Dimitar Nikolov

Influence of Inflow Cannula Length in Axial-flow Pumps on Neurologic Adverse Event Rate: Results From a Multi-center Analysis

BACKGROUND The application of axial-flow pumps in patients with end-stage heart failure reveals a significantly reduced infectious complication rate as compared with rates observed with pulsatile devices. The remaining adverse event rate relates mainly to thromboembolic complications with neurologic consequences. We investigated the dependence of the neurologic adverse event rate on the length of the inflow cannula. METHODS A total of 216 consecutive patients with an axial-flow pump (INCOR; Berlin Heart GmbH, Berlin, Germany) were included in a retrospective multi-center analysis. In 138 patients, a short inflow cannula (24-mm tip length into the left ventricle), and in 78 patients a long inflow cannula (tip length 34 mm) was applied. RESULTS Patients with a long inflow cannula (LC) demonstrated a better survival rate than those with a short inflow cannula (SC) at the end of the observation period (LC, 63.4%; SC, 52.9%; p = 0.05). The thromboembolic adverse event rate was also significantly lower. Only 3 of the 78 patients (3.8%) with an LC had a thromboembolic adverse event (thromboembolic events per patient-year = 0.11) as compared with 32 (23.2%) of SC patients (thromboembolic events per patient-year = 0.50, p < 0.001). CONCLUSIONS Patients with a long inflow cannula had a better survival rate and a lower incidence of cerebrovascular adverse events than patients with a short inflow cannula.

Endovascular Repair of Dissecting Thoracic Aortic Aneurysm in a Patient With Turner Syndrome

Purpose: To report a rare case of dissecting thoracic aortic aneurysm in a young patient with Turner syndrome owing to complete or partial monosomy of the X chromosome. Case Report: A 22-year-old patient with Turner syndrome presented with a 2-month history of voice loss and dysphagia. Multislice computed tomography (MSCT) disclosed a large (53times75-mm) aneurysm with focal dissection affecting the distal part of the aortic arch and the proximal descending aorta, partially involving the left subclavian artery. A TAG endoprosthesis was implanted without complications. MSCT scans at 3 and 6 months after the procedure showed good position and patency of the stent-graft, with total exclusion and shrinkage of the aneurysm. After 1 year of follow-up, she is doing well, without voice disturbances or dysphagia. Conclusion: Although cardiovascular malformations are common in patients with Turner syndrome, dissecting thoracic aortic aneurysm is unusual. Stent-graft repair would appear to be feasible in this situation, but long-term implantation in young patients has not been explored.

Emergency surgical intervention after unsuccessful percutaneous transluminal angioplasty and stenting of aortic coarctation

Coarctation of thoracic aorta is an uncommon diagnosis in adults. Catheter-based intervention consisting of primary ballooning and stenting is becoming one of the methods of choice for the treatment of native coarctation. We describe the case of a young adult with coarctation of the aorta treated unsuccessfully with percutaneous transluminal angioplasty and stent implantation that resulted in stent migration into the aortic arch and led to an urgent operative intervention. In one step, we performed the evacuation of the foreign body from the aortic arch as well as the treatment of the aortic coarctation through an extra-anatomical vascular graft interposition between the ascending and descending thoracic aorta. In this article, we discuss the need for emergency surgical intervention in this case.

Rare diagnosis of fibrous cardiac diverticulum in an adult followed by urgent surgical intervention.

We describe the case of a 59-year old male patient with an acute onset of chest pain who was admitted to our unit with a suspected rupture of the left ventricle pseudoaneurysm, compressing the left atrium and the ascending aorta. Our urgent surgical intervention caused us to reject our initial diagnosis and revealed a cardiac diverticulum arising from the left ventricle outflow tract, spreading to the sub-valvular area compressing the left atrium, the ascending aorta and the pulmonary trunk, and compromising the aortic and mitral valve, causing moderate regurgitation. We removed the defect and replaced the aortic valve, eliminating the compression of the left atrium, aorta and pulmonary trunk. This article discusses the surgical technique for treating this ventricular diverticulum, its aetiology and the possible differential diagnosis in this case.

Safety belt abdominal trauma associated with anthropometric characteristics of an injured person—a case report

BackgroundThe aim of this report is to present a case of a blunt abdominal trauma with vascular and spinal involvements of an overweight man, caused by the front seat safety belt.Case presentationIt took place as a result of the car bonnet collision with a roadside pillar. During the primary inspection of the crash site, it was found that the car had collided with a roadside pillar. The driver was found dead in the driver’s seat with the seat belt on. The lower part of the belt was in the inguinal region and the upper part was high on the chest, separated by the bulky midriff. The autopsy revealed a transverse fracture of the body of tenth thoracic vertebra, complicated by a torn abdominal aorta, and severe bleeding into the abdominal cavity, which was the cause of the death. The complications of the abdominal trauma result from the atypical position of the seat belt holding the upper and lower part of the body to the seat at two very distant levels, while between them the bulky, heavy midriff continued to move forward, carrying with it the vertebral column and surrounding anatomical structures. On the other hand, the forceful contact between the abdominal wall and the instrumental panel of the car generates pressure which transmits force through the adjacent organs to the aortic wall. The specific anthropometric features of the victim had an impact on the mechanism of death. The improper position of the seat belt relative to the body affected the severity of abdominal injuries, instead of protecting from them.ConclusionsThe driver’s body disproportion, combined with the restraining effect of the seat belt, could increase the risk of a fatal outcome. It is incorrect to think that if the victim had not worn a seat belt, he would have survived. The safest seatbelt type for occupants with a similar anthropometric data would be the 4-point seat belt system, which is used in children’s car seats. This type of safety belt is crossed over the chest and abdomen and holds the entire trunk better at dynamic loads in all directions.