RESUMO
A 68-year-old man with a history of valve-sparing aortic root replacement and endoscopic aortic valve replacement was admitted to our hospital with dyspnea. Transthoracic echocardiography revealed severe pulmonary valve regurgitation. The patient had undergone cardiac surgery twice, through median sternotomy and right thoracotomy; therefore, we planned endoscopic pulmonary valve replacement via the left thoracic approach. The patient was placed in a modified right lateral decubitus position and underwent mild hypothermic cardiopulmonary bypass. An on-pump beating-heart technique was used during surgery. The 3D endoscopic system and trocars for surgical instruments were inserted through the left 3rd and 4th intercostal spaces. After incision of the pulmonary artery, the pulmonary cusps were resected. A 27-mm St Jude Medical Epic heart valve was implanted in the intra-annular position. Subsequently, the left atrial appendage was resected. The patient was discharged without complications. To our knowledge, this is the first case of totally endoscopic pulmonary valve replacement.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Pulmonar , Masculino , Humanos , Idoso , Implante de Prótese de Valva Cardíaca/métodos , Valva Pulmonar/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Endoscopia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodosRESUMO
A 60-year-old woman was admitted to our institution for exertional dyspnea. Transthoracic echocardiography revealed a 1.6 cm secundum atrial septal defect( ASD) and a 4.2×3.1 cm mobile left atrial mass originating from the ASD. The tumor migrated to the mitral valve during diastole and to the atrial septal defect during systole. A totally endoscopic approach via a small right thoracotomy was adopted to resect the mass and close the ASD with a Hemashield patch. Histopathologic examination of the excised mass was consistent with myxoma. The postoperative course was uneventful. A 2-year follow-up revealed no recurrence of the myxoma and ASD.
Assuntos
Fibrilação Atrial , Neoplasias Cardíacas , Comunicação Interatrial , Mixoma , Feminino , Humanos , Pessoa de Meia-Idade , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Ecocardiografia , Mixoma/diagnóstico por imagem , Mixoma/cirurgiaRESUMO
BACKGROUND: Descending aortic replacement often involves making large incisions; thus, it results in massive invasions. We report the case of a patient with dilated descending aorta treated using endoscopic-assisted descending aortic replacement with essentially minimal invasions. CASE PRESENTATION: We performed endoscopic-assisted descending aortic replacement with a single incision involving six wounds by trocar puncturing on a 59-year-old man who was diagnosed with dilated descending aorta by stent graft-induced new entry. Subsequently, the patient was discharged on postoperative day 11 without any complications. CONCLUSIONS: Despite minor incisions, our approach can be indicated to almost the same group of patients in whom the conventional approach can be performed. Our procedure involved a single incision of only 8 cm and six wounds by trocar puncturing. Thus, endoscopic-assisted surgery can be a useful option in descending aortic surgery.
