The treatment of mitral valve disease—the only thing constant is change

The mitral valve is without doubt the part of the human body that is most under pressure. For every beat of the heart, the mitral valve has to open to let the blood into the most muscular chamber in the body, and then closes to withstand high systolic pressures that, during periods of exertion, can exceed over 200 mmHg

Left atrial anomalous muscular band as incidental finding during video-assisted mitral surgery

Congenital fibromuscular bands have been described inleft ventricle or right atrium and have been diagnosed by echocardiography and CT scan. The first report of anomalous band in the left atrium was described in 1897 by Rollestone (1). We hereby present a case of a patient with an incidental finding of left atrial band during a minimally invasive mitral surgery procedure

The ability of Salmonella to drill holes in the aorta.

A 56-year-old male with fever and enlarged mediastinum underwent examinations for lymphoma. He had back pain and hypotension. Computed tomography showed a false aneurysm of the aortic arch (Fig. 1a). Pathological aorta was excised. Reconstruction of the large hole on the aortic arch (Fig. 1b) with oval patch tailored from cryopreserved thoracic aorta was performed under hypothermic circulatory arrest. Blood and aortic cultures grew Salmonella. The patient had uneventful recovery. One year later is free from infection

Video-assisted cardioscopy for removal of primary left ventricular myxoma.

Left ventricular myxoma is a rare benign cardiac tumor. Surgical excision is the treatment of choice and completeness of removal is mandatory to avoid late recurrence. A case is presented in which aortic transvalvular video-assisted cardioscopy was used to facilitate removal

Skeletonization of the internal thoracic artery: a randomized comparison of harvesting methods.

We performed a randomized study to compare internal thoracic artery (ITA) flow response to two harvesting methods used in the skeletonization procedure: ultrasonic scalpel and bipolar electrocautery. Sixty patients scheduled for CABG were randomized to receive either ultrasonically (ns30 patients) or electrocautery (ns30 patients) skeletonized ITAs. Intraoperative ITA graft mean flows were obtained with a transit-time flowmeter. ITA flows were evaluated at the beginning (Time 1) and at the end (Time 2) of the harvesting procedure. Post-cardiopulmonary bypass (CPB) flow measurement (Time 3) was obtained in the ITA grafts anastomosed to the left anterior descending artery. Intraoperative mean flow decreased significantly within ultrasonic group (Group U) and electrocautery group (Group E) at the end of the harvesting procedure (P-0.0001 in both cases). Within both groups the final mean flow measured on anastomosed ITAs (Time 3) was significantly higher than the beginning ITA flow value (Time 1). No statistical difference was noted comparing ITA flows between the two groups at any time of evaluation. Skeletonization harvesting of the ITA produces a modification of the mean flow. The quantity and the reversibility of this phenomenon, probably related to vasospasm, are independent from the energy source used in the skeletonization procedure

Surgical embolectomy for acute massive pulmonary embolism: state of the art

Massive pulmonary embolism (PE) is a severe condition that can potentially lead to death caused by right ventricular (RV) failure and the consequent cardiogenic shock. Despite the fact thrombolysis is often administrated to critical patients to increase pulmonary perfusion and to reduce RV afterload, surgical treatment represents another valid option in case of failure or contraindications to thrombolytic therapy. Correct risk stratification and multidisciplinary proactive teams are critical factors to dramatically decrease the mortality of this global health burden. In fact, the worldwide incidence of PE is 60–70 per 100,000, with a mortality ranging from 1% for small PE to 65% for massive PE. This review provides an overview of the diagnosis and management of this highly lethal pathology, with a focus on the surgical approaches at the state of the art

Cerebrovascular complications and infective endocarditis. impact of available evidence on clinical outcome

Infective endocarditis (IE) is a life-threatening disease. Its epidemiological profile has substantially changed in recent years although 1-year mortality is still high. Despite advances in medical therapy and surgical technique, there is still uncertainty on the best management and on the timing of surgical intervention. The objective of this review is to produce further insight intothe short- and long-term outcomes of patients with IE, with a focus on those presenting cerebrovascular complications

Port-Access cardiac surgery: from a learning process to the standard.

Background: Port-Access™ surgery has been one of the most innovative and controversial methods in the spectrum of minimally invasive techniques for cardiac operations and has been widely used for the treatment of several cardiac diseases. The technique was introduced in our center to evaluate its efficacy in reproducing standardized results without an additional risk. Methods: Endovascular cardiopulmonary bypass (CPB) through femoral access and endoluminal aortic occlusion were used in 129 patients for a variety of surgical procedures, all of which were video-assisted. A minimal (4-6 cm) anterior thoracotomy through the fourth intercostal space was used in all cases as the surgical approach. Results: More than 96% of the planned cases concluded as true Port-Access™ procedures. Mean CBP and crossclamp times were 87.2 min. ± 51.2 (range of 10-457) and 54.9 min. ± 30.6 (range of 10-190), respectively. Hospital mortality for the overall group was 1.5%, and mitral valve surgery had a 2.2% hospital death rate. The incidence of early neurological events was 0.7%. Mean extubation time, ICU stay, and total length of hospital stay were 5 hours ± 6 hrs. (range of 2-32), 12 hours ± 11.8 hrs. (range of 5-78), and 7 days ± 7.03 days (range of 1-72), respectively. Conclusions: Our experience indicates that the Port- Access™ technique is safe and permits reproduction of standardized results with the use of a very limited surgical approach. We are convinced that this is a superior procedure for certain types of surgery, including isolated primary or redo mitral surgery, repair of a variety of atrial septal defects (ASDs), and atrial tumors. It is especially useful in high-risk patients, such as elderly patients or those requiring reoperation. Simplification of the procedure is nevertheless desirable in order to further reduce the time of operation and to address other drawbacks