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.

Sustainable knowledge transfer in pediatric cardiac surgery: a team approach to shared learning.

The study assesses the impact of a program using a model of knowledge transfer on the long-term development of a pediatric cardiac service in Lithuania. A team from the United Kingdom evaluated Lithuanian pediatric cardiac services and provided support in areas targeted for improvement. The total number of infant operations performed in Lithuania from 1990 to 2008, together with in-hospital mortality rates, was broken down into 3 time periods and analyzed to estimate the efficacy of the program: (1) 1990-1998, before the program; (2) 1999-2002, during the program; (3) 2003-2008, following the end of the program. Lithuanian results in children older than 1 year were comparable with other European centers. However, only 315 infant and neonatal cardiac procedures were performed between 1990 and 1998, and there was an in-hospital mortality of 34.2%. Between 1999 and 2002, the UK team performed 23 highly complex demonstration procedures (in-hospital mortality, 13%). During the same period the Lithuanian team performed 305 additional operations in neonates and infants, and in-hospital mortality decreased to 18.7%. From 2003 to 2008 results continued to improve-559 infant operations were performed, with in-hospital mortality of 11.3% (P < .0001). Knowledge transfer has led to substantial and sustainable long-term improvement in the results of infant cardiac surgery in Lithuania. Demonstrating techniques and care on a limited number of more complex cases is an efficient way of transferring knowledge and skills to the developing pediatric cardiac centers.

[Results of surgical treatment of aortic root infection]. / Aortos saknies infekcijos chirurginio gydymo rezultatai.

AIM OF THE STUDY: To investigate preoperative status and results of surgery of patients with confirmed diagnosis of aortic root infection. MATERIALS AND METHODS: We have analyzed data of 21 patients who were operated on at the Heart Surgery Center, Vilnius University, since January 1, 1997, till December 31, 2006. All these patients underwent surgery because of aortic root infection. The patients were aged 25-72 years (mean age, 53+/-14 years). There were 17 (80.9%) male patients. Sixteen patients (76%) preoperatively were in NYHA class IV. The abscesses of aortic root were confirmed preoperatively by means of esophageal echocardiography in 18 patients (86%). Blood cultures positive for Staphylococcus aureus were found in four patients (19.9%). All the patients underwent replacement of the aortic valve by mechanic prosthesis; one of these patients was reoperated because of persistent sepsis, and replacement of the aortic root with homograft was performed. The duration of follow-up of the patients was 1 to 10 years. RESULTS: Inhospital mortality rate was 14.3%. The causes of death included sustained heart failure and sepsis. All these patients were in NYHA functional class IV preoperatively; one of these patients had culture positive for Staphylococcus aureus. Inhospital survival was 85.7%, one-year postoperative survival - 80.9%, and both five-year and ten-year survivals were 76.0%. The long-term survival was negatively influenced by recurrent infective endocarditis, heart failure, and age. Death occurred in 1 patient (11.1%) of the 9 patients who at the time of surgery were younger than 50 years and 4 patients (33.3%) of the 12 who were older than 50 years at the time of operation. CONCLUSIONS: The infection of aortic root is not common pathology; however, it is a complicated disease. Esophageal echocardiography is an informative method while diagnosing aortic root abscesses. The inhospital mortality is increased by the heart failure persisting after the operation and sepsis. The long-term survival is decreased by preoperative infective endocarditis of the prosthesis and heart failure. The mortality rate of patients older than 50 years is 3-fold higher than mortality rate of younger ones.

[Survival rate of patients with ascending aorta aneurysm and aortic valve regurgitation in the late postoperative period]. / Pacientu, operuotu esant letinei kylanciosios aortos aneurizmai ir aortos voztuvo nesandarumui, isgyvenamumas velyvuoju pooperaciniu laikotarpiu.

UNLABELLED: The aim of the study was to evaluate the long-term survival in patients undergoing surgical treatment for chronic aortic aneurysms with aortic regurgitation. MATERIAL AND METHODS: We analyzed survival data of 188 patients during follow-up period of 1 month to 20 years postoperatively. The patients were divided into the following groups according to the clinical course: Group 1--chronic dissecting aneurysm of ascending aorta with aortic regurgitation (42 patients, 22.3%); Group 2--chronic nondissecting aneurysm of ascending aorta with aortic regurgitation (146 patients, 77.7%). Mean NYHA functional class of the patients was 3.5+/-0.06. In the Group 1, 64.3% of the patients were in NYHA functional class IV; 35.7% of the patients were in NYHA class III. In the Group 2, the majority of the patients (58.2%) were in class III; in class IV - 41.8%. The most common etiological factors in both groups were atherosclerosis, arterial hypertension, and Marfan's syndrome. RESULTS: No differences in overall and long-term survival rates between the groups were found. However, the patients who were in class III before the operation showed significantly higher overall and long-term survival rates in comparison with the survival rate of the patients who were in NYHA class IV preoperatively (overall survival rate, 91.4+/-3.0% vs 62.9+/-6.9%; and long-term survival rate, 93.2+/-2.7% vs 72.9+/-5.6; respectively). There were 24 deaths (12.8%) during the late postoperative period. The main causes of death were progressive heart failure and infective prosthetic endocarditis (Group 2), chronic heart failure and dysfunction of the conduit (Group 1). CONCLUSIONS: The analysis of patients' long-term survival demonstrated the efficacy of surgical treatment of such a complex pathology as chronic aneurysm of the ascending aorta with aortic valve regurgitation. The survival rate in the late postoperative period was higher in NYHA class III patients. The main causes of death were chronic heart failure and infective prosthetic endocarditis.

[Late outcomes of on-pump and off-pump redo coronary artery bypass grafting]. / Pakartotiniu aortos vainikiniu arteriju jungciu suformavimo operaciju su (be) dirbtine kraujo apytaka velyvieji pooperaciniai rezultatai.

UNLABELLED: Benefits of off-pump surgery are still widely debated in the literature comparing with conventional coronary artery bypass grafting. The aim of our study was to compare the late outcomes of patients who underwent on-pump redo coronary artery bypass surgery with those who had off-pump redo coronary artery bypass surgery. MATERIAL AND METHODS: Two groups of patients were compared. Group 1 consisted of 34 patients who underwent off-pump redo coronary artery bypass surgery, and Group 2 included 160 patients who underwent on-pump redo coronary artery bypass surgery. Both groups of patients were operated on by the same team of surgeons at the same time period. Groups did not differ by age, gender, functional class, preoperative myocardial infarction rate, and left ventricular function. More patients with hypertension were in the off-pump group. Significantly more grafts were performed in the on-pump group. Survival, presence of angina, reoccurrence of postoperative myocardial infarction, necessity of percutaneous transluminal coronary angioplasty and reoperations were evaluated in late follow-up period. The duration of follow-up was 3.37+/-2.15 years in the off-pump group and 3.27+/-2.36 years in the on-pump group. RESULTS: Survival after 6 years in the off-pump and on-pump redo coronary artery bypass surgery groups was 85.3% and 83.6%, respectively (P=0.758). Five years after redo operation, 54.9% of patients who underwent off-pump coronary artery bypass surgery and 69.3% of patients who underwent on-pump coronary artery bypass surgery had no angina (P=0.174). There were no major cardiac events (percutaneous transluminal coronary angioplasty, death, myocardial infarction, and reoperations) after 6 years in 69.7% of patients in the off-pump group and 76.9% of patients in the on-pump group (P=0.343). Five years after redo surgery, 79.4% of patients in the off-pump group and 91.9% in the on-pump group were free of percutaneous transluminal coronary angioplasty (P<0.02). CONCLUSIONS: There was no difference in survival despite the fact that patients in the on-pump group received more grafts than those in the off-pump group. Recurrence of angina and incidence of major cardiac events were almost equal in both the groups. Percutaneous transluminal coronary angioplasty was more frequently performed in the patients of off-pump group at late follow-up.

[Extra-anatomic thoracic aortic bypass operations]. / Krutines aortos apeinamuju jungciu suformavimo operacijos.

OBJECTIVE: When the patient condition contraindicates major surgery for descending thoracic aneurysms, the surgeon should consider using an ascending aorta to abdominal aorta bypass graft, leaving the diseased segment undisturbed. Our experience with eight patients is presented. MATERIAL AND METHODS: Between 1988 and 2008, eight patients were treated for the following indications: reoperation for coarctation (two patients), complicated descending aortic aneurysms (five patients), and posttraumatic descending aorta dissection (one patient). The mean age of the patients was 44+/-8 years (range, 27-53 years). There were 6 (75%) males and 2 (25%) females. Emergency operations were performed in three patients (two with aortic recoarctation, one with posttraumatic aortic dissection). Two cases were reoperations (both after recoarctation). Descending aorta was ligated in seven cases. Distal anastomosis was connected with abdominal aorta in four cases and with iliac arteries in four patients. RESULTS: Three early deaths occurred. Two patients died after emergency operation after recoarctation and posttraumatic aortic dissection, and one patient died after descending aorta aneurysm correction because of bleeding. CONCLUSIONS: In complex aortic coarctation, extra-anatomic bypass operation remains an effective procedure. The usage of these procedures in patients with descending aortic aneurysms remains complicated.

[Follow-up results after left ventricular geometry and volume restoration operations in patients with postinfarctic aneurysm]. / Kairiojo skilvelio geometrijos ir turio atkurimo operaciju velyvieji rezultatai.

UNLABELLED: Fifty patients underwent surgery due to reconstruction of the left ventricular volume and geometry together with heart revascularisation since 1999.02 till 2002.05 of Clinic of Heart Surgery, Vilnius University and Vilnius Heart Surgery Center. Forty eight patients were evaluated in late postoperative period at 3-44 months after the surgery. The functional status of patients improved and the mean NYHA functional class went down from 3.75 till 2.31 (p<0.01). The mean left ventricular ejection fraction significantly raises after operation from 31.8 to 37.8%. Twelve patients in late postoperative period had symptoms of congestive heart failure. These patients had a large asynergy and most intraventricular conductivity disturbances preoperatively. The left ventricular ejection fraction after operation for these patients had no changes and compared with good filling patients they still had larger asynergy. CONCLUSIONS: 1. The functional status of most patients improved after the operation. 2. The left ventricular ejection fraction became better after operation. 3. The stability of good results after 3 years was 65%. 4. Long- term survival after 3 years was 89%.

[Coronary artery revascularization without cardiopulmonary bypass]. / Vainikiniu arteriju revaskulizacija nenaudojant dirbtines kraujo apytakos.

OBJECTIVE: We sought to report our recent experience with off-pump coronary artery revascularization. MATERIAL AND METHODS: Between July 1998 and July 2002, 80 off-pump beating heart operations were performed at Vilnius University Hospital Heart Surgery Clinic, representing 4.05% of all coronary artery revascularization. This cohort of patients was compared with 241 patients operated on with cardiopulmonary by pass. RESULTS: Mean age and preoperative risk factors were comparable for the two groups. On average, 2.02+/-0.86 and 4.09+/-1.09 grafts per patient were completed in the beating and cardiopulmonary bypass groups, respectively. Operation time was shorter in the beating heart group (169+/-41 vs. 215+/-59 minutes). Similarly, the need for transfusion was significantly smaller in the beating heart group (beating heart operations, 10%; cardiopulmonary bypass, 28%; p<0.001). CONCLUSIONS: In majority of patients, off-pump coronary artery revascularization is an acceptable alternative to conventional operations with good results.

[Myocardial revascularization combined with mitral valve surgery in case of ischemic mitral valve insufficiency]. / Miokardo revaskulizacija ir mitralinio voztuvo operacija esant iseminiam mitralinio voztuvo nesandarumui.

BACKGROUND: The aim of the study was to evaluate the possibility of mitral valve surgery in patients with mitral valve insufficiency and short time outcomes following mitral valve correction combined with coronary artery bypass grafting. METHODS: Thirty one combined coronary artery bypass grafting with mitral valve correction procedures were performed from 1994 to 2002. Mean age was 65.4+/-6 years. 29 pts were in NYHA IV-V functional class. 84% of pts were with impaired left ventricle function. RESULTS: Mitral valve replacement was performed in 16 patients and correction of mitral valve in 15 cases. Mitral valve replacement was performed in cases with significant lesions of the papillary muscles. The mean of 3.05+/-1.8 graft per patient was performed and total coronary revascularisation for 84% of patients. Hospital mortality was 32.2% (10/31). CONCLUSION: In cases of coronary artery bypass grafting for patients with moderate and significant mitral insufficiency after myocardial infarction, mitral valve correction must be performed.

[Congenital heart surgery in neonates]. / Naujagimiu igimtu sirdies ydu chirurgija.

From January 1974 trough August 2002 184 neonates with congenital heart disease underwent surgical repair in Heart Surgery Clinic of Vilnius University. It came to 3.8% of all 4813 procedures of congenital heart diseases performed. Number of neonates operations considerably increased in the latter's years, because special Department with proper technique was established. One hundred and seven neonates were operated without cardiopulmonary bypass with 36.4% postoperative mortality rate. Seventy seven neonates underwent surgery repair with cardiopulmonary bypass. Postoperative mortality rate was 67.5% in this group. Mean age of patients was 11.96+/-0.28 days. Unsatisfactory results of neonates operations with cardiopulmonary bypass, especially such as left heart hypoplasia syndrome is the main problems. The group of specialists performing repair of congenital heart diseases is working actively in the heart Surgery Clinic of Vilnius University. Improvement of surgery methods and results, following the best Heart Surgery Clinics of the world, is the main purpose of this group.

[Revision surgery after closure of isolated ventricular septal defects]. / Pakartotines operacijos po izoliuoto skilveliu pertvaros defekto korekcijos.

During the period from 1964 10 15 to 2002 06 01 428 patients underwent defect closure for isolated ventricular septal defect at Vilnius University Heart Surgery Clinic. Seventeen (4.2%) patients necessitated revision surgery in the postoperative period to repair haemodinamically significant postoperative complications. The interval between definitive defect correction and revision surgery ranged from 1 month to 24 years. Repeated procedures were contemplated because of large (Q(p)/Q(s) >1.5) interventricular residual shunts, aortic and pulmonary valve insufficiency, complete persistent heart block. Hospital mortality was 5.88%. No late postoperative deaths were observed.

[Septical complications after ascending aorta replacement]. / Septines komplikacijos ligoniams, kurie operuoti del kylanciosios aortos aneurizmos ir aortos voztuvo nesandarumo ar be jo.

Between December 1972 and January 2002, 201 patients had replacement of the ascending aorta at Vilnius University Heart Surgery Clinic. 171 of them had aortic valve replacement, too, and 30 patients - without aortic valve correction. Septical complications post operation had 24 (11.94%) patients. Their age ranged from 30 to 73 years (mean 49.4 years). Most of the patients were male (87.5%) and IV functional class NYHA (70.8%) preoperatively. Main etiological factor of ascending aorta aneurysm was atherosclerosis, rare - Marfan's syndrome. Sepsis, prosthetic infective endocarditis was detected in 10 (41.7%), mediastinitis - in 9 (37.5%) and sepsis with mediastinitis - in 5 (20.8%) cases. Hospital period (< 1 month) septical complications were diagnosed in 91.7% of all cases. Total sepsis related hospital period mortality was 3.5%, late - 4.0% from all 201 operated. Septical complications were not common in patients after ascending aorta replacement. Reoperations were associated with early mortality and satisfactory long-term results. Conservative treatment was not successful.