Ressecção de membrana subvalvar aórtica

Abstract

CHARACTERIZATION OF THE PATIENT Male child with a diagnosis of parachute mitral valve stenosis at birth, subvalvular aortic stenosis and aortic coarctation (Shone syndrome). At 2 years presented fatigue and dyspnea on exertion. Complementary tests showed aortic coarctation with significant hemodynamic repercussion, which was surgically repaired with resection and end anastomosis of the aorta. The electrocardiogram and echocardiogram associated with clinical signs and symptoms guided to the operation of resection of aortic subvalvular stenosis caused by fibromuscular membrane. DESCRIPTION OF THE TECHNIQUE After median sternotomy, it is observed the opening of the pericardial sac, performing confection of purse in the aorta, introduction of the arterial cannula and fixation. Air was removed and connection to the arterial system of cardiopulmonary bypass (CPB) was performed. Opening in the right atrial appendage, introduction of single venous cannula and fixation. Aspiration of the pericardial cavity. Started CPB, dissection between the aorta and pulmonary artery. Fixation of the cardioplegic system after needle insertion in the aorta. Aortic clamping. Aspiration of the left atrium. During cardiac arrest, which began at the transverse aorta, which was expanded to the left in “L” shape toward the noncoronary sinus of the aorta up to near the anterior mitral leaflet. Suture using 5-0 polypropylene yarn in the aortic wall were performed for better presentation of the structures. Identification of fibromuscular tissue to be resected, starting vertical incision below the right coronary leaflet. With the aid of a spatula, was initiated careful detachment of the fibromuscular membrane into the left coronary leaflet, circling to the mitral-aortic continuity. Special care was taken to not damage the septum and cause ventricular septal defect or atrioventricular block.