Jesús Gómez-Plana

Mitral stenosis after IMR ETlogix ring annuloplasty for ischemic regurgitation

Objectives: Ring annuloplasty combined with coronary artery bypass grafting is the standard approach for treatment of patients with ischemic mitral regurgitation. We evaluated mitral valve hemodynamic performance and recurrence of mitral regurgitation after ring annuloplasty. Patients and methods: 40 consecutive patients (mean age, 70 ± 8 years) with chronic ischemic mitral regurgitation grade ≥2+ received annuloplasty with an IMR ETlogix ring. During follow-up (25.9 ± 15.5 months), 84% of surviving patients underwent exercise stress echocardiography to assess recurrence of mitral regurgitation and differences between rest and exercise mitral valve hemodynamic performance. Results: Hospital mortality was 10%. During follow-up, we found no significant differences between left ventricular ejection fraction or end-diastolic and end-systolic diameters pre- and postoperatively (41% vs. 45%, 59 vs. 56 mm, and 49 vs. 46 mm, respectively), but there was a significant increase in mitral mean gradient with exercise (3.3 ± 1.2 vs. 7.8 ± 4 mm Hg, p < 0.001). Two patients had mitral regurgitation ≥grade III–IV. Conclusions: Mitral annuloplasty with the IMR ETlogix ring provides effective correction of chronic ischemic mitral regurgitation, but this technique may induce functional mitral stenosis.

Mitral valve prosthesis implanted in atrial wall over huge calcified annulus

We describe an alternative technique for mitral valve replacement in patients with severe mitral annular calcification, in whom conventional techniques are not feasible. A new annulus that allows supra-annular prosthetic implantation is created.

Endovascular treatment of a tuberculous aneurysm of the descending thoracic aorta in a young patient

treatment of a tuberculous aneurysm of the descending thoracic aorta in a young patient. A 28-year old male patient was diagnosed with a mycotic aortic tuberculous aneurysm (Fig. 1A) and a thoracic endoprosthesis was implanted. An additional 6-month course of tuberculostatic drugs was completed. After 24 months of follow-up, the patient remains asymptomatic with no evidence of infection recurrence (Fig. 1B). Figure 1: (A) A mycotic tuberculous aneurysm of the descending thoracic aorta as a complication of a paravertebral T10–T12 spinal tuberculous abscess confirmed by histological and microbiological tests. (B) No radiological evidence of infection recurrence and aneurysm regression after 24 months of follow-up.

Placement of a Rigid Tricuspid Annuloplasty Ring Over a Flexible Ring for the Treatment of Recurrent Tricuspid Regurgitation

Abstract  We describe a technique that implants a rigid tricuspid annuloplasty ring over a previously inserted flexible ring for the treatment of recurrent tricuspid regurgitation. This technique avoids the trauma associated with the excision of a flexible ring in patients with friable annular tissue. (J Card Surg 2012;27:549‐550)

Early thrombosis of a tricuspid annuloplasty ring and mild hyperhomocysteinemia.

Tricuspid annuloplasty ring thrombosis is an extremely infrequent pathology, and no evidence-based antithrombotic management has been described. We present the case of a 40-year-old female with isolated mild hyperhomocysteinemia and early ring thrombus formation after surgical primary closure of an atrial septal defect and ring tricuspid annuloplasty. Clinical management, antithrombotic treatment, and hyperhomocysteinemia implications are discussed.

Efficacy of Oral Anticoagulation in Stroke Prevention among Sinus-Rhythm Patients Who Lack Left Atrial Mechanical Contraction after Cryoablation.

The customary recommendation is that oral anticoagulation be withdrawn a few months after cryoablation for atrial fibrillation, independently of left atrial mechanical contraction in patients in sinus rhythm. Recently, a 5-fold increase in stroke has been described in sinus-rhythm patients who lack atrial mechanical contraction. One aim of this study was to evaluate the efficacy of oral anticoagulation in preventing postoperative stroke in such patients. This prospective study divided 154 sinus-rhythm patients into 2 groups, depending on the presence (108 patients) or absence (46 patients) of left atrial mechanical contraction at 6 months after surgery, and monitored them annually for 5 years. Those without left atrial contraction were maintained on acenocumarol. The primary endpoint was the occurrence of ischemic stroke. The median follow-up period was 29 ± 16 months; 4 patients (2.5%), all belonging to the group with preserved atrial contraction, had ischemic stroke; the group of patients without left atrial contraction had no episodes of stroke during follow-up. Logistic binary regression analyses showed no evidence of factors independently predictive of stroke. Among anticoagulated patients in sinus rhythm without left atrial contraction, we found the incidence of stroke to be zero. In a small, nonrandomized group such as this, we cannot discount the element of chance, yet we suggest that maintaining anticoagulation might lower the incidence of stroke in this population.

Giant left main coronary artery to right atrium fistula

Aneurysmal arterial origin of coronary fistulae is an extremely rare combination. We report a case of a giant left main coronary artery to right atrium fistula in a 48-year-old male. We describe the clinical course and management options.