Incisión de Clamshell con esternotomía media como abordaje del aneurisma de arco aórtico complicado

Surgical treatment of aortic arch aneurysm is one of the greatest challenges of aortic surgery. We present a young woman with Marfan syndrome, severe Excavated Pectus and previous Bentall procedure, who underwent emergency surgery for ruptured aortic arch aneurysm. We achieved a successful approach through a Clamshell incision associated with a median re-sternotomy.El tratamiento del aneurisma de arco aórtico constituye uno de los mayores desafíos en la cirugía de aorta. Presentamos el caso de una mujer joven con antecedente de síndrome de Marfan, Pectus Excavatum severo y cirugía de Bentall, que ingresó a cirugía de emergencia por aneurisma de arco aórtico roto-contenido. Se logró un abordaje exitoso mediante una incisión de Clamshell asociada a reesternotomía media

Aortic valve replacement through minithoracotomy. Results from the Peruvian experience

Objectives. To assess mortality, major valve-related events (MAVRE), and other complications in the perioperative period and follow up in patients with aortic valve replacement (AVR) through minithoracotomy (MT). Methods. We retrospectively analyzed patients aged <80 who underwent AVR through MT between January 2017 and December 2021 in a national reference center in Lima, Peru. Patients undergoing other surgical approaches (mini-sternotomy, etc.), other concomitant cardiac procedures, redo, and emergency surgeries were excluded. We measured the variables (MAVRE, mortality, and other clinical variables) at 30 days and a mean follow-up of 12 months. Results. Fifty-four patients were studied, the median age was 69.5 years, and 65% were women. Aortic valve (AV) stenosis was the main indication for surgery (65%), and bicuspid AV represented 55.6% of cases. At 30-days, MAVRE occurred in two patients (3.7%), with no in-hospital mortality. One patient had an intraoperative ischemic stroke, and one required a permanent pacemaker. No patient underwent reoperation due to prosthesis dysfunction or endocarditis. In a mean follow-up of one year, MAVRE occurrence did not show variations with the perioperative period, most patients remained in NYHA I (90.7%) or II (7.4%) compared to the preoperative period (p<0.001). Conclusions. AV replacement through MT is a safe procedure in our center for patients under 80 years.Objectives. To assess mortality, major valve-related events (MAVRE), and other complications in the perioperative period and follow up in patients with aortic valve replacement (AVR) through minithoracotomy (MT). Methods. We retrospectively analyzed patients aged <80 who underwent AVR through MT between January 2017 and December 2021 in a national reference center in Lima, Peru. Patients undergoing other surgical approaches (mini-sternotomy, etc.), other concomitant cardiac procedures, redo, and emergency surgeries were excluded. We measured the variables (MAVRE, mortality, and other clinical variables) at 30 days and a mean follow-up of 12 months. Results. Fifty-four patients were studied, the median age was 69.5 years, and 65% were women. Aortic valve (AV) stenosis was the main indication for surgery (65%), and bicuspid AV represented 55.6% of cases. At 30-days, MAVRE occurred in two patients (3.7%), with no in-hospital mortality. One patient had an intraoperative ischemic stroke, and one required a permanent pacemaker. No patient underwent reoperation due to prosthesis dysfunction or endocarditis. In a mean follow-up of one year, MAVRE occurrence did not show variations with the perioperative period, most patients remained in NYHA I (90.7%) or II (7.4%) compared to the preoperative period (p<0.001). Conclusions. AV replacement through MT is a safe procedure in our center for patients under 80 years

Taponamiento cardíaco por ruptura de aneurisma coronario gigante sobre fístulas coronarias: Reporte de un caso inusual

Coronary artery fistulas are rare clinical entities, and their association with giant coronary aneurysms is even more unusual. Most fistulas are asymptomatic, in the other hand, aneurysms could develop symptoms depending on their diameter. We present the clinical case about a patient with chest pain and cardiac arrest, who later developed cardiac tamponade with the need for emergency surgery, due to rupture of a giant coronary aneurysm developed from confluent coronary artery fistulas from two coronary arteries to pulmonary artery.Las fístulas de arterias coronarias son entidades clínicas infrecuentes y su asociación con aneurismas coronarios gigantes, es aún más inusual. La mayoría de las fístulas son asintomáticas, por otro lado, los aneurismas podrían desarrollar síntomas según su diámetro. Presentamos el caso clínico, de un paciente con dolor torácico y arresto cardíaco, que posteriormente desarrolló taponamiento cardíaco con necesidad de cirugía de emergencia, por ruptura de aneurisma coronario gigante desarrollado a partir de fístulas de arterias coronarias confluentes desde dos arterias coronarias hacia la arteria pulmonar

A new surgical technique for left atrial reduction in giant left atrium

Objective: The study objective was to evaluate the safety and clinical and echocardiographic outcomes of a new surgical technique in adult patients diagnosed with a giant left atrium. Methods: We analyzed a cohort of patients who underwent left atrium reduction surgery between January 2016 and June 2020 performed by a specialized surgical team in 2 national reference centers in Lima, Peru. We assessed the major adverse valvular-related events and the New York Heart Association functional class as primary clinical outcomes. Also, our primary echocardiographic endings were the diameter, area, and volume of the left atrium. We assessed these variables at 3 time periods: baseline (t0), perioperative period (t1), and extended follow-up (t2: 12 3.4 months). We carried out descriptive and bivariate exploratory statistical analysis for dependent measures. Results: We included 17 patients, 70.6% of whom were women. Rheumatic mitral valve disease (76.5%) was the main etiology. We performed 14 (82.4%) mitral valve replacements and 3 repairs. Major adverse valvular-related events occurred in 1 patient (5.9%) (hemorrhagic stroke) at t1. A significant reduction in the size of the left atrium was observed: diameter (77 mm vs 48 mm, P<.001), area (75 cm2 vs 31 cm2P<.001), and volume (332 cm3 vs 90 cm3 , P<.001). Compared with t0 and t1, these echocardiographic findings remained without significant changes during t2. Conclusions: Our surgical left atrium reduction technique was associated with improved clinical functionality and reduced left atrium measures in patients with a giant left atrium undergoing mitral valve surgery. (JTCVS Techniques 2023;17:56-64)Revisión por pare