The consolidation of surgery for hypertrophic obstructive cardiomyopathy in Asia and the Pacific Rim

A peak gradient ≥50 mmHg and advanced symptoms expressed as New York Heart Association (NYHA) classess III/IV, angina and/or syncope are acknowledged indications to surgically treat hypertrophic obstructive cardiomyopathy (HOCM). This is still a relatively neglected disease despite surgical myectomy has shown extreme efficacy since it was introduced by Morrow and Brockenbrough in 1961.(1) Over the past six decades, credit went to Morrow and Brockenbrough, although Kirklin and Ellis also published their first experience with resection of diffuse subaortic stenosis through the left ventricle.(2) There were only a couple of months difference in the chronology of these pioneering contributions and both groups reported surgery in critically symptomatic young patients. This is the gold standard sixty years later

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

Prevalence of Structural Heart Diseases Detected by Handheld Echocardiographic Device in School-Age Children in Iran: The SHED LIGHT Study

Background: Structural heart disease (SHD) has great impacts on healthcare systems, creating further public health concerns. Proper data are scant regarding the magnitude of the affected population by SHD. Objectives: This study aimed to determine the prevalence of SHD among children and adolescents in an Iranian population. Methods: In this population-based study, a multistage cluster-random sampling was used to choose schools from the Tehran urban area. All students were examined using a handheld Vscan device by echocardiographer, and the results were concurrently supervised and interpreted by cardiologists. All the major findings were reevaluated in hospital clinics. Results: Of 15,130 students (6-18 years, 52.2% boys) who were examined, the prevalence of individuals with congenital heart disease (CHD) and cardiomyopathy was 152 (10.046 per 1,000 persons) and 9 (0.595 per 1,000 persons), respectively. The prevalence of definite and borderline rheumatic heart disease (RHD) was 30 (2 per 1,000 persons) and 113 (7.5 per 1,000 persons), correspondingly. Non-rheumatic valvular heart disease (VHD) was also detected in 465 (30.7 per 1,000 persons) students. Of all the pathologies, only 39 (25.6%) cases with CHD and 1 (0.007%) cases with RHD had already been diagnosed. Parental consanguinity was the strongest predictor of CHD and SHD (odds ratio [OR]: 1.907, 95% CI, 1.358 to 2.680; P < 0.001 and OR, 1.855, 95% CI, 1.334 to 2.579; P < 0.001, respectively). The female sex (OR, 1.262, 95% CI, 1.013 to 1.573; P = 0.038) and fathers' low literacy (OR, 1.872, 95% CI, 1.068 to 3.281; P = 0.029) were the strongest predictors of non-rheumatic VHD and RHD, correspondingly. Conclusions: The implementation of echocardiographic examinations for detecting SHD among young population is feasible which detected SHD prevalence in our population comparable to previous reports. Further studies are required to delineate its economic aspects for community-based screening. Keywords: Echocardiography; Prevalence; Screening; Structural heart disease

What does an explanted PASCAL device look like?

We report the case of a 78-year-old female patient who had a PASCAL device implanted for severe degenerative mitral regurgitation. Intraprocedural echocardiography revealed persistent severe mitral regurgitation due to device dislocation. Implanting another device was not possible. After 8 days, the device was explanted, and the valve was replaced with a biological pro We report the case of a 78-year-old female patient who had a PASCAL device implanted for severe degenerative mitral regurgitation. Intraprocedural echocardiography revealed persistent severe mitral regurgitation due to device dislocation. Implanting another device was not possible. After 8 days, the device was explanted, and the valve was replaced with a biological prosthesis. The PASCAL device and resected mitral valve leaflets were sent for histopathological workup. Keywords: Mitral regurgitation; PASCAL device; Transcatheter therapysthesis. The PASCAL device and resected mitral valve leaflets were sent for histopathological workup

Concomitant Coronary Artery Bypass in Patients with Acute Type A Aortic Dissection

Coronary Artery Bypass Grafting (CABG) is sometimes necessary in acute Type A Aortic Dissection (AAAD) repair. The aim of this study is to analyze the incidence, indications and influence in-hospital outcomes of AAAD repair requiring concomitant CABG in a high-volume single-center experience. Retrospective study of all consecutive AAAD patients. Those who underwent concomitant CABG were identified. Preoperative, intraoperative, postoperative and follow-up data were collected and analyzed. Between January 1, 2010 and December 31, 2016, 382 patients underwent emergency surgery for AAAD. Forty-one (10.7%) underwent concomitant CABG. In this group, mean age was 64 ± 14 years, 32 were male (78%). Indication for CABG was coronary dissection in 28 patients (68.3%), post-cardiopulmonary bypass (CPB) right heart failure in 7 (17.1%), post CPB left heart failure in (7.3%) and native coronary pathology in 3 (7.3%). In 33 (80.5%) one graft was needed, in 7 (17%) two were performed and in 1 patient (2.4%) 3 were necessary. The right coronary artery (RCA) was the only revascularized vessel in 26 cases (63.4%), the left coronary artery (LCA) alone in 11 (26.8%), and both coronary systems in 4 (9.8%). In-hospital mortality was 51.2% (N = 21); eight (19.5%) patients had postoperative myocardial infarction (MI) and 11 (26.8%) had a major neurological event. Multivariable logistic regression identified concomitant CABG as a predictor of in-hospital mortality (Odds Ratio (OR) = 3.8115, 95% CI= 0.514-2.138, p = 0.001). In our study, concomitant CABG was performed in 10.7% of AAAD repair surgery and it was associated with high in-hospital mortality. Keywords: Concomitant CABG; Predictors of mortality; Type A acute aortic dissectio

Endocarditis trombótica no bacteriana (Libman-Sacks)

Mujer de 47 años ingresada en 2002 por ictus. Se diagnosticó masa valvular aórtica. Se intervino realizándose exéresis de trombo no bacteriano (Fig 1a, b). Durante el estudio de trombofilia fue diagnosticada de síndrome antifosfolípido primario (SAP), inciándose anticoagulación. Hasta la fecha, ha padecido múltiples accidentes cerebrovasculares, isquémicos y hemorrágicos. Está en diálisis peritoneal con probable origen en SAP. SAP es un trastorno autoinmune caracterizado por fenómenos trombóticos iterativos y alargamiento de tiempos de coagulación. La cirugía cardiaca conlleva morbimortalidad por tromboembolias, suponiendo un reto en el manejo de la circulación extracorpórea. Las complicaciones tromboembólicas son frecuentes durante el seguimiento.A 47-year-old woman was admitted in 2002 due to stroke. An aortic valve mass was diagnosed and surgical removal of non-bacterial thrombus performed (Fig. 1a, b). During the study for thrombophilia, primary antiphospholipidic syndrome (PSA) was diagnosed and oral anticoagulation started. Up to date, she presented with multiple episodes of cerebrovascular accident, ischemic and hemorrhagic. She is on peritoneal dialysis. PAS is an autoimmune disorder characterized by recurrent thrombotic phenomena and prolonged coagulation time. Cardiac surgery carries morbidity and mortality due to thromboembolic events, representing a challenge in the management of extracorporeal circulation. Thromboembolic complications are frequent during the follow-up

Acute pulmonary embolectomy

Acute pulmonary embolism (PE) is a common condition frequently associated with a high mortality worldwide. It can be classified into non-massive, sub-massive and massive, based on the degree of haemodynamic compromise. Surgical pulmonary embolectomy, despite having been in existence for over 100 years, is generally regarded as an option of last resort, with expectedly high mortality rates. Recent advances in diagnosis and recognition of key qualitative predictors of mortality, such as right ventricular stress on echocardiography, have enabled the re-exploration of surgical pulmonary embolectomy for use in patients prior to the development of significant circulatory collapse, with promising results. We aim to review the literature and discuss the indications, perioperative workup and outcomes of surgical pulmonary embolectomy in the management of acute P