Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy).

Background: new minimally invasive sternotomy (mini-sternotomy) procedures have improved the treatment outcome and reduced the incidence of perioperative complications leading to improved patient satisfaction and a reduced cost of aortic valve replacement in comparison to the conventional median sternotomy (full sternotomy). The aim of this study is to compare and gain new insights into operative and early postoperative outcomes, long-term postoperative results, and 5-year survival rates after aortic valve replacement through a ministernotomy and full sternotomy. Methods: This is a retrospective study of patients who underwent an isolated replacement of the aortic valve via a full sternotomy or ministernotomy from 2011 to 2016. From 2011 to 2016, 426 cardiac interventions were performed, 70 of which (16.4%) were of the ministernotomy and 356 (83.6%) of the full sternotomy. Through propensity score matching, 70 patients who underwent the ministernotomy (ministernotomy group) were compared with 70 patients who underwent the full sternotomy (control group). Results: in the propensity matching cohort, no statistical difference in operative time was noted (p = 0.856). The ministernotomy had longer cross clamp (88.7 ± 20.7 vs. 80.3 ± 24.6 min, p = 0.007) and bypass (144.0 ± 29.9 vs. 132.9 ± 44.9 min, p = 0.049) times, less ventilation time (9.7 ± 1.7 vs. 11.7 ± 1.4 h, p < 0.001), shorter hospital stay (18.3 ± 1.9 vs. 21.9 ± 1.9 days, p = 0.012), less 24-h chest tube drainage (256.2 ± 28.6 vs. 407.3 ± 40.37 mL, p < 0.001), fewer corrections of coagulopathy (p < 0.001), fewer patients receiving catecholamine (5.71 vs. 30.0%, p < 0.001) and better cosmetic results (p < 0.001). Moreover, the number of patients without complaints at 1 year after the operation was significantly greater in the ministernotomy group (p = 0.002), and no significant differences in the 5-year survival between the groups were observed. In the overall cohort, the ministernotomy had longer cross clamp times (88.7 ± 20.7 vs. 79.9 ± 24.8 min, p < 0.001), longer operative times (263.5 ± 62.0 vs. 246.7 ± 74.2 min, p = 0.037) and bypass times (144.0 ± 29.9 vs. 132.7 ± 44.5 min, p = 0.026), lower incidence of 30-day mortality (1(1.4) vs. 13(3.7), p = 0.022), shorter hospital stays post-surgery p = 0.025, less 24-h chest tube drainage, p < 0.001, and fewer corrections of coagulopathy (p < 0.001). Conclusions: the ministernotomy has a number of advantages compared with the full sternotomy and thus could be a better approach for aortic valve replacement.

Small Intestinal Inflammatory Myofibroblastic Metastasis in the Left Ventricle.

Inflammatory myofibroblastic tumors (IMTs) are rare and usually appear in childhood and adolescence. These tumors often take a benign course, but tend to reoccur in a quarter of cases and metastasize locally. Distant IMT metastases are extremely uncommon. To our knowledge, metastatic spread to the heart has not been reported. We present a case of a 43-year-old woman with small intestinal IMT metastatic spread to the cavity of the left ventricle, stomach, liver, vertebra, and pelvic bones. The cardiac tumor was resected, and the patient survived for 9 months. She dies because the progression of IMT at other sites.

Surgical correction of atrial septal defect in the elderly.

INTRODUCTION: Atrial septal defects (ASDs) are one of the most common congenital malformations in adults. Correction of ASDs in advanced age remains controversial, even though beneficial effects in this patient group were found in recent studies. In older patients, less invasive transcatheter closure of ASDs has been recommended. AIM: The aim of this study was to analyze our advanced age ASD surgical cohort: early and late results. MATERIAL AND METHODS: Retrospective analysis of 32 patients operated on at an age of ≥ 60 years (i.e. age 66.13 ± 4.8, range from 60 to 78) in our center between 2001 and 2011 was carried out. We reviewed our experience of surgical ASD closure in elderly patients over a 10-year period to assess the effects of this type of treatment on early postoperative and long-term survival, early and late complications, preoperative and postoperative clinical status (New York Heart Association [NYHA] functional class), pulmonary hypertension (PH) and atrial arrhythmias. The patients were divided into two groups according to age. RESULTS: The frequency of comorbidities was lower in younger age group patients (11 [61%] vs. 13 [93%], p < 0.05). Atrial fibrillation/flutter was found in 21 (66%) of all patients. Late postoperative mortality was higher in the older patient group (3 [21%] vs. 1 [5.6%]). Despite this, we observed significant improvement of symptoms and functional ability in the older population after surgical ASD closure (group I, n = 10 [56%] vs. group II, n = 12 [86%]). CONCLUSIONS: Surgical correction of clinically significant ASD is effective even in older patients with comorbidities.

A double-orifice tricuspid valve associated with a divided right atrium.

Right atrioventricular valve duplication is a rare congenital anomaly with only isolated cases of a double-orifice tricuspid valve having been described. This article presents a case of the surgical repair of a double-orifice tricuspid valve associated with a divided right atrium, a ventricular septal defect, and Wolff-Parkinson-White syndrome.

[Congenital coronary artery anomalies in patients with tetralogy of Fallot]. / Igimtos vainikiniu arteriju anomalijos sergantiems Fallot tetrada.

OBJECTIVE: The aim of the study was to establish frequency of congenital coronary arteries anomalies in patients with tetralogy of Fallot; to evaluate importance of early diagnostics in planning of surgical tactics and impact on early surgical results. MATERIAL AND METHODS: Consecutive retrospective analysis of angiography data of 278 patients with tetralogy of Fallot and 219 surgical protocols of total corrections of tetralogy of Fallot was performed. RESULTS: Twenty coronary arteries anomalies were diagnosed by means of angiography and 2 during surgery. Sixteen patients with coronary arteries anomalies underwent total tetralogy of Fallot correction. For all of them two stage strategy (palliative operation before total correction) was chosen. Correction by means of extracardiac conduit was performed in 5 (31.25%) patients, right ventricular infundibulectomy via right atrium in one patient. Modified ventriculotomy was performed for 8 patients. CONCLUSIONS: 1. Coronary arteries anomalies have been found in approximately 8% patients with tetralogy of Fallot. 2. For infants with tetralogy of Fallot and coronary arteries anomalies two stage strategy was chosen, so total correction has been made in older patients. 3. In order to prevent anomalous coronary arteries injury, alternative correction of right ventricle obstruction has been chosen. Total tetralogy of Fallot correction using pulmonary artery conduit was made in 31.3% of the patients.

[Influence of reconstruction of right ventricle outflow tract to the results of radical correction of tetralogy of Fallot]. / Desiniojo skilvelio ir plauciu arterijos rekonstrukcijos reiksme tetrados Fallot radikalios korekcijos rezultatams.

UNLABELLED: We wanted to compare results of different methods of correction of right ventricle outflow tract (RVOT) obstruction. In our clinic 259 radical corrections of tetralogy of Fallot were performed from 1984 till 2002. Age of patients from 1 and a half-year to 55 years; 42 from them were children till 3 years age. One hundred twenty nine were primary corrections and 130 after palliative procedure. We divided patients into 6 groups. First group 83 cases - RV reconstruction with pericardial patch. II(nd) group 27 RV reconstruction and commisurotomy of PA. III(rd) group 97 cases RVOT reconstruction with transannular patch. IV(th) group - 30 cases. RVOT reconstruction with monocusp patch. V(th) group - 16 cases - we had used homograft conduit from RV to PA. VI(th) group - reconstructions were made through right atrium incision - 6 cases. RESULTS: Early postoperative mortality 13.2% In I(st) group 10 (12%) patients died, in II(nd) group 3 (11.1%), in III(rd) - 14 (14.4%), in IV(th) - 4 (13.3%) and in V(th) - 3 (18.7%). In group VI nobody died. Main reason of death was acute heart insufficiency because of too high residual RV pressure. CONCLUSIONS: Radical correction of TF may be safely performed for patients of all ages. Early postoperative mortality doesn't depend on way of correction. Main reason of early postoperative deaths is heart insufficiency because of too high residual RV pressure.

[Closure of atrial septal defect via small lateral thoracotomies, partial and full length sternotomies]. / Priesirdziu pertvaros defekto pasalinimas per nedideles sonines torakotomijas, daline bei pilnutine sternotomijas.

Surgical closure of atrial septal defect is considered a low risk procedure. Various minimally invasive surgical techniques spread over the conventional full-length sternotomy. But the risk profile and complication rates of the minimally invasive closure of atrial septal defect are not revealed sufficiently. We present the results of atrial septal defect surgery via small thoracotomies: right anterolateral, right posterolateral, partial sternotomies and full-length median sternotomies. Ninety four patients underwent surgical closure of atrial septal defect via minimal approaches through the period from February 1999 to December 2001. Via median sternotomies were operated 85 patients. Right anterolateral group consisted of 17 patients, right posterolateral - 68, partial sternotomies - 9. The intracardiac period of operation was performed on electrical fibrillation under mild hypothermia. Median bypass time was 33 min. in right anterolateral, 31 min. - right posterolateral, 32 min. - partial sternotomies, 37 min. - median sternotomies. Median fibrillation time was 21 min. in right anterolateral, 18 min. - right posterolateral, 15 min. - partial sternotomies, 21 min. - median sternotomies. There were no technical procedure related complications in minimally invasive group. Intrahospital morbidity consisted of 6 pneumonias, 4 pleural effusions. There were 3 pneumonias, 2 pleural and 2 pericardial effusions in median sternotomies group.