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Background This study aimed to identify early postoperative complications after carotid endarterectomy and the factors that may influence their occurrence. Methods This was an observational, analytical, prospective study conducted over a period of 3 years in 2 university hospitals in Târgu Mureș, Romania. One hundred nineteen patients who underwent carotid endarterectomy for severe carotid stenosis were included. Statistical analysis was used to identify the independent factors with a direct influence on the acute complications in the first 48 h after carotid endarterectomy. Results We followed up on the acute postoperative complications occurring in the first 2 days after surgery. These were represented by a limited number of neurological complications and major neck hematomas. Among all comorbidities and risk factors, only advanced coronary artery disease (p = 0.05) and smoking (p = 0.03) were independent factors that directly influenced the occurrence of major neck hematomas. Operative time exceeding the median time of 90 minutes increased the risk of neurological complications (p = 0.02). The risk of major neck hematomas was also increased by preoperative treatment with anticoagulants (p = 0.01) and anticoagulants associated with antiplatelet therapy (p = 0.009). Conclusions This study has identified factors such as advanced coronary artery disease, smoking, operative time, and anticoagulant therapy that may be independently associated with an increased risk of acute postoperative complications after carotid endarterectomy.

Background An intrapericardial organized haematoma secondary to chronic type A aortic dissection is an extremely rare cause of right heart failure. Imaging studies are essential in recognising and diagnosis of this distinctive medical condition and guiding the anticipated treatment. Case presentation A 70-year-old male patient was admitted for progressive symptoms of right heart failure. His cardiovascular history exposed an aortic valve replacement 22 years before with a Medtronic Hall 23 tilting valve with no regular follow-up. Classical signs of congestion were recognized at physical examination. Transthoracic two-dimensional echocardiography and thoraco-abdominal computed tomography angiography, as essential parts of multimodality imaging algorithm, established the underlying cause of right heart failure. Under total cardiopulmonary bypass and cardiac arrest, surgical removal of the haematoma and proximal repair of the ascending aorta with a patient-matched vascular graft were successfully performed. The patient was discharged in good condition with appropriate pharmacological treatment, guideline-directed; no imagistic signs of acute post-surgery complications were ascertained. Conclusion This paper highlights the importance of recognizing and providing a timely clinical and imagistic diagnosis of this very rare, potentially avoidable cause of right heart failure in patients with previous cardiac surgery.

Aortic dissection (AD) is a critical heart condition with potentially severe outcomes. Our study aims to investigate the existence of a "weekend effect" in AD by examining the correlation between patient outcomes and the timing of their treatment during weekdays vs weekends. Specifically, we assessed prospectively the effects of the timing of treatment on patient outcomes for acute aortic dissection, both before surgical intervention and during hospitalization, as well as during the follow-up period. The mean age of the study population used here was 62.5 years with a high degree of variability. We recorded a rate of mortality before surgery of 8.65% for the weekend group and 15% for the weekday group, with no significant differences noted in the results of statistical tests. During hospitalization, mortality was found to be 50% (n=52) in the weekend group and 25% (n=5) in the weekday group, again with no significant differences observed in the results of the same statistical tests. Patient mortality after discharge was 9.61% (n=10) in the weekend group and 5% (n=1) in the weekday group. Our findings suggest that there is no significant difference in mortality rates between patients admitted to the hospital on weekends versus weekdays. Therefore, the period of the week when a patient presents to the hospital with aortic dissection appears to not affect their mortality outcomes.

Postoperative coronary vasospasm is a well-known cause of angina that may lead to myocardial infarction if not treated promptly. We report a case of a 70-year-old female with severe mitral regurgitation submitted to mitral valve replacement, and a history of diabetes mellitus type II, stroke, idiopathic thrombocytopenic purpura on steroid therapy, and previous percutaneous coronary intervention (PCI) for severe obstruction of the circumflex coronary artery, 4 months prior to surgery. Immediately after intensive care unit admission, the patient developed pulseless electrical activity which required extracorporeal membrane oxygenation for hemodynamic support. The coronary angiography showed diffuse occlusive coronary artery vasospasm, ameliorated after intra-coronary administration of nitroglycerin. The following postoperative evolution was marked by cardiogenic shock and multiple organ dysfunction syndrome. Subsequent echocardiographic findings showed an increase in left ventricular function with an EF of 40%, and extracorporeal membrane oxygenation (ECMO) support was weaned after seven days. However, after a few hours, the patient progressively deteriorated, with cardiac arrest and no response to resuscitation maneuvers. Hemodynamic instability following the surgical procedure in a patient with previous PCI associated with an autoimmune disease and diabetes mellitus should raise the suspicion of a coronary artery vasospasm.

Acute kidney injury (AKI) is a complication that can occur after cardiac surgery and requires ongoing research in light of the exponential expansion of technological advancements and knowledge in medicine. In this study, we aim to evaluate the outcomes of treated electives of emergency aortic disease with high serum creatinine levels (SCr). Methods: The cohort includes 183 patients, all of whom have an aortic disease and whose SCr levels were checked upon admission on the first day in the intensive care unit (ICU) and upon discharge from the hospital. We examined the correlation of SCr levels with in-hospital mortality and immediate mortality at least six months after discharge as well as with cross-clamp time and bypass time.Results: A high SCr level upon admission is a significant predictive factor of n-hospital mortality (p = 0.001) but not immediate mortality (p = 0.409). A statistically significant correlation was also observed between elevated SCr level on the first day of ICU and aortic disease (p = 0.041) but not immediate mortality (p = 0.119). We observed a significant correlation between aortic disease and in-hospital mortality (p < 0.001), but no correlation was found between high SCr level on the first day of ICU and immediate mortality (p = 0.119). The cross-clamp time is statistically significant correlated with elevated SCr level (p = 0.013) and in-hospital mortality (p = 0.001) but not immediate mortality (p = 0.847). Furthermore, the bypass time is negatively correlated with a high SCr level on the first day of ICU (p = 0.090), in-hospital mortality (p = 0.410), and immediate mortality (p = 0.625). We also found that aortic disease is not correlated with elevated creatinine levels at ICU discharge (p = 0.152) or long-term mortality (p = 0.106). Conclusions: Although this study only included a small portion of the elaborate aspects of surgical and medical management developed around cardiac patients who received invasive treatment, the conclusions reached are nevertheless clearly relevant, as evidenced by the significantly correlations uncovered. In order to manage AKI after AAS and improve the outcome, the SCr level could be used as a marker for renoprotective strategy. Moving forward, these results serve as a first step in motivating us to expand the range of our research, collect newly relevant data, and use it to benefit patients.

Background: Statin therapy has been proven to reduce the risk of cardiovascular events. The objective of our retrospective study was to investigate the relationship between preoperative chronic administration of statins to postoperative 2-month heart transplantation complications. Methods: A total number of 38 heart transplantation recipients from the Cardiovascular and Transplant Emergency Institute of Târgu Mureș between May 2014 and January 2021 were included in our study. Results: In logistic regression, we found a statistical significance between statin treatment and the presence of postoperative complications of any cause (OR: 0.06, 95% CI: 0.008–0.56; p = 0.0128), simultaneously presenting an elevated risk for early-postoperative acute kidney injury (AKI). From the statin group, atorvastatin therapy had a higher risk of type 2 diabetes mellitus (T2DM) development (OR: 29.73, 95% CI: 1.19–741.76; p = 0.0387) and AKI (OR: 29.73, 95% CI: 1.19–741.76; p = 0.0387). C-reactive protein (CRP), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-c) represented risk factors, atorvastatin administration being independently associated with lower CRP values. Conclusions: Chronic previous administration of statins represented a protective factor to the development of 2-month postoperative complications of any cause in heart transplant receipts.

Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy in children. Heart transplantation is considered standard therapy in dilated cardiomyopathy with end-stage heart failure. We present a case of a 15-year-old patient diagnosed with DCM in the neonatal period, who underwent heart transplantation for end-stage heart failure. Despite the use of induction therapy, the endomyocardial biopsy performed at two weeks post-transplant revealed mixed moderate cellular (2R) and humoral (pAMR2) allograft rejection. Aggressive rejection treatment was initiated with good outcome. Besides endomyocardial biopsy, advanced echocardiography can also be a valuable noninvasive tool for rejection assessment.

Over the time, numerous studies have been reported describing successful pulmonary valve replacement, either with xenografts or allografts, performed in sheep model. In contrast, comparable results have not been achieved yet for aortic valve replacement in orthotopic position, which involves a more difficult surgical technique, high hemodynamic demands for the implanted valve and poor survival of animals undergoing this kind of surgery. To our knowledge, in Romania, these were the first orthotopic allogeneic aortic root implantations using the subcoronary technique, carried out by our team. We established feasible perioperative, anesthetic and surgical protocols, which will be used in future studies to evaluate the in vivo functional performances of decellularized valves compared with autologous adipose derived stem cells seeded valves. Therefore, a unique research core was created, which is currently the only center of this kind in our country, by joining a multidisciplinary team consisting of biomedical engineers, cardiovascular surgeons, anesthesiologists, cardiologists, pathologists, microbiologists and veterinarians, who will continue the research activity in the field of tissue engineering and translate experimental results into clinical activity.

Abstract: Introduction: Left ventricular aneurysm is a severe complication of acute myocardial infarction, which contributes significantly to mortality and morbidity associated with this pathology. Despite the progress of correction techniques, there are still controversies about the optimal approach addressing this pathology. Aim: The aim of this study was to analyse short and medium term outcomes of left ventricular reconstruction for ischemic left ventricular aneurysm using two surgical techniques (endoventricular patch plasty and liniar suture) in order to determine if one of these techniques has supperior results. Method: 117 patients were included in the study, 48 patients (41%) underwent left ventricular reconstruction with endoventricular patch (Group 1), 69 patients (59%; Group 2) had linear reconstruction. 113 patients (96.5%) required associated procedures: 108 surgical myocardial revascularization, 18 mitral valvuloplasty and 8 ventricular septal defect closure. Short and medium term morbidity, mortality, alteration of ejection fraction and NYHA class were analysed. Results: Perioperative mortality was 11.11%, 4.2% in the endoventricular patch group, and 15.9% in the linear suture group (p = 0.03). The overall 5-year survival was 78.5% (88.7% in Group 1 and 71.2% in Group 2). The left ventricular ejection fraction and NYHA functional class improved in both groups, with greater improvement in the endoventricular patch group. Conclusions: Surgical ventricular reconstruction is a procedure performed for the correction of ischemic left ventricular aneurysm with good early and medium-term results, but with better results with the endoventricular patch technique regarding early and medium-term mortality, ejection fraction and NYHA functional class improvement. Orv Hetil. 2018; 159(51): 2167–2174.

Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an unusual complication related to various injuries or conditions which involve the mitro-aortic region; it communicates with the left ventricular outflow tract and is associated with a high-risk of redoubtable complications or sudden death. The cerebral and splenic localizations are frequently seen as manifestations of systemic embolism in infective endocarditis. Currently, there are no specific recommendations related to the diagnosis, management, treatment, or further evolution of patients with P-MAIVF and concomitant splenic infarction. This paper presents the case of a 43-year-old Caucasian woman with a late diagnosis of mixed bicuspid aortic valve disease, affected by an under-detected and undertreated episode of infective endocarditis leading to asymptomatic P-MAIVF. Prime clinical and imagistic diagnosis of splenic infarction indicated further extended investigations were required to clarify the source of embolism. Methods: Integrated multimodality imaging techniques confirmed the unexpected diagnosis of P-MAIVF. Results: The case had a fatal outcome following an uncomplicated yet laborious cardiac surgery. Patient death was attributed to a malignant ventricular arrhythmia. Conclusion: The present case raises awareness by highlighting an unexplained and unexpected splenic infarction association with P-MAIVF as a result of infective endocarditis related to mixed bicuspid aortic valve disease.

BACKGROUND: Development of valvular substitutes meeting the performance criteria for surgical correction of congenital heart malformations is a major research challenge. The sheep is probably the most widely used animal model in heart valves regenerative medicine. Although the standard cardiopulmonary bypass (CPB) technique and various anesthetic and surgical protocols are reported to be feasible and safe, they are associated with significant morbidity and mortality rates. The premise of this paper is that the surgical technique itself, especially the perioperative animal care and management protocol, is essential for successful outcomes and survival. METHODS: Ten juvenile and adult female sheep aged 7.8–37.5 months and weighing 32.0–58.0 kg underwent orthotopic implantation of tissue-engineered pulmonary valve conduits on beating heart under normothermic CPB. The animals were followed-up for 6 months before scheduled euthanasia. RESULTS: Based on our observations, we established a guide for perioperative care, follow-up, and treatment containing information regarding the appropriate clinical, biological, and ultrasound examinations and recommendations for feasible and safe anesthetic, surgical, and euthanasia protocols. Specific recommendations were also included for perioperative care of juvenile versus adult sheep. CONCLUSION: The described surgical technique was feasible, with a low mortality rate and minimal surgical complications. The proposed anesthetic protocol was safe and effective, ensuring both adequate sedation and analgesia as well as rapid recovery from anesthesia without significant complications. The established guide for postoperative care, follow-up and treatment in sheep after open-heart surgery may help other research teams working in the field of heart valves tissue regeneration.

Funding Acknowledgements This work was supported by the University of Medicine, Pharmacy, Science and Technology of Targu Mures Research Grant number 615/13/17.01.2019 Background An early appearance of cardiac masses after valve replacement raises differential diagnosis problems. The specific therapeutic approach of autoimmune comorbidities enhances the risk of infective endocarditis or inflammatory reactions. Among systemic disorders leading to cardiac complications, rheumatoid arthritis is cited. Leflunomide is a synthetic disease-modifying antirheumatic drug (DMARD) with immunomodulatory actions as it inhibits the de novo synthesis of pyrimidine, hence suppressing T cell activation and proliferation. It is used as first line treatment strategy for rheumatoid arthritis (RA) patients, with contraindication or non-tolerance of Methotrexate. Case presentation We present the case of a 63-year old Caucasian male with seropositive RA, treated with Leflunomide 20 mg od, with history of severe calcified aortic stenosis and permanent atrial fibrillation. The patient underwent an aortic valve replacement with a St. Jude Regent 25 mechanical valve and ascending aorta replacement with a Dacron 30mm graft. Leflunomide was forthwith discontinued before surgery. Five months after surgery, in a routine check-up, including proper adherence to the anticoagulation regimen (regular INR 2.6-3.2), and stable hemodynamic status, a right atrial mass was identified by transthoracic echocardiography (figure). The mobile hyperechogenic mass appeared to be attached by a narrow stalk to the atrial septum, presenting a quasi-parallel movement to the septal cusp. The haemodynamic of the tricuspid valve was not affected. A suspicion of early infective endocarditis was ruled out. Cardiac CT identified a well-defined, pedunculated, mobile mass measuring 2.8x3.1 cm originating above the tricuspid annulus, attached to the atrial septum without hemodynamic impact. An inflammatory pseudotumor was identified and a granulomatous mass was diagnosed. Consecutively, Leflunomide 20 mg od along with adjusted doses of corticosteroids were initiated with progressively diminished dimensions of the tumour three months after the ultrasound and CT diagnosis. One year after complete resolution of the mass, the patient continues his immunosuppressive and cardiac pharmacological regimen. Repeated echocardiograms showed standard functionality of the aortic prosthesis, without recurrent intracardiac mass. Conclusion Management of an intracardiac mass after cardiac surgery in patients with systemic inflammatory diseases may be challenging. Cardiac imaging is mandatory to differentiate among thrombi, vegetations, primary or metastatic cardiac tumours. In RA patients DMARD and immunosuppressive therapy should not be discontinuing during perioperative procedures as they do not increase the risk of infectious complications. Sequential imaging studies in patients presenting systemic inflammatory comorbidities should be used to assess and identify the immunological responses in the absence of targeted therapy. Abstract P1454 Figure.

Acute pancreatitis is a very mortal disease, mortality that increases even more in patients with cardiac transplantation. Medical-surgical management of acute pancreatitis in transplanted patients can make the difference between life and death. The aim of this paper was to highlight the severity of this pathology especially because the patient is immunosuppressed after cardiac transplant. A case of 36-year-old man, known with heart transplant, immunosuppressive treatment and chronic renal frailer, who arrived to Emergency Department, with severe abdominal pain and abdominal distention which started after a traumatic accident. Investigations revealed acute pancreatitis that needed three surgeries for acute necrotic hemorrhagic pancreatitis, acute bleeding, left subphrenic abscess and intensive care therapy. With favorable postoperative evolution, patient is discharged 60 days later He�s follow up reveled no gastrointestinal or cardiac complication with an improved quality of life.

Left ventricular anevrysm (LVA) is the effect of left ventricular (LV) remodeling after myocardial infarction (MI). The surgical technique to improve cardiac function is geometric reconstruction of the LV. The aim of this paper is to highlight the importance of restoring left ventricle geometry. We report a case of 53 year-old man, without any known cardiovascular history, with acute anterior myocardial infarction, left ventricular aneurysm and massive left ventricular thrombus, who arrived into the emergency department 24 hours after the onset of symptomatology. After hemodynamic stabilization, we performed geometric reconstruction of the left ventricle. With favorable postoperative evolution, patient is discharged 14 days later. At the periodic checkups it is noted that he�s postoperative ejection fraction (EF) improved and also the quality of life.

Many methods of stem cells collection and isolation from various tissue types harvested either from small or large experimental animals or from human tissues have been published so far, all evaluating them as a potential source of adult mesenchymal stem cells with applicability in various pathologies or tissue bioengineering. The present study purposed to describe a minimally invasive surgical protocol for adipose tissue collection from sheep�s inter-scapular area. The procedure was carried out on adult sheeps, in aseptic conditions. A light sedation protocol with Detomidine was performed, the recovery from anesthesia being carried out with Atipamezole. Throughout the sedation, the surgical procedure and the recovery from anesthesia, the vital functions of the animal were monitored. The adipose tissue samples collected in sterile tubes with culture medium (Dulbecco�s modified Eagle�s medium - DMEM/10% / FBS10 - fetal bovine serum, 2% antibiotic/antifungal), have been succesfully used by our research team for adipose tissue derived stem cells (ADSCs) isolation for further use in cardiac valves tissue engineering.

The purpose of the study was to prove to efficacy of Milrinone in the management of open heart surgery in children with congenital heart malformations, the link between Milrinone efficacy and the prevention of low cardiac output syndrome and Milrinone side effects. We conducted a retrospective study on a group of 24 patients, admitted to the Tg Mures Emergency Institute for Cardiovascular Diseases and Transplant, between August 2016 and February 2017. Milrinone was administered to children that underwent open heart surgery for different congenital heart malformations, using doses between 0.25 and 0.75 mcg per kg bodyweight, in continuous intravenous drip, before de-clamping of the Aorta, the procedures being conducted in extracorporeal circulation. We recorded demographic data, biological parameters of renal function, myocardial function and hemodynamic parameters, before and after surgery. The administration of Milrinone determined a reduction of incidence of low cardiac output syndrome, registering only 4 deaths, the survival rate being 83.33%, 13 cases presenting complications. Postoperatively we registered a significant improvement of the mean heart rate. Milrinone proved efficient in the re-establishment of hemodynamic parameters in patients with this type of clinical manifestations. Using Milrinone in children that undergo open heart surgery determines a decrease in incidence of low cardiac output syndrome, its� presence in the pharma market being necessary.

Left ventricular aneurysm is a severe complication of acute myocardial infarction, which contributes significantly to mortality and morbidity associated with this pathology. Despite the progress of correction techniques, there are still controversies about the optimal approach addressing this pathology.The aim of this study was to analyse short and medium term outcomes of left ventricular reconstruction for ischemic left ventricular aneurysm using two surgical techniques (endoventricular patch plasty and liniar suture) in order to determine if one of these techniques has supperior results.117 patients were included in the study, 48 patients (41%) underwent left ventricular reconstruction with endoventricular patch (Group 1), 69 patients (59%; Group 2) had linear reconstruction. 113 patients (96.5%) required associated procedures: 108 surgical myocardial revascularization, 18 mitral valvuloplasty and 8 ventricular septal defect closure. Short and medium term morbidity, mortality, alteration of ejection fraction and NYHA class were analysed.Perioperative mortality was 11.11%, 4.2% in the endoventricular patch group, and 15.9% in the linear suture group (p = 0.03). The overall 5-year survival was 78.5% (88.7% in Group 1 and 71.2% in Group 2). The left ventricular ejection fraction and NYHA functional class improved in both groups, with greater improvement in the endoventricular patch group.Surgical ventricular reconstruction is a procedure performed for the correction of ischemic left ventricular aneurysm with good early and medium-term results, but with better results with the endoventricular patch technique regarding early and medium-term mortality, ejection fraction and NYHA functional class improvement. Orv Hetil. 2018; 159(51): 2167-2174.Absztrakt: Bevezetés: A balkamra-aneurysma az akut myocardialis infarctus súlyos szövődménye; jelentősen növeli a morbiditást, mortalitást. A sebészi korrekciós technikák fejlődése ellenére számtalan kérdőjel van e kórkép kezelésének optimális megközelítésével kapcsolatban. Célkitűzés: Tanulmányunk célja az ischaemiás eredetű balkamra-aneurysma két különböző sebészi technikával (endoventriculoplastica és lineáris varrat) végzett műtéti rekonstrukciója rövid és középtávú eredményeinek vizsgálata annak érdekében, hogy meghatározzuk, melyik eljárás előnyösebb. Módszer: A vizsgálatba 117 beteget vontunk be, 48 esetben (41%) endoventriculoplasticával (1. csoport), 69 betegnél (59%) lineáris varrattal (2. csoport) végeztük a balkamra-rekonstrukciót. 113 betegnél (96,5%) egy időben más eljárás is szükséges volt: 108 esetben műtéti myocardialis revascularisatio, 8 betegnél kamrai septumsutura, 18 esetben mitralisbillentyű-plastica történt. A rövid és középtávú morbiditást és mortalitást, az ejekciós frakció változásait és a szívelégtelenség súlyosságát (NYHA) elemeztük. Eredmények: A perioperatív mortalitás 11,11% volt, 4,2% az endoventriculoplasticás csoportban, 15,9% a lineárisvarrat-csoportban (p = 0,03). Az 5 éves túlélés 78,5% volt (88,7% az 1. csoportban és 71,2% a 2. csoportban). Mindkét csoportban javult a bal kamra ejekciós frakciója, a szív funkcionális osztályba sorolása (NYHA); az eredmények szignifikánsan jobbak voltak az endoventriculoplasticával műtött betegek csoportjában. Következtetések: A bal kamra műtéti rekonstrukciója jó korai és középtávú eredményeket mutató eljárás az ischaemiás balkamra-aneurysma korrigálására; az endoventriculoplastica jobb eredményeket biztosít a korai és középtávú mortalitás, az ejekciós frakció és a NYHA funkcionális osztály szempontjából. Orv Hetil. 2018; 159(51): 2167–2174.

There is a great need for living valve replacements for patients of all ages. Such constructs could be built by tissue engineering, with perspective of the unique structure and biology of the aortic root. The aortic valve root is composed of several different tissues, and careful structural and functional consideration has to be given to each segment and component. Previous work has shown that immersion techniques are inadequate for whole-root decellularization, with the aortic wall segment being particularly resistant to decellularization. The aim of this study was to develop a differential pressure gradient perfusion system capable of being rigorous enough to decellularize the aortic root wall while gentle enough to preserve the integrity of the cusps. Fresh porcine aortic roots have been subjected to various regimens of perfusion decellularization using detergents and enzymes and results compared to immersion decellularized roots. Success criteria for evaluation of each root segment (cusp, muscle, sinus, wall) for decellularization completeness, tissue integrity, and valve functionality were defined using complementary methods of cell analysis (histology with nuclear and matrix stains and DNA analysis), biomechanics (biaxial and bending tests), and physiologic heart valve bioreactor testing (with advanced image analysis of open–close cycles and geometric orifice area measurement). Fully acellular porcine roots treated with the optimized method exhibited preserved macroscopic structures and microscopic matrix components, which translated into conserved anisotropic mechanical properties, including bending and excellent valve functionality when tested in aortic flow and pressure conditions. This study highlighted the importance of (1) adapting decellularization methods to specific target tissues, (2) combining several methods of cell analysis compared to relying solely on histology, (3) developing relevant valve-specific mechanical tests, and (4) in vitro testing of valve functionality.

Background: We hypothesized that an ideal heart valve replacement would be acellular valve root scaffolds seeded with autologous stem cells. To test this hypothesis, we prepared porcine acellular pulmonary valves, seeded them with autologous adipose derived stem cells (ADSCs) and implanted them in sheep and compared them to acellular valves. Methods: Fresh porcine pulmonary valve roots were decellularized with detergents and enzymes. ADSCs were isolated from subdermal fat and injected within the acellular cusps. Valves were then implanted in an extra-anatomic pulmonary position as RV to PA shunts: Group A (n=6) consisted of acellular valves and Group B (n=6) of autologous stem cell-seeded acellular xenografts. Sheep were followed up for 6 months by echocardiography and histologic analysis was performed on explanted valves. Results: Early evolution was favorable for both groups. All Group A animals had physiologic growth without any signs of heart failure and leaflets were found with preserved structure and mobility, lacking signs of thrombi, inflammation or calcification. Group B sheep however expressed signs of right ventricle failure starting at one month, accompanied by progressive regurgitation and right ventricle dilatation, and the leaflets were found covered with host tissue. No cells were found in any Group A or B explants. Conclusions: Acellular stabilized xenogeneic pulmonary valves are reliable, stable, non-immunogenic, non-thrombogenic and non-calcifying scaffolds with excellent hemodynamics. Seeding these scaffolds with autologous ADSCs was not conducive to tissue regeneration. Studies aimed at understanding these novel observations and further harnessing the potential of stem cells are ongoing.

Objective: To describe a particular harvesting procedure for isolating intact porcine aortic heart valve roots as potential sources for biologic scaffolds. Methods: Fresh porcine hearts were brought to the Tissue Engineering and Regenerative Medicine Laboratory at the University of Medicine and Pharmacy in Targu Mures. The aortic roots were extracted from the porcine hearts by anatomical dissection. For this purpose, we used a basic surgical instrument kit. This initial phase was the first step in obtaining acellular extracellular matrix as a biologic scaffold material. Results: Aortic roots were isolated with preservation of the ascending aorta as well as the intact aortic sinus and coronaries together with the adjacent myocardial tissue and anterior leaflet of the mitral valve. This approach allowed for safe mounting of roots into mounting rings for perfusion decellularization. Conclusions: The described procedure is a feasible protocol for obtaining intact biological valvular scaffolds from porcine hearts. Reduced requirements regarding tools and personnel underline the easiness of aortic root harvesting using this particular procedure.

We present the case of a 65 years old patient, initially hospitalized at Regional Pneumology Clinic with marked fatigue, severe pulmonary symptoms (suddenly developed severe resting dyspnea, orthopnea, irritating cough), loss of appetite, weight loss and dysphagia. Chest radiography raises the suspicion of giant ascending aortic aneurysm. Echocardiography confirms the presence of the aneurysm, but CT scan with contrast and angiography showed a giant pseudoaneurysm of ascending aorta with severe local compression of the right lung hilum and right main bronchus and in posterior on the esophagus. Coronary angiography also shows significant compression and deformation of the left main coronary artery. Echocardiography reveals marked dilated ascending aorta in the suprabulbar portion without aortic insufficiency. Replacement of the ascending aorta was performed in extracorporeal circulation with a impregnated Dacron prosthesis. Because of technically difficult approach, the ascending aorta ( being the right anterolateral wall of the pseudoaneurysm) was incanculated via right axillary artery, the aortic crossclamp was performed initially transluminal with Foley catheter and later with classical metallic instruments, and myocardial protection was achieved initially by retrograde administration of cardioplegic solution with monitoring of lactic acid, pH and base excess simultaneous from coronary sinus and the coronary ostia during administration of cardioplegic solution. The postoperative evolution was favorable, the weaning from extracorporeal circulation was succeeded without inotropics, with a 48 hours length of stay in ICU, and the patient was discharged after 8 days postoperatively.

Among failed parathyroidectomy causes an important role is played by glandular ectopies, encountered in approximately 20% of cases; in 2% of cases they are localized in the mediastinum. In this latter situation there is a need for a thoracic approach which may be either classical or minimally invasive. The minimally invasive surgery is appealing and the results surpass those of classical surgery. Nevertheless, there are situations in which minimally invasive surgery is inefficient, not indicated, or unaffordable, thus, the classical approach remains the only option for surgical treatment. Partial sternotomy could represent a good alternative to classical full sternotomy or thoracotomy. We present the case of a hemodialysed patient with secondary persistent hyperparathyroidism after two failed parathyroidectomies; localization studies identified an ectopic hyperfunctional mediastinal parathyroid gland which was excised through a partial sternotomy. To the best of our knowledge, this is the first case reported in Romanian literature which describes this kind of approach for a mediastinal ectopic parathyroid gland.

In a retrospective study, the safety profile and efficacy of immunosuppressive medication was evaluated in 35 patients with cardiac transplant in Targu Mures during 1999-2011 (11 treated with cyclosporine, 24 with tacrolimus, both drugs were associated with mycophenolate mofetil). Therapeutic benefit was measured by survival curve and lack of rejection while safety was evaluated by measuring plasma immunosuppressive drugs levels and evaluation of specific adverse events (nephrotoxicity, diabetes, and hypertension). The most frequent side effect was nephrotoxicity (significant reduction in glomerular filtration rate estimated by MDRD formula), but no significant differences were found between the 2 medications.

Constrictive pericarditis is an uncommon condition, often of unknown etiology. The diagnosis of constrictive pericarditis can be difficult and is often delayed, because the signs and symptoms of this disease can be falsely attributed to other causes. We report the case of a 62-year-old woman presented with a one year history of progressively worsening dyspnea, peripheral oedema, prominent jugular distension, hepatomegaly, ascites. The patient is known with a history of effusive pericarditis. Blood test showed a normal white cell count, anaemia, raised CRP. Chest X-Ray shows a normal sized heart and without calcification of the pericardium. The echocardiographic exam showed septal bounce-abrupt transient rightward movement, left, right ventricular size decreased-heart tubularin shape, mild atrial enlargement, IVC plethoric and unresponsive to respiration, hepatic veins dilated. Doppler echocardiographic findings were consistent with constrictive pericarditis. Cardiac catheterization showed elevation and equalization of diastolic filling pressures, and dips and plateau configuration of ventricular pressure during diastole (square root sign). Based on these results pericardiectomy was necessary. Constrictive pericarditis was also confirmed at the time of surgery. The pericardium was found with thickening of up to 30 mm in some areas. Histopathological exam showed fibrosis and calcification within the pericardium with no evidence of malignancy or tuberculosis. The patient was discharged 10 days later. At 3 months she had no significant symptoms. Diagnosis of constrictive pericarditis remains challenging. Constrictive pericarditis should be suspected in patients with clinical features of right-sides heart failure. Echocardiography and cardiac catheterisation are important investigation in diagnosis of constrictive pericarditis and avoiding unnecessary treatments.

Bicoronary - pulmonary artery fistulae are rare conditions. Their association with mitral valve prolapse is even rarer and randomly reported. This association is important to be recognized in clinical practice because of the differential diagnose problems. Closing the coronary fistulae and mitral valve replacement during the same surgical procedure is probably the optimal management of these patients. We report a case involving the correction of congenital bicoronarypulmonary artery fistulae and mitral valve replacement within the same surgical procedure in a 56 years old female patient with angina and clinical signs of left ventricular failure associating the fistulae to severe mitral regurgitation due to mitral valve prolapse. Past medical history revealed autoimmune thyroiditis, atrial fibrillation, mitral and tricuspid valve regurgitation. At admission physical examination revealed stable vital signs, irregular tachycardia with significant pulse and a mitral regurgitation systolic murmur. ECG showed atrial fibrillation, no ischemia. Echocardiography revealed severe mitral regurgitation, prolapse of anterior and posterior mitral leaflets, moderate tricuspid valve regurgitation, and mild pulmonary hypertension. Coronary angiogram showed no significant lesions of the epicardial vessels but high flow congenital bicoronary-pulmonary fistulae (right coronary artery and left coronary artery to main pulmonary artery). Surgical correction of the congenital bicoronarypulmonary fistulae was performed simultaneously with mitral valve replacement in the same session. Postsurgical evolution was uneventful. Post-procedural ECG showed atrial fibrillation with a controlled heart rate, postoperative echocardiography showed normal functional and normal positioned prosthetic mitral mechanical valve, and rather normal left ventricle function. Coexistence of bicoronary-pulmonary fistulae and mitral valve insufficiency due to prolapse in a symptomatic patient with angina pectoris is a very rare clinical entity. Solving both abnormalities within the same surgical procedure was the optimal management for this patient.

Introduction. Perioperative myocardial injuries are one of the most frequent causes of morbidity and mortality after cardiac surgery, the most common etiology being the poor myocardial protection during aortic crossclamp. During aortic crossclamp progressive accumulation of lactate and intracellular acidosis are well-known phenomena, and are associated with alteration of myocardial contractile function. Our objective was to study the coronary sinus lactate levels as a predictor of postoperative hemodynamic outcome in open-heart surgical patients.Material and methods. We performed a prospective clinical trial, including 142 adult patients with elective cardiac surgery. Anterograde cardioplegia was administered in 82 patients, retrograde cardioplegia in 60 (in 30 patients it was administrated intermittently and in 30 continuously). Blood was collected simultaneously from the aortic cardioplegic line (inflow) and from coronary sinus or the aortic root (outflow) before aortic crossclamp, after crossclamp at every 10 minutes and after crossclamp removal at 0 and 10 minutes. All patients were operated on cardiopulmonary bypass with cardiac arrest, using warm-blood cardioplegia for cardioprotection.Results. Lactate levels showed increasing values during aortic crossclamp, and a rapid decline after crossclamp removal. The incidence of low cardiac output was significantly higher in patients with lactate levels that exceeded 4 mmol/L. In patients who died in the postoperative period, lactate level was even higher (5 mmol/L), with only a modest recovery after crossclamp removal.Conclusion. Monitoring lactate level in coronary sinus blood is a reliable method and has a good prognostic value regarding postoperative morbidity and mortality in open heart surgery

Aim: Our long-term aim is to develop a living valvular substitute using Regenerative Medicine principles, by seeding decellularized porcine heart valve scaffolds with adult stem cells and conditioning them in bioreactors before implantation. In this study, adult stem cells were isolated from sheep adipose tissue (ADSCs). However, we found it impractical to use cells immediately after propagation and thus, in order to extend their availability in time, a preservation method was needed. Methods: Adipose tissue was harvested from 6 sheep. ADSCs were isolated using enzymatic agents and cultured. The cells were tested for plasticity using chondrogenic, adipogenic and osteogenic differentiation kits and then cryopreserved in DMSO at -1400C. Viability was tested after a 3 week storage using Trypan Blue Staining. Results: Ovine ADSCs exhibited excellent plasticity and differentiation potential. An average of 18 million ADSCs were obtained from each ovine, exhibiting more than 88% viability after a 3-week cryopreservation period followed by thawing. Conclusions: DSMO cryopreservation represents a suitable method for ovine ADSCs for regenerative medicine. This method expands the usage of stem cells in vitro before they are differentiated into more specialized cells, offering large numbers of usable ADSCs with minimal cell loss at any desired time point.