Virgilijus Tarutis

CT angiography of mildly symptomatic, isolated, unilateral right pulmonary vein atresia

We report a mildly symptomatic 12-year-old boy with a very rare congenital anomaly—isolated unilateral pulmonary vein atresia. Diagnosis was made using CT angiography and its role in diagnosis is discussed.

Primary cardiac lymphoma: two cases and a review of literature.

BackgroundPrimary cardiac lymphoma is one of the rarest tumours of the heart. It belongs to the extra-nodal non-Hodgkin’s lymphomas. The most common type of this tumour is diffuse large B cell lymphoma. Usually, right atrium and right ventricle are involved. This tumour is fatal unless diagnosed and treated in time. In this article two female patients who were diagnosed with primary cardiac lymphoma and treated at our clinic are described. The first patient went to remission after the treatment, while the second patient died. The goals of this article are to show the difficulties of diagnosing and treating this disease, the role of cardiac surgery in its treatment and to raise awareness of this disease.Case reportsIn this article two female patients who were diagnosed with primary cardiac lymphoma and treated at our clinic are described. The first patient went to remission after the treatment, while the second patient died.ConclusionsPrimary cardiac lymphoma is a very rare disease. At the moment the most effective treatment is chemotherapy. Palliative surgery may be necessary to correct hemodynamics when venous blood flow to the lungs is disturbed.

Surgical repair of a giant congenital right atrial aneurysm: a case report

Giant congenital right atrial aneurysms are rare defects of the heart. Though usually asymptomatic, they can be potentially life-threatening. Major risks include heart failure, supraventricular arrhythmias, rupture of the wall of the aneurysm. This defect is usually diagnosed incidentally. It is commonly found when transthoracic echocardiography or chest X-ray is performed. In some cases computed tomography or cardiac magnetic resonance imaging is needed to establish the diagnosis. Potential therapeutic options include surgery, catheter ablation and conservative follow-up. Currently preferred method for correcting this defect is surgical excision of the aneurysm, when surgical indications are met. In this article we describe a successful aneurysmectomy performed on a 16-month old female infant, who at the time of hospitalization presented with severe heart failure and symptoms of cardiac tamponade.

Sustainable Knowledge Transfer in Pediatric Cardiac Surgery A Team Approach to Shared Learning

The study assesses the impact of a program using a model of knowledge transfer on the long-term development of a pediatric cardiac service in Lithuania. A team from the United Kingdom evaluated Lithuanian pediatric cardiac services and provided support in areas targeted for improvement. The total number of infant operations performed in Lithuania from 1990 to 2008, together with in-hospital mortality rates, was broken down into 3 time periods and analyzed to estimate the efficacy of the program: (1) 1990-1998, before the program; (2) 1999-2002, during the program; (3) 2003-2008, following the end of the program. Lithuanian results in children older than 1 year were comparable with other European centers. However, only 315 infant and neonatal cardiac procedures were performed between 1990 and 1998, and there was an in-hospital mortality of 34.2%. Between 1999 and 2002, the UK team performed 23 highly complex demonstration procedures (in-hospital mortality, 13%). During the same period the Lithuanian team performed 305 additional operations in neonates and infants, and in-hospital mortality decreased to 18.7%. From 2003 to 2008 results continued to improve—559 infant operations were performed, with in-hospital mortality of 11.3% (P < .0001). Knowledge transfer has led to substantial and sustainable long-term improvement in the results of infant cardiac surgery in Lithuania. Demonstrating techniques and care on a limited number of more complex cases is an efficient way of transferring knowledge and skills to the developing pediatric cardiac centers.

Successful experience with Levitronix PediVAS for management of acute heart failure after Fontan surgery

An extracorporeal membrane oxygenation was long a golden standard in the pediatric population with acute cardiac failure for short-term mechanical circulatory support. It gives the limited availability of pediatric-sized pumps and the outcomes remain disproportionately poor. The Levitronix PediVAS system (Levitronix LLC, Waltham, MA) offers expanded options for short-term support for this population. We report our experience with the successful use of the PediVAS (left heart bypass) in the 3-year-old male patient as a bridge to recovery after Fontan surgery in acute heart failure. Short-term circulatory support with the Levitronix PediVAS has proven to be a less invasive, safe, and effective for our pediatric patient.

Surgical correction of atrial septal defect in the elderly

Introduction Atrial septal defects (ASDs) are one of the most common congenital malformations in adults. Correction of ASDs in advanced age remains controversial, even though beneficial effects in this patient group were found in recent studies. In older patients, less invasive transcatheter closure of ASDs has been recommended. Aim The aim of this study was to analyze our advanced age ASD surgical cohort: early and late results. Material and methods Retrospective analysis of 32 patients operated on at an age of ≥ 60 years (i.e. age 66.13 ± 4.8, range from 60 to 78) in our center between 2001 and 2011 was carried out. We reviewed our experience of surgical ASD closure in elderly patients over a 10-year period to assess the effects of this type of treatment on early postoperative and long-term survival, early and late complications, preoperative and postoperative clinical status (New York Heart Association [NYHA] functional class), pulmonary hypertension (PH) and atrial arrhythmias. The patients were divided into two groups according to age. Results The frequency of comorbidities was lower in younger age group patients (11 [61%] vs. 13 [93%], p < 0.05). Atrial fibrillation/flutter was found in 21 (66%) of all patients. Late postoperative mortality was higher in the older patient group (3 [21%] vs. 1 [5.6%]). Despite this, we observed significant improvement of symptoms and functional ability in the older population after surgical ASD closure (group I, n = 10 [56%] vs. group II, n = 12 [86%]). Conclusions Surgical correction of clinically significant ASD is effective even in older patients with comorbidities.

Vieno etapo Taussig ir Bingo anomalijos esant aortos koarktacijai ir aortos lanko hipoplazijai korekcija kūdikiui

Virgilijus Tarutis 1 , Virgilijus Lebetkevicius 1 , Kestutis Versockas 2 , Kestutis Lankutis 3 , Rita Sudikienė 3 , Daina Liekienė 1 , Virginijus Jakutis 2 , Žydrė Jurgelienė 2 , Asta Bliūdžiūtė 2 , Solveiga Umbrasaitė 2 , Vidmantas Žilinskas 1 , Vytautas Sirvydis 1 1 Vilniaus universiteto Sirdies chirurgijos centras, Santariskių g. 2, LT-08661 Vilnius 2 Vilniaus universiteto ligoninės Santariskių klinikos, Anesteziologijos, intensyviosios terapijos ir skausmo gydymo centras, Santariskių g. 2, LT-08661 Vilnius 3 Vilniaus universiteto ligoninės Santariskių klinikos Sirdies chirurgijos centras, Santariskių g. 2, LT-08661 Vilnius El pastas: virgilijus.tarutis@santa.lt Straipsnyje pasakojame apie kompleksinės Taussig ir Bingo anomalijos esant aortos koarktacijai ir hipoplastiskam aortos lankui vienmomentį chirurginį gydymą, pirmąkart atliktą Lietuvoje. 2007 m. vasario 8 d. Vilniaus universiteto ligoninės Santariskių klinikų Sirdies chirurgijos centre operuotas 2 mėnesių 4,2 kg svorio kūdikis, kurio klinikinė diagnozė buvo: dvigubas istekėjimas is desiniojo skilvelio, Taussig ir Bingo anomalija, skilvelių pertvaros defektas, aortos koarktacija ir aortos lanko hipoplazija, plautinė hipertenzija, lėtinė hipoksemija, lėtinis sirdies nepakankamumas. Atlikta vienmomentė istaisanti visas ydas chirurginė korekcija – aortos koarktacijos ir hipoplastisko aortos lanko plastika, stambiųjų arterijų apkeitimo (Jatene) operacija ir skilvelių pertvaros defekto plastika. Operacija pavyko sėkmingai, kūdikis isleistas į namus stabilios būklės 26 parą po operacijos. Pagrindiniai žodžiai: dvigubas istekėjimas is desiniojo skilvelio, Taussig ir Bingo anomalija, aortos lanko hipoplazija, Jatene operacija Left ventricular reconstruction: preoperative and operative risk factors Virgilijus Tarutis 1 , Virgilijus Lebetkevicius 1 , Kestutis Versockas 2 , Kestutis Lankutis 3 , Rita Sudikienė 3 , Daina Liekienė 1 , Virginijus Jakutis 2 , Žydrė Jurgelienė 2 , Asta Bliūdžiūtė 2 , Solveiga Umbrasaitė 2 , Vidmantas Žilinskas 1 , Vytautas Sirvydis 1 1 Vilnius University, Cardiac Surgery Centre, Santariskių str. 2, LT-08661 Vilnius, Lithuania 2 Vilnius University Hospital „Santariskių klinikos“, Centre of Anaesthesiology, Intensive Therapy and Pain Management, Santariskių str. 2, LT-08661 Vilnius, Lithuania 3 Vilnius University Hospital „Santariskių klinikos“,Cardiac Surgery Centre, Santariskių str. 2, LT-08661 Vilnius, Lithuania E-mail: virgilijus.tarutis@santa.lt We report a case of a successful one-stage repair of Taussig–Bing anomaly with aortic coarctation and hypoplastic aortic arch in a 2-month-old infant. It was the first surgical correction of this type in Lithuania. The patch augmentation of the aortic arch and ascending aorta, arterial switch operation and ventricular septal defect patch closure were accomplished as a switch operation. Key words: double outlet right ventricle, Taussig–Bing anomaly, hypoplastic aortic arch

Radikali Fallot tetrados korekcija vaikams iki trejų metų

Rimantas Karalius 1 , Giedrė Nogienė 1 , Vidmantas Žilinskas 1 , Rita Sudikienė 2 , Virgilijus Lebetkevicius 1 , Virgilijus Tarutis 1 , Daina Liekienė 1 , Vytautas Sirvydis 1 1 Vilniaus universiteto Sirdies chirurgijos centras, Santariskių g. 2, LT-08661 Vilnius 2 Vilniaus universitetinės ligoninės Santariskių klinikų Sirdies chirurgijos centras, Santariskių g. 2, LT-08661 Vilnius El pastas: chirurgai@santa.lt Įvadas / tikslas Pastarąjį desimtmetį radikali Fallot tetrados (FT) korekcija atliekama kūdikiams ar net naujagimiams. Toliau tesiama diskusija, ar ankstyva korekcija turi įtakos isgyvenimui, pakartotinių operacijų dažnumui dėl liekamosios desiniojo skilvelio isstūmimo trakto (DSIT) obstrukcijos ar plaucių arterijos nesandarumo. Sio darbo tikslas yra isanalizuoti vaikų iki 3 metų Fallot tetrados radikalios korekcijos ankstyvus ir atokius pooperacinius rezultatus Vilniaus universiteto Sirdies chirurgijos centre. Ligoniai ir metodai Per du penkerių metų laikotarpius 1996–2000 ir 2001–2005 metais 23 pacientams atlikta radikali Fallot tetrados korekcija. Amžiaus vidurkis pirmąjį laikotarpį buvo 25,9 ± 2,8 mėn. ir antrąjį – 16,8 ± 2,9 mėn. Per abu laikotarpius buvo atlikta 10 (43,5%) ir 18 (78,3%) pirminių radikalių FT korekcijų. Per pirmąjį laikotarpį 22 ligoniams (95,6%) atlikta transanuliarinė plastika: 8 ligoniams tik transanuliarinė plastika ir 14 ligonių – transanuliarinė plastika naudojant lopą su viena bure. Per antrąjį laikotarpį tik 4 ligoniams DSIT plastika atlikta naudojant transanuliarinį lopą. Rezultatai 1996–2000 metais ankstyvuoju pooperaciniu laikotarpiu ir atokiuoju pooperaciniu laikotarpiu mirė po 2 ligonius (8,7%). Per antrąjį laikotarpį mirė vienas ligonis (4,3%). Atokiu pooperaciniu laikotarpiu ligoniams buvo atliekama echokardiografija ir matuojamas plaucių arterijos nesandarumo, taip pat DSIT obstrukcijos laipsnis. Per pirmąjį laikotarpį 8 ligoniams (42,1%) nustatytas II–III° ir III° plaucių arterijos nesandarumas. Keturiems is jų DSIT plastikai naudotas transanuliarinis turintis bure lopas. 2 ligoniams DSIT gradientas buvo didesnis kaip 40 mm Hg. Per antrąjį laikotarpį 3 ligoniams (13,6%) nustatytas II–III° ir III° plaucių arterijos vožtuvo nesandarumas ir 6 – DSIT gradientas, didesnis kaip 40 mm Hg. Keturiems ligoniams per pirmąjį laikotarpį reikėjo pakartotinės operacijos: 3 dėl isreiksto plaucių arterijos nesandarumo ir vienam dėl skilvelių pertvaros rekanalizacijos. Isvados Radikali Fallot tetrados korekcija gali būti saugiai atliekama jaunesnio amžiaus ligoniams. Didėja pirminių radikalių FT korekcijų skaicius. Transanuliarinio lopo panaudojimas padidina pakartotinių operacijų riziką dėl plaucių arterijos vožtuvo nesandarumo. Transanuliarinio lopo, turincio bure, panaudojimas neapsaugo nuo plaucių arterijos vožtuvo nesandarumo atokiuoju laikotarpiu. Pagrindiniai žodžiai: Fallot tetrada, radikali korekcija Complete repair of tetralogy of Fallot in the first three years of life RIMANTAS KARALIUS1, GIEDRĖ NOGIENĖ1, VIDMANTAS ŽILINSKAS1, Rimantas Karalius 1 , Giedrė Nogienė 1 , Vidmantas Žilinskas 1 , Rita Sudikienė 2 , Virgilijus Lebetkevicius 1 , Virgilijus Tarutis 1 , Daina Liekienė 1 , Vytautas Sirvydis 1 1 Vilnius University Heart Surgery Centre, Santariskių str. 2, LT-08661 Vilnius 2 Vilnius University Hospital „Santariskių klinikos“, Heart Surgery Centre, Santariskių str. 2, LT-08661 Vilnius E-mail: chirurgai@santa.lt Background / objective Complete corrections of tetralogy of Fallot (TOF) have been frequently performed for infants and even newborns in the last decade. The discussion whether early correction of tetralogy of Fallot influences the survival and the frequency of re-operation due to residual right ventricle outflow tract (RVOT) or pulmonary artery insufficiency rate is still going on. The aim of the present work was to evaluate the early and late results of radical corrections in children less than 3 years of age, performed at Vilnius University Heart Surgery Centre. Patients and methods During two 5-year periods (1996–2000, 2001–2005) 23 infants underwent repair for TOF. The mean age of the patients during the first period was 25.9 ± 2.8 months and during the second period 16.8 ± 2.9 months. During both periods 10 (43.5%) and 18 (78.3%) primary radical corrections of TOF were performed. A transannular patch was inserted in 22 patients (95.6%) during the first 5-year period: 8 patients underwent transannulorplasty only, and for 14 patients transannulorplasty using a monocusp patch was performed. During the period 2001 through 2005, only 4 patients underwent RVOTplasty by means of monocusp patch. Results Two patients (8.7%) died within 30 days postoperatively during the first 5-year period and there were two late deaths. There was one death (4.3%) during the second period. The patients underwent echocardiography evaluation, measurements of pulmonary artery insufficiency and RVOT obstruction grade at late postoperative periods. Pulmonary artery insufficiency grade 2–3 and 3 was revealed in 8 (42.1%) patients operated on during the first 5-year period. For four of them, transannular monocusp patch was used for RVOTplasty. Two patients showed a RVOT gradient higher than 40 mm Hg. For three patients (13.6%) operated on during the second 5-year period, pulmonary insufficiency grade 2–3 and 3 was diagnosed, and a RVOT gradient higher than 40 mm Hg was found in six patients. Re-operation was required for four patients of the first 5-year period: three patients needed to be operated on because of a marked pulmonary artery insufficiency and one for re-canalization of a ventricle septum defect. Conclusions Radical correction of tetralogy of Fallot may be safely performed in younger patients. Therefore, the number of primary radical correction of this malformation is increasing. The use of transannular patch increases the risk of re-operations due to pulmonary artery insufficiency. The use of transannular monocusp patch does not prevent pulmonary artery valve insufficiency at a late postoperative period. Key words: tetralogy of Fallot, radical correction

Subaortinė stenozė ir dviburio vožtuvo anoma-lijos: chirurginio gydymo ypatumai

Daina Liekienė 1 , Virgilijus Lebetkevicius 1 , Virgilijus Tarutis 2 , Rimantas Karalius 1 , Rita Sudikienė 2 , Kestutis Lankutis 2 , Giedrė Nogienė 1 , Alicija Dranenkienė 1 , Vytautas Sirvydis 1 1 Vilniaus universiteto Sirdies chirurgijos centras, Santariskių g. 2, LT-08661 Vilnius 2 Vilniaus universiteto ligoninės Santariskių klinikų Sirdies chirurgijos centras, Santariskių g. 2, LT-08661 Vilnius El pastas: dainal@takas.lt Subaortinės stenozės diagnozė apima didelį spektrą anatominių pakitimų – nuo paprastos membranos iki fibroraumeninio tunelio. Straipsnyje aprasoma reta subaortinė stenozė, sukelta dviburio vožtuvo priekinės burės ir papilinio raumens anomalijos. Trys pacientai, operuoti dėl subaortinės stenozės, sukeltos dviburio vožtuvo anomalijos, dviem atlikta dviburio vožtuvo plastika ir kairiojo skilvelio infundibulinės dalies raumenų rezekcija. Vienam ligoniui atliktas mitralinio vožtuvo (MV) protezavimas ir kairiojo skilvelio infundibulinės dalies raumenų rezekcija. Dviburį vožtuvą issaugancias operacijas dažniau pavyksta padaryti, kai dviburio vožtuvo yda yra antrinė liga. Dviburio vožtuvo plastika galima reciau, jei anomalaus dviburio vožtuvo audiniai siaurina kairiojo skilvelio infundibuline dalį. Pagrindiniai žodžiai: subaortinė stenozė, dviburio vožtuvo anomalija, kairiojo skilvelio isvarymo trakto obstrukcija Subaortic stenosis and mitral valve anomaly: surgical treatment aspects Daina Liekienė 1 , Virgilijus Lebetkevicius 1 , Virgilijus Tarutis 2 , Rimantas Karalius 1 , Rita Sudikienė 2 , Kestutis Lankutis 2 , Giedrė Nogienė 1 , Alicija Dranenkienė 1 , Vytautas Sirvydis 1 1 Vilnius University, Cardiac Surgery Centre, Santariskių str. 2, LT-08661 Vilnius, Lithuania 2 Vilnius University Hospital „Santariskių klinikos“, Cardiac Surgery Centre, Santariskių str. 2, LT-08661 Vilnius, Lithuania E-mail: dainal@takas.lt The diagnosis of subaortic stenosis contains a broad spectrum of anatomical changes varying from discrete membrane to fibromuscular tunnel. We review a rare subaortic stenosis caused by anomaly of mitral valve anterior leaflet and papillary muscle. We review three patients who underwent surgery because of subaortic stenosis caused by anomalous mitral valve. Two patients underwent mitral valve plastic and resection of the left ventricular outflow tract muscles. One patient underwent mitral valve replacement and resection of the left ventricular outflow tract muscles. Valve preserving operations are more easy to perform when mitral valve disease is a comorbidity. Mitral valvoplasty is more complicated to perform when the mass of anomalous mitral valve obstructs the outflow tract of the left ventricle. Key words: subaortic stenosis, anomalous mitral valve, left ventricle outflow tract obstruction