Our Experience in the Surgical Treatment of Chronic Constrictive Pericarditis

Introduction: We reviewed the cases of 21 consecutive patients who underwent surgery for chronic constrictive pericarditis between January 2004 and January 2016, to determine causes, surgical techniques, mortality and morbidity rates, and improvement of functional capacity. Patients and Methods: Eleven of our patients were men (52.3%) and ten were women (47.7%); their average age was 48.71±15.6 years. The pericarditis was tuberculous in 13 patients (61.9%), idiopathic in 4 patients (19%), rheumatic in two patients (9.5%), post surgical in one patient (4.75%) and neoplastic in one patient (4.75%).  Results: In all the cases, our approach was median sternotomy. All anterior pericardium was resected from left phrenic nerve to right phrenic nerve. No patient required cardiopulmonary bypass. We had no early postoperative mortality. In the 1st postoperative month, functional capacity improved dramatically: the number of patients in New York Heart Association functional class IV moved from 13 (preoperatively) to 4; in class III, from 7 to 3; in class II, from 1 to 6; and in class I, from 0 to 10.  Conclusions: We recommend the median sternotomy approach for chronic constrictive pericarditis. Tuberculosis still remains the main cause at our country. It can be treated with excellent results nowadays. Keywords: surgical treatment, chronic constrictive pericarditis DOI: 10.7176/JMPB/68-03 Publication date:September 30th 202

Prosthetic Subclavian-Aortic Bypass as a Safe Surgical Technique for the Coarctation of the Aorta in Adults

BACKGROUND: Coarctation represents 5-8% of congenital heart disease. Residual hypertension remains the main problem after late correction. Surgical treatment in the adult remains a challenge for the surgeon. Our prefered method used in this category is the Subclavian-aortic bypass.MATERIAL AND METHODS: We have reviewed our registry for the period of 12 years (1998- 2010) and we found a group of 18 adult patients being operated for coarctation of the aorta. The mean age of this group of patients was 24.7 ± 8.43 years (range 16-42 years). 13 were males and 5 females. RESULTS: Sugical technique: Most of the patients (13 pts, 72%) which were obviously treated with subclavian-aortic bypass with a Dacron prostheses. Mean preoperative and postoperative pressure gradients measured by echocardiography were 77.7 ± 20.16 mmHg and 22.3 ± 9.14 mmHg respectively. No mortality was observed in this series of patients. Chylothorax was the only complication observed in one patient in the early postoperative period.CONCLUSION: Coarctation of the aorta in adults is treated with optimal early results at our surgical centre. Subclavian-aortic bypass grafting requires less aortic dissection, can be performed with a partially occluding clamp, and does not compromise the spinal cord vascularization

A Very Rare Case of Cor Triatriatum with Severe Mitral Regurgitation

BACKGROUND: Cor triatriatum sinister is rare congenital heart disease. It is mainly presented in childhood and often accompanied with other congenital anomalies. The cases with cor triatriatum treated surgically in adults and accompanied with severe mitral regurgitation are very rare.CASE REPORT: We present a case with diagnosed cor triatriatum and severe mitral regurgitation. The diagnose was made by echocardiography. She was a female 25 years that was hospitalised with signs of heart failure NYHA II-III.CONCLUSION: We performed the resection of the membrane in the left atrium and repair of a mitral valve according to Alfieri. The patient did very well after the surgery

Aortic Annular Enlargement during Aortic Valve Replacement

In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery

Retrograde autologous priming RAP reduces deep hemodilution during cardiopulmonary bypass CPB

Immediate hemodilution and rapid decrease in osmotic pressure at the time of CBP onset are associated with the aforementioned organic dysfunctions. Decreased osmotic pressure increases effective filtration pressure and microvascular filtration. Consequently, an increase in pulmonary interstitial fluid and myocardial edema is observed after discontinuation of CBP. Retrograde autologous priming (RAP) is a means to effectively and safely restrict the hemodilution caused by the direct homologous blood transfusion and reduce the blood transfusion requirements during cardiac surgery.   Materials and Methods The study included 40 patients scheduled to undergo coronary surgical revascularization, divided into two groups: the RAP group and the non-RAP group. The average age in both groups is 55 years (SD 5).   Conclusion A significant benefit was observed between the two groups in the study regarding the amount of transfused blood (1.55 -SD 0.88) / (2.15 -SD 0.81). This is a very important fact in favor of using the RAP technique, taking into account the reduction of the risk for complications carried by heterologous transfusion. Also, a significant reduction in the use of donated blood at a time when the problems of blood insufficiency in the collection centers are known, is equally important. The hospitalization (days of staying) in the ICU is also significantly lower in the RAP group (2.6 -SD 0.68) / (3.1-SD 0.64). This should be related to the faster activation of RAP in patients as a result of faster return to normal weight (with less fluid load), better ventilator function, and faster decline of cerebral edema. Keywords: Retrograde autologous priming (RAP), hemodilution, cardiopulmonary bypassCPB)   DOI: 10.7176/ALST/81-04 Publication date: August 31st 202

Incidence and Impact of Patient-Prosthesis Mismatch in Isolated Aortic Valve Surgery

AIM: The mains topics of this work are the incidence of patient-prosthesis mismatch and the influence in the early results of isolated aortic valve surgery.METHODS: In 193 patients isolated aortic valve surgery was performed. The study population was divided in three subgroups: 20 patients with severe, 131 patients with moderate and 42 patients without patient-prosthesis mismatch. The indexed effective orifice area was used to define the subgroups. Operative mortality and perioperative complications were considered the indicators of the early results of aortic valve surgery.RESULTS: The incidence of severe and moderate patient-prosthesis mismatch was respectively 10.3% and 67.8%. Hospital mortality and perioperative complications were: mortality 5% vs. 3.1% vs. 2.4% (p = 0.855), low cardiac output 5% vs. 6.9% vs. 4.8% (p = 0.861); pulmonary complications 5% vs. 3.1 vs. 0.0% (p = 0.430); exploration for bleeding 5% vs. 0.8% vs. 2.4% (p = 0.319); atrial fibrillation 30% vs. 19.8% vs. 11.9% (p = 0.225); wound infection 5% vs. 0.8% vs. 0.00% (p = 0.165), respectively for the group with severe, moderate and without patient-prosthesis mismatch.CONCLUSIONS: Patient-prosthesis mismatch is a common occurrence in aortic valve surgery. This phenomenon does not affect the early results of aortic valve surgery

A Report of Two Cases with Caseous Annular Calcification of the Mitral Valve.

Introduction: Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annulus calcification, a chronic and degenerative mitral valve fibrous ring process. It usually carries a benign prognosis. The prevalence of CCMA is about 0.06%-0.07% of the population. CCMA is generally diagnosed incidentally and can be confused with other intracardiac masses such as cardiac tumors, abscesses, vegetation, or calcified thrombi. Multimodality imaging, including TEE, cardiac computed tomography, and cardiac magnetic nuclear resonance, can easily differentiate CCMA from other masses and help avoid unnecessary surgery. CCMA is typically located in the basal area of the posterior mitral valve, and the calcification seems like a round, large, soft mass with a central echo-dense location. CCMA may have a benign course, but it may sometimes be complicated with mitral valvular dysfunction, systemic embolization, or conduction abnormalities in the scenarios mentioned above, as well as when the diagnosis is unclear, surgery is indicated. Mitral valve replacement should be preferred compared to mitral valve repair. Conclusions: It is important to note that the decision for mitral valve replacement, including CAC cases, should be individualized based on various factors, including the patient's clinical condition, symptoms, severity of valve disease, and associated comorbidities. As scientific understanding and research progress, there may be ongoing developments and refinements in the conservative and surgical management of CCMA

The 6th Albanian Congress of Trauma and Emergency Surgery

After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have something to learn, discuss, debate, and agree with updated methods, techniques, and protocols.I hope you will join us on Friday morning, and continue the journey of our two-day event together