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1.
Ann Thorac Surg ; 105(1): e21-e22, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29233356

ABSTRACT

We report a case of a 69-year-old woman who required an apicoaortic bypass conduit after stenosis of a biological aortic prosthesis valve previously implanted 4 years earlier. The patient was admitted to the emergency department 8 years later with a diagnosis of congestive heart failure. Echocardiography and nuclear magnetic resonance revealed severe regurgitation of the conduit valve. Because the patient had a very high Society of Thoracic Surgeons risk score associated to an acute angle between the aorta artery and the apicoaortic conduit, we decided to perform an antegrade and direct transcatheter valve-in-valve implantation on the apicoaortic valve, with a good result.


Subject(s)
Aortic Valve Stenosis/surgery , Blood Vessel Prosthesis Implantation , Blood Vessel Prosthesis , Heart Valve Prosthesis Implantation/methods , Aged , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/etiology , Female , Humans , Reoperation
2.
Res Cardiovasc Med ; 1(1): 37-9, 2012 Nov.
Article in English | MEDLINE | ID: mdl-25478487

ABSTRACT

Transcatheter Aortic Valve Implantation (TAVI) is a new therapeutic option for patients with severe aortic stenosis with unacceptable surgical risk for conventional aortic valve surgery. A Bicuspid Aortic Valve (BAV) is the most common congenital cardiac disorder (1% of the population) and currently is considered exclusion criteria for TAVI, because it predicts an increased risk of adverse aortic events as incomplete sealing, severe paravalvular regurgitation, or dislocation due to more frequent elliptic shape and asymmetric calcifications in BAV annulus. Only few cases have been published in recent literature, so in this case report we illustrate our experience and management of TAVI in a BAV, with excellent outcomes and no late complications at 1 year follow-up. We believe that currently the presence of a BAV might not be considered an absolute contraindication for TAVI, because although there is no sufficient data for assess the safety or efficacy of TAVI in BAV, this case report shows that it could be performed safely in selected patients with unacceptable surgical risk after an extensive preoperative evaluation, avoiding this procedure in patients with bad prognostic factors as huge and heavy calcifications, asymmetric valves, elliptic annulus or small distance from leaflets to coronary ostia. Each case must be individualized, being alert at follow-up because the risk of late complications.

3.
Interact Cardiovasc Thorac Surg ; 13(6): 655-6, 2011 Dec.
Article in English | MEDLINE | ID: mdl-21979986

ABSTRACT

We present the case of a 62-year-old female with a diagnosis of osteogenesis imperfecta and mitral valve regurgitation. The patient underwent a mitral valve repair without complications. We describe the case and our surgical technique.


Subject(s)
Heart Valve Prosthesis Implantation , Mitral Valve Annuloplasty , Mitral Valve Insufficiency/surgery , Osteogenesis Imperfecta/complications , Cardiopulmonary Bypass , Echocardiography, Doppler, Color , Female , Humans , Middle Aged , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/diagnostic imaging , Osteogenesis Imperfecta/diagnosis , Sternotomy , Suture Techniques , Treatment Outcome
4.
Ann Thorac Surg ; 92(3): 1102-4, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21871307

ABSTRACT

We report a case of a 77-year-old patient with severe aortic stenosis who underwent transapical aortic valve implantation with a 23-mm Edwards Sapien valve (Edwards Lifesciences Inc, Irvine CA). This procedure was complicated with the occurrence of an acute regurgitation due to entrapment of one of the leaflets that was successfully managed by valve after valve technique.


Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/methods , Reoperation/methods , Acute Disease , Aged , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/etiology , Cardiac Catheterization , Echocardiography, Transesophageal , Female , Follow-Up Studies , Humans , Postoperative Complications , Radiography, Thoracic
5.
Ann Thorac Surg ; 92(2): 729-31, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21801933

ABSTRACT

Transcatheter aortic valve implantation by an apical approach has been developed as an alternative to conventional aortic valve replacement. Complications with these relatively new procedures are being reported. We report a case of transapical transcatheter aortic valve implantation, in which a pseudoaneurysm at the apex of the left ventricle as a complication of the procedure developed in the patient and was treated without surgery. The defect spontaneously closed.


Subject(s)
Aneurysm, False/diagnosis , Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Cardiac Catheterization , Heart Aneurysm/diagnosis , Heart Valve Prosthesis Implantation , Minimally Invasive Surgical Procedures , Postoperative Complications/diagnosis , Aged , Comorbidity , Echocardiography , Follow-Up Studies , Humans , Male , Postoperative Complications/surgery , Prosthesis Design , Remission, Spontaneous , Reoperation , Thoracotomy , Tomography, X-Ray Computed
6.
Interact Cardiovasc Thorac Surg ; 11(3): 360-1, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20542979

ABSTRACT

There is a lack of published information about intraoperative and postoperative course of cardiac surgery in patients with essential thrombocytosis using cardiopulmonary bypass. Both risks of intraoperative thrombosis of extracorporeal conduits or uncontrolled postoperative bleeding are present, but its incidence and treatment are not well known. Here, we present a rare case of a patient with essential thrombocytosis, moderate mitral regurgitation and severe aortic stenosis who had a transapical aortic valve implantation with short-term severe periprosthetic regurgitation, who needed a mitroaortic replacement on cardiopulmonary bypass with no complications.


Subject(s)
Aortic Valve Stenosis/therapy , Cardiac Catheterization/instrumentation , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Mitral Valve Insufficiency/surgery , Prosthesis Failure , Thrombocytosis/complications , Aortic Valve Stenosis/blood , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Cardiac Catheterization/adverse effects , Cardiopulmonary Bypass , Heart Valve Prosthesis Implantation/adverse effects , Humans , Male , Middle Aged , Mitral Valve Insufficiency/blood , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/diagnostic imaging , Prosthesis Design , Thrombocytosis/blood , Treatment Outcome , Ultrasonography
7.
Infect Disord Drug Targets ; 10(1): 32-46, 2010 Feb.
Article in English | MEDLINE | ID: mdl-20218951

ABSTRACT

Despite medical advances, the mortality in infective endocarditis is today very high. Its clinical and epidemiological characteristics are changing over time, with more elderly patients affected, with more underlying co-morbidities and with Staphylococci as the most frequent pathogen. Effective treatment in complicated cases needs a multidisciplinary approach, and surgery is necessary in 40-50% of cases. Since clinical trials are difficult to be conducted in infective endocarditis, the scientific evidence is weak. The main indications of surgical treatment are heart failure due to valvular regurgitation and uncontrolled infection because of periannular extension or difficult-to-treat micro-organisms. Prospective analysis has demonstrated that medical-surgical treatment is better than only medical treatment in complicated endocarditis with severe cardiac failure but mortality is still high with periannular extension. Prosthetic endocarditis has better prognosis with surgical treatment in the presence of complications and when the aetiology is S aureus. In patients without extensive non-hemorrhagic neurological lesions, early surgical intervention is safe. Mitral repair is nowadays an effective surgical technique when there is not extensive valve destruction, since replacement with a prosthetic valve has several problems like risk of infection, requirement for anticoagulation and durability. There is no evidence that the employment of homografts is better than aortic valve replacement, and the most important issue is the complete removal of the infected tissue. The pacemaker and defibrillator infection is best treated by removal of the device and the leads along with effective antibiotic therapy. Percutaneous lead extraction is the method of choice, and surgery is reserved only when there are contraindications or failure of the percutaneous techniques, large vegetations, and tricuspid regurgitation. Whenever is possible, tricuspid repair, is preferable, but replacement must be considered when there is a chance for recurrence after repair.


Subject(s)
Endocarditis/surgery , Aortic Valve/microbiology , Aortic Valve/surgery , Endocarditis/complications , Endocarditis/drug therapy , Endocarditis/microbiology , Humans , Mitral Valve/microbiology , Mitral Valve/surgery , Pacemaker, Artificial/adverse effects , Pacemaker, Artificial/microbiology
8.
Infect Disord Drug Targets ; 10(1): 59-64, 2010 Feb.
Article in English | MEDLINE | ID: mdl-20218953

ABSTRACT

Indications of endocarditis prophylaxis have changed in the past years, because of the absence of any evidence that justified its use. The last guidelines only recommend prophylaxis in patients with underlying cardiac conditions with the higher risk of adverse outcomes, including patients with a previous history of infective endocarditis, patients with prosthetic heart valve or prosthetic material used for valve repair, patients with a valvulopathy after cardiac transplantation, and patients with an specific congenital heart disease. The list of procedures in which prophylaxis is necessary has been limited too. Nowadays it is recommended in patients who undergo any dental procedure that involves the gingival tissues or periapical region of a tooth and for those invasive procedures of the oral cavity or an invasive procedure of the respiratory tract that involves incision or biopsy of the respiratory mucosa. In this revision we try to expose the recent tendencies recommended by the international guidelines.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis/methods , Endocarditis/prevention & control , Anti-Bacterial Agents/administration & dosage , Humans
9.
Interact Cardiovasc Thorac Surg ; 10(2): 344-5, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19939851

ABSTRACT

We present a case of a cardiac fibroma affecting the base of the anterior papillary muscle resected under cardiopulmonary bypass with cardioscopy and video-assisted thoracic surgery (VATS) instruments through the mitral valve. The surgical approach and instrumentation of previous case reports are reviewed.


Subject(s)
Cardiac Surgical Procedures/methods , Fibroma/surgery , Heart Neoplasms/surgery , Thoracic Surgery, Video-Assisted , Adult , Biopsy , Cardiac Surgical Procedures/instrumentation , Fibroma/pathology , Heart Neoplasms/pathology , Heart Ventricles/surgery , Humans , Papillary Muscles/surgery , Thoracic Surgery, Video-Assisted/instrumentation , Thoracoscopes , Treatment Outcome
12.
Ann Thorac Surg ; 87(2): 653-4, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19161813

ABSTRACT

We present a case of acute endocarditis due to enterococcus faecalis involving partially A2 and completely A3 (Carpentier classification) with destruction of the free margin of the mitral valve. Repair was performed by using glutaraldehyde treated porcine pericardium to replace the defect and neochordae of polytetrafluoroethylene sutured to the free margin of the pericardium to achieve competence. Intraoperative and follow-up echocardiogaphies showed no regurgitation.


Subject(s)
Endocarditis, Bacterial/complications , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/surgery , Pericardium/transplantation , Suture Techniques , Adult , Cardiac Surgical Procedures/methods , Chordae Tendineae/surgery , Echocardiography, Transesophageal , Endocarditis, Bacterial/microbiology , Female , Follow-Up Studies , Gram-Positive Bacterial Infections/complications , Gram-Positive Bacterial Infections/microbiology , Humans , Mitral Valve Insufficiency/diagnostic imaging , Polytetrafluoroethylene , Preoperative Care , Risk Assessment , Transplantation, Autologous , Treatment Outcome
13.
Ann Thorac Surg ; 84(3): 1008-10, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17720421

ABSTRACT

We report a case of a 51-year-old patient with suspected prosthetic valve endocarditis. Capnocytophaga haemolytica was isolated in blood cultures and the repeated echocardiograms showed growth of vegetations and disruption of the proximal prosthetic valve suture line with progressive aortic regurgitation. The patient underwent a root debridement and replacement with a stentless bioprosthesis.


Subject(s)
Aortic Valve , Capnocytophaga/isolation & purification , Endocarditis, Bacterial/etiology , Heart Valve Diseases/etiology , Heart Valve Prosthesis/adverse effects , Anti-Bacterial Agents/therapeutic use , Aortic Valve/surgery , Endocarditis, Bacterial/surgery , Heart Valve Diseases/surgery , Humans , Male , Middle Aged
14.
Hepatogastroenterology ; 51(58): 1030-6, 2004.
Article in English | MEDLINE | ID: mdl-15239240

ABSTRACT

BACKGROUND/AIMS: We aim to determine in which way the local immune system would be responsible for the structural changes in intestinal obstruction, and how these are influenced by Somatostatin, an intestinal peptide with immunomodulatory properties. Simple ileus causes a series of functional and anatomical changes, which have been related to the peptidergic neural system, and inflammatory mediators. These changes are reversible with the use of Somatostatin. METHODOLOGY: 27 rabbits divided into three groups, were subjected to the same procedure, in which a simple closed loop obstruction is caused by means of jejunum ligatures. The three groups are perfused with physiologic saline during 24 hours post-obstruction; one of them is perfused with Somatostatin from the time of intervention, and other after 8 hours. Samples of the intestinal wall are taken for histological analysis, and of the intraluminal liquid to determine the tumor necrosis factor alpha, interleukin 2, interleukin 6, and serotonin. RESULTS: Both group treated with Somatostatin show a wall which is in good condition, while the untreated group showed lesions. These lesions are related to higher levels of tumor necrosis factor alpha, and interleukin 2, while there were no changes in the levels of interleukin 6. CONCLUSIONS: The Somatostatin in perfusion shows a cytoprotective activity in the intestinal wall, and a blockage of the production of mediators of cellular immunity, while humoral immunity does not appear to be involved in these phenomena.


Subject(s)
Adjuvants, Immunologic/administration & dosage , Hormones/administration & dosage , Ileus/pathology , Intestinal Mucosa/pathology , Somatostatin/administration & dosage , Animals , Drug Administration Schedule , Female , Gastrointestinal Contents/chemistry , Ileus/metabolism , Interleukin-2/analysis , Interleukin-5/analysis , Intestinal Mucosa/drug effects , Jejunum/drug effects , Jejunum/metabolism , Jejunum/pathology , Lipids/analysis , Rabbits , Serotonin/analysis , Tumor Necrosis Factor-alpha/analysis
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