Post-traumatic tricuspid insufficiency: a case report

Post-traumatic tricuspid insufficiency is a rare complication of chest trauma. An 18-year-old male patient was injured in a bicycle accident from his abdominal and anterior chest wall. The tear on the inferior diaphragmatic surface of the heart was repaired with primary sutures by the attending surgeon. Eighteen years later, he was admitted to the hospital with severe tricuspid regurgitation (3+/4+). During the operation, the valve was determined unsuitable for repair and was replaced with a bioprosthesis. The hemodynamic aberrations relevant to an isolated tricuspid valve injury are very often well-tolerated. Reconstructive surgery may be possible in the early period. In the late cases, repair is sometimes not feasible due to degeneration of the valvular apparatus. Replacement with a biological prosthesis may give the best long-term results in longstanding cases

Successful coronary artery bypass grafting in a patient with bilateral internal carotid artery occlusion: a case report

The best management regimen for patients with coronary artery disease requiring surgery and bilateral total internal carotid artery occlusion remains controversial. A 61-year-old male patient presented with unstable angina pectoris. His medical history revealed that he had a cerebrovascular accident 11 years ago. On physical examination, he had dysarthria and monoparesis on the right upper extremity. Coronary and carotid angiography revealed critical coronary artery stenosis and total occlusion of bilateral internal carotid arteries, total occlusion of the right vertebral artery and 40% stenosis of the left proximal vertebral artery. After general intravenous fentanyl anesthesia, low dose heparin was administered, and coronary artery bypass grafting (CABG) was performed under off-pump beating heart condition. Systolic blood pressure was maintained above 120 mmHg to preserve cerebral blood flow during the operation. The postoperative course was uneventful and the patient was discharged in the 7(th) day postoperatively. If CABG is mandatory in patients having high cerebrovascular risk, off-pump CABG could be performed to reduce the stroke risk

On-pump beating heart mitral valve surgery without cross-clamping the aorta

Background and Aim: Cardiac reperfusion injury is a well-described complication occurring after ischemia or following cardioplegic arrest. Various strategies have been developed to prevent ischemic reperfusion injury. The aim of this study was to assess the efficacy and applicability of the on-pump beating heart mitral valve surgery without cross-clamping the aorta in order to prevent reperfusion injury. Methods: The prospective study (between April 2005 and December 2006) included 88 consecutive patients who underwent mitral valve surgery. The operations were carried out on a beating heart using normothermic cardiopulmonary bypass without cross-clamping the aorta, therefore perfusing the heart antegradely through the aortic root. Venting the heart from the aorta and the pulmonary vein provided adequate visualization of the operative field. Results: Seventy-eight patients (88.6%) underwent mitral valve replacement and 10 patients (11.3%) underwent mitral valve repair with this technique. Concomitant surgery was required in 29 patients (32.9%). Twenty-five patients (28.4%) had also undergone previous open heart surgery. Mean cardiopulmonary bypass time was 57.4 +/- 18.4 minutes. Mean duration of ventilation was 12.2 +/- 3.5 hours, mean intensive care unit stay was 1.3 +/- 1.6 days, and mean hospital stay was 6.9 +/- 4.5 days. One-year survival was 96.6% for all causes of mortality. Conclusions: In this study, we showed that on-pump beating heart operations without cross-clamping is an acceptable surgical choice for mitral valve disease. Complication rates are low and perioperative mortality is lower than that generally reported with conventional technique

Mitral valve replacement with the beating heart technique in a patient with previous bypass graft from ascending to descending aorta due to aortic coarctation

Background and Aim: Conventional mitral valve replacement (MVR) is carried out under cardioplegic arrest with cross-clamping of the ascending aorta during cardiopulmonary bypass. In this case, MVR was performed with on-pump beating heart technique without cross-clamping the aorta because of the diffuse adhesion around the ascending aorta, and tube graft presence between ascending and descending aortas. Methods: A 47-year-old female patient had aorto-aortic bypass graft from ascending aorta to descending aorta with median sternotomy and left thoracotomy in single stage because of aortic coarctation 2 years ago in our cardiac center. She was admitted to the hospital with palpitation and dyspnea on mild exertion. Transthoracic echocardiography revealed 4th degree mitral insufficiency. Results: MVR was carried out through remedian sternotomy with on-pump beating heart technique without cross-clamping the aorta. Conclusions: MVR with on-pump beating heart technique offers a safe approach when excessive dissection is required to place cross-clamp on the ascending aorta

Patient-prosthesis mismatch in patients with mechanic aortic valve replacement: Which method is better: In vitro or in vivo measurement?

Patient-prosthesis mismatch is usually accepted to be associated with poor outcomes in patients with aortic valve replacement (AVR). This study aims to evaluate prevalence, sensitivity and specificity of mismatch measured with in vivo and in vitro methods, look for a relationship between mismatch and obesity, and investigate the effect of mismatch on left ventricle mass index (LVMI) regression and mortality. A total of 72 consecutive patients who underwent mechanical AVR between December 2011 and May 2013, were prospectively evaluated. EOA was measured with echocardiography in all patients on the 6th postoperative month and an Indexed Effective Orifice Area (EOA) ≤0.85cm2/m2 was accepted as mismatch with the in vivo measurement method. For the in vitro measurement method, charts provided by the valve manufacturers were used for EOA prediction. LVMI was also evaluated on the 6th and 12th postoperative months. Postoperative follow-up is 100% complete with 68.5±14.4 months. In vivo and in vitro mismatch prevalences were 43.5% and 25.0% with slight concordance (kappa=0.172). Sensitivity of in vitro measurements was poor (35.7%), but specificity was 80.5%. LVMI regressions were significant with both mismatch methods (p0.05 in both). In vitro EOA measurements have a poor sensitivity to predict mismatch preoperatively. Left ventricular mass regressions were significant in all groups with no difference in early and late mortality. [Med-Science 2020; 9(4.000): 1045-52

Fifteen years survival without anticoagulation after mechanical tricuspid valve replacement: a case report

Isolated tricuspid valve replacement is not a common operation and the choice between mechanical and biologic prostheses remains controversial. When mechanical prosthesis are used, anticoagulant therapy is mandatory. In this article, we report a 21-years-old female patient who survived 15-years without anticoagulation following tricuspid valve replacement with a Bjork-Shiley prosthesis. Ultimately the mechanical valve was stuck and we replaced the tricuspid valve with a St. Jude Medical trileaflet bioprosthesis

Tricuspid Valve Replacement Through Right Thoracotomy has Better Outcomes in Redo Cases

Background The tricuspid valve is usually ignored and tricuspid interventions are mostly done in the context of other planned cardiac surgery. Isolated tricuspid reoperative procedure, especially tricuspid valve replacement (TVR) is very rare and carries a very high mortality rate. In this prospective study, clinical results of isolated TVR either through a median re-sternotomy or an antero-lateral thoracotomy with conventional cardiopulmonary bypass (CPB) have been evaluated