A modified ventriculotomy dilator-cum-probe for transventricular mitral commissurotomy

A convenient one-pass ventriculotomy wound dilator-cum-probe for mitral commissurotomy is described.     

Mitral valve disease in young; Review of surgical treatment

In India rheumatic mitral valve disease in younger age group continues unabated. The present study consists of 170 cases of mitral valve disease in young, operated upon at Military Hospital (Cardiothoracic Centre), Pune, during the last 10 years. The clinical electro-cardiographic and roentgenographic findings are presented. Echocardiographic and haemodynamic studies were performed in a few cases. 136 cases underwent closed mitral valvotomy and in 34 cases open heart surgery was performed. Closed mitral valvotomy achieved satisfying results in majority of the cases of mitral stenosis. Open heart surgery was considered when there was gross mitral regurgitation, multivalvular disease or left atrial thrombus. Closed mitral valvotomy continues to be the treatment of choice in the majority of the cases in this age group.     

Anaesthetic management for mitral valve replacement

Anaesthetic management for mitral valve replacement in 138 patients is presented. Value of preoperative visits, control of haemodynamic status, cheerful operative surroundings and smooth induction is stressed. Haemodilution technique, effective myocardial preservation and modern monitoring facilities help to maintain the patients near-normal physiological status during the procedure. In patients with unstable cardiovascular status, postoperative overnight ventilation is advocated, which maintains better oxygenation, acid-base values and reduces the work of breathing. Management of patients by anaesthesiologists and surgeons as a team reduces the mortality and morbidity significantly.     

A modified self-retaining retractor for epimyocardial pacemaker implantation

A modified self-retaining retractor facilitating wide access to the ventricular surface for epimyocardial permanent pacemaker implantation through the subxiphoid approach is described.     

Hemolysis after mitral valve replacement with mechanical valve prostheses

OBJECTIVE: We evaluated effects of type, size, and orientation of mechanical mitral valve prostheses on hemolysis. METHODS: Subjects were 84 patients who had undergone mitral valve replacement. Lactate dehydrogenase was mainly used as a marker of hemolysis and was measured before surgery, 1 month after surgery, and in the late postoperative period. RESULTS: Valves used included 16 Medtronic-Hall, 32 St. Jude Medical, and 36 CarboMedics valves. Medtronic-Hall valves caused less hemolysis than St. Jude Medical or CarboMedics valves in the late postoperative period. This resulted because hemolysis due to Medtronic-Hall valves was more severe 1 month after surgery than in the late postoperative period and because hemolysis due to St. Jude Medical or CarboMedics valves was more severe in the late postoperative period than 1 month after surgery. One reason for this finding is that cardiac output was greater in the late postoperative period than 1 month after surgery, making regurgitation through the pivots of bileaflet valves more severe. The orifice area and the orientation of prostheses did not affect hemolysis. CONCLUSION: St. Jude Medical or CarboMedics valves caused more severe hemolysis than Medtronic-Hall valves in the late postoperative period.     

Special issues regarding redo mitral valve procedures in the developing countries

Redo mitral valve replacement remains the standard treatment for recurrent mitral valve disease. Most patients referred for a redo surgery in the western world are older and present with multiple comorbidities. With the successful broad implementation of anti-infective treatment, rheumatic mitral valve disease has become highly uncommon. Nonetheless, rheumatic heart disease is still thriving in developing countries causing the most severe mitral valve conditions. The guidelines are there to help us in our decision-making process, but the actual decision has to be made based on each patients' individual criteria.     

Heart valve surgery

As the general population ages the incidence of degenerative valve disease is increasing. This is reflected by the changing workload of cardiac surgeons, indicated by the rising number of heart valve operations. Improved imaging techniques facilitate diagnosis, surveillance and guide surgical management in correcting the underlying defect. Patients with valvular heart disease require close follow-up and monitoring for changes in symptomatology, valve and ventricular function. Medical therapy is limited to antibiotic prophylaxis against endocarditis. Surgery is the mainstay of treatment for symptomatic and severe lesions, and is associated with excellent haemodynamic improvements and long-term outcomes. The timing of valve surgery is critical in order to avoid irreversible consequences of ventricular dysfunction or pulmonary hypertension.     

主动脉瓣置换术前合并中度功能性二尖瓣关闭不全治疗策略的回顾性队列研究

目的分析主动脉瓣置换术(aortic valve replacement,AVR)同期不同方式处理中度功能性二尖瓣关闭不全(functional mitral regurgitation,FMR)对患者预后的影响。方法回顾性纳入2014～2018年在本中心接受AVR且合并中度FMR的118例患者,其中男84例、女34例,年龄(58.1±12.4)岁。根据不同二尖瓣处理方式将患者分为三组:A组(未处理,11例)、B组(二尖瓣修复,51例)及C组(二尖瓣置换,56例)。研究主要终点为患者近中期生存情况,次要终点为FMR改善情况。结果中位随访时间为29.5个月。围术期死亡5例,均为C组患者;术后早期A、B两组FMR改善率分别为90.9%、94.1%(P=0.694)。A、B、C三组中期死亡率分别为0.0%、5.9%、3.9%(P=0.264),而主要心脑血管病事件发生率分别为0.0%、9.8%、17.7%(P=0.230)。A、B两组中期FMR改善率分别为100.0%、94.3%(P>0.05)。结论对于接受AVR合并中度FMR的患者,不处理或同期修复二尖瓣更为合理,而二尖瓣置换可能会...     

Transcatheter mitral valve therapies: State of the art

Mitral regurgitation (MR) is one of the most prevalent valvular pathologies in the developed world. There continues to be a growing population of aging patients with MR who may be too high risk for surgical management. The rapid adoption and remarkable success of transcatheter aortic valve replacement (TAVR) generated enthusiasm for transcatheter mitral valve therapies; however, the complex anatomy and pathophysiology of the mitral valve confers several unique challenges for a fully percutaneous approach. Nevertheless, several devices are under development and in various phases of preclinical or clinical testing, both for transcatheter mitral valve replacement and repair. MitraClip (Abbott Vascular), which has received FDA approval, is the most established percutaneous repair strategy and has been performed in over 80,000 patients as of 2019. The following article serves as a review of the available and upcoming devices for the various etiologies of mitral valvular disease, as well as the unique challenges and potential complications of transcatheter mitral valve intervention.     

Redo aortic valve replacement

Thirty two patients had a second operation after previous aortic valve replacement during a six-year period. The indications for reoperations were infection, thrombo embolism, paraprosthetic leak and actual or anticipated valve failure. Three patients died at operation and there were four late deaths. Two patients developed heart block at operation. Mortality was highest in patients undergoing emergency and urgent surgery.     

Redo mitral valve repair with complete ring implantation over an open band

We present a case of redo mitral valve surgery after failed repair that consisted of implantation of a complete ring over an open band implanted several years prior. The patient presented with severe central mitral regurgitation. During surgical intervention, the open band was identified consolidated with the native annulus. We elected not to remove the posterior annulus given the presence of calcification. Instead, a new complete ring was secured with single sutures posteriorly over the band and anterior to the native annulus. This approach was safe, fast, and achieved a significant reduction in annulus circumference with no residual mitral regurgitation.     

Repeat open-heart operations: Review of sixty-eight operations

Between January, 1973 and September, 1982, 68 repeat open-heart operations were performed on 62 patients who had had previous open-heart surgery. Indications for reoperation were recurrent or incompletely corrected congenital malformations (21 cases), paraprosthetic leak (11 cases), thrombosed prosthesis (8 cases), incomplete diagnosis (5 cases), prosthetic endocarditis (4 cases), structural failure of mechanical valve (4 cases), homograft failure (2 cases), operative damage to aortic valve (1 case), and failure of conservative surgery (1 case). In eleven patients the natural disease process progressed after the first operation requiring further open-heart procedures. Operations performed included 24 procedures for congenital defects, 22 for mitral valve replacement, 17 for aortic valve replacement, 2 for repair of paraprosthetic leak, and 3 for mis-cellaneous operations. There were ten deaths within 30 days of operation. Postoperative complications were slightly more frequent than in patients under-going similar operations for the first time. The late functional results were good in the majority of survivors.     

Successful valve repair for congenital bicuspid aortic valve and degenerated prolapsed mitral valve

A 54-year-old man with congenital bicuspid aortic valve underwent simultaneous valve repair for aortic and mitral regurgitation. Surgical technique consisted of plication of redundant aortic valve repair and mitral annuloplasty with chordal replacement. One-year follow-up transthoracic echocardiography showed no valve regurgitation. Valve repair for both bicuspid aortic valve and mitral valve regurgitation should be the first option in this subset of patients.     

Semidisposable venous and arterial cannulae

Semidisposable stainless steel venous and arterial cannulae tips used in open heart operations are described, emphasising their economic advantage over the imported disposable ones.