Search

Background: Postoperative atrial fibrillation (AF) has a complex etiology, and beta-blockers are commonly recommended for its pharmacological prevention. This study aims to assess the impact of beta-blocker therapy on postoperative AF occurrence in patients undergoing aortic valve replacement, mitral valve replacement, surgical revascularization of the myocardium, or a combination of these procedures. Methods: The study encompassed 472 patients who received aortic valve replacement, mitral valve replacement, surgical revascularization, or their combination. We evaluated the efficacy of preoperative and one-month postoperative beta-blocker administration in preventing postoperative AF, and the associated risk factors involved in the development of postoperative AF. Results: Of the total patient population, 36% experienced postoperative AF. Our study demonstrated a significant reduction in postoperative AF incidence among patients receiving beta-blocker treatment (all p-values < 0.05). Additionally, one-month post-surgery, beta-blocker treatment exerted a protective effect by maintaining the sinus rhythm (p = 0.0001). Regarding the risk factors involved in the development of postoperative AF, both age and left atrium (LA) sizeassessed pre-and postoperatively—were positively correlated with the occurrence of postoperative AF (p = 0.006). No relationship was found between leukocyte counts and AF incidence. Notably, C-reactive protein (CRP) levels were significantly elevated on the fifth postoperative day in patients with AF (p < 0.007). The duration of ischemia was significantly longer in patients with AF (p = 0.009). Conclusions: This study establishes the efficacy of perioperative beta-blocker treatment in mitigating postoperative AF. One month post-surgery, most patients under beta-blocker therapy maintained sinus rhythm, suggesting a potential long-term protective effect of beta-blockers against late-onset AF.

The inherent limitations of current heart valve substitutes create the premise for the Tissue Engineered Heart Valve (TEHV), considered the perfect substitute. We aimed to compare in vitro hemodynamic performances of our TEHV, the conventional prosthetic valve and similar porcine valves, by ultrasonography and geometry resulting in six valve models analysis. In a bioreactor, pulmonary and aortic physiology were replicated thus hemodynamic characteristics were tested. Using ultrasound, transvalvular pressure gradients and flow were measured and used to calculate their valvular functional area (VFA) and using a high-speed camera, the geometric peak opening area (GOA) was assessed. The obtained results were normalized to the diameter of the biological prosthesis in order to increase the measurement’s accuracy. The ultrasound revealed normal function of all valves and physiologic transvalvular pressure gradients. The TEHV scaffold revealed absence of laceration or dehiscence, and performances in accordance with the control prostheses. The GOA was facile to obtain and the normalized values proved to be greater than the calculated functional area in all analyzed cases and the peak opening areas resulted lesser for the aortic conditions for all six used valves prototypes. To our knowledge, this is the first study to use bioreactors, for in vitro evaluation of heart valves.

Introduction: Pediatric patients with cardiac congenital diseases require heart valve implants that can grow with their natural somatic increase in size. Current artificial valves perform poorly in children and cannot grow; thus, living-tissue-engineered valves capable of sustaining matrix homeostasis could overcome the current drawbacks of artificial prostheses and minimize the need for repeat surgeries.Materials and Methods: To prepare living-tissue-engineered valves, we produced completely acellular ovine pulmonary valves by perfusion. We then collected autologous adipose tissue, isolated stem cells, and differentiated them into fibroblasts and separately into endothelial cells. We seeded the fibroblasts in the cusp interstitium and onto the root adventitia and the endothelial cells inside the lumen, conditioned the living valves in dedicated pulmonary heart valve bioreactors, and pursued orthotopic implantation of autologous cell-seeded valves with 6 months follow-up. Unseeded valves served as controls.Results: Perfusion decellularization yielded acellular pulmonary valves that were stable, no degradable in vivo, cell friendly and biocompatible, had excellent hemodynamics, were not immunogenic or inflammatory, non thrombogenic, did not calcify in juvenile sheep, and served as substrates for cell repopulation. Autologous adipose-derived stem cells were easy to isolate and differentiate into fibroblasts and endothelial-like cells. Cell-seeded valves exhibited preserved viability after progressive bioreactor conditioning and functioned well in vivo for 6 months. At explantation, the implants and anastomoses were intact, and the valve root was well integrated into host tissues; valve leaflets were unchanged in size, non fibrotic, supple, and functional. Numerous cells positive for a-smooth muscle cell actin were found mostly in the sinus, base, and the fibrosa of the leaflets, and most surfaces were covered by endothelial cells, indicating a strong potential for repopulation of the scaffold.Conclusions: Tissue-engineered living valves can be generated in vitro using the approach described here. The technology is not trivial and can provide numerous challenges and opportunities, which are discussed in detail in this paper. Overall, we concluded that cell seeding did not negatively affect tissue-engineered heart valve (TEHV) performance as they exhibited as good hemodynamic performance as acellular valves in this model. Further understanding of cell fate after implantation and the timeline of repopulation of acellular scaffolds will help us evaluate the translational potential of this technology.

Cardiac undifferentiated pleomorphic sarcoma (UPS) associated with fever and inflammatory response is an extremely rare condition. Herein, we report a rare case of cardiac UPS with unusual clinical presentation and inflammatory response. A 67-year-old male complaining of progressive dyspnea and intermittent fever of unknown cause was referred to our hospital for surgical resection of a left atrial mass. Laboratory analysis showed leukocytosis (26 × 103/μL) and high C-reactive protein (CRP) levels (155.4 mg/L). Hemoculture tests and urine analysis were negative for infection. A contrast chest computed tomography revealed a mass measuring 5.5 × 4.5 cm, occupying the left atrium cavity. The patient underwent surgical excision of the mass, however, surgical margin of the resected tumor could not be evaluated, due to the multifragmented nature of the resection specimen. Postoperative CRP and leukocyte levels normalized, highlighting the relationship between the tumor and the inflammatory status. Early diagnosis is crucial for a proper management and favorable outcome, enabling patients to undergo chemotherapy and achieve complete surgical resection.

Left ventricular non-compaction (LVNC) is a form of cardiomyopathy characterized by prominent trabeculae and deep intertrabecular recesses which form a distinct “non-compacted” layer in the myocardium. It results from intrauterine arrest of the compaction process of the left ventricular myocardium. Clinical manifestations vary from asymptomatic to heart failure (HF), arrhythmias, or thromboembolic events. We present a case of mother and son diagnosed with isolated LVNC (ILVNC). A 4-years-old male patient, diagnosed at 3 months with ILVNC, and NYHA functional class IV HF, was admitted to the Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, Romania, for cardiologic reevaluation, and diagnosis confirmation. ILVNC was confirmed using echocardiography, revealing a non-compaction to compaction (NC/C) ratio of > 2.7. His evolution was stationary until the age of 8 years, when severe pneumonia caused hemodynamic decompensation, and he was listed for heart transplantation (HT). The patient underwent HT at the age of 11 years with favorable postoperative outcome. Meanwhile, a 22-years-old female patient, mother of the aforementioned patient, was also admitted to our institute due to severe fatigue, dyspnea, and recurrent palpitations with multiple implantable cardioverter defibrillator (ICD) shock delivery. Extensive medical history revealed that a presumptive ILVNC diagnosis was established when she was 11 years old. She was asymptomatic until 18 years old, when 3 months post-partum, she developed NYHA functional class III HF, and subsequently underwent ICD implantation. Her diagnosis was confirmed using multi-detector computed tomography angiography, which revealed a NC/C ratio of > 3.3. ICD adjustments were carried out with a favorable evolution under chronic drug therapy. The last evaluation, at 27 years old, revealed that she was in NYHA functional class II HF. In conclusion, ILVNC, even when familial, can present different clinical pictures and therefore requires different medical approaches.

Background: Coronary artery bypass grafting (CABG) is the most common procedure in adult cardiovascular surgery. Great saphenous vein is the most used conduit for coronary revascularization. Leg-wound complications are an underestimated cause of morbidity in CABG patients, causing prolonged hospitalization, antibiotics administration or secondary surgical treatments. Risk factors include female sex, peripheral vascular disease (PVD), diabetes mellitus, smoking, obesity and dyslipidemia. Leg-wound complications vary from mild erythema or secretion to wound dehiscence, infection and skin necrosis. Objective: Underlining the importance of interdisciplinary management in a leg-wound dehiscence (LWD) with unfavorable evolution. Material and methods: A 73-year-old female patient, diagnosed with coronary artery disease, underwent CABG by harvesting the great saphenous vein. Two weeks later, the leg wound started presenting progressive localized necrosis. No purulent secretion was observed and bacteriology culture was negative. Daily dressings and local therapy with an antifungal, antiseptic and re-epithelizing cream were inefficient. Doppler ultrasound revealed hypoperfusion of the lower extremities. Results: Intravenous Pentoxyfillin was administered. Wound debridement followed by application of a negative pressure wound therapy (Vivano device) were performed. One week later, the patient underwent secondary suture of the thigh and a 0,6 mm autologous split-thickness skin graft was stapled on the calf. The evolution was favorable and the patient was discharged after ten weeks of hospitalization, with oral Pentoxyfillin therapy. One month follow-up showed a viable skin graft and healing wound. Conclusions: LWD is an overlooked complication of CABG which can delay recovery and increase morbidity of the patient. Rigorous skin preparation, proper surgical technique and identifying modifiable risk factors can prevent LWD. Skin graft thickness is decisive for the graft viability. Hypovascularization can occur in case of excessive thickness, especially in PVD patients, whereas a too thin graft might get resorbed due to the inflammatory process. Early recognition, prompt intervention and interdisciplinary management are crucial for a favorable outcome. [ABSTRACT FROM AUTHOR]

Background: Despite the appearance of transcatheter aortic valve implantation (TAVI), classic surgical aortic valve replacement (C-AVR) is still considered the gold-standard treatment of aortic stenosis (AS), at least in low and intermediate risk patients. Recently, The sutureless aortic valve replacement (S-AVR) technique has been introduced, which allows implanting a stented valve without needing sutures. Objective: Efficacy of a new, innovative surgical technique in treating severe AS, one of the first cases in IuBCvT Târgu Mure&351;. Material and methods: A 68-year-old female patient was admitted with progressive exertional dyspnea and fatigue. Echocardiography revealed severe AS with a maximum and mean pressure gradient of 120/67 mmHg, significant valvular calcification and hypertrophied left ventricle with an ejection fraction of 50%. Carotid Doppler ultrasonography and coronary angiography revealed no significant lesions. Contrast CT Scan revealed AS with an aortic annulus of 2,31 cm. Results: The patient underwent S-AVR with a Perceval size L aortic bioprosthesis. During cardiopulmonary bypass (CPB), the native calcified valve was excised and three temporary guiding sutures were placed in the annulus and passed through the eyelets of the valve. Deployment and ballooning of the valve were then performed, and the temporary sutures were removed. Total CPB time was 68 minutes and cross-clamp time was 51 minutes. Postoperative echocardiography revealed a maximum and mean trans-prosthetic pressure gradient of 39/20 mmHg, no paravalvular leak (PVL) or trans-prosthetic regurgitation. Conclusions: Despite its recent introduction, current studies suggest S-AVR as a promising alternative to C-AVR. The major advantage over C-AVR is reduced CPB and cross-clamp duration, which are major determinants in surgical outcome. Furthermore, the advantage over TAVI is direct visualization of the valve, as well as the possibility of calcified valve excision and therefore a lower incidence of PVL. Further studies are needed, but S-AVR could become a new goldstandard in treating AS, especially in high risk patients. [ABSTRACT FROM AUTHOR]

Background: Extrahepatic portal vein obstruction (EHPVO), although rare in children, is one of the most important causes of noncirrhotic portal hypertension (NCPH) among children. The incidence of EHPVO is estimated to be 0,72/million. The initial clinical manifestation can be represented by upper gastrointestinal bleeding, splenomegaly or ascites. In children, identified risk factors of EHPVO are neonatal vein catheterization, umbilical cord infections, blood transfusions, sepsis, dehydration and coagulation abnormalities. Objective: To present the case of a 9 years old female patient who was hospitalized in a regional hospital with abdominal pain and diarrhea. Two days later she was transferred to our hospital with the suspicion of a malignant hematologic disorder due to important splenomegaly. Material and methods: At the admission in our hospital the clinical exam revealed ponderal hypotrophy and splenomegaly. The patient history determined: small for gestational age, acute fetal distress, perinatal asphyxia, neonatal sepsis, resuscitated cardiac arrest at 2 days of life, cerebral hemorrhage and umbilical vein catheterization. Laboratory findings revealed signs of mild microcytic normochromic anemia associated with thrombocytopenia and leukopenia. The abdominal ultrasonography and color Doppler showed portal vein cavernous transformation, important splenomegaly (123mm), accessory spleen and normal hepatic parenchyma. The upper endoscopy determined 1st grade esophageal varices. The investigations for thrombophilia revealed deficiency of Protein C. Results: The diagnosis of EHPVO was based on splenomegaly, thrombocytopenia due to hypersplenism and the portal cavernoma. Sepsis and umbilical vein catheterization in neonatal period associated with deficiency of protein C were the risk factors for EHPVO in our patient. Conclusions: EHPVO represents a rare disorder in children having similarities with the malignant hemopathies. NCPH represents an uncommon cause of portal hypertension in children and the main cause is represented by EHPVO. The major risk factor is represented by the umbilical vein catheterization, therefore close follow up should be conducted in these cases. [ABSTRACT FROM AUTHOR]