A Stepwise Aortic Clamp Procedure to Treat Porcelain Aorta Associated with Aortic Valve Stenosis and Hemodialysis
| Autor: | Tamizo Kimura, Tadaaki Maehara, Susumu Isoda, Motohiko Osako, Nozomu Yamanaka, Kenji Nishimura, Shingo Nakamura |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Aortic Diseases Hypothermia Induced Renal Dialysis Internal medicine medicine.artery Mitral valve Ascending aorta medicine Humans Heart Valve Prosthesis Implantation Cardiopulmonary Bypass business.industry Abdominal aorta Gastroenterology Calcinosis Aortic Valve Stenosis General Medicine Middle Aged medicine.disease Surgery Cardiac surgery Stenosis medicine.anatomical_structure Heart Valve Prosthesis Aortic valve stenosis Pulmonary artery cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business Commissurotomy |
| Zdroj: | Annals of Thoracic and Cardiovascular Surgery. 20:725-729 |
| ISSN: | 2186-1005 1341-1098 |
| DOI: | 10.5761/atcs.cr.13-00018 |
| Popis: | A 62-year-old man was referred for an aortic-valve surgery because of severe aortic stenosis. Thirty years ago, he had undergone a mitral valve commissurotomy and after 9 years, the valve had been replaced by a mechanical valve. He had been undergoing hemodialysis for the past 8 years. A computed tomographic (CT) scan of the chest and abdomen showed a dense circumferential calcification in the wall of the entire thoracic and abdominal aorta, pulmonary artery, and left and right atrium. A conventional aortic-valve replacement was performed. To avoid an embolic event, a "stepwise aortic clamp" procedure was attempted and involved the following: (1) brief circulatory arrest and aortotomy during moderate hypothermia; (2) balloon occlusion at the ascending aorta during low-flow cardiopulmonary bypass (CPB); (3) endoarterectomy by using an ultrasonic surgical aspirator to enable aortic cross-clamping; and (4) a cross-clamp reinforced with felt and full-flow CPB. The patient recovered without any thromboembolic events. Using this procedure to treat a porcelain aorta seemed to reduce the time limit and reduced the risk of brain injury during cardiac surgery. |
| Databáze: | OpenAIRE |
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