Mitral paravalvular abscess with left ventriculo-atrial fistula in a patient on dialysis

Background: Infective endocarditis in hemodialysis patients is challenging but is becoming more common recently. Case report: A 64-year-old man with end-stage renal disease on hemodialysis presented with infective endocarditis of mitral valve and coronary artery disease after commencing training for home hemodialysis. During a course of antibiotic treatment the patient developed left ventriculo-atrial fistula due to mitral paravalvular abscess. Abscess debridement followed by reconstruction of the mitral annulus with fresh autologous pericardial patch and mitral valve replacement using a mechanical prosthesis with concomitant coronary artery bypass grafting was performed successfully. Conclusion: Timely diagnosis, proper antibiotic treatment and early surgical intervention including aggressive debridement should improve the outcome of this high-risk disease. © 2009 Kitamura et al; licensee BioMed Central Ltd.Tadashi Kitamura, James Edwards, Suchi Khurana and Robert G Stukli

Right pleuropericardial release: a useful technique in off-pump coronary surgery

We describe the use of right pleurotomy combined with right pericardial release during off-pump coronary surgery. The maneuver releases the compression exerted on the right cardiac chambers during cardiac verticalization and improves hemodynamic stability during exposure of the posterior or lateral coronary vessels

Long term outcomes following Freestyle stentless aortic bioprosthesis implantation : an Australian experience

Background: The Freestyle stentless bioprosthesis (FSB) has been demonstrated to be a durable prosthesis in the aortic position. We present data following Freestyle implantation for up to 10 years post-operatively and compare this with previously published results. Methods: A retrospective cohort analysis of 237 patients following FSB implantation occurred at five Australian hospitals. Follow-up data included clinical and echocardiographic outcomes. Results: The cohort was 81.4% male with age 63.2±13.0 years and was followed for a mean of 2.4±2.3 years (range 0-10.9 years, total 569 patient-years). The FSB was implanted as a full aortic root replacement in 87.8% patients. The 30-day all cause mortality was 4.2% (2.0% for elective surgery). Cumulative survival at one, five and 10 years was 91.7±1.9%, 82.8±3.8% and 56.5±10.5%, respectively. Freedom from re-intervention at one, five and 10 years was 99.5±0.5%, 91.6±3.7% and 72.3±10.5%, respectively. At latest echocardiographic review (mean 2.3±2.1 years post-operatively), 92.6% had trivial or no aortic regurgitation. Predictors of post-operative mortality included active endocarditis, acute aortic dissection and peripheral vascular disease. Conclusions: We report acceptable short and long term outcomes following FSB implantation in a cohort of comparatively younger patients with thoracic aortic disease. The durability of this bioprosthesis in the younger population remains to be confirmed.7 page(s

Relation between blood and atrial fatty acids in patients undergoing cardiac bypass surgery

BackgroundStudies relating cardiovascular outcomes to dietary or blood measures of various fatty acids rely on the implicit assumptions that dietary change results in changes in blood fatty acids that, in turn, alter cardiac fatty acids. Although dietary intakes of n-3 (omega-3), n-6 (omega-6), and trans fatty acids are reflected in their concentrations in blood, there are few human data on the relation between blood and cardiac concentrations of fatty acids.ObjectiveThe objective was to explore relations between blood and myocardial n-3, n-6, trans, monosaturated, and saturated fatty acids over a range of community intakes to evaluate whether blood fatty acids are useful surrogate markers of their cardiac counterparts.DesignPatients undergoing on-pump coronary bypass surgery were recruited. Right atrial appendages and blood were collected at surgery for fatty acid analysis.ResultsAtrial appendages and matching blood samples were collected from 61 patients. Highly significant correlations were identified between atrial and erythrocyte or plasma n-3 [eg, eicosapentaenoic acid (erythrocytes: r = 0.93, P ConclusionErythrocyte- and plasma phospholipid-derived fatty acids can be used to estimate cardiac fatty acid status in humans.Robert G. Metcalf, Leslie G. Cleland, Robert A. Gibson, Kurt C. Roberts-Thomson, James R.M. Edwards, Prashanthan Sanders, Robert Stuklis, Michael J. James and Glenn D. Youn

Effects of fish-oil supplementation on myocardial fatty acids in humans

Copyright © 2007 by The American Society for NutritionBackgroundIncreased fish or fish-oil consumption is associated with reduced risk of cardiac mortality, especially sudden death. This benefit putatively arises from the incorporation of the long-chain n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) into cardiomyocyte phospholipids.ObjectiveThe study examined the kinetics of incorporation of n-3 fatty acids into human myocardial membrane phospholipids during supplementation with fish oil and alpha-linolenic acid-rich flaxseed oil.DesignPatients with low self-reported fish intake (ResultsSurgery rescheduling resulted in a range of treatment times from 7 to 118 d. In the fish-oil-treated subjects, accumulation of EPA and DHA in the right atrium was curvilinear with time and reached a maximum at approximately 30 d of treatment and displaced mainly arachidonic acid. Flaxseed oil supplementation yielded a small increase in atrial EPA but not DHA, whereas olive oil did not significantly change atrial n-3 fatty acids.ConclusionThe results of the present study show that dietary n-3 fatty acids are rapidly incorporated into human myocardial phospholipids at the expense of arachidonic acid during high-dose fish-oil supplementation.Robert G Metcalf, Michael J James, Robert A Gibson, James RM Edwards, John Stubberfield, Robert Stuklis, Kurt Roberts-Thomson, Glenn D Young and Leslie G Clelan