ABSTRACT
We report on a young patient with a bicuspid aortic valve operated on for type A acute aortic dissection because of a blunt thoracic trauma. Aortic root replacement and ascending aortic and total arch repair together with the postoperative course were uneventful. Multigenerational genetic analyses revealed mutations in the NOTCH1 and ACTA2 genes in the patient and his father. The screening of his parents and children revealed no bicuspid aortic valve or aortic root dilation. This exceptionally rare case of double-hit mutations and the presence of blunt trauma reveals the complex etiology of aortic dissection in patients with a bicuspid aortic valve.
Subject(s)
Aortic Dissection/complications , Bicuspid Aortic Valve Disease/complications , Bicuspid Aortic Valve Disease/genetics , Mutation , Thoracic Injuries/complications , Wounds, Nonpenetrating/complications , Acute Disease , Adult , Humans , MaleABSTRACT
A 70-year-old woman with persistent atrial fibrillation underwent pulmonary vein isolation and linear ablation with a contact sensor catheter. During cavotricuspid isthmus ablation, a steam pop resulted in cardiac tamponade, and the patient developed severe hypotension despite successful pericardial puncture and minimal residual pericardial effusion. Right coronary artery angiography revealed extravasal contrast medium accumulation posterior of the Crux Cordis. Emergent cardiac surgery confirmed isolated disruption of the artery in the absence of additional heart perforation. Although contact sensor catheters may reduce complications, steam pops can still occur and result in dramatic complications.
Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Coronary Vessels/injuries , Coronary Vessels/surgery , Wounds, Penetrating/etiology , Wounds, Penetrating/surgery , Aged , Atrial Fibrillation/diagnosis , Body Surface Potential Mapping/adverse effects , Body Surface Potential Mapping/instrumentation , Catheter Ablation/instrumentation , Female , Humans , Treatment Outcome , Wounds, Penetrating/diagnosisABSTRACT
We report on a patient with familial bicuspid aortic valve disease operated on for proximal aortic aneurysm. The surgery was complicated by intraoperative aortic dissection. Multi-generational genetic analysis demonstrated a mutation in the transforming growth factor-beta receptor type II gene. This case confirms the clinical hypothesis that the proximal aortic disease has a genetic origin in some bicuspid aortic valve patients.
Subject(s)
Aortic Aneurysm, Thoracic/genetics , Aortic Dissection/genetics , Aortic Valve/abnormalities , Intraoperative Complications/surgery , Mitral Valve , Protein Serine-Threonine Kinases/genetics , Receptors, Transforming Growth Factor beta/genetics , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Elective Surgical Procedures/methods , Female , Follow-Up Studies , Genetic Predisposition to Disease , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/genetics , Heart Defects, Congenital/surgery , Heart Valve Diseases/diagnosis , Heart Valve Diseases/genetics , Heart Valve Diseases/surgery , Humans , Incidental Findings , Intraoperative Complications/diagnosis , Middle Aged , Mutation , Radiography , Receptor, Transforming Growth Factor-beta Type II , Risk Assessment , Treatment Outcome , Vascular Surgical Procedures/methodsABSTRACT
BACKGROUND: In the last five years, mitral valve surgery has changed fundamentally. This study reviews our experience in less invasive mitral valve surgery (LIMS) during that time. METHODS: LIMS was performed in 449 patients (age 59 +/- 14 years, 237 female) via a right lateral minithoracotomy. The operations included 42 "redo" procedures. After initially experiencing a high number of complications, we have modified and simplified the procedure. After using the Port- Access? Technique (PAT) in the earlier stages of our series, in the last 226 patients the aorta was clamped directly using the transthoracic clamping (Chitwood) technique (TTC). In our most recent cases, PAT was only employed in redo procedures. In 336 patients, the procedure was completed with robotic assistance, and in 23 of these we used the da Vinci telemanipulation system. RESULTS: The mitral valve was repaired in 327 patients and replaced in 122 patients. In 100 patients, additional surgical procedures (TVR n = 13, ASD closure n = 16, left atrial ablation n = 65, left atrial reduction plasty n = 6) were performed. Bypass and clamp time, including times for both additional and redo procedures, were 124 +/- 44 min. and 65 +/- 29 min. in the overall series. Complications, which were mainly neurological, were fewer in the TTC group than in the PAT group (n = 4 vs. n = 17; p <0.04). Hospital mortality was 3.1% and 5.2%, respectively, for the two groups. There were no additional costs associated with using the TTC technique compared to conventional procedures. Mean survival rate was 96.3% at a mean follow-up of 727 +/- 451 days (95% CI, 677 to 779). CONCLUSIONS: Less invasive mitral valve surgery enables the patient to avoid the surgical trauma associated with sternotomy. It has developed into a reliable technique with reproducible results for primary, redo, and additional procedures. LIMS has become the standard approach for mitral valve operations at our institution.
