ABSTRACT
The combined superior transsseptal approach (CSTA) has been used for 12 mitral or left atrial myxoma operations. This approach provided excellent exposure of the mitral valve or myxoma. This approach was compared with the transseptal and left atrial approaches in 1 and 3 cases, respectively. There were no differences in operative time, cardiopulmonary bypass time, anoxic time, bleeding volume, blood transfusion volume and postoperative arrhythmic complications. We use CSTA for cases with tricuspid valve disease, small left atrium, reoperation and left atrial myxomas.
ABSTRACT
In the past 9 years, 37 patients with infective endocarditis underwent valve replacement. The aortic valve was involved in 17 patients, the mitral valve in 10, and both valves in 10, respectively. 35 patients had native valve and 2 had prosthetic valve endocarditis. Bacterial findings were <i>Streptococcus</i> in 20 patients (54%), <i>Staphylococcus</i> in 5 (13.5%), gram-negative in 3 (8%), and undetected in 10 (27%). 10 patients developed aortic annular abscess. After aggressive debridement of all apparently infected tissue of annular abscess, the defects left in the left ventricular outflow tract were repaired by interrupted mattress sutures with pledgets in 4 patients, by autologous pericardial patch in 4, and by valved conduit in 2 PVE patients, respectively. Retrograde cardioplegic infusion from the coronary sinus not only facilitated operative manipulation but also provided superior myocardial protection in such patients. Operative mortality was 11% (4/37). Reoperation was necessary in 2 patients; one for periprosthetic leak, and the other for newly developed severe left coronary ostial stenosis after the first operation, but both died eventually. Late mortality was 8% (3/37). Mean follow-up of 31 months was achieved in all 30 survivors, in whom there was no recurrence of infection and clinical improvement was excellent.