Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular最新文献

Introduction: Aortic valve stenosis (AS) is the most common valvular pathology in the elderly and surgery (AVR) remains the gold-standard. However, transcatheter aortic valve replacement (TAVI) has become an emerging alternative to surgery. In a recent survey from the European Society of Cardiology, 9,4% stated that age was the main reason to propose for TAVI.

Methods: Single-center retrospective study including 353 patients (149 ≥80 years-old;204 with 60-69 years-old) submitted to AVR between 2013-2016. Primary endpoint was survival. Secondary outcomes included the rate of post- -operative complications. Long-term survival was determined by Kaplan-Meier survival analysis. Continuous variables were analyzed with t-test and linear regression and categorical variables with chi-square or Fisher.

Results: clinical characteristics were similar between the two groups. Both had similar survival at 30 days, 12 (93,29% 60-69yo vs 91,47% ≥80yo) and 24 months (88,34% 60-69yo vs 86,11% ≥80yo). However, rapid deployment valves (RD) had better survival rates in elderly patients. Cross-clamp time was lower in ≥80yo group, with higher percentage of RD valves (20,1% vs 4.9% in 60-69yo). The rate of post-operative atrial fibrillation was higher in >80yo group (29,06% vs. 17,28%,p=0,0147). In all patients, cross-clamp time was directly related to ventilation time(p=0,025) and chest drainage(p=0,0015).

Conclusion: AVR after 80yo is safe. Cross-clamp time is directly correlated with ventilation time and bleeding, with a stronger correlation in patients over 80yo. RD valves reduce cross-clamp times, so their use in elderly may improve surgery outcome. Prospective studies are needed to evaluate if age may be clinical criteria for a RD.

Exercise echocardiography is used mainly in the study of patients with coronary artery disease, however the technique is increasingly used in the study of other pathologies. We present the first case of use of exercise stress echocardiography for clinical decision in one patient with biological prostheses in tricuspid position. The clinical exam, the echocardiogram, the cardiac MRI, the NT proBNP were normal and the patient has been considered to have no indication for surgery. The patient was only presented and accepted for surgery after the results of exercise stress echocardiography.

Objectives: Jatene surgery or arterial switch is performed at our institution since the late nineties. We reviewed our results to identify the main causes of reoperation and, more importantly, to determine what variables predict the need for reoperation.

Methods: In this retrospective analysis were included all the 91 patients with d-TGA who underwent an arterial switch operation at our institution between 1995 and 2016.

Results: Mean follow-up was 10 years (range 5-25 years). Seventy-one percent of patients had simple TGA and 29% had complex TGA. The need of reoperation was 21% (n=19 patients). Right ventricle outflow tract obstruction was the main indication for reoperation (58%). The overall mortality was 9.9%. The gender (P= 0.8), diagnosis (simple or complex TGA) (P= 0,5) or the existence of palliative surgeries (P=0.9) were unable to predict the need for reoperation. The presence of anomalous coronary pattern was the only variable reaching statistical significance (P < 0.05), both in univariate and multivariate analysis.

Conclusions: In our series, the main indication for reoperation after arterial switch operation was right ventricle outflow tract obstruction and the only predictive variable was the presence of anomalous coronary pattern.

We present 2 cases presented to the emergency department with shortness of breath (SOB). Their preoperative echocardiographies showed ruptured right sinus of Valsalva (RSOV) into the right ventricle (RV). Ventricular septal defect (VSD) was diagnosed only intraoperatively.

A 26 year old male, submitted to resection of a ganglioneuroma of the right pulmonary apex through a right Grunenwald approach. The mass insinuated through the innominate vessels, extending posteriorly to the subclavian artery, which it encircled for over 180 degrees, and the right thyrocervical arterial trunk, which was ligated.

AIntroduction: Doege-Potter's syndrome is a rare paraneoplastic syndrome, consisting in hypoglycemia and solitary fibrous tumor of the pleura. These tumors represent < 5% of all pleural tumours and can only be cured by surgery. In this article, we report a case of a patient presenting with severe hypoglycemia, as the only symptom, and a mass occupying the entire left hemithorax. Case presentation: A54 year old female with severe hypoglycemia, a chest radiography with almost total opacification of the left hemithorax and a computed tomography scan with a mass in the left hemithorax. Surgery was performed and a mass with 30cm × 18cm × 11cm weighing 3195g was resected. The postoperative course was uneventful with immediate resolution of the hypoglycemia. The immunohistochemistry diagnosis was solitary fibrous tumor of the pleura. Conclusions: Solitary fibrous tumor of the pleura are very rare. Less than 5% are associated with hypoglycemia, taking the form of Doege-Potter Syndrome. Radiation therapy and chemotherapy have shown low response rate and complete surgical resection is the only procedure that offers cure. This case reports describes a rare giant solitary fibrous tumor of the pleura with severe hypoglycemia, successfully treated by surgery. Long-term follow-up of the patient after the surgery is necessary for detection of any possible recurrence.

Background: An asymptomatic carotid stenosis (CS) is defined as a stable atherosclerotic luminal narrowing in patients with no history of ipsilateral cerebral or ocular ischemic events in the past six months. The bifurcation of the common carotid artery makes this area vulnerable to atherosclerosis due to the features of haemodynamic flow. The exact prevalence of asymptomatic patients with CS remains unknown and opinions on the treatment of these patients are controversial.

Objective: The authors aimed to review the evidence on the management of the asymptomatic CS and describe its clinical characteristics, diagnosis and treatment management.

Methods: A comprehensive review of the literature was carried out to collate data from relevant studies concerning patients with extracranial moderate to severe asymptomatic carotid stenosis. The data used was identified by a search using PubMed and Google Scholar with the keywords / MESH terms "carotid stenosis", in combination with the term "asymptomatic". For this study, the authors focused on publications in the past two decades, using English publications.

Results: A few studies have addressed the prevalence, natural course and/or prognostic impact of asymptomatic CS in patients under medical treatment or undergoing vascular surgery procedures. The prevalence of asymptomatic CS ranged from 0.3% to 4.5% in women and 0.5% to 5.7% in men - The risk of stroke/TIA in these patients was reported between 2% to 5% annually with a downward trend across time to 0.5% with current best medical therapy.

Conclusion: A great proportion of patients with asymptomatic CS should be submitted to conservative management with best medical therapy. However, selective surgical management should be considered if high risk features are present.