Search

Aortic valve replacement is a standard procedure for the treatment of severe aortic valve stenosis. Due to lower flow velocities stentless valves are associated with a more effective regression of left ventricular hypertrophy in comparison to stented valves. However, mismatch between body surface area and valve size supports unfavourable hemodynamic results. The aim of the study was to analyze hemodynamic parameters by echocardiography after implantation of the Shelhigh SuperStentless bioprosthesis and to analyze the occurrence of patient-prosthesis mismatch and left ventricular remodelling in this specific valve type.A total of 20 patients with severe aortic stenosis underwent implantation of a Shelhigh Super Stentless prosthesis. Clinical and echocardiographic assessment was done prior to, immediate after and six months after surgery.All surgical procedures were successful, no surgery-related complication was documented perioperatively. One patient died after development of multiorgan failure. Echocardiography during the first eight days after surgery showed mean gradients of 16 mmHg, mean valve orifice areas of 1.8 cm(2) and indexed effective orifice areas at 0.95 cm(2)/m(2). Six-months follow-up data were obtained in 19/20 patients. There were no relevant changes in echocardiographic hemodynamic findings at the time of follow-up measurements. Significant regression of left ventricular hypertrophy was shown (P=0.0088). A patient-prosthesis mismatch occurred in one patient (0.54 cm(2)/m(2)). No recurrent symptoms were documented.Patient-prosthesis mismatch after implantation of SuperStentless Shelhigh prosthesis is rare. A significant regression of left ventricular hypertrophy could be shown after six months. Hemodynamic valve function assessed by echocardiography may be predicted early after surgery.

Aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG), particularly in a patent left internal thoracic artery (ITA), is a challenge. Avoidance of injuring the patent graft and ensuring myocardial protection are important issues in the management of these patients. The aim of this study was to evaluate a simplified surgical approach to these reoperations.Between January 2003 and June 2005, 19 of 287 AVRs performed at our institution were in a patient subset (mean age 70 years, range: 62-82) who received AVR after previous CABG surgery. The aortic valve gradients were between 50 and 107 mm Hg. Our operation strategy followed the KIS-principle (keep it simple): both femoral vessels were cannulated using the Seldinger technique. Only the area around the ascending aorta and the right atrium was dissected to permit x-clamping, aortotomy, and catheterization for retrograde cardioplegia and a left ventricular vent. The anterior aspect of the heart and the left side, where the ITA was embedded and patent, were left untouched and not clamped.The mean interval between the first and second operation was 6.5 years. Fourteen patients received biological prostheses. Four patients received an additional surgery at the time of AVR. The mean operating time was 267 min; the mean AoX-clamp time was 63 min. One patient died because of severe heart failure. In all others the postoperative course was uneventful.We believe that the indication for AVR in patients scheduled for CABG should be re-evaluated. In those in which Redo-surgery for new or increased valve stenosis is indicated, a simple and safe surgical option is presented.

Postinfarct ventricular septal defect (VSD) still remains associated with a high mortality and morbidity. Despite the development of modern surgical techniques and medical care it continues to be a difficult therapeutic challenge. This report describes a case of a 70-year-old female patient, who presented with a postinfarct VSD after having anterior wall infarction. She presented with left heart failure, pulmonary hypertension and left to right shunt of 78% (Qp/Qs=4.3). The patient was operated on using cardiopulmonary bypass on the beating heart. The closure was performed with a Dacron-patch and a single bypass to the diagonal branch using the left internal thoracic artery. Postoperatively the patient did well and was discharged in good condition on the 13th postoperative day. We conclude that postinfarction VSD can be repaired on cardiopulmonary bypass avoiding cross-clamping. This method is helpful for the outcome as well as for the early postoperative recovery of elderly patients.

Two years after surgical removal of a right atrial myxoma, recurrences were found in both atria: multiple tumors in the right atrium and one tumor in the left atrium. All were subsequently removed. There was no further recurrence during the following 3 years. We report on an unusual case which, to our knowledge, is the first time that such a case appears in the literature. We also discuss the clinical symptoms, diagnostic aspects, as well as details of a literature review regarding recurring myxoma. We think the recurrence in our case was due to totipotent multicentricity of the tumor. Previous studies showed that the recurrence might be due to the following reasons: inadequate resection, or multifocal pattern behaviour of a benign myxoma, either in the same or in a different location as the primary tumor. Familial disposition may also play a role in recurrent development. The abnormal DNA ploidy pattern of myxoma patients showed a high recurrence.

From January 1980 through July 1994 fiftyseven patients underwent emergency coronary bypass grafting (CABG) after unsuccessful percutaneous transluminal angioplasty (PTCA), (Group I). This group was compared with a cohort of 57 patients, who underwent elective coronary bypass grafting (Group II). The 2 groups were compared in the rate of perioperative myocardial infarction, amount of blood loss, rethoracotomy because of bleeding, use of blood units and products, and length of stay in the intensive care unit. The data of both groups were retrospectively analyzed. Significant differences were observed: Perioprative myocardial infarction in group I was 18 patients (31%) versus 2 patients (3%) in group II (p0.0008). Amount of blood loss was higher (p0.038), and the use of packed red blood cells was higher too (p0.000) in group I. The length of stay in the intensive care unit was longer (p0.000) in group I. Six rethoracotomies (10%) occured in group I versus 0 in group II. There were no hospital mortalities in either groups. We conclude there is a significant increase in morbidity in patients with emergency CABG after failed PTCA than patients who underwent elective CABG.

From September, 1986 through December, 1989, 121 patients underwent aortic valve replacement with the Mitroflow pericardial valve. There were 70 males (58%) and 51 females (42%), with an average age of 71 years (range 50-85 years). Reported here are the long-term results from these patients. Concomitant cardiac procedures were performed in addition to aortic valve replacement in 38 patients (31%); Coronary artery revascularization in 27 patients (22%); 4 patients (3%) had combination aortic/mitral valve replacement; mitral valve reconstruction in 4 patients (3%) and 3 patients (2%) had other additional procedures. Following surgery, standard postoperative examinations were performed every six month for 2 years; then yearly thereafter. At these times valvular function assessed echocardiographically. Current follow-up extends to 7 years (mean = 5 years) for surviving patients. Postoperative mortality for all observation period is as follows: Early deaths (or =30 days postop) = 6 patients (5%), late death (30 days) = 18 patients (15%). Valve-related causes of death included cerebral insult (thromboembolism) in two patients (one 10 months, other 15 months postoperatively). Postoperative valve-related morbidity included prosthetic endocarditis (1 patient) one year postoperatively; degenerative prosthetic failure (1 patient) 27 months postop; cusp tear (1 patient) with minimal hemodynamic changes after four years. In the patients with endocarditis and failure, a second successful operation corrected the problem. Also, in two patients antithrombolitic therapy related hemor-rhage occurred (one 9 months, the second 11 months postoperatively). This therapy was a result of atrial fibrillation, and we do not recommended it. In conclusion, we find that the Mitroflow pericardial heart valve gives adequate long-term results, especially in elderly patients with a small aortic ring, with very satisfactory quality of life.