Surgery for Ascending Aortic Aneurysm and Aortic Valve Insufficiency in Conditions of Active Proceeding Syphilitic Aortitis and Valvulitis.

A syphilitic aortitis is a late cardiovascular lesion of tertiary syphilis that has become exceptionally rare in the antibiotic era but not eradicated completely. Syphilitic aortitis of ascending aorta complicates in ascending aortic aneurysm formation and aortic valve regurgitation, both requiring surgical treatment. After surgery, lifelong surveillance of the remainder of the aorta is recommended because of a priori supposed high incidence of delayed involvement of noninvolved aortic segments. A 3-year follow-up result of surgery of syphilitic ascending aortic aneurysm with aortic valve regurgitation in condition of active ongoing syphilitic aortitis and valvulitis is described with addressing the dimensions of remaining aortic segments. This case demonstrates that the dilatation of the remainder of the aorta does not occur during 3 years, at least when anti-syphilitic course of antibiotic is used just after operation without additional treatment during the follow-up period. A few reports on surgical treatment of syphilitic aneurysms of the ascending aorta are discussed.

Pulmonary valve reconstruction by allograft replacement of underdeveloped anterior leaflet in case of late combined pulmonary restenosis after early primary repair.

INTRODUCTION: The native pulmonary valve (PV) reconstruction is an attractive alternative to a replacement but is challenging due to the systematic underdevelopment of the valve structures in congenital heart diseases. The partial replacement of underdeveloped parts of the valve and saving of well-developed may have advantages versus replacing the whole valve in terms of durability and patient outgrowth of the prosthesis. CASE PRESENTATION: This report describes a case of the PV reconstruction by allograft replacement of an underdeveloped anterior leaflet in an adolescent patient who previously corrected pulmonary stenosis during the first year of her life. The normal anatomy of the right and left leaflets was revealed. The rudimental anterior leaflet determined the annular restenosis. The monocusp with the related supporting aortic wall was sewn instead of the anterior leaflet. The Z-score of the pulmonary annulus changed from minus 3, 9 before to +0.8 after the procedure. The excellent function of the PV was observed in 1-year follow-up. DISCUSSION: Valve deterioration over time will have a less negative impact on the function when it occurs in a limited area. The annular dilatation becomes unlikely if the annulus predominantly consists of natural tissues. The procedural effectiveness allows the transcatheter valve-in-valve therapy in case of late dysfunction. The expected feature of the procedure described is that the growth of the PV remains possible. CONCLUSION: If allograft replacement of the PV is scheduled and allograft is available, the partial replacement may be superior to replacement of the whole valve in terms of durability and patient outgrowth of the prosthesis.

Surgical angioplasty of the left main coronary artery and/or proximal segment of the right coronary artery by pulmonary autograft patch.

OBJECTIVES: There are controversial opinions about the expediency of performance of the surgical angioplasty of the left main coronary artery (LMCA) and/or proximal segment of the right coronary artery (RCA) in rare cases of isolated lesion or with limited involving of distal coronary branches. One of the many fears restraining a wider performance of this operation is the uncertainty in longevity of patch material. It is supposed that the autovein has tendency to proliferating degeneration similar to that in case of coronary artery bypass grafting (CABG), while the autopericardium may be subjected to calcification. Autoarterial patches have a limited width. To withdraw these real or hypothetical negative properties of patch materials we offer to harvest the pulmonary autograft patch (PAP) for coronary angioplasty. METHODS: Our experience with PAP-angioplasty of LMCA and/or proximal segment of RCA includes four cases. Simultaneous angioplasty of LMCA and proximal segment of RCA was performed in one patient; angioplasty of LMCA--in two patients; angioplasty of RCA--in one patient. In two cases the stenosis of LMCA was accompanied by stenotic lesion of left anterior descending coronary artery (LAD). The surgical approach to LMCA was performed by complete crossing of pulmonary artery (PA). There was no necessity to use any plastic material for restoring of PA integrity in all cases. RESULTS: All patients survived after the operation. The postoperative course was uncomplicated except one case of LMCA/LAD lesion. There was a temporary low cardiac output syndrome and ventricular arrhythmia resulting in additional CABG as 'back-up' procedure. This complication was not a consequence of impassability of LMCA because its good patency was established at control coronary angiograms. The postoperative coronary angiograms were performed in all cases. They showed a satisfactory width of the main coronary vessels. The maximal follow-up period is 30 months. CONCLUSION: We suppose that the use of viable pulmonary autograft patch for surgical angioplasty of LMCA and proximal segment of RCA removes one of a lot of fears, which restrain the wider use of this alternative to CABG operation.

Simultaneous multi-vessel coronary artery bypass grafting, ischemic mitral regurgitation repair and descending aortic aneurysm replacement: analysis of technical points.

The combination of coronary artery disease and its complications (ischemic mitral regurgitation etc.) with the aneurysm of the descending thoracic aorta is not a rare case. The single-stage correction of coronary/intracardiac/aortic lesions may be considered as a way of managing the combined patients. Simultaneous multi-vessel coronary artery bypass grafting, suture mitral annuloplasty and descending aortic aneurysm replacement with synthetic prosthesis is described. The operation was performed through the left thoracotomy with cardiopulmonary bypass established by the cannulation of the ascending aorta and of the right atrial appendage. Ventricular fibrillation and no clamping of the ascending aorta were used. The circulatory arrest was induced for the construction of the proximal anastomosis between the descending aorta and the synthetic prosthesis. No complications related to the operation were diagnosed for the 14-month follow-up. Several technical points seem optimal for the combined procedure: (1) Minimization of manipulations on the ascending aorta (using of pedicled left internal thoracic artery; construction of the proximal anastomoses with synthetic aortic prosthesis; unclamped ascending aorta). (2) Revascularization of all coronary areas and correction of intracardiac lesions through the left thoracotomy. Individual planning of the procedural technical points for every patient may provide a safe feasibility of the combined procedure.

Primary left atrial leiomyosarcoma: literature review and lessons of a case.

Primary cardiac sarcoma is an uncommon disease. In particular, leiomyosarcoma of cardiovascular origin is extremely rare. Half of all cardiac leiomyosarcomas are located in the left atrium. Due to the extreme rarity of left atrial leiomyosarcoma, there is no great experience in its management. This review includes a report of a case of left atrial leiomyosarcoma followed up over 45 months. The literature review examines the distribution of left atrial leiomyosarcoma, the physiological reasons for the tendency of cardiac leiomyosarcoma to be localized to the left atrial cavity, the clinical and physical appearance of this disease, and the key differences between left atrial leiomyosarcoma and the most common left atrial tumor, myxoma. The morphological features, using light and electron microscopy and immunochemical staining, are discussed. Treatment modalities including adjuvant therapy and surgical resection are examined and their effectiveness compared. Opinions regarding the results and optimal treatment of leiomyosarcoma are not always in agreement. This highlights the need for inter-hospital comparison to determine the optimal treatment regimen.