imally invasive video-assisted mitral valve surgery: a 12-year, 2-center experience in 1178 patients.

No abstract

The pedicled left internal thoracic artery graft is the mandatory conduit in coronary artery bypass surgery. A grossly emphysematous lung may sometimes present a significant problem for positioning of the pedicled left internal thoracic artery conduit. An inverted pedicled left internal thoracic artery graft (internal thoracic artery transected near its origin, thus supplied by retrograde flow from superior epigastric and musculophrenic arteries) might occasionally be the conduit of choice for those patients.

Hypertrophic obstructive cardiomyopathy (HOCM) is an idiopathic disease frequently associated with systolic anterior motion (SAM). The anterior leaflet of mitral valve is sucked by Ventury effect into the left ventricle outflow tract making subaortic stenosis more severe and producing mitral insufficiency at the same time. Septal myectomy along with mitral valve replacement has been the treatment of choice for a long time. An understanding of pathoanatomy and hemodynamics of the disease has opened possibility for total reconstructive treatment of both subaortic stenosis and mitral insufficiency in such patients. This is a case report of 50-year-old male with severe subaortic stenosis (136/70 mmHg) due to HOCM and SAM along with grade IV mitral insufficiency. Septal myectomy was performed. Mitral insufficiency was managed by reducing the height of posterior cusp along with remodeling of mitral annulus by Carpentier-Classic ring. In that way, subaortic obstruction was reduced to 30.9/10 mmHg while mitral insufficiency was lowered to negligible level. The patient was discharged from hospital with sinus rhythm eight days after the surgery.

Disekcija aorte je jedno od najhitnijih stanja u kardiovaskularnoj hirurgiji. Preko 40% pacijenata ne stigne do ustanove tercijarnog tipa, a više od četvrtine umire u prvih 24 časa po nastanku disekcije. Prikaz slučaja: Muškarac star 37 godina primljen je na Institut sa jakim retrosternalnim bolovima, koji su bili refraktorni na vazodilatatornu terapiju nitroglicerinom. Suspektna disekcija aorte dijagnostikovana je multidetektorskom kompjuterizovanom tomografijom (MDCT) grudnog koša i transtorakalnim ehokardiografskim pregledom (TTE). Na MDCT grudnog koša i abdomena registrovana je velika, heterogena, feohromocitomu slična masa nadbubrežne žlezde. Zbog hemodinamske nestabilnosti bolesnika i hitnosti operacije, indikovano endokrinološko ispitivanje i kompletna dijagnostika potencijalnog feohromocitoma su odloženi za period nakon operativnog lečenja. Diskusija i zaključak: U lečenju bolesnika sa suspektnim feohromocitomom i akutnom disekcijom aorte, od krucijalnog značaja je obezbediti hemodinamsku stabilnost pre same hirurške intervencije. Hronična vazokonstrikcija, uzrokovana visokim vrednostima cirkulišućih kateholamina, može izazvati tešku, malignu hipertenziju. Da bi se prevazišli najvulnerabilniji periodi, uvod u anesteziju i perioperativne hemodinamske oscilacije, u upotrebi je kratkodelujući alfa-1 adrenergički blokator-fentolamin. Najveći izazov za anesteziologa u lečenju feohromocitoma i posledične disekcije aorte predstavlja brzo prepoznavanje simptoma bolesti i blagovremeno postavljanje prave dijagnoze, kako bi se smanjio mortalitet.

Surgical reconstruction of the rheumatic mitral valve back to the functional state is a demanding procedure, which, however, provides certain benefit for the successfully treated patient.

The innominate artery is the most commonly affected supra-aortic vessel in the acute ascending aorta dissection. The brachiocephalic vessels, separated from the true lumen, need reimplantation. The fragile vessel tissue might be challenging to reconstruct. Cerebral blood flow could be restored using an extra-anatomic bypass.

In order to expand the revascularization of the left anterior descending coronary artery, we have applied the inverted left internal thoracic artery (left internal thoracic artery [LITA] transected near its origin, thus supplied by retrograde flow from superior epigastric and musculophrenic arteries) in carefully selected cases (four patients). The 64-slice multidetector row computed tomographic scans performed postoperatively (range, 6 to 40 days), as well as the scans performed in the follow-up period (range, 18 to 35 months) showed preserved inverted LITA conduits with thrombolysis in myocardial infarction (TIMI) 3 flow in all patients.