Surgical treatment of aortic coarctation in adults: Beneficial effect on arterial hypertension

Background: The aim of this study was to determine the outcome after surgical repair of aortic coarctation in adults, analysing its effect on arterial blood pressure. Methods: Twenty-five adults (9 women, 16 men), mean age 43.4 years (19 to 70 years), underwent aortic coarctation surgical repair. All patients suffered from preoperative hypertension. Mean blood pressure was 182/97 mm Hg. Sixteen (64%) patients demonstrated reduced load capacity. Operative technique was resection and end-to-end anastomosis for 5 patients (20%), interposition of a Dacron-tube graft for 3 patients (12%), Dacron-patch dilatation was performed in 7 (28%) patients, and in 10 (40%) patients we performed an extra-anatomical bypass graft. Results: Early mortality occurred in 1 patient (4%). The mean blood pressure was reduced [systolic 182 mm Hg vs. 139 mm Hg (p < 0.001), diastolic 97 mm Hg vs. 83 mm Hg (p < 0.001)] in all patients. In 12 patients, blood pressure normalized immediately after surgery, in 7 patients it remained slightly elevated (systolic blood pressure between 140-160 mm Hg), and 1 patient suffered from prolonged arterial hypertension. Preoperatively, all patients were treated with antihypertensive drugs. Eleven of 20 patients received long-term medication during follow- up. In the remaining 4 patients, medication lists were unobtainable in retrospect. The mean follow-up was 7.1 years (min. 1.0 years; max. 16.6 years). One patient (5%) died from cardiac failure 12.4 years after the operation. On average, the New York Heart Association (NYHA) class was improved by 0.92. Conclusions: The surgical repair of aortic coarctation in adults can be performed with low surgical risk. Surgery reduces hypertension and permits more effective medical treatment

Cardiac myxomas: Short- and long-term follow-up

Background: Cardiac myxomas are the most frequently encountered benign intracardiac tumors, that, if left untreated, are inexorably progressive and potentially fatal. Patients with cardiac myxoma can be treated only by surgical removal. This study summarizes our experience over 22 years with these tumors. Methods: Fifty seven patients (M/F: 14/43, age: 57.9 &#177; 14.6 years) with cardiac myxomas underwent surgical resection at our institution. There were 82.4% left atrial myxomas, 14.0% right atrial myxomas, 3.6% biatrial myxomas. The duration of symptoms prior to surgery ranged from 6 to 1,373 days (median 96 days). The surgical approach comprised complete wide excision. The diagnostic methods, incidence of thromboembolic complications, valve degeneration, surgical repair techniques, recurrence and re-operation were reviewed and the Kaplan-Meier survival curve was calculated. Results: There were no in-hospital deaths. Hospital stay amounted to a mean of 13.7 &#177; 6.9 days. Late follow-up was available for 54 (94.7%) patients for a median 7.5 years after surgery (23 days to 21.4 years). Fifty two patients are alive, while five patients had died after a mean interval of 6.3 years. Cause of death was cardiac in 40% of the patients (n = 2) and non-cardiac in the other 60% (n = 3). Conclusions: Surgical excision of cardiac myxoma carries a low operative risk and gives excellent short-term and long-term results. Surgical excision of the tumor appears to be curative, with few recurrences at long-term follow-up. After diagnosis, surgery should be performed urgently, in order to prevent complications such as embolic events or obstruction of the mitral orifice. Follow-up examination, including echocardiography, should be performed regularly

Mid-term results of a modified arterial switch operation using the direct reconstruction technique of the pulmonary artery

Background: There is ongoing discussion as to whether it is beneficial to avoid pulmonary sinus augmentation in the arterial switch operation. We report a single-surgeon series of mid-term results for direct pulmonary artery anastomosis during switch operation for transposition of the great arteries (TGA). Methods: This retrospective study includes 17 patients with TGA, combined with an atrial septal defect, patent foramen ovale or ventricular septal defect. Patient data was analyzed from hospital charts, including operative reports, post-operative course, and regular follow-up investigations. The protocol included cardiological examination by a single pediatric cardiologist. Echocardiographic examinations were performed immediately after arrival on the intensive unit, before discharge, and then after three, six, and 12 months, followed by yearly intervals. Pulmonary artery stenosis (PAS) was categorized into three groups according to the Doppler-measured pulmonary gradient: grade I (trivial stenosis) = increased pulmonary flow with a gradient below 25 mm Hg; grade II (moderate stenosis) = a gradient ranging from 25 to 49 mm Hg; and grade III (severe stenosis) = a gradient above 50 mm Hg. Follow-up data was available for all patients. The length of follow-up ranged from 1.2 to 9.7 years, median: 7.5 years (mean 6.1 years &#177; 14 months). Results: During follow-up, 12 patients (70.6%) had no (or only trivial) PAS, five patients (29.4%) had moderate stenosis without progress, and no patient had severe PAS. Cardiac catheterization after arterial switch operation was performed in 11 patients (64.7%) and showed a good correlation with echocardiographic findings. During follow-up there was no reintervention for PAS. Conclusions: Direct reconstruction of the neo-pulmonary artery is a good option in TGA with antero-posterior position of the great vessels, with very satisfactory mid-term results. (Cardiol J 2010; 17, 6: 574-579

Significance of patient categorization for perioperative management of children with tetralogy of Fallot, with special regard to co-existing malformations

Background: The aim of our study was to facilitate perioperative calculation of potential risk factors on the outcome of corrective surgery for children with tetralogy of Fallot. Methods: The medical records of 81 (44 female and 37 male) out of a total of 87 patients undergoing complete surgical repair of tetralogy of Fallot between 1988 and 2004 at the Children&#8217;s Hospital of the Johannes Gutenberg University of Mainz were reviewed. Patients were divided into four categories, depending on the severity of pulmonary stenosis and cyanosis, as well as on the type of pulmonary circulation. Results: Additional malformations did not affect mortality rates, but did directly affect the number of pleural effusions, time of epinephrine administration, duration of surgery, bypass, and ischemia, as well as length of hospitalization and intensive care unit treatment. In contrast to longer periods of extracorporeal circulation and ischemia during surgery, which are directly related not only to more complex anatomical situations but also to higher mortality and complication rates, the much-debated question of age at surgery had no influence either on the surgical approach itself or on the post-operative outcome. Conclusions: Our patient categorization, and evaluation of potential pre-operative risk factors and intraoperative parameters, should prove useful for the future planning and execution of therapeutic procedures in institutions around the world. (Cardiol J 2010; 17, 1: 20-28

Chirurgiczne leczenie koarktacji aorty u dorosłych - korzystny wpływ na nadciśnienie tętnicze

Wstęp: Celem badania była ocena chirurgicznej korekcji koarktacji aorty u dorosłych, z analizą jej wpływu na ciśnienie tętnicze. Metody: Dwadzieścia pięć osób dorosłych (9 kobiet, 16 mężczyzn, średni wiek 43,4 roku 19.&#8211;70. rż.) przebyło chirurgiczną korekcję koarktacji aorty. U wszystkich chorych przed operacją obserwowano nadciśnienie tętnicze. Średnie ciśnienie tętnicze wynosiło 182/97 mm Hg. U 16 osób (64%) stwierdzono zmniejszoną wydolność wysiłkową. Zastosowana technika operacyjna obejmowała resekcję miejsca zwężenia i zespolenie &#8222;koniec do końca&#8221; u 5 chorych (20%). U 3 pacjentów (12%) wszczepiono pełną dakronową protezę naczyniową. Operację poszerzenia z użyciem łaty dakronowej wykonano u 7 (28%) osób, a u pozostałych 10 (40%) chorych wszczepiono ekstraanatomiczny pomost omijajacy miejsce zwężenia cieśni aorty. Wyniki: Wczesna śmiertelność okołooperacyjna dotyczyła 1 chorego (4%). Średnia wartość ciśnienia tętniczego została zredukowana [ciśnienie skurczowe 182 mm Hg v. 139 mm Hg (p < 0,001), ciśnienie rozkurczowe 97 mm Hg v. 83 mm Hg (p < 0,001)] u wszystkich pacjentów. U 12 chorych ciśnienie tętnicze uległo normalizacji natychmiast po zabiegu chirurgicznym, u 7 pozostało nieznacznie podwyższone (ciśnienie skurczowe 140-160 mm Hg), a u 1 chorego nadciśnienie tętnicze utrzymywało się długotrwale. Przed operacją wszystkich pacjentów leczono za pomocą preparatów przeciwnadciśnieniowych. Spośród 20 pacjentów, którzy byli objęci długotrwałą obserwacją pooperacyjną (follow-up), 11 chorych wymagało przeciwnadciśnieniowego leczenia farmakologicznego. Czterech chorych z powodu zmiany miejsca zamieszkania było nieosiągalnych. Średni okres obserwacji wynosił 7,1 roku (min. 1 rok; maks. 16,6 roku). Jedna osoba zmarła w późnym okresie pooperacyjnym z powodu niewydolności serca 12,4 roku po operacji. Klasa NYHA poprawiła się średnio o 0,92. Wnioski: Chirurgiczną korekcję zwężenia cieśni aorty u dorosłych można przeprowadzić przy niskim ryzyku operacyjnym. Operacja redukuje nadciśnienie tętnicze i pozwala zmniejszyć liczbę stosowanych preparatów przeciwnadciśnieniowych