Objective: The aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such a risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for the aortic position implant.Methods: After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median Logistic EuroSCORE was 43.7%. Four patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. All patients presented symptoms. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis was implanted through the ventricular apex under ventricular pacing or hemorrhagic shock, after aortic valvoplasty. Echocardiograph and angiograph controls were performed, and the patients were referred to ICU.Results: Implant was feasible in 13 cases. There were no intra-operative deaths. Rev Bras Cir Cardiovasc 2010; 25(3): 293-302 treatment. The survival rate with the technique was not satisfactory with a mortality rate of 65% at 1 year. Only 40% of patients at 1 year were free of reintervention, aortic valve replacement surgery, heart block, or death [6].
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GAIA, DF ET AL -Transapical aortic valve implantation: results of a Brazilian prosthesis
Implante transapical de endoprótese valvada balão-expansível em posição aórtica sem circulação extracorpóreaOff-pump transapical balloon-expandable aortic valve endoprosthesis implantation Abstract Objective: The aortic valve replacement is a routine procedure, and involves replacement of the native valve/ prosthesis. In most of the patients who undergo such procedure the risk is acceptable, but in some cases, such risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation without cardiopulmonary bypass (CPB) has been shown to be viable, with lower morbidity and mortality. The aim of this study was to develop a catheter-mounted aortic bioprosthesis for implantation without CPB.Methods: After developing in animals, three patients with high EuroSCORE underwent implantation. Case 1: patients with bioprosthesis dysfunction; Case 2: severe aortic stenosis; Case 3: dysfunction of aortic bioprosthesis. After minithoracotomy and under echocardiographic and fluoroscopic control, a balloon catheter was placed on aortic position and inflated. After, a second balloon with valved endoprosthesis was positioned and released under high ventricular rate. Echocardiographic and angiographic controls were performed and the patients were referred to ICU.
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234GAIA, DF ET AL -Off-pump transapical balloon-expandable aortic valve endoprosthesis implantation Bras Cir Cardiovasc 2009; 24(2): 233-238
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Type A aortic dissection is usually treated with standard surgery, requiring cardiopulmonary bypass and sometimes deep hypothermia. Besides the well-established procedure, mortality and complications are considerable. Using the knowledge and lessons learned from the endovascular treatment of descending aortic diseases, emerging reports describe new approaches to the condition, using endovascular stent-grafts. This report describes an endovascular treatment of a chronic type A aortic dissection without cardiopulmonary bypass and avoiding thoracotomy.
Pentalogy of Cantrell (PC) is a congenital anomaly characterized by a defect in the lower sternum, anterior diaphragm, and anterior abdominal wall; ectopia cordis; and congenital heart disease. It is a very rare congenital anomaly and the prenatal diagnosis is possible in the beginning of second trimester of pregnancy using the conventional ultrasonography. The prognosis is poor with high rates of perinatal mortality. We present a case report of prenatal diagnosis of PC at 22 weeks and 3 days of gestation. We emphasize the prenatal care follow up in a tertiary reference center, the parental counseling, the planning of delivery, and the management of newborn by a multidisciplinary team, including the description of immediate postnatal surgical repair.
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