Multiple Surgical Aproachs, A Necessity To Mantein Mics In Patients With Multiple Pathologies
Waldo E. Daniel, MD, Ricardo J. Queiroz e Silva, MD, Waldo E. Daniel Filho, MS.
Federal University of RN-UFRN, Natal, Brazil.
BACKGRAUND: Although cardiovascular surgery procedures are well established, their great invasiveness and morbidity have been increasing patients' dissatisfaction, often making them opt for suboptimal procedures. MICS emerge to fill this gap, but with patients with multiple patologies, it is necessary to customize the treatment ( In two times, more than one access, etc.) because minimally access, oftentimes it's not easy treat two patologies through the same approach.
METHODS: In the case to be reported, this is a female patient, small and fragile. She had two aneurysms in two bronchial arteries, which fistulized to the right pulmonary hilum. In addition, she also had a high ASD, venous sinus type with anomalous drainage of the RSVC. There was moderate pulmonary hypertension. To avoid the trauma of the sternotomy, a prolonged extracorporeal circulation, in a procedure that would treat both pathologies, we decide to treat in two times. FIRST, We treat endovasculary with a short endoprosthesis (10 cm) that occluded at once the origin of the aneurysmal bronchial arteries, repeat the aortic AngioCT one month, and then schedule the video-assisted ASD correction. The patient was underwent transesophageal & transoperative echocardiography & no postoperative gradient was detected in RSPV or in the SVC.
RESULT: The interposition of the stent graft was great and the patient spent 12 hours in the ICU and 18 hours in the hospital. Just over one month after the procedure AngioCT showed minor aneurysm thrombosis and almost complete major thrombosis, showing the effectiveness of the treatment. One month after AngioCT, electively, we performed atrioseptoplasty with correction of anomalous VPSD drainage, video-assisted. The patient remained in the ICU for 18 hours and had a drainage of only 375 ml. At 42 hours postoperatively, she was discharged from the hospital, with excellent aesthetic results, Clinically well & without limitation.
CONCLUSION: Today, the surgical treatment must be planned much more considering the patients and his peculiarities than exclusively the pathology! The treatment must be customized! And the surgeon has at his disposal a immense therapeutic arsenal, capable of treating combined as well complex pathologies, while still offering as little trauma as possible.
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