Andrea Mazza

Acute heart failure related to a large left atrial myxoma

ABSTRACT An association between atrial myxoma and left ventricular failure is rarely described, is not completely understood, and may have multiple etiologies. We present a 49-year-old man with no history of cardiovascular disease who was admitted to our hospital with pulmonary edema. He was in atrial fibrillation with rapid ventricular response. Echocardiography showed a 10.5-cm left atrial myxoma, which had been asymptomatic until the onset of congestive heart failure in the presence of severe left ventricular systolic dysfunction. Left ventricular inflow obstruction associated with the giant atrial mass could not be the only cause for acute heart failure.

Acute Clinical Presentation of Pseudoaneurysm and Aortopulmonary Fistula as a Very Late Complication of Aortic Coarctation Patch Repair.

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Rapid-deployment or transcatheter aortic valves in intermediate-risk patients?

Background Transcatheter aortic valve implantation and rapid-deployment aortic valve replacement represent two emerging therapies for patients with intermediate surgical risk and severe aortic stenosis. However, head-to-head comparisons between such novel therapies are lacking. Methods Severe aortic stenosis patients with intermediate surgical risk treated with rapid-deployment valve replacement at our institution were identified and compared with a propensity-matched population of patients who underwent transcatheter aortic valve replacement. Postoperative echocardiographic findings, in-hospital and midterm clinical outcomes were compared. Results We identified 60 patients who received transcatheter (n = 30) or rapid-deployment (n = 30) valve replacement. On postoperative echocardiography, freedom from paravalvular regurgitation was higher in the rapid-deployment valve group (p < 0.001), while postoperative mean transprosthetic gradient was lower in the transcatheter valve group (p = 0.03). Permanent pacemaker implantation was required more frequently in transcatheter valve patients (p = 0.01). Postoperative atrial fibrillation was more common in the rapid-deployment valve group (p = 0.03). Hospital mortality was similarly low in both groups (p = 0.33). At midterm follow-up, mortality was comparable (p = 0.42) but the rapid-deployment valve group still had a lower degree of paravalvular regurgitation. Conclusions Transcatheter and rapid-deployment valve replacement are promising treatment options for patients with intermediate surgical risk. These two techniques are associated with specific patterns of prosthesis function and postoperative complications. Further evaluation of the clinical impact of these therapies in this patient population is needed.

Competitive Flow and Coronary Artery Bypass Grafts

We herein review the current evidence on the effect of chronic native competitive flow on coronary artery bypass patency and function and provide an overview of the methods to evaluate competitive flow.

Long-term results of an open flexible prosthetic band for mitral insufficiency

Background use of a prosthetic ring is an integral part of any mitral valve repair and can influence the long-term stability of the results. We evaluated the long-term results of the AnnuloFlex ring implanted as an open flexible band in patients affected by degenerative mitral disease. Methods between 2001 and 2010, 82 patients (52 women, 30 men) with a mean age of 62 years, underwent repair of a prolapsing mitral valve with an AnnuloFlex band. One patient was reoperated on for a technical error and received a mechanical prosthesis, 3 were missing at follow-up, and the other 78 were prospectively followed up with clinical interviews and transthoracic echocardiography. Results the mean follow-up was 7.0 ± 1.8 years. Six patients died; 2 deaths were considered valve-related. The overall survival estimate at 10 years was 88.6% (95% confidence interval: 76.1%–94.8%). Freedom from endocarditis was 97.1% (95% confidence interval: 89.1%–98.5%). Freedom from thrombosis or hemorrhage was 93.7% (95% confidence interval: 81.6%–97.9%). Freedom from new or increased regurgitation was 93.1% (95% confidence interval: 87.3%–97.3%). The cumulative freedom from any valve-related event was 78.6% (95% confidence interval: 69.7%–97.1%). A single case of systolic anterior motion occurred before hospital discharge. Conclusion the long-term results of the AnnuloFlex band are excellent and stable.