A case of postinfarction left ventricular free wall rupture is successfully treated. Prompt diagnosis was provided by echocardiography and an emergency operation was carried out. Following sternotomy, hemodynamic stabilization was obtained by gradually evacuating blood from the pericardium, while the femoral vessels were cannulated and the extracorporeal circulation was established. An autologous glutaraldehyde stiffened pericardial patch was sealed over the infarcted area using fibrin glue and fixed with a running suture on the surrounding healthy myocardium.
Intermittent antegrade intermediate lukewarm blood cardioplegia is appropriate and clinically safe. Cardiac troponin I release suggests that intermediate lukewarm cardioplegia is better than cold cardioplegia but less effective than warm cardioplegia in low-risk patients. We therefore recommend the use of warm cardioplegia in low-risk patients.
Backgruond and Aim:
We present our casuistry links to prolapse/flail of P2 LPM in mitral regurgitation treated with edge-to-edge technique when contraindicated to quadrangolar resection.
We hereby present our experience using a modified edge-to-edge technique to address this peculiar MR.
Methods:
From January 1999 to January 2015, 89 consecutive patients (mean age 56 ± 14,56, 53 males) affected by prolapse/flail of P2 LPM in mitral regurgitation. Preoperative transesophageal echo (TEE) in all the cases showed prolapse/flail of P2 LPM when it exists a controindication to quadrangolar resection like: extensive resection 52%, posterior anulus calcification 23%, hypertrofic/small ventricle 27%. In all the patients, a doble orifice valve (DOV) repair with annuloplasty was performed. Intra-operative TEE and postoperative transthoracic echocardiography (TTE) were carried out to evaluate results of the DOV repair.
Results:
There was no in-hospital death. At intra-operative TEE, the two orifices showed a mean total valve area of area 3,06 ± 0,63 cm with no residual regurgitation or trivial and no sign of valve stenosis (Grad med 3,73 ± 1,66; Grad max 11,02 ± 7,48). At follow up (from 1999 to 2015) we appreciated a freedom from reoperation 97%(fig.1) and survival 95% (Fig. 1).
Conclusions:
We consider edge to edge a valid alternative in pts with prolapse/flail of P2 in LPM when exist: extensive resection that may determinate a residual mitral regurgitation by LPM retraction, posterior anulus calcification that may determinate no possibility of annular plication and hypertrofic/small ventricle for high risk of persistent SAM.
Medicine is an art full of probabilities and a science full of uncertainties. " Sir William OslerAt the end of the 198Os, cardiac surgery entered its scientific era.' Science in cardiac surgery is based mainly upon the statistical study of all measurable phenomena that can influence the indications, accomplishments, and results of operations. It is easy to argue the advantages of such a scientific approach: statistical analysis introduces a logical method to the thinking process which stratifies and organizes the clinical and biological data. Decisions may then be based upon objective criteria and the results analyzed. In other words, the chaos is rationalized. This endeavor has proved very effective in improving the quality of cardiothoracic surgical literature. But now, perhaps, a word of caution is needed in the face of the increasing, almost systematic and monopolistic, use of statistics in the cardiothoracic surgical literature. Fax: 33-91 -75-53-63. theoretical basis. (A few discussions among professional statisticians support this point.6) At times it seems, when reading an article, a J CARD SURG 1994.9 288-291 EEX. ET AL STATISTICS IN CARDIAC SURGERY
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