Coronary sinus reconstruction - 2 cases report

University of Medicine and Pharmacy "Gr. T. Popa”, Iasi, Cardiovascular Disease Institute, Iasi (IBCV Iasi)Introduction: Coronary sinus and ostium primum (unique atrium type) atrial septal defects (ASD) represent rare congenital malformations (less than 1% o f total ASDs) and are frequently associated with persistent left superior vena cava (LSVC). The shunt is caused in the first case by the incomplete development of the wall between the coronary sinus and the left atrium and in the second case, the coronary sinus drains into the single atrial cavity. Case description: Two patients (I. P., 15 years, B. G., 12 years) were operated in 2013 in our clinic. In the first case, although enlargement of the coronary sinus was not identified during echography, angio-CT showed fenestration of the coronary sinus wall and cardiac catheterization documented the bidirectional shunt as well as the persistent LSVC. Moreover, the ASD was associated with patent ductus arteriosis and cor triatriatum. In the second case the ostium primum ASD and the persistent LSVC as well as an anterior mitral valve cleft were diagnosed by echography and CT. Both patients underwent elective surgery. The coronaiy sinus was reconstructed in both cases using autologous pericardial patches. Moreover, in the first patient the ductus arteriosis was ligated and the intraatrial trabeculum was excised. In the second case the interatrial septum was reconstructed with autologous pericardium. Both cases had an unremarkable postoperatory recovery. Conclusions: Both cases showed that although the diagnosis for these malformations requires multiple investigations, a surgical correction with good long term results is feasible if the mechanism of the shunt is well documented

Preoperative Arrhythmias Such as Atrial Fibrillation: Cardiovascular Surgery Risk Factor

Atrial fibrillation is still the most common arrhythmia that occurs in heart surgery. However, there is few literature data on the manner in which preoperative atrial fibrillation may influence the postoperative outcome of various heart surgery procedures. The purpose of our research is to assess the effects of preoperative atrial fibrillation on patients having undergone different heart surgery procedures. The results of our research are a review of clinical data which were collected prospectively, over a 10-year period, from all the patients who had undergone heart surgery in our Institute. The study group included 1119 heart surgery patients, who were divided as follows: the preoperative AFib group (n=226, 20.19%) and the sinus rhythm group (n=893, 79.80%). Major postoperative complications and hospital mortality rates were analyzed. According to our statistical analysis, preoperative atrial fibrillation significantly increased the mortality risk (P=0.001), the patients’ mechanical ventilation needs (P=0.022), the rate of occurrence of infectious complications (P<0.5), the rate of occurrence of complications such as acute kidney failure (P=0.012), and the time spent by the patients in the intensive care ward (P<0.01). In conclusion, preoperative atrial fibrillation in heart surgery patients increases the mortality and major complication risk further to heart surgery

In Vitro Antioxidant, Antitumor and Photocatalytic Activities of Silver Nanoparticles Synthesized Using <i>Equisetum</i> Species: A Green Approach

The ethanolic extracts of three Equisetum species (E. pratense Ehrh., E. sylvaticum L. and E. telmateia Ehrh.) were used to reduce silver ions to silver nanoparticles (AgNPs). The synthesized AgNPs were characterized using UV-Vis spectrophotometry, Fourier Transform Infrared Spectroscopy (FTIR), Energy Dispersive X-ray (EDX), Transmission Electron Microscopy (TEM) and Dynamic Light Scattering (DLS) measurements. FTIR data revealed the functional groups of biomolecules involved in AgNPs synthesis, such as O-H, C-H, C=O, C-O, and C-C. EDX spectroscopy was used to highlight the presence of silver, while DLS spectroscopy provided information on the mean diameter of AgNPs, that ranged from 74.4 to 314 nm. The negative Zeta potential values (−23.76 for Ep–AgNPs, −29.54 for Es–AgNPs and −20.72 for Et–AgNPs) indicate the stability of the obtained colloidal solution. The study also focused on establishing the photocatalytic activity of AgNPs, which is an important aspect in terms of removing organic dyes from the environment. The best photocatalytic activity was observed for AgNPs obtained from E. telmateia, which degraded malachite green in a proportion of 97.9%. The antioxidant action of the three AgNPs samples was highlighted comparatively through four tests, with the best overall antioxidant capacity being observed for AgNPs obtained using E. sylvaticum. Moreover, the biosynthesized AgNPs showed promising cytotoxic efficacy against cancerous cell line MG63, the AgNPs obtained from E. sylvaticum L. providing the best result, with a LD50 value around 1.5 mg/mL

Transcatheter Tricuspid Valve-in-Valve Replacement by Transatrial Approach

Reoperation on the tricuspid valve after prior heart valve surgery is associated with an increased operative risk due to a poor clinical status with severe heart failure and late presentation. Transcatheter tricuspid valve-in-valve implantation emerged as an attractive alternative to a high-risk redo surgery. The authors report a case of successful treatment of a failed bioprosthetic tricuspid valve in a 58-year-old woman with severe heart failure, decompensated cardiac cirrhosis and atrial fibrillation using transcatheter tricuspid valve-in-valve implantation of a Sapien 3 valve (Edwards Lifesciences, Irvine, California) via a transatrial approach. This case demonstrates the efficiency of this novel approach for the treatment of dysfunctional surgical tricuspid bioprosthetic valves and the technical feasibility and safety of a rarely used route