Diagnostic and surgical management of HeartMate 3 outflow graft obstruction due to two different mechanisms.

Outflow graft obstruction is a potentially catastrophic complication of left ventricular assist devices that may occur secondary to different mechanisms. Two cases of Heartmate 3 outflow graft obstruction associated with two different pathophysiological mechanisms are presented. The first one was a 70-year-old man who developed outflow graft obstruction secondary to kinking. The second case was a 72-year-old man who presented with signs and symptoms of heart failure due to outflow graft extrinsic obstruction. Both cases were diagnosed with 3D-CT scan and successfully surgically treated.

Post-Myocardial Infarction Ventricular Septal Defect Closure by a Percutaneous Septal Occluder Device After Unsuccessful Surgical Closure: Never Lose Hope.

Post myocardial infarction ventricular septal defect (VSD) is a life-threatening complication following ST elevation myocardial infarction (STEMI). Current guidelines recommend the urgent VSD closure for its significant mortality. Despite VSD is generally treated by surgical repair, surgeons often refrain from early surgery due to extremely poor results. We report the case of a 76-year-old women admitted to our hospital for a subacute myocardial infarction complicated by acute heart failure with VSD and apical thrombosis. The patient underwent an urgent surgical repair of VSD with a bovine pericardium patch and concomitant double saphenous vein graft for the left anterior descending and the first diagonal branch. After two days an early surgical patch dehiscence was observed and a percutaneous closure was planned. Due to the particular morphology of the unnatural anatomy of the septum generated by the dehiscence, we decided to close the defect using an off-label device for ventricular rupture. A 30/30 mm Amplatzer ASD-MF occluder was successfully implanted. At one-year follow up the patient was alive without significant residual shunt.

[Pericardial cyst with intracystic hemorrhage. A case report and review of the literature]. / Cisti pericardica complicata da emorragia intracistica. Descrizione di un caso e revisione della letteratura.

Pericardial cysts are rare benign intrathoracic lesions, more often located in the right rather than in the left cardiophrenic angle. At echocardiography, they appear as echolucent unilocular structures, which are in contact with the pericardium. They contain a clear water-like fluid and, thus, are referred to as "spring water cysts". They are usually discovered incidentally in asymptomatic patients. Sometimes they can cause symptoms (dyspnea, chest pain, dysphagia, cough), depending on their dimensions and location, or severe complications such as cardiac tamponade. Asymptomatic cases are managed conservatively with a close follow-up, being surgical excision recommended only in symptomatic patients. Actually, the treatment options include excision via thoracotomy, video-assisted thoracoscopic surgery, and percutaneous echo-guided aspiration. We describe the case of a patient for whom the echocardiographic follow-up allowed to disclose intracystic hemorrhage, leading to surgical treatment before the patient became symptomatic.

[Omentopexy associated with the use of Redon catheters in post-cardiac surgery mediastinitis with vascular prosthesis infection: immediate results in five patients]. / Omentopessi associata all'utilizzo dei cateteri di Redon nelle mediastiniti post-cardiochirurgiche con infezione di protesi vascolari: risultati immediati in cinque pazienti.

BACKGROUND: Post-cardiac surgery mediastinitis is a dangerous complication with an elevated mortality risk particularly when infection affects vascular prostheses. In this paper we report our experience with the use of extensive disinfection and washing of the mediastinum with iodopovidone, followed by omental transposition into the chest with the use of Redon catheters. METHODS: Between September 2001 and March 2007, 5 patients were treated with this technique (submitted to Bentall intervention in 2 cases, substitution of the ascending aorta, Bentall intervention with substitution of the aortic arch and substitution of the aortic arch in 1 case, respectively), due to a sternomediastinitis and correlated infection of the vascular prosthesis. Among them, 3 consisted of a redo surgery. RESULTS: One patient with unstable hemodynamic conditions died of multiorgan failure following a state of generalized sepsis; the remaining 4 patients had complete resolution of the clinical picture. None showed complications related to the procedure. The 4 survived patients were followed up at 1 month and underwent clinical and instrumental evaluation by chest computed tomography, which yielded negative results without signs of infection. CONCLUSIONS: Our limited experience definitely encourages us to use these combined techniques in the treatment of post-cardiac surgery mediastinitis in patients with vascular prostheses.

[Bentall operation after previous repair of tetralogy of Fallot]. / Intervento di Bentall in paziente con pregresso intervento di correzione di tetralogia di Fallot.

Pathologies that involve the ascending aorta are described in case reports of patients after complete repair of tetralogy of Fallot. Here, we present a case report. Preoperative tests showed an aortic ratio of > 1.5. The patient was operated on replacement of the ascending aorta according to the Bentall technique. At present, the guidelines for replacement of the ascending aorta recommend an aortic ratio of > 1.5 and in case of Marfan syndrome of > 1.3. In these patient subsets, cystic medial necrosis and an increased risk of aortic dissection have been described. Therefore, as for Marfan syndrome, why an aortic ratio of >1.3 should not be considered a proper surgical indication also for these patients?