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1.
World J Cardiol ; 15(5): 244-252, 2023 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-37274377

RESUMO

Non-A non-B aortic dissection (AAD) is an infrequently documented condition, comprising of only a small proportion of all AADs. The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD, have led to an ongoing controversy around the topic. It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections, frequently leading to serious complications and thus mandating early intervention. Currently, the available treatment methods in the surgical armamentarium are conventional open, endovascular techniques and combined hybrid methods. The optimum approach is tailored in every individual case and may be determined by the dissection's location, extent, the aortic diameter, the associated complications and the patient's status. The management of non-A non-B dissections still remains challenging and a unanimous consensus defining the gold standard treatment has yet to be reached. In an attempt to provide further insight into this perplexing entity, we performed a minireview of the literature, aiming to elucidate the epidemiology, clinical course and the optimal treatment modality.

2.
Surg Case Rep ; 7(1): 131, 2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34037883

RESUMO

BACKGROUND: Surgical treatment of prosthetic valve endocarditis (PVE) with destruction of the aortic root and aortomitral continuity is demanding even in experienced hands. CASE PRESENTATION: Herein, we describe a case of a 71-year-old female patient who presented with PVE that was further complicated by a fistulous abscess cavity. The patient underwent removal of the dehisced prosthetic valve, radical annular debridement, reconstruction of the aortomitral curtain with a pericardial patch as a patch exclusion technique and implantation of a sutureless valve. CONCLUSION: Patch exclusion technique, followed by sutureless valve implantation, might represent a feasible and safe alternative for the surgical treatment of complicated PVE.

3.
World J Pediatr Congenit Heart Surg ; 11(5): 664-665, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32853081

RESUMO

Discrete fibromembranous subaortic stenosis is a common type of subaortic stenosis causing clinically significant left ventricular outflow obstruction. Surgery for discrete subaortic stenosis is most often performed through a typical midline sternotomy. Herein, we present our experience with an adult patient who underwent a right mini-thoracotomy for subaortic membrane resection with central cannulation under direct operative vision.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Estenose Subaórtica Fixa/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Toracotomia/métodos , Adulto , Estenose Subaórtica Fixa/diagnóstico , Ecocardiografia , Feminino , Humanos
4.
Curr Opin Cardiol ; 35(6): 636-642, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32852349

RESUMO

PURPOSE OF REVIEW: Aberrant subclavian artery (ASCA) represents one of the most common congenital vascular anomalies of the aortic arch. The majority of ASCAs are associated with an aneurysm which occurs at their origin from the descending thoracic aorta, namely, the Kommerell's diverticulum. In this review, we discuss recent data with regards to indications of treatment and surgical management of these anatomical variants. RECENT FINDINGS: Various surgical methods have been described for the repair of ASCA and Kommerell's diverticulum. Traditionally, treatment included open surgery; however, recent studies describe a shift of conventional treatment to more hybrid or endovascular approaches. The heterogeneity in the anatomy and presentation of these clinical entities as well as patient-related factors have prevented conduction of randomized trials for the best available modality of treatment. This dearth of literature is well depicted in the current guidelines. SUMMARY: The optimal surgical procedure has to be tailored to every patient according to the presentation, individual anatomy, and patient's risk profile. Conventional surgery for ASCA and Kommerell's diverticulum has acceptable mortality and complication rates, whereas hybrid repairs report encouraging results. Further studies are required to provide sufficient evidence which will formulate a clear frame of treatment indications and optimal surgical methods, as well as evaluate long-term results following hybrid repair.


Assuntos
Anormalidades Cardiovasculares , Divertículo , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Anormalidades Cardiovasculares/cirurgia , Humanos , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia
5.
World J Pediatr Congenit Heart Surg ; 9(2): 254-256, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-27881809

RESUMO

Transposition of the great arteries occurs rarely in patients with mirror image dextrocardia and situs inversus, while the combination with severe coarctation of the descending aorta (CoA) makes the anatomy even more unusual. Therefore, it is not surprising that a case with such unusual and complicated anatomy presents unique problems when a primary definitive correction is attempted. We report a patient with situs inversus totalis and complex congenital heart disease including transposition of the great arteries and severe CoA who underwent successful complete, single-stage, anatomic correction.


Assuntos
Anormalidades Múltiplas/cirurgia , Coartação Aórtica/cirurgia , Situs Inversus/cirurgia , Transposição dos Grandes Vasos/cirurgia , Anormalidades Múltiplas/diagnóstico , Coartação Aórtica/diagnóstico , Humanos , Recém-Nascido , Masculino , Situs Inversus/diagnóstico , Transposição dos Grandes Vasos/diagnóstico
6.
Ann Thorac Surg ; 99(1): 319-21, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25555955

RESUMO

A 9-year-old girl with a giant tumor of the right lung and an isolated metastasis of the left lower lobe underwent combined pneumonectomy and metastasectomy through means of a right thoracotomy. Her postoperative course was uneventful. The operative approach of a tumor of this scale and the concurrent contralateral metastasectomy are described and discussed.


Assuntos
Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Neurilemoma/cirurgia , Pneumonectomia/métodos , Toracotomia , Criança , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neurilemoma/patologia
7.
Updates Surg ; 66(4): 247-52, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25381550

RESUMO

Thoracic incisions are the portals of choice for accessing thoracic organs. There are instances, however, that more than one incision are required at the same or a later stage, in order to access other, thoracic or extrathoracic, organs for more complicated procedures. Then again, a single thoracic incision may offer more than adequate access to extrathoracic organs and in selected cases becomes valuable surgical approach to organs of the upper abdomen or the contralateral hemithorax. The experience with this technique is discussed.


Assuntos
Toracotomia/métodos , Abdome/cirurgia , Glândulas Suprarrenais/cirurgia , Diafragma/anatomia & histologia , Diafragma/lesões , Diafragma/cirurgia , Trato Gastrointestinal/cirurgia , Humanos , Fígado/cirurgia , Pulmão/cirurgia , Pâncreas/lesões , Pâncreas/cirurgia , Pleura/anatomia & histologia , Pleura/cirurgia , Baço/lesões , Baço/cirurgia
8.
Cardiovasc J Afr ; 25(4): e1-3, 2014 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-25192408

RESUMO

The case is presented of a previously healthy infant with a known asymptomatic bicuspid aortic valve who developed fungal endocarditis. The patient underwent aortic root replacement with a pulmonary autograft (Ross procedure). Cultured operative material revealed Aspergillus infection. The patient had an excellent recovery and remained well one year later.


Assuntos
Valva Aórtica/anormalidades , Aspergilose/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Endocardite/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valva Aórtica/cirurgia , Aspergilose/complicações , Aspergilose/diagnóstico , Doença da Válvula Aórtica Bicúspide , Ecocardiografia , Endocardite/complicações , Endocardite/diagnóstico , Feminino , Humanos , Lactente
9.
Korean J Thorac Cardiovasc Surg ; 47(4): 394-7, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25207250

RESUMO

Numerous technical modifications and various complications of the Senning procedure have been described in the literature. We describe the excellent clinical status and anatomic result of a 33-year-old patient who underwent a modified Senning operation using the left atrial appendage for reconstruction more than 30 years prior to presentation.

10.
Case Rep Surg ; 2014: 795726, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24741444

RESUMO

Supravalvar aortic stenosis (SVAS) in patients with Williams' syndrome is often accompanied by coronary, pulmonary, and even myocardial lesions and therefore associated with increased perioperative morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) provides reliable short-term mechanical circulatory support to patients, especially young, in acute postoperative cardiac failure when conventional means are ineffective. The incorporation of centrifugal pumps in these systems has made their use more efficient and less traumatic. We describe our experience of using the Levitronix CentriMag pump in two patients with Williams' syndrome who underwent surgical correction of supravalvular aortic stenosis.

11.
Korean J Thorac Cardiovasc Surg ; 47(6): 545-7, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25551078

RESUMO

A coronary artery fistula was surgically ligated in a 38-year-old woman via a left anterior mini-thoracotomy without the use of cardiopulmonary bypass. In selected cases, this surgical approach can provide an excellent surgical exposure for coronary artery fistula ligation. It also offers an excellent cosmetic result and shorter hospital stay.

13.
BMJ Case Rep ; 20122012 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-23257646

RESUMO

In patients with corrected tetralogy of Fallot (TOF), progressive right ventricular volume overload from longstanding regurgitation of the pulmonary valve, results in severe late complications. The presence of additional major clinical conditions may aggravate the clinical status in these patients. We describe the case of a patient with coexistence of mitral and pulmonary regurgitation in the setting of corrected TOF who underwent successful surgical treatment.


Assuntos
Insuficiência da Valva Mitral/complicações , Complicações Pós-Operatórias , Insuficiência da Valva Pulmonar/complicações , Tetralogia de Fallot/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/cirurgia , Insuficiência da Valva Pulmonar/cirurgia
14.
Heart Surg Forum ; 15(4): E182-4, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22917820

RESUMO

Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients. We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion. An open commissurotomy was performed, and within 8 months the patient developed recurrent symptoms of severe aortic stenosis. He underwent redo sternotomy and a Ross-Konno procedure with an uneventful recovery.


Assuntos
Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/cirurgia , Valva Pulmonar/transplante , Obstrução do Fluxo Ventricular Externo/congênito , Obstrução do Fluxo Ventricular Externo/cirurgia , Adulto , Humanos , Masculino , Reoperação , Resultado do Tratamento
15.
Hellenic J Cardiol ; 53(3): 246-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22653251

RESUMO

We describe a woman with tetralogy of Fallot and pulmonary atresia, with a history of four previous cardiac operations, who decided to bear her own children. Under interdisciplinary counselling and the appropriate medical care, she underwent a successful vaginal delivery and had a healthy baby.


Assuntos
Parto Obstétrico/métodos , Atresia Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Adulto , Cardiomegalia , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Complicações Cardiovasculares na Gravidez , Artéria Pulmonar/cirurgia
16.
Heart Surg Forum ; 14(4): E255-7, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21859647

RESUMO

Congenital coronary artery fistula is an extremely rare anomaly that may involve any of the coronary arteries and any of the cardiac chambers. We report the case of a 14-year-old female patient with a symptomatic congenital coronary fistula starting from the left main coronary artery and draining to the coronary sinus. The patient underwent surgical ligation of the fistula and had an excellent outcome.


Assuntos
Fístula Artério-Arterial/congênito , Seio Coronário/anormalidades , Anomalias dos Vasos Coronários/diagnóstico , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Fístula Artério-Arterial/diagnóstico , Fístula Artério-Arterial/cirurgia , Angiografia Coronária , Anomalias dos Vasos Coronários/cirurgia , Diagnóstico Diferencial , Ecocardiografia , Feminino , Seguimentos , Humanos
17.
Hellenic J Cardiol ; 52(2): 177-81, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21478131

RESUMO

We present the case of a 42-year-old man with mitral valve prolapse (MVP) and infective endocarditis. He was referred to our hospital by his family physician for the evaluation of a cardiac murmur. A detailed medical history revealed that he had been feeling fatigue with occasional episodes of slight fever during the last two months. Echocardiography revealed MVP with a sizeable vegetation and severe mitral insufficiency. Serial blood cultures were positive for Streptococcus viridans, highly penicillin susceptible. He was put on appropriate antimicrobial therapy, but both the vegetation and the concomitant mitral insufficiency persisted after otherwise successful medical therapy. Thus, the patient underwent surgical vegetectomy with mitral valve repair. He had an uneventful postoperative course and remains free of disease at the 12-month follow up. Our case report reinforces the value of early diagnosis in the presence of a high clinical suspicion of MVP endocarditis. An extended clinical workup, including serial detailed echocardiography studies, is mandatory in such a patient. Medical treatment of infective endocarditis in the setting of MVP is often successful. However, cardiac surgical intervention plays an important role in the treatment of intracardiac complications. Mitral valve repair in the context of a healed and stable infective endocarditis is the treatment of choice.


Assuntos
Endocardite Bacteriana/cirurgia , Prolapso da Valva Mitral/cirurgia , Infecções Estreptocócicas/terapia , Estreptococos Viridans , Adulto , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Humanos , Masculino , Prolapso da Valva Mitral/diagnóstico , Prolapso da Valva Mitral/microbiologia , Infecções Estreptocócicas/diagnóstico
18.
Med Sci Monit ; 17(1): BR10-15, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21169902

RESUMO

BACKGROUND: The feasibility and the hemodynamic outcome of Fontan circulation, without the use of cardiopulmonary bypass, were studied on a beating heart of an adolescent pig model, using a modified total cavopulmonary connection. MATERIAL/METHODS: Eight open-chest anesthetized pigs underwent a successful total cavopulmonary connection with the use of an appropriate Y-shaped Dacron-type conduit. Through a median sternotomy, the distal part of the superior vena cava was anastomosed end-to-end to one side of the conduit. The other side of the graft was anastomosed end-to-side to the main pulmonary artery. The conduit was tailored to an appropriate length and anastomosed end-to-end to the inferior vena cava. The hemodynamic status of the animals was recorded before and after the establishment of the total cavopulmonary connection. RESULTS: Forty-five minutes after completion of total cavopulmonary connection, and for a total of 1 hour, hemodynamic measurements showed a decrease in mean arterial and mean pulmonary artery pressures, heart rate and cardiac output. The inferior vena caval pressure and total pulmonary vascular resistance were increased. CONCLUSIONS: A total cavopulmonary connection, performed on a beating heart, without extracorporeal circulation or other means of temporary bypass, although it is technically demanding, is feasible.


Assuntos
Técnica de Fontan/métodos , Derivação Cardíaca Direita/métodos , Animais , Pressão Sanguínea , Débito Cardíaco , Ponte Cardiopulmonar , Frequência Cardíaca , Masculino , Sus scrofa
19.
Heart Surg Forum ; 13(5): E339-41, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20961839

RESUMO

Anomalous origin of a pulmonary artery from the ascending aorta (AORPA) is a rare congenital cardiac malformation that needs prompt surgical repair; otherwise it is associated with poor prognosis. We describe 3 cases of AORPA that successfully underwent complete surgical correction without extracorporeal circulation.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Implante de Prótese Vascular/métodos , Ponte Cardiopulmonar , Artéria Pulmonar/anormalidades , Malformações Vasculares/cirurgia , Aorta Torácica/cirurgia , Contraindicações , Ecocardiografia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Imagem Cinética por Ressonância Magnética , Masculino , Artéria Pulmonar/cirurgia , Malformações Vasculares/diagnóstico
20.
Heart Surg Forum ; 12(3): E155-7, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19546068

RESUMO

BACKGROUND: We present an alternative treatment employing a hybrid approach used in 3 patients with congenital heart disease. The goal was to provide optimal therapy by minimizing the potentially harmful effects of methods that accompany conventional surgical procedures. METHODS: Two patients aged 4 and 6 months underwent beating-heart closure of a muscular ventricular septal defect (VSD) with an occluding device. In addition, an 8-year-old patient with supraaortic, main, and branch pulmonary artery (PA) stenosis underwent conventional surgical patch augmentation of the ascending aorta and the main PA and intraoperative stenting of the branch PA stenoses. RESULTS: No patient deaths occurred. One patient developed a postoperative pneumothorax. Median intensive care unit and hospital stays for the VSD patients were 1 and 5 days and for the other patients 2 and 20 days, respectively. At median follow-up of 25 months, all patients were well and had required no further interventions. CONCLUSIONS: Patients with muscular VSD can currently be treated with the hybrid approach. Intraoperative PA stenting in addition to conventional surgical repair can be performed safely and may be complementary in patients with complex lesions.


Assuntos
Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos de Cirurgia Plástica/instrumentação , Procedimentos de Cirurgia Plástica/métodos , Feminino , Humanos , Lactente , Masculino , Resultado do Tratamento
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