Revista portuguesa de cirurgia cardio-torácica e vascular : órgão oficial da Sociedade Portuguesa de Cirurgia Cardio-Torácica e Vascular
-
Rev Port Cir Cardiotorac Vasc · Jul 2017
Case ReportsUniportal VATS Lobectomy: Subxiphoid Approach.
Interest in uniportal video-assisted thoracic surgery (VATS) is rapidly growing worldwide because it represents the surgical approach to the lung with the least possible trauma and in recent years the subxiphoid approach has been used in the field of thoracic surgery as it is associated with lesser pain because there is no intercostal nerve damage and it provides excellent cosmetic outcomes. This technique was recently introduced for major pulmonary resections and even bilateral approaches in selected patients. ⋯ The subxiphoid approach is a variant of uniportal VATS approach without opening the intercostal space with its striking advantages in terms of pain control and cosmetics in selected patients. However, this technique has yet some limitations such as the control of major bleeding and the performance of a complete oncologic lymph node dissection related to its surgical complexity expected in emerging techniques. Further studies are necessary to certify the feasibility, safety and benefits of this approach.
-
Rev Port Cir Cardiotorac Vasc · Jul 2017
Trifecta Bioprothesis for Aortic Valve Replacement: Our Experience.
Bioprosthesis are increasingly used for aortic valve replacement (AVR), as a result of increasing elderly patients, as well as, continuous improvements in durability and hemodynamic performance of pericardial prosthesis. The Trifecta aortic prosthesis is a latest-generation trileaflet stented pericardial valve designed for supra-annular placement in the aortic position. This study establishes the safety and early clinical and hemodynamic performance of the Trifecta valve. ⋯ The present systematic review demonstrated that AVR with this prosthesis provided excellent early safety and hemodynamic outcomes with acceptable mean gradients; nevertheless, their timing, pathological characteristics, and clinical presentation mandate continued follow-up.
-
Rev Port Cir Cardiotorac Vasc · Jul 2017
Case ReportsAcute Iatrogenic Limb Ischaemia, a Report of 2 Late Presentation Cases.
With increasing use of percutaneous vascular procedures, access complications that present to a vascular surgeon increase. The most limb-threatening condition is acute limb ischaemia. Acute limb ischaemia is the most common vascular surgical emergency. In spite of recent advances in vascular surgery, it continues to carry a poor prognosis, if not early diagnosed and managed. ⋯ Acute limb ischaemia continues to carry a poor limb and life prognosis if not early diagnosed. We should be alert for the increasingly prevalence of iatrogenic acute limb ischaemia, and regularly evaluate perfusion status of limbs after any percutaneous procedure.
-
Rev Port Cir Cardiotorac Vasc · Jul 2017
Case ReportsAnalgesia Management for Mitral Valve Repair Via Minithoracotomy - A Case Report.
Minimally invasive cardiac surgery (MICS), via minithoracotomy, is thought to be a fast track to extubation and recovery after surgery. Chronic pain, due to intercostal nerve injury, develops in up to 50% of postthoracotomy patients.A number of regional anaesthesia and analgesia techniques may be employed, and the anaesthesiologists play a key role in facilitating optimal outcomes after surgery. ⋯ Thoracotomy incisions are associated with severe pain, leading to a decrease in pulmonary function, an increase in metabolic and hormonal activity and increased cardiac morbidity. Regional analgesia techniques have an opioid-sparing effect, reducing stress response and pain chronification. The local infiltration through catheter with local anaesthetics allows excellent analgesia for 8-12 hours, providing a route of additional analgesia according to pain control.
-
Rev Port Cir Cardiotorac Vasc · Jul 2017
Case ReportsIs Invasive Pressure Monitoring More Reliable Than Non-Invasive in Patients with Cardiovascular Pathology? - A Case Report.
Patients undergoing carotid endarterectomy (CEA) require strict arterial blood pressure (BP) control to maintain adequate cerebral perfusion. Invasive blood pressure (IBP) is the gold standard, however artifacts may lead to erroneous readings. ⋯ IBP allow beat-by-beat measures with optimization of BP in order to improve cerebral perfusion during CEA. IBP can be inaccurate in patients with diffuse atheromatosis. NIBP may be an alternative, however is not continuous and is expected to be less accurate than the IBP.1 The high IBP-NIBP difference (>40 mmHg) was clinically relevant and in this patient might be explained by diffuse atheromatosis. NIBP was compatible with carotid SP, indicating that, in this case was a reliable and accurate method of monitoring.