1,721,064 research outputs found
Sutureless valves fit/perform well in a small aortic annulus
No full textAortic valve replacement (AVR) in patients with severe aortic disease and a small aortic annulus (SAA) represents a clinical challenge, especially in the setting of aortic stenosis. The optimal valvular substitute for treating these patients remains controversial
Leiomyosarcoma of the right inferior pulmonary vein: 2 years survival with multimodality therapy
Get PDFPrimary leiomyosarcoma of the heart is an extremely rare and aggressive tumor. The authors report a case of a 29-year-old man with a leiomyosarcoma of the right inferior pulmonary vein who underwent surgery, chemotherapy, and radiotherapy. The patient experienced two local recurrences and he finally died 2 years after onset of symptoms because of multiple distal metastases
Late cardiovascular complication after varicose vein endovascular ablation
No full textVenous insufficiency of the lower limbs is one of the most common vascular disorders affecting millions of people worldwide. Endovascular techniques are considered by current guidelines as simple, safe and effective. Persistence or even migration of foreign bodies after varicose vein endovascular surgery is a rare and unfeared complication. Herein, we present the case of a 39-year-old woman who underwent endoluminal treatment of varicose veins >2 years ago and she was admitted to our department for late cardiovascular complication caused by catheter or guidewire rupture and the dissemination of its fragments in the inferior vena cava, right heart chambers, liver and pulmonary arteries. A systematic verification of the length and integrity of the devices should be performed at the end of every endovascular procedure
Influence of patient-prosthesis mismatch on postoperative outcome after aortic valve replacement for pure aortic stenosis in the presence of impaired left ventricular contractility
No full textOBJECTIVES: To assess the effects of patient/prosthesis mismatch (PPM) (EOAI < 1 cm2/m2) on postoperative results of patients submitted to aortic valve replacement (AVR) for pure valve stenosis with concomitant left ventricular dysfunction (LVEF ≤ 40%). The persistence of left ventricular outflow tract obstruction after AVR might affect postoperative results in the presence of LV contractile impairment.
METHODS: From January 1989 to December 2001, 201 patients submitted to AVR for pure aortic valve stenosis and affected by LV dysfunction (mean LVEF 30±6.8%) were retrospectively identified. After surgery, 161 patients had no PPM whereas PPM was present in 40 patients (mean EOAI 0.87±0.07 cm2/m2). All patients were followed up in terms of postoperative survival, morbidity and functional capacity. Univariate and Cox regression analysis were carried out to evaluate predictors of postoperative outcome.
RESULTS: Follow up was 99,8% complete, and 985 patients/year were available for the analysis. No differences were found between the two groups in terms of demographics, except for age (73±9 years in PPM group, and 67±11 years in the second group, respectively). Adjusted Kaplan-Meyer estimations did not show any difference between the two groups in terms of postoperative event-free outcomes. Postoperative functional capacity improved in the majority of the patients, irrespective of the presence of PPM. At multivariate analysis PPM did not show to represent a negative determinant of postoperative outcome, whereas advanced age and NYHA class were predictive of unfavorable results.
CONCLUSIONS: After AVR for pure aortic stenosis in the presence of LV dysfunction, PPM did not apparently influence mortality and morbidity outcomes. Further investigations are necessary to elucidate LV response in this setting
Successful Use of Extracorporeal Membrane Oxygenation Postpartum as Rescue Therapy in a Woman With COVID-19
No full textClinical manifestations of coronavirus disease 2019 in pregnant women, in contrast to previous outbreaks, seem to be similar to those of nonpregnant women. During severe acute respiratory syndrome (SARS), SARS influenza A, and Middle East respiratory syndrome outbreaks, an increased severity of disease among pregnant women was observed. In some pregnant women, respiratory failure can occur and progress quickly to acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) as a rescue therapy. Despite a lack of current guidelines on the use of ECMO in pregnant or postpartum women, this support therapy is an effective salvage therapy for patients with cardiac and/or respiratory failure, and is associated with favorable maternal and fetal outcomes. Herein, the authors report a case of severe COVID-19 disease in a pregnant patient after urgent cesarean delivery, who was treated successfully with ECMO during the postpartum. Extracorporeal membrane oxygenation should be considered early when conventional therapy is ineffective, and it is essential to refer to ECMO expert centers
Clinical feedback from experience with COVID-19: Specific considerations for extracorporeal membrane oxygenation
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Small prosthesis (size23-25) for mitral valve replacement. Analysis of postoperative outcome from a retrospective multicenter study.
No full textOBJECTIVES: To assess through a retrospective multicenter analysis the postoperative results of mitral valve replacement (MVR) with small prosthesis (size 23-25). The impact of small prosthetic size at mitral position on postoperative outcome after MVR is unknown.
METHODS: From January 1989 to December 2001, 285 patients (mean age 62±14 years, 23% male and 77% female) submitted to MVR with small artificial valves were identified from institutional databases. Surgery in emergency was required in 54 cases, re-operation in 61, and associated procedures in 68, respectively. Thirty-two patients had size-23 mitral prosthesis, whereas 253 patients had size-25 artificial valve. Mechanical valve was implanted in 243 patients, whereas 38 patients had a biological prosthesis. Preservation of the native valve (one or both leaflets) was accomplished in 114 patients. Postoperative survival, morbidity and functional capacity were assessed. Univariate and multivariate analysis were carried out to evaluate determinants of postoperative outcome.
RESULTS: Follow up was complete, and 1112 patient-years were available for the analysis. There were 12 early and 41 late deaths (34 cardiac-related). Kaplan-Meyer estimation showed 91% survival at 2 years and 82% at 5 years. Significant improvement of functional capacity was observed postoperatively in the majority of the patients. Cardiac-related complications occurred in 102 patients (36 major events). At multivariate analysis only the use of biological valve was identified as independent predictor of unfavorable postoperative result.
CONCLUSIONS: Mitral valve replacement with small prosthesis in adult patients has a favorable outcome. Further investigations are ongoing to elucidate whether patient/prosthesis mismatch at the mitral level affects the results of MVR
Surgery for delayed leaflet impingement after transcatheter closure of a paravalvular leak associated with an aortic pseudoaneurysm
No full textBackground: Paravalvular leak (PVL) is a recognized and challenging complication after surgical or transcatheter valve replacement. The transcatheter closure of PVL has become the first-line treatment in clinical practice when the procedure is not contraindicated. Transcatheter PVL closure rests on a complex procedure and complications still occur in approximately 9% of patients. Case Report: We describe the case of a delayed mechanical prosthetic leaflet impingement after transcatheter closure of a paravalvular leak associated with a Valsalva pseudoaneurysm that required an urgent surgery. Conclusion: Aorta–left ventricle communication could be a relative contraindication to be assessed on a case-by-case basis, but transcatheter closure does not preclude subsequent attempt for surgical repair and outcome
Caseous calcification of the mitral annulus: a neglected lesion mimicking intracardiac mass
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