Isolated giant aortic arch aneurysm repair in a 13-year-old girl: a case report.

BACKGROUND: Aortic arch aneurysm is a very rare condition in children. Surgery is the life saving procedure but it performing might be challenging due to the complex anatomy. CASE PRESENTATION: We describe a 13-year-old girl who was diagnosed to have an isolated giant aortic arch aneurysm. This girl was referred to our institution with persistent cough as a leading symptom, which started two months ago. Surgery was performed as combined approach: left-sided thoracotomy and midline sternotomy. The left subclavian artery was re-implanted via supraclavicular approach to the left common carotid artery end-to-side anastomosis. Aneurysm was excised after midline sternotomy and initiation of cardiopulmonary bypass under mild hypothermia. Histological evaluation of the wall of the aneurysm revealed no evidence of any specific changes. CONCLUSIONS: The using of the combined method was characterised by a good postoperative surgical results. Pediatricians should be aware of persistent cough in children as a symptom of mediastinal mass of different origin and identity.

ULTRASONIC DECALCIFICATION OF AORTIC VALVE IN MODERN ERA: A CASE REPORT.

Aortic stenosis (AS) - a constantly progressing disease characterized by thickening and calcification of leaflets of the valve, which leads to obstruction of the blood outflow from the left ventricular (LV), inadequate cardiac output, heart failure, and even sudden death. Prevalence of stenosis consistently increases with age, 0.2% incidence observes in the 50-59 year cohort of patients and almost 10% in patients from the 80-89 year cohort. We report the case of a 78-year-old man who presented with severe aortic valve stenosis. Since conventional valve replacement was problematic because of a small annular diameter we performed ultrasonic aortic valve decalcification. As a result, the systolic pressure gradient across the aortic valve decreased from 106 mm Hg to 22 mm Hg. Our case demonstrated that even in modern era ultrasonic aortic valve decalcification can be an effective option for restoration of mobility of the aortic valve cusps. We advocate the use of it for elderly patients with small aortic annulus in which surgical or transcatheter valve replacement, valve reconstruction could be extremely difficult or unavailable and consider ultrasonic valve decalcification as an additional tool in cardiac surgeon's hands.

Synchronized diaphragmatic stimulation for heart failure using the VisONE system: a first-in-patient study.

AIMS: Synchronized diaphragmatic stimulation (SDS) modulates intrathoracic and intra-abdominal pressures with favourable effects on cardiac function for patients with a reduced left ventricular ejection fraction (LVEF) and heart failure (HFrEF). VisONE-HF is a first-in-patient, observational study assessing the feasibility and 1 year effects of a novel, minimally invasive SDS device. METHODS AND RESULTS: The SDS system comprises a pulse generator and two laparoscopically delivered, bipolar, active-fixation leads on the inferior diaphragmatic surface. Fifteen symptomatic men with HFrEF and ischaemic heart disease receiving guideline-recommended therapy were enrolled (age 60 [56, 67] years, New York Heart Association class II [53%] /III [47%], LVEF 27 [23, 33] %, QRSd 117 [100, 125] ms, & N terminal pro brain natriuretic peptide [NT-proBNP] 1779 [911, 2,072] pg/mL). Implant success was 100%. Patients were evaluated at 3, 6, and 12 months for device-related or lead-related complications, quality of life (SF-36 QOL), 6 min hall walk distance (6MHWd), and by echocardiography. No implant procedure or SDS-related adverse event occurred, and patients were unaware of diaphragmatic stimulation. By 12 months, left ventricular end-systolic volume decreased (136 [123, 170] mL to 98 [89, 106] mL; P = 0.05), 6MHWd increased (315 [300, 330] m to 340 [315, 368] m; P = 0.004), and SF-36 QOL improved (physical scale 0 [0, 0] to 25 [0, 50], P = 0.006; emotional scale 0 [0, 33] to 33 [33, 67], P = 0.001). Although neither reached statistical significance, LVEF decreased (28 [23, 40]% vs. 34 [29, 38]%; P = ns) and NT-proBNP was lower (1784 [920, 2540] pg/mL vs. 1492 [879, 2028] pg/mL; P = ns). CONCLUSIONS: These data demonstrate the feasibility of laparoscopic implantation and delivery of SDS without raising safety concerns. These encouraging findings should be investigated further in adequately powered randomized trials.