Minimally Invasive Mitral Valve Surgery for Rheumatic Valve Disease.

BACKGROUND: The development of minimally invasive mitral valve surgery has created the motivation for using this approach in young patients with chronic rheumatic valve disease. We report our recent experience with patients undergoing minimally mitral valve surgery in this group of patients. METHODS: Between July 2014 and June 2018, 142 patients with rheumatic mitral valve dysfunction underwent minimally invasive surgery through a right thoracotomy approach at the University Medical Center of Ho Chi Minh City in Vietnam. Diagnosis was confirmed with transthoracic and transesophageal echocardiography (TTE and TEE). We analyzed the in-hospital and midterm follow-up outcomes of this group. RESULTS: The mean age was 42.6 ± 9.6 years. Sixty patients (42.3%) were male. Sixty-three patients were diagnosed with functional severe tricuspid regurgitation, 29 patients were identified with moderate tricuspid regurgitation, and tricuspid annulus was more than 21 mm/m²). Mitral valve repair was performed in 16 patients (11.3%), and 126 patients underwent mitral valve replacement. Mitral valve repair techniques included annuloplasty, leaflet peeling, and commissurotomy. Thirty-day mortality was 0.7%. Two patients had to be converted to conventional sternotomy, due to left atrial appendage laceration and mitral annular rupture. The overall survival rate was 98.6%. Freedom from reoperation was 97.1%. CONCLUSIONS: In patients with rheumatic valve disease, minimally invasive mitral surgery safely and effectively can be performed with few perioperative complications and good midterm results.

Late Onset of Organizing Pneumonia Following SARS-CoV-2 Infection: A Case Report of Successful Management and Review Literature.

A late consequence of COVID-19, organizing pneumonia is characterized by significant imaging and pathological abnormalities. The goals of this study are to better understand these abnormalities. The use of corticoid continues to be the recommended course of treatment for COVID-19. On the other hand, it is not clear whether or not corticoid has the same impact on organizing pneumonia after COVID-19. A 53-year-old male patient was identified with organized pneumonia following COVID-19 infection. He was diagnosed after experiencing severe respiratory symptoms several days with no improvement. We initiated a high dose of corticoid based on imaging and pathological findings and observed a significant response. In addition, we looked into the research that has been done concerning the diagnosis and treatment of this peculiar ailment. Patients who have been diagnosed with pneumonia after COVID 19 are required to undergo a reevaluation that includes a chest CT scan, and some of these patients may be candidates for an early lung biopsy. The most effective and convincing therapy for COVID-19-induced organizing pneumonia is corticoid treatment at a dose equivalent to 0.5 mg/kg/day of prednisone.

Risk-related clinical outcomes after minimally invasive mitral valve surgery: insights from the Mini-Mitral International Registry.

OBJECTIVES: With the popularization of catheter-based mitral valve procedures, evaluating risk-specific differentiated clinical outcomes after contemporary mitral valve surgery is crucial. In this study, we assessed the operative results of minimally invasive mitral valve operations across different patient risk profiles and evaluated the value of EuroSCORE (ES) II predicted risk of mortality model for risk prediction, in the large cohort of Mini-Mitral International Registry (MMIR). METHODS: The MMIR database was used to analyse mini-mitral operations between 2015 and 2021. Patients were categorized as low (<4%), intermediate (4% to <8%), high (8% to <12%) and extreme risk (≥12%) according to ES II. The observed-to-expected mortality ratio was calculated for each risk group. RESULTS: A total of 6541 patients were included in the analysis. Of those, 5546 (84.8%) were classified as low risk, 615 (9.4%) as intermediate risk, 191 (2.9%) as high risk and 189 (2.9%) as extreme risk. Overall operative mortality and stroke rates were 1.7% and 1.4%, respectively, and were significantly associated with patient's risk. The observed mortality was significantly lower than expected-according to the ES II-in all risk categories (observed-to-expected ratio < 1). CONCLUSIONS: The present study provides an international contemporary benchmark for operative outcomes after minimally invasive mitral surgery. Operative results were excellent in low-, intermediate- and high-risk patients, but were less satisfactory in extreme risk. The ES II model overestimated the in-hospital mortality. We believe that findings from the MMIR may assist surgeons and cardiologists in clinical decision-making and treatment allocation for patients with mitral valve disease.

Compartment syndrome following minimally invasive mitral valve repair: A case report.

A 38-year-old Asian male with severe mitral valve regurgitation underwent elective minimally invasive mitral valve repair with artificial chordae and concomitant Cox-Maze procedure. Cardiopulmonary bypass required large peripheral cannulas due to the patient's increased body surface area with a total bypass time of 216 min. At 10 h, the patient reported progressive right lower extremity pain with evidence of swelling, diffuse paresthesias, and weak peripheral pulses. The patient underwent double-incision lower leg fasciotomies, revealing significant interstitial fluid and bulging muscle chambers. Compartment syndrome demonstrates non-traumatic etiologies. Elevated body mass index, Kawashima Type D femoral artery classification, prolonged bypass times, driven partially due to concomitant Cox-Maze, and larger cannula sizes should increase the index of suspicion.

Aortic prosthetic size predictor in aortic valve replacement.

BACKGROUND: Patient-prosthesis mismatch (PPM) is a major concern in aortic valve replacement (AVR) and leads to perioperative morbidity and rehospitalization. Predicting aortic annulus diameter pre-procedurally is crucial to managing patients with high-risk of PPM. OBJECTIVES: To compare preoperative measurements of aortic annulus from echocardiography and CT scan with surgical sizing and develop an imaging-based algorithm to predict PPM. METHODS: From January 2017 to December 2020, patients underwent AVR at a teaching hospital were examined. The relationship between imaging measurements with operative values was assesed using scatter plots and Pearson's correlation coefficient. Univariable linear regression was then used to build the predictive model. RESULTS: A total of 144 patients underwent AVR during the study period. Suture types and surgical approaches were not significantly associated with prosthesis size. CT scan-based measurements showed strong correlation with prosthesis size: mean diameter (R = 0.79), perimeter-derived diameter (R = 0.76), and area-derived diameter (R = 0.75). Mechanical valve and tissue valve shared similar correlation coefficients. Prosthesis size predictive models based on CT scan were 12.89 + 0.335 × d for mean diameter, 13.275 + 0.315 × d for perimeter-derived diameter and 13.626 + 0.309 × d for area-derived diameter. CONCLUSIONS: Preoperative CT scan measurements are a reliable predictor of aortic prosthesis size. Transthoracic echocardiography is a possible alternative, though it is highly performer-dependent and unable to represent the aortic annulus fully. Together, these two imaging modalities can be used to quantitatively anticipate PPM preoperatively.

Conservative Treatment of Postinfarction Left Ventricular Free Wall Rupture.

Left ventricular free wall rupture is a fatal complication of acute myocardial infarction. Emergency surgical repair is usually indicated to treat this condition. However, in very high surgical risk cohort, conservative treatment can also be considered. We report a case of left ventricle pseudoaneurysm that was successfully treated conservatively in a 4-year period.

Learning curve in minimally invasive mitral valve surgery: a single-center experience.

BACKGROUND: Minimally invasive mitral valve surgery is becoming a gold standard and provides many advantages for patients. A learning curve is required for a surgeon to become proficient, and the exact number to overcome this curve is controversial. Our study aimed to define this number for mitral valve surgery in general, for replacement and repair separately. METHODS: A total of 204 mitral valve surgeries were performed via the right minithoracotomy approach from October 2014 to January 2019 by a single surgeon who isexperienced in conventional mitral valve surgery. Learning curves were analysed based on the trend of important variables (cross-clamp time, CPB time, ventilation time, ICU time, composite technical failure) over time, and the number of operations required was calculated by CUSUM method. RESULTS: MIMVS provided an excellent outcome in the carefully selected patients, with low mortality of 0.5% and low rate of complications. The decreasing trend of the important variables were observed over the years and as the cumulative number of procedures increased. The number of operations required to overcome the learning curve was 75 to 100 cases. When considered separately, the quantity for mitral valve replacement was 60 cases, whereas valve repair necessitated at least 90 cases to have an acceptable technical complication rate. CONCLUSION: MIMVS is an excellent choice for mitral valve surgery. However, this approach required a long learning curve for a surgeon who is experienced in conventional mitral valve surgery. TRIAL REGISTRATION: The research was registered and approved by the ethical board of the University of Medicine and Pharmacy at Ho Chi Minh City, number 141/DHYD-HDDD, on April 11th 2018.

Left isomerism syndrome with total anomalous systemic connection.

We present a case of left isomerism with total anomalous systemic venous connection where the inferior vena cava was absent and all other systemic veins connected abnormally to the left atrium. The right atrium was hypoplastic with an intact atrial septum. Blood flow to the lungs was through a large ventricular septal defect. The diagnosis was made with echocardiography, angiography, and computed tomography. Complete repair was performed successfully, and the 7-year-old patient had an uneventful recovery.

Ministernotomy for correction of ventricular septal defect.

BACKGROUND: The development of minimally invasive surgery in the adult has created motivation for similar approaches in the congenital heart domain. Over the past 20 years, this type of surgery has been advocated in an effort to reduce costs related to hospital stay, and to improve the cosmetic results. We report our experience with ventricular septal defect repair utilizing a ministernotomy incision. METHODS: From August 2014 to August 2015, 26 patients underwent ministernotomy for correction of ventricular septal defect at our center. All patients were between the ages of 14 months-old to 24 years-old with weight ranged from 7.5 to 54 kg (median weight 12 kg). Diagnoses were confirmed with echocardiography. We analysed in-hospital and 6 months follow-up outcomes of the group. RESULTS: All defects were corrected successfully with satisfactory exposure. The median cardiopulmonary bypass time was 64 min, and median cross clamp time was 42 min. The intensive care unit stay ranged from 1 day to 3 days (median ICU stay, 1.5 days) and the hospital stay ranged from 4 to 13 days (median hospital stay, 5 days). There were no deaths during the operation or severe postoperative complications. No residual shunts were observed. CONCLUSION: Our results demonstrated the safety and efficacy of ministernotomy for the correction of ventricular septal defect with improved cosmetic results in patients greater than 7.5 kg. This aprroach can be used in either the transatrial or transarterial approach, and in smaller weight infants.