Subject(s)
Aorta, Thoracic/diagnostic imaging , Mediastinum/diagnostic imaging , Wounds, Gunshot/diagnostic imaging , Accidents , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Computed Tomography Angiography/methods , Firearms , Humans , Male , Middle Aged , Pericardium/diagnostic imaging , Treatment Outcome , Wounds, Gunshot/complications , Wounds, Gunshot/drug therapy , Wounds, Gunshot/pathologyABSTRACT
BACKGROUND: Recent data have highlighted a higher rate of neurological injuries in minimal invasive mitral valve surgery (MIMVS) compared with the standard sternotomy approach; therefore, the role of specific clamping techniques and perfusion strategies on the occurrence of this complication is a matter of discussion in the medical literature. The purpose of this trial is to prospectively evaluate major, minor and silent neurological events in patients undergoing right mini-thoracotomy mitral valve surgery using retrograde perfusion and an endoaortic clamp or a transthoracic clamp. METHODS/DESIGN: A prospective, blinded, randomized controlled study on the rate of neurological embolizations during MIMVS started at the University of Turin in June 2014. Major, minor and silent neurological events are being investigated through standard neurological evaluation and magnetic resonance imaging assessment. The magnetic resonance imaging protocol includes conventional sequences for the morphological and quantitative assessment and nonconventional sequences for the white matter microstructural evaluation. Imaging studies are performed before surgery as baseline assessment and on the third postoperative day and, in patients who develop postoperative ischemic lesions, after 6 months. DISCUSSION: Despite recent concerns raised about the endoaortic setting with retrograde perfusion, we expect to show equivalence in terms of neurological events of this technique compared with the transthoracic clamp in a selected cohort of patients. With the first results expected in December 2016 the findings would be of help in confirming the efficacy and safety of MIMVS. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT02818166 . Registered on 8 February 2016 - trial retrospectively registered.
Subject(s)
Cardiac Surgical Procedures/methods , Cerebrovascular Disorders/diagnostic imaging , Magnetic Resonance Imaging , Mitral Valve/surgery , Thoracotomy , Adult , Aged , Aorta/surgery , Asymptomatic Diseases , Cardiac Surgical Procedures/adverse effects , Cerebrovascular Disorders/etiology , Clinical Protocols , Constriction , Female , Humans , Italy , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Research Design , Risk Factors , Thoracotomy/adverse effects , Time Factors , Treatment Outcome , Young AdultABSTRACT
Mechanical prosthesis is the first choice for valve replacement at the mitral position in children. Replacement of the original prosthesis because of prosthesis-patient mismatch (PPM) is almost inevitable when prostheses are implanted in small children. The impact of PPM on long-term mortality becomes significant when the effective orifice area (EOA) is severely reduced. In these cases prosthesis replacement can be technically difficult, and it often requires extended enlargement of the mitral valve annulus ring. We report a case of a woman who underwent a mitral valve replacement with a 19-mm St. Jude mechanical prosthetic valve at the age of 3 years. At the age of 33 years, the patient underwent a successful minimally invasive mitral annulus ring enlargement and implantation of a 23-mm St. Jude mechanical prosthetic valve via a right minithoracotomy.
