Rare association of two cardiovascular malformations successfully corrected in a single surgery: a case report.

BACKGROUND: Partial anomalous pulmonary venous connection (PAPVC) without an atrial septal defect (ASD) associated with coarctation of the aortic arch is a rare congenital cardiac anomaly. This rare combination is only described in a few studies; none report the correction of these two malformations in a single surgery. CASE PRESENTATION: A 5-year-old girl was admitted to our hospital because the echocardiography revealed coarctation of the aortic arch; this diagnosis was confirmed by computed tomography (CT), which also showed her left superior pulmonary vein draining into the vertical vein without ASD (Fig. 1). She exhibited no special clinical symptoms. Her upper-limb blood pressure was approximately 110/90 mmHg, whereas her lower-limb blood pressure was approximately 75/50 mmHg. CONCLUSIONS: We surgically repaired the case of PAPVC to the vertical vein with aortic coarctation, in which the two cardiovascular malformations were corrected in a single surgery without cardiopulmonary bypass.

A modified Cox maze IV procedure: a simpler technique for the surgical treatment of atrial fibrillation.

OBJECTIVES: To determine the effectiveness of a simplified surgical treatment method for atrial fibrillation (AF). METHODS: Between September 2012 and October 2013, 120 patients (mean age, 52.3 ± 8.8 years) underwent valve surgery and concomitant bipolar radiofrequency ablation for the treatment of AF. Patients were randomized to a Cox maze IV procedure (CMP-IV) group (n = 60) or a modified CMP-IV (MCMP-IV) group (n = 60). Freedom from AF was defined as freedom from any left atrial arrhythmia lasting <30 s and no requirement of antiarrhythmic drugs after 6 months. Data were recorded at postoperative follow-up examinations, which were scheduled at 1, 3, 6 and 12 months, and annually thereafter. RESULTS: No ablation-related complications occurred in either group. The mean ablation time was longer in the CMP-IV group than in the MCMP-IV group (18.5 ± 1.7 vs 16.6 ± 1.6 min, P < 0.001). The mean follow-up time was 32.4 ± 3.6 months (range, 26-39 months). Freedom from AF tended to be higher, but not significantly so, among the MCMP-IV group than among the CMP-IV group over the entire follow-up period. CONCLUSIONS: The MCMP-IV is an effective surgical procedure for the treatment of AF. In certain patients, such as those with anatomic variations of the pulmonary veins, the MCMP-IV is simpler than the CMP-IV. CLINICAL TRIALS REGISTRATION ID: ChiCTR-TRC-12002742.

Papillary fibroelastoma of the aortic valve in association with rheumatic heart disease: a case report.

BACKGROUND: Papillary fibroelastoma (PFE) is a rare primary cardiac neoplasm that is usually discovered incidentally at autopsy or during cardiac surgery. PFE combined with rheumatic heart disease (RHD) is extremely rare, and only a few cases have been reported. Additionally, the growth rate of the tumor is unknown. CASE PRESENTATION: Here, we present a very rare case of PFE of the aortic valve combined with RHD, which were identified in a female patient who survived for 5 years without surgical intervention, and who subsequently underwent successful surgical treatment. CONCLUSIONS: PFEs may be generally slow-growing tumors, however, the better treatment of choice may be surgery because it produces good curative effects with very low risk of complications, while preventing serious disease consequences.

A novel "box lesion" minimally invasive totally thoracoscopic surgical ablation for atrial fibrillation.

INTRODUCTION: Minimally invasive surgical ablation is an emerging alternative method to catheter ablation and the full surgical maze procedure for nonpharmacologic treatment of atrial fibrillation (AF). We present a totally thoracoscopic "box lesion" radiofrequency ablation procedure in patients with paroxysmal or persistent AF. MATERIALS AND METHODS: From June 2011 to October 2012, 14 patients with lone paroxysmal (n = 7) or persistent AF (n = 7) were enrolled in this study. Procedures were performed through 3 5-12 mm holes on each side of the chest wall. A bipolar ablation device was used to create a box lesion in the posterior wall of the left atrium that encircled the 4 pulmonary veins (achieving bilateral pulmonary vein/posterior left atrial wall isolation). Perioperative complications were recorded for all patients. Freedom from AF was assessed by 24-hour Holter monitoring every 3 months or during symptoms of arrhythmia. RESULTS: The ablation was successfully performed in all patients, with median operation time of 128 minutes (range, 45 to 180 minutes). No operative mortality or morbidity were noted during the study period. Freedom from AF was achieved in 12 patients (85.7%) during follow-up (median follow-up 9 months). One patient with persistent AF was shifted to paroxysmal AF. No atrial flutter or atrial tachycardia was noted during the follow-up. CONCLUSION: These early results show that totally thoracoscopic surgical ablation using a unique "box lesion" procedure for persistent or paroxysmal AF is a feasible and effective method with good short-term results. Further study is necessary to validate this result.

Rare early prosthesis obstruction after mitral valve replacement: a case report and literature review.

As a dreadful complication after the mechanical heart valve replacement, prosthetic valve obstruction caused by pannus formation occurs increasingly with time. The authors here present a case of 42-year-old woman who was urgently admitted to hospital with acute heart failure symptoms due to the mechanical mitral valve failure only 3 months after surgery. Transthoracic and transesophageal echocardiography demonstrated that the bileaflet of the mitral prosthesis were completely immobilized with only a small transvalvular jet remained. During the reoperation, the reason of the prosthetic valve obstruction was attributed to the noncircular pannus ingrowth extending from the atrioventricular side. For a better understanding of the prosthetic valve dysfunction caused by pannus formation, the authors then compile a literature review to briefly discuss the status quo of the clinical characteristics of this uncommon complication.