Alessandro Maria Budillon

Myocardial protection in adult cardiac surgery: current options and future challenges

Current techniques of myocardial protection are evolving with the use of less conventional modalities of cardioplegia and have reduced the morbidity and mortality of cardiac operations. Blood cardioplegic solutions appear superior to cold cardioplegia in terms of myocardial protection and adjuncts as glutamate/aspartate enhancement, antioxidant supplementation, nitric oxide donors and maintenance of calcium homeostasis seem effective. In the near future, further experimental and clinical investigations about pharmacological preconditioning, sodium-hydrogen exchangers inhibition and gene therapy need to be addressed to well define their potential role in the improvement of current techniques of myocardial protection that are suboptimal in high-risk clinical settings.

Recurrence of a right ventricular hemangioma.

The majority of cardiac tumors are benign, with only 25% to 30% being histologically malignant. Only 0.8% to 5% of all benign primary cardiac tumors are hemangiomas. Cardiac hemangiomas are vascular tumors, composed of capillaries or cavernous vascular channels. Patients usually have a variety of symptoms depending on location and extension of the tumor. Diagnosis and management of these tumors are difficult and delayed and require multiple investigations. We report a case of late recurrence of a cardiac hemangioma of the right ventricle from surgical treatment at our institution 10 years previously.

Giant aneurysm of Valsalva's sinus: diagnosis and preoperative planning using 64-slice computed tomography.

We describe a giant unruptured acquired aneurysm of the noncoronary sinus of Valsalva, which was detected incidentally in a 30-year-old rugby player with clinical suspicion of dermatomyositis. Sixty-four-slice cardiac computed tomography showed a giant aneurysm (diameters: 91 x 78 x 100 mm) of noncoronary sinus of Valsalva compressing both atrial chambers. The patient underwent cardiac surgery according to the Tirone David technique based on the information provided by cardiac computed tomography.

64-slice computed tomography of bovine internal mammary artery coronary grafts.

In cases where conventional aortocoronary grafts cannot be used, No-React bovine internal mammary artery is a possible alternative. The aim of this study was to assess the patency and clinical performance of bovine internal mammary artery as a coronary bypass conduit, using 64-slice computed tomography coronary angiography. Eleven patients (mean age, 68.2 ± 5.9 years) received 11 bovine grafts between 2002 and 2006. Eight of these patients were alive after a mean follow-up of 29.4 ± 16.3 months. Their mean additive EuroSCORE was 6.5 ± 3.2. The mean number of distal anastomoses was 2.5 ± 0.5. Six grafts were anastomosed to the right coronary artery, 2 to the left anterior descending artery, and 3 to the circumflex artery. All 11 bovine grafts were found to be occluded after 14.1 ± 3.6 months. This demonstrates very poor results with the bovine coronary graft, thus we do not recommend its use, and we suggest considering an hybrid approach in selected cases.