tailieunhanh - Báo cáo y học: "Eyes wide shut - unusual two stage repair of pectus excavatum and annuloaortic ectasia in a 37 year old marfan patient: case report."

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Eyes wide shut - unusual two stage repair of pectus excavatum and annuloaortic ectasia in a 37 year old marfan patient: case report. | Grapow et al. Journal of Cardiothoracic Surgery 2011 6 64 http content 6 1 64 JCTS JOURNAL OF CARDIOTHORACIC SURGERY CASE REPORT Open Access Eyes wide shut - unusual two stage repair of pectus excavatum and annuloaortic ectasia in a 37 year old marfan patient case report Martin TR Grapow Paula Campelos Clemente Barriuso and Jaume Mulet Abstract We report about a 37 year old male patient with a pectus excavatum. The patient was in NYHA functional class III. After performed computed tomography the symptoms were thought to be related to the severity of chest deformation. A Ravitch-procedure had been accomplished in a district hospital in 2009. The crack of a metal bar led to a reevaluation 2010 in which surprisingly the presence of an annuloaortic ectasia root 73 X 74 mm in direct neighborhood of the formerly implanted metal-bars was diagnosed. Echocardiography revealed a severe aortic valve regurgitation the left ventricle was massively dilated presenting a reduced ejection fraction of 45 . A marfan syndrome was suspected and the patient underwent a valve sparing aortic root replacement David procedure in our institution with an uneventful postoperative course. A review of the literature in combination with discussion of our case suggests the application of stronger recommendations towards preoperative cardiovascular assessment in patients with pectus excavatum. Background There are no guidelines concerning the clinical evaluation of patients with isolated pectus excavatum prior surgical repair but some recommendations do exist 1 2 . Besides radiographic evaluation using a computerized tomographic scan CT performance of an ECG transthoracic or transesophageal echocardiogram pulmonary function testing and cardio-pulmonary exercise testing are suggested. However the extent of physical und especially image-guided examinations is generally on discretion of the physician in charge. In our patient important signs have been ignored .