need for medical care and a new lifestyle as well as the scientific characteristics of COVID-19.
Assuntos
COVID-19 , Mídias Sociais , COVID-19/epidemiologia , Análise por Conglomerados , Humanos , Análise de Componente Principal , SARS-CoV-2Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Desenho de Prótese , Fluxo Sanguíneo Regional , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Infected aortic aneurysm (IAA) is a rare, life-threatening disease with rapid progression and a high mortality rate. An 84-year-old man developed IAA caused by urosepsis owing to extended-spectrum ß-lactamase-producing Escherichia coli infection. Considering surgical risk and perioperative mortality, the patient underwent computed tomography-guided percutaneous abscess drainage and continuous irrigation with optimal antibiotic therapy. We controlled his systemic inflammation without surgery; thus, he was discharged. Six months later, we confirmed that the abscess had almost disappeared in the follow-up computed tomography scan. Percutaneous abscess drainage and irrigation may be an effective therapeutic option for surgical high-risk patients with IAA.
L'anévrisme aortique infecté (AAI) est une affection rare menaçant le pronostic vital, qui évolue rapidement et est associée à un taux de mortalité élevé. Nous exposons le cas d'un homme de 84 ans présentant un AAI secondaire à un urosepsis, lui-même causé par une infection à Escherichia coli productrice de bêta-lactamases à spectre étendu. Compte tenu du risque associé à une intervention chirurgicale et du risque de mortalité périopératoire, nous avons procédé à un drainage percutané de l'abcès guidé par tomographie assistée par ordinateur et sous irrigation continue, puis prescrit une antibiothérapie optimale. Nous avons ainsi réussi à maîtriser l'inflammation générale sans intervention chirurgicale, et le patient a pu recevoir son congé de l'hôpital. Six mois plus tard, une tomodensitométrie de suivi a permis de confirmer la disparition presque complète de l'abcès. Le drainage et l'irrigation d'un abcès par voie percutanée peuvent donc être une option thérapeutique efficace dans le cas des patients présentant un AAI les exposant à un risque chirurgical élevé.
RESUMO
OBJECTIVES: Although the patency of internal artery grafts in coronary artery bypass grafting (CABG) is superior to that of saphenous vein grafts (SVGs), good long-term patency rates have been reported with SVGs harvested using the no-touch technique. Here, we report the early results of CABG with no-touch SVGs (NT-SVGs) along with the precautions required while handling these grafts. METHODS: This retrospective study included 41 patients who underwent CABG with NT-SVGs between May 2016 and March 2018. NT-SVGs were harvested with minimal electric scalpel use, and post-harvesting vascular overdilation with a syringe was not performed. Blood with heparinized saline was used to prevent vascular endothelial damage. A drain was inserted into the SVG harvest site, which was closed with a single interrupted suture, and elasticated bandage and compression stockings were used to prevent fluid retention and avoid delayed wound healing. RESULTS: There was no case of postoperative thoracotomy due to bleeding or myocardial infarction, and postoperative graft assessment confirmed graft patency in all patients, with a little mismatch between the diameters of SVG and the anastomotic vessel. Delayed wound healing at the graft harvest site seemed to improve after introducing the above procedures. CONCLUSIONS: Early results of CABG with NT-SVGs were good. Some precautions must be taken during harvesting and anastomosis. Taking precautions described in this study may help reduce the risk of perioperative complications and make the no-touch technique the standard procedure for harvesting SVGs for CABG.
Assuntos
Ponte de Artéria Coronária/métodos , Veia Safena/transplante , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Angiografia Coronária , Endotélio Vascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Estudos Retrospectivos , Meias de Compressão , Toracotomia , CicatrizaçãoRESUMO
A 79-year-old woman with advanced non-small cell lung cancer was admitted to our hospital for palliative terminal care after failure of initial radiotherapy followed by chemotherapy with S-1. She had severe back pain due to metastasis at the sixth thoracic spinal bone. Gefitinib was administered and rapid relief of bone pain was obtained. During the first four months, gradual reduction of all measurable lesions was obtained. However, these lesions except for spinal bone metastasis re-grew and five months later, she died of cachexia. Treatment with gefitinib was continued until she died because of the complete relief of bone pain.
Assuntos
Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Dor/tratamento farmacológico , Dor/etiologia , Quinazolinas/uso terapêutico , Coluna Vertebral/patologia , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Evolução Fatal , Feminino , Gefitinibe , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada por Raios XRESUMO
Objective: Endograft limb occlusion (ELO) is a complication of endovascular aneurysm repair (EVAR). In this study, we investigated the mechanism and anatomical features of ELO. Materials and Methods: We retrospectively reviewed 227 consecutive patients with abdominal aortic aneurysm who underwent EVAR between 2007 and 2017. We then analyzed the preoperative risk factors and anatomical features of patients with ELO. Results: A total of nine patients had ELO (4.0%). The diameter of the terminal aorta was significantly smaller in patients with ELO than in patients without ELO (18.0 mm vs. 22.3 mm, p=0.039). We measured the diameter of each limb near the terminal aorta. The smaller limb (SL) was occluded in all patients with occlusion. The difference between the larger limb (LL) and the SL (LL-SL) was significantly larger in patients with ELO than in patients without ELO (4.0 mm vs. 1.7 mm, p<0.001). The following were considered risk factors for ELO: younger age, narrow terminal aorta, severe calcification at the terminal aorta, and use of an Endurant device. Conclusion: ELO occurs when the diameter of one side of the stent graft limb is small compared with the diameter of the other side owing to the narrow terminal aorta and calcification.
RESUMO
BACKGROUND: Trans-right axillary aortic valve replacement (TAX-AVR) remains uncommon. We developed a special method to pull the heart closer to the right chest wall to make the surgery as easy and safe as aortic valve replacement via median sternotomy. Because the retraction sutures lifting the ascending aorta and aortic root are arranged circularly around the wound, we named this technique "Stonehenge technique". METHODS: We examined 47 patients who underwent aortic valve replacement through a small right infra-axillary thoracotomy as the initial surgical therapy. These patients were divided into two groups: the conventional TAX-AVR group that underwent AVR via the conventional small right axillary incision approach (n = 20) and the TAX-AVR with SH group that underwent AVR with the Stonehenge technique (n = 27). RESULTS: The aortic cross-clamp and the extracorporeal circulation time were significantly shorter in the TAX-AVR with SH group than in the conventional TAX-AVR group (conventional TAX-AVR group: 125.5 ± 47.9; TAX-AVR with SH group: 96.0 ± 14.0, p = 0.004, and conventional TAX-AVR group: 163.8 ± 55.9; TAX-AVR with SH group: 140.0 ± 16.8, p = 0.04). CONCLUSION: The outcomes of this technique depend on the site of the retraction sutures in the opened pericardium, direction of pull, amount of force applied, and precautions taken. If performed correctly, the ascending aorta and the root can be pulled from the wound to within the surgeon's fingers' reach, thereby reducing aortic cross-clamp and extracorporeal circulation times in group of minimally invasive aortic valve replacement via right infra-axillary thoracotomy.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Idoso , Idoso de 80 Anos ou mais , Aorta/cirurgia , Axila , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Esternotomia/métodos , Suturas , Toracotomia/métodos , Resultado do TratamentoRESUMO
Here we describe the case of a 33-year-old woman who was diagnosed with interrupted aortic arch (IAA) type A and who underwent radical surgery in her infancy. She developed a 42-mm anastomotic pseudoaneurysm in the distal aortic arch. We decided to perform thoracic endovascular aortic repair because of the patient's special request to avoid open surgery. We selected a reversed taper-type leg stent graft for the iliac artery and successfully implanted it without problems. However, the long-term outcomes of the stent graft in young people remain unclear, and careful regular follow-up for a long period is mandatory.
RESUMO
We report on a rare case of a 61-year-old female patient with tetralogy of Fallot who had a late radical repair. The patient had no previous surgical interventions, and her postoperative course was uneventful. One year after the repair, the patient is doing well and has no symptoms of cardiac failure. Surgical treatment greatly benefited our patient by improving her functional status and extending her life expectancy.
Assuntos
Tetralogia de Fallot/cirurgia , Cineangiografia , Dilatação Patológica , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Pulmonar/patologia , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/fisiopatologiaRESUMO
A 94-year-old woman with rupture of a thoracic aortic aneurysm (rTAA) was referred to us. She previously underwent thoracic endovascular aortic repair and was considered to be at high risk for a conventional open operation. Therefore an endovascular procedure was planned. The proximal landing zone needed to be placed at the ascending aorta to seal a type 1a endoleak. A hybrid operation consisting of supraaortic total debranching on the common femoral artery and endovascular repair was performed. All debranched bypasses were patent and the aneurysm was excluded. The patient regained sufficient ambulatory strength and showed no symptoms of syncope.