RESUMO
Aortic root remodeling using the Florida sleeve technique was proposed as a simpler alternative to classical reconstructive interventions in patients with aortic root aneurysm without aortic insufficiency. We present a 10-year result of valve-sparing surgical treatment using the Florida sleeve technique in a patient with connective tissue dysplasia and aortic root aneurysm.
Assuntos
Aneurisma da Aorta Torácica , Aneurisma da Raiz da Aorta , Insuficiência da Valva Aórtica , Doenças do Tecido Conjuntivo , Humanos , Valva Aórtica/cirurgia , Resultado do Tratamento , Insuficiência da Valva Aórtica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Tecido ConjuntivoRESUMO
OBJECTIVE: To evaluate the effectiveness of two cardioplegia techniques in patients with severe myocardial hypertrophy undergoing septal myectomy or aortic valve replacement. MATERIAL AND METHODS: A comparative pilot prospective single-center randomized study included 46 patients between 2022 and 2023. Patients were randomized into 2 groups: Del Nido (n=23) and Custodiol (n=23). We analyzed perioperative echocardiography data, troponin I at several time points, perioperative complications and histological data. RESULTS: Both groups were comparable in time of myocardial ischemia, cardiopulmonary bypass, duration of anesthesia and surgery (p>0.05). The maximum ischemia time in the Del Nido group was 84 min. The same group showed significantly higher percentage of spontaneous rhythm recovery (65.2% vs. 30%, p=0.008). None patient required mechanical support, high-dose inotropes or vasopressors. Troponin I in 2 hours after cardiopulmonary bypass (p=0.415), 12 (p=0.528) and 24 hours after admission to the intensive care unit (p=0.281) were similar in both groups. No significant difference was found in ventilation time, ICU- and hospital-stay. CONCLUSION: Del Nido cardioplegia has some advantages compared to Custodiol and does not lead to perioperative complications in case of aortic cross-clamping time <90 min in patients with myocardial hypertrophy.
Assuntos
Soluções Cardioplégicas , Troponina I , Humanos , Soluções Cardioplégicas/efeitos adversos , Estudos Prospectivos , Parada Cardíaca Induzida/efeitos adversos , Parada Cardíaca Induzida/métodos , Hipertrofia , Estudos RetrospectivosRESUMO
OBJECTIVE: To analyze the incidence and causes of mitral valve replacement in patients with obstructive hypertrophic cardiomyopathy (HCM). MATERIAL AND METHODS: There were 172 patients (98 women and 74 men) with obstructive HCM and severe mitral valve insufficiency between November 2017 and May 2023. All patients complained of chronic heart failure NYHA class III. Surgical correction of left ventricular outflow tract (LVOT) obstruction and mitral valve repair with elimination of systolic anterior motion were technically successful in 160 (93.0%) patients. RESULTS: The need for mitral valve replacement was noted in 12 (7.0%) patients. Mean cardiopulmonary bypass time was 83.5±19.2 min (94; 127), aortic cross-clamping - 62.8±14.3 min (70; 102). In 5 cases, primary mitral valve replacement was scheduled due to obvious organic lesion of the mitral valve (tearing of chords, rheumatic lesion with leaflet restriction). In 7 patients, valve replacement was forced after ineffective primary septal myectomy (LVOT pressure gradient, severe mitral insufficiency). CONCLUSION: Mitral valve replacement is an involuntary strategy after ineffective myectomy with severe mitral insufficiency and high LVOT pressure gradient.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica , Insuficiência Cardíaca , Insuficiência da Valva Mitral , Obstrução da Via de Saída Ventricular Esquerda , Masculino , Humanos , Feminino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência Cardíaca/etiologia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To analyze early and mid-term results of aortic root remodeling with aortic valve annuloplasty in patients with aortic root aneurysm and no severe aortic valve disease. MATERIAL AND METHODS: There were 33 patients with connective tissue dysplasia, aneurysm of aortic root and/or ascending aorta and aortic regurgitation between September 2019 and December 2022. All patients underwent aortic root remodeling with aortic valve annuloplasty. RESULTS: Mean time of cardiopulmonary bypass was 138.5±21.5 min, aortic clamping - 115.3±20.5 min. According to postoperative transthoracic echocardiography, mild aortic regurgitation was observed in 28 patients, 5 patients had moderate regurgitation. Postoperative follow-up period varied from 3 months to 2 years. There was no in-hospital mortality or significant cardiovascular complications. Two-year freedom from moderate-to-severe aortic regurgitation was 93.9%, overall survival - 100%. CONCLUSION: Aortic root remodeling is characterized by favorable hemodynamic efficiency and low complication rate.
Assuntos
Aneurisma da Aorta Torácica , Aneurisma Aórtico , Insuficiência da Valva Aórtica , Humanos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/cirurgia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/diagnóstico por imagem , Aorta/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Hospitais , Resultado do Tratamento , Reoperação/efeitos adversosRESUMO
OBJECTIVE: Analysis of the outcomes after aortic root remodeling with aortic valve annuloplasty in patients with aortic root aneurysm and no severe aortic valve disease. MATERIAL AND METHODS: There were 19 patients with connective tissue dysplasia, aneurysm of aortic root and/or ascending aorta and aortic regurgitation between September 2020 and December 2021. All patients underwent aortic root remodeling with aortic valve annuloplasty. RESULTS: Mean time of cardiopulmonary bypass was 148.7±23.5 min, aortic clamping - 117.3±19.5 min. According to postoperative transthoracic echocardiography, mild aortic regurgitation was observed in 6 patients, 13 patients had no regurgitation. There was no in-hospital mortality or significant cardiovascular complications. Freedom from moderate-to-severe aortic regurgitation after 14 months was 94.7%, overall survival - 100%. CONCLUSION: Aortic root remodeling is characterized by favorable hemodynamic efficiency and low complication rate. Further accumulation of data with clinical analysis are planned for a more accurate assessment of effectiveness of surgical treatment, determination of predictors of successful reconstruction, development of indications, contraindications and a personalized algorithm for patient selection.
Assuntos
Aneurisma da Aorta Torácica , Insuficiência da Valva Aórtica , Aorta , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/cirurgia , Ecocardiografia , HumanosRESUMO
Myocardial bridging is often detected during diagnostic coronary angiography in patients with congenital and acquired heart defects. In most cases, muscle bridging does not require surgical treatment. Myocardial bridging and tunnels causing compression of one or more major coronary arteries is a potential cause of myocardial ischemia in patients with hypertrophic cardiomyopathy. The authors report surgical treatment of a patient with obstructive hypertrophic cardiomyopathy and myocardial bridging of the left anterior descending artery.
Assuntos
Cardiomiopatia Hipertrófica , Ponte Miocárdica , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/cirurgia , Angiografia Coronária , Humanos , Músculos , Ponte Miocárdica/complicações , Ponte Miocárdica/diagnóstico , Ponte Miocárdica/cirurgiaRESUMO
Hypertrophic cardiomyopathy (HCM) is a hereditary myocardial disease characterized by ventricular wall and interventricular septum thickening not associated with heart valve disease or any other external cause. Considering different localization of left ventricular obstruction, surgeons should be aware of various surgical approaches to various segments of interventricular septum. A personalized approach to each patient is essential to achieve favorable postoperative effect with minimal incidence of complications. This review is devoted to various surgical approaches to interventricular septum for different phenotypic variants of HCM.
Assuntos
Cardiomiopatia Hipertrófica , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Miocárdio , Resultado do TratamentoRESUMO
Bleeding is a significant cause of complications and mortality in surgery for ascending aorta and aortic root disease. This is especially true after complex reconstructions associated with hypothermic circulatory arrest and long-standing cardiopulmonary bypass. The review is devoted to modern methods of hemostasis in reconstructive aortic root surgery.
Assuntos
Doenças da Aorta , Hemostáticos , Aorta/cirurgia , Ponte Cardiopulmonar/efeitos adversos , Parada Cardíaca Induzida , Hemostasia , HumanosRESUMO
Tricuspid leaflet lesion following infective endocarditis is a severe condition requiring surgical treatment in most cases. Currently, tricuspid valve replacement with mechanical prosthesis is still essential in the treatment of patients ineligible for reconstructive surgery or bioprosthesis implantation. The authors describe redo tricuspid valve replacement with mechanical prosthesis for repeated early bioprosthetic valve failure.
Assuntos
Bioprótese , Endocardite , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Bioprótese/efeitos adversos , Endocardite/diagnóstico , Endocardite/etiologia , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Desenho de Prótese , Falha de Prótese , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgiaRESUMO
OBJECTIVE: To analyze the results of endocardial pulmonary vein cryoablation in patients with atrial fibrillation (AF) undergoing on-pump cardiac surgery. MATERIAL AND METHODS: The authors report postoperative outcomes in 19 patients after on-pump coronary artery bypass grafting and/or heart valve surgery and endocardial pulmonary vein cryoablation for concomitant AF. All procedures were performed for the period from September 2018 to December 2020. RESULTS: Successful procedure was determined by restoration of stable sinus rhythm in postoperative period. In 14 (79%) patients, sinus rhythm was restored in early postoperative period. In 5 (21%) patients (2 women, 3 men), AF recurred within 6-12 days after surgery. In one patient, postoperative period was complicated by atrioventricular blockade grade I. CONCLUSION: Endocardial pulmonary vein cryoablation is effective for AF. This procedure is expedient in patients with concomitant cardiac disease scheduled for open heart surgery.
Assuntos
Fibrilação Atrial , Procedimentos Cirúrgicos Cardíacos , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Criocirurgia/efeitos adversos , Feminino , Humanos , Masculino , Veias Pulmonares/cirurgia , Resultado do TratamentoRESUMO
Connective tissue dysplasia (CTD) is an urgent problem, especially in young and employable people. Damage to cardiovascular system and, in particular, aorta is predominant factor determining the incidence of various complications and mortality in patients with CTD. The authors report surgical treatment of aortic hypoplasia in an adolescent patient with connective tissue dysplasia syndrome and combined deficiency of coagulation factors.
Assuntos
Aorta Torácica , Coartação Aórtica , Transtornos de Proteínas de Coagulação/complicações , Doenças do Tecido Conjuntivo/complicações , Malformações Vasculares/cirurgia , Adolescente , Aorta/anormalidades , Aorta/cirurgia , Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Coartação Aórtica/etiologia , Coartação Aórtica/cirurgia , Humanos , Malformações Vasculares/etiologiaRESUMO
Post-infarction ventricular septal defect (VSD) is a rare but formidable complication of myocardial infarction following mortality rate up to 90% without invasive treatment. Surgical closure is preferred for VSD. The authors report successful surgical treatment of a patient with post-infarction LV aneurysm and residual post-infarction VSD in 5 years after implantation of two occluders.
Assuntos
Aneurisma Cardíaco , Comunicação Interventricular , Ventrículos do Coração , Infarto do Miocárdio , Dispositivo para Oclusão Septal , Cateterismo Cardíaco , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgia , Comunicação Interventricular/etiologia , Comunicação Interventricular/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Infarto do Miocárdio/complicações , Implantação de Prótese/métodos , Resultado do TratamentoRESUMO
An efficacy and safety of valve-sparing aortic root surgery with aortic ring annuloplasty have been demonstrated in various trials. The main technical features of aortic root remodeling with external aortic ring annuloplasty are reported in the article.
Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Doenças das Valvas Cardíacas/cirurgia , Doenças das Valvas Cardíacas/fisiopatologia , HumanosRESUMO
OBJECTIVE: To analyze in-hospital results of surgical treatment of patients with obstructive hypertrophic cardiomyopathy. MATERIAL AND METHODS: There were 15 patients (8 women and 6 men) with obstructive hypertrophic cardiomyopathy and severe mitral insufficiency for the period from November 2017 to March 2019. Mean age of patients was 55.9±7.1 years. All patients had chronic heart failure NYHA class III and secondary coronary insufficiency. RESULTS: Surgical correction of LVOT obstruction and mitral valve repair with elimination of systolic anterior motion were technically successful in all cases. There was no need for mitral valve replacement in all patients. Heart failure NYHA class I-II in early postoperative period was observed in all cases. CONCLUSION: Careful preoperative planning with a comprehensive analysis of hemodynamic and anatomical features of LV and certain surgical experience are essential for adequate correction of LVOT obstruction without atrioventricular node injury and mitral valve repair.
Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Insuficiência da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/complicações , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/complicações , Obstrução do Fluxo Ventricular Externo/cirurgiaRESUMO
Cardiovascular diseases and malignancies are leading causes of mortality in the world. Two categories of advanced age patients with cancer are observed in clinical practice. These are patients with cardiovascular diseases as comorbidities and patients with cardiovascular diseases as a complications of targeted therapy for cancer. Cardiac toxicity of chemotherapeutic drugs results myocardial dysfunction, occurrence or progression of heart valve disease, coronary artery disease, arterial hypertension and thromboembolism. A patient who underwent aortic valve replacement and coronary artery bypass surgery is discussed in the article. Aortic valve disease and coronary artery disease were complications of targeted radio- and chemotherapy for sigmoid colon cancer followed by lung and liver metastases. Questions of timely diagnosis and treatment of advanced age patients in multi-field surgical clinic are also analyzed.
Assuntos
Antineoplásicos/efeitos adversos , Cardiopatias/etiologia , Radioterapia/efeitos adversos , Neoplasias do Colo Sigmoide/terapia , Valva Aórtica/efeitos dos fármacos , Valva Aórtica/efeitos da radiação , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/cirurgia , Ponte de Artéria Coronária , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/cirurgia , Cardiopatias/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Neoplasias do Colo Sigmoide/patologiaRESUMO
AIM: To analyze own experience of coronary artery bypass grafting (CABG) using microsurgical technique and operating microscope. MATERIAL AND METHODS: There were 100 patients with coronary artery disease who underwent CABG in the Petrovsky Russian Research Center for Surgery for the period from April 2017 to December 2018. Mean age of patients was 59.7 ± 8.9 years. Triple-vessel disease was noted in 83 (83%) patients, two-vessel - in 17 (17%) patients. Stenosis of left main coronary artery was observed in 34 (34%) patients. On-pump myocardial revascularization using microsurgical technique was performed in all patients. RESULTS: A total of 360 distal anastomoses with coronary arteries were formed in 100 patients using surgical microscope. Revascularization index was 3.6 ± 0.8, mean CPB time - 104 ± 24 min, aoric cross-clamping time - 72 ± 16 min. In-hospital mortality was absent. There were no cases of resternotomy for bleeding, infectious complications of postoperative wounds. One (1%) patient had intraoperative myocardial infarction. CONCLUSION: CABG using microsurgical technique and operating microscope may be appropriate in patients with multiple-vessel coronary lesion and small diameter of coronary arteries.
Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Idoso , Ponte de Artéria Coronária/instrumentação , Estenose Coronária , Humanos , Microcirurgia/instrumentação , Pessoa de Meia-IdadeRESUMO
Hypertrophic cardiomyopathy (HCM) is congenital heart disease with prevalence 1 per 500. There are still unclear issues regarding optimal surgical strategy despite more than 50-year research of this disease. It is presented case report of surgical treatment of patient with obstructive HCM by using of non-standard volume and method of intervention.
Assuntos
Cardiomiopatia Hipertrófica/complicações , Valva Mitral/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Aorta/cirurgia , Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica/cirurgia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Humanos , Obstrução do Fluxo Ventricular Externo/etiologiaRESUMO
The main aspects of epidemiology, pathophysiology, medication and surgical treatment of hypertrophic cardiomyopathy (HCM) are reviewed in the article. The authors emphasize that surgical treatment is still the method of choice for HCM and can guarantee excellent immediate and long-term results with minimal risk.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Cardiomiopatia Hipertrófica/tratamento farmacológico , Cardiomiopatia Hipertrófica/epidemiologia , Cardiomiopatia Hipertrófica/fisiopatologia , Humanos , Resultado do TratamentoRESUMO
Case report of successful conservative treatment of patient with thrombosis of aortic valve bioprosthesis after 8 months postoperatively is presented.
Assuntos
Valva Aórtica , Tratamento Conservador , Doenças das Valvas Cardíacas/terapia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Trombose/terapia , Bioprótese/efeitos adversos , Doenças das Valvas Cardíacas/etiologia , Humanos , Desenho de Prótese , Trombose/etiologia , Resultado do TratamentoRESUMO
Endoscopic harvesting of internal mammary artery for minimally invasive coronary artery bypass surgery seems to be highly justified and expedient. Technical features of this procedure are reviewed in the article. There are certain advantages of this method including ligation of proximal branches, reduced surgical trauma, better cosmetic results and enhanced postoperative rehabilitation.