Update on percutaneous mitral valve therapy: clinical results and real life experience.

Mitral regurgitation (MR) is a common valvulopathy worldwide increasing in prevalence. Cardiac surgical intervention, preferable repair, is the standard of care, but a relevant number of patients with severe MR do not undergo surgery because of high peri-operative risk. Percutaneous mitral valve repair with the MitraClip System has evolved as a new tool for the treatment of severe MR. The procedure simulates the surgical edge-to-edge technique, developed by Alfieri in 1991, creating a double orifice valve by a permanent approximation of the two mitral valve leaflets. Several preclinical studies, registries and Food and Drug Administration approved clinical trials (EVEREST, ACCESS-EU) are currently available. The percutaneous approach has been recently studied in a randomized controlled trial, concluding that the device is less effective at reducing MR, when compared with surgery, by associated with a lower adverse event rate. The patients enrolled in this trial had a normal surgical risk and mainly degenerative MR with preserved left ventricular function. On the other hand, results derived from the clinical "real life" experience, show that patients actually treated in Europe present a higher surgical risk profile, more complex mitral valve anatomy and functional MR in the most of cases. Thus these data suggest that MitraClip procedure is feasible and safe in this subgroup of patients that should be excluded from the EVEREST trial due to rigid exclusion criteria. Despite the promising results clinical experience is still small, and no data related the durability are currently available. Therefore, MitraClip device should be reserved now to high risk or inoperable patients.

Reduction of mitral valve regurgitation with Mitraclip® percutaneous system.

Mitral regurgitation (MR) is the second most common heart valve disease worldwide and the current gold-standard treatment is surgical repair or replacement. Nevertheless, many patients do not undergo surgical intervention due to several comorbidities. Percutaneous "edge-to-edge" mitral valve repair using the MitraClip System is an emerging and effective option to this subset of patients. This device has been used to treat both functional and degenerative mitral valve regurgitation and has been compared to surgery in the Endovascular Valve Edge-to-Edge Repair Study II (EVEREST II) randomized trial. Although the field of percutaneous management of MR is at an early stage, it has been demonstrated that percutaneous approaches can reduce MR, suggesting there is a great deal of potential for clinical benefit to patients with MR.

[Surgical treatment of spontaneous pneumothorax: comparison of thoracotomy and thoracoscopy]. / Trattamento chirurgico del pneumotorace spontaneo: toracotomia e toracoscopia a confronto.

The video-thoracoscopic treatment of spontaneous pneumothorax currently has the same role of laparoscopic cholecystectomy in abdominal surgery. The Authors consider thoracoscopic approach and traditional thoracotomy examining advantages versus disadvantages, comparing 50 patients with spontaneous pneumothorax treated by thoracoscopy, from February 1992 up to February 1995, and 50 patients, previously treated by open surgery. Video-thoracoscopy has the same percentage of recurrences of thoracotomic approach but assures a quicker functional recovery and, above all, a remarkable reduction of pain.

[Pleuroscopy and talc pleurodesis in recurrent pleural effusions: experience with 51 cases]. / Pleuroscopia e talcaggio nei versamenti pleuric recidivanti: esperizena su 51 casi.

From January '92 up to January '94 thoracoscopy was performed in 51 patients with recurrent pleural effusion: 49 of these patients underwent talc pleurodesis. 10 pleural mesotheliomas, 29 diffuse metastasic pleural involvement and 12 benign effusions were diagnosed. Intrapleural talc therapy allowed a definitive pleurodesis in 43 patients with a success rate of 87%.

[Tracheal resection-anastomosis in carcinoma of the thyroid infiltrating the airways. A case report]. / Resezione--anastomosi tracheale per carcinoma della tiroide infiltrante la via aerea. Caso clinico.

The Authors report a case of thyroid carcinoma with tracheal involvement. Since the neoplastic invasion of the trachea was 3 cm long total thyroidectomy with sleeve tracheal resection and immediate reconstruction with end-to-end anastomosis were performed. The diagnostic and therapeutic approach is discussed and the Literature data reviewed.

[Leiomyosarcoma of the inferior vena cava: description of a new case and review of the literature]. / Leiomiosarcoma della vena cava inferiore: descrizione di un nuovo caso e revisione della letteratura.

A case of primary leiomyosarcoma of the inter-renal vena cava is reported. This tumor is rare and up to date no more than 100 cases have been reported. Surgical treatment consisted in the removal of vena cava from the iliac veins to the suprahepatic veins with right nephrectomy. Restoration of vena cava and left renal vein continuity was not necessary because of the presence of collateral venous circulation at the time of operation. Venous ligation was haemodynamically well tolerated and the patient is disease-free at one year from operation. However, despite surgical radicality, prognosis remains poor given the frequency of metastases reported in more than 35% of cases.

[Low anterior resection of the rectum using mechanical anastomosis in intestinal endometriosis]. / Resezione anteriore bassa del retto con anastomosi meccanica per endometriosi intestinale.

A case of sigmoid-rectal endometriosis prompted the authors to focus attention on the question of indications for surgery and operative tactics in intestinal endometriosis. In this case, the presence of a pelvic mass which could not be cut away from the intestinal wall without the risk of perforation led to the performance of a low anterior resection of the rectum with mechanical stapler, a choice which was certainly radical but necessary in view of the impossibility of excluding the malignant nature of the mass either macroscopically or extemporaneously.

[Malignant mesothelioma located in the pleura: its radical surgical treatment]. / Il mesotelioma maligno localizzato della pleura: trattamento chirurgico radicale.

The authors report a rare case of localized malignant pleural mesothelioma infiltrating the thoracic wall. The absence of widespread pleural involvement allowed for a radical operation with removal of a large portion of the thoracic wall. However, due to rarity of such tumor, an hypothesis on long term prognosis is difficult to formulate.