Aortic regurgitation due to quadricuspid aortic valve--case report and literature review.

Quadricuspid aortic valve is a rare variant of aortic semilunar valve, often being an unexpected discovery during cardiac surgery. We present the case of a 59 years old patient, who was admitted for dyspnea on light exertion and palpitations. The transthoracic echocardiography revealed severe aortic valve regurgitation due to a quadricuspid aortic valve, the result being confirmed by the transesophageal echo examination. The patient had a first class indication for aortic valve replacement and the surgical intervention was uneventful. The operative technique and case particularities are discussed in view of the literature published so far regarding this uncommon condition.

[Second recurrence of cardiac myxoma 7 years after the initial operation]. / A doua recidiva a unui mixom cardiac aparuta la 7 ani de la prima operatie.

We report a rare case of a 23-year-old woman in who recurrent multiple cardiac myxomas were resected first time 4 years after the initial operation and second time three years after the second operation. In February 2000, she was diagnosed with right ventricular myxoma. The initial cardiac tumor was successfully resected through a right atrium approach and the tricuspid valve was changed with a biological prosthesis; the patient has been followed-up by ultrasound echocardiography every 6-month after discharge. Four years after, the echocardiography revealed one masse in the left atrium, which was resected using a trans-septal approach. Due to malfunction of the tricuspid prosthesis, this was changed with a biological one. After another three years, the echocardiography revealed once again two masses, this time in the right atrium and left ventricle. The third surgery was performed and all 2 myxomas were successfully resected through a combined right atrial and left ventricle approach. One year after the third operation, she has been doing well without any sign of recurrence of myxoma. A long-term follow-up is mandatory in patients after the resection of a cardiac myxoma.

[Off pump total arterial revascularization--clinical and technical considerations]. / Revascularizarea coronariana off pump integral arteriala--consideratii tehnice si clinice.

Integral arterial myocardial revascularization seems to become the standard method in coronary surgery, but the international experience is still limited. We are communicating our results in arterial off pump coronary artery grafting (OFF CABG) in a centre specialized in "on pump" total arterial revascularisation. Between January 2004 and June 2006 we performed off pump CABG in 58 patients, using skeletonized arterial grafts; the vein grafts was rarely used. In 94.95% of cases we used only arterial grafts, and we achieved complete arterial revascularization in 47 (81.03%) of cases. We didn't noted major postoperative complications, the mean UCU stay was 1.7 days, mean hospital stay was 7.3 days, and no postoperative deaths were noted. The off pump CABG using arterial grafts is a secure method, without postoperative complications, which offers viable solutions of complete revascularization of the heart.

[The surgical angioplasty of the left main coronary ostial stenosis--a low risk operation]. / Plastia de largire a ostiului coronarian stâng--o interventie chirurgicala cu risc scazut.

To evaluate a different technique for the treatment of the left main coronary artery ostial stenosis, the coronary ostial surgical angioplasty. Three patients underwent this operation. After placing the patient on cardiopulmonary bypass and aortic cross clamping, the main pulmonary trunk was retracted laterally. The left main coronary artery was approached anteriorly through a curved aortotomy. Reconstruction was performed using fresh or treated with glutaraldehyde pericardial patch. There were no in-hospital deaths. In one case, the aortic suture had to be reconstructed with a GoreTex patch. We didn't note other complications. The patch plasty of the left main coronary trunk is a safe procedure, with no important complications, despite its technical difficulty.

[Fungal native aortic valve endocarditis. Combined medico-surgical treatment]. / Endocardita fungica de valva aortica nativa. Rezolvare medico-chirurgicala.

The fungal etiology of the native aortic endocarditis is a rare situation. Most often the etiologic factors are medical manoeuvres like cardiovascular surgery (cardiac prosthesis), cardiac defibrillators or stimulators, the prolonged use of the intravenous catheters, antibiotics, immunosuppressors, etc. We are presenting the case of a patient with cardiac stimulator, with rare fungal native aortic endocarditis, complicated with cerebral embolization, in which we have chosen a combined therapy: aortic replacement with biologic prosthesis and pre and post operative anti fungal therapy. We are considering that in this case the combined medico-surgical therapy was the right choice.

The brachio-brachial arteriovenous fistula: a new method in patients without a superficial venous system in the upper limb.

PURPOSE: This study aimed to report our experience in the creation of brachio-brachial arteriovenous fistulas (AVFs) in patients without adequate superficial venous circulation at the upper limb. METHODS: A retrospective study of 33 patients, operated on between 2004-2005, in whom we created a brachio-brachial fistula between the brachial artery and the brachial vein. After dissection and adequate mobilization, the brachial vein was anastomized to the brachial artery in an end-to-side fashion. After the maturation period (1 month) the brachial vein was transposed into the subcutaneous tissue. RESULTS: Thirty-three patients underwent 33 brachio-brachial fistula constructions. Primary patency was achieved in all patients. After 1 month, 27 fistulas (81.8%) were functional. Six patients developed fistula occlusion. The 27 remaining patients had subsequently good fistulas for hemodialysis (HD) afterwards. Discrete edema of the forearm was noted in 12 patients (36%); in one of these patients the edema was extended to the entire arm. No other complications were noted. A follow-up study, extended from 3-26 months (mean 14 +/- 6.6 months), was performed. The overall patency rate of the brachio-brachial fistula at the end of the follow-up was 85.2%. CONCLUSIONS: The brachio-brachial fistula can represent a viable choice in patients with an inadequate superficial venous system in the upper limb.

[Pulmonary embolism--complication of proximal deep venous thrombosis in colorectal cancer. Diagnosis and management]. / Tromboembolismul pulmonar--complicatie a tromboflebitei proximale paraneoplazice în cadrul neoplasmului colo-rectal. abordare diagnostica si terapeutica.

We present the case of a 57 years old male, without cardiovascular history, with colorectal cancer and proximal deep venous thrombosis, who develops a massive pulmonary embolism. The surgical treatment consists in embolectomy of right ventricle, pulmonary trunk, left and right pulmonary artery. The specifics of the case is discussed: etiology and prevention of pulmonary embolism (caval filter) and treatment: the contraindications of thrombolytic therapy and the indications and perspectives of surgical treatment.