Aneurismas de aorta abdominal infrarrenal y pararrenal: Resultados del reparo abierto

Objetivo: Determinar los resultados de los pacientes sometidos a cirugía de reparo abierto del aneurisma de aorta abdominal (AAA), infrarrenal (IR) y pararrenal (PR). Material y métodos: Estudio retrospectivo, tipo serie de casos. Se revisaron las historias de 75 pacientes con AAA, IR (55) y PR (20). Se determinó la mortalidad, complicaciones y reintervenciones. El seguimiento promedio fue de 5 años. Resultados : No hubo mortalidad operatoria en los 56 casos de reparo abierto electivo de AAA IR-PR. En los casos de AAA roto la mortalidad operatoria fue 31,6% (3/10 IR y 3/9 PR). Hubo disfunción renal KDIGO Estadio I en 14% de los IR y 33% de los PR, en ambos fue transitoria. Hubo 9% de reintervenciones que fueron tratados con resultado exitoso (4% tempranas y 5% tardías). Conclusiones : El reparo abierto electivo de los AAA IR y PR, puede realizarse con bajo riesgo de morbimortalidad operatoria y bajo riesgo de requerimiento de reintervención a corto y largo plazo. En los AAA rotos o de emergencia, el shock fue el factor asociado más importante para la mortalidad operatoria. Los resultados son equivalentes a publicaciones de centros especializados extranjeros.

SUMMARY Objective : To To determine the clinical outcomes of patients undergoing open surgical repairmen of abdominal aortic aneurisms (AAA), infrarenal abdominal aortic aneurisms (IAA) and pararenal abdominal aortic aneurisms (PAA). Methods : A case series involving the review of 75 patient records with AAA, 55 with IAA and 20 with PAA over a period of 5 years. Results: No intraoperatory mortality was detected in the 56 cases of elective surgeries for AAA, IAA and PAA. In cases of rupture AAA, the intraoperatory mortality was 31.6% (3/10 IAA and 3/9 PAA). Transient renal dysfunction KDIGO stage I in 14% of IAA and 33% of PAA. There was a need for re interventions in 9% all of them successful (4% early and 5% late). Conclusions: Elective open surgical repairmen of AAA, IAA and PAA can be performed at low intraoperatory risk for both morbidity and need for re intervention. In patients with rupture AAA, shock was associated with intraoperatory mortality. These results are similar to those reported from foreign specialized centers.

[Persistent abdominal pain caused by superior mesenteric artery and celiac trunk dissection that does not respond to conservative treatment]. / Dolor abdominal persistente por disección de arteria mesentérica superior y tronco celiaco, que no responde a tratamiento conservador.

We report the case of a 32 year old male with recurrent colic abdominal pain due to superior mesenteric artery (SMA) and celiac trunk dissection, which resolved after placing 3 stents in SMA. The patient presented atypical clinical signs and symptoms, which made the diagnosis difficult. Clinical presentation, diagnostic methods and treatment options are discussed. We started with conservative management with pain medication, anticoagulation, antihypertensive drugs and image control, but on the seventh day, after restarting oral ingestion, he presented with abdominal angina, after which we proceeded to endovascular treatment with successful results and with an uneventfully 2 year follow up.

Dolor abdominal persistente por disección de arteria mesentérica superior y tronco celiaco, que no responde a tratamiento conservador / Persistent abdominal pain caused by superior mesenteric artery and celiac trunk dissection that does not respond to conservative treatment

Reportamos el caso de un paciente varón de 32 años con dolor abdominal recurrente tipo cólico a causa de disección de arteria mesentérica superior (AMS) y tronco celíaco, el cual se resolvió luego de la colocación de 3 stents en AMS. El paciente presentó una clínica atípica lo cual dificultó el diagnóstico. Discutimos la clínica, métodos diagnósticos y alternativas de tratamiento. Iniciamos con un manejo conservador con analgesia, anticoagulación plena, antihipertensivo y control de imágenes, pero al séptimo día luego de reiniciar la vía oral, presenta angina abdominal, por lo cual procedimos a tratamiento endovascular con resultado exitoso y buena evolución, sin eventos, a un seguimiento de 2 años

We report the case of a 32 year old male with recurrent colic abdominal pain due to superior mesenteric artery (SMA) and celiac trunk dissection, which resolved after placing 3 stents in SMA. The patient presented atypical clinical signs and symptoms, which made the diagnosis difficult. Clinical presentation, diagnostic methods and treatment options are discussed. We started with conservative management with pain medication, anticoagulation, antihypertensive drugs and image control, but on the seventh day, after restarting oral ingestion, he presented with abdominal angina, after which we proceeded to endovascular treatment with successful results and with an uneventfully 2 year follow up

Postoperative stroke related to cardiac surgery in octogenarians.

OBJECTIVES: Demographics of cardiac surgery patients are changing, with an increase in aged patients. We aim to identify risk factors, mortality, morbidity and increasing postoperative costs due to postoperative stroke in octogenarians following cardiopulmonary bypass (CPB). METHODS: A total of 418 consecutive patients older than 80 years (Group A) who underwent cardiac surgery with CPB between 2000 and 2012 were matched according to gender, surgical procedure and comorbidities with 426 younger patients (Group B). Risk factors for postoperative stroke were retrospectively evaluated. RESULTS: We identified postoperative stroke in 4.1% of patients in Group A and in 3.5% in Group B (P = 0.65). Early stroke was diagnosed in 13 patients in Group A (76.5%) and 10 patients in Group B (66.7%) (P = 0.53). In multivariate analysis, preoperative anaemia (P = 0.033; odds ratio [OR]: 3.84; 95% CI: 1.11-13.28) was the only risk factor associated with postoperative stroke in Group A. In Group B, preoperative peripheral vascular disease (P = 0.0003; OR: 7.30; 95% CI: 2.47-21.55) and postoperative atrial fibrillation (P = 0.0134; OR: 4.05; 95% CI: 1.33-12.31) were identified as risk factors. CONCLUSIONS: Incidence of postoperative stroke after CPB was not significantly higher in our octogenarian population. Although in younger patients peripheral vascular disease and cardiac rhythm disturbances were significant risk factors, it seems that factors related to intraoperative brain oxygenation (secondary to preoperative anaemia) are the most critical determinant of stroke in the elderly.

Fulminant mediastinitis due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: atypical presentation and spreading following cardiac surgery.

Mediastinitis due to Klebsiella pneumoniae, related to thoracic wall contamination after cardiac surgery, has rarely been described. We aim to report a case of fulminant mediastinitis due to extended-spectrum beta-lactamase-producing K. pneumoniae, secondary to a disseminated concomitant pulmonary infection. The patient remained pauci-symptomatic until clinical manifestations of sepsis acutely appeared.

Mitral approach in prosthetic endocarditis with calcified annulus and abscess.

Abscess resection and prosthesis reimplantation is the only effective treatment for mitral prosthesis endocarditis with extensive annular abscess, but it has high morbidity and mortality when associated with severe mitral annular calcification in the atrial and ventricular walls. We describe a technique that allows repair of the abscess cavity, reconstruction of the annulus, and implantation of a new mitral prosthesis when there is severe adjacent myocardial calcification, so decreasing the reoperation risk.