Henrique MuradIII; José L FeitosaI; Rubens Giambroni FilhoIII; José Augusto de AzevedoIII; João de Deus e BritoI; Márcia S PalharesI; Eliane C GomesI; Francisco José do NascimentoIII; Diniz Alves de OliveiraIII; Maria Elisa G FonsecaII; Amauri Dias do CoutoII; Mauro Paes Leme de SáI; Juscileide M. de Araújo PiresI
DOI: 10.1590/S0102-76381994000200005
ABSTRACT
The authors have used for spinal cord protection during descending aortic surgery, partial extracorporeal circulation from left atrium to left femoral artery, low dose of heparin (1 mg/kg), centrifugal pump (bio-pump) and controlled exsanguination. They have operated upon with this methodology 4 patients without mortality, paraplegia or excessive bleeding.RESUMO
Os autores utilizam como método de proteção medular em cirurgia de aorta descendente, circulação extracorpórea átrio esquerdo-femoral esquerda, com baixa dose de heparina (1 mg/kg), bomba centrífuga (bio-pump) e exsangüinação controlada. Operaram 4 doentes com esta metodologia sem que houvesse mortalidade, paraplegia ou sangramento excessivo.REFERENCES
1. BERKOFF, H. A. & FOLLETTE, D. A. - Paraplegia associated with thoracic aortic surgery. Chest Surg. Clin. N. Am., 2: 379-381, 1992.
2. CARPENTIER, A.; DELOCHE, A.; FABIANI, J. N.; et al.: New surgical approach to aortic dissection: flow reversal and tromboexclusion. J. Thorac. Cardiovasc. Surg., 81: 659-668, 1981. [MedLine]
3. CERNAIANU, A. C; OLAH, A.; CILLEY Jr., J. H. et al.: Effect of sodium nitroprusside on paraplegia during cross-clamping of the thoracic aorta. Ann. Thorac. Surg., 56: 1035-1037, 1993. [MedLine]
4. CONNOLLY. J. E. - Prevention of paraplegia secondary of operation on the aorta. J. Cardiovasc. Surg., 27: 410-415, 1986.
5. COSELLI, J. S. - Descending/ Thoracic Abdominal Repair. Aortic Surgery Symposium, 3. New York, Futura Publishing Co., 1992.
6. CRAWFORD, E. S.; SVENSSON. L. G.; HESS. K. R. - A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high-risk surgery on the thoracoabdominal aorta. J. Vasc Surg., 13: 36-45, 1991. [MedLine]
7. CUNNINGHAM, J. N. - Spinal cord protection during thoracic aortic surgery. Aortic Surgery. Symposium, 3. New York, abril 1992.
8. ERGIN, M. A. - Descending aneurysm: methods of protection. Aortic Surgery Symposium, 3. New York, april, 1992.
9. GLOWER, D. D.; SPEIER, R. F.; WHITE, W. D.; et al.: Management and long term outcome of aortic dissection. Ann. Surg., 214: 31-41, 1991. [MedLine]
10. KIEFFER, E.; RICHARD, T.; CHICAS, J.; et al.: Preoperative spinal cord arteriography in aneurysmal disease of the descending thoracic and thoracoabdominal aorta: preliminary results in 45 patients. Ann. Vasc. Surg., 3: 34-39, 1989.
11. LASCHINGER, J. C.; CUNNINGHAM Jr., J. N.; COOPER, M. M.; et al.: Prevention of ischemic spinal cord injury following aortic cross-clamping. Use Of corticosteroids. Ann. Thorac. Surg., 38: 500-507, 1984. [MedLine]
12. MILLER, D. C. - The continuing dilema concerning medical versus surgical management of patients with acute type 3 dissections. Sem. Thorac. Cardiovasc. Surg., 5: 33-46, 1993.
13. MURAD, H. - Estudo dos métodos para prevenir isquemia medular em cirurgia da aorta descendente. Rio de Janeiro, RJ, 1992. [Tese. Mestrado. Universidade Federal do Rio de Janeiro].
14. MYHRE, H. O.; SAETHER, O. D.; STENSETH, R. - Attempts to reduce paraplegia risk. In: Aortic surgery in the cause and management of aneurysms. GREENHALGH, R. M. & MANICK, J. A. (eds.) W. B. Saunders Co., London, 1990. p. 373-385.
15. PALMA, H.; JULIANO, J. A.; CAL, R. G. R.; ALMEIDA, D. R.; OTA, L. H.; GIANOTTI, I. A.; ANDADE, J. C. S.; BUFFOLO, E. - Tratamento dos aneurismas da aorta descendente por endoprótese (tromba de elefante). Rev. Bras. Cir. Cardiovasc., 4: 190-194, 1989.
16. SVENSON, L. G. & CRAWFORD, E. S. - Aortic dissection and aortic aneurysm surgery: clinical observations, experimental investigations and statistical analysis. Part I. Curr. Probl. Surg., 29 (11): 817-911, 1992. [MedLine]
17. SVENSON, L. G. & CRAWFORD, E. S. - Aortic dissection and aortic aneurysm surgery: clinical observations, experimental investigations and statistical analysis. Part III. Curr. Probl. Surg., 30 (1): 1-163, 1993. [MedLine]
18. SVENSON, L. G.; CRAWFORD, E. S.; HESS, K. R.; et al.: Dissection of the aorta and dissecting aneurysms: improving early and long-term surgical results. Circulation, 82 (Supl. 4): 24-38, 1990.