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Velandia-Sánchez A, Gómez-Galán S, Gallo-Bernal S, Polania-Sandoval CA, Pineda-Rodríguez IG, Florez-Amaya P, Sanabria-Arévalo LM, Senosiain-González J, Barrera-Carvajal JG, Umana JP, Camacho-Mackenzie J. Emergent hybrid surgical approaches for non-dissecting ruptured Kommerell's aneurysm: a case report series. J Cardiothorac Surg 2023; 18:93. [PMID: 36964599 PMCID: PMC10037773 DOI: 10.1186/s13019-023-02156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/24/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Kommerell's aneurysm is a saccular or fusiform dilatation found in 3-8% of Kommerell's diverticulum cases. A non-dissecting rupture rate of 6% has been reported. If ruptured, emergent surgical correction is usually granted. However, evidence regarding the optimal surgical approach in this acute setting is scarce. In this case report series, we aim to describe our experience managing type-1 non-dissecting ruptured Kommerell's aneurysm with hybrid emergent surgical approaches. CASES PRESENTATION From January 2005 to December 2020, three cases of type-1 non-dissecting ruptured Kommerell's aneurysm requiring emergent surgical repair were identified. The mean age was 66.67 ± 7.76 years, and 3/3 were male. The most common symptoms were atypical chest pain, dyspnoea, and headache (2/3). The mean aneurysm's diameter was 63.67 ± 5.69 mm. Frozen Elephant Trunk was the preferred surgical approach (2/3). The Non-Frozen Elephant Trunk patient underwent a hybrid procedure consisting of a supra-aortic debranching and a zone-2 stent-graft deployment. We found a mean clamp time of 140 ± 60.75 min, cardiac arrest time of 51.33 ± 3.06 min, and a hospital stay of 13.67 ± 5.51 days. The most common complications were surgical-site infection and shock (2/3). Only one patient died (1/3). CONCLUSION Evidence of management for non-dissecting ruptured Kommerell's aneurysms is scarce. Additional, robust, and more extensive studies are required. The selection of the appropriate surgical approach is challenging, and each patient should be individualized. Frozen Elephant Trunk was feasible for patients requiring emergent surgical repair in our centre. However, other hybrid or open procedures can be performed.
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Affiliation(s)
- Alejandro Velandia-Sánchez
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia.
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
| | - Sebastián Gómez-Galán
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Sebastian Gallo-Bernal
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- Division of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Camilo A Polania-Sandoval
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Ivonne G Pineda-Rodríguez
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
| | - Paula Florez-Amaya
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Lina M Sanabria-Arévalo
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | | | - Juan G Barrera-Carvajal
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Juan P Umana
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Jaime Camacho-Mackenzie
- Department of Cardiovascular Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Cra 13B No. 161-85 Torre I Piso 8, 110131, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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Gómez-Galán S, Velandia-Sánchez A, Sanabria-Arévalo LM, Polania-Sandoval CA, Gallo-Bernal S, Cabrales-Arévalo J, Camacho-Mackenzie J, Barrera-Carvajal JG. Endovascular Repair of a Spontaneous Popliteal Arteriovenous Fistula Associated With a Venous Aneurysm. Vasc Endovascular Surg 2022; 56:501-504. [PMID: 35651321 DOI: 10.1177/15385744221077557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Popliteal arteriovenous fistulae (PAF) are anomalous communications between the arterial and venous systems of the lower extremity. They are usually secondary to trauma and are rarely associated with additional vascular defects. The coexistence of a PAF and a venous aneurysm is rare and usually occurs in patients with connective tissue disorders. Evidence regarding the management of this type of anomaly is scarce. However, both open and endovascular approaches seem feasible alternatives for treating this condition. Here, we describe a spontaneous popliteal arteriovenous fistula associated with a venous aneurysm in a 42-year-old male patient who presented with a popliteal mass. Satisfactory endovascular closure of the fistula and exclusion of the venous aneurysm were achieved using an Amplatzer™ Vascular Plug II.
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Affiliation(s)
- Sebastián Gómez-Galán
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Alejandro Velandia-Sánchez
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Lina María Sanabria-Arévalo
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Camilo Andrés Polania-Sandoval
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Division of Radiology, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Sebastian Gallo-Bernal
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Division of Radiology, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Jaime Cabrales-Arévalo
- Interventional Cardiology, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Jaime Camacho-Mackenzie
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Juan Guillermo Barrera-Carvajal
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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Villa-Hincapie CA, Carreno-Jaimes M, Obando-Lopez CE, Camacho-Mackenzie J, Umaña-Mallarino JP, Sandoval-Reyes NF. Risk Factors for Mortality in Reoperations for Pediatric and Congenital Heart Surgery in a Developing Country. World J Pediatr Congenit Heart Surg 2017; 8:435-439. [PMID: 28696882 DOI: 10.1177/2150135117704657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The survival of patients with congenital heart disease has increased in the recent years, because of enhanced diagnostic capabilities, better surgical techniques, and improved perioperative care. Many patients will require reoperation as part of staged procedures or to treat grafts deterioration and residual or recurrent lesions. Reoperations favor the formation of cardiac adhesions and consequently increase surgery time; however, the impact on morbidity and operative mortality is certain. The objective of the study was to describe the risk factors for mortality in pediatric patients undergoing a reoperation for congenital heart disease. METHODS Historic cohort of patients who underwent reoperation after pediatric cardiac surgery from January 2009 to December 2015. Operations with previous surgical approach different to sternotomy were excluded from the analysis. RESULTS In seven years, 3,086 surgeries were performed, 481 were reoperations, and 238 patients fulfilled the inclusion criteria. Mean number of prior surgeries was 1.4 ± 0.6. Median age at the time of reoperation was 6.4 years. The most common surgical procedures were staged palliation for functionally univentricular heart (17.6%). Median cross-clamp time was 66 minutes. Younger age at the moment of resternotomy, longer cross-clamp time, and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories risk category greater than three were risk factors for mortality. The number of resternotomies was not associated with mortality. Mortality prior to hospital discharge was 4.6%, and mortality after discharge but prior to 30 days after surgery was 0.54%. Operative mortality was 5.1%. CONCLUSIONS Resternotomy in pediatric cardiac surgery is a safe procedure in our center.
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Affiliation(s)
- Carlos A Villa-Hincapie
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia.,2 Universidad del Rosario. Bogotá, Colombia
| | - Marisol Carreno-Jaimes
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia
| | - Carlos E Obando-Lopez
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia.,2 Universidad del Rosario. Bogotá, Colombia
| | - Jaime Camacho-Mackenzie
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia.,2 Universidad del Rosario. Bogotá, Colombia
| | - Juan P Umaña-Mallarino
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia.,2 Universidad del Rosario. Bogotá, Colombia
| | - Nestor F Sandoval-Reyes
- 1 Fundación Cardioinfantil (FCI), Instituto de Cardiología. Department of Congenital Heart Disease. Bogotá, Colombia.,2 Universidad del Rosario. Bogotá, Colombia
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Monsalve-Torra A, Ruiz-Fernandez D, Marin-Alonso O, Soriano-Payá A, Camacho-Mackenzie J, Carreño-Jaimes M. Using machine learning methods for predicting inhospital mortality in patients undergoing open repair of abdominal aortic aneurysm. J Biomed Inform 2016; 62:195-201. [PMID: 27395372 DOI: 10.1016/j.jbi.2016.07.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 11/27/2022]
Abstract
An abdominal aortic aneurysm is an abnormal dilatation of the aortic vessel at abdominal level. This disease presents high rate of mortality and complications causing a decrease in the quality of life and increasing the cost of treatment. To estimate the mortality risk of patients undergoing surgery is complex due to the variables associated. The use of clinical decision support systems based on machine learning could help medical staff to improve the results of surgery and get a better understanding of the disease. In this work, the authors present a predictive system of inhospital mortality in patients who were undergoing to open repair of abdominal aortic aneurysm. Different methods as multilayer perceptron, radial basis function and Bayesian networks are used. Results are measured in terms of accuracy, sensitivity and specificity of the classifiers, achieving an accuracy higher than 95%. The developing of a system based on the algorithms tested can be useful for medical staff in order to make a better planning of care and reducing undesirable surgery results and the cost of the post-surgical treatments.
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Affiliation(s)
- Ana Monsalve-Torra
- Bio-inspired Engineering and Health Computing Research Group, IBIS, University of Alicante, Spain
| | | | - Oscar Marin-Alonso
- Bio-inspired Engineering and Health Computing Research Group, IBIS, University of Alicante, Spain
| | | | - Jaime Camacho-Mackenzie
- Departamento de cirugía cardiovascular - Fundación Cardioinfantil- Instituto de Cardiología, Bogotá, Colombia
| | - Marisol Carreño-Jaimes
- Departamento de cirugía cardiovascular - Fundación Cardioinfantil- Instituto de Cardiología, Bogotá, Colombia
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