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Combined aortic, valvular and coronary anomalies: a case of complex cardiac surgery
Session:
CASOS CLÍNICOS DE INTERVENÇÃO (PERCUTÂNEA E CIRÚRGICA)
Speaker:
Rita Almeida Carvalho
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Rita Almeida Carvalho; Maria Resende; Paulo Oliveira; Catarina Brízido; João Abecasis; António Ferreira; José Pedro Neves; Márcio Madeira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Presentation:</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">A 56-year-old man presented to the emergency department with chest pain. The patient had undergone aortic conduit graft placement for aortic dissection five years prior and had a history of arterial hypertension, for which he was receiving appropriate treatment and follow-up. Physical examination revealed a diastolic murmur.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Diagnosis and Management:</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">The electrocardiogram indicated a known complete right bundle branch block. Laboratory analyses, including T Troponin levels, and thoracic X-ray were unremarkable. Transthoracic echocardiography revealed a bicuspid aortic valve with moderate regurgitation. Cardiac computed tomography (CT) showed a chronic dissection of the thoracic and abdominal aorta, beginning just above the aortic conduit graft and extending to the iliac arteries, with the largest diameter being 68 mm in the distal ascending aorta. The aortic conduit graft, which extended for 6 cm, was unaffected and showed no signs of pseudoaneurysm or other complications. Additionally, coronary artery evaluation revealed an anomalous origin of the right coronary artery (RCA) from the opposite sinus of Valsalva with an intramural course. The patient underwent urgent cardiac surgery, which included the placement of a frozen elephant trunk for the aneurysm in chronic aortic dissection, a mechanical aortic prosthesis for the bicuspid aortic valve with moderate regurgitation, and unroofing of the RCA for the anomalous origin with high-risk features. The surgery was uneventful, and complete correction was confirmed by intraoperative transesophageal echocardiography. The patient achieved a full recovery and was discharged seven days later without further complications.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">Learning Points:</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif">We present a case of a patient with long-term complications following aortic dissection and graft placement surgery, underscoring the importance of ongoing postoperative surveillance. Additionally, the recognition of concomitant conditions such as moderate aortic regurgitation and coronary artery anomalies using a multidisciplinary approach was essential to ensure comprehensive surgical correction.</span></span></span></p>
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