Perfusão cerebral retrógrada e anterógrada no tratamento cirúrgico de dissecção aguda da aorta ascendente

Abstract

Perfusão cerebral retrógrada e anterógrada no tratamento cirúrgico de dissecção aguda da aorta ascendenteCerebral retrograde perfusion alternating with carotid artery anterograde perfusion in the surgical treatment of acute dissection of ascending aorta dissection AbstractThe authors report an original case using cerebral retrograde perfusion alternating with carotid artery anterograde perfusion, during the surgical treatment of acute ascending aorta dissection. The patient was discharged on the 32nd post-operative day in a clinically controlled condition. The Mini Mental State Examination was applied after 30 days and showed normal cerebral cognitive activity. The authors believe that this method can give a protective effect to the brain during procedures involving aortic dissection or aneurysms, after evaluating its use after a significant series of cases. [2,3]. The objective of this report is to inform about the alternate use of retrograde and anterograde cerebral perfusion at normothermia, as a method of cerebral protection in the surgical treatment of acute aortic dissection and the results of the late neurological evaluation. CASE REPORTA 46-year-old male patient with characteristics of Marfan's Syndrome was attended in the Hospital Emergency Department with acute aortic dissection. The disease was associated to acute myocardial infarction, acute aortic insufficiency, acute renal insufficiency, long-term symptoms and cardiogenic shock.An urgent surgery was performed. The operation was conducted in the routine manner with normothermic cardiopulmonary bypass (CPB), which was established and utilized according to Figure 1.Subsequently at normothermia, a number 32 valved tubular prosthesis with a number 27 St. Jude prosthesis were implanted, as the annulo-aortic ectasia was great and there was significant aortic insufficiency due to dilation of the valve annulus and collapse of the non-coronary cusp.Infusion of cold crystalloid cardioplegic solution was made at twenty-minute intervals to the ostia of the coronary arteries. The left coronary artery ostium was implanted in the tubular prosthesis, utilizing a continuous 6-0 prolene suture. An autogenic saphenous vein bridge was performed to the right coronary artery which was proximally ligated.At normothermia CPB was interrupted. Retrograde cerebral perfusion was made using Line D, with a flow that varied between (300-500 mL/min.) and the drainage through Line C was interrupted. The ascending aorta was opened lengthwise as far as the pericardial reflection, it was inspected and the right and left coronary arteries were located. Both carotids were cannulated and isolated using external tourniquets. The return flow of the retrograde perfusion was utilized to fill the perfusion cannulae of the carotids (Line F) which, after being filled of blood, were clamped, the air was removed and they were connected to the anterograde perfusion line (Line E), obtained with a 'Y2' connector.The anterograde flow at 11 mL/kg of body weight/min and interruption of the retrograde ...