[Hybrid operation theatre from the point of view of cardiac surgery. The future for the heart team]. / Hybridoperationssaal aus Sicht der Herzchirurgie. Zukunft für das Herzteam.

Nowadays, increasing numbers of procedures jointly conducted by cardiac surgeons and cardiologists are performed as minimally invasive surgical procedures or interventions. Transcatheter aortic valve implantation, endovascular aortic aneurysm repair and a large variety of hybrid procedures for congenital heart disease have become current standards. Some of these hybrid procedures were shown to improve the therapeutic safety and efficacy, effects particularly true for high-risk patients and complex interventions. Hybrid procedures require indirect imaging, commonly provided by an angiography system in the hybrid operation theatre. This article describes the technical prerequisites required for a hybrid operation theatre as well as indications and rationales for hybrid procedures conducted in this environment. It is likely that the indications for cardiovascular hybrid procedures will continue to be expanded and that the hybrid operation theatre may become a laboratory for developing innovative approaches in the cardiovascular field. Therefore, the hybrid operation theatre will not only be the working environment for hybrid surgeons and interventionalists but also help to evolve their future.

Prolapsing left atrial myxoma: preoperative diagnosis using a multimodal imaging approach with magnetic resonance imaging and real-time three-dimensional echocardiography.

Real-time three-dimensional echocardiography (RT3DE) is a new promising technique for the evaluation of intracardiac masses. We present the diagnostic work-up using a multimodal-imaging approach in a 74-year-old patient with a prolapsing tumour in the left atrium suggestive of a myxoma, causing severe congestive heart failure attributable to dynamic left ventricular inflow obstruction, and mimicking severe mitral valve stenosis. Real-time three-dimensional echocardiography allowed to accurately image the entire volume of the myxoma, and to analyse the dynamic left ventricular inflow obstruction. The size of the lobulated mass as assessed by RT3DE was 65 x 25 x 22 mm. The mass was surgically removed, histology was diagnostic for myxoma, and the patient had an uneventful recovery. Real-time three-dimensional echocardiography images the entire volume of a mass allowing for accurate measurements in multiple planes, and allowing for real-time evaluation of obstructive effects on ventricular in- or outflow. This case shows how RT3DE and other non-invasive imaging modalities may be used as complementary techniques for evaluation of intracardiac masses.

[Surgical treatment of the hypereosinophilic syndrome with cardiac involvement (Löffler's endocarditis)]. / Operative Therapie bei Hypereosinophiliesyndrom mit kardialer Beteiligung (Löffler-Endokarditis).

UNLABELLED: HISTORY AND LABORATORY FINDINGS: A 38-year-old woman presented for further treatment of heart failure with NYHA class III symptoms and the idiopathic eosinophilia syndrome. Differential blood count had previously revealed an eosinophilia of 19%, which had fallen to normal under immunosuppression . INVESTIGATIONS: Echocardiography demonstrated echo-rich material in the left ventricular (LV) apex, severe mitral regurgitation and a restriction pattern in the transmitral flow profile. Magnetic resonance imaging (MRI) additionally showed a parietal thrombus sitting on the echo-rich mass in the LV apex. TREATMENT AND COURSE: Surgical LV endocardial resection and allogenic mitral valve replacement were performed. At follow-up (currently four years after the operation) the patient reported marked improvement of symptoms. Echocardiography and MRI demonstrated a normal configuration of the LV apex. CONCLUSION: While endomyocardial fibrosis usually has a poor prognosis, this case illustrates hat surgical treatment of an associated mitral regurgitation can in selected cases be successful.