Um caso de pericardite constritiva e aneurisma da aorta torácica: abordagem terapêutica híbrida

The authors describe the case of a 59-year-old man, a former smoker, with hypertension, chronic renal failure undergoing hemodialysis, and a history of stent grafting for repair of an abdominal aortic aneurysm and miliary tuberculosis, who was diagnosed with constrictive pericarditis and a thoracic aortic aneurysm. In a patient with such a complex medical history, there were several etiologies to consider. The treatment consisted of pericardiectomy and a hybrid technique of supra-aortic debranching and subsequent endovascular stent-graft repair.     

Cirugía torácica 2009

Started with tuberculosis and developed in parallel with smoking and cancer and under the protection of anaesthesia, thoracic surgery appeared in the 1980's as a specialty with a difficult long-term survival.However, with the development of lung transplant, tracheal surgery, the appearance of video-assisted thoracic surgery, along with the confirmation that despite the excellent progress of chemoradiotherapy, surgery continues to be the best option for curing lung cancer, means that it is currently a specialty of great growth and a wider scope in the future.     

Muerte súbita por disección de aorta torácica en jóvenes: estudio multicéntrico forense

Introduction and objectivesThoracic aortic dissection (TAD) is infrequent in young people and its characteristics differ from those in the adult population. This study aimed to analyze the clinical and pathological characteristics of sudden death due to TAD in people aged 1 to 35 years.MethodsMulticenter population-based study based on forensic autopsies conducted in the provinces of Biscay (1991-2016), Valencia (2000-2016), and Seville (2004-2016).ResultsWe identified 35 individuals with sudden death due to TAD (80% males), with a mean age of 29 ± 5 years. The incidence was 0.09/100 000 inhabitants/y. Eighteen persons had at least 1 risk factor for TAD, and this figure increased to 29 when postmortem findings were included: congenital heart disease (n = 16), suspicion of familial TAD (n = 11), cocaine use (n = 6), and hypertension (n = 5). Twenty-four individuals, 12 with at least 1 risk factor, had prodromal symptoms, and 16 of them visited their physician, but TAD was not suspected in any of them. The most frequent symptom was chest pain (n = 12). The main autopsy findings were cystic degeneration of the media (n = 27), dilatation of the ascending aorta (n = 21), cardiac hypertrophy (n = 20), and bicuspid aortic valve (n = 14).ConclusionsThe incidence of sudden death due to TAD in young people was very low. The most frequent risk factors were congenital heart disease followed by suspicion of familial TAD and cocaine use. TAD should be included in the differential diagnosis of chest pain in young people, mainly male patients with at least 1 risk factor.