Jacques Tomasi

Extracorporeal Membrane Oxygenation in Pregnancy.

Adult respiratory distress syndrome (ARDS) may pose specific challenges in pregnant women, including the need for prone decubitus ventilation and extracorporeal membrane oxygenation (ECMO). We present our experience with ECMO during pregnancy and review the literature on this topic.

Acute aortic valve thrombosis secondary to recombinant factor VIIa.

A60-year-old male patient was admitted on an elective basis for coronary artery bypass grafting. His past medical history included hypertension and multiple sclerosis. He had experienced an acute inferior myocardial infarction 1 month earlier. Coronary angiography revealed severe triple-vessel disease. Transthoracic echocardiography disclosed a normal aortic valve and an ejection fraction of 45%. The patient had normal hepatic and renal function and a normal coagulation profile before the operation. Cardiopulmonary bypass was established through a median sternotomy. A saphenous vein was grafted onto the right coronary artery, and the left internal thoracic artery was anastomosed to the left anterior descending artery. The obtuse marginal artery was not identified during the operation and was therefore left ungrafted. Attempts to wean the patient from cardiopulmonary bypass were unsuccessful, and femorofemoral extracorporeal membrane oxygenation (ECMO) was instituted. Electrocardiography revealed ST segment elevation in lateral chest derivations. The patient was

Elective frozen elephant trunk procedure using the E-Vita Open Plus prosthesis in 94 patients: a multicentre French registry

OBJECTIVES Our goal was to evaluate the operative outcomes of the frozen elephant trunk technique using the E‐Vita Open Plus® hybrid prosthesis in chronic aortic arch diseases and report clinical and radiological outcomes at the 1‐year follow‐up. METHODS As determined from a prospective multicentre registry, 94 patients underwent frozen elephant trunk procedures using the E‐Vita Open Plus hybrid device for the treatment of chronic aortic conditions, including 50% chronic aortic dissections, 40% degenerative aneurysms and 10% miscellaneous indications. Fifty percent of the cases were reoperations. RESULTS The perioperative mortality rate was 11.7%. Spinal cord ischaemia and stroke rates were 4% and 9.6%, respectively. The mean cardiopulmonary bypass time was 252 ± 97 min, cardiac ischaemia time was 152 ± 53 min and cerebral perfusion time was 82 ± 22 min. Concomitant procedures were observed in 15% of patients. Among the 83 surviving patients, the survival rate after the 1‐year follow‐up was 98%. Eleven percent of patients underwent endovascular completion, whereas 4% of patients required aortic reintervention at 1 year. CONCLUSIONS The E‐Vita Open Plus hybrid device confirms the favourable short‐ and mid‐term outcomes offered by its predecessor in frozen elephant trunk procedures in patients with chronic aortic arch disease. Implantation of the E‐Vita Open Plus is associated with good 1‐year survival rates, good rates of favourable aortic remodelling in both chronic dissection and degenerative aneurysms and a reproducible technique in a multicentre registry. Continued follow‐up is required due to the risk of evolution at the downstream aorta.

Aortic Root Replacement in a Patient With Left Ventricular Noncompaction

We describe the case of a 57-year-old woman with noncompaction of the left ventricle and regurgitant bicuspid aortic valve who presented with progressive congestive heart failure and was successfully treated with aortic root replacement. The long-term outcome for these patients is poor because of progressive left ventricular impairment, increased rates of life-threatening arrhythmias, and intraventricular thrombi. To our knowledge, only 3 patient with noncompaction of the left ventricle has been reported to have undergone aortic valve replacement for severely regurgitant bicuspid aortic valve. Herein, we describe a patient with noncompaction of the left ventricle who underwent successful mechanical aortic root replacement.

Post‐Myocardial Infarction Ventricular Septal Defect

A 74-year-old patient presented with shortness of breath one week after untreated anterior myocardial infarction (MI). Coronary angiography showed an occluded left anterior descending artery and a severe stenosis of the circumflex artery and the diagonal branch. An echocardiogram revealed an antero-apical large aneurysm with a left-to-right shunt flow (Fig. 1A) and a depressed left ventricle ejection fraction (EF 1⁄4 40%). A cardiac-enhanced CT scan depicted clearly aneurysm location and small septal perforation site (Fig. 1 B). Prompt surgical treatment was undertaken (Fig. 2). The small septal channel was identified after

Bartonella as a Cause of Mechanical Prosthetic Aortic Root Endocarditis

Bartonella henselae infection is typically associated with cat scratch disease. This microorganism can also lead to culture-negative infective endocarditis in immunocompromised patients. We present a rare case of a previously healthy 65-year-old man with B. henselae-associated endocarditis of a prosthetic aortic root. All blood cultures, as well as cultures of the resected aortic valve vegetations, remained negative. Polymerase chain reaction with specific bacterial primers with DNA sequencing was used to identify B. henselae as the etiologic agent. This was successfully managed by an aortic root re-replacement using a mechanical conduit, reimplantation of coronaries ostia, and antibiotic therapy.

Conventional aortic valve replacement in 2005 elderly patients: a 32-year experience

OBJECTIVES Considering the good immediate results reported for transcatheter aortic valve implantation in high-risk patients, the role of conventional aortic valve replacement (AVR) is being questioned, especially in elderly patients. The aim of this study was to evaluate our long-term results of conventional AVR in octogenarians. METHODS A total of 2005 patients aged ≥80 years underwent AVR for aortic stenosis in our institution between 1978 and 2011. Of these, 1009 (50%) patients had an associated extracardiac comorbidity and 650 (32%) patients had coronary lesions. Valve replacement was the sole procedure in 1515 (76%) patients, and 396 (19%) patients had concomitant coronary artery bypass grafting. Data were collected at the time of surgery in our database, and regularly updated by mailed questionnaires and telephone contact. RESULTS Early mortality of isolated AVR was 5.5% for the last 10 years of the series. Significant risk factors were chronic obstructive pulmonary disease, chronic renal failure, advanced cardiac disease [left or right ventricular failure, New York Heart Association (NYHA) Class IV and atrial fibrillation] and coronary disease. Long-term follow-up was 99.5% complete (9 patients lost to follow-up), totalling 8849 patient-years. Nine hundred and one patients died at late follow-up with a median survival of 7.1 years, with 7 patients becoming centenarian. Apart from older age, main late causes of death were cardiovascular (20.5%), neurological deficit (10.2%) and cancer (10.2%). Actuarial survival was 83%, 62.5% and 25% at 2, 5 and 10 years, respectively. This survival compares favourably with that of a French-matched population. Above all, 90% of late survivors reported functional improvement. Univariable and multivariable analysis identified risk factors of late death as male gender, associated comorbidity, renal failure, advanced cardiac disease, atrial fibrillation and impaired ventricular function. Coronary lesions, associated cardiac surgery and small diameter prostheses (19 or 21 mm) did not impair long-term survival. CONCLUSIONS AVR is effective for all age groups to treat aortic stenosis. Elderly people should not be denied surgery only because of their old age as conventional AVR provides an excellent quality of life and restores life expectancy. Percutaneous valve implantation is to be considered, in cases of non-operable or high-risk patients. However, to date, open-heart surgery remains the treatment of choice for aortic stenosis for the majority of patients.

Multilevel obstruction of left ventricular outflow tract in Shone complex adult

Shone complex is a congenital cardiac malformation including a supravalvular mitral ring, parachute mitral valve, subaortic stenosis, and coarctation of the descending aorta. We encountered a patient with Shone anomaly without mitral involvement, who was successfully treated for severe and multilevel obstruction of the left ventricular outflow tract 44 years after a first operation. A 57-year-old woman with a history of surgical coarctation repair at 13-years old, presented with dyspnea on exertion. Transthoracic echocardiography (Figure 1a) showed an anomalous crescent-shaped membrane and a prominent septal bulge inducing flow turbulence, as well as severe bicuspid aortic stenosis (valve area 0.6 cm, mean gradient 60mmHg). There was no abnormality of the mitral valve. Cardiac computed tomography (Figure 1b) demonstrated a membrane obstructing the left ventricular outflow tract, located 7mm under a bicuspid aortic valve and above a prominent septal bulge. Under cardiopulmonary bypass, mechanical aortic valve replacement for a stenotic bicuspid type 0 aortic valve, resection of the subaortic crescent-shaped stenotic ridge, and septal myectomy for the prominent septal bulge were carried out. The patient’s postoperative course was uneventful. At follow-up 6 months after the surgery, left ventricular outflow tract velocity was significantly reduced to 1.6m s , and the patient’s symptoms had resolved.

Surgical Management of an Epithelioid Hemangioendothelioma of the Superior Vena Cava Protruding into the Right Atrium

Epithelioid hemangioendothelioma (EH) is a rare malignant tumor of vascular origin that often involves soft tissues and visceral organs, and less commonly, large veins. We report a case of EH of the superior vena cava protruding into the right atrium and its surgical management. doi: 10.1111/jocs.12370 (J Card Surg 2014;29:779–781)

Abnormal origin of the right coronary artery in a patient with left ventricular non-compaction

A 61-year old patient presented with chest pain on exertion. Transthoracic echocardiogram showed trabeculations in the lateral aspect of the left ventricular wall (Fig. 1A), with an ejection fraction of 50%. Cardiac magnetic resonance imaging confirmed the diagnosis of left ventricular non-compaction (Fig. 1B). Cardiac computed tomography scan showed an aberrant origin of the right coronary artery from the left sinus of Valsalva (Fig. 2A and B).