Manuseio da dissecção aórtica envolvendo artéria coronária direita

• Autor(a) principal: PÊgo-fernandes, Paulo M.
• Data de Publicação: 1998
• Outros Autores: Stolf, Noedir A. G., Hervoso, Cristina M. [UNIFESP], Silva, João M., Arteaga, Edmundo, Jatene, Adib D.
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0102-76381998000200007; http://repositorio.unifesp.br/handle/11600/611
• topic: Blood vessel prosthesis; Aneurysm; Aortic aneurysm; Aorta; Próteses vasculares; Aneurisma dissecante; Aneurisma aórtico; Aorta

It is well known that aortic dissection may involve coronary arteries. However, only a few reports deal with surgical management of this problem. We present the report of the follow-up of 11 patients who suffered from ascending aortic dissection involving the right coronary artery and underwent surgical treatment at our Institution - InCor, Hospital das Clínicas, University of São Paulo Medical Center. The left coronary ostia was also affected in two patients. In seven patients the dissection was acute and at four, chronic. The ascending aorta was substituted by a Dacron tubular graft in all patients. Right coronary artery saphenous vein bypass or gore-tex graft to the coronary ostia or right coronary artery was performed in nine patients and reimplantation of both dissected coronaries in two. There were three early postoperative deaths (27.3%) due to low-output syndrome and myocardial infarction. One patient suffering from Marfan's Syndrome died during the fourteenth postoperative month due to hepathyc disease. Another Marfan's patient died from descending aorta rupture during the thirty-nineth month. The six surviving patients were followed from 78 to 96 months (mean 83 months). This experience suggests that although carrying high risk, involvement of the right coronary ostia in aortic dissection is an onset that can be successfully managed by some surgical procedures if done before irreversible complications arise.