RESUMO
A case is reported of aneurysm of both the ascending aorta and pulmonary artery, associated with massive pulmonary valve insufficiency. Pulmonary artery aneurysm is a rare condition of unknown natural history; therapeutic management has not yet been established. Pulmonary valve insufficiency is also rare, with reported etiologies comprising mainly pulmonary valve anomalies. A comparative review of the literature relating to the diagnosis and therapeutic management of the condition is provided.
Assuntos
Aneurisma da Aorta Torácica/diagnóstico , Artéria Pulmonar/anormalidades , Insuficiência da Valva Pulmonar/diagnóstico , Adulto , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Ponte Cardiopulmonar , Ecocardiografia , Ecocardiografia Transesofagiana , Humanos , Masculino , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Cardiopulmonary bypass (CPB) has evolved from a complex multifunctional system to the minimally invasive extracorporeal circuit (MIEC). Concerns currently exist regarding the technically demanding nature of off-pump coronary artery bypass (OPCAB) procedures, the quality of anastomosis associated with it, and the difficulty in achieving "complete revascularization." Recognizing these issues, the so-called mini-CPB concept has evolved in an effort to offer the perceived benefits of OPCAB with the technical advantages of CPB and at the same time minimize the adverse effects of full-scale CPB. The first generation of MIEC had an inherited risk of gas embolisms. Therefore, there was the introduction of the resting heart system (RHS), the main characteristic of which is the venous air removal device. The aim of this study was to describe our early experience, feasibility, and safety with this system to help others who are considering introducing this technique into their clinical practice. Using this system, we operated on 30 consecutive patients. Moderate hypothermia (33 degrees C) CPB and cold intermittent antegrade cardioplegia was used. No technical incidents were encountered. One death from multiorgan failure occurred in a patient operated on for a thoraco-abdominal aneurysm. Our own short-term experience with the RHS has been very favorable, and we will continue to explore this development in CPB technology.
Assuntos
Ponte Cardiopulmonar/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Projetos PilotoRESUMO
Pasteurella multocida is a rare cause of infective endocarditis that occurs mostly in immunocompromised patients and is therefore associated with a high mortality rate. The case is reported of a 48-year-old male patient with liver cirrhosis, who developed aortic valve endocarditis caused by P. multocida. The infection was detected by blood cultures. The patient presented with generalized symptoms and initial neurologic symptoms suggestive of meningitis. Transthoracic echocardiography conducted after the discovery of a diastolic murmur revealed a large vegetation on the aortic valve, and notable insufficiency. These findings were confirmed at surgery, where-upon the patient underwent aortic valve replacement using a bioprosthetic valve. Subsequently he developed a recurrent episode of endocarditis that was successfully treated with antibiotic therapy. Other similar cases reported in the literature are reviewed.
