Minimally invasive and full sternotomy in aortic valve replacement: a comparative early operative outcomes.

INTRODUCTION: aortic valve replacement is usually performed through a median full sternotomy (MFS) in our department. Minimally invasive aortic valve replacement (MIAVR) has been recently adopted as a new approach. According to the literature, the superiority of MIAVR is controversial. In this study we report early post-operative outcomes in MIAVR compared with MFS access with reference to blood Loss, wound infections, post-operative recovery, morbidity and mortality. METHODS: this study was a prospective data collection from 36 consecutive patients undergoing isolated valve replacement. Two population study was identified, MIAVR group (group I n=18) and MFS group (group II n=18). Patients´ data were collected and analyzed using IBM SPSS statistics 21 software and Khi2 test has been used to compare the variables. The study variables are presented as numbers, percentage, median with interquartile range. Pre-operative planning was performed so that to obtain similar characteristics. RESULTS: in group I, upper mini-sternotomy was used in 12 patients and right mini-thoracotomy in 6 patients. There was no difference in term of mortality and morbidity. MIAVR was associated with longer CPB time (93.25 (58-161) vs 131 (75-215) mins, P=0.047) with no significant difference in term of ACC time (81 (33-162) vs 58.8 (59-102) mins P=0.158). MIAVR´ Patients had likely lower incidence of red blood cells transfusion (16.7 vs 52.3%) without significant difference about post-operative haemoglobin (P = 0,330). Patients in group I had shorter ventilation time (2.35 (1-12) vs 9.3 (1-48) hours P < 0.01), shorter ICU stay (2.44 (1-8) vs 4.25 (1-9) days, P = 0,024). The length of hospital stay was shorter, 6.5 (5-9) days in group I vs 7.4 (6-11), P=0.0274. Length of chest tube stay was shorter in group I (mean 1.53 vs 2.4 days, P=0,033). Wound infections were not found in both groups. CONCLUSION: minimally invasive aortic valve replacement is associated with less blood loss, faster post-operative recovery faster post-operative recovery but increase operation time.

Current Status of Training and Certification for Congenital Heart Surgery Around the World: Proceedings of the Meetings of the Global Council on Education for Congenital Heart Surgery of the World Society for Pediatric and Congenital Heart Surgery.

The optimal training of the highly specialized congenital heart surgeon is a long and complex process, which is a significant challenge in most parts of the world. The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has established the Global Council on Education for Congenital Heart Surgery as a nonprofit organization with the goal of assessing current training and certification and ultimately establishing standardized criteria for the training, evaluation, and certification of congenital heart surgeons around the world. The Global Council and the WSPCHS have reviewed the present status of training and certification for congenital cardiac surgery around the world. There is currently lack of consensus and standardized criteria for training in congenital heart surgery, with significant disparity between continents and countries. This represents significant obstacles to international job mobility of competent congenital heart surgeons and to the efforts to improve the quality of care for patients with Congenital Heart Disease worldwide. The purpose of this article is to summarize and document the present state of training and certification in congenital heart surgery around the world.

Pulse Oximetry and Congenital Heart Disease Screening: Results of the First Pilot Study in Morocco.

Congenital heart disease (CHD) is the most common congenital malformation. Diagnosis of critical congenital heart disease (CCHD), the most severe type of congenital heart disease, in a newborn may be difficult. The addition of CCHD screening, using pulse oximetry, to clinical assessment significantly improves the rate of detection. We conducted a pilot study in Morocco on screening neonates for critical congenital heart disease. This study was conducted in the maternity ward of Mohammed VI University Hospital of Marrakesh, Morocco, and included asymptomatic newborns delivered between March 2019 and January 2020. The screening of CCHD was performed by pulse oximetry measuring the pre- and post-ductal saturation. Screening was performed on 8013/10,451 (76.7%) asymptomatic newborns. According to the algorithm, 7998 cases passed the screening test (99.82%), including one inconclusive test that was repeated an hour later and was normal. Fifteen newborns failed the screening test (0.18%): five CCHD, five false positives, and five CHD but non-critical. One false negative case was diagnosed at 2 months of age. Our results encourage us to strengthen screening for CCHD by adding pulse oximetry to the routine newborn screening panel.

Tricuspid Valve Endocarditis Following a Scorpion Sting: A Case Report.

Scorpion sting envenoming is a common pediatric emergency in the Moroccan southern areas. Cardiomyopathy is the most common cardiovascular manifestation of envenoming, resulting from the stimulation of the sympathetic nervous system by the venom or from the direct effect of the venom toxins on the myocardium. Rare cases of infective endocarditis following a scorpion sting have been reported in the literature. We report a case of tricuspid valve infective endocarditis following a scorpion sting in a previously healthy eight-year-old child. The patient initially was managed medically before undergoing tricuspid valve replacement with a bioprosthesis. The postoperative course was uneventful with a full recovery.

Ligation of the aorta for a mycotic abdominal aortic aneurysm in an infant.

Mycotic aortic aneurysms are exceedingly uncommon in infants and they have a high risk of rupture. Their surgical management is extremely challenging. We report a case of a 22-month-old girl who presented with abdominal pain and fever revealing a ruptured mycotic aneurysm of the infrarenal aorta. The surgical treatment consisted of a ligature of the proximal and distal ends of the aneurysm. Postoperative course was significant for hypertension. A year and a half follow-up showed no other complications. Limited data are available concerning our chosen technique, but the reported cases showed a good short-term outcome.

Blood Culture-Negative Endocarditis, Morocco.

We investigated the microorganisms causing blood culture-negative endocarditis (BCNE) in Morocco. We tested 19 patients with BCNE by serologic methods, molecular methods, or both and identified Bartonella quintana, Staphylococcus aureus, Streptococcus equi, and Streptococcus oralis in 4 patients. These results highlight the role of these zoonotic agents in BCNE in Morocco.

Diagnostic and Management Difficulties of Complete Atrioventricular Block In Children in Marrakech: A Report of Three Cases With a Review of the Literature.

Complete atrioventricular (AV) block is a rare affection in children. It is the consequence of abnormal conduction tissue within a cardiac malformation or it is due to cardiac injury. Yet the etiology of late complete atrioventricular block in child remains mostly unknown. The treatment of children's Complete atrioventricular block is the implantation of a pacemaker with immediate results satisfactory in the absence of associated cardiomyopathy. In this observation we will treat three cases.

Aortopulmonary Window Associated with an Ascending Aorta Aneurysm in an Adult.

Aortopulmonary window (APW) is a rare congenital malformation. It results from an incomplete division between the ascending aorta and the pulmonary artery. We describe a 26-year-old male, who presented with a grade II exertional dyspnea and palpitations. Echocardiography revealed an APW with an ascending aorta aneurysm. He underwent surgery under cardiopulmonary bypass without aortic cross-clamping. The APW was closed via the pulmonary artery flap technique using an autologous pericardial patch, and the aneurysm was repaired through the reduction aortoplasty technique. The patient was discharged on the 4(th) postoperative day. At 2 years' follow-up, he had remained asymptomatic and echocardiography showed aortic valve competence, ascending aorta diameter of 38 mm, and no residual shunt.

Silent embolization of an Amplatzer septal occluder into the left ventricular outflow tract requiring emergent surgical retrieval.

Percutaneous closure of secundum atrial septal defect is an established safe alternative to surgery with rare complications and high primary success rate. This procedure can be complicated by early or late device embolizations. We report an asymptomatic delayed nonobstructive embolization of an amplatzer septal occluder (ASO) into the left ventricle outflow tract detected by routine transthoracic echocardiography 1 week after implantation, which required emergent surgical retrieval in a stable patient.

A large aneurysm of a left sinus of Valsalva invading the interventricular septum--a rare cause of syncope.

Sinus of Valsalva aneurysms are uncommon, especially those in the left sinus of Valsalva. A case of a 45-year-old woman with syncope is presented. She was in complete heart block. Auscultation revealed moderate aortic regurgitation. Transthoracic echocardiography revealed a subaortic membrane attached to the interventricular septum with expansion in diastole and collapse in systole. A diastolic flow was seen at the edge of this membrane. Transesophageal echocardiography revealed a cystic mass that was thought to be a large aneurysm with a parietal thrombus of the left coronary sinus extending into the interventricular septum. Magnetic resonance imaging confirmed the diagnosis. The aneurysm extension to the interventricular septum resulted in complete heart block, presumably through compression of normal atrioventricular nodal function. Case reports of the latter association are extremely rare. The present is a rare report describing the magnetic resonance imaging appearance of a left sinus of Valsalva aneurysm.

Intrapericardial paraganglioma.

We report a case of intrapericardial paraganglioma accidentally discovered during surgery for mixed mitral valve disease. The 6 cm tumor was located in the aorta-caval groove, adherent to the roof of the left atrium and compressing the superior vena cava. A biopsy of the mass established the histological diagnosis of a non pressor secreting paraganglioma. The tumor was resected 2 months after the original mitral valve surgery. The patient made an uneventful recovery and remains well 2 years after surgery.