Haemodynamic improvement of older, previously replaced mechanical mitral valves by removal of the subvalvular pannus in redo cardiac surgery

Introduction/aim: We are presenting the case of a patient suffering from fibrous cardiac skeleton damage caused by advanced infective endocarditis after aortic valve replacement surgery, whose cardiac surgery treatment proved to be successful. Case report: A redo procedure was performed through a median sternotomy using cardiopulmonary bypass. Artificial aortic and native mitral valves were excised and all infected tissue removed. Reconstruction of the fibrotic cardiac skeleton was done using two autologous pericardial patches according to Tyrone-David. Both mechanical valves were implanted. Conclusion: Successful treatment of one of the most difficult conditions in cardiac surgery can be achieved in our country.

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Clinical response to arginine vasopressin therapy after paediatric cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951112000996 ◽

2012 ◽

Vol 23 (3) ◽

pp. 387-393 ◽

Cited By ~ 9

Author(s):

Christopher W. Mastropietro ◽

Maria C. Davalos ◽

Shivaprakash Seshadri ◽

Henry L. Walters ◽

Ralph E. Delius

Keyword(s):

Blood Pressure ◽

Cardiac Surgery ◽

Arginine Vasopressin ◽

Heart Surgery ◽

Open Heart Surgery ◽

P Value ◽

Haemodynamic Instability ◽

Post Operation ◽

The Mean ◽

Haemodynamic Improvement

AbstractObjectiveTo describe the haemodynamic response of children who receive arginine vasopressin for haemodynamic instability after cardiac surgery and to identify clinical variables associated with a favourable response.Materials and MethodsWe reviewed patients less than or equal to 6 years undergoing open heart surgery in our institution between January, 2009 and July, 2010 who received arginine vasopressin during the first 7 days post operation. Favourable responders were defined as those in whom blood pressure was increased or maintained and catecholamine score was decreased, or blood pressure was increased by greater than or equal to 10% of baseline and catecholamine score was unchanged at 6 hours following arginine vasopressin initiation.ResultsOf the 34 patients identified, 17 (50%) patients responded favourably to arginine vasopressin. At 6 hours, the mean blood pressure was increased by 32.2% in responders as compared with 4.6% in non-responders, with a p-value less than 0.001. The mean catecholamine score decreased by 30.1% in responders and increased by 7.6% in non-responders, with a p-value less than 0.001. Anthropometric, demographic, and intra-operative variables were similar in both groups, as was maximum dose of arginine vasopressin. The median time after arrival to the intensive care unit at which arginine vasopressin was initiated, however, was later in those who responded, 20 hours as compared with those who did not, 6 hours, with a p-value equal to 0.032.ConclusionsArginine vasopressin therapy led to haemodynamic improvement in only half of the children in this study, and improvement was more likely to occur if arginine vasopressin was initiated after the post-operative night.

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Thrombolytic treatment of prosthetic valve thrombosis: a study using Urokinase

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01324-7 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Feng Huang ◽

Yongrong Lan ◽

Zhangbo Cheng ◽

Zili Zhang ◽

Fei Ren

Keyword(s):

Thrombolytic Therapy ◽

Prosthetic Valve ◽

Treatment Time ◽

Cerebral Haemorrhage ◽

International Normalized Ratio ◽

Thrombolytic Treatment ◽

Mitral Valves ◽

Prosthetic Valve Thrombosis ◽

Valve Thrombosis ◽

Haemodynamic Improvement

Abstract Objective We analysed the efficacy and safety of thrombolytic therapy with urokinase in patients with prosthetic valve thrombosis. Methods Twenty-three patients with valve thrombosis received thrombolytic treatment using urokinase. First, a 250,000 IU intravenous bolus injection was administered as a loading dose, followed by intravenous infusion of 100,000 IU/h for 10 h and anticoagulation with low molecular weight heparin every day. The maximum treatment time was 5 days, i.e., until the transvalvular pressure gradient was normal or close to normal. Transthoracic echocardiography (TTE) was used every 12 h to monitor whether the thrombus was reduced and whether there was haemodynamic improvement. Routine blood tests, the prothrombin time (PT), international normalized ratio (INR) and complications were observed every day. Results Sixteen (69.6%) patients were successfully treated with thrombolytic therapy: 2/2 (100%) aortic valves and 14/21 (66.7%) mitral valves. The partial success rate of this study was 13.0% (3/23). Four patients did not show any improvement in haemodynamics. Two cases had slight urine haemorrhage. One patient died of severe cerebral haemorrhage and shock. The overall mortality was 13.0% (3/23), including two patients who died after subsequent surgery. Conclusion Urokinase is more convenient and successful in the treatment of PVT. More experience may make TT the optimal treatment for PVT, especially in high-risk surgical situations.

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Treating Children With Advanced Rheumatic Heart Disease in Sub-Saharan Africa: The NGO EMERGENCY's Project at the Salam Centre for Cardiac Surgery in Sudan

Frontiers in Pediatrics ◽

10.3389/fped.2021.704729 ◽

2021 ◽

Vol 9 ◽

Author(s):

Rossella Miccio ◽

Maria Quattrociocchi ◽

Lorenzo Valgoi ◽

Liliane Chatenoud ◽

Salvatore Lentini ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Open Heart Surgery ◽

Sub Saharan Africa ◽

Mitral Valves ◽

Operative Care ◽

Sub Saharan ◽

Rheumatic Heart

Rheumatic heart disease is endemic in Sub-Saharan Africa and while efforts are under way to boost prophylaxis and early diagnosis, access to cardiac surgery is rarely affordable. In this article, we report on a humanitarian project by the NGO EMERGENCY, to build and run the Salam Centre for Cardiac Surgery in Sudan. This hospital is a center of excellence offering free-of-charge, high-quality treatment to patients needing open-heart surgery for advanced rheumatic and congenital heart disease. Since it opened in 2007, more than 8,000 patients have undergone surgery there; most of them Sudanese, but ~20% were admitted from other countries, an example of inter-African cooperation. The program is not limited to surgical procedures. It guarantees long-term follow-up and anticoagulant treatment, where necessary. By way of example, we report clinical features and outcome data for the pediatric cohort: 1,318 children under the age of 15, operated on for advanced rheumatic heart disease between 2007 and 2019. The overall 5-year survival rate was 85.0% (95% CI 82.7–87.3). The outcomes for patients with mitral valves repaired and with mitral valves replaced are not statistically different. Nevertheless, observing the trend of patients undergoing valve repair, a better outcome for this category might be assumed. RHD in children is an indicator of poor socio-economic conditions and an inadequate health system, which clearly will not be cured by cardiac surgery alone. Nevertheless, the results achieved by EMERGENCY, with the crucial involvement and participation of the Sudanese government over the years, show that building a hospital, introducing free cardiac surgery, and offering long-term post-operative care may help spread belief in positive change in the future.

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