Aneurisma de seno de valsalva fistulizado a auricula derecha / Fístula of sinus of valsalva aneurysm to the right atrium

Resumen: Los aneurismas de seno de Valsalva son una malformación rara de observar en la práctica clínica. Se presentan a cualquier edad y pueden ser de origen congénito o adquirido. La importancia de su estudio radica en que potencialmente pueden complicarse con rotura y fistulización a otra estructura cardíaca o extracardíaca, con una alta mortalidad asociada. El diagnóstico muchas veces puede ser complejo, pero existen algunos elementos clínicos inespecíficos que pueden orientarnos en su detección y rápido manejo, lo que puede marcar una diferencia en el pronóstico del paciente. Se presenta el caso de un paciente de 49 años con un aneurisma de seno de Valsalva complicado y a continuación una breve revisión del tema.

Abstract: Aneurysms of the sinus of Valsalva are. They occur at any age, either as a congenital or an acquired malformation. They may rupture and form a fístula to other cardiac structures, with a high mortality rate. The clinical case of a 49 year-old patient with a ruptured sinus of Valsalva an a fístula to the right atrium is presented. A brief review of the subject is included.

Terson Syndrome: Assessment of 53 Patients with Subarachnoid Hemorrhage by a Ruptured Aneurysm

Objective Terson syndrome (TS), also known as vitreous hemorrhage, is reported in patients with subarachnoid hemorrhage caused by a ruptured aneurysm. This study aims to evaluate the presence of ocular hemorrhage in such patients, trying to identify those who could benefit from the specific treatment for visual deficit recovery. Methods Prospective study of 53 patients with spontaneous subarachnoid hemorrhage (SSAH) due to ruptured aneurysm. The patients were evaluated for vitreous hemorrhage through indirect fundoscopy with 6 to 12 months of follow-up. Results The ages of the patients ranged from 17 to 79 years-old (mean age, 45.9 11.7); 39 patients were female (73%) and 14 were male (27%). Six patients (11%) presented TS, and 83.3% had a transient loss of consciousness during ictus. Conclusions An ophthalmologic evaluation must be routinely performed in subarachnoid hemorrhage patients, especially in those with worse neurological grade. Moreover, prognosis was bad in TS patients.

Ruptured sinus valsalva aneurysm - an uncommon cause of new onset heart failure onset heart failure / Rotura de aneurisma del seno de valsalva: una causa infrecuente de insuficiencia cardíaca aguda

Abstract: A young man presented to the emergency room with symptoms of recent onset heart failure. On physical examination he showed signs of right heart failure and a continuous murmur. Transesophageal echocardiography an computed tomography confirmed the diagnosis of a ruptured right sinus of Valsalva aneurysm an left to right shunt. After successful surgical repair the patient became asymptomatic, the shunt disappeared and he is well 3 months after surgery.

Resumen: Se presenta el caso clínico de un hombre joven que desarrolla insuficiencia cardíaca de reciente comienzo. Clínicamente lo relevante eran signos de insuficiencia cardíaca derecha y la presencia de un soplo continuo. Por ecocardiografía trans esofágica y Angio TAC, se confirmó la presencia de un aneurisma del seno de Valsalva derecho roto con cortocircuito de izquierda a derecha. Se procedió al cierre del aneurisma, confirmando se buen resultado, acompañado de una evolución asintomática 3 meses después de la intervención.

Anterior Communicating Artery Aneurysm Uncommon Hemorrhagic Presentation: Case Report

Intracranial aneurysm rupture causes subarachnoid hemorrhage in 80% of the cases, and it may be associated with intracerebral hemorrhage and/or intraventricular hemorrhage (IVH) in 34% and 17% of the patients, respectively. However, on rare occasions, aneurysm rupturemay be present causing isolate intracerebral hemorrhage or IVH without subarachnoid hemorrhage. We describe an unusual case of an anterior communicating aneurysm rupture presented with IVH, without subarachnoid hemorrhage. Although isolated IVH is rare, aneurysm rupture is a possible condition. Patients presenting with head computed tomography revealing IVH without subarachnoid hemorrhage should be promptly investigated with contrasted image exam to identify and treat possible causes, even in the absence of subarachnoid hemorrhage.

Endotension: rupture of abdominal aortic aneurysm / Endotensão: ruptura de aneurisma de aorta abdominal

Aortic endovascular exclusion technique called 'chimney' consists of placing stents through abdominal aortic visceral branches and a prosthesis that excludes the thoraco-abdominal aneurysm. Stents and an aortic endoprosthesis are placed in the renal arteries. This method is primarily used when open surgery is too risky. The mechanism that provides aneurysm sac increase without the visible presence of endoleaks has not been fully elucidated. The expansion of the aneurysm sac, due to endotension, is difficult to diagnose, even with the use of advanced imaging tests. Its diagnosis is made by exclusion. We present a case of a late complication in a high-risk patient after a 'chimney' endovascular procedure. Following the surgery, the patient presented a ruptured aneurysm sac without a visible endoleak. A second intervention was not feasible due to the high risk of occluding all of the branches, and complicated by previous 'chimney'. Endotension is a possible cause of aneurysm rupture and death.

A técnica de exclusão endovascular conhecida como 'chaminé' consiste na colocação de stent em ramos viscerais e de endoprótese excluindo o aneurisma toracoabdominal. São colocados stents revestidos nas artérias renais e uma endoprótese aórtica, que o método utilizado quando a cirurgia aberta tem risco muito alto. O mecanismo que causa a expansão aneurismática sem a presença detectável de vazamento pelos métodos de imagem não está completamente esclarecido. A expansão do saco aneurismático por endotensão é de difícil diagnóstico, mesmo com o uso de técnicas de imagem avançadas, como tomografia computadorizada e eco-Doppler, sendo o diagnóstico por exclusão. Apresenta-se um caso de complicação tardia após o tratamento endovascular pela técnica da 'chaminé'. Após a cirurgia, o paciente apresentou ruptura sem endoleak visível. Outro procedimento endovascular foi impossibilitado pela técnica da 'chaminé', que dificulta novos procedimentos e há alto risco de oclusão dos ramos. Endotensão é causa de ruptura e óbito.

Spontaneous rupture of an aneurysm of the sinus of Valsalva into the right atrium, associated with an atrial septal aneurysm / Ruptura espontánea de un aneurisma del seno de Valsalva a la aurícula derecha en una paciente con aneurisma del septum interatrial

Aneurysms of the sinus of Valsalva (SV) and the atrial septum are a rare association. We report the case of a 28-year-old woman, who was admitted to our department complaining of progressive dyspnea of 10 days of evolution, five hours previous to her admission to the hospital; she presented sudden oppressive anterior chest pain, accompanied by palpitations. The presence of rupture of the right SV to the right atrium was clinically confirmed, by echocardiography and hemodynamic studies. In addition, an associated atrial septal aneurysm was found. She underwent surgical correction through sinusplasty without requiring aortic valve replacement. The patient presented persistent postoperative atrioventricular block, which required a permanent pacemaker. Clinical evolution was satisfactory. To our knowledge, this case is a rare combination of two isolated malformations, without previous events that could explain the rupture of the right SV.

Los aneurismas del seno de Valsalva y del septum interauricular son una asociación rara. Informamos el caso de una mujer de 28 años de edad con un cuadro de disnea progresiva en los últimos 10 días, al cual se agregó dolor precordial opresivo, cinco horas previas a su ingreso. Se comprobó clínicamente, por ecocardiografía y hemodinamia la presencia de ruptura del seno de Valsalva derecho hacia el atrio derecho. Un hallazgo interesante fue la presencia de un aneurisma del septum interauricular asociado. La paciente fue sometida a corrección quirúrgica con plastía del seno de Valsalva, sin requerir reemplazo valvular aórtico. En el postoperatorio presentó bloqueo aurículo-ventricular persistente, requiriendo implante de marcapaso definitivo. Su evolución fue satisfactoria. Este es un caso de una rara asociación de dos malformaciones aisladas.

Aneurismas de aorta torácica e dissecção aórtica / Thoracic aortic aneurysms and aortic dissection

Doença da aorta é uma patologia significante e representa a 12ª maior causa de morte. Apesar de os aneurismas da aorta abdominal e aorta ascendente serem mais comum, aneurismas de aorta ascedentes (AATs) são uma significante contribuição para a patologia. AATs aumentam o risco de dissecção da aorta ou ruptura e representam uma importante fonte de morbidade e mortalidade. Podem ser classificadas como sindrômicas, familiares ou esporádicas. As formas sindrômicas incluem a Síndrome de Marfan, Síndrome de Loeyes-Dietz, Homocistinúria, Sindrome de Ehlers-Danlos, Síndrome B A V e Síndrome de Turner. Em vários casos, já existem testes genéticos específicos que permitem um diagnóstico precoce da patologia em familiares de indivíduos afetados que permitem o acompanhamento precoce com melhora da qualidade de vida e sobrevida desses indivíduos.

Aortic disease is a significant pathology and represents the 12th leading cause of death. Although aneurysms of the ascending aorta and abdominal aorta are more common, descendents aortic aneurysms (TAAs) are a significant contribution to the pathology. TAAs increase the risk of aortic dissection or rupture and represent an important source of morbidity and mortality. They can be classified as syndromic, familial or sporadic. The syndromic forms include Marfan syndrome, Dietz-Loeyes Syndrome, homocystinuria, Ehlers-Danlos syndrome, Turner syndrome and BAV syndrome. In several cases, specific genetic tests are already available and allow an early diagnosis of pathology in relatives of affected individuals that can lead to an early monitoring and improve the quality of life and survival of these individuals.

Síndrome de Marfan: como fazer o diagnóstico e a investigação familiar? / Marfan Syndrome: how to make the diagnosis and the family investigation?

A Síndrome de Marfan é uma doença do tecido conjuntivo, de origem genética, autossômica dominante e que afeta principalemente três sistemas: esquelético, ocular e cardiovascular. Embora os dois primeiros acarretem graus significativos de morbidade como, por exemplo, a perda de visão, a mortalidade precoce desta síndrome se deve principalmente às complicações no sistema cardiovascular. A base molecular do efeito está numa mutação do gene da fibrilina, principal constituinte das microfibrilas. A prevalência da Síndrome de Marfan é estimada em torno de 1/10.000 indivíduos. As principais alterações cardiovasculares nas Síndromes de Marfan são: a dilatação progressiva e o aneurisma da aorta ascendente, com ruptura ou dissecção desta e o prolapso da válvula mitral com diversos graus de refluxo valvar. A descoberta de achados moleculares e sua correlação com o fenótipo deram origem aos critérios de GHENT. Recentemente, os critérios diagnósticos de GHENT foram reavaliados e consideraram que os mesmos mostram excelente especificidade. Decorrente das complicações cardiovasculares, a expectativa de vida nestes pacientes atingia poucos anos atrás até a terceira ou quarta década de vida. Nos últimos anos, porém, o prognóstico tem melhorado significativamente...

Marfan Syndrome is a connective tissue disease, genetic, autosomal dominant, which primarily affects three systems: skeletal, ocular and cardiovascular systems. Although the first two systems cause significant levels of morbidity, e.g., vision loss, the early mortality of this syndrome is mainly due to complications in the cardiovascular system. Molecular basis of the defect is a mutation of the fibrillin gene, major constituent of microfibrils. The prevalence of Marfan Syndrome is estimated at around 1/10.000 people.The main cardiovascular changes in Marfan Syndrome are progressive dilatation and ascending aortic aneurysm with rupture or dissection and mitral valve prolapse with varying degrees of valve regurgitation. The discovery of molecular findings and their correlation with the phenotype developed GHENT criteria. Recently, GHENT diagnostic criteria were reassessed and considered they demonstrated great specificity...

Spontaneous aortocaval fistula: a case report and literature review

Spontaneous aortocaval fistula is a rare complication of abdominal aortic aneurysms. We describe two cases of spontaneous aortocaval fistula. The first patient is a woman who was admitted with abdominal pain and pulsatile abdominal mass. Another patient was a man admitted with progressive abdominal pain and hypotension. Computed tomography [CT] scan in both patients showed an infrarenal aortic aneurysm and simultaneous contrast enhancement in the inferior vena cava. Both patients underwent an urgent laparotomy in which the diagnosis of an aortocaval fistula was confirmed. We review the literature on spontaneous aortocaval fistula as a consequence of complicated aortic aneurysms

Hemoptise e hemotórax como apresentação de ruptura de aorta torácica / Hemoptysis and hemothorax as presentation of thoracic aortic rupture

Dissecção da aorta torácica é doença de grande mortalidade em sua fase inicial, mas pode, em alguns casos, se cronificar. Relatamos caso de paciente com dissecção crônica de aorta tipo B (Stanford), admitido na Emergência com confusão mental, dispnéia e relato de hemoptise importante. O eletrocardiograma mostrava alterações inespecíficas e a radiografia de tórax revelou opacificação do hemitórax esquerdo. O ecocardiograma transtorácico não evidenciou dissecção aórtica, mas demonstrou imagem compatível com hemotórax, ocasionando a suspeita de ruptura da aorta. O paciente evoluiu em colapso cardiovascular e óbito. Este caso descreve duas apresentações atípicas da dissecção de aorta: hemotórax e hemoptise importante.

Thoracic aortic dissection is a disease of great mortality in its initial phase, but in some cases it can assume chronic course. We report a case of a patient with Stanford type A1 aortic dissection, admitted with mental confusion, dyspnea and event of severe hemoptysis. Electrocardiogram showed unspecific change and chest X-ray revealed opacification of the left hemithorax. Transthoracic echocardiogram did not show aortic dissection, but showed image similar to hemithorax leading to the suspicion of aortic rupture. The patient developed cardiovascular collapse and evolved to death. This case describes two unusual presentations of aortic dissection: hemothorax and severe hemoptysis.

A Nasal Myiasis in a 76-Year-Old Female in Korea

On July 2009, 5 fly larvae were discovered inside the nose of a 76-year-old female. She was living in Cheonan-si, and in a state of coma due to rupture of an aortic aneurysm. Surgery was performed on the day of admission, and the larvae were found 4 days later. By observing their posterior spiracle, the larvae were identified as Lucilia sericata. Considering the rapid development of this species, the infection was likely acquired during hospitalization. Further investigation on the hospital environment should be needed to know the origin of the infection.

Aneurisma de aorta com ruptura para esôfago / Aortic aneurysm rupture into the esophagus

Apresentamos o caso de uma paciente portadora de aneurisma de aorta descendente com ruptura para o esôfago que, após aortoplastia com interposição de tubo de dacron e rafia da laceração esofágica, evoluiu com fístula esôfago pleural no terceiro dia pós-operatório. A paciente necessitou de reintervenção e cuidados intensivos, reabilitando-se adequadamente. A propósito deste caso incomum e do aprendizado adquirido no seu manejo, revisamos a literatura a fim de discutir a melhor alternativa de correção desta rara e, freqüentemente, fatal forma de apresentação das doenças da aorta.

We present the case of a patient with a descending aorta aneurysm rupture into the esophagus, which, after aortoplasty with Dacron tube interposition and suture of esophageal laceration, developed a pleural-esophagus fistula on the 3rd postoperative day. She needed re-intervention and intensive care, followed by adequate recovery. Considering this unusual case and the knowledge acquired through its management, we reviewed the literature in order to discuss the best alternative for the correction of this rare and often fatal form of presentation of aortic diseases.

Tratamiento endoluminal de disección aguda complicada en aorta descendente: Comunicación de un caso / Endoluminal stent-graft placement for acute dissection of the descending aorta complicated with rupture: Report of one case

Acute dissection of the aorta, although not common, has early and highly lethal complications. The type A dissection is treated with surgery. Patients with type B dissections are treated with surgery if they have complications like rupture, growth or visceral ischemia. Surgery, however, has complications such as spinal cord ischemia. Endovascular grafts have less mortality and complications. We report a 59 years old male patient with a type B dissection complicated with rupture. He was treated successfully with the placement of an endoluminal graft. He was discharged five days after the procedure in good conditions. After one year of follow up, the patient remains asymptomatic.

Aneurisma do arco aórtico com fístula aorto-pulmonar: tratamento cirúrgico com sucesso / Aortic arch aneurysm with aorto-pulmonary fistula: successful surgical repair

Aneurisma de arco aórtico com fístula aorto-pulmonar aguda é uma afecção rara e, geralmente, diagnosticada postmortem. Poucos relatos de sucesso cirúrgico foram realizados e persiste uma alta taxa de mortalidade. Os autores relatam o caso de um paciente de 78 anos, com comunicação aguda entre aneurisma de arco aórtico e artéria pulmonar com precordialgia, instabilidade hemodinâmica e congestão pulmonar. A operação foi realizada com sucesso, sendo realizada a substituição da porção proximal da aorta descendente, do arco aórtico e da porção distal da aorta ascendente, além do fechamento da fístula.

Aortic Dissection Presenting with Secondary Pulmonary Hypertension Caused by Compression of the Pulmonary Artery by Dissecting Hematoma: A Case Report

The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension.

Cervical Epidural Abscess Secondary to Aorto-Duodenal Fistula: A Case Report

Although cervical epidural abscess is rare, it should be strongly suspected in any patient with unexplainable neck pain and fever, especially when the patient has a predisposing factor for this infectious process. The authors report a case of cervical epidural abscess in a 39-yr-old man with an aorto-duodenal fistula, which complicated the interposition of artificial graft for abdominal aortic aneurysm rupture, which had undertaken 40 months before. Timely detection and intervention rendered him a full neurological recovery. This extremely rare case is presented with a literature review.

Spontaneous aortocaval fistula.

Spontaneous aortocaval fistula is rare, occurring only in 4% of all ruptured abdominal aortic aneurysms. The physical signs can be missed but the presence of low back pain, palpable abdominal aortic aneurysm, machinery abdominal murmur and high-output cardiac failure unresponsive to medical treatment should raise the suspicion. Pre-operative diagnosis is crucial, as adequate preparation has to be made for the massive bleeding expected at operation. Successful treatment depends on management of perioperative haemodynamics, control of bleeding from the fistula and prevention of deep vein thrombosis and pulmonary embolism. Surgical repair of an aortocaval fistula is now standardised--repair of the fistula from within the aneurysm (endoaneurysmorraphy) followed by prosthetic graft replacement of the aneurysm. A case report of a 77-year-old woman, initially suspected to have unstable angina but subsequently diagnosed to have an aortocaval fistula and surgically treated successfully, is presented along with a review of literature.

Ruptura traumática de la aorta torácica y tratamiento no operatorio de lesión esplénica concomitante: caso clínico / Traumatic rupture of thoracic aorta and non operative treatment of concomitant splenic lesion: report of 1 case

We report a 26 years old male that suffered a motorcycle accident resulting in a traumatic aortic rupture and splenic laceration. He was subjected to a surgical repair of the aortic lesion under complete heparinization. The splenic rupture was non operatively managed successfully