Right ventricle hydatid cyst with a pericardial cavity involvement: a case report

The echinococcal disease with a cardiac location of the hydatid cyst is uncommon and potentially fatal for the patient's life. The diagnosis could be difficult because no specific symptoms ever occur. However, this pathology should be always kept in mind in endemic regions. Herein we report a rare case of hydatid cyst situated in the right ventricular free wall. The diagnosis was ensured by transthoracic and transesophageal echocardiography, CT and MRI. The patient underwent a total cardiopulmonary bypass without aortic cross-clamping. Several ruptured daughter cysts were removed. The fibrous capsule was opened and the germinative membrane was extirpated. Postoperatively, albendazole therapy was administered. No complications were reported.Scripta Scientifica Medica 2013; 45(4): 84-87

Three-year results from the surgical treatment of diseases of the aortic valve and aortic root

PURPOSE: Pathology of the aortic root and aortic valve is subjected to adult cardiac surgery and includes Stanford A aortic dissection, annuloaortic ectasia or chronic aneurysm of the ascending aorta. In such cases, Bentall-De Bono procedure is usually preferred. Aortic valve reimplantation by using Tirone David's technique presenting with the advantages of valve-sparing surgery can be performed in selected cases.MATERIAL AND METHODS: A retrospective analysis of a three-year experience with the complex surgical treatment of diseases of the aortic valve and root was carried out. During the period from January 1, 2009 to December 31, 2012, fifty-three patients with aortic valve and aortic root pathology were treated in the Division of Cardiac Surgery, St. Marina University Hospital of Varna. Bentall procedure was carried out in 37 patients (Group B). In 19 of them (51%) emergency surgery was done for acute aortic dissection of type Stanford A. The rest 18 patients underwent elective surgery for dilated ascending aorta and aortic valve dysfunction. Aortic valve-sparing surgery by David's technique for aortic aneurysm was accomplished in 16 patients (Group D). This technique was emergently applied in one patient with aortic dissection, too. Baseline data, intraoperative details, early results and complications were compared.RESULTS: Early (30-day) mortality after Bentall-De Bono procedure was 10.5% (0% after elective surgery and 21.1% after dissection repair). All the patients survived after David's procedure that proved the significant advantages of the valve-sparing surgery.CONCLUSION: The aortic valve reimplantation provides long-term results that are comparable to those after the Bentall-De Bono procedure such as high survival rates, low incidence rate of endocarditis, and slightly higher risk of reinterventions. There is no need of life-long anticoagulation that improves patient's quality of life.Scripta Scientifica Medica 2013; 45(4): 50-55

Cryoablation for simultaneous surgical treatment of atrial fibrillation and valvular or ischemic heart diseases - our early experience in Varna

Atrial fibrillation (AF) is a problem with rising frequency and importance in developed countries. The consequences of that condition are a significant medical, social and economic problems: high risk of development of heart failure, ischemic stroke, decreased quality of life and lowered life expectancy. With the development of theoretical knowledge and technical means in medicine, new surgical methodshave been established and validated for the treatment of AF, among them is cryoablation. We present our early experience with the concomitant treatment of AF with cryoablation for patients undergoing surgical treatment of coronary artery disease (CAD), mitral and aortic valvular pathology. The system used for cryoalbation uses nitrous oxide (N2O). The results from patient follow-up show higheffectiveness of the procedure even in the initial phase of mastering the skill

Prognosis and Prognostic Factors in Aortic Valve Replacement for Aortic Stenosis /// Прогноза и прогностични фактори при аортно клапно протезиране по повод на аортна стеноза

[EN] Calcific aortic valve stenosis is a chronic disease with a progressive course. In the final stage of the disease the clinical signs and symptoms of heart failure are manifested leading to a lethal outcome. Calcific aortic valve stenosis is in first place as a reason for surgical aortic valve prosthesis in Europe and in the USA. Seventy percent of all cardiac surgeries for aortic valve replacement are performed on patients over 65 years of age. This circumstance relates to a significantly higher expenditure on health care for elderly population. The contemporary approach to improvement of the clinical outcome and patients’ prognosis is based upon: (1) Identification of patients exposed to higher risk factors for heart valve diseases; (2) Correct assessment of the grade (severity) of aortic valve stenosis and correct specification of its haemodynamic type, respectively; (3) Diagnosis, differential diagnosis and treatment of comorbidities; (4) Defining optimal timing for cardiac surgery; (5) Choice of proper procedure for replacement of the aortic valve and (6) Choice of optimal aortic valve type. This thesis investigates the outcome after aortic valve replacement in patients with a severe pure calcific aortic stenosis, without coronary heart disease and analyses the principal factors determining the prognosis. The clinical research is planned, organised and executed as an observational (cohort), prospective and single-centre study. Is was performed at the Cardiac Surgery Clinic, St. Marina University Hospital – Varna. Thesis conclusions are clinically oriented and will find an application in everyday clinical practice.[BG] Калцификационната аортна клапна стеноза е хронично заболяване с прогресиращ ход. В крайния стадий на болестта се изявяват клинично белезите и симптомите на сърдечната недостатъчност и настъпва летален изход. Калцификационната аортна стеноза заема първо място, като причина за хирургично аортно клапно протезиране в Европа и в САЩ. Седемдесет процента от сърдечните операции за протезиране на аортна клапа са извършени при пациенти на възраст над 65 години. Последното е свързано със значително по-големи разходи за здравни грижи, каквито са необходими при застаряващото население. Съвременният подход към подобряване на клиничния изход и прогнозата на болните с аортна стеноза се базира на: (1) Идентифициране на пациентите, изложени на риск от клапни сърдечни болести; (2) Коректно измерване на степента (тежестта) на аортната стеноза и, съответно, правилно дефиниране на хемодинамичния вариант; (3) Диагноза, диференциална диагноза и лечение на коморбидните състояния; (4) Определяне на оптималния срок за извършване на протезиране на аортната клапа; (5) Избор на процедурата за смяна на аортна клапа и (6) Избор на типа клапна протеза. В дисертационния труд се изследва прогнозата след хирургично аортно клапно протезиране при пациенти с високостепенна, калцификационна чиста аортна стеноза, без коронарна болест на сърцето и се проучват основните фактори, които я определят. Настоящото клинично проучване е замислено, проектирано, и изпълнено, като обсервационно (кохортно), проспективно и едноцентрово. Извършено е в клиниката по кардиохирургия, базирана в Университетска болница „Св. Марина“ – Варна. Направените изводи са с чисто практическа насоченост и ще намерят приложение в ежедневната клинична работа

Surgical remodelling of the left ventricle. Theory and practice in the Department of Cardiac Surgery in St. Marina University Hospital, Varna, Bulgaria

С ранното и агресивно лечение на острия миокарден инфаркт (МИ) честотата на неговите късни усложнения намалява. В днешно време еволюцията на около 7.6% от случаите на трансмурален МИ на лява камера (ЛК) е свързана с формирането на аневризма. Аневризмата сама по себе си и в корелация с други последствия от загубата на ЛК миокард е свързана с влошена систолна и диастолна функция на ЛК, риск от руптура на ЛК стена, интракавитарна тромбоза с ембологенен потенциал.Тези особености спомагат както за непрекъснат стремеж за по-навременно, стратегически и технически издържано и актуализирано оперативно лечение при тези пациенти, така и за провеждането на проучвания в областта и натрупването на бази данни, съдържащи ранно-, средно- и дългосрочни резултати при тези пациенти и спомагащи по-нататъшното развитие на концепцията за най-правилно поведение. От първите операции през 50-те години на XX век техниките еволюират, като предлагат все по-индивидуализиран подход и се отличават по сложност на изпълнение и постигнат резултат.Наред с описателната характеристика на развитието на кардиохирургичните техники за корекция на ЛК аневризми, настоящият текст представя и опита на Клиниката по кардиохирургия на УМБАЛ „Св. Марина` - Варна при хирургичното ремоделиране на ЛК и ранните резултати при тази категория пациенти. За периода 01.01.2008 - 31.12.2013 г. за миокардна реваскуларизация и корекция на хронична ЛК аневризма са оперирани 22 пациента - 8 с линеарна пластика и 14 с операция на Дор. 87.5% (7/8) от пациентите с линеарна пластика и 85.7% (12/14) от пациентите с операция на Дор са преживели ранния следоперативен период и преди дехоспитализацията са със значимо намалени обеми и подобрена функция на ЛК. Въпреки малкия брой случаи, това показва, че двете техники осигуряват приемливи оперативни резултати при тази тежка категория пациенти.Early and aggressive treatment of acute myocardial infarction (MI) results in a decrease of the incidence of late complications. Nowadays the evolution of about 7.6% of all cases of transmural MI of the left ventricle (LV) results in aneurysm formation. The aneurysm itself as well as other consequences of the myocardial loss is related to impaired systolic and diastolic LV function, risk of rupture of the LV wall or potentially embologenous thrombosis in the LV cavity.These characteristics contribute to a constant trend towards timely and contemporary surgical treatment of this category of patients in terms of operative strategy and technique. It also stimulates the conduction of large and powerful trials in this field and the creation of databases including the early, midterm and late outcomes that further enhance the understanding of the most suitable treatment algorithm. Since the first surgical procedures in the 1950s, the techniques have evolved offering an individualized approach as each procedure is distinguished by its surgical complexity and achieved results.Along with the descriptive characteristics of the evolution of surgical techniques for correction of LV aneurysms the current text also presents the experience of the Department of Cardiac Surgery in St. Marina University Hospital in Varna, Bulgaria with the surgical remodeling of the LV and the early results in this patient category. During the period 01.01.2008 - 31.12.2013 a total of 22 patients underwent myocardial revascularization and repair of LV aneurysm, 8 were with linear repair and 14 - with Dor procedure. Of the patients with linear repair 87.5% (7/8) and 85.7% (12/14) of these with Dor procedure survived the early postoperative period and presented with significantly reduced postoperative volumes and improved function of the LV. Despite the small number of cases this proves both techniques ensure acceptable surgical results for these severely ill patients