| Journal: | Brazilian journal of cardiovascular surgery |
| Database: | PERIÓDICA |
| System number: | 000290572 |
| ISSN: | 1678-9741 |
| Authors: | Silva, Paulo Rodrigues da1 |
| Institutions: | 1Instituto Nacional de Cardiologia Laranjeiras, Rio de Janeiro. Brasil |
| Year: | 2006 |
| Season: | Oct-Dic |
| Volumen: | 21 |
| Number: | 4 |
| Pages: | 453-460 |
| Country: | Brasil |
| Language: | Portugués |
| Document type: | Artículo |
| Approach: | Caso clínico, analítico |
| English abstract | OBJECTIVE: Eighteen years ago, two young male patients of 8 months and 13 years with aortic coarctation associated to aortic hypoplasia between the left subclavian artery and the coarctated area, were submitted to surgical correction using a new world-pioneering surgical technique developed in our service. METHOD: This technique consists of sectioning the patent ductus arteriosus, followed by resection of all the coarctated tissue in the aortic wall and aortoplasty correction by means of the lengthwise implantation of a pediculated autogenous pericardial flap. This flap is inserted into the thoracic aorta, from the root of the left subclavian artery to 2.0 cm below the coarctated area. RESULTS: For both patients, the blood pressure and arterial pulses of both arms and legs have been normal since the surgery until the present moment. Clinical examination and Doppler evaluation evidenced no pressure gradient between arms and legs, normal blood flow and no pressure gradient through the coarctated area. Both patients were submitted to other evaluations 18 years after surgery, including cardiac and thoracic aortic catheterization followed by aortography. These evaluations demonstrated normal aortic configuration, with normal diameter, including the areas above and below the coarctated site. There was no evidence of any kind of degenerative lesions of the vascularized pericardial flap or re-coarctation of the lesion and no signs of aneurysms forming or the presence of atherosclerosis of the flap. Moreover, and very importantly, it was evident that the pediculated completely vascularized autologous pericardial flap had been kept alive and had grown in diameter as well as in length. CONCLUSION: The surgical technique using a pediculated vascularized autologous pericardial flap is the most complete and adequate for the correction of the different types of simple or complex forms of thoracic aortic coarctation in all age groups, including newborn babies when compared t |
| Portuguese abstract | OBJETIVO: Dezoito anos atrás, dois jovens pacientes, do sexo masculino, com 8 meses e 13 anos de vida, ambos com coarctação da aorta torácica associada à hipoplasia da aorta, entre a artéria subclávia esquerda e a área coarctada, foram submetidos à correção cirúrgica destas lesões por meio de uma nova e pioneira técnica cirúrgica desenvolvida por nós. MÉTODO: A técnica consiste na secção do canal arterial e ressecção de todo tecido coarctado da aorta, seguida por uma aortoplastia, utilizando-se de um retalho longitudinal de pericárdio vascularizado autógeno, implantado desde a saída da artéria subclávia até 2,0 cm abaixo da área coarctectomizada. Em ambos os casos, a pressão arterial sistêmica e os pulsos arteriais dos membros superiores e inferiores ficaram normais, imediatamente após a cirurgia até os dias de hoje. RESULTADOS: Os exames clínicos e de medidas com Doppler mostraram, respectivamente, nenhum gradiente pressórico braço/perna, assim como, demonstraram fluxo sanguíneo arterial normal e não gradiente arterial pressórico através da área coartectomizada. Ambos foram submetidos a rigorosas avaliações 18 anos após a cirurgia, incluindo cateterismo cardíaco e torácico aórtico, com aortografia, testes ergométricos e angiotomografia computadorizada aórtica. Essas avaliações mostraram uma configuração aórtica normal, com diâmetros transversos normais, inclusive nas regiões acima e abaixo da área coartectomizada. Não houve demonstração de qualquer forma de lesão degenerativa do retalho pericárdico pediculado implantado ao longo d |
| Disciplines: | Medicina |
| Keyword: | Cirugía, Sistema cardiovascular, Cardiopatías congénitas, Coartación de la aorta, Técnicas quirúrgicas |
| Keyword: | Medicine, Cardiovascular system, Surgery, Congenital cardiopathies, Aortic coarctation, Surgical techniques |
| Full text: | Texto completo (Ver HTML) |
