RESUMO
In the spectrum of congenital heart diseases, anomalies involving the venous coronary sinus have received relatively little attention, although they are often associated with major congenital defects, such as atrioventricular septal defects. In cases of mitral surgery in patients with these conditions, it is mandatory to keep the problem in mind and to respect the coronary sinus when approaching the left atrium and the mitral valve.
Assuntos
Seio Coronário/anormalidades , Seio Coronário/cirurgia , Comunicação Interatrial/cirurgia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Reoperação , Adulto , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
We present a case of double aortic arch with a predominant right and a double arterial duct detected by echocardiogram in a 28-week gestation foetus. The first evaluation revealed that both arches were perfused; the 1-month postnatal echocardiogram showed the closure of both arterial ducts and the partial obliteration of the left aortic arch between the left subclavian artery and the dorsal aorta. In our case, the postnatal obliteration of the left arch in a double aortic arch was probably due to the closure of the left-sided arterial duct.
Assuntos
Aorta Torácica/anormalidades , Síndromes do Arco Aórtico/etiologia , Aorta Torácica/cirurgia , Síndromes do Arco Aórtico/cirurgia , Humanos , LactenteRESUMO
MitraClip system has been recently introduced in clinical practice for percutaneous mitral valve repair in selected patients. In the case of early or late detachment of the device dedicated tools, either with percutaneous or surgical approach, have been developed. We describe a novel technique to atraumatically remove the MitraClip.
Assuntos
Remoção de Dispositivo/métodos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Falha de Prótese , Idoso , Ecocardiografia Doppler/métodos , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Cuidados Intraoperatórios/métodos , Insuficiência da Valva Mitral/diagnóstico por imagem , Recuperação de Função Fisiológica , Reoperação/métodos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores/métodosRESUMO
BACKGROUND: Re-operative mitral valve surgery is sometimes burdened by a greater technical difficulty and a higher complications rate than the first operation. Minimally invasive cardiac surgery has become routine, and it could significantly reduce the surgical risk in redo surgery. The objective of our retrospective observational study is to assess the results of cardiac reoperations in patients with mitral valve disease approached trough a 5-7 cm right mini-thoracotomy. METHODS: From February 2017 to December 2019, 65 patients underwent re-operative mitral valve surgery in our institution. Cardiopulmonary bypass (CPB) was started by cannulation of the femoral and jugular vein and femoral artery or alternatively right axillary artery. Patients enrolled had a mean age of 66.6±11.5 years. Patients were divided into three groups based on the procedure adopted: external aortic cross-clamp (EAC), EndoAortic balloon occlusion (EABO) and ventricular fibrillation (VF). Major complications were evaluated and compared with a propensity matched population of patients undergoing elective isolated mitral valve surgery via right minithoracotomy (MVS). RESULTS: The average time between last operation and reoperation was 7.1±3.4 years. Fourteen patients (21%) underwent mitral valve repair and 51 patients (78%) underwent mitral valve replacement; 9 patients (14%) received tricuspid valve surgery. There was no statistically significant difference in CPB time between the groups. Seven patients (11%) had a postoperative renal failure, 5 patients (8%) underwent surgical reopening for bleeding; incidence of post-operative stroke and pace-maker implantation was 3% for both. No deaths were registered during in-hospital stay and at 30-days echocardiographic control all patients respect the criterions of device success according with MVARC. Propensity matched patients of group redo had a longer CPB time (100.8±42.7 versus 72.8±16.7 min, P<0.001) and cross-clamp time (71.9±30.7 versus 59±10.7 min, P<0.001) respect to first operation mitral valve surgery patients. CONCLUSIONS: Minimally invasive mitral valve redo surgery is a safe procedure. Less invasive techniques in redo surgery could minimize morbidity and mortality without prolonging the duration of CPB.
Assuntos
Coração Triatriado/complicações , Estenose da Valva Mitral/diagnóstico , Adulto , Fibrilação Atrial/etiologia , Ecocardiografia , Humanos , Angiografia por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Masculino , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/cirurgiaRESUMO
BACKGROUND: Papillary fibroelastoma is the third most common primary benign tumor with an incidence of up to 0.33% in autopsy series; it accounts for approximately 75% of all cardiac valvular tumors. CASE PRESENTATION: We describe a rare case of a 28-Year-old man that while playing football, had a sudden onset of neurological deficit: aphasia, right hemiparesis and right facial numbness. Transthoracic echocardiography (TTE) showed a 10x10 mm mass attached to the anterior mitral valve leaflet. The patient was treated surgically for the prevention of further embolic complications. Histologic examination of the resected mass revealed a papillary fibroelastoma. It is the third most frequent primary cardiac tumor, after myxoma and fibroma, and the most common primary tumor of heart valves. Despite the benign nature of this tumor, it carries very high risk of embolic complications. The successful complete resection of the papillary fibroelastoma is curative and the long-term postoperative prognosis is excellent. CONCLUSIONS: Differential diagnosis of cardiac masses requires clinical informations, laboratory tests, blood cultures and appropriate use of imaging modalities. Papillary fibroelastoma is a potential cause of embolic stroke in the young. The prompt surgical excision of papillary fibroelastoma is curative and the long-term postoperative prognosis is excellent.
Assuntos
Fibroma/complicações , Neoplasias Cardíacas/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Fibroma/diagnóstico , Fibroma/cirurgia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Humanos , Angiografia por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Masculino , Músculos Papilares , Período Pós-Operatório , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Minimally invasive and video assisted mitral valve surgery has been used widely since beginning of 20th. Different reduced surgical approaches allowed replacing or repairing a mitral valve sparing sternal incision. Nevertheless the most used strategy has been in the last years the right mini thoracotomy and the extra thoracic cardiopulmonary bypass (CPB). The main goal is avoiding sternal approach for mitral valve procedures and improve postoperative course of the patients. Some postoperative complication likes blood loss, need for transfusion, prolonged intubation and infection has been reduced using this alternative technique. A special advantages has been reported in elderly or high risk patients and in redo cases. METHODS: Several cardiac centres using videoscopy and a revolutionary set up for CPB management and aortic occlusion have adopted the approach. The team approach, including surgeon, anaesthesiologist, nurse, cardiologist and perfusionist, is crucial for a safe and effective realization of this surgical strategy. The proper use of catheters and Seldinger skilfulness, and the guidance of trans-esophageal echocardiography (TEE) during the procedure are two milestones of this technique. A careful and progressive learning curve is required for all the components of the team. In fact some peculiarity likes modified surgical instruments, 3D and Full HD video assisted view, percutaneous canulation for CPB and myocardial protection, etc., make this procedure challenging for all members of the operative room (OR) team. RESULTS: Our favourite set-up include right mini thoracotomy in the IV intercostal space, femoral vein and arterial canulation and an additional venous cannula in the superior vena cava for the drainage of the upper part of the body. Aortic occlusion is achieved usually using an endo-aortic clamp positioned by means of continuous and careful TEE guidance. A mitral valve procedure is realized by direct or video guided view; using adapted and shaft instruments or special atrial retractors all standard techniques are used in this setting. CONCLUSIONS: The literature reports and our published results showed the technique is safe, easy to replicate and allows an excellent rate of valve repair even in more complex patients.
RESUMO
Intraluminal aortic clamping has been achieved until now by means of a sophisticated device consisting of a three-lumen catheter named Endoclamp, which allows at the same time occlusion of the aorta, antegrade delivering of cardioplegia, and venting through the aortic root. This tool has shown important advantages allowing aortic occlusion and perfusate delivering without a direct contact with ascending aorta reducing meanwhile the risk of traumatic and/or iatrogenic injuries. Recently, a new device (Intraclude catheter) with the same characteristics and properties has been proposed and introduced in clinical practice. The aim of this paper is to investigate the differences between Endoclamp and Intraclude catheters and to analyze the advantages advocated by this new device for intraluminal aortic occlusion since it is noticeable as these new technological tools are gaining more and more attractiveness due to their appraised clinical efficacy.
Assuntos
Cateteres Cardíacos , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Dispositivos de Acesso Vascular , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Avaliação da Tecnologia BiomédicaRESUMO
The aim of this review is to focus the attention on the "state of the art" of port-access and video-assisted mitral valve surgery appraising the results compared to the traditional approach, describing different technical strategies and analyzing how to avoid and manage its related complications concomitantly elucidating which procedure is associated with the most favorable risk-benefit and cost-benefit profile. Our default strategy is to use the minimally invasive approach combining video-assisted right mini-thoracotomy with endo-cardiopulmonary bypass and endo-aortic balloon occlusion (EBO) whenever possible. This choice is supported by the evidence that, after an initial learning curve, it is a safe and effective approach in terms of short- and long-term results, mainly for redo operations and even for elderly patients with moderately elevated peri-operative risk.