Patch-and-glue sutureless repair for blowout rupture after myocardial infarction: report of two cases.

A blowout cardiac rupture is sudden and dramatic. The most appropriate surgical repair remains controversial. We report our experience with blowout rupture treated by sutureless technique. The two cases were males aged 58 and 79 years respectively. Echocardiography confirmed the diagnosis of cardiac rupture. Resuscitation was continued in the operating suite, and the myocardial tear and necrotic area were covered with two sheets of fibrin tissue-adhesive collagen fleece and an equine pericardial patch secured to the heart surface with biologic glue with the aid of cardiopulmonary bypass. Both patients survived and were discharged from our hospital. One has been doing well for 15 months after surgery and the other remains breathing on his own but otherwise nonreactive for 20 months since. We have adopted a patch-and-glue sutureless technique instituting cardiopulmonary bypass for blowout rupture. Cardioplegic arrest was performed to achieve a bloodless surgical field and maximize glue function. All rupture sites should be covered with a properly large patch. This technique is simple, versatile, and considered to be associated with a favorable outcome.

Patch-and-glue repair in combination with or without direct suture for cardiac rupture after myocardial infarction.

OBJECTIVE: Left ventricular free-wall rupture is a catastrophic event after myocardial infarction. The most appropriate surgical management remains controversial. We have performed a patch-and-glue technique, with or without direct suture and using cardioplegic arrest, to treat postinfarction cardiac rupture. We describe our experiences over a 5-year period, and discuss the optimal surgical repair for each type of rupture. METHODS: Since 2002, we have managed 5 patients with cardiac rupture. Two patients had a blowout rupture, 2 were of the subacute type, and 1 experienced an oozing rupture. There were 3 men and 2 women, with an average age of 76.2 +/- 12.5 years. Echocardiography confirmed the diagnosis in all patients. Two patients underwent a patch-and-glue repair in combination with direct suture, one had an infarctectomy, and the others had a completely sutureless patch-and-glue treatment performed using cardioplegic arrest. RESULTS: All patients survived the initial treatment and were moved to the intensive care unit with complete hemostasis. The 2 patients who were treated in combination with direct suture died of brain death or cardiac failure (mortality rate 40%). The 3 patients who were treated with the patch-and-glue sutureless technique were discharged from our hospital, and are alive 15-27 months after the operation. Two are doing well, and the other is breathing on his own but remains nonreactive. CONCLUSION: We prefer the patch-and-glue sutureless technique even for a blowout rupture. We performed cardioplegic arrest to provide a bloodless surgical field and maximize adhesive function. The whole necrotic area should be covered with a large patch of appropriate size.

Large saccular aneurysm in a coronary arterial fistula--a case report.

The authors present a case of a large saccular aneurysm in a coronary artery fistula originating from the proximal left anterior descending coronary artery, draining into the main trunk of the pulmonary artery. The diagnosis was made by 3-dimensional computed tomography and coronary arteriography. Congenital coronary artery fistula is not uncommon. With a saccular aneurysm, however, it is very rare. A ruptured aneurysm will induce sudden death if surgical repair is not done.

Comparison of the strain Doppler echocardiographic features of familial amyloid polyneuropathy (FAP) and light-chain amyloidosis.

Previous work has demonstrated that familial amyloid polyneuropathy (FAP) and light-chain amyloidosis with similar degrees of cardiac involvement cannot be distinguished by standard echocardiographic parameters, yet the severity of congestive heart failure and cardiac mortality is much less in FAP. It was therefore hypothesized that strain and strain-rate imaging, sensitive markers of longitudinal systolic dysfunction, might detect a difference in left ventricular function between FAP and light-chain amyloidosis that could account for the clinical differences.

[Inflammatory markers and cytokines in cardiovascular disease].

Inflammatory processes play a pivotal role in the pathogenesis of atherosclerosis and mediate the stages of atheroma development from initial leukocyte recruitment to eventual rupture of the unstable atherosclerotic plaque. Recent investigations demonstrated that several inflammatory markers are considered as new predictable risk factors for atherosclerosis and cardiac events. Among these markers, C-reactive protein (CRP) has been most widely studied. CRP is produced in the liver in response to interleukin-6 (IL-6), it is an acute phase reactant and used as a general inflammatory marker. High-sensitivity-CRP (hs-CRP) which could detect a small amount of CRP was recently developed, and numerous large-scale, prospective studies have found that elevated baseline levels of hs-CRP are independent predictor of cardiovascular events. Inflammatory cytokines such as IL-6 and tumor necrosis factor-alpha (TNF-alpha) have also been evaluated as potential tools for prediction of the cardiovascular events. In this review, we focused on the recent reports and potential use of the inflammatory markers and cytokines as a predictable tool for the cardiovascular events.