Emergency Endovascular Total Arch Exclusion With an Off-the-Shelf Bimodular Device

A patient with a history of surgery for type A acute aortic dissection was readmitted for aortic arch and descending aortic dissection with rupture at the isthmus and periaortic hematoma. Due to the high surgical risk, the aortic team chose an endovascular approach, and the patient successfully underwent emergency total arch exclusion with an off-the-shelf, bimodular, single-branch device. The main module was deployed in the aortic arch and in the brachiocephalic trunk, and the second module was deployed in the ascending aorta. Despite the good perioperative outcome with no cerebrovascular events, the patient died 20 days later because of sudden iliac rupture.

Features on cardiac magnetic resonance imaging and accuracy of echocardiographic findings for diagnosing constrictive pericarditis

Constrictive pericarditis is a rare disease with a difficult diagnosis. Cardiac magnetic resonance (CMR) imaging data of Aga Khan University Hospital, from January 2011 to March 2020 was retrospectively reviewed and patients with the diagnosis of constrictive pericarditis were included. A total of 22 patients were included with the mean age of 46 + 16 years and majority (77%, n=17) being male. The most common findings on transthoracic echo were significant respiratory variation in mitral and tricuspid inflow velocities (91%, n=20) and septal annular e’>9 (86%, n=19). Most common finding on CMR was respiratory septal shift in 100% (n=22) followed by septal bounce in 95% (n=21), and thickened pericardium in 82% (n=18). Nearly two-third patients (n=15) were considered for pericardiectomy but it was deferred in 5 patients due to high surgical risk. Ten patients underwent pericardiectomy with no mortality on a mean follow up of 4 + 2 years. Continuous...

The First Experience of Aortic Valve Repeated Replacement Using the “Valve in Valve” Technique in a Patient With Dysfunction of a Biological Prosthesis

Introduction. Aortic valve replacement in cardiopulmonary bypass with suture fixation of the prosthesis is the “gold standard” in cardiac surgery. Currently, the frequency of use of heart valve bioprostheses is increasing in older patients. Despite all the advantages of using heart valve bioprostheses, this type of prosthesis has a major drawback - it is not durable. In most cases, the reason for the dysfunction of prostheses in the late postoperative period is early calcification of the prosthesis valves or their rupture due to degeneration. With the development of new “gentle” techniques for replacing heart valves, transcatheter aortic valve implantation was introduced into clinical practice. The use of transcatheter aortic valve implantation (TAVI) “valve in valve” for reoperations in older patients is of great interest, since in recent years the procedure has been widely used in clinical practice and shows promising data in patients with high surgical risk.Aim of study. Show first experience of using a technique «valve in valve» at N.V. Sklifosovsky Research Institute for Emergency Medicine.Material and methods. The results of surgical treatment of a patient with aortic valve bioprosthesis dysfunction using the TAVI “valve in valve” technique are presented.Results. The use of the TAVI “valve in valve” method made it possible to perform reprosthetics of the aortic valve (AV) from a transfemoral approach, not to increase the volume of intervention during reoperation, to avoid trauma to the structures of the heart and nearby tissues when accessing the AV in a patient with a high surgical risk.Conclusion. The use of the TAVI “valve in valve” method in cardiac surgery makes it possible to achieve good immediate and long-term results when it is necessary to replace the AV in patients with a high surgical risk.

Ventricular septal intramyocardial dissection after cardiac fibrosarcoma excision

Intramyocardial dissection following cardiac tumor excision is uncommon. The evidence available is limited to few case reports. Herein,we report an infant with large cardiac fibrosarcoma arising from the interventricular septum and underwent surgical excision.One month after surgery echocardiography revealed a cystic dissection located in the interventricular septum with residual shunts within the ventricular chambers. we performed conservative strategy due to the high surgical risk, difficulty of interventional therapy and hemodynamic stability.

Gastric volvulus is a rare and life-threatening abdominal pain

Gastric volvulus is a rare and life-threatening abdominal pain condition resulting from the stomach twisting on its own longitudinal (organo-axial) or transverse (mesentero-axial) axis. Gastric volvulus can be primary or secondary. Secondary is most commonly related to para-esophageal hernia. Gastric volvulus can have an acute or chronic presentation, the acute form presents abdominal pain with a risk of gastric ischemia with subsequent perforation. Diagnosis is made by imaging studies such as barium contrast studies in the upper digestive tract or abdominal and chest computed tomography (CT). CT of the abdomen and thorax is very useful in the diagnosis as it can demonstrate the abnormal position and gastric torsion The goal in the definitive treatment of gastric volvulus is resolution of gastric obstruction and prevention of recurrence. Performing volvulus reduction, repair of the concomitant cause (para-esophageal hernia), fundoplication and/or gastropexy to the anterior abdominal wall. Gastropexy is considered safe and effective in elderly patients with high surgical risk.

Transcatheter mitral valve-in-valve implantation: a 10-year single center experience

Background Transcatheter mitral valve-in-valve (TMVIV) appears a reasonable alternative to surgical redo mitral valve replacement in patients with degenerated mitral prosthesis and high surgical risk with favorable early and mid-terms outcomes. Long-term outcomes are limited by high mortality in a comorbid population. Purpose We aimed to evaluate early prosthesis hemodynamic performance and late clinical outcomes following TMVIV. Methods All patients who underwent TMVIV for degenerated surgical mitral bioprostheses from 2011 to 2020 in our center were included. Prospectively collected demographic, clinical, procedural, and imaging variables were analyzed. Clinical and echocardiographic outcomes were defined according to Mitral Valve Academic Research Consortium (MVARC) definitions and assessed at 30-day and at the latest follow-up available. Results A total of 67 patients were included; mean age 76.9±9.6 years, mean STS score 11.0±6.2%, 53.7% male (n=36). Mechanisms of bioprosthetic failure were mitral stenosis (n=32, 47.8%), mitral regurgitation (n=24, 35.8%), and mixed (n=11, 16.4%). Mean time from mitral valve surgery to TMVIV was 10.2±4.3 years. Access was mostly transapical (n=45; 67.2%), followed by transseptal (n=22; 32.8%). Following the first transseptal procedure in 2016; transseptal access accounted for the majority of procedures (22 of 37 cases, 59.4%). Technical success was achieved in 65 patients (97.0%). Mean hospitalization was 9.2±10.0 days; shorter with the transseptal as opposed to the transapical approach (6.3±8.1 days versus 11.0±10.5 days, p=0.001). At 30-day echographic follow-up, mean mitral valve gradient was 7.3±2.7 and 1 patient (1.9%) had mitral regurgitation >mild. At 30-day follow-up, 3 patients had died (4.5%); due to left ventricular outflow tract obstruction (1), heart failure (1), and stroke (1). New pacemakers were required in 2 patients (3.0%) and pacemaker lead dislodgement occurred in 1 patient (1.5%), 4 patients (6.2%) were hospitalized for heart failure. At a median follow-up of 3.8 years [1.7–5.1], 29 patients had died (43.3%), valve thrombosis was found in 6 (8.9%) and endocarditis in 4 patients (6.2%). Mitral valve reintervention was performed in 4 patients (6.2%); redo TMVIV due to valve migration in 1 (1.9%), surgical valve replacement in 1 (1.9%), and delayed redilation with a non-compliant balloon due to underexpansion in 2 patients (3.8%). Conclusion TMVIV is associated with acceptable 30-day mitral valve hemodynamics. Long-term mortality remains high in this high-surgical risk comorbid group. FUNDunding Acknowledgement Type of funding sources: None.