Myocardial localization of coronavirus in COVID-19 cardiogenic shock.

We describe the first case of acute cardiac injury directly linked to myocardial localization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a 69-year-old patient with flu-like symptoms rapidly degenerating into respiratory distress, hypotension, and cardiogenic shock. The patient was successfully treated with venous-arterial extracorporeal membrane oxygenation (ECMO) and mechanical ventilation. Cardiac function fully recovered in 5 days and ECMO was removed. Endomyocardial biopsy demonstrated low-grade myocardial inflammation and viral particles in the myocardium suggesting either a viraemic phase or, alternatively, infected macrophage migration from the lung.

Veno-venous ECMO during surgical repair of tracheal perforation: A case report.

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is used extensively in cardiothoracic surgery both for hemodynamic and respiratory support. It has proven to be a valuable tool to maintain adequate oxygenation during tracheal surgery. Airway lesion may be an indication for veno-venous ECMO both in case of conservative management and in case of surgical repair. Here we report the case of a patient with a iatrogenic tracheal injury, successfully operated with the support of veno-venous extracorporeal oxygenation. PRESENTATION OF CASE: A 39-year-old female underwent an elective laparoscopic adhesiolysis. At the end of the procedure, the patient had developed subcutaneous emphysema. A CT-scan showed mediastinal and subcutaneous emphysema and left pneumothorax with a laceration of the membranous portion of the middle third of the trachea. A left pleural drain was inserted and a bronchoscopy showed a 2-cm long tear of the membranous portion in the middle third of the trachea. Veno-venous ECMO was established and surgical repair of the tracheal lesion was performed. Post-operative recovery was uneventful and the patient was discharged on 8th postoperative day. DISCUSSION: The use of Veno-venous ECMO allowed a safe intubation with optimal oxygenation. A selective intubation with a small tube was performed to prevent further tracheal injury and allow an adequate surgical space for tracheal repair. CONCLUSION: The use of ECMO support represents a safe and effective way to manage patients with ITI when surgical repair with minimally invasive ventilation is needed. Since this is a case report larger studies are needed to validate the technique.

[Valve-in-valve treatment of a degenerated supra-annular stentless bioprosthesis using a balloon-expandable transcatheter valve in a patient at high risk for coronary occlusion]. / Trattamento valve-in-valve con protesi balloon-expandable di bioprotesi chirurgica stentless sovra-anulare degenerata con alto rischio di occlusione coronarica.

Transcatheter valve-in-valve treatment of degenerated supra-annular stentless bioprostheses may be challenging and associated with a high risk of coronary occlusion. Preprocedural imaging evaluation is a key step to assess feasibility and to minimize or prevent coronary occlusion. We report the case of a degenerated Freedom Solo valve, treated with a balloon-expandable valve and a previously deflated stent positioned at the level of both coronary ostia. The procedure was successful but stent inflation at the right coronary ostium was required due to slow flow that occurred after valve implantation.

Patent foramen ovale diagnosis: The importance of provocative maneuvers.

Patent foramen ovale (PFO) is a frequent congenital anomaly, but massive right-to-left shunt (RTLS) is normally prevented by higher pressures in left heart chambers. However, mechanical ventilation with positive end-expiratory pressure (PEEP) can significantly increase right atrial pressure, accentuating the RTLS, mainly after major cardiothoracic surgery. We report a patient admitted to the intensive care unit after cardiac surgery. Pre- and intraoperative transesophageal echocardiography only described an aneurysmal interatrial septum with no shunt. However, high-PEEP ventilation induced a paradoxical response with life-threatening hypoxemia, triggering further echocardiographic evaluation, revealing massive RTLS across a stretch PFO. Provocative maneuvers (Valsalva/PEEP) significantly increase echocardiographic sensitivity, unmasking silent PFO. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:58-61, 2017.

Minimally invasive heart-port assisted technique as standard first choice approach for left ventricle endoplasty: a ten-year single-center experience.

BACKGROUND: Although the port-access technique has been shown to be an effective and safe approach for cardiac surgery procedures it has never become routine practice, and it is still limited to few and selected centers. Furthermore, such technique has rarely been applied to treat left ventricle disease. In 1999 we introduced left ventricle aneurysm repair through a left minithoracotomy using the port-access technique. Here we present the results in terms of early and medium-term follow-up using such technique as a routine first choice approach for left ventricle endoplasty. METHODS: From 1999 to date, out of 38 patients undergoing left ventricle endoplasty (+/-associate procedures), mini-left thoracotomy and port-access techniques have been used in 32 patients (84%). All patients underwent endoventricular patch-repair with ventricular reshaping and associated procedures were performed in 8 patients. RESULTS: All patients survived the operation and were discharged from the hospital (30 days mortality 0%). Two patients (6.2%) experienced prolonged mechanical ventilations and 3 patients (9.3%) prolonged intensive care unit stay. Mean follow-up was 40+/-34 months (range, 2 to 105). One patient died during follow-up (cumulative mortality 3.3%). Follow-up revealed an improvement of hemodynamic performances (left ventricular ejection fraction 0.44+/-0.09 compared with 0.34+/-0.09 preoperatively, p=0.004) and improved clinical conditions (New York Heart Association class 1.4+/-0.5 compared with 2.3+/-1 preoperatively, p=0.003). CONCLUSIONS: The port-access technique can be safely applied to perform left ventricle endoplasty through a left minithoracotomy. Such approach allows optimal surgical view and therefore optimal surgical correction. Based on our satisfactory experience we support left minithoracotomy as a valuable alternative approach for left ventricle endoplasty in view of an extended use of minimally invasive techniques.

Successful surgical management of invasive aspergillosis of the pulmonary arteries.

We describe an 11-year-old girl with severe obstruction of the main pulmonary arteries caused by invasive aspergillosis and managed with combined pulmonary endarterectomy and antimycotic treatment.

Right ventricular failure after left ventricular assist device insertion: preoperative risk factors.

Right ventricular failure after left ventricular assist device placement is the major concern on weaning from cardiopulmonary bypass and it is one of the most serious complications in the postoperative period. This complication has a poor prognosis and is generally unpredictable. The identification of pre-operative risk factor for this serious complication is incomplete yet. In order to determine pre-operative risk for severe right ventricular failure after left ventricular assist device support we analyzed preoperative hemodynamics, laboratory data and characteristics of 48 patients who received Novacor (World Heart Corp., Ottawa, ON, Canada). We compared the data from the patients who developed right ventricular failure and the patients who did not. Right ventricular failure occurred in 16% of the patients. There was no significant difference between the groups in demographic characteristics. We identified as preoperative risk factors the pre-operative low mean pulmonary artery and the impairment of hepatic and renal function on laboratory data. Our results confirm in part the findings of the few previous studies. This information may be useful for the patient selection for isolated left ventricular assist device implantation, but other studies are necessary before establishing criteria for patient selection for univentricular support universally accepted.