Minimally invasive mitral valve repair surgery in patient with systemic sclerosis

Cardiac involvement is an often fatal and underestimated complication in systemic sclerosis, but only few reports have been published on the surgical intervention of patients with cardiothoracic complication in patient with systemic sclerosis. We hereby present a case of severe mitral valve regurgitation due to infective endocarditis on patient with systemic sclerosis. The patient underwent mitral valve reconstruction and post-operative management of systemic sclerosis.

Annular and subvalvular dynamics after extracellular matrix mitral tube graft implantation in pigs

OBJECTIVES Entire mitral valve reconstruction with an extracellular matrix tube graft is a potential candidate to overcome the current limitations of mechanical and bioprosthetic valves. However, clinical data have raised concern with respect to patch failure. The aim of our study was to evaluate the impact of extracellular matrix mitral tube graft implantation on mitral annular and subvalvular regional dynamics in pigs. METHODS A modified tube graft design made of 2-ply extracellular matrix was used (CorMatrix®; Cardiovascular Inc., Alpharetta, GA, USA). The reconstructions were performed in an acute 80-kg porcine model (N = 8), where each pig acted as its own control. Haemodynamics were assessed with Mikro-Tip pressure catheters and mitral annular and subvalvular geometry and dynamics with sonomicrometry. RESULTS Catheter-based peak left atrial pressure and pressure difference across the mitral and aortic valves in the reconstructions were comparable to the values seen in the native mitral valves. Also comparable were maximum mitral annular area (755 ± 100 mm2), maximum septal-lateral distance (29.7 ± 1.7 mm), maximum commissure–commissure distance (35.0 ± 3.4 mm), end-systolic annular height-to-commissural width ratio (10.2 ± 1.0%) and end-diastolic interpapillary muscle distance (27.7 ± 3.3 mm). Systolic expansion of the mitral annulus was, however, observed after reconstruction. CONCLUSIONS The reconstructed mitral valves were fully functional without regurgitation, obstruction or stenosis. The reconstructed mitral annular and subvalvular geometry and subvalvular dynamics were found in the same range to those in the native mitral valve. A regional annular ballooning effect occurred that might predispose to patch failure. However, the greatest risk was found at the papillary muscle attachments.

Epileptic seizure discharges in patients after open chamber cardiac surgery – A prospective prevalence study using continuous electroencephalography

Background Patients undergoing cardiac surgery often develop delirium and postoperative cognitive deficits (POCD), which lead to a higher postoperative morbidity, mortality and a reduced quality of life. Retrospective studies show a higher incidence of delirium, stroke and mortality in patients with convulsive and non-convulsive seizures after cardiac surgery. However, these studies do not systematically detect subclinical seizures in the early postoperative period; so, the incidence of seizures after cardiac surgery remains speculative. To investigate the real frequency of seizures, we conducted this prospective pilot study on patients with open-chamber cardiac surgery using continuous electroencephalography (EEG) monitoring utilizing widely distributed electrodes and 10-channel registration. The main objective of the study is to determine the prevalence of seizure-specific patterns in EEG after elective open-chamber cardiac surgery. Methods The prospective, blinded, monocentric, observational study investigated patients scheduled for elective open-chamber aortic or mitral valve reconstruction or replacement. The anaesthetic, surgical and postoperative treatment was standardized and not influenced by the presented observation. After surgery, all patients arrived at the ICU, and EEG monitoring started within the first hour after admission to the ICU (10 channel registration: Fp1,Fp2,C3,C4,P3,P4,T3,T4,Fz,Cz). EEG recording was continuously performed for up to 24 hours, and the EEG results were independently analysed with a focus on epileptic discharges and seizure activity by two blinded EEG board-certified physicians Results One hundred patients were included, 76% of whom underwent aortic valve replacement, 24% of whom endured mitral valve reconstruction or replacement. Early postoperative EEG recording lasted 12.9±7.2 hours. Epileptic EEG patterns were present in 38% of patients and seizure-specific EEG patterns were present in 22% of patients. Main EEG activity at the beginning of recording was suppressed or showed a burst-suppression pattern, and at the end of recording, all patients had an alpha/theta-rhythm. Conclusion This pilot study reveals a surprisingly high prevalence of seizure-specific EEG patterns (22%) in patients undergoing open-chamber cardiac surgery. As seizures potentially induce delirium and POCD, this finding is a relevant phenomenon in the post-cardiac surgery population, representing a promising target for the treatment and prevention of postoperative delirium and POCD.

Penetration cardiac wound associated with anterior mitral leaflet perforation: a case report and review of the literature

The paper presents a rare case of successful correction of an anterior mitral leaflet perforation. A 28-years old patient was referred with progressive heart failure symptoms at 18 weeks after he had a penetrating stab wound of the right ventricle. Massive pericardial effusion with cardiac tamponade risk and severe mitral valve insufficiency were found at examination. By the time of referral, spontaneous closure of the ventricular septal defect, which is an inevitable component of the “unhappy triad”, had happened. Accurate topical ultrasound diagnosis of the intracardial lesion that resulted from the penetrating wound of the left ventricular outflow allowed for a successful urgent mitral valve reconstruction with a xenopericardial patch and the insertion of a 28 mm MedEng annuloplasty band. To prevent any future pericardial constriction, subtotal pericardectomy by Cooley was performed.Conclusion: Perioperative echocardiography and subsequent follow up by cardiologist are obligatory in all cases of precordial wounds after discharge from hospital. Timely surgery for traumatic mitral leaflet perforation allows for a successful valvuloplasty.