Ramón Sánchez

Repair of left ventricular rupture after mitral valve replacement: use of a Teflon patch and glue

Rupture of the left ventricular wall is an infrequent but lethal complication after mitral valve replacement. We present the case of a patient in whom such a rupture was successfully repaired in the intensive care unit with a patch of Teflon felt stuck in place with glue.

Congenital Aneurysm of the Left Atrial Appendage

Aneurysm of the left atrial appendage (LAA) is very infrequent. We present the case of 24-year-old man in functional class I with atrial fibrillation but no other symptoms. Radiology showed an abnormality in the outline of the heart. Echocardiography revealed left appendage aneurysm. After median sternotomy, aneurysmectomy was performed under cardiopulmonary bypass without cross clamping. Atrial fibrillation ceased as soon as the aneurysm had been removed. There were no postoperative complications. Three months later the patient remained asymptomatic and in sinus rhythm.

Intact Medtronic and Carpentier Edwards S.A.V.: clinical and hemodynamic outcomes over 13 years.

UNLABELLED We report on 215 consecutive patients with isolated aortic replacement of which 91 received an Intact Medtronic (IM) prosthesis and 124 a Carpentier Edwards SAV. (CE). More than 50% of patients were over 70 years old. Follow-up was complete for 95% of patients. Mean follow-up was 6.04 years (16 days-13 years); a total of 1244 patient-years (IM 6.61years, 590 patient-years, CE 5.95 years, 670 patient-years). RESULTS the following results are expressed for IM and CE groups respectively. Early mortality: 3.3% and 8.13%. Late mortality: 23 and 27 patients. Survival at 13 years: 53.31+/-7.63% and 47.47+/-7.9%. Major thromboembolism: 0.34% and 0.30% per patient-year. SVD: 0.16% and 0.14% per patient-year. Endocarditis: 0.33% and 0.29%. Re-operation: 0.5% and 0.44%. Over 95% of patients are re-operation free at 13 years. CONCLUSION Intact and Carpentier valves had similar durability and clinical/hemodynamic results. Both have proved excellent aortic valve substitutes in elderly patients.

2 TESTING LIMA GRAFT PERMEABILITY BY TRANSTHORACIC ECHO‐DOPPLER.

Purpose: Postoperative measurement of graft permeability by angiography is invasive. The aim of this study is to evaluate the utility of transthoracic echo-Doppler (TTE) in measuring LIMA graft permeability. Methods: We studied 89 consecutive patients (average age 65 years, range 37–79 years) who were revascularized with a LIMA. Graft permeability was evaluated by both color- and pulsed-Doppler TTE. We measured the following parameters: systolic velocity peak (SVP), diastolic velocity peak (DVP), average velocity, pulsatility index (PI), resistivity index (RI). Of the 89 patients, 60 also underwent angiography. We considered stenosis to be severe if greater than 70% as indicated by angiography. Results: We were able to obtain TTE data for 85 patients (95.5%) and of these 57 had angiography as well. Doppler registers were biphasic, with both systolic and diastolic components. In patients with grafts functioning normally, registers were predominantly diastolic. When the graft was dysfunctional registers were predominantly systolic (similar to the register of the mammary artery in its anatomic position). Patients with dysfunctional grafts had higher SVP (p < 0.01), higher DVP (p < 0.05), and higher PI (p < 0.001). The sensitivity and specificity of TTE in the detection of severe graft dysfunction were 86% and 100%, respectively. The positive prediction value was 100%. Conclusions: TTE has high sensitivity, specificity, and predictive value in determination of LIMA graft permeability. Being noninvasive, TTE is ideal for the follow-up of patients with LIMA grafts.