[Reconstruction of the aortic root: midterm results]. / Ricostruzione della radice aortica: risultati a medio termine.

BACKGROUND: The aim of this study was to assess mid-term results of aortic reconstruction. METHODS: According to Dr. David's technique, 20 patients (17 males, 3 females, median age 63 years) were examined, who underwent surgery between September 1996 and August 1999. Indications for operation were aortic insufficiency with ascending aorta aneurysm in 19 patients, and acute Stanford type A dissection in 1 patient. In every patient the native valve was preserved and suspended inside a tubular prosthesis on which the coronaries were reimplanted. RESULTS: No patient died in hospital. Follow-up (mean 13 months) was complete for all patients. One patient died of extracardiac causes. Seventeen of 19 survivors are in NYHA functional class I, the remaining 2 in class II. Nineteen patients underwent echocardiography which showed moderate aortic regurgitation in 1, mild in 6 and absent or trivial in 12. There were no instances of thromboembolism. CONCLUSIONS: These results are encouraging and have brought us to consider aortic reconstruction a valid alternative to traditional aortic root replacement. Dr. David's technique is reproducible and reliable in the long term.

Linear segmental annuloplasty for mitral valve repair.

A method of posterior mitral annulus remodeling is presented. The posterior annulus is divided into three segments, each segment encircled by a suture that is passed in a tourniquet. Coaptation of the leaflets can be achieved by tightening the tourniquets while the ventricle is being filled. This technique is simple and quick, avoids the use of foreign material, and requires less expertise and judgment than traditional annuloplasties.

The role of transesophageal echocardiography in the monitoring of cardiac mass removal: a review of 17 cases.

Intraoperative transesophageal echocardiography (TEE) was used to monitor the removal of intracardiac masses in 17 patients. Prebypass TEE was used to confirm the preoperative diagnosis. It gave a clear image and anatomical definition of the mass in 16 cases. Moreover, in 11 of these patients, prebypass TEE provided information not obtained previously by traditional exams. This information was judged either useful or indispensable for a successful outcome in 10 of these patients. However, in one of the remaining six patients, TEE did not clearly visualize a flat thrombus in the left atrium. Postbypass TEE was used in each case to monitor the surgical results of the mass removal and the associated procedures. In one patient, it disclosed a progressively expanding hematoma in the left atrial wall, which was interfering with mitral valve function. From this experience, we consider intraoperative TEE the best monitoring device during cardiac mass removal because it usually provides a more complete diagnosis and anatomical definition of the mass than the traditional preoperative methods and permits monitoring of the surgical results before chest closure. Some limitations to this method may exist.