A mitralis billentyű sebészete atrioventricularis septumdefektusban

Összefoglaló. A veleszületett szívbetegségek egyik gyakori formáját jelentő atrioventricularis septumdefektus korrekciós műtétjének kritikus pontja a közös atrioventricularis szájadék elválasztásával a mitralis billentyű kialakítása. A korrekció sikere számos anatómiai variáns függvénye, ezért nem lehet minden esetben a tökéletes anatómiai viszonyokat kialakítani. A fennmaradó billentyűstenosisok, regurgitatiók a későbbi életkorban progressziót mutatva olyan hemodinamikai kórképeket, keringési elégtelenséget okozhatnak, melyek további beavatkozásokat igényelhetnek. A mitralis billentyűnek az atrioventricularis septumdefektushoz társuló betegsége koraszülöttkortól aggkorig minden életkorban előfordul, más-más műtéti megoldást igényelve. A szerzők részletezik a különböző életkorokra vonatkozóan a napjainkban lehetséges és szükséges műtéti megoldásokat, sebészi kihívásokat. A mitralis billentyű műbillentyűre történő cseréjében a klasszikus sebészi megoldások mellett napjainkban új beavatkozásokként jelentős számban jelentkeznek a katéteres intervenciós és hibrid megoldások. A felnőttkort egyre nagyobb számban megélő betegek fokozott odafigyelést, speciális ellátást igényelnek a kardiológusoktól, szívsebészektől. Orv Hetil. 2021; 162(35): 1397–1401. Summary. The critical point of the atrioventricular septal defect correction is to separate the common atrioventricular orifice, which results in the reconstruction of the mitral valve. The success of the correction depends on many anatomical aspects, therefore a perfect anatomical outcome is not always possible. The remaining valvular stenoses and regurgitations, showing progression at a later age, may result in hemodynamic disorders and circulatory insufficiency that may require further interventions. Mitral valve disease associated with atrioventricular septal defect occurs at all ages from preterm to adulthood, requiring different surgical solutions. The authors detail the possible and necessary surgical solutions and surgical challenges at different ages. In addition to the classic surgical solutions, a significant number of catheter interventional and hybrid solutions are emerging as new interventions in the replacement of the mitral valve with an artificial valve. An increasing number of patients living in adulthood require increased attention and special care from cardiologists and cardiac surgeons. Orv Hetil. 2021; 162(35): 1397–1401.

A Case of Aortic Valve Annulus Reconstruction with Bovine Pericardial Patch for Artificial Valve Detachment in Behcet’s Disease

A 36-year-old patient with Behcet’s disease was hospitalized because of severe aortic valve regurgitation accompanied by aortic valve neoplasia and perforation of the valve body. In the first operation, we performed aortic valve replacement and ascending aortoplasty. The regular examination after surgery found no obvious regurgitation or discomfort. Four months later, however, the artificial valve fell off the valve frame and the annulus, with severe perivalvular leakage; the range of detachment was about two thirds. In the second operation, we applied a bovine pericardial patch. The aortic valve annulus was reconstructed using the lower edge of the bovine pericardial patch. The upper edge of the patch was sutured to the top of the aortic sinus to strengthen it, and the lateral edge was sutured 3 to 5 mm from the left coronary opening. The artificial valve was fixed well 6 months after the operation, and no valve detachment was observed. This method of reconstructing an aortic valve annulus with a bovine pericardial patch may be referential for preventing artificial valve detachment in patients with Behcet’s disease.

Acute Mitral Valve Injury Following Percutaneous Left Atrial Appendage Occlusion: A Case Report and Literature Review

Acute mitral valve injury following percutaneous left atrial appendage (LAA) occlusion is a rare, but potentially life-threatening complication. This report presents a case of severe mitral valve injury following left atrial appendage occlusion (LAAO) that required mitral valve replacement. The LAAO device successfully was removed, and the LAA was closed with a double-running polypropylene suture. In addition, the mitral valve was replaced with an artificial valve. The patient had an uneventful clinical evolution and was discharged 10 days after emergency surgery.

Antifreezing and Stretchable Organohydrogels as Soft Actuators

Inspired by the freezing tolerance performances found in living creatures, an effect approach is presented to develop novel antifreezing polymeric organohydrogel actuators. Through construction of a bilayer hydrogel including a nonresponsive polyacrylamide (PAAm) layer and a pH-responsive polyacrylic acid (PAA) layer in the presence of a mixed solvent of water and glycerol, organohydrogel actuators that could produce various shape deformations at subzero temperatures have been achieved, and the actuating speed could be tuned by adjusting the temperature and the ratio between glycerol and water. Moreover, a series of application demonstrations including a weightlifting robot, artificial valve, and robotic arm have been displayed. In addition, by introducing the ionic compound KI into the glycerol-based organogel, flexible conductors that could perform stable sensing performance over a wide range of temperatures from -30°C to 60°C have been developed.