Correction of microcirculatory disorders in the surgical treatment of late-stage mitral stenosis

The article is concerned with an analysis of results of the aimed medicamental correction of microcirculatory disorders performed by an original scheme. It shortened the time of preoperative preparation, extended indications for surgery, reduced the amount of postoperative complications and gave good results of the surgical correction.     

A successful surgical repair of mitral stenosis and regurgitation with pulmonary arteriovenous fistula

The patient was a 74-year-old man who was complained cyanosis and shortness of breath on exertion. He had undergone open mitral commissurotomy for mitral stenosis 19 years previously. He was diagnosed with mitral stenosis and regurgitation combined with pulmonary arteriovenous fistula (PAVF). Moderate pulmonary hypertension was also observed. It appeared that the PAVF was located where one-step operation with open heart surgery was anatomically feasible, and that his condition would be improved by resection of the fistula and decreasing overload of left atrium by mitral valve replacement. One-step operation including mitral valve replacement and tricuspid annuloplasty with enuculation of the PAVF was therefore performed. The patient has done well postoperatively, and postoperative cardiac catheterization revealed no increase in pulmonary arterial pressure.     

Spinal Arachnoid Web: A didactic report of two cases with clinical,radiological, surgical and pathological correlations

BackgroundArachnoid web (AW) is a rare but probably underestimated cause of spinal cord injury that is complex to diagnose due to subtle MRI findings and similarities to other better-known diseases such as arachnoid cyst (AC) or transdural spinal cord herniation (TSCH). Increased recognition of AW is mandatory since delay in diagnosis can lead to potentially serious neurological sequelae.Case presentationsWe report two additional cases of AW for didactic purposes, with special emphasis on the distinctive MRI and intraoperative findings. Both patients presented with progressively worsening neurological symptoms, including proprioceptive ataxia, motor weakness, numbness and neuropathic pain. The diagnosis of AW was suspected on the basis of specific MRI criteria, especially the so-called “scalpel sign”. Formal confirmation of the diagnosis was obtained in two patients that were managed surgically. Postoperative follow-up demonstrated significant functional recovery.DiscussionThere is a need for better recognition of AW by the medical community. Careful analysis of MRI semiology is crucial for the distinction between AW, AC and TSCH. Prompt and accurate diagnosis is mandatory to conserve functional prognosis, since appropriate surgical treatment with AW resection is curative, halting or even resolving the neurological symptoms.     

Left ventricular contractile function and prognosis of surgical treatment in patients with chronic mitral regurgitation

We assessed the preoperative left ventricular contractile function affected to the postoperative prognosis in 28 patients with chronic mitral regurgitation (MR). The patients were divided into two groups and compared with 11 normal subjects. 21 patients improved clinically after surgery (group-A) and 7 patients died or did not improve with surgery (group-B). Both preoperative end-diastolic volume index (EDVI) and end-systolic volume index (ESVI) were significantly greater in group-B than in group-A (220 +/- 48 vs 162 +/- 48 ml/M2, 143 +/- 50 vs 66 +/- 21 ml/M2, p less than 0.01). Ejection fraction (EF) was lower in group-B than in group-A (0.36 +/- 0.07 vs 0.59 +/- 0.08, p less than 0.01). End-systolic stress (ESS) was higher in group-B than in group-A (250 +/- 38 vs 170 +/- 37 kdyne/cm2, p less than 0.01). ESS/ESVI was lower in group-B than in group-A (1.83 +/- 0.28 vs 2.66 +/- 0.68 kdyne.M2/cm5, p less than 0.01). The ratio of wall thickness to radius at end-systole (h/R) was higher in group-A than in group-B (0.32 +/- 0.13 VS 0.18 +/- 0.05, p less than 0.01). There were significant positive correlation between ESS and ESVI in normal subjects (Y = 2.14X + 78, r = 0.59, p less than 0.05) and in MR (Y = 210 logX - 206, r = 0.81, p less than 0.001). Patients in group-B were distributed rightward on the logarithmic correlation curve in MR. These data indicated more depressed contractility in group-B than group-A.(ABSTRACT TRUNCATED AT 250 WORDS)