Cardiac autotransplantation for repair of left ventricular rupture after mitral valve replacement.

Left ventricular rupture is an infrequent but potentially fatal complication of mitral valve replacement. We report a case of large posterior mid-ventricular rupture following mitral valve replacement, which was successfully treated by a patch repair and autotransplantation.

Adults forms of scimitar syndrome.

Scimitar syndrome is a rare malformation defined as the partial or total anomalous pulmonary venous return of the right lung veins to the inferior vena cava just above or below the diaphragm. Severe forms of the disease are diagnosed in infancy and childhood. However, because of the mild form of the syndrome in adult patients, they remain asymptomatic and few cases are reported in the literature. We report two adults cases of this syndrome with one presenting with chest discomfort.

Unexpected normal left ventricular systolic function after total chronic occlusion of left main coronary artery and stenosis of right coronary artery: a case report and review of the literature.

INTRODUCTION: Total occlusion of the left main coronary artery is a very rare finding in coronary angiography because of its highly lethal nature. Right coronary artery dominance and extensive collateral circulation are the principal determinant factors of survival after total occlusion of the left main coronary artery. The impact on the left ventricle is often significant with a profound alteration of its systolic function. CASE PRESENTATION: We describe a 52-year-old North African man, a tobacco smoker, who presented symptoms of unstable angina related to a total chronic occlusion of his left main coronary artery with a right coronary artery stenosis. Unexpectedly, the impact on his left ventricle was absent with normal dimensions and systolic function. He underwent a successful on-pump coronary artery bypass grafting with uneventful postoperative course and good recovery. CONCLUSIONS: Total occlusion of the left main coronary artery is a rare condition, the fact that the left ventricle retains a normal size and systolic function makes it exceptional, which must be kept in mind to avoid dangerous examinations and delayed treatment. Coronary artery bypass surgery should be considered the main treatment of total chronic occlusion of the left main coronary artery.

Early results for active infective endocarditis.

INTRODUCTION: Cardiac surgery is frequently needed during active phase of infective endocarditis (IE). The purpose of this study was to analyze the immediate and late results and determine the risk factors for death. METHODS: We retrospectively reviewed 101 patients with IE operated in the active phase. The mean age was 40.5 ± 12.5 years. 16 patients (15.8%) were diagnosed with prosthetic valve endocarditis (PVE). 81 (80.9%) were in NYHA functional class III-IV. Blood cultures were positive in only 24 cases (23.9%). RESULTS: in-hospital mortality rate was 17.9% (18 cases). Multivariate analysis indentified five determinant predictor factors: congestive heart failure (CHF), renal insufficiency, high Euroscore, prolonged cardiopulmonary bypass time (> 120 min) and long ICU stay. The median follow-up period was 4.2 (2-6.5) years. Overall survival rate for all patients who survived surgery was 97% at 5 years and 91% at 10 years. CONCLUSION: Despite high in-hospital mortality rate, when patients receive operation early in the active phase of their illness, late outcome may be good.