RESUMO
Post-myocardial infarction ventricular septal defect is a devastating complication of ST-elevation myocardial infarction. Although surgical intervention is considered the gold standard for treatment, it carries high morbidity and mortality rates. We present 2 cases that illustrate the application of percutaneous closure of a post-myocardial infarction ventricular septal defect: the first in a patient who had undergone prior surgical closure and then developed a new shunt, and the second as a bridge to definitive surgery in a critically ill patient.
Assuntos
Cateterismo Cardíaco , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/terapia , Idoso , Cateterismo Cardíaco/instrumentação , Angiografia Coronária , Ecocardiografia Doppler em Cores , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Desenho de Prótese , Dispositivo para Oclusão Septal , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/etiologiaRESUMO
Pectus excavatum is a chest wall deformity that commonly warrants pediatric surgical correction for cosmesis or respiratory impairment via sternotomy. The repair typically consists of sternal wedge osteotomy and subsequent placement of a Steinman pin across the sternum with fixation to the ribs bilaterally. Coronary artery bypass grafting (CABG) after surgical repair of the sternum with a metal implant poses an intriguing surgical challenge. Literature review reveals only one such previously described case. We present a case of coronary revascularization in an adult who previously underwent pectus excavatum repair with ligation of the internal mammary arteries. Our coronary revascularization was accessed through a resternotomy after surgical removal of the metal implant previously placed during the pectus excavatum repair. Autologous greater saphenous vein was used as a conduit for bypass. The patient did well postoperatively and was discharged on postoperative day 4. The pectus repair remained intact even after the median sternotomy was performed. This was confirmed at the 1-year follow-up for the patient. Resternotomy after pectus excavatum repair with a prosthetic implant poses a challenge to cardiothoracic surgeons. Many such repairs have been described in the pediatric population. As our society ages and coronary artery disease becomes more prevalent, this unique situation may be more commonly encountered. We present an approach to coronary artery bypass grafting via median resternotomy after pectus excavatum repair.
Assuntos
Ponte de Artéria Coronária/métodos , Estenose Coronária/cirurgia , Tórax em Funil/cirurgia , Próteses e Implantes , Esterno/cirurgia , Adulto , Cateterismo Cardíaco , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Remoção de Dispositivo , Seguimentos , Tórax em Funil/diagnóstico , Humanos , Masculino , Procedimentos de Cirurgia Plástica/instrumentação , Procedimentos de Cirurgia Plástica/métodos , Reoperação , Medição de Risco , Índice de Gravidade de Doença , Toracotomia/métodos , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
Pericardial cysts are mediastinal tumors that usually have a benign course. Diagnostic and therapeutic thoracoscopy are warranted for suspect mediastinal masses, unsuccessful nondiagnostic less invasive procedures, and symptomatic unusually located pericardial cysts. We report a case of thoracoscopic resection of symptomatic pericardial cysts.
