An alternative patch repair technique during valve replacement for native valve endocarditis

A patient with native valve endocarditis and vegetation on anterior mitral leaflet underwent aortic valve replacement with preservation of aortic noncoronary leaflet as a patch over the inflammated intervalvular fibrous body. This technique may minimize prosthetic material use, which is the most important risk factor for reinfection

Bilateral renal artery occlusion due to intraoperative retrograde migration of an abdominal aortic aneurysm endograft

Retrograde (proximal) migration of an abdominal aortic aneurysm endograft is an extremely rare event during endovascular insertion and may lead to occlusion of the bilateral renal arteries and dialysis-dependent renal failure. This case report describes the intraoperative retrograde migration of a bifurcated abdominal aortic endograft during the initial endovascular procedure after deployment of an extender limb graft into the right iliac artery and associated bilateral renal artery occlusion. This was treated with renal artery bypass, and the patient had a favorable outcome

Mitral valve replacement with bileaflet preservation for complex annular calcification

Extensive calcification of mitral apparatus may preclude optimal valve repair, thus requiring debridement. We performed mitral valve replacement in a 55-year-old woman with a modified bileaflet preservation technique to avoid complications related to extensive debridement. Posterior transposition of the anterior leaflet as a buttress over the posterior ventricular wall provided extra support for the weakened tissues and covered the decalcified areas, which protected against debris embolism. This technique is safe and reproducible, especially for elderly patients who have complex calcification that requires extensive debridement, enables better preservation of ventricular function, and avoids disruption of the mechanical left ventricular wall

Posterior pericardial ascending-to-descending aortic bypass through median sternotomy

Background and Aim: Adult patients with complex forms of descending aortic disease remain a surgical challenge and have a high risk of postoperative mortality and morbidity. Surgical management may be complicated when there is an associated cardiac defect, necessitating repair, or a hostile anatomy exists. We present our experience with extra-anatomic bypass through posterior pericardial route at the same stage with intracardiac/ascending aortic aneurysm repair. Methods: Patients that underwent one-stage surgery with posterior pericardial bypass between ascending and descending aorta during 2003-2007 were reviewed. Data from early and mid-term follow-up, including mortality, perioperative blood loss, graft-related complications, patency, and persistant hypertension, were noted. Results: Six male patients with a mean age of 20.8 +/- 0.7 years were operated for coarctation of the aorta associated with additional pathologies (three cases of ascending aortic aneurysm-one with associated aortic valve insufficiency, one case of isolated aortic valve regurgitation, two cases of mitral valve regurgitation). No early or mid-term mortality was observed during follow-up of a mean of 21.6 +/- 10.0 months. No late graft-related complications or reoperations were observed with patent grafts. Systolic blood pressure decreased after surgery by an average of 43 mmHg. Conclusions: Coarctation of the aorta with concomitant cardiac lesions can be repaired simultaneously through sternotomy and posterior pericardial approach, when patients present in adulthood, to minimize morbidity and mortality