RESUMEN
BACKGROUND: Valve replacement surgeries holds risks of morbidity and mortality. MATERIALS AND METHODS: The study cohort included 346 patients who underwent different types of valve surgery, excluding redo and Bentall operations. All operations were performed through a median sternotomy using cardiopulmonary bypass. RESULTS: Mean patient age was 51.6 ± 16.1 years, and 51% were male. Approximately 21% had diabetes, and 44.6% were hypertensive. Aortic valve replacement (AVR) was performed in 125 patients (37%), mitral valve replacement (MVR) in 95 (28%), combined AVR and MVR in 42 (13%), AVR plus coronary artery bypass grafting (CABG) in 19 (6%), and MVR plus CABG in 32 (10%). Operative mortality was 5.8% (n = 20). In the bivariate-level analysis, older age, operation type, hypertension, emergency surgery, use of a biological valve in the aortic or mitral position, pump time greater than 120 min, and aortic clamp time greater than 60 min were significant predictors of 30-day mortality. Use of medications stratified by duration (less than or more than a month) was also shown to be a predictor of mortality. Use of angiotensin-converting enzyme inhibitors, digoxin, beta-blockers, statins, and loop diuretics was associated with mortality. Older age, emergency/salvage surgery, use of beta-blockers for less than 1 month preoperatively, and use of a biological valve in the aortic position were significant and independent predictors of 30-day mortality. CONCLUSION: Age, emergency valve surgery, use of a biological valve, use of beta-blockers for less than 1 month before surgery, type of surgery, EF<35%, pump time, and cross clamp time were all found to be independent predictors of mortality in patients undergoing valve surgery. Further prospective multicenter studies may be needed to provide a comprehensive assessment of mortality in patients undergoing valve surgery in Jordan.
RESUMEN
BACKGROUND May-Thurner syndrome (MTS) is a condition characterized by compression of the left common iliac vein (LCFV) between the right common iliac artery (RCIA) and the lumbar vertebrae. This anatomical entrapment typically affects young women and is mostly asymptomatic. High index of suspicion is required in cases of recurrent left-sided deep vein thrombosis (DVT) and severe leg pain. We describe a case of MTS in a young male patient with a left-sided superior vena cava (LSSVC) that was successfully managed by an endovascular approach. To the best of our knowledge, the coexistence of MTS and LSSVC anomaly has not been reported previously. CASE REPORT A 31-year-old man presented with a history of left-sided iliofemoral deep vein thrombosis and disabling venous claudication of 2 years' duration. Duplex ultrasound and computed tomography venogram (CTV) revealed evidence of MTS with chronic subtotal occlusion of the left common iliac vein (LCIV) with extensive venous collaterals. Venogram via the left femoral vein puncture confirmed the aforementioned findings. Retrograde recanalization of the occluded segment was attempted without success. Therefore, an antegrade approach via the right internal jugular vein was performed to facilitate recanalization. Surprisingly, venography revealed an LSSVC. The occluded CIV was successfully stented and the patient had complete resolution of his symptoms at 22-month follow-up. CONCLUSIONS MTS is a potentially treatable and often-overlooked pathology. In the era of expanded endovascular management of MTS, recognition of this coincidence is essential to prevent unwarranted mishaps during endovascular management when the jugular approach is used.
