A Case of Dyspnea in a Patient with a Previous Coronavirus Disease Infection: Pulmonary is not always the Cause.

Myxoma is the most common benign primary tumor of the heart. Diagnosis of cardiac myxoma is difficult as it presents itself with varying nonspecific symptoms, and an echocardiography can easily diagnose it. Sometimes, it can cause cardiac syncope and thromboembolic events. A woman with a recent infection by severe acute respiratory syndrome coronavirus-2 was admitted to our hospital with respiratory symptoms: dyspnea and tachypnea; cardiac symptoms: atrial fibrillation; and neurological symptoms: syncope. Initially, she performed brain computed tomography (CT) and CT angiography value. Transthoracic echocardiogram and transesophageal echocardiogram showed an atrial mobile mass. Chest X-ray did not show any interstitial lesions. Therefore, urgent cardiac surgery was performed to remove the mass. The histological examination confirmed the presence of a cardiac myxoma. Our experience could show the importance of early diagnosis and prompt surgical treatment to prevent stroke.

Adjustable sinotubular junction for aortic valve reimplantation procedures.

Sinotubular junction size in aortic valve reimplantation procedures is usually predetermined on the basis of mathematical calculations and intraoperative measurements. We propose a new method for aortic valve reimplantation by which intraoperative measurements can be eliminated and sinotubular junction size adjusted after cross clamp removal to fit the patient's need. Aortic valve commissures are reimplanted in the expandable skirt of a Valsalva (Vascutek, Renfrewshire, Scotland) graft to realize an oversized sinotubular junction that is subsequently reduced to the proper size by wrapping, with Dacron rings of decreasing size, the neo-sinotubular ridge under transesophageal echocardiographic guidance.

The ideal theoretical graft oversizing in valve-sparing aortic operations with a standard tubular or a Valsalva graft.

OBJECTIVE: We sought to determine, by a mathematical model, the ideal theoretical degree of ascending aortic graft oversizing needed to obtain normal sinuses dimension in the reimplantation type of valve-sparing aortic operations. METHODS: To define a normal-range value, size of sinuses of Valsalva was conventionally expressed as the area surrounding fully opened aortic cusps, the so-called beyond leaflets area (BLA), and measured in 50 healthy subjects. A mathematical relationship between aortic annulus diameter, aortic sinuses diameter and resulting BLA was defined. By simulating intra-operative scenarios, the effect of different degrees of a standard or Valsalva graft oversizing on BLA extension was tested. RESULTS: The same degree of graft oversizing resulted in a bigger beyond leaflets area for the Valsalva graft than for a standard graft. Oversizing degrees exceeding +7mm for a standard graft and +3mm for the Valsalva graft resulted in a beyond leaflets area over normal limits. Results were expressed in a visual form as two different normograms, one for the standard graft and one for the Valsalva graft. CONCLUSIONS: A less pronounced graft oversizing is needed to achieve normal-range sinuses size when using a Valsalva graft, the ideal theoretical graft oversizing was +7mm for a standard graft and +3mm for the Valsalva graft, our normograms can be helpful in selecting a proper graft size when performing a valve-sparing aortic procedure.

Aortic homograft improves hemodynamic performance and clinical outcome at mid-term follow-up.

BACKGROUND: Cryopreserved homograft is currently considered an excellent choice for the replacement of a diseased aortic valve in adults and it is the first choice for 1 with aortic endocarditis. The aim of this study was to analyze our single institution experience with the cryopreserved aortic homograft by a mid-term follow-up. METHODS: Between December 1996 and September 2003, 46 consecutive patients underwent aortic valve replacement using either aortic or pulmonary homograft. The risk profile was moderate-to-high, with a mean log EuroSCORE of 6.33+/-5.12. All patients were periodically evaluated at discharge, at 6 and 12 months, and yearly thereafter, to assess their clinical status and hemodynamic performance by comparing the ejection fraction, left ventricular mass index, mean gradient, effective orifice area index, and diastolic and systolic eccentricity indexes. RESULTS: The overall 30-day mortality was 4.3%. At univariate analysis, the significant determinants of in-hospital mortality were: aortic dissection (p < 0.001), urgent operation (p = 0.05) and a log EuroSCORE > 10 (p = 0.05). At multivariate analysis no independent predictors of in-hospital mortality were found. At 5 years of follow-up, the survival was 91.3+/-5.0%, the freedom from reoperation was 95.8+/-4.1%, the freedom from sudden death was 96.1+/-3.9%, and the freedom from readmission for congestive heart failure was 94.1+/-3.1%. In patients with either prevalent aortic valve stenosis or prevalent aortic valve insufficiency, a significant improvement in the preoperative ejection fraction during follow-up (49+/-4 vs 51+/-7%; F = 5.1, p = 0.04 and 50+/-10 vs 53+/-10%; F = 7.1, p = 0.01 respectively) and a significant reduction in the preoperative left ventricular mass index during follow-up (202+/-55 vs 143+/-28 g/m2; F = 7.5, p = 0.008 and 177+/-49 vs 138+/-24 g/m2; F = 8.8, p < 0.001) were recorded. CONCLUSIONS: Replacement of the diseased aortic valve with a cryopreserved homograft offers clear advantages in terms of excellent hemodynamics, resistance to infection, and a negligible incidence of postoperative regurgitation.

Off-pump coronary surgery improves in-hospital and early outcomes in octogenarians.

BACKGROUND: A retrospective study on octogenarians who underwent off-pump (OPCAB) or conventional (CCAB) coronary artery bypass surgery undertaken to evaluate the in-hospital and early outcomes in terms of survival and cardiac and neurological events. METHODS: The design of the study was single-institutional, retrospective and comparative. Between January 1997 and May 2003, 114 patients were included and 73 underwent OPCAB, while 41 underwent CCAB. Uni- and multivariate analyses were used to determine the correlation between the pre- and intraoperative data and hospital death or complications. The overall survival and freedom from cardiac events were determined using Kaplan-Meier analysis. The linearized rates of follow-up complications were compared between the two groups. RESULTS: Overall, comparison of CCAB to OPCAB revealed differences in the operative mortality (6 deaths for CCAB, 14.6% vs 5 deaths for OPCAB, 6.8%; p = 0.05). Postoperative complication variables showed that there was no significant difference in the number of patients who suffered from cardiac events and stroke (2.4% CCAB vs 1.4% OPCAB, p = NS) whereas there was a significant difference for minor neurological events (12.2% CCAB vs 2.8% OPCAB, p = 0.04). The mean follow-up was 2.1 +/- 1.8 years, for a total follow-up of 234 patient-years. There were 12 late deaths, 6 in the CCAB group and 6 in the OPCAB group. The linearized rate of overall death was 9.5 +/- 2.6%/year in the CCAB group and 13.3 +/- 3.9%/year in the OPCAB group (p = NS). The actuarial survival at 24 months was 84 +/- 7% for OPCAB and 81 +/- 12% for CCAB (p = NS). The actuarial freedom from cardiac events at 24 months was 89 +/- 4% for OPCAB and 90 +/- 6% for CCAB (p = NS). The linearized rate of neurological events was 0.7 +/- 0.7%/year for the CCAB group and 1.1 +/- 1.1%/year for the OPCAB group (p = NS). CONCLUSIONS: Our analysis shows that OPCAB improves the early outcome and that octogenarians can lead event-free lives after cardiac surgery.