[Surgical treatment of acute type-B aortic dissection associated with cocaine use]. / B típusú aortadissectio sebészi kezelése kokaint használó beteg esetében.

UNLABELLED: Cocaine abuse is on a rise in Hungary as well. It is known that cocaine users have a higher risk developing cardiovascular complications, for example aortic dissection. Almost all patients in Hungary suffering from type B aortic dissection are referred to our department for treatment. AIM: We introduce the case of a regular cocaine user, who suffered an acute type B aortic dissection and was treated surgically. To our best knowledge this is the first similar case in our country to be published. METHOD: Case presentation. RESULTS: We performed a successful operation: acute thoracoabdominal aortic refenestration, no complication was detected. The patient is doing well three months after the procedure, returned to his regular activities, he is normotensively receiving medical treatment, and he gave up cocaine. CONCLUSIONS: Thoracoabdominal aortic refenestration can save the life of patients presenting with acute type B dissection. Good long-term result depends on adequate hypertension control and cocaine abstinence. As the frequency of cocaine abuse increases in Hungary, similar cases may be more often encountered.

[Hybrid solution in aortic arch surgery]. / Hybrid megoldások az aortaív sebészetben.

Since the introduction of endografts, treatment of vascular diseases has remarkably changed. Due to less surgical trauma patients--those were not amenable to open surgery--now have the chance to be treated with remarkably lower risk. At certain segments of the aorta with life important side branches combination of open surgery is needed to get free segment for deployment of endografts. These "hybrid" interventions have opened new horizon at aortic arch surgery without use of cardiopulmonary bypass and deep hypothermia. In selected types of diseases by debranching of the aortic arch and transposition of the supra-aortic trunks we can achieve suitable landing zones to fix the endografts properly. In this paper we provide an overview of the possible solutions.

[A simple surgical method for removing a large floating thrombus from the ascending aorta]. / Egyszeru sebészi módszer az aorta ascendensben elhelyezkedo nagy, lebego thrombus eltávolítására.

We report the successful surgical removal of a large floating thrombus from the ascending aorta causing systemic embolization. It was diagnosed by transesophageal echocardiography (TEE), CT scan, aortography and Cardiovascular Magnetic Resonance Imaging (CMR). The free-floating, highly embolic source 2 cm distal to the left coronary sinus was removed from the ascending aorta using a simple surgical technique. Isolated cerebral perfusion with circulatory arrest on normothermia provided a simple and safe access to the thrombus attached to a ruptured atherosclerotic plaque. The patient was discharged on the 7 th postoperative day after an uneventful recovery.

[Risk of cardiac complications in patients undergoing major vascular surgery]. / Ersebészeti mutetekkel kapcsolatos cardialis kockázatok.

In patients undergoing major vascular surgery cardiac complications are the major cause of perioperative morbidity and mortality. This is related to the frequent presence of underlying coronary artery disease. The aim of the preoperative cardiac risk assessment is to evaluate the presence and degree of coronary artery disease along with other risk factors such as cerebrovascular disease, renal insufficiency, and diabetes mellitus that may influence the perioperative risk of these patients. Based on the presence and number of cardiac risk factors the individual risk profile can be determined, which may facilitate medical decision making about the perioperative and long-term management of these patients. In the present review based on data from current literature we summarized the pathology of perioperative cardiac complications, and the role of cardiac risk assessment and risk reduction strategies in patients undergoing major vascular surgery. In this review the authors summarized data from current literature and found that a limited set of risk factors and a result of a noninvasive test used for detection of coronary artery disease may help to stratify patients into low-, intermediate- and high risk for perioperative cardiac complications. If patients with intermediate- to high-risk prescribed beta-blockers the risk of cardiac complications can be reduced. Along with beta-blockers it was also found that perioperative use of statins may also help to reduce the risk of cardiac complications. In patients identified to be at very high-risk further perioperative evaluation and management should include coronary angiography with subsequent coronary revascularization if there is a clearly defined need, independent of the need for vascular surgery.

[The advantages of axillary artery cannulation in surgical treatment of type A acute aortic dissection]. / Az arteria axillaris kanülálás elonyei az akut "A" típusú aorta dissectio sebészi kezelésében.

There are more alternative cannulation techniques during surgery of type A aortic dissection. The most frequently used femoro-atrial cannulation method provides limited possibility for brain protection during surgery. This theory is confirmed by relatively high frequency of major brain complications in patients operated on while using this cannulation technique. During the last years cannulationis used more often, as it may provide more protection for the brain than other methods. In 2003 seven patients underwent aortic reconstruction because of type A acute aortic dissection using axillary cannulation. All patients except one were discharged after uneventful recovery. There were no postoperative neurological complications following surgery. We lost one patient due to distal progression of the dissection. He was the only patient with clinical evidence of transient postoperative brain damage. We are strongly convinced that the spectacular improvement in our results for the surgery of type A acute aortic dissection is due to the axillary cannulation, the anterograde flow and the isolated cerebral perfusion. We recommend the axillary cannulation technique as the first choice in type A acute aortic dissection.