Lucio Careddu

Primary malignant tumors of the heart: Outcomes of the surgical treatment:

Background Malignant cardiac tumors are rare and have an extremely poor prognosis even when complete resection is attempted. The aim of this study was to review the experience of primary malignant cardiac tumors in 2 Italian academic hospitals. Methods The hospital records were searched to identify patients with primary malignant cardiac tumors who underwent surgery between January 1979 and December 2012. Secondary cardiac tumors, whether metastatic or invasive, were excluded as were primary sarcomas of the great arteries. Fourteen patients selected from our institution’s surgical series were identified. Eleven (78.6%) were men and 3 (21.4%) were women, and the mean age at surgery was 47.4 years. Results The most common histological type was angiosarcoma (28.6%). The mean survival was 28.8 ± 28 months and it was better in men than in women (30.5 ± 8.7 vs. 21.1 ± 3.2 months). Patients with a radical resection at the first surgery had a longer survival compared to patients with a partial resection (39.9 ± 23.2 vs. 24 ± 4 months). Conclusions The treatment outcome for patients affected by primary malignant heart tumors remains poor. Aggressive surgery alone does not provide good results in terms of survival rate. A new multidisciplinary approach is mandatory to improve long-term survival.

Combined heart-liver transplantation: a single-center experience.

Combined orthotopic heart and liver transplantation (CHLT) is a lifesaving procedure for patients with end‐stage heart–liver disease. We reviewed the long‐term outcome of patients who have undergone CHLT at the University of Bologna, Italy. Fifteen patients with heart and liver failure were placed on the transplant list between November 1999 and March 2012. The pretransplant cardiac diagnoses were familial amyloidosis in 14 patients and chronic heart failure due to chemotherapy with liver failure due to chronic hepatitis in one patient. CHLT was performed as a single combined procedure in 14 hemodynamically stable patients; there was no peri‐operative mortality. The survival rates for the CHLT recipients were 93%, 93%, and 82% at 1 month and 1 and 5 years, respectively. Freedom from graft rejection was 100%, 90%, and 36% at 1, 5, and 10 years, respectively, for the heart graft and 100%, 91%, and 86% for the liver graft. The livers of eight recipients were transplanted as a “domino” with mean overall 1‐year survival of 93%. Simultaneous heart and liver transplantation is feasible and was achieved in this extremely sick cohort of patients. By adopting the domino technique, we were able to enlarge the donor cohort and include high‐risk patients.

Aortic atresia with interrupted aortic arch: a combination incompatible with life?

Aortic valve atresia is a common feature of hypoplastic left heart syndrome, which consists of various degrees of underdevelopment of the left ventricle aorta complex; nevertheless it can also be associated with a large ventricular septal defect (VSD) and a rather developed left ventricle. Atresia of the aortic valve prevents antegrade blood flow from the left ventricle to the ascending aorta, so perfusion of the coronary arteries, ascending aorta and aortic arch is provided by the ductus arteriosus in a retrograde fashion. Interrupted aortic arch (IAA) is quite often associated with aortic or subaortic stenosis; however, very few cases of IAA have been reported in association with aortic valve atresia. Aortic valve atresia with IAA is an extremely rare association which would be incompatible with life, unless blood flow is provided to the ascending aorta and coronary arteries from (i) the ductus/descending aorta through ‘collaterals’ [1], or (ii) from the pulmonary trunk and pulmonary arteries through an aorto-pulmonary window [2] or bilateral ductus [3]. In the absence of a direct connection, blood flow to the coronary arteries is exclusively provided by the Circle of Willis through both carotid arteries, in a reverse

Cystic atrioventricular node tumor excision by minimally invasive surgery.

Cystic tumor in the atrioventricular (AV) node region is a rare cardiac primary tumor that can lead to sudden death. Our patient was a 43-year-old woman who presented with dyspnea and a first-degree AV block seen on electrocardiography. Echocardiography revealed a cystic mass attached to the inferior portion of the interatrial septum. After surgical excision of the mass, placement of a permanent pacemaker was required for complete heart blockage. Histopathologic examination revealed the mass to be a cystic tumor of the AV node region. To our knowledge, this is the first report of this condition diagnosed ante mortem and treated successfully with minimally invasive surgery.

Angiographic aspect of longstanding Starr-Edwards valve for type C Ebstein anomaly

A 66-year-old man was admitted with dyspnea during normal activities (New York Heart Association class III). At 12-years-old, he had received a classic BlalockTaussig shunt for type C Ebstein anomaly according to Carpentier’s classification. At 35-years old, he underwent tricuspid valve replacement with a 30-mm StarrEdwards caged ball prosthesis (model unknown) for severe tricuspid valve regurgitation associated with surgical ablation for Wolf-Parkinson-White syndrome and placement of a heterologous pericardial patch in the right ventricular outflow tract. At this admission, he was on warfarin therapy (international normalized ratio 2.79). Transthoracic echocardiography demonstrated severe biatrial dilation (left atrial volume index 48mL m , right atrial volume index 52mL m ), reduced biventricular systolic function (left ventricular diastolic volume index 66mL m , left ventricular ejection fraction 30%, S-wave velocity 3 cm s ), and mild mitral and aortic valve regurgitation with preserved function of the tricuspid valve prosthesis (mean gradient 4mm Hg and no regurgitation). Angiography revealed no coronary artery disease and a well-functioning tricuspid valve prosthesis (Figure 1, Video 1). Computed tomography and pulmonary function tests showed that severe mixed respiratory impairment was the primary origin of the patient’s clinical status. Spirometry tests showed a moderate restrictive deficit. This is a rare report of a longstanding well-functioning StarrEdwards valve in the tricuspid position.

Primary Cardiac Leiomyoma Causing Right Ventricular Obstruction and Tricuspid Regurgitation

We report the unique case of a primary cardiac leiomyoma originating from the right ventricle and involving the tricuspid valve in a 43-year-old woman. Echocardiography showed a giant mass causing severe pulmonary stenosis and tricuspid valve regurgitation. The patient underwent surgical excision and histologic examination revealed a primary cardiac leiomyoma. To the best of our knowledge only three cases of primary cardiac leiomyoma have so far been reported, and this is the first case of primary cardiac leiomyoma involving the tricuspid valve apparatus.

ReliantHeart: Forward Compatibility and TET

ReliantHeart (ReliantHeart Inc., Houston, TX, USA) HeartAssist5 (HA5) left ventricular assist device (LVAD) system is a miniaturized, implantable, second-generation axial-flow pump capable of long-term circulatory support in patients with end-stage heart failure. The device results to be the first continuous-flow LVAD ever implanted in human being. This compact axial-flow pump has been in development since 1988 named as MicroMed DeBakey [1] (MicroMed Cardiovascular Inc., Houston, TX, USA) whose design belongs to the second-generation pump category [2, 3].

Neonatal aortic coarctation: a spectrum of anatomic lesions repaired trough left thoracotomy in 22 years experience

Methods One hundred and thirty-four patients underwent CoA repair from January 1990 to December 2012 (mean FU 115.6±82.9 months). Mean age was 11.5±7.6 days (range 0-30 days). Mean weight was 3.0±0.7kg, 26.1% under 2.5kg of weight. 88 patients (65.7%) presented isolated CoA,36 (26.9%) associated VSD, 10 (7.5%) associated complex cardiac defects. All patients were treated through left thoracotomy, 79.9% with end to end extended anastomosis, 7.4% with prosthetic and 12.7% with subclavian patch. Concomitant pulmonary artery banding was performed in 28 patients (21.1%). During follow up all patients underwent thoracic aortic MR and cardiological evaluation. Cerebral MR angiography was performed to avoid the risk of the association between neonatal CoA repair and IAs development.

The repaired tetralogy of Fallot become adult: what should we expect

Methods 82 patients with repaired tetralogy of Fallot were collected from the database of our pediatric and congenital adult cardiology and cardiac surgery unit. Only patients older than 16 years of age at the time of the study were selected. All patients underwent complete surgical repair during childhood at a mean age of1.6±1.3 years. Forty-nine patients (71.9%) were treated with transannular patch, 17(23.2%) infundibular patch, 3(3.65%) endoventricular repair and 1(1.2%) with conduit between the right ventricle(RV) and the pulmonary artery(PA); 17/82(20.7%) of all patients required palliative BT shunt at birth before repair. Mean age at follow up was 23.7± 6.7 years. Follow-up schedule comprised clinical evaluation along with echocardiographic and cardiac-MR, quality of life and VO2 consumption assessment.

Can we Make an Early Prediction of who will be Discharged from the Intensive Care Unit the Day After Heart Surgery

Introduction: Most of the patients undergoing heart operation are discharged from the intensive care unit the day after their operation. The aim of this study was to evaluate preoperative, intraoperative and early postoperative risk factors for prolonged intensive care unit length of stay (intensive care unit stay greater than 1 day) in cardiac surgery patients. Materials and Methodology: This retrospective study examines the determinants of prolonged intensive care unit length of stay in 2182 consecutive surgical patients. Univariate and multivariate analyses have been performed. Results: 46.76% of all patients had a prolonged intensive care unit length of stay. Multivariate analysis revealed the following independent predictors for prolonged intensive care unit length of stay: Preoperative: Age (p = 0.001), chronic obstructive pulmonary disease (p = 0.049), serum creatinine (p = 0.003), serum total bilirubin (p = 0.048), chronic renal failure requiring dialysis (P = 0.040), intravenous infusion of nitrates (p = 0.014), NYHA class � 3 (p = 0.032), left ventricular ejection fraction (p = 0.006). Intraoperative: aortic cross-clamping time (p = 0.04), CPB duration (P < 0.0001), lowest hematocrit on CPB (p < 0.0001), type of operation (p = 0.012), high doses of catecholamine therapy after CPB (p = 0.001). Postoperative: re-exploration (p < 0.0001), massive transfusions (p < 0.0001), arterial pH at ICU admission (p = 0.024). Conclusion: Due to the increasing number of high-risk patients needing cardiac surgery, it is important to identify risk factors for a prolonged intensive care unit length of stay. This can be applied for scheduling patients for cardiac surgery as well as in optimizing intensive care unit resource planning when resources are limited.