Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy by Video-Assisted Surgery for Pleural Malignancies: Technical Aspects and Safety Profile

Background: Pleural malignancies are challenging conditions in terms of possibility of cure. Recent growing interest towards Hyperthermic Intrathoracic Chemotherapy (HITHOC) after Cytoreductive Surgery (CRS) has been referred. Minimally invasive approach (VATS) may be suggest in this context but evidence is still lacking. Methods: A preliminary experience in seven patients submitted to cytoreductive surgery and HITHOC is described, with a focus on technical aspects related to VATS approach, operating median time and postoperative complication. Results: A triportal VATS approach has been employed in all cases. Median time of surgery including pleural perfusion was 200 min (range 165 to 370). Mean blood loss was 217 cc (range 100 and 600). Thirty days mortality was nothing. Conclusion: VATS cytoreductive surgery and HITHOC is a safe procedure and could be proposed in the setting of a multimodality strategy employing adjuvant radio-chemotherapy in referral centers

Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy by Video-Assisted Surgery for Pleural Malignancies. Technical Aspects and Safety Profile from A Single Center

Background Pleural malignancies are challenging conditions in terms of possibility of cure. Recent growing interest towards Hyperthermic Intrathoracic Chemotherapy (HITHOC) after Cytoreductive Surgery (CRS) has been referred. Minimally invasive approach (VATS) may be suggest in this context but evidence is still lacking. Methods A preliminary experience in seven patients submitted to cytoreductive surgery and HITHOC is described, with a focus on technical aspects related to VATS approach, operating median time and postoperative complication. Results A triportal VATS approach has been employed in all cases. Median time of surgery including pleural perfusion was 200 minutes (range 165-370). Mean blood losswas 217 cc (range 100 and 600). Thirty days’ mortality was nihil. Conclusions VATS cytoreductive surgery and HITHOC is a safeprocedure and could be proposed in the setting of a multimodality strategy employing adjuvant radio-chemotherapy in referral center

CARATTERIZZAZIONE DEL MICROBIOTA ORALE E DI BIOPSIE DI TESSUTO VALVOLARE PATOLOGICO IN UN CAMPIONE DI PAZIENTI PARODONTALI E NON PARODONTALI

Aim. To assess the prevalence of periodontal disease among patients presenting severe heart valve impairment and requiring coronary by-pass surgery. To investigate the presence of periodontal pathogens in cardiovascular specimens and to analyse the relationship between oral and cardiovascular patterns of the microorganisms detected. Materials and Methods. An observational study was conducted at the Cardiovascular Surgery Division, University Hospital of Verona, Verona, Italy. The Ethical approval was previously obtained in order to enroll subjects referring to the Hospital for heart valves replacement and coronary bypass surgery. Patients were scheduled to be visited by a dentist, together with a dental hygienist, the day before the surgery: periodontal conditions were accurately registered through clinical and radiographic examinations and dental plaque or salivary samples were collected. Cardiovascular specimens were collected during surgical heart valve replacement for the scheduled microbiological 16 rRNA gene sequencing. Plaque samples and cardiovascular specimens were analyzed according to periodontal status. A qualitative comparison between oral and cardiovascular profiles of the microorganisms detected was also performed. Results. 26 patients (15 men and 11 women) attended the study. The overall number of patients examined for the conditions of soft tissues were 19, as 7 patients were edentulous and reported to had lost dentition for history of periodontal disease. 46.15% and 11.54% individuals respectively presented moderate periodontitis and severe periodontitis. A statistically significant difference (p=0.04) was found for PPD between healthy patients, patients with moderate periodontitis and patients with severe periodontitis. Regarding plaque samples and cardiovascular specimens, no statistically significant differences were found in both cases between healthy patients, patients with moderate periodontitis, patients with severe periodontitis and edentulous patients. Nine valves were found to be positive at the presence of oral and periodontophatic bacterial DNA. The principal species detected were Streptococcus periodonticum, Streptococcus mutans, Fusobacterium nucleatum-periodonticum, Aggregatibacter segnis and Porphyromonas pasteri. Conclusions. The significant number of oral and periodontopathic bacterial DNA species found in valve tissue samples, in patients with periodontitis, suggests that the presence of these microrganisms in valve tissue seems to be not coincidental, and that they may have a role in the development of vascular diseases

Usefulness of the Right Parasternal Echocardiographic View to Improve the Hemodynamic Assessment after Valve Replacement for Aortic Stenosis

Right-parasternal-view (RPV) often provides the best hemodynamic assessment of the aortic-valve-stenosis by echocardiography. However, no detailed study on patients with aortic prosthesis is available. Thus, RPV usefulness is left as an anecdotical notion in this context. We aimed to define feasibility and clinical-impact of RPV before and soon-after percutaneous implantation (TAVI) or surgical (SAVR) aortic-valve-replacement (AVR) for AS. Patients with severe-AS electively referred for AVR between September-2019 and February-2020 were prospectively evaluated. Echocardiographic examinations inclusive of apical and RPV to measure aortic-peak-velocity , gradients and area (AVA) were performed the day before AVR and at hospital discharge and compared by matched-pair-analysis. Forty-seven patients (mean age 79 \ub1 8 years, 63% female, ejection-fraction 61 \ub1 6%) referred for SAVR (24 [51%]) or TAVI (23 [49%]) were enrolled. RPV was feasible in 45 patients (96%) before-AVR but in only 32 after-AVR (68%), particularly after SAVR (50%) than TAVI (87% p = 0.005). RPV remained the best acoustic window after TAVI in 75% of cases. Hemodynamic assessment of TAVI, but not SAVR, invariably benefit from RPV versus apical evaluation (aortic-peak-velocity: 2.57 \ub1 0.39 vs 2.23 \ub1 0.47 m/sec, p = 0.002; mean gradient: 15 \ub1 5 vs 12 \ub1 5 mm Hg, p = 0.01). Five (11%) patients presented severe patient-prosthesis-mismatch, 4 of which were detectable only by RPV. This pilot-experience demonstrates that RPV feasibility is slightly reduced after AVR. RPV can improve the hemodynamic assessment of the prosthetic valve versus apical view, including the detection of patient-prosthesis-mismatch. Furthermore, when RPV is the best acoustic windows in patients with severe AS, it generally remains so after-TAVI

Scalloped Freehand Pulmonary Homograft for Prosthetic Tricuspid Valve Replacement

Tricuspid valve replacement is commonly performed using biologic or mechanical prostheses. Partial or complete valve replacement using mitral homograft tissue has also been described. Anecdotal reports exist of valve replacement using a pulmonary homograft within a cylinder. This report describes a technique for native or prosthetic valve replacement using a freehand scalloped pulmonary homograft. Late follow-up confirmed the efficacy of this surgical strategy. (C) 2021 by The Society of Thoracic Surgeon

Combined Replacement of Aortic Valve and Ascending Aorta{ extemdash}A 70-Year Evolution of Surgical Techniques

: Simultaneous replacement of the ascending aorta and aortic valve has always been a challenging procedure. Introduction of composite conduits, through various ingenious procedures and their modifications, has changed the outlook of patients with aortic valve disease and ascending aorta pathology. In the past 70 years, progress of surgical techniques and prosthetic materials has allowed such patients to undergo radical procedures providing excellent early and long-term results in both young and elderly patients. This article aims to review the most important technical advances in the treatment of aortic valve disease and ascending aorta aneurysms recognizing the important contributions in this field

Late Aortic Valve Rupture After Blunt Chest Trauma

Aortic valve injury after blunt chest trauma due to avulsion of the valve from the annulus or cusp tear commonly results in severe acute regurgitation. Here reported is an unusual case of a 56-year-old woman with multiple traumatic injuries to head, chest, abdomen, and pelvis, in whom massive aortic regurgitation resulting in wide pulse pressure and low cardiac output presented 10 days after admission. The left coronary leaflet explosion was eventually identified at the surgery and managed by valve replacement, due to the extremely weak consistency of the remaining valve tissue. Whether leaflet rupture occurred late after original blunt chest trauma remains conjectural

Midventricular Takotsubo cardiomyopathy complicated by a ventricular septal rupture: a surgical management

Takotsubo cardiomyopathy, also known as 'Broken Heart Syndrome', is a form of acute heart failure, featured by a reversible impairment in cardiac contractility. About 20% of patients during hospitalization experience complications including cardiogenic shock, stroke, left ventricular thrombosis or death. Ventricular rupture has already been reported in Takotsubo cardiomyopathy in patients with typical apical ballooning pattern. We report one of the first cases of a midventricular ballooning Takotsubo cardiomyopathy in a 57-year-old woman complicated by ventricular septal rupture, successfully repaired with a surgical interrupted suture technique. \ua9 2019 Wolters Kluwer Health, Inc. All rights reserved

Mesothelial/monocytic incidental cardiac excrescence in autoimmune disease

Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare benign finding made of mesothelial cells, histiocytes, and fibrin, usually found during heart valve surgery. The clinical relevance resides in the potential misdiagnosis as metastatic carcinoma or arterial embolism. The pathogenesis remains uncertain, with artifactual and reactive hypotheses. Here we present a case of MICE with paradigmatic clinical, imaging, and histological features in a 28-year-old woman with undifferentiated connective tissue disease without previous cardiac catheterization with possible pathogenesis, highlighting the importance of awareness of the existence of this lesion in patients with autoimmune disease

An odd couple: acalculous cholecystitis masking a fulminant myocarditis

: Acute myocarditis is an inflammatory cardiac disease with different underlying causes and a wide spectrum of clinical presentations from asymptomatic cases to sudden or rapidly evolving acute heart failure. Furthermore, the initial diagnosis can be challenging as it can mimic other respiratory or gastrointestinal disorders. We report the case of an otherwise healthy 24-year-old Caucasian man with a fulminant myocarditis successfully treated with mechanical circulatory support, which was initially misdiagnosed as an isolated uncomplicated acute acalculous cholecystitis