The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Oct 2013
Case ReportsEndovascular repair of mycotic aneurysm of the descending thoracic aorta: diagnostic and therapeutic dilemmas-two case reports with 1-year follow-up.
A mycotic aneurysm of the thoracic aorta is a rare diagnosis with high mortality. We present two cases of endovascular reconstruction of mycotic descending thoracic aorta. Specific or nonspecific bacterial or other infectious agent in serial samples of blood, urine, cerebrospinal fluid, and pleural puncture was not detected in the first case, but we found in sputum sample Mycobacterium tuberculosis in the second patient. ⋯ Control computed tomographic scans 6 months after reconstruction showed no endoleak in both patients. Repair of mycotic descending thoracic aortic aneurysms by endoluminal stent graft is reasonable alternative to open surgical intervention. A broad-spectrum antibiotic therapy has a high significance in the treatment of patients with mycotic aneurysm.
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Thorac Cardiovasc Surg · Oct 2013
Pancreaticopleural fistula-induced empyema thoracis: principles and results of surgical management.
Pancreaticopleural fistula is a very uncommon complication of pancreatitis resulting from pancreatic duct disruption with leakage of pancreatic secretions into the pleural cavity. Fistulization occurs either through the esophageal hiatus or straight through the diaphragm. Pleural effusion with dyspnea is the main presenting symptom, and delayed diagnosis is frequent. Initial conservative treatment fails in a significant number of cases. Ascending infection via the fistulous tract results in empyema and life-threatening sepsis. ⋯ Surgical management combining minimally invasive thoracic surgery and removal of the fistulous tract is highly effective. If initial medical treatment fails, surgery should be considered early to prevent severe sepsis. Further improvement seems achievable by reducing the time between fruitless conservative efforts and surgical intervention.
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Thorac Cardiovasc Surg · Oct 2013
Case ReportsHybrid approach to treat total thoracic aortic aneurysm in a patient undergoing emergency surgery for descending aortic rupture.
Rupture of the descending aorta is a life-threatening complication requiring emergency intervention. The endovascular approach (TEVAR) has been recently introduced to treat the descending aorta in the emergency setting, resulting in better early postoperative outcome as compared with traditional surgery. However, when the pathology involves the aortic arch and ascending aorta, TEVAR alone cannot be performed, requiring an alternative approach. We describe a one-stage hybrid repair via midline sternotomy to treat rupture of the descending thoracic aortic segment in toto.
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Thorac Cardiovasc Surg · Oct 2013
Hypothermic circulatory arrest using antegrade cerebral perfusion is safe for elective aortic arch surgery.
We hypothesized that hypothermic circulatory arrest (HCA) can be performed with a low operative risk and does not add to the morbidity in elective procedures. ⋯ HCA with open distal anastomosis for elective aortic repair can be performed with low operative mortality, even in the elderly, and seems not to add to the morbidity of the procedure.