Silent Kawasaki Disease Affecting Multiple Coronary Arteries in a 39-Year-Old Egyptian Woman.

Kawasaki disease, an acute febrile illness, can cause vasculitis in the coronary arteries. It is the chief acquired cause of myocardial infarction and sudden cardiac death in infants, children, and young adults in developed countries. We report a case of chronic, silent Kawasaki disease complicated by multivessel thrombosis in a 39-year-old Egyptian woman. The patient presented with progressive, unstable angina but was otherwise asymptomatic and at negligible risk of ischemic heart disease. Coronary angiograms showed critical arterial stenosis with multiple aneurysms. During revascularization surgery, the patient's harvested left internal mammary artery was found to have occlusive lesions and aneurysmal areas that made it unfit for bypass grafting, and subsequent histopathologic examination revealed features characteristic of chronic Kawasaki disease-associated systemic vasculitis. We think that this is only the second report of Kawasaki disease in the Arabian Mediterranean region. In addition to the patient's case, we discuss the epidemiology and management of Kawasaki disease, in hopes of increasing clinicians' awareness.

Previous Stenting Doesn't Affect Outcome of Extensive Endarterectomy for Diffuse Coronary Artery Total Occlusions: A Propensity Score Matching Analysis.

BACKGROUND AND AIM: Extensive diffuse coronary artery total occlusions (CTOs) constitute a challenging surgical problem. Extensive coronary endarterectomy (CE) combined with CABG was suggested as a revascularization technique. It was claimed that previous stenting may affect outcome. The present study aimed to report the outcome of LAD endarterectomy for CTO and to determine the effect of previous stenting on this outcome. PATIENTS AND METHODS: The present retrospective study was conducted on 194 patients with CTO indicated for left anterior descending artery (LAD) endarterectomy. To reduce the bias related to unbalanced patients selection, propensity score matching analysis was used. According to the propensity score, 194 patients were included in the analysis. They comprised 66 patients with previous stent and 128 patients without previous stent. Patients were followed for a median (range) of 74.0 (6.0-149.0) months. The primary study outcome was LAD graft patency. Other outcome parameters included postoperative complications, hospital and ICU stay, and mortality. RESULTS: Comparison between the studied groups regarding outcome parameters revealed no significant differences regarding graft patency (93.9% versus 89.1%; P = .27), graft survival (median [95% CI]: 134.3 months [127.0-141.5] versus 135.2 months [128.4-142.0]; P = .35), patients' survival (93.9% versus 91.4%) and patients' survival time (median [95% CI]: 132.3 months [125.0-139.5] versus 138.0 months [132.0-144.1]; P = .75]. CONCLUSION: The present study supports using CE as an adjuvant technique with CABG in patients with TCOs.   Patients and methods: The present retrospective study was conducted on 194 patients with CTO indicated for left anterior descending artery (LAD) endarterectomy. To reduce the bias related to unbalanced patients selection, propensity score matching analysis was used. According to the propensity score, 194 patients were included in the analysis. They comprised 66 patients with previous stent and 128 patients without previous stent. Patients were followed for a median (range) of 74.0 (6.0-149.0) months. The primary study outcome was LAD graft patency. Other outcome parameters included postoperative complications, hospital and ICU stay and mortality.   Results: Comparison between the studied groups regarding outcome parameters revealed no significant differences regarding graft patency (93.9 % versus 89.1; p=0.27), graft survival [median (95% CI): 134.3 months (127.0-141.5) versus 135.2 months (128.4-142.0); p=0.35], patients' survival (93.9 % versus 91.4 %) and patients' survival time [median (95% CI): (132.3 months (125.0-139.5) versus 138.0 months (132.0-144.1); p= 0.75].   Conclusions: The present study supports use CE as an adjuvant technique with CABG in patients with TCOs.

Mitral Valve Bioprosthesis Is Safer Than Mechanical Mitral Prosthesis in Young Women.

BACKGROUND: The ultimate goal of mitral valve surgery in young women is to extend life expectancy and improve quality of life. Mitral valve replacement (MVR) prosthesis in middle-aged women is a difficult choice between the lifelong anticoagulation by mechanical prosthesis versus the limited long-term durability of bioprosthesis. The current trend towards reducing women's age for selecting bioprosthesis over mechanical prosthesis leads to a dilemma for younger women decision making. The aim of this study was to compare the safety and freedom from complications in pregnancy and survival rate after mitral valve bioprosthesis versus mechanical prosthesis in young women for whom mitral valve repair is not feasible, or unsuitable. METHODS: This single-center non randomized prospective study included all female patients undergoing MVR at our center from January 2010 to February 2020. RESULTS: In total, 355 young women patients underwent MVR at our center, of whom 174 received a bioprosthesis and 181 received a mechanical prosthesis. The use of anticoagulation among young women with mechanical prosthesis was associated with a remarkable risk of postoperative bleeding, abortion, and increased frequency of pregnancy-related complications (P < .0001). In contrast, there was a considerable survival benefit for those who received bioprosthesis (P = .0001). CONCLUSION: Our data confirm that the use of mitral bioprosthesis in young women who desire to become pregnant is safe, reduces complications, and increases survival.

Should Moderate Functional Tricuspid Regurgitation Be Repaired During Surgery for Rheumatic Mitral Valve Disease?

BACKGROUND: Surgical repair of concomitant functional moderate tricuspid valve (TV) regurgitation at the time of mitral valve (MV) surgery remains controversial. AIM: The objective of this study was to evaluate the outcomes of concomitant repair of functional moderate tricuspid regurgitation (TR) during MV surgery for rheumatic valve disease. METHOD: From 1998 to 2016, 1,240 patients had rheumatic MV disease associated with moderate functional TR: 974 patients had MV surgery and concomitant TV repair (group 1) and 266 patients had MV surgery alone (group 2). Study endpoints were operative outcomes, rehospitalisation for congestive heart failure (CHF), and TV reintervention. Propensity score matching identified 192 well-matched pairs for outcomes comparison. RESULTS: Patients who had concomitant TV repair were younger (p=0.02) and there were fewer diabetics (p=0.015). In matched patients, low cardiac output was significantly higher in group 2 (p=0.044) and there was no difference in ventilation time, intensive care unit stay, cardiopulmonary bypass, and ischaemic times (p=0.480, p=0.797, p=0.232, and p=0.550, respectively) between groups. Patients in group 2 required more TV reintervention (1 vs 35 in group 1 and 2, respectively; p=0.004) and rehospitalisation for CHF (5 vs 40 in group 1 and 2, respectively; p<0.001). CONCLUSIONS: Concomitant TV repair for moderate TR in patients undergoing rheumatic MV surgery was not associated with increased operative risk. Postoperative low cardiac output syndrome and the risk of late TV reinterventions and rehospitalisation for CHF were lower with TV repair. Concomitant repair of the moderate TV regurgitation maybe beneficial for patients undergoing rheumatic MV surgery.