Aref Rashed

Late postinfarction rupture of the interventricular septum

UNLABELLED Postinfarction ventricular septal rupture complicates 1 to 2% of cases of acute myocardial infarction and accounts for 5% of early mortality. This severe complication usually occurs within two weeks after acute myocardial infarction, and the elderly are more susceptible. We present a case of late rupture of the septum. CASE REPORT In a 75-year-old man, a ventricular septal defect developed more than two months after an extensive inferoseptal myocardial infarction due to occlusion of the right coronary artery. After more than two months of no symptoms he was referred to hospital due to symptoms of right ventricle failure. The diagnosis was made by echocardiography, pulmonary artery catheterization and ventriculography. Coronarography was also performed. Intraaortic balloon pump was introduced and the patient was transferred to the operating room. The defect was repaired using a circular polytetrafluoroethylene patch supported by buttressed interrupted sutures from both sides. Due to significant mitral valve regurgitation mechanical bileaflet mitral valve was implanted with preservation of the entire mitral apparatus and the left descending artery was revascularized using a saphenous graft. CONCLUSION This case is reported to emphasize that later postinfarction rupture of the ventricular septum may occur with symptoms of right ventricle failure dominating the clinical course.

The etiology, differential diagnosis and therapy of pericardial effusion

Considerable etiologic factors may lead to the development of pathologic pericardial effusion. In many cases these factors remain unidentified, the fact which leads to difficulties in choosing the appropriate therapeutic strategy. The therapy of pericardial effusion associated with purulent pericarditis must be different than that effusion developed as a consequence of neoplasm or autoimmune disease. The cytological examination of the fluid and the hystological examination of the pericardial tissue play an important role in identifying the accurate etiologic diagnosis. In case of recurrent pericardial effusions, performing pericardioperitoneal, pericardiopleural shunt or pericardial window may be indicated. This palliative solution serves to prevent the development of pericardial tamponade and its haemodynamic consequences.

A poststernotomiás sebfertőzések kezelési sikertelenségének prediktív faktorai

INTRODUCTION AND AIM Post-sternotomy wound infection is still a major concern and it affects morbidity, mortality, and hospital costs. Reconstruction failure may further increase these risks with significant financial implications. METHOD Here, we attempted to verify some factors that may significantly influence the success of the surgical treatment. We performed a single-center retrospective analysis of data from 3177 consecutive patients who underwent midline sternotomy. The diagnostic signs of post-sternotomy wound infections were observed in 60 patients (1.9%). These data were thoroughly analyzed. RESULTS Beside late diagnosis, the positive microbiological culture of the wounds, radical surgical intervention and peripheral vascular disease were found to significantly contribute to the development of surgical reconstruction failure. Radical surgical reconstruction was associated with a higher success rate (81.8 vs. 11.1%), p<0.001. CONCLUSION Identification of the predictive factors that may lead to treatment failure can assist in developing treatment algorithms and improving the success rates of surgical reconstructions. Orv Hetil. 2018; 159(14): 566-570.Absztrakt: Bevezetes es celkitűzes: A szivműtetek soran a sternotomia utani sebfertőzesek komoly aggodalomra adnak okot, ugyanis befolyasoljak a morbiditast, a mortalitast es a korhazi koltsegeket is. A rekonstrukcio sikertelensege tovabb noveli ezeket a kockazatokat, mert a sebfertőzesek sulyos szovődmenyekkel jarhatnak. Azoknak a tenyezőknek a feltarasa, amelyek jelentősen befolyasolhatjak a sebeszi kezeles sikeresseget. Modszer: Egycentrumos retrospektiv vizsgalat tortent egymast kovető 3177, median sternotomian atesett beteg adataibol. A poststernotomias sebfertőzesek diagnozisa 60 betegnel (1,9%) volt megallapithato. Az adatok alapos elemzesevel olyan tenyezőket kerestunk, amelyek jelentősen hozzajarulhatnak a sebeszi rekonstrukcio sikertelensegehez. Eredmenyek: A diagnozis kesői felallitasa mellett a pozitiv sebvaladek mikrobiologiai vizsgalata, a radikalis sebeszi rekonstrukcio es a periferias erbetegseg jelentősen befolyasolja a sebeszi kezeles eredmenyesseget. A radikalis sebeszi rekonstrukcio sz...

Is sternal rewiring mandatory in surgical treatment of deep sternal wound infections

Background Deep sternal wound infections (DSWIs) are a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. We compared treatment outcomes after conventional sternal rewiring and reconstruction with no sternal rewiring in patients with a sternal wound infection. Methods We retrospectively enrolled patients who developed a DSWI after an open-heart procedure with median sternotomy at the Department of Cardiac Surgery, at the St. Rafael Hospital, Zalaegerszeg, Hungary, between 2012 and 2016. All patients received negative pressure wound and antibiotic therapy before surgical reconstruction. Patients were divided into groups determined by the reconstruction technique and compared. Subjects were followed up for 12 months, and the primary end-points were readmission and 90-day mortality. Results Among 3,177 median sternotomy cases, 60 patients developed a DSWI, 4 of whom died of sepsis before surgical treatment. Fifty-six patients underwent surgical reconstruction with conventional sternal rewiring (23 cases, 41%) or another interventions with no sternal refixation (33 cases, 59%). Eighty-one percent of sternal wound infections followed coronary bypass surgery (alone or combinated with another procedures), and 60% were diagnosed after hospital discharge. Staphylococcus aureus was cultured in 30% of all wounds and, 56.5% of cases reconstructed by sternal rewiring vs. 26.5% with no sternal rewiring, (P=0.022). Hospital readmission occurred in 63.6% of the sternal rewiring group vs. 14.7% of the no sternal rewiring group. The rate of death before wound healing or the 90th postoperative day was 21.7% in the sternal rewiring group vs. 0% in the no sternal rewiring group. The median hospital stay was longer in the sternal rewiring group than in the other group (51 vs. 30 days, P=0.006). Conclusions Sternal rewiring may be associated with a higher rate of treatment failure than other forms of treatment for sternal wound infections.

Xiphoid-sparing midline sternotomy reduces wound infection risk after coronary bypass surgery

Background Because of its advantages, full midline sternotomy has remained the main approach for cardiac surgery. However, the development of post-sternotomy wound infections is its primary disadvantage. We evaluated the impact of xiphoid process (XIP)-sparing midline sternotomy regarding reducing the risk of deep sternal wound infections (DSWIs). Methods Data from 446 patients who underwent coronary artery bypass grafting by one surgeon, from January 2007 through May 2017, were retrospectively analyzed. Patients were divided into preliminary (from 2007-2011; n=202) and contemporary (January 2012-May 2017; n=244) groups. Traditional midline sternotomy was performed in the preliminary group, while xiphoid-sparing midline sternotomy was performed in the contemporary group. To adjust for differences in baseline and operative characteristics, the inverse probability of treatment weighting (IPTW) was applied. The generalized linear model was used to compare xiphoid-sparing and conventional sternotomy regarding the development of sternal wound infections. Results The sternal infection rates were 0.8% and 4.5% in the xiphoid-sparing and standard sternotomy groups, respectively (P=0.014). After adjustment for the IPTW, the xiphoid-sparing group showed a decreased risk for DSWIs (odds ratio 0.171, 95% confidence interval, 0.036-0.806, P=0.026) compared to the traditional sternotomy group. Conclusions XIP-sparing midline sternotomy may be an alternative approach in coronary artery bypass surgery and seemed to reduce the risk of post-sternotomy wound infections in this study.

Total proximal anastomosis detachment after classical bentall procedure

Highlights • Total proximal anastomosis detachment after classical Bentall procedure is very rare and life-threatrning complication.• Elongation of the left ventricle tract may serve a surgical solution to treat this complication.• Surgeons performing the Bentall procedure must be familiar with all existing modifications.

Iatrogenic ventricular septal defect: A rare complication of surgical reconstruction of mitral paravalvular dehiscence

Highlights • Iatrogenic septal defects may remain undetectable after cardiac valve surgeries.• Small defects may increase in size and lead to severe hemodynamic deterioration.• Understanding the mechanism of development of iatrogenic defects is essential.

Early Results of a Novel Mitral Valve Repair Procedure: The Interpapillary Polytetrafluoroethylene Bridge Formation.

BACKGROUND Surgical repair of ischemic mitral regurgitation (IMR) associated with chordal rupture in patients with ischemic cardiomyopathy is challenging as it aims to correct several structural pathologies at once. There are ongoing studies evaluating multiple approaches, however long term results are still scarce. METHODS AND RESULTS 19 patients with IMR underwent mitral valve repair with interpapillary polytetrafluoroethylene (PTFE) bridge and neochordae formation at the Zala County Teaching Hospital. Concomitant coronary artery bypass grafting was performed in all patients. Post-procedural Transesophageal Echocardiogram (TEE) showed no mitral regurgitation (MR) in eighteen (94.7%) patients, with a leaflet coaptation mean height of 8 ± 3 mm. No operative mortality was observed. At the follow up (mean 17.7 ± 4.6 months; range 9 to 24 months), 17 (89%) patients showed no leakage and 2 had regurgitation grade ≤1, with documented NYHA functional class I or II in all patients. CONCLUSION This retrospective study presents the first results of a novel surgical approach to treating ischemic mitral regurgitation. The interpapillary PTFE bridge formation is a safe and feasible surgical procedure that is reproducible, time sparing and effectively eliminates mitral valve regurgitation with promising long-term results.

Endoscopic saphenic vein harvesting during coronary artery bypass operations

Az ischaemias szivbetegseg gyogyitasaban meghatarozo jelentősegű coronaria-bypassműtetek soran a szerzők leggyakrabban vena saphena magna graftot hasznalnak az athidalasokhoz. Tekintettel a betegek novekvő eletkorara, a tobb tarsbetegsegre, a rosszabb altalanos allapotra, alapvető jelentősegű a lehető legkisebb sebfelulet kialakitasa az ilyen műtetek alatt. Celkitűzes: A vizsgalatok celja az endoszkopos saphenakivetel altal adott lehetősegek felmerese, illetve az igy nyert saphenagraft minősegenek megitelese volt. Modszer: A szerzők 24 betegnel hasznaltak endoszkopos technikat a vena saphena kivetelere coronaria-bypassműtet vagy kombinalt billentyű-coronaria bypassműtet soran. A kivett venabol szovettani vizsgalatra 10 alkalommal kuldtek mintat a vena-endothel megitelesere. Eredmenyek: Sebszovődmeny a modszer alkalmazasa utan nem volt. A kivett venaszakaszokat a műtetek soran felhasznaltak, ket esetet kiveve, amikor a vena kis kaliberűnek bizonyult. A szovettani vizsgalat minden esetben a vena ep endothelreteget igazolta. Kovetkeztetes: Az endoszkopos technika jol alkalmazhato a vena saphena eltavolitasara bypassműtetek soran. Alkalmazasanak a szerzők jelenlegi gyakorlataban hatart szab az egyelőre hosszabb műteti idő (amely a kesőbbiekben remelhetőleg rovidulni fog). | The great saphenous vein is the most commonly applied conduit in coronary bypass surgery during the treatment of ischaemic heart disease. Regarding the increasing age of patients, multiple comorbid factors and poor patient’s general state, the minimally invasive approach is of basic significance during these operations. Objectives: The aim of study was to evaluate the possibilities of endoscopic saphenous vein harvesting and the quality of saphenous veins harvested endoscopically. Methods: The authors applied the endoscopic approach for saphena harvesting in 24 patients undergoing coronary bypass surgery or combined bypass surgery with valve reconstruction. Ten of the harvested veins were sent for histological examination to evaluate the structure of the endothel layer. Results: No wound complications were noted with the endoscopic approach. The harvested veins were used as conduits during surgery except for 2 cases, where the calibre of the vein was too small to apply. The histological examination revealed normal endothel layer structure in all of the 10 cases. Conclusion: The endoscopic approach can be used in the harvesting of saphenous vein during coronary bypass surgery. For the time being, the apply of this approach is restricted by the longer operation time, which hopefully would be reduced in the future.UNLABELLED The great saphenous vein is the most commonly applied conduit in coronary bypass surgery during the treatment of ischaemic heart disease. Regarding the increasing age of patients, multiple comorbid factors and poor patients general state, the minimally invasive approach is of basic significance during these operations. OBJECTIVES The aim of study was to evaluate the possibilities of endoscopic saphenous vein harvesting and the quality of saphenous veins harvested endoscopically. METHODS The authors applied the endoscopic approach for saphena harvesting in 24 patients undergoing coronary bypass surgery or combined bypass surgery with valve reconstruction. Ten of the harvested veins were sent for histologic examination to evaluate the structure of the endothelial layer. RESULTS No wound complications were noted with the endoscopic approach. The harvested veins were used as conduits during surgery except for 2 cases, where the calibre of the vein was too small to apply. The histologic examination revealed normal structure of the endothelial layer in all of the 10 cases. CONCLUSION The endoscopic approach can be used in the harvesting of saphenous vein during coronary bypass surgery. For the time being, the apply of this approach is restricted by the longer operation time, which hopefully would be reduced in the future.