RESUMO
Aortico-left ventricular tunnel is a rare congenital cardiac defect, which bypasses the aortic valve via the paravalvar connection from the aorta to the left ventricle. The authors present the case of a 14-year-old boy with aortico-left ventricular tunnel in whom the aortic orifice arose from the right aortic sinus and was closed by a pericardial patch. The diagnosis was confirmed by combined two-dimensional and real time three-dimensional echocardiogram and magnetic resonance imaging. This is the first case, in which these complex diagnostic imaging methods have been used in the pre- and postoperative management of this defect. Optimally the new transthoratic three-dimensional echocardiography would be needed to define the anatomy and functional consequences of the aortico-left ventricular tunnel and in the postoperative follow-up.
Assuntos
Aorta/anormalidades , Aorta/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Ecocardiografia Tridimensional , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Adolescente , Aorta/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/patologia , Insuficiência da Valva Aórtica/fisiopatologia , Ecocardiografia Transesofagiana , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/patologia , Cardiopatias Congênitas/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Hemodinâmica , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
The upright posture of man had been a major evolutional challenge. The mechanisms responsible for orthostatic tolerance mostly affect the venous system. In this paper, we discuss new results regarding the biomechanics of the venous system highlighting a rather neglected field, the biomechanical properties of the vein wall. These properties change according to localization of veins, age, gender and body mass. The anti-gravitational adaptation of veins is a complex process involving all three layers of the venous wall. Local myogenic and humoral mechanisms as well as systemic hormonal and nervous influences control the adaptive processes in the veins. Long term adaptation involves structural and functional remodeling of the venous wall. Disorders of the veins mostly cause pathological remodeling. Hemodynamic factors (pressure and flow) together with inflammatory processes may lead to pathological alterations, changing the biomechanical properties of the vein wall, which further contribute to the reservation and progression of venous dysfunction. Appropriate testing of venous function can reveal biomechanical disorders even in clinically asymptomatic patients. Thus, biomechanical investigation of veins not only helps to understand the underlying pathomechanism but it also can contribute to early diagnosis and follow-up of venous disorders. When recognized in time, pathological remodeling can be prevented or treated. In this way, the incidence of venous disorder could be cut back reducing both human suffering and material loss.
Assuntos
Hemodinâmica , Veias/anatomia & histologia , Veias/fisiologia , Fatores Etários , Fenômenos Biomecânicos , Índice de Massa Corporal , Doença Crônica , Elasticidade , Gravitação , Humanos , Postura , Grupos Raciais , Fatores Sexuais , Veias/patologia , Veias/fisiopatologia , Insuficiência Venosa/patologia , Insuficiência Venosa/fisiopatologia , Trombose Venosa/patologia , Trombose Venosa/fisiopatologia , Ausência de PesoRESUMO
Treatment of high-flow priapism varies and has included transcatheter embolization when conservative approaches fail. We present the case of an 8-year-old boy with high-flow priapism, who was treated with ultrasound-guided thrombin injection because of encouraging experience with the method obtained when treating aneurysms and pseudoaneurysms. This procedure appears to be a useful alternative to transcatheter embolization and results in no radiation exposure.