Tricuspid valve disease carries a very unfavorable prognosis when medically treated. Despite that, surgical intervention is still underperformed for tricuspid valve disease due to the reported high morbidity and mortality from a sternotomy approach. This had led to a shift towards maximizing medical therapy for right ventricular failure and, as a result, a more significant delay in surgical referrals with surgical risks when patients are finally referred. Tricuspid valve patients usually have other co-morbidities resulting from their systemic venous congestion and low flow cardiac output. Minimally invasive tricuspid valve surgery provides less tissue injury and, as a result, less trauma during surgery. This provides a hope for both patients and treating doctors to be more open for providing this procedure with less complications. Isolated minimally invasive tricuspid valve surgery is still not performed as widely as expected. This can be partly due to the adverse outcomes historically labelled to tricuspid valve surgery or by the long journey of learning the surgical team would need to commit to with a minimal access approach. In this article we will review the perioperative pathway, and outcomes of isolated minimally invasive tricuspid valve surgery in the available English literature.
SUMMARYWe report a case of a 51-year-old male patient with a known history of Carney complex, who was operated on for the fourth time due to recurrent left atrial myxomas. Despite surgical challenge, the operation was uneventful.The patient had a difficult postoperative period and needed further treatment for complications. After a prolonged recovery, he is currently well and remains myxoma-free up until now (36 months postsurgery) with regular follow-up using cardiac CT and transthoracic echocardiogram. BACKGROUND
Background Minimally invasive surgical approaches have gained popularity among patients and surgeons. The aim of this project was to assess the safety of initiating aortic valve replacement via an anterior right thoracotomy program. Methods Between May 2015 and May 2019, data of all isolated primary aortic valve replacements were extracted retrospectively from our prospectively collected database and categorized into conventional median sternotomy, hemisternotomy, and anterior right thoracotomy cases. In total, 661 patients underwent isolated primary aortic valve replacement, of whom 429 (65%) had a median sternotomy, 126 (19%) had a hemisternotomy, and 106 (16%) had an anterior right thoracotomy. Preoperative characteristics were similar in each of the three groups. Statistical testing of the surgical groups was undertaken using the chi-square test for categorical variables and one-way analysis of variance with Tukey post-hoc pairwise tests (where appropriate) for continuous variables, to identify differences between pairs of data. Results Cardiopulmonary bypass and crossclamp times were significantly longer in the anterior right thoracotomy group compared to the hemisternotomy and median sternotomy groups ( p < 0.001). Blood loss was significantly less and hospital stay significantly shorter in the hemisternotomy group compared to median sternotomy group but not the anterior right thoracotomy group. Mortality, stroke, renal, gastrointestinal and respiratory complications showed no statistical differences. Conclusion Surgical aortic valve replacement had a very low mortality and morbidity in our experience, and it is safe to start a minimal access program for aortic valve replacement.
SUMMARYA 33-year-old man without medical history or cardiovascular disease risk factors presented with recurrent progressively worsening chest pain that had been preceded by few days of flu like illness. His initial ECG and troponin rise supported the diagnosis of myopericarditis for which he was treated with aspirin and non-steroidal antiinflammatory drugs (NSAIDs) with good response initially. He later on developed severe recurrent chest pain and became tachycardic and hypotensive. Serial ECGs revealed a pattern of significant dynamic ST elevation in several leads, a pattern that is not usually seen in pericarditis. Subsequently, features of bedside echo did not support the diagnosis of acute ST-elevation myocardial infarction. The patient did well on conservative management with NSAIDs. He did not undergo urgent coronary angiography which would not have offered the patient any clinical benefit at the time and would have put him at procedural risk unnecessarily. The diagnosis of myopericarditis was confirmed retrospectively with typical features on cardiovascular magnetic resonance.
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