RESUMO
A 14-year-old male pedestrian was hit by a truck and admitted with respiratory distress and subcutaneous emphysema. Aortography revealed disruption of the ascending aorta. Bronchoscopy revealed rupture of the left main bronchus at the carina. Both lesions were repaired using a median sternotomy, cardiopulmonary bypass, and a transpericardial approach for the bronchial repair. To our knowledge, this is the first report of successful repair of a combined rupture of a major bronchus and the ascending aorta.
Assuntos
Ruptura Aórtica/cirurgia , Brônquios/lesões , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/cirurgia , Adulto , Aorta/lesões , Ruptura Aórtica/diagnóstico por imagem , Aortografia , Broncoscopia , Humanos , Masculino , Ruptura , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnósticoRESUMO
The coexistence of the Taussig-Bing anomaly and coarctation of the aorta is a highly complex situation carrying a dismal prognosis. Through our experience and a review, we have observed that neonates requiring coarctation repair, pulmonary artery banding, and patent ductus ligation are at high risk of expiring before reaching an age at which a difficult total repair is feasible. It appears that patients presenting beyond the neonatal period have a better chance of surviving an initial surgical procedure and the definitive repair. A surgical management protocol has been suggested. Although associated with an uncertain late prognosis, arterial level repairs are the most physiologic, and their results to date are encouraging.
Assuntos
Coartação Aórtica/complicações , Transposição dos Grandes Vasos/complicações , Coartação Aórtica/patologia , Coartação Aórtica/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Prognóstico , Transposição dos Grandes Vasos/patologia , Transposição dos Grandes Vasos/cirurgiaRESUMO
Intraoperative angiography in carotid extracranial surgery demonstrates technical defects in 5% to 8% of patients. A simple and safe method of completion contact angiography (CCA) has been perfected by adapting dental x-ray equipment, small dental film cassettes, and a "shoe box" type of developing unit. The method is not technician dependent, requires only 5 ml of contrast medium, has a completion time of less than 5 minutes, and produces no measurable radiation to the operating team. CCA was performed with no complications in 40 patients undergoing carotid endarterectomy. Two unsuspected internal carotid artery defects (5%) were discovered: in one a stenosis was immediately repaired, and in the other small thrombi that were seen but not removed were probably the cause of a postoperative transient ischemic attack. Two complete occlusions and one prominent intimal flap in the external carotid artery were also identified. We believe that CCA after carotid surgery should be used routinely because it is safe and simple and reveals unsuspected operative defects that can be corrected immediately.
