RESUMO
We report a case of a large false aortic aneurysm that had developed in a 43-year-old man who had had coarctation repair 30 years previously. The coarctation repair had been done by inserting an end-to-end Dacron tubular graft which was sutured with silk. The re-operation was successfully performed under deep hypothermic arrest and it was noted that there was complete separation of the graft from both ends and no sutures were visualised. The deep hypothermic technique has considerably improved the ease and safety of this operation. We attribute this complication to the reabsorption of the silk sutures. Patients after coarctectomy with graft material should have regular chest X-rays for life in order to detect false aneurysms.
Assuntos
Falso Aneurisma/etiologia , Aneurisma Aórtico/etiologia , Coartação Aórtica/cirurgia , Prótese Vascular/efeitos adversos , Falha de Prótese , Adulto , Falso Aneurisma/cirurgia , Aneurisma Aórtico/cirurgia , Humanos , Masculino , Fatores de TempoRESUMO
Three cases of aortic valve replacement with porcine bioprostheses are reported in liver transplant recipients at two to six years after transplantation. Indications for aortic valve replacement (AVR) were aortic stenosis (n = 2) and aortic regurgitation (n = 1). The use of bioprostheses was recommended because of patient age, the need for multiple liver biopsies, and contraindication to the use of anticoagulation therapy. The patient who underwent AVR because of aortic regurgitation developed structural valve deterioration (SVD) during the next five years after surgery, and thus replacement of the bioprosthetic valve was required. Recipients of liver transplant who undergo valve replacement with tissue valves should be carefully followed up because of the risk of early SVD. AVR may be performed safely after liver transplantation.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca , Transplante de Fígado , Adulto , Animais , Valva Aórtica , Próteses Valvulares Cardíacas , Humanos , Hepatopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação , SuínosRESUMO
A 62-year-old man was admitted to the emergency department with chronic dysphagia and lower back pain. Chest radiography revealed a wide mediastinal shadow and an elevated left diaphragm, which proved to be secondary to left phrenic paralysis. The patient was diagnosed with an aneurysm of the descending thoracic aorta and was admitted to the hospital. After the patient was admitted, the aneurysm ruptured into the right chest. The patient underwent an emergency operation to replace the ruptured segment with a synthetic graft. Postoperative recovery and follow-up were uneventful. This report describes an unusual presentation of a thoracic aortic aneurysm. Hemidiaphragmatic paralysis caused by compression of the phrenic nerve is an unusual complication that, to our knowledge, has not been previously reported.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Derrame Pleural/etiologia , Paralisia Respiratória/etiologia , Aneurisma da Aorta Torácica/diagnóstico , Ruptura Aórtica/diagnóstico , Implante de Prótese Vascular , Doença Crônica , Diagnóstico Diferencial , Emergências , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural/cirurgia , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/cirurgiaRESUMO
The thoracic approach for cardiac surgery in a patient with a tracheostoma can result in difficult problems, such as mediastinitis, stoma necrosis or inadequate operative exposure. We present a distinct approach consisting of an incision at the second intercostal space, transverse sternum transection and longitudinal median sternotomy to the xiphoid process, performed for coronary artery bypass grafting and aortic valve replacement, in a patient with previous tracheotomy. This approach permitted adequate surgical exposure for cardiopulmonary bypass, aortic valve replacement and coronary revascularization procedures.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Traqueostomia , Idoso , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Ponte Cardiopulmonar , Ponte de Artéria Coronária/métodos , Doença das Coronárias/complicações , Doença das Coronárias/cirurgia , Seguimentos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , MasculinoRESUMO
The shortage of ideal donor hearts has led to an extension of the classical donor criteria of age. Higher incidence of focal coronary artery disease has been found in this older donor population requiring conventional angioplasty therapy. The authors present two patients with early coronary angiogram post transplantation, requiring angioplasty and stent in the lesions found.
Assuntos
Angioplastia Coronária com Balão , Doença das Coronárias/terapia , Transplante de Coração , Seleção de Pacientes , Complicações Pós-Operatórias/terapia , Stents , Doadores de Tecidos , Adulto , Fatores Etários , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Risco , Transplante HomólogoRESUMO
We report a case that, to the best of our knowledge, is the only published instance of infection of a pacemaker and its leads by Brucella melitensis. Furthermore, this case suggests that B. melitensis may be able to persist around pacemaker devices despite its having been eliminated from the rest of the body. The patient was a sheep shearer who had just undergone a 45-day course of antibiotic therapy for brucella and had been considered cured on the basis of negative blood cultures.