Interatrial Septum Stenting for Hypoplastic Left Heart Syndrome in Ex Utero Intrapartum Therapy.

Patients with hypoplastic left heart syndrome (HLHS) with intact atrial septum have an increased mortality rate. This presentation occurs in 6% to 10% of cases. We present a patient with fetal diagnosis of HLHS with restrictive atrial septum. We performed a cesarean section at 37 weeks of gestation, and under ex utero intrapartum treatment proceeded with a median sternotomy and transatrial stenting for left atrial decompression due to findings of intact atrial septum on the fetal echocardiogram performed during the procedure. Subsequently, the patient underwent hybrid stage I palliation followed by a comprehensive stage II procedure at five months of age, but unfortunately died from postoperative complications.

MitraClip as bridge to mitral valve replacement in the setting of ischemic cardiogenic shock and papillary muscle rupture.

MitraClip implantation has been reported in severe mitral regurgitation following ischemic papillary muscle rupture in surgically high-risk patients with cardiogenic shock. Here we present a case of a 68-year-old female patient who suffered an ischemic papillary muscle rupture resulting in severe mitral prolapse and had a MitraClip implanted. Three months later, due to progressive symptoms, she was taken to surgery and had an elective minimally invasive mitral valve replacement. Informed consent was given and ethics board approval was obtained.

Miniature Minimally Invasive Pulmonary Banding in Neonates (MINI-MICS): A Novel Technique.

Single-ventricular cardiopathies are challenging conditions requiring multiple surgical interventions to hopefully achieve adulthood. In neonates, pulmonary artery banding allows ventricular adaptation and pulmonary vascular bed protection. Here we present a novel minimally invasive approach to pulmonary artery banding through a 1.5 cm left parasternal minithoracotomy. This technique not only allows for a less traumatic first procedure but also a less manipulated mediastinum and untouched sternum for the consequent surgeries to come. This technique is reproducible in experienced hands and shows favorable and promising results when performed properly.

MitraClip as bridge to mitral valve replacement in the setting of ischemic cardiogenic shock and papillary muscle rupture.

MitraClip implantation has been reported in severe mitral regurgitation following ischemic papillary muscle rupture in surgically high-risk patients with cardiogenic shock. Here we present a case of a 68-year-old female patient who suffered an ischemic papillary muscle rupture resulting in severe mitral prolapse and had a MitraClip implanted. Three months later, due to progressive symptoms, she was taken to surgery and had an elective minimally invasive mitral valve replacement. Informed consent was given and ethics board approval was obtained.

Nuevas técnicas de imagen en diagnóstico y planeación quirúrgica: reporte de caso de anillo vascular / New imaging techniques in diagnosis and surgical planning: case report of vascular ring

Resumen El crecimiento del campo de las imágenes cardiacas ha permitido realizar diagnósticos más precisos de enfermedades cardiacas complejas, con mejores planeaciones quirúrgicas; por esta razón, las imágenes multimodales cada vez son más útiles en el ámbito clínico y quirúrgico, ya que ofrecen información mejorada sobre la anatomía intracardiaca y extracardiaca. Se presenta el caso de un paciente masculino de once meses de edad, con sintomatología respiratoria y gastrointestinal, en quien se documentó doble arco aórtico gracias a la evaluación imagenológica multimodal, que permitió comprender, con mayor detalle morfológico, la anatomía cardiovascular y, a su vez, evaluar las diferentes proyecciones con las que los cardiólogos y los cirujanos cardiacos están familiarizados. Se contó con la posibilidad de realizar la impresión de corazones tridimensionales, lo cual facilita la comprensión de las relaciones anatómicas, y conduce a mejoría en la toma de decisiones clínicas individualizadas.

Abstract The growth in the field of cardiac imaging has made it possible to make more accurate diagnoses of complex cardiac pathologies, with better surgical planning. This is the because the multimodal images are increasingly useful in the clinical and surgical setting, since they allow improved information on intracardiac and extracardiac anatomy. We present the case of an eleven-month-old male patient with respiratory and gastrointestinal symptoms, in whom A double aortic arch was documented and, thanks to the multimodal imaging evaluation, it made it possible to understand cardiovascular anatomy in greater morphological detail, in turn evaluating the different projections with which cardiologists and cardiac surgeons are familiar, with the possibility of performing the impression. of three-dimensional hearts that can facilitate compression of the intracardiac anatomy, leading to improvement in individualized clinical decision making.

Bench bioprosthetic aortic valve replacement in a donor heart before transplantation.

Critical donor shortages have impulsed the need to expand donor heart eligibility through the use of marginal hearts in cardiac transplantation. Donor valvular disease has been considered as an absolute contraindication for transplant. A 39-year-old male patient with end-stage non-compaction cardiomyopathy, an INTERMACS II heart failure, and a left ventricular ejection fraction of 8% was taken to an orthotopic heart transplantation. During donor bench graft examination, a congenital bicuspid and calcified aortic valve was found. The native bicuspid valve was removed and the annular calcification debrided; a #21 bioprosthetic aortic valve was then implanted.

Peri-operative nutrition in cardiovascular surgery: current pitfalls and future directions.

In the field of cardiovascular surgery, many areas are frequently evaluated to improve patient outcomes. Even though cardiac surgery has advanced significantly, peri-operative nutrition remains an area needing special attention and is under-considered in patient results. The three portions of cardiac surgical nutrition optimization are pre-operative, intra-operative and post-operative. All these, merit important clinical intervention which when done properly can significantly improve patient recovery and reduce morbidity and mortality. Here we provide a narrative review and recommendations for peri-operative nutritional optimization in cardiac surgery.