No abstract

From our study, bicuspidization is an attractive surgical option to repair UAV, particularly in young patients who do not want to be subjected to long-term anticoagulation therapy or who refuse a more traditional surgical approach, such as Ross procedure, for reasons described previously.

We report the case of a 31-year-old female in her 32nd week of pregnancy, who experienced an acute type A aortic dissection resulting in severe aortic insufficiency, dissection of the left anterior descending coronary artery, and left ventricular infarct with ejection fraction of 20%. After a successful cesarean section, she underwent a Bentall operation and three-vessel coronary artery bypass grafting. Despite maximal inotropic support, her cardiovascular indices deteriorated postoperatively. On the first postoperative day she was started on mechanical circulatory support with the Levitronix CentriMag left ventricular assist device. Her myocardial function improved and she was successfully weaned from this mechanical support on post-implant day 14. She remains alive and well to date.

Klippel-Feil syndrome has been associated with cardiovascular malformations, but only 3 cases have been reported to be associated with aortic coarctation and surgical management is not defined. A 51-year old woman with Klippel-Feil syndrome associated with an aneurysm of the ascending aorta, hypoplastic aortic arch and aortic coarctation at the level of the left subclavian artery presented with shortness of breath 2 years after diagnosis. Imaging identified interim development of a 7.2-cm aneurysm at the level of the aortic coarctation. She underwent surgical repair with a Dacron interposition graft under hypothermic circulatory arrest. She continues to do well 18 months following repair.

Fibrilácia predsiení (AF) je najčastejšou komplikáciou po operácii srdca. Len niekoľko štúdií popisuje incidenciu a rizikové faktory pooperačnej fi brilácie predsiení (POAF) po izolovanej operácii aortálnej chlopne (AVR). Dôležité je aj to, že miesto zavedenia ventu počas AVR môže vytvoriť lokality s pomalým vedením vzruchu, čo predstavuje substrát pre vznik re-entry. Cieľom štúdie je porovnať vplyv techniky zavedenia ventu cez truncus pulmonalis (PA) a pulmonálnu žilu (PV) počas AVR na incidenciu POAF. Do retrospektívnej štúdie boli zaradení pacienti (n = 497) podstupujúci izolovanú AVR, okrem pacientov s predoperačnou permanentnou AF alebo implantovaným kardiostimulátorom. Použitie techniky ventovania srdca cez PV v porovnaní s ventom cez PA je spojené so signifi kantnou prolongáciou času mimotelového obehu o 10,6 minúty (p < 0,0001, 95 % CI 7,76-13,35), času svorky aorty o 7,7 minúty (p < 0,0001, 95% CI 5,34-10,16), predĺžením pobytu pacienta na jednotke intenzívnej starostlivosti o jeden deň (p = 0,0025, 95% CI 0,34-1,56) a času hospitalizácie o 1,4 dňa (p = 0,003, 95% CI 0,34-2,23). Skupina pacientov s ventom zavedeným cez PV vykazovala v porovnaní s pacientmi s ventom cez PA 32%-ný relatívny nárast incidencie POAF (34 %-PA, 45 %-PV, p = 0,03). Univariačná logistická regresná analýza identifi kovala implantáciu ventu cez PV ako rizikový faktor vzniku POAF (p = 0,04, OR 1,50, 95% CI 1,02-2,22).