Redo surgery for a type A aortic dissection in a pregnant woman with Marfan syndrome: a complex clinical case.

Aortic dissection during pregnancy is a very rare event in the general population but can be fatal to both the mother and the fetus. A rate of dissection as high as 10% was observed in pregnant patients affected by Marfan syndrome. Facing this kind of disease can represent a challenge for the involved physicians because of its rarity. Here we present the case of an aortic dissection in a pregnant woman with Marfan syndrome who previously underwent an open heart surgery for a mitral prolapse. The diagnosis and the treatment of this case, given the mid-term gestational age combined with an increased surgical risk due to the reintervention, required a particular effort by our team. A multidisciplinary approach to the management of this patient was the key to achieve a favorable outcome both for the mother and for the baby.

Left atrial ball thrombus after edge-to-edge mitral valve repair.

A thrombus can develop in the left atrium during atrial fibrillation because the loss of contractile function leads to blood flow stasis. Anticoagulation therapy is indicated for prevention of systemic embolism, usually maintaining an international normalized ratio between 2 and 3. Rarely a massive thrombosis develops in the atrium resulting in a peduncolated ball valve thrombus or in a free-floating thrombus. These two conditions are characterized by variables in the physical findings. Such masses are hazardous and upon discovery surgical treatment, often in emergency, is mandatory. We present here the case of a patient who developed an unnoticed huge left atrial ball thrombus despite warfarin therapy after previous mitral valve surgery. .

Papillary fibroelastoma of an anomalous mitral valve chorda.

Cardiac papillary fibroelastoma (CPF) is a rare primary cardiac tumour. This tumour constitutes about 10-15% of all primary cardiac tumours. We report here a case of CPF of an anomalous mitral valve chorda.

Postendocarditis mitral valve aneurysm.

Mitral valve aneurysm is defined as a localized, thin-walled, saccular bulge of the mitral leaflet toward the left atrium. In this study, we report a case of mitral aneurysm of the posterior leaflet (scallop P3) secondary to primary mitral endocarditis in a patient who underwent prosthetic aortic valve replacement and coronary artery bypass graft.

A rare case of anterior chest closure only with omental flap after devastating mediastinitis: case report.

We describe a case of 73-year-old patient who has been operated in emergency on triple coronary artery bypass graft (CABG), which was complicated with respiratory insufficiency and devastating mediastinitis. The anterior mediastinum was closed with an omental flap that was allowed to epithelize spontaneously. The patient was discharged after 110 days. Despite the large number of cases with mediastinitis described in the literature, the chest closure with only an omental flap without closure of subcutaneous tissue and skin is rare.

Left ventricle remodelling by double-patch sandwich technique.

BACKGROUND: The sandwich double-patch technique was adopted as an alternative method for reconstruction of the left ventricle after excision of postinfarction dysfunctional myocardium to solve technical problems due to the thick edges of the ventricular wall. METHODS: Over a 5-year period, 12 of 21 patients with postinfarction antero-apical left ventricular aneurysm had thick wall edges after wall excision. It was due to akinetic muscular thick tissue in 6 cases, while in the other 6 with classic fibrous aneurysm, thick edges remained after the cut of the border zone. The ventricular opening was sandwiched between two patches and this is a technique which is currently used for the treatment of the interventricular septum rupture. In our patients the patches are much smaller than the removed aneurysm and they were sutured simply by a single row of single stitches. However, in contrast to interventricular septum rupture where the patches loosen the tension of the tissues, in our patients the patches pull strongly and restrain the walls by fastening their edges and supporting tight stitches. In this way they could narrow the cavity and close the ventricle. RESULTS: The resected area varied from 5 x 4 to 8 x 8 cm. Excision was extended into the interventricular septum in 5 patients, thus opening the right ventricle. CABG was performed on all patients but two. Left ventricular volumes and the ejection fraction changed significantly: end-systolic volume 93.5 +/- 12.4 to 57.8 +/- 8.9 ml, p < 0.001; end-diastolic volume 157.2 +/- 16.7 to 115.3 +/- 14.9 ml, p < 0.001; ejection fraction 40.3 +/- 4.2 to 49.5 +/- 5.7%, p < 0.001. All patients did well. One patient suffered from bleeding, which was not from the wall suture, and another had a left arm paresis. The post-operative hospital stay was 5 to 30 days with a mean 10.5 +/- 7.5 days/patient. At follow-up, 9 to 60 months mean 34, all patients were symptom-free. NYHA class 2.5 +/- 0.8 changed to 1.2 +/- 0.4, p < 0.001. CONCLUSION: The double-patch sandwich technique (bi-patch closure) offers some advantages and does not result in increased morbidity and mortality. In the case of excising a left ventricular aneurysm, this technique in no way requires eversion of the edges, felt strips, buttressed and multiple sutures, all of which are needed for longitudinal linear closure. Moreover, it does not require purse string sutures, endocardial scar remnant to secure the patch or folding the excluded non-functional tissue, all of which are needed for endoventricular patch repair.

[Cardiac surgery in octogenarians: a five-year experience]. / La cardiochirurgia nell'ultraottantenne: cinque anni di esperienza.

BACKGROUND: Cardiac surgery in octogenarians is increasing in industrialized countries and therefore represents a growing population. The aim of this study was to evaluate characteristics and outcomes of octogenarian patients undergoing cardiac surgery. METHODS: We reviewed all consecutive octogenarians operated on during the last 5 years. Among 1912 patients operated on between April 2000 and December 2004, we identified 223 patients (11.6%) aged > 80 years. Median age was 82.17 +/- 2.11 years, and 52.5% were males. The mean EuroSCORE score was 9.4 +/- 1.8. Among them 43 patients (19.3%) had isolated aortic valve replacement, 127 patients (57%) had isolated coronary artery bypass graft, 40 patients (17.9%) had aortic valve replacement combined with coronary artery bypass graft, 11 patients (4.9%) had mitral valve repair, and 2 patients (0.9%) had ventricular septal rupture repair. RESULTS: The overall hospital mortality was 5.4%; cumulative actuarial survival at 4 years was 77.6%. CONCLUSIONS: We conclude that for unselected octogenarians the operative mortality is acceptable and only slightly increased than in younger age groups; the late survival rate is good.

Transatrial approach of acquired posterior ventricular septal rupture and double orifice technique in tricuspid valve repair.

We present a successful transatrial repair of ventricular septal rupture and tricuspid valve reconstruction, using the "edge-to-edge" technique, as a serious complication of a posterior myocardial infarction in an 83-year-old woman.