Successful percutaneous septal alcohol ablation after surgical myectomy.

Hypertrophic obstructive cardiomyopathy (HOCM) is a primary, usually familial and genetically fixed myocardial hypertrophy, with dynamic left ventricular outflow tract obstruction. An alternative to surgical myectomy in the treatment of severe, drug refractory, HOCM is percutaneous transluminal septal myocardial ablation (PTSMA). We report a case of 24 year old female patient who had the first septal myectomy but because of progression of her disease, the percutaneous treatment of hypertrophic obstructive cardiomyopathy was performed. A year after the PTSMA the patient was without of symptoms.

The development of cardiac surgery in an emerging country: a completed project.

The necessity to develop cardiac surgery centers in the emerging world is widely accepted. Numerous groups and organizations from the developed world are involved in such work; however, the best method in which to develop a sustainable center in the emerging world is still debated. Herein, we present an approach that we have used in several such projects, which involves regular and frequent instructional visits with progressive reduction of our instructional support. Data to support our approach are presented.

[Aid to development of cardiac surgery in the emerging world: mutual benefits?]. / Aide au développement de la chirurgie cardiaque dans les pays emergents: bénéfices?

Aid to the development of cardiac surgery in the emerging world is mandatory to help these countries develop their own capacities of treatment for their patients. A personal experience of ten years involvement with such projects is described, as well as the means and difficulties to achieve tangible results in this field.

[Role of intraoperative transesophageal echocardiography in repair of mitral valve (our experience)]. / Uloga intraoperativne transezofagealne ehokardiografije kod reparacija mitralnih valvula (nasa iskustva).

INTRODUCTION: Intraoperative transesophageal echocardiography (TEE) is a useful tool during valvular, great vessels and CABG surgery. In several large studies TEE has been shown to have higer sensitivity than TTE for native valve (94-100% vs. 44-63%) and prosthetic valves (75% vs 25%) both have high specificity (91-98%). TEE has got its value, particularly when surgeon intends to repair diseased valves, which are favorable operations due to its better survival rate, better ventricular function and fewer tromboembolic events. Most commonly valve repairs performed in patients with mitral and tricuspid valve diseases although reparative procedures have been described for all valve positions. AIM: Our aim is to define how important is TEE during mitral valve repairing operations. PATIENTS AND METHODS: At our institution, during five years period (between may 1999. and may 2004.) 29 patients have been operated with mitral valve repairing and monitored by TEE intraoperatively. They all went through preoperative preparations at the Clinic for Heart diseases and rheumatism, as well as Cardiology dept. of Cardiac surgery clinic KCU Sarajevo. We were following ASE/SCE guidelines for intraoperative examination during four different intraoperative mitral valve surgery stages, using Siemens ultrasound machine Sonoline Versa Plus with TEE multiplane probe type MPT-4. RESULTS: For 20 pts. (71%) mitral valve repairing has been performed solely, in 9 (29%) pts. combined mitral and tricuspide valves repairing. In two cases (6,9%) after not satisfied repairing cardiac surgeon had to replaced native (previously repaired) mitral valve with mechanical prosthesis. 7 pts. (24%) got Carpantier rings and others 22 (76%) have been operated with pericardium patch. CONCLUSIONS: IOP TEE proved to be very useful in determination of the nature, severity and egzact anatomic location (scaloping) of the mitral and other valves disorders, in assessment of the urgency and feasibility of valves reparation and in plaining of the surgical procedures. In the case of poor surgical valve reparations, intraoperative TEE is the first method of choice in monitoring the process of valve reparation and in estimating the time for valve replacement.