Surgical repair of residual shunt after transcatheter closure of secundum atrial septal defect with an amplatzer septal occluder: a case report.

Secundum atrial septal defect is the most common congenital heart defect in adulthood. As an alternative to surgery, the transcatheter occlusion appears to be safe. We herein report a case of a residual shunt after transcatheter closure of ASD of a 66 year old man. Surgical repair was indicated. Real and potential problem with device closure of ASD are discussed.Case ReportsJournal Articleinfo:eu-repo/semantics/publishe

Robotic beating-heart totally endoscopic coronary artery bypass.

Clinical vignette : Since the mid-nineties, minimally invasive direct coronary artery bypass grafting (MIDCAB) has evolved thanks to technological development of robotically assisted coronary surgery known as totally endoscopic coronary artery bypass (TECAB). Here, we report the case of a 51-year old lady with typical angina pectoris without any other relevant comorbidity. The angiogram showed a single and severe lesion at the ostium of the left anterior descending (LAD) coronary artery. Following an interdisciplinary heart team approach, a TECAB was proposed and accepted by the patient. This tutorial demonstrates the technical aspects of a single beating-heart TECAB. [...

Left ventricular outflow tract obstruction after mitral valve replacement

We describe a patient with left ventricular outflow tract obstruction after mitral valve replacement preserving the anterior subvalvular apparatus. Postoperative transesophageal echocardiography demonstrated systolic narrowing of the left ventricular outflow tract by a bulging septum and systolic anterior motion of the preserved anterior mitral leaflet. Septal myectomy and transaortic mitral apparatus resection enabled us to relieve the left ventricular outflow tract obstruction. This suggests that septal hypertrophy might be a relative contraindication to the preservation of the anterior mitral subvalvular apparatus in mitral replacement.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Images in cardiovascular medicine. 21st-century imaging for a 19th-century disease.

Case ReportsJournal Articleinfo:eu-repo/semantics/publishe

Robotic-enhanced biventricular resynchronization: An alternative to endovenous cardiac resynchronization therapy in chronic heart failure

Background. Cardiac resynchronization therapy (CRT) by pacing the left and right ventricles is an emerging option for treatment of severe heart failure with ventricular conduction disturbances. Stimulation through a coronary vein is currently the technique of choice to achieve left ventricular (LV) pacing. Unfortunately, this approach carries significant limitations and drawbacks. Therefore we explored robotic-enhanced thoracoscopic implantation of an epicardial lead as an alternative technique to stimulate the LV in cardiac resynchronization therapy. Methods. A total of 15 patients were included in this study. Right (atrial and ventricular) leads were implanted classically through the left subclavian vein. Robotic-enhanced thoracoscopy was then performed to implant the LV epicardial lead. Results. Of the 15 patients, 13 underwent successful endoscopic robotic cardiac resynchronization therapy. Two patients underwent conversion to a small thoracotomy. No perioperative complication occurred in the patients who did not undergo conversion. Acute and chronic LV lead thresholds were satisfactory in all patients, improving over time. All were subjectively and objectively improved at 4 months. As compared with conventional methods, the procedural cost was not significantly affected. Conclusions. Based on this feasibility study, we believe that robotic LV epicardial lead implantation is a valuable option to achieve biventricular resynchronization therapy. It allows for more reproducible acute thresholds for LV pacing and sensing than does the percutaneous approach; enables fine tuning of the LV lead position, thus potentially providing optimal hemodynamic benefit; and avoids the pitfalls and limitations of the endovenous approach. Therefore it deserves further prospective studies to assess its place in the therapeutic armamentarium against heart failure. © 2003 by The Society of Thoracic Surgeons.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Epicardial lead implantation techniques for biventricular pacing via left lateral mini-thoracotomy, video-assisted thoracoscopy, and robotic approach

Purpose: For optimal biventricular pacing, the left ventricular (LV) lead has been found to be best placed in the area where optimal concordance is achieved between the LV pacing site and the site of the most delayed LV wall. For anatomical or technical reasons, the placement of the LV lead via the coronary sinus at the intended target area of the LV is often not possible. An option for avoiding these drawbacks is the surgical implantation of the LV lead under direct vision. This report describes 3 epicardial lead implantation techniques that are less invasive. Methods: In 80 patients with advanced heart failure and left bundle branch block, epicardial LV leads for biventricular pacing were implanted with 3 different methods: (1) left lateral mini-thoracotomy; (2) a video-assisted thoracoscopy approach using lead implantation tools; and (3) a robotically enhanced telemanipulation system. Video films are provided for all 3 techniques in The Heart Surgery Forum online. Results: Independent of the surgical techniques, the intended lead location on the LV was achieved in all patients. Acute and 3-month LV lead thresholds were satisfactory in 79 patients (99%). Two lead displacements were observed. One thoracotomy was carried out after thoracoscopic lead placement because the patient developed an early exit block. Five patients who underwent an operation with the robot needed a conversion to thoracotomy because of technical failure of the robot (2 patients) or massive pleural adhesions (3 patients). There were no severe adverse events related to any technique. Three patients died in the hospital from the progression of end-stage heart failure. Conclusion: Epicardial lead implantation for biventricular pacing is feasible with all 3 surgical techniques. Each method allows optimal lead implantation under direct vision and therefore reduces the incidence of nonresponders resulting from suboptimal lead placement.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Early experience with a new aortic clamping system designed for port access cardiac surgery: the PortaClamp.

We report a clinical study to demonstrate the feasibility and safety of a new aortic crossclamping concept for use in port-access cardiac surgery. The limited access to the aorta in minimally invasive cardiac surgery mandates specific clamping modalities, which entail specific limitations, drawbacks, and costs. Therefore a new autoguided, extravascular, and atraumatic clamping system (PortaClamp) was developed to facilitate port-access surgery while potentially avoiding the complications and costs inherent to endoluminal clamping or "blind" crossclamping.Clinical TrialJournal Articleinfo:eu-repo/semantics/publishe

Fifty years of coronary artery bypass grafting.

Coronary artery bypass grafting (CABG) remains the most common cardiac surgery performed today worldwide. The history of this procedure can be traced back for more than 100 years, and its development has been touched by several pioneers in the field of cardiac surgery, who have contributed with both their successes and failures. With ever increasing follow up and number of patients treated, thinking regarding optimal CABG technique evolves continually. This article reviews the history of CABG from its early experimental work to recent technological advances

21st-century imaging for a 19th-century disease

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Unusual Images of Perioperative Transesophageal Echocardiography

SCOPUS: ar.jinfo:eu-repo/semantics/publishe