Up to 30 % of all ischemic heart disease patients present with some degree of ischemic mitral regurgitation. It is proven that any grade adversely affects long-term outcomes. Surgical revascularization and restoration of the valvular function both trigger left atrial and ventricular reverse remodeling and improve the prognosis.
PURPOSE: Pathology of the aortic root and aortic valve is subjected to adult cardiac surgery and includes Stanford A aortic dissection, annuloaortic ectasia or chronic aneurysm of the ascending aorta. In such cases, Bentall-De Bono procedure is usually preferred. Aortic valve reimplantation by using Tirone David's technique presenting with the advantages of valve-sparing surgery can be performed in selected cases. MATERIAL AND METHODS: A retrospective analysis of a three-year experience with the complex surgical treatment of diseases of the aortic valve and root was carried out. During the period from January 1, 2009 to December 31, 2012, fifty-three patients with aortic valve and aortic root pathology were treated in the Division of Cardiac Surgery, St. Marina University Hospital of Varna. Bentall procedure was carried out in 37 patients (Group B). In 19 of them (51%) emergency surgery was done for acute aortic dissection of type Stanford A. The rest 18 patients underwent elective surgery for dilated ascending aorta and aortic valve dysfunction. Aortic valve-sparing surgery by David's technique for aortic aneurysm was accomplished in 16 patients (Group D). This technique was emergently applied in one patient with aortic dissection, too. Baseline data, intraoperative details, early results and complications were compared. RESULTS: Early (30-day) mortality after Bentall-De Bono procedure was 10,5% (0% after elective surgery and 21,1% after dissection repair). All the patients survived after David's procedure that proved the significant advantages of the valve-sparing surgery. CONCLUSION: The aortic valve reimplantation provides long-term results that are comparable to those after the Bentall-De Bono procedure such as high survival rates, low incidence rate of endocarditis, and slightly higher risk of reinterventions. There is no need of lifelong anticoagulation that improves patient's quality of life.
Efficient control of liquid level - in a carbonization column (CCl) of soda ash production plants - is a difficult task because the plants are nonlinear, subjected to disturbances and lack a reliable mathematical model. To attain such efficient control, model-free fuzzy logic controllers (FLC) based on empirical knowledge are successfully developed and implemented, and adaptation mechanisms are added to aid the FLC tuning and compensate for plant changes. However, the stability analysis - of the adaptive FLC (AFLC) systems - is a critical issue that needs addressing. For this reason, the current investigation is devoted to the development of a method for analyzing AFLC system stability using robust stability and robust performance criteria. The suggested method is employed for the stability analysis of a designed PID AFLC utilized for liquid level control in an industrial CCl. The obtained results reveal that the AFLC preserves stability and high system performance in the whole range of adaptation and considered changes of the plant and the operation conditions. Moreover, the results unveil that the developed method can also be applied for the design of a robust FLC system that competes with adaptive counterparts.
INTRODUCTION:Patients on permanent hemodialysis need constant and secure vascular access with optimal flow to perform the procedure. Failure to provide such access can lead to life-threatening deterioration of the patient's condition.
CASE PRESENTATION:We report a case of implantation of a hemodialysis catheter directly in the right atrium (RA) in an emergency in a 46 year-old woman, placed on permanent hemodialysis (HD) for nine years due to end-stage renal disease with exhausted opportunities for vascular access over the years and unsuitable for peritoneal dialysis.After a consultation between a cardiac surgeon, a vascular surgeon and an interventional radiologist, a decision was made to directly implant a permanent catheter for HD in the superior vena cava (SVC).The operation was performed as a matter of urgency, operative access was through ministerotomy and the catheter was implanted directly in the right atrium (RA) due to thrombosis and fibrosis of the SVC. No cardiac complications associated with the procedure were observed in the postoperative period. On the first postoperative day, HD was performed, followed by others according to the therapeutic plan. The patient was discharged from the Cardiac Surgery Department on the 7th postoperative day.
CONCLUSION:The use of open surgical access and the implantation of a permanent HD catheter directly into the RA can be considered a life-saving procedure in HD patients with acute uremic syndrome and exhausted vascular access.
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