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

Pericardial effusions have multiple causes and when significant percutaneous drainage is standard. Usually removal is a simple and quick procedure with reduced risks. Still, the authors present a case were the drain surrounded the heart and great vessels, causing severe pain, bradycardia and hypotension when pulled, forcing a surgical removal of the same.

We report a rare case of an advanced stage thymoma with right superior pulmonary lobe, superior vena cava, innominate vein and pericardium invasion in a patient with Good's syndrome. In a multidisciplinary discussion, surgical resection was deemed the best initial approach, since invaded structures could be safely managed. The tumor was fully resected and included partial resection of the superior pulmonary lobe, superior vena cava and innominate vein. The encircled right phrenic nerve was dissected from the tumor and preserved. The superior vena cava and innominate vein were reconstructed using autologous pericardium patch. Immunoglobulin replacement and radiotherapy were initiated afterwards. No signs of relapse at 6 months follow-up. In such advanced cases, aggressive surgical intervention should be considered as first line of treatment, as long as full resection can be anticipated, since complete resection is the leading factor for long-term prognosis.

Objective: determine whether patient transfer adversely affects the survival of ruptured abdominal aortic aneurysm (rAAA) patients after conventional surgery.

Methods: We performed a retrospective review of all patients undergoing attempted repair of an rAAA at a tertiary center, over January 2008 and December 2014. Patients were divided into those presenting directly to our center and those transferred from another hospital. The main outcome variable was 24-hour or 30-day mortality, with secondary variables including time to surgical treatment, length of intensive care unit stay and total length hospitalization.

Results: 78 patients (88% men) underwent attempted open repair of an rAAA during this period, 69% (54 cases) were transferred from another institution. Both groups were similar in terms of demographic characteristics, comorbidities and hemodynamic stability. The overall mortality rate was 51% at 30 days. Transferred patients took twice as long as direct patients to get to the operating room (median 7,9 vs. 3,9 horas, p < 0,05), Although the difference for surgery treatment, there was no difference in 24-hour and 30-day mortality between the transferred group and direct group (26% e 50% vs. 29% e 58%, p < 0,05). Mean intensive care unit stay (median, 12 vs. 4 dias, p = 0,04) and total hospitalization (median 11 vs. 4 dias, p = 0,04) were sustantially superior in the transferred group.

Conclusions: Transfer of patients with RAAA in this series results in a doubling of the time interval between initial patient presentation and arrival in the operating room. This, however, did not result in any disadvantage in the survival rate between the groups. The total length and resources consumption were higher in the transfer group. These results may be attributed to a pre-selection of patients (clinically stable) who are able to tolerate such a delay in surgical treatment, secondary to transfer.

Bioprosthetic valve thrombosis is a rare complication. Left atrial dilatation, atrial fibrillation, hypercoagulability and low cardiac output are known risk factors. We report the case of a patient undergoing a bioprosthetic mitral valve replacement who required postoperative circulatory support with extracorporeal membrane oxygenation and presented acute bioprosthetic valve thrombosis. Some aspects regarding pathogenesis, diagnosis and treatment are discussed.

The authors describe a clinical case of correction of a type 1A endoleak after EVAR using endo-anchors. An 85-year old female was referred due to an abdominal aortic aneurysm. The patient´s previous medical history included hypertension, dyslipidemia, renal insufficiency and multiple abdominal surgeries (appendicectomy, classic cholecystectomy and hysterectomy). The aneurysm had 7.5 cm diameter with an angulated short 14 mm neck extension. She underwent an uneventful EVAR with placement of a Medtronic® Endurant II stentgraft. One month after the procedure the abdominal computed tomographic angiography (CTA) revealed a type 1A endoleak. Correction of endoleak consisted of left renal artery stenting (the lowest one), placement of a proximal aortic cuff and 9 endo-anchors (APTUS® System) with satisfactory end result. The control CTA after re-intervention showed patency of the renal arteries and the stentgraft, aneurysm exclusion and absence of endoleaks.

Objectives: Thymic cysts represent 1-3% of all tumors in the anterior mediastinum, but their knowledge is important during the differential diagnosis of a mediastinal mass.

Methods: We describe the case of a 52 years old woman, totally asymptomatic, with an incidental diagnosis of a mediastinal mass at thoracic computed tomography evaluation.

Results: Thoracic magnetic resonance showed an heterogeneous mass with approximately 3,6 cm, at the anterior mediastinum. For diagnostic clarification, surgical excision was performed. The histopathological exam revealed an epidermoid thymic cyst.

Conclusion: Surgical excision and histopathological evaluation allow definite diagnosis of this tumor, associated with a good prognosis.