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1.
J Card Surg ; 37(11): 3801-3810, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36040710

RESUMO

BACKGROUND: Although concomitant pulmonary vein isolation (PVI) is used more frequently than the Cox-Maze procedure, which is currently the gold standard treatment for atrial fibrillation (AF), data on the comparative effectiveness of the two procedures after concomitant mitral valve (MV) surgery are still limited. OBJECTIVE: We conducted a systematic review to identify randomized controlled trials (RCTs) and observational studies comparing the mid-term mortality and recurrence of AF after concomitant Cox-Maze and PVI in patients with AF undergoing MV surgery based on 12-month follow-up. METHODS: Medline, EMBASE databases, and the Cochrane Library were searched from 1987 up to March 2022 for studies comparing concomitant Cox-Maze and PVI. Additionally, a meta-analysis of RCTs was performed to compare the mid-term clinical outcomes between these two surgical ablation techniques. RESULTS: Three RCTs and three observational studies meeting the inclusion criteria were included in this systematic review with 790 patients in total (532 concomitant Cox-Maze and 258 PVI during MV surgery). Most studies reported that the concomitant Cox-Maze procedure was associated with higher freedom from AF at 12-month follow-up than PVI. Regarding AF recurrence, estimates pooled across the three RCTs indicated large heterogeneity and high uncertainty. In the largest and highest quality RCT, 12-month AF recurrence was higher in the PVI arm (risk ratio = 1.58, 95% CI: 0.91-2.73). In two out of three higher-quality observational studies, 12-month AF recurrence was higher in PVI than in the Cox-Maze arm (estimated adjusted probabilities 11% vs. 8% and 35% vs. 17%, respectively). RCTs demonstrated comparable 12-month mortality between concomitant Cox-Maze and PVI, while observational studies demonstrated the survival benefit of Cox-Maze. CONCLUSIONS: Concomitant Cox-Maze in AF patients undergoing MV surgery is associated with better mid-term freedom from AF when compared to PVI with comparable mid-term survival. Large observational studies suggest that there might be a mid-term survival benefit among patients after concomitant Cox-Maze. Further large RCTs with longer standardized follow-up are required to clarify the benefits of concomitant Cox-Maze in AF patients during MV surgery.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/complicações , Ablação por Cateter/métodos , Humanos , Procedimento do Labirinto , Valva Mitral/cirurgia , Veias Pulmonares/cirurgia , Recidiva , Resultado do Tratamento
3.
Eur J Cardiothorac Surg ; 63(5)2023 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-36946284

RESUMO

OBJECTIVES: Studies concerning factors associated with long-term outcomes in adult congenital heart disease (ACHD) patients after infective endocarditis (IE) are scarce, while IE-related mortality in these patients remains a burden. We evaluated the factors associated with long-term survival in ACHD patients admitted for IE. METHODS: We performed a retrospective single-centre study of all ACHD patients admitted for IE to a tertiary cardiothoracic centre between 1999 and 2015. Underlying ACHD, detailed echocardiographic and clinical data, surgical treatment and long-term follow-up were analysed. RESULTS: We identified 151 ACHD patients admitted due to 176 episodes IE with 30-day, 6-month and 1-, 5- and 10-year survival of 95.4%, 92.7%, 92.7%, 84.7% and 75.6%, respectively. In a multivariable analysis, adjusted estimated probability of death was consistently higher after an IE episode among patients with complex as compared to simple/moderate ACHD: 10.6% vs 2.4% at 30 days, 15.0% vs 3.4% at 6 months and 1 year, 30.4% vs 7.8% at 5 years and 44.9% vs 13.1% at 10 years. Risk of death was higher among patients with prosthetic valve in comparison with those without (risk ratios 1.73-1.92). Surgical treatment was required in 76 (43.2%) episodes with 30-day mortality of 3.9%. Risk of death appeared to be lower than in the conservatively treated subgroup (risk ratios 0.71-0.78). CONCLUSIONS: We demonstrated satisfactory long-term survival in ACHD patients who were treated for IE in a tertiary cardiothoracic centre. Early mortality tended to be lower in the surgically treated subgroup. Factors negatively associated with long-term survival were complex ACHD and presence of prosthetic valve.


Assuntos
Endocardite Bacteriana , Endocardite , Cardiopatias Congênitas , Humanos , Adulto , Estudos Retrospectivos , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Endocardite Bacteriana/complicações , Endocardite/complicações , Endocardite/cirurgia
4.
Eur J Cardiothorac Surg ; 63(6)2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-37233116

RESUMO

OBJECTIVES: While open surgical repair remains the gold standard for thoracoabdominal aortic aneurysm (TAAA) treatment, there is still no consensus regarding perioperative neuromonitoring technique for prevention of spinal cord ischaemia. METHODS: In this systematic review, we aimed to explore the effects and practices of neuromonitoring during the open TAAA repair. A systematic literature search in PubMed, Embase via Ovid, Cochrane library and ClinicalTrialsGov until December 2022 was performed. RESULTS: A total of 535 studies were identified from the literature search, of which 27 studies including a total of 3130 patients met the eligibility criteria. Most studies (21 out of 27, 78%) investigated the feasibility of motor-evoked potentials (MEP), while 15 analysed somatosensory-evoked potentials (SSEP) and 2 studies analysed near-infrared spectroscopy during open TAAA repair. CONCLUSIONS: Current literature suggest that rates of postoperative spinal cord ischaemia can be kept at low levels after open TAAA repair with the adequate precautions and perioperative manoeuvres. Neuromonitoring with MEP provides the surgeon objective criteria to direct selective intercostal reconstruction or other protective anaesthetic and surgical manoeuvres. Simultaneous monitoring of MEP and SSEP is a reliable method that can rapidly detect important findings and direct adequate protective manoeuvres during open TAAA repair.


Assuntos
Aneurisma da Aorta Torácica , Aneurisma da Aorta Toracoabdominal , Implante de Prótese Vascular , Isquemia do Cordão Espinal , Humanos , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Resultado do Tratamento , Potencial Evocado Motor , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/prevenção & controle , Estudos Retrospectivos
6.
Swiss Med Wkly ; 150: w20192, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-32031667

RESUMO

On 3 December 1967, Christiaan Barnard performed the first heart transplantation in the world at Groote Schuur Hospital in Cape Town, South Africa. In the succeeding months, heart transplantations in the USA, Asia and Europe followed. On 14 April 1969, Åke Senning successfully accomplished the first heart transplantation in Switzerland at the former Cantonal Hospital in Zurich. In the summer of 1969, he undertook a second heart transplantation. Although the surgical procedure went well technically, both patients died within weeks to months after transplantation. Causes of death were infection in the first and rejection in the second patient. Senning’s colleagues around the world had similar experiences. Survival after heart transplantation was unacceptably low. The heart transplant community recognised the lack of knowledge about immunological processes and appropriate immunosuppressive regimens as underlying reason for the early deaths. Most transplant centres decided to refrain from heart transplantation until sufficient immunological insight became available. After the introduction of the new immunosuppressive drug ciclosporin into the clinic and the availability of tools to monitor rejection in the early 1980s, heart transplant programmes were restarted all over the world. The legal recognition of brain death allowed procurement of donor hearts without exposure to warm ischaemia, and the principle of cold storage enabled prolongation of ischaemia time and acceptance of donors in distant hospitals, resulting in enlargement of the donor pool. In Switzerland, Marko Turina resumed heart transplantation in 1985 at Senning’s former workplace in Zurich. The number of heart transplants in Switzerland and in the world grew rapidly because the outcome markedly improved. Particularly over the long-term, survival in Zurich surpassed the outcome worldwide. Zurich created internationally recognised milestones such as transplantation of patients with grown-up congenital heart disease, the implementation of the bicaval instead of the right atrial anastomosis during the transplant procedure and the dual transplantation of one heart. Since the middle of the 1990s, however, the number of heart transplants has plateaued, mainly because of donor shortage. The current era is characterised by efforts to increase the number of donors. The utilisation of marginal donors, the change from informed to presumed consent for organ donation and donation after cardiocirculatory-determined death have been proposed to augment the donor pool.


Assuntos
Transplante de Coração/história , Aniversários e Eventos Especiais , Ciclosporina/uso terapêutico , Transplante de Coração/métodos , Transplante de Coração/mortalidade , Transplante de Coração/estatística & dados numéricos , História do Século XX , História do Século XXI , Humanos , Imunossupressores/uso terapêutico , Consentimento Presumido , África do Sul/epidemiologia , Suíça/epidemiologia
7.
Eur J Cardiothorac Surg ; 34(1): 55-61, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18482844

RESUMO

BACKGROUND: In this retrospective study we evaluate the causative mechanisms underlying postoperative atrioventricular block (AVB) following mitral valve replacement and mitral valve annuloplasty. METHODS: Between January 1990 and December 2003, 391 patients underwent mitral valve replacement or ring annuloplasty and quadrangular resection. Exclusion criteria were preoperative AV block, two or three valvular procedures, reoperations and procedures combined with coronary artery bypass grafting. The presence of the postoperative AVB was compared with preoperative and intraoperative variables. On 55 post-mortem specimens the relationship between the AV node, AV node artery and mitral valve annulus was investigated. RESULTS: The mean age was 59+/-14 years and 44% of patients were female. Postoperatively AVB occurred in 92 (23.5%) patients. AVB III was found in 17 (4%) patents, in whom a pacemaker was implanted within median interval of 4 days. Second degree AVB occurred and first degree AVB in five (1.3%) and in 70 (18%) patients respectively. In dry dissected human hearts in 23% of investigated cases the AV node artery was discovered to run close to the annulus of the mitral valve. CONCLUSIONS: Data collected in this study showed that, sotalol and amiodarone as well as a prolonged cross-clamp time may slightly influence the 23% incidence of postoperative AVB. The morphological investigation showed that the AV node artery runs in close proximity to the annulus in 23% of cases. We speculate that damage of the AV node artery may play a role in development of AVB.


Assuntos
Bloqueio Atrioventricular/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adolescente , Adulto , Idoso , Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Artérias/anatomia & histologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Nó Atrioventricular/anatomia & histologia , Criança , Constrição , Métodos Epidemiológicos , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/anatomia & histologia , Insuficiência da Valva Mitral/etiologia , Marca-Passo Artificial , Complicações Pós-Operatórias , Sotalol/efeitos adversos
8.
Eur J Cardiothorac Surg ; 31(1): 31-5, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17126557

RESUMO

OBJECTIVE: To discuss geometric factors, which may influence long-term results relating to homograft competence following the Ross procedure, we describe the 3D morphology of the pulmonary and aortic roots. MATERIALS: Measurements were made on 25 human aortic and pulmonary roots. Inter-commissural distances and the heights of the sinuses were measured. For geometrical reconstruction the three commissures and their vertical projections at the root base were used as reference points. RESULTS: In the pulmonary root, the three inter-commissural distances were of similar dimensions (17.9+/-1.6mm, 17.5+/-1.4mm and 18.6+/-1.5mm). In the aortic root, the right inter-commissural distance was greatest (18.8+/-1.9mm), followed by the non-coronary (17.4+/-2.0mm) and left coronary sinus commissures (15.2+/-1.9mm). The mean height of the left pulmonary sinus was greatest (20+/-1.7mm) followed by the anterior (17.5+/-1.4mm) and right pulmonary sinus (18+/-1.66mm). In the aortic root, the height of the right coronary sinus was the greatest (19.4+/-1.9mm) followed by the heights of the non-coronary (17.7+/-1.8mm) and left coronary sinus (17.4+/-1.4mm). Measured differences between parameters determine the tilt angle and direction of the root vector. The tilt angle in the pulmonary root averaged 16.26 degrees , respectively; for the aortic roots, it was 5.47 degrees . CONCLUSIONS: Herein we suggest that the left pulmonary sinus is best implanted in the position of the right coronary sinus, the anterior pulmonary in the position of the non-coronary sinus and the right pulmonary sinus in the position of the left coronary sinus. In this way, the direction of the pulmonary root vector will be parallel to that of the aortic root vector.


Assuntos
Valva Aórtica/anatomia & histologia , Implante de Prótese de Valva Cardíaca/métodos , Modelos Cardiovasculares , Valva Pulmonar/anatomia & histologia , Valva Pulmonar/transplante , Adulto , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Humanos , Pessoa de Meia-Idade , Modelos Anatômicos
9.
J Heart Valve Dis ; 15(2): 225-9, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16607905

RESUMO

BACKGROUND AND AIM OF THE STUDY: The study aim was to describe the topographical relationship of the atrioventricular (AV) node artery and mitral valve annulus fibrosus with regard to AV node dysfunction following mitral valve replacement or ring annuloplasty. METHODS: The anatomy of the AV node artery was analyzed in 55 human hearts without previous pathological alterations. Selective coronary angiograms were performed to identify the AV node origin. Run-off of the AV node artery and its topographical relationship to the mitral valve attachment was analyzed in dry-dissected hearts. The position of the AV node was verified by histological sectioning. RESULTS: The AV node artery originated from the right coronary artery in 73% of examined cases, and from the left coronary artery in 27% of cases. The left AV node artery was closely related to the mitral valve attachment, especially at the area of the left proximal part of the posterior leaflet. CONCLUSION: These morphological data were compared to clinical reports emphasizing the postoperative incidence of AV block after mitral valve implantation and ring annuloplasty. The occurrence of early postoperative AV node block ranged from 20% to 37%. By comparing the present data with available literature, it can be stated that there is a high risk of intraoperative damage to the left AV node artery during manipulation of the mitral valve annulus fibrosus.


Assuntos
Nó Atrioventricular/anatomia & histologia , Vasos Coronários/anatomia & histologia , Adulto , Idoso , Cadáver , Angiografia Coronária , Ventrículos do Coração/anatomia & histologia , Humanos , Técnicas In Vitro , Pessoa de Meia-Idade , Valva Mitral/anatomia & histologia
10.
Circulation ; 106(12 Suppl 1): I143-50, 2002 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-12354724

RESUMO

BACKGROUND: We previously demonstrated the successful tissue engineering and implantation of functioning autologous heart valves based on vascular-derived cells. Human marrow stromal cells (MSC) exhibit the potential to differentiate into multiple cell-lineages and can be easily obtained clinically. The feasibility of creating tissue engineered heart valves (TEHV) from MSC as an alternative cell source, and the impact of a biomimetic in vitro environment on tissue differentiation was investigated. METHODS AND RESULTS: Human MSC were isolated, expanded in culture, and characterized by flow-cytometry and immunohistochemistry. Trileaflet heart valves fabricated from rapidly bioabsorbable polymers were seeded with MSC and grown in vitro in a pulsatile-flow-bioreactor. Morphological characterization included histology and electron microscopy (EM). Extracellular matrix (ECM)-formation was analyzed by immunohistochemistry, ECM protein content (collagen, glycosaminoglycan) and cell proliferation (DNA) were biochemically quantified. Biomechanical evaluation was performed using Instron(TM). In all valves synchronous opening and closing was observed in the bioreactor. Flow-cytometry of MSC pre-seeding was positive for ASMA, vimentin, negative for CD 31, LDL, CD 14. Histology of the TEHV-leaflets demonstrated viable tissue and ECM formation. EM demonstrated cell elements typical of viable, secretionally active myofibroblasts (actin/myosin filaments, collagen fibrils, elastin) and confluent, homogenous tissue surfaces. Collagen types I, III, ASMA, and vimentin were detected in the TEHV-leaflets. Mechanical properties of the TEHV-leaflets were comparable to native tissue. CONCLUSION: Generation of functional TEHV from human MSC was feasible utilizing a biomimetic in vitro environment. The neo-tissue showed morphological features and mechanical properties of human native-heart-valve tissue. The human MSC demonstrated characteristics of myofibroblast differentiation.


Assuntos
Células da Medula Óssea/citologia , Próteses Valvulares Cardíacas , Células Estromais/citologia , Engenharia Tecidual/métodos , Implantes Absorvíveis , Adulto , Reatores Biológicos , Diferenciação Celular , Células Cultivadas , Matriz Extracelular/química , Estudos de Viabilidade , Citometria de Fluxo , Valvas Cardíacas/anatomia & histologia , Valvas Cardíacas/citologia , Valvas Cardíacas/fisiologia , Valvas Cardíacas/ultraestrutura , Humanos , Imuno-Histoquímica , Microscopia Eletrônica de Varredura , Células Estromais/química , Resistência à Tração
11.
Eur J Cardiothorac Surg ; 27(2): 222-5, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15691674

RESUMO

OBJECTIVE: Pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) lead to poor outcome after heart transplantation due to postoperative failure of the non-conditioned right ventricle. The role of continuous flow left ventricular assist device (LVAD) support in the reduction of elevated PVR was evaluated in a series of clinical implants. METHODS: Among 17 patients with terminal heart failure receiving a MicroMed DeBakey LVAD as bridge to transplant, there were six patients with pulmonary hypertension (mean systolic PAP 47 mmHg) and high PVR (398 dynes/cm5), previously not considered suitable for heart transplantation, who underwent serial right heart catheters during their LVAD support period. RESULTS: In these patients mean systolic pulmonary pressure dropped to 29 mmHg and PVR decreased to a mean 167 dynes/cm5 under LVAD support. Clinical improvement was significant in all patients. Four patients were successfully transplanted without major postoperative difficulties (mean duration 130 days support) and all are doing well to date. Post-transplant-PVR remained in the normal range in all transplanted patients. CONCLUSIONS: Elevated PVR and severe PH were both previously considered as contraindication for heart transplantation. A period of LVAD pumping leads to a progressive decrease of PVR and normalization of pulmonary pressures, making these patients amenable for heart transplantation. LVAD as bridge to heart transplantation is safe and highly beneficial for terminal heart failure patients with severe PH.


Assuntos
Baixo Débito Cardíaco/cirurgia , Transplante de Coração/métodos , Coração Auxiliar , Resistência Vascular/fisiologia , Adulto , Baixo Débito Cardíaco/complicações , Baixo Débito Cardíaco/fisiopatologia , Ventrículos do Coração/cirurgia , Hemodinâmica/fisiologia , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Pressão Propulsora Pulmonar/fisiologia , Resultado do Tratamento , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/fisiopatologia , Disfunção Ventricular Direita/cirurgia
12.
J Thorac Cardiovasc Surg ; 127(6): 1678-81, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15173723

RESUMO

OBJECTIVE: The objective of this study was to assess the safety of directly closing the septum primum during the correction of atrioventricular canal defects. METHODS: We performed a retrospective analysis of our experience with direct closure of the septum primum during the repair of atrioventricular canal defect. The series consisted of 28 consecutive patients presenting with a partial (15 patients) and complete (13 patients) atrioventricular canal defect. The cleft in the atrioventricular valve was closed completely in 25 patients and partially in 3 patients (those with a small left lateral leaflet). In complete atrioventricular canal, the ventricular septum defect was closed with a patch of polytetrafluoroethylene (Gore-Tex, W. L. Gore & Associates, Inc, Flagstaff, Ariz) or xenopericardium. Follow-up was complete and ranged from 3 to 21 months (median 11 months). RESULTS: There were no early or late deaths and no surgical complications. The septum primum defect was closed completely in all patients as assessed by echocardiography. All the patients were in sinus rhythmus, and none had even a temporary complete atrioventricular block. The surgical result and heart rhythm have remained stable over time. CONCLUSIONS: Direct closure of the septum primum is an easy, quick, and safe procedure during repair of atrioventricular defects.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana , Comunicação Atrioventricular/diagnóstico por imagem , Comunicação Atrioventricular/cirurgia , Septos Cardíacos/cirurgia , Fatores Etários , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Pré-Escolar , Feminino , Testes de Função Cardíaca , Humanos , Lactente , Masculino , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
13.
J Thorac Cardiovasc Surg ; 127(5): 1421-6, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15116002

RESUMO

BACKGROUND: Reducing the negative side effects associated with extracorporeal circulation is the major advantage of off-pump revascularization. However, side clamping of a calcified aorta for proximal anastomoses can cause emboli, resulting in neurologic damage. This problem has been addressed by introducing a mechanical anastomosis device (Symmetry, St Jude Medical) that allows vein-to-aorta anastomosis without manipulating the aorta. This report describes our experience with this device. METHODS: Between June 2001 and April 2002, 77 connectors (1.3 per patient) were deployed in 61 patients (51 men and 10 women; mean age, 68 +/- 8.6 years) undergoing off-pump coronary artery bypass grafting or beating-heart revascularization. Intraoperative quality assessment included transit-time flow measurement (Medistim) and indocyanine green-based angiography (Spy, Novadaq). RESULTS: The surgeons were meticulously trained in loading of the device. No postoperative neurologic deficits were detected. Fifty-three patients had an uneventful course. However, 8 (13.1%) patients with 12 implanted connectors were symptomatic within 8 months (1 day to 8 months). Angiography revealed significant (95%) stenosis or even occlusion of the proximal vein-to-aorta anastomosis at the level of all connectors. Four patients underwent reoperation (2 dilated-stented and 2 treated with drugs). CONCLUSION: On the basis of these observations, the routine use of the connector was halted at our institution. At the moment, the use of this therapy is reserved for patients with severely calcified aortas with no technical alternative. Further investigations appear necessary to evaluate the clinical patterns of this otherwise promising technology.


Assuntos
Ligas , Anastomose Cirúrgica/instrumentação , Aorta/cirurgia , Ponte de Artéria Coronária , Veias/transplante , Idoso , Doenças da Aorta/patologia , Calcinose/patologia , Angiografia Coronária , Falha de Equipamento , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Complicações Pós-Operatórias
14.
Ann Thorac Surg ; 76(3): 732-5; discussion 735-6, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12963186

RESUMO

BACKGROUND: Our basic aim was to describe the topographic relation between the sinus node artery and the superior posterior border of the interatrial septum with regard to the sinus node dysfunction that follows the superior transseptal approach to the mitral valve. METHODS: During our study 50 human hearts without previous pathologic alterations were analyzed. The position of the sinus node and the course of the sinus node artery were investigated. For identification of the origin of the artery, selective coronary angiograms were performed. The course of sinus node artery and its topographic relation to the interatrial septum was identified by the dry dissections of the hearts. Based on histologic and dry dissected specimens the exact position of the sinus node was determined. RESULTS: We found that the sinus node artery originates from the right coronary artery in 66% of examined cases and from the left coronary artery in 34% of cases. The sinus node artery crosses the superior posterior border of the interatrial septum in 54% of cases. CONCLUSIONS: Our results were compared with clinical studies focusing the incidence of the sinus rhythm disturbance after the superior transseptal approach. The incidence of rhythm disturbance varies from 52% to 60% of cases. Comparing our morphologic and clinical results we can state that the risk for intraoperative damage to the sinus node artery during the superior transseptal approach to the mitral valve is high.


Assuntos
Nó Atrioventricular/anatomia & histologia , Vasos Coronários/anatomia & histologia , Adulto , Idoso , Artérias , Cadáver , Humanos , Pessoa de Meia-Idade
15.
Ann Thorac Surg ; 77(5): 1857-9, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15111215

RESUMO

Harmonious reduction of the posterior annulus of the mitral valve can be a useful adjunct to obtain complete valve competence in case of annular dilatation. We present a technique with the use of two resorbable sutures that overlap over the middle third of the posterior annulus that was used in 10 children with good short-term results. Resorption of the sutures should permit subsequent normal growth of the mitral valve. If the primary cause of valvular regurgitation was corrected, it can be expected that the repair will remain stable after resorption of the sutures.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Criança , Pré-Escolar , Dilatação Patológica , Feminino , Humanos , Lactente , Masculino , Valva Mitral/patologia , Técnicas de Sutura
16.
Ann Thorac Surg ; 75(5): 1626-9, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12735592

RESUMO

Recently the Symmetry Bypass System (SJM, St. Paul, MN) became available. Now the system is frequently applied for vein-graft to aorta anastomoses in off-pump coronary artery bypass operations. This report describes a complication associated with the use of the Symmetry Bypass System (SJM) in a patient undergoing a standard off-pump coronary artery bypass procedure. A novel imaging system (SPY, Novadaq, Toronto, Canada) was applied for intraoperative assessment of graft function, and this system immediately diagnosed the occlusion of the proximal mechanical anastomosis caused by a mobile atheromatous aortic plaque.


Assuntos
Ponte de Artéria Coronária/instrumentação , Oclusão de Enxerto Vascular/etiologia , Idoso , Anastomose Cirúrgica/instrumentação , Embolia/diagnóstico , Oclusão de Enxerto Vascular/diagnóstico , Humanos , Masculino , Veias
17.
Ann Thorac Surg ; 75(3): 944-6, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12645721

RESUMO

BACKGROUND: Detachment of the septal leaflet of the tricuspid valve has been described for better access to perimembranous ventricular septal defects. Detachment confined to the anterior leaflet is less known, although it provides a better exposure of the subaortic area and puts less jeopardy on the conduction tissues. METHODS: Data regarding 49 consecutive patients who had congenital perimembranous ventricular septal defect closure were retrospectively reviewed. Thirty-three patients (67%) underwent temporary detachment of the anterior leaflet of the tricuspid valve. The defect was closed with a Gore-Tex patch and a continuous suture. In 10 patients (29%), concomitant right ventricular outflow tract enlargement was performed. Follow-up was obtained in every patient (median time, 11 months; range, 2 to 26 months). RESULTS: No early or late death occurred. Closure of the ventricular septal defect was complete, with no more than trivial residual jet leaks found in perioperative echocardiography. All patients were in sinus rhythm. The tricuspid valve never showed more than mild insufficiency after repair. No patient showed subaortic obstruction. CONCLUSIONS: Detachment of the anterior leaflet of the tricuspid valve to expose the ventricular septal defect is a safe approach that allows rapid closure of the defect with a continuous suture and provides excellent results.


Assuntos
Comunicação Interventricular/cirurgia , Valva Tricúspide/cirurgia , Implante de Prótese Vascular , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Politetrafluoretileno , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Técnicas de Sutura , Obstrução do Fluxo Ventricular Externo/cirurgia
18.
Ann Thorac Surg ; 74(1): 46-52; discussion 52, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12118802

RESUMO

BACKGROUND: Tissue engineering represents a promising approach to in vitro creation of living, autologous replacements with the potential to grow, repair, and remodel. Particularly in a congenital operation, there is a substantial need for such implantation materials. We previously demonstrated fabrication of completely autologous, functional heart valves on the basis of peripheral vascular cells. Presently the feasibility of creating pulmonary artery conduits from human umbilical cord cells was investigated. METHODS: Human umbilical cord cells were harvested and expanded in culture. Pulmonary conduits fabricated from rapidly bioabsorbable polymers were seeded with human umbilical cord cells and grown in vitro in a pulse duplicator bioreactor. Morphologic characterization of the generated neo-tissues included histology, transmission, and scanning electron microscopy. Characterization of extracellular matrix was comprised of immunohistochemistry. Extracellular matrix protein content and cell proliferation were quantified by biochemical assays. Biomechanical testing was performed using stress-strain and burst-stress tests. RESULTS: Histology of the conduits revealed viable, layered tissue and extracellular matrix formation with glycosaminoglycans and collagens I and III. Cells stained positive for vimentin and alpha-smooth muscle actin. Scanning electron microscopy showed confluent, homogenous tissue surfaces. Transmission electron microscopy demonstrated elements typical of viable myofibroblasts, such as collagen, fibrils, and elastin. Extracellular matrix proteins were significantly lower compared with native tissue; the cell content was increased. The mechanical strength of the pulsed constructs was comparable with native tissue; the static controls were significantly weaker. CONCLUSIONS: In vitro fabrication of tissue-engineered human pulmonary conduits was feasible utilizing human umbilical cord cells and a biomimetic culture environment. Morphologic and mechanical features approximated human pulmonary artery. Human umbilical cord cells demonstrated excellent growth properties representing a new, readily available cell source for tissue engineering without necessitating the sacrifice of intact vascular donor structures.


Assuntos
Artéria Pulmonar , Engenharia Tecidual , Cordão Umbilical/citologia , Implantes Absorvíveis , Divisão Celular , Células Cultivadas , Técnicas de Cultura/métodos , Endotélio Vascular/citologia , Matriz Extracelular/metabolismo , Estudos de Viabilidade , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Estresse Mecânico , Transplante Autólogo
19.
J Heart Valve Dis ; 13(2): 272-80, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15086267

RESUMO

Heart valve replacement represents the most common surgical therapy for end-stage valvular heart diseases. One major drawback that all heart valve replacements have in common is the lack of growth, repair, and remodeling capability once implanted into the body. The emerging field of tissue engineering is focusing on the in-vitro generation of functional, living semilunar heart valve replacements. This review presents a state-of-the-art overview of the physiological and biomechanical requirements of semilunar heart valves, focusing on the aortic valve. Moreover, recent heart valve tissue engineering is summarized and future options and improvements on the way towards clinical applications are discussed.


Assuntos
Próteses Valvulares Cardíacas/tendências , Engenharia Tecidual/tendências , Animais , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Bioprótese/tendências , Previsões , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/tendências , Humanos , Desenho de Prótese/tendências
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