Colsen Pr

An unusual case of mitral valve aneurysm: Two dimensional echocardiographic and cineangiocardiographic features☆

A patient is described in whom an aneurysm of the posterior mitral leaflet caused severe mitral incompetence and cardiac failure. The aneurysm was seen as an additional echo-free space within the left atrium in the real time two dimensional echocardiogram. Both echocardiographic and cineangiocardiographic appearances were misinterpreted initially because the aneurysmal leaflet did not more into the left ventricle during diastole. This feature was explained during the successful surgical repair of the valve by the observation that the aneurysm was adherent to the left atrial wall.

Emergency Heart Valve Replacement: An Analysis of 170 Patients

The results of 170 emergency heart valve procedures performed during a 4 1/2-year period were analyzed. Five pathological groups of patients were recognized: those with infective endocarditis (Group 1, 28 patients); acute rheumatic carditis (Group 2, 43 patients); previous valve operation (Group 3, 29 patients); acute-on-chronic cardiac disease (Group 4, 67 patients); and miscellaneous conditions (Group 5, 3 patients). Mitral, aortic, and multiple valve procedures were performed on 58, 65, and 44 patients, respectively. The most common functional lesion was regurgitation. Hospital mortality was highest in Groups 3 (34%) and 4 (31%). By contrast, among the hospital survivors, the highest rate of attrition was in Group 2. Myocardial failure was the predominat cause of death. In view of the hopeless prognosis without operation, the 52% overall 3-year actuarial survival is a gratifying salvage. Unnecessary procrastination can only jeopardize the prospects for surgical cure.

Late primary arterial switch for transposition of the great arteries with intact ventricular septum in an african population.

The arterial switch operation (ASO) is the optimal management of transposition of the great arteries with intact ventricular septum (TGA-IVS) within the first 3 weeks of life; beyond this age optimal treatment is debatable. The authors adopted a strategy of primary ASO for TGA-IVS in the first 10 weeks of life regardless of left ventricular (LV) status. This report reviews the early outcomes with this management approach. Between August 2006 and December 2009, 22 patients with TGA-IVS underwent the primary ASO. Sixteen of them were less than 21 days old (early switch group) and 6 were between 31 and 66 days old (late switch group). A review of their hospital records was performed to determine outcomes in the 2 groups. Operative variables and postoperative outcomes were recorded. There was 1 hospital death in the early switch group (6.3%) but none in the late group (0%). Temporary mechanical circulatory support was required in 1 patient (6.3%) in the early switch group and in 2 of the 6 (33.3%) in the late switch group. One late death of undetermined cause occurred in the late switch group 8 weeks after discharge. No significant difference could be demonstrated between the 2 groups in terms of operative variables and the measured postoperative outcomes. It is concluded that the age limit for the primary ASO can be extended to at least 10 weeks; temporary mechanical circulatory support may be required as a rescue.

Prediction of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery

OBJECTIVE We sought to determine the value of preoperative left ventricular function and cardiopulmonary bypass parameters in the prediction of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery. METHODS Multivariate logistic regression was performed to identify a predictive model for postrepair left ventricular assist device implantation using the records of 27 patients who underwent direct aortic implantation of anomalous left coronary artery from the pulmonary artery from 1994 to 2011. RESULTS Seven patients required left ventricular assist device implantation. Patients in group 1 (n = 20) were successfully weaned from cardiopulmonary bypass. Patients in group 2 (n = 7) required left ventricular assist device as a bridge to recovery. The 2 groups were similar in age, weight, and body surface area. Six of the 7 patients (85.7%) who required left ventricular assist device survived to hospital discharge. Hospital mortality was 3.7%. In the univariate model, fractional shortening, ejection fraction, and aortic crossclamp time were significantly associated with left ventricular assist device implantation (P = .026, .035, .031, respectively). In the multivariate analysis, the aortic crossclamp time was the only significant independent predictor of left ventricular assist device implantation. Aortic crossclamp time and fractional shortening together accounted for 80.9% (P < .001) of the variability in left ventricular assist device implantation and constituted the best predictive model: All patients requiring postrepair left ventricular assist device implantation had a fractional shortening less than 20% and an aortic crossclamp time greater than 56 minutes. CONCLUSIONS The fractional shortening and aortic crossclamp time together predict 80.9% of the variability in postrepair left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery. When preoperative left ventricular dysfunction is severe (fractional shortening < 20%), an aortic crossclamp time greater than 56 minutes is associated with a substantial risk of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery.

Paediatric cardiac surgery for a continent – The experience of the Walter Sisulu Paediatric Cardiac Centre for Africa

Very few African countries have the resources to provide optimum paediatric cardiac services to their largely indigent populations. In the current era, in countries with access to modern paediatric cardiac care, mortality for congenital heart disease occurs more often in adulthood than in childhood. This level of care is largely unavailable in Africa. The Walter Sisulu Paediatric Cardiac Centre for Africa was set up in 2003 as a public-private collaborative initiative to extend modern paediatric cardiac care to the continent. Three core functions form the basis of our operations: service delivery, training, and research. This communication reviews our experience with this effort over an eight-year period. We have performed 2 023 procedures on 1 738 patients including a large proportion of neonates and infants with an overall mortality of 7.1%. Our charity arm sponsored 21.5% of these patients. We have encountered problems peculiar to the African context which we discuss. We also describe innovative techniques in management of specific patient populations. Our training efforts yielded two qualified paediatric cardiac surgeons who now work at the centre and two additional surgeons are in training. We have participated in research leading to publication of papers in peer-reviewed journals. In spite of our achievements, we recognise the enormous challenges faced by the continent in terms of paediatric cardiac care. An attempt has been made to quantify the burden of congenital disease in Africa to guide planning and training. We offer recommendations on how to address some of these pressing health issues for children of the continent.