RESUMO
Annuloplasty should always accompany mitral valve repair in order to achieve proper annular remodeling and stabilization. Numerous types of annuloplasty rings-that differ from rigid to semi-rigid and flexible devices, from complete to partial, and from flat to saddle-shaped rings-are clinically available. A deeper understanding of mitral valve function, in conjunction with several recent studies, suggest it is advisable to prefer annuloplasty rings that mimic the physiological mitral annulus shape and three-dimensional (3D) dynamic changes in order to reduce haemodynamic stress on valve components and optimize leaflet coaptation, perhaps improving valve repair durability too. This paper aims to focus on 3D annuloplasty rings, with dynamic features: MEMO 3D™ and MEMO 4D™ (Sorin Medical, New York, New York), as well as Physio Flex (Edwards Lifesciences, Irvine, California).
RESUMO
Aortic annuloplasty has been clearly demonstrated to have a protective influence in aortic valve repair. Over the past 20 years, different annuloplasty concepts have been proposed by different groups. However, the most appropriate approach to enable long-term annular stability remains highly controversial. The aim of this article is to give a general overview of all types of aortic annuloplasty, particularly focusing on the use of an external Teflon ring, as proposed by our group. In this technique, external root dissection is performed in the same fashion as for reimplantation; the only difference is that it is necessary to go below the coronary ostia take-off. A series of pledgeted sutures (usually between 6 and 9 sutures) are placed at the level of the virtual basal ring. The external ring is made using a Teflon strip with a length of 8 to 9 cm, to reduce the annulus to a diameter of between 21 and 23 mm. The sub-annular sutures are then passed at the appropriate level through the Teflon strip and the strip is parachuted outside the aortic root base, passing under the coronary ostia. The two ends of the Teflon strip are tied at the level of the non-coronary sinus. Aortic annuloplasty is a crucial step to improve valve competence and stabilization. While several techniques offer good mid- to long-term results, annuloplasty with an external Teflon ring appears to be a simple and effective alternative to guarantee stable root diameters. Longer follow-up studies are needed to confirm the mid- to long-term results.
RESUMO
Cardiac myxoma is the most common primary benign cardiac tumor in adults and right atrial myxoma is a rare observation. We report a case of a 56-year-old woman who presented with dyspnea and diagnosed with a right atrial myxoma. Urgent operation through a right mini thoracotomy was done and myxoma was completely excised. Traditionally, median sternotomy with cardiopulmonary bypass is used for excision of cardiac myxoma. Excision through a mini thoracotomy for patients with right atrial myxoma appear to be safe, feasible and efficacious.
RESUMO
INTRODUCTION: Progressive saphenous vein graft (SVG) failure remains a key limitation to the long-term success of coronary artery bypass grafting (CABG). SVG disease after the first year is dominated by intimal hyperplasia, which predisposes the SVG to thrombosis and accelerated atherosclerosis. The objective of this study was to review and summarize the latest experimental and clinical data on the use of mechanical external stents for vein grafts. METHODS: In January 2020, the PubMed database was searched using the terms "external stent", "CABG", "saphenous vein graft" and "intimal hyperplasia". The results were reviewed and only randomized experimental and clinical studies that analyzed the effect of external stenting on venous intimal hyperplasia were included in the analysis, together with studies that investigated the clinical benefit of external stenting. RESULTS: Eight experimental and four clinical trials met the search criteria. Controlled trials in different large animal models concluded that external stenting significantly reduced intimal hyperplasia 3-6 months post implantation, and reduced both thrombosis rates and the development of lumen irregularities. Data from randomized controlled trials with a follow-up period of 1-4.5 years supported the pre-clinical findings and demonstrated that external stents significantly reduced vein graft disease. CONCLUSION: Strong evidence indicates that supporting the vein with external stents is safe and leads to clear advantages at both the anatomical and cellular levels. With the further accumulation of consistent positive results, external stenting of SVG may become the standard of care in future CABG.
Assuntos
Ponte de Artéria Coronária/métodos , Oclusão de Enxerto Vascular/prevenção & controle , Veia Safena/transplante , Stents , Túnica Íntima/patologia , Animais , Aterosclerose/etiologia , Aterosclerose/prevenção & controle , Implante de Prótese Vascular/métodos , Oclusão de Enxerto Vascular/etiologia , Humanos , Hiperplasia/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Veia Safena/cirurgia , Trombose/etiologia , Trombose/prevenção & controle , Túnica Íntima/cirurgia , Grau de Desobstrução VascularAssuntos
Ponte de Artéria Coronária/efeitos adversos , Seio Coronário/lesões , Traumatismos Cardíacos/terapia , Técnicas Hemostáticas/instrumentação , Adesivos Teciduais/uso terapêutico , Idoso de 80 Anos ou mais , Seio Coronário/diagnóstico por imagem , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: Structural valve deterioration (SVD) is the Achilles' heel of bioprostheses. Its correlation with younger age is well known. In recent years we exclusively reserved use of small-size Mitroflow valve prostheses (LivaNova, London, United Kingdom) to an older patient population with small aortic annuli. This study aimed to assess the incidence of SVD and its effect on patient survival and need for reoperation. MATERIALS AND METHODS: Two hundred five patients (aged 75.9 ± 5.3 years; range, 62-92 years) underwent aortic valve replacement with a 19-mm or 21-mm Mitroflow valve prosthesis between 2005 and 2011. The great majority was female (n = 170; 83%). In half of patients it was an isolated procedure. All valve prostheses were implanted in a supra-annular position using pledgeted sutures. A 19-mm valve was implanted in 93 patients (45.3%), whereas in 112 patients (54.6%) a 21-mm valve was used. RESULTS: Twenty-three patients (11.2%) were diagnosed with early SVD by echocardiography. Average time from surgery to diagnosis of SVD was 64.3 ± 26.8 months. Ten patients needed a reoperation for SVD. Average time from surgery to a second operation was 45.7 ± 35.7 months. Overall survival was 64.5% and 42.3% at 5 and 9 years, respectively. Cumulative freedom from SVD at 5 and 9 years was 94.8% ± 1.6% and 77.4% ± 5.4%, respectively. In 4 patients death was linked to the presence of SVD. There were no differences in mortality, reoperation, or SVD between the 2 Mitroflow valve sizes. CONCLUSIONS: Small-size Mitroflow pericardial valve prostheses have shown a worrisome incidence of SVD even in patients aged >70 years. Based on this experience we have discontinued their use.