Background— aortic regurgitation in a bicuspid aortic valve is a complex entity that involves not only the semilunar valve but also the structure of the aortic root which is functionally & pathologically in a very close relationship to it. Considering repairing a bicuspid valve mandates a mindful involvement of all related structures concurrently. Here We report an interested case of both bicuspid aortic valve and mitral valve regurgitation in a patient with history of infective endocarditis, that was successfully managed by double valves repair.
anterior mini‐thoracotomy in multivessel coronary revascularization by Cyn I read with interest the article, routine minimally invasive approach via left ak and colleagues1. The main problem of mini anterior thoracotomy coronary revascularization is the limited or even bad exposure to the right coronary and posterior obtuse marginal branches which may affect the quality of the distal anastomosis. This is the most important technical point of a successful revascularization.
Title Page:Title: Letter To The Editor: Long-Term Renal Function After Venoarterial Extracorporeal Membrane Oxygenation.Article Type: Letter To The EditorCorrespondence: 1. Rohit KumarContact No: +923332669103 Email: [email protected]: Dow Medical CollegeAddress: Baba-e-urdu road, KarachiCo-Authors: 2. Sunil KumarContact No: +923008088669. Email: [email protected]: Liaquat University of Medical and Health Sciences.Word Count: 476Conflict of interest : NoneAcknowledgment : NoneDeclaration: NoneDisclosure : NoneFunding : None
Aorto-tracheal fistulas are rare and highly lethal, with few reports of successful surgical intervention. We present a 48 year old man with aorto-tracheal fistula induced by radiation therapy for tracheal squamous cell carcinoma. He presented with hemoptysis and chest pain and workup revealed the aorta-tracheal fistula between the posterior aortic arch and anterior distal trachea. He was emergently taken to surgery. To our knowledge, this is the first report of an aorto-tracheal fistula successfully treated with a transverse aortic arch replacement and complex tracheal repair using autologous pericardium with an omental buttress.
Cervantes-Salazar and colleagues report the long-term surgical outcomes of 414 patients with total anomalous pulmonary venous connection (TAPVC) from January 2003 to June 2019. With an overall survival rate of 87.2% from 2003 to 2019, the authors found that an increased mortality risk was associated with infra-cardiac TAPVC, pulmonary venous obstruction (PVO), and postoperative mechanical ventilation. Their comprehensive study with a large sample size of varying age groups, and patients with late referrals for surgery, provide valuable insight into TAPVC surgical outcomes. Improved survival for these patients continues to be a major goal of clinical teams striving to transform treatment paradigms. The comprehensive and promising results of the study reported by Cervantes-Salazar and colleagues gives our field hope for a better future for these patients.
Here, we report a case of a dissected thoracoabdominal aortic aneurysm repair after frozen elephant trunk implantation, using aortic balloon occlusion technique to simplify the proximal anastomosis and avoid deep hypothermic circulatory arrest. In addition, detailed CT follow-up pictures showed that false lumen thrombosis is a time-dependent and reversible variable. Repeated measurements with time series analysis should be performed to explore false lumen remodeling.
Dear Editor, First we would like to thank Dr Lopez de la Cruz for her comments and interest about our recently published article “the odyssey of suturing cardiac wounds: lessons from the past”. We highly appreciated and agree with the complements she made especially about Larrey and Milton role in this field. One should also note Theodore Tuffier’s attempt at cardiac resuscitation in 1898 in a young man dying on the wards at La Pitié Hospital (Paris)¹. Although this act was performed on an unwounded heart it adds information about the history of surgical approach in such dramatic condition. We do recognize left anterolateral thoracotomy as the gold standard in an emergency room to treat a penetrating cardiac injury. However a median longitudinal sternotomy may be discussed in our opinion if the patient arrived directly in a cardiac surgery operating theater. The patent presented in our paper was directly brought in our operative theater of cardiac surgery and managed immediately by cardiac surgeons and cardiac anesthesiologists, with a cardiopulmonary bypass ready, dedicated scrub nurses and perfusionist. In such specific conditions a sternotomy may be discussed, depending on the context and the anatomical suspected lesions (it was the option retained in the presented case and the surgical procedure was safely performed with good outcome). Clearly, in a peripheral hospital or at the emergency room sternotomy is not an option to be considered and we agree with Dr Lopez de la Cruz.
Cardiac Transplantation as Surgical Treatment for Cardiac Sarcoidosis Ali Ghodsizad MD, PhD, FACC, FETCS, FACSSarcoidosis is a complex disease with different clinical presentations that can involve multiple organs (1). The lung is typically the most common organ involved, multiple organ involvements with pulmonary and cardiac sarcoidosis account for most of the morbidity and mortality observed with this disease (1). Cardiac sarcoidosis presents as a progressive infiltrative cardiomyopathy that can lead to heart failure, arrhythmia and death (1).Here McGoldrick and colleagues report on their database study with data from Organ Procurement and Transplantation Network (OPTN) involving 289 cardiac sarcoidosis patients with end stage restrictive cardiomyopathy, who needed cardiac transplantation and compared them with all non-sarcoid patients undergoing cardiac transplantation for restrictive cardiomyopathy and end stage heart failure of other causes between Jan 1999 to March 2020 (n=41447).Patients with cardiac sarcoidosis had a comparable survival to non-sarcoid patients at 1 and 5 years and a significantly longer survival at up to 10 years.Patients with cardiac sarcoidosis had an increased chance to die from aspergillus infections at 1 year. Jackson et al showed in their multicenter trial comparable survival, rate of graft failure, and incidence of treated rejection at 1 year when compared to matched non-sarcoid patients. Sarcoid patients after heart transplantation were less likely to be hospitalized for infection in their study at 1 year (2). Liu et al performed a similar UNOS data base study showing that cardiac sarcoidosis heart transplant recipients were an older population with less underlying co-morbidities with a lower overall mortality (3).The diagnosis of cardiac sarcoidosis in patients who undergo left ventricular assist device implantation can be confirmed by histological examination of myocardium at the time of ventricular assist device insertion, but unclear is the predictive value (4,5).McGoldrick and colleagues excluded patients who required multiorgan transplantation in all 3 groups and we have to consider that multiorgan recipients belong to the sickest subpopulation.McGoldrick et al and other groups confirm the role of cardiac transplantation as a viable option for patients with cardiac sarcoidosis. Considering the increasing number of the cardiac transplantation for sarcoidosis in recent years, the 10 years survival data may have to be reevaluated with more follow up time in future.
Significant dilemma exists regarding management of the aortic root pathology in acute aortic dissections. Several strategies for both repair and replacement exist and there is a lack of clarity on the superiority of one over the other. Important factors that influence management strategies include involvement of the sinuses, competence of the aortic valve, presence of Marfan's syndrome and connective tissue disorders, as well as availability of surgical expertise. The wide variability in these factors makes it unlikely for any one technique to be suitable for management of all aortic roots and the root pathology has to be tailored to an individual patient.
Management of aortic arch pathologies remains challenging. Open total arch replacements have been associated with significant morbidity and mortality owing to the need for cardiopulmonary bypass and circulatory arrest. On the other hand, aortic arch branched stent grafts are not widely available. In this context, hybrid techniques combining open arch debranching with endovascular graft placement have been identified as an attractive option in select patients. However, there still is a paucity of literature on their application and outcomes. A case is presented of an elderly frail patient diagnosed with a pseudoaneurysm of the aortic arch and who was successfully treated by an off-pump arch debranching followed by endovascular arch repair. This case highlights (i) the feasibility of hybrid debranching techniques, (ii) their technical challenges, and (iii) the need for long-term follow-up data.
Background and aim of the study: Blood cysts of cardiac valves are generally seen in newborns and infants and very rarely in adults. Although in most cases they are incidental findings they may be associated to severe cardiac or systemic complications. This study analyzes incidence, presentation and treatment of valvular blood cysts in adults. Methods: A review of the pertinent literature through a search mainly on PubMed and Medline was performed. Results: In patients ≥ 18 years of age, our search disclosed 54 patients with mitral blood cysts (mean age, 48±18 years), 9 with a tricuspid valve cyst (mean age, 67±15 years), 3 with a blood cyst on the pulmonary valve (age 31, 43 and 44 years) and 1 aortic valve cyst in a 22-year-old man. Most patients were asymptomatic while stroke, syncope or myocardial infarction occurred in 6 patients with a mitral valve cyst. Blood cysts were removed surgically in 70% of patients with a mitral cyst, in 55% with a tricuspid cyst and in all those with a pulmonary or aortic cyst. At histology the cyst wall was composed mainly by fibrous tissue and with the inner surface lined with typical endothelium. Conclusions: Blood cysts of cardiac valves are rare in adults but may cause life-threatening complications particularly when located on the mitral valve. For such reason surgical removal appears advisable, with low-risk procedures. Widespread use of multimodality imaging techniques will most likely increase the number of valvular blood cysts diagnosed also in adults.
Background: Presently, there are limited reports in the literature on the post-operative (mid-term) clinical outcome for pure Aortic Regurgitation (AR) following Transcatheter Aortic Valve Replacement (TAVR). Methods: Between March 2014 and June 2019, a total of 134 high-risk patients with pure, symptomatic severe AR patients were enrolled in the current study. The outcome was assessed according to the VARC-2 criteria. Procedural results, clinical outcomes, and the patients’ hemodynamics for a period of 1-year were analyzed. Results: Patient mean was 73.1±6.4 years and 25.4% were female. The average STS score was 9.8+5.3%. Procedural success was 97.1% (130/134), and the device success rate was 96.3% (129/134). Five cases were converted to open surgery, while two patients underwent valvular reinterventions (surgical aortic valve replacement for thrombosis and increasing paravalvular regurgitation). The mean aortic valve gradient was 10.2±4.1 mmHg, while the moderate and severe aortic regurgitation was 1.6% at 1 year. Paravalvular regurgitation was none/trivial in 79.8% and mild in 18.5%. The 1-year all-cause mortality rate was 7.4%. At 1-year, the stroke incidence rate was 2.2%. And pacemaker was implanted in 8.9% of the enrolled patients. Conclusions: In high-risk patients undergoing transapical-TAVR for AR, the use of the J-Valve is safe and effective TAVR should be considered as a reasonable option for high-risk patients with pure AR.
Since the first in-human implantation, trans-catheter aortic valve replacement (TAVR) has shown an exciting development in both technical and technological terms, becoming the standard of care for many patients, even not only inoperable ones. Although trans-femoral (TF) access has the scepter of first-line route for TAVR, in some cases, this access is not feasible, so several alternative routes were introduces over time. The network meta-analysis by Hameed et al has the great merit to provide a comprehensive picture. Hence, through either direct and indirect comparison, the authors confirmed as TF is the gold standard as access, followed by trans-carotid and trans-subclavian. Conversely, trans-thoracic (trans apical and trans-aortic) routes are the least safe and should be reserved only to sporadic cases.
anomalous pulmonary veins drain into the right side of the left atrium is an uncommon variety of anomalous pulmonary venous return. Rarely, anomalous pulmonary venous drainage combined with cor triatriatum and atrial septal defect. We presented the imaging findings of a male patient who had anomalous pulmonary venous drainage which has not previously been described.
Redo cardiac surgery can present a unique set of challenges even to the experienced surgeon. Although outcomes have steadily improved in the modern era; if an intraoperative adverse event occurs, there is a 5% incidence of mortality and 19% incidence of myocardial infarction, stroke or death [(1)](#ref-0001). Overall, the modern incidence of mortality at reoperation varies but be segregated into low and higher risk cohorts depending on the planning computed tomography imaging and risk to substernal structures on re-entry [(2, 3)](#ref-0002). Patients with ascending aortic or root pseudoaneurysms represent a particularly difficult subset of high-risk patients requiring re-operative cardiac surgery due to the danger of exsanguination and air embolization [(4)](#ref-0004). Some surgeons advocate the use of deep hypothermic circulatory arrest (DHCA) to achieve safe re-entry in such cases however this can result in unpredictable DHCA duration depending on the degree of pericardial adhesions [(5)](#ref-0005). We report a case of aortic pseudoaneurysm in a patient with patent coronary grafts managed using an endoballoon precisely positioned relative to the proximal anastomoses resulting in a safe surgical re-entry and shorter DHCA time.