Septic coronary embolism in a deceptive case of presumed isolated tricuspid valve endocarditis

A 46‐year‐old female presented with native tricuspid valve endocarditis complicated by a stroke with a hemorrhagic component. There was no evidence of intracardiac shunt nor left‐sided valve involvement. Delayed surgery was planned to allow neurologic recovery, however, the patient developed an ST‐elevation myocardial infarction and cardiac arrest from an occluded right posterior ventricular branch of the right coronary artery from a septic embolism. Repeat imaging demonstrated new aortic valve vegetation involving the right coronary cusp. This case highlights a unique sequence of events in a patient initially presenting with presumed isolated tricuspid valve vegetation.     

An observational,prospective study on surgical treatment of secondary mitral regurgitation: The SMR study. Rationale,purposes, and protocol

The natural history of secondary mitral regurgitation (MR) is unfavorable. Nevertheless, there are no evidence that its correction can improve the outcome. If from one side the original cause of secondary MR can be such to limit the possibilities of improvement, from the other side it is possible that the surgical technique widely applied to repair, restrictive mitral annuloplasty, is not adequate to correct the regurgitation. The addition of valvular and/or subvalvular techniques has been considered a possible technical solution. However, we do not know the prevalence of each technique, how many times mitral replacement is used to correct secondary MR. This aspect is of particular importance, as we know that a successful mitral repair causes a better left ventricular systolic remodeling than a unsuccessful repair or replacement. This study is a prospective, observational registry, conceived to understand what is done in the real world. Any surgeon will use the technique he thinks the most suitable for the patient. Every year, for 5 years, patients will have a clinical and echocardiographic follow-up, to evaluate the risk factors for a worse result (death, rehospitalization for heart failure, reoperation for MR return, moderate, or more MR return). This knowledge will give us the possibility to understand which is the technique, or the strategy, more efficient to treat this disease and the real efficacy of the surgical treatment.     

Anomalous coronary sinus: A predictor of challenging redo mitral surgery

In the spectrum of congenital heart diseases, anomalies involving the venous coronary sinus have received relatively little attention, although they are often associated with major congenital defects, such as atrioventricular septal defects. In cases of mitral surgery in patients with these conditions, it is mandatory to keep the problem in mind and to respect the coronary sinus when approaching the left atrium and the mitral valve.     

Surgical resection of the giant right coronary artery aneurysm

A 74‐year‐old man had undergone two‐vessel coronary artery bypass grafting (CABG), 19 years ago, with the left internal mammary artery (LITA) to the left anterior descending artery and the saphenous vein graft (SVG) to the posterior descending artery. In outpatient care, a thoracic aortic aneurysm was suspected by the chest X‐ray. In the computed tomography, appeared the distal arch aortic aneurysm, abdominal aortic aneurysm (AAA), and giant right coronary artery aneurysm (rCAA). The diameter of rCAA was 70 mm and it oppressed the right atrium and ventricle of the heart. The patient was referred to our hospital. After the initial treatment of distal arch aneurysm and AAA, surgical treatment for the rCAA was performed. The rCAA was resected completely and CABG with new SVG was performed without cardiopulmonary bypass. The histopathology of rCAA wall revealed that the etiology was an atherosclerotic change. The postoperative course was good, the oppressed right heart system was released and the hemodynamics of the tricuspid valve showed improvement.     

Modern cardiac surgery: the future of cardiac surgery in Australia

Cardiac surgery is a relatively young specialty and is undergoing many changes presently. The advent of catheter‐based technology, minimally invasive surgery and better information regarding the roles of cardiac surgery in the management of common cardiac disease is changing the way we provide services. In Australia, attention must be turned to the way cardiac surgical services are provided to enable delivery of modern procedures. This has implications for the provision of training. We explore the face of modern cardiac surgery and how this may be taken up in Australia.