Aortic and aortic-mitral annular enlargement

Abstract

Letters to the Editor 2 0 7 nected to the ECLS system with a Y-shaped heparinbonded connector. The ECLS flow is started and slowly increased as the CPB flow is slowly decreased and then stopped. The superior vena caval cannula used for CPB is then removed. Teflon tapes that were placed around the femoral artery and vein are loosely tied, cut short, and left in the wound so that the vessels can be easily found during the second-look operation. Both Dacron grafts are left in the subcutaneous space. One gram of kanamycin powder is placed on the wound and the wound is closed.In case of perioperative myocardial infarction, we consider the combination of ECLS and intraaortic balloon pumping to be the best means to unload the heart and augment coronary flow so that the stunned myocardium can rest and recover from the acute ischemic injury. 4 The present technique provides the following advantages: (1) Myocardial damage is avoided and systemic circulation is maintained while mechanical support is set up; (2) ischemic or congestive complications of the lower leg are lessened; (3) massive bleeding, which is the most serious complication of ECLS, is infrequent2; (We have recently stopped using heparin and now use nafamostat mesilate applied to the inflow of the centrifugal pump to achieve an activated clotting time of 140 seconds. This system can run for 48 to 72 hours without fibrin clot formation or thromboembolic complications.); (4) fewer complications are caused by reopening the chest or mediastinum, which necessitates general anesthesia. Only local anesthesia and simple surgical techniques are necessary to remove the cannulas in our method.ECLS is a reasonable mechanical support system for postcardiotomy cardiac failure, especially in the case of perioperative myocardial infarction. Our technique is recommended to allow easy weaning from CPB and to safely maintain long-term mechanical support.

Long-term outcomes after mechanical aortic valve replacement with aortic root enlargement in adolescents

“…In the adolescent patients with growth potential, aortic root enlargement techniques minimize the risk of PPM by allowing insertion of a prosthetic valve one to two sizes larger than with an AVR alone. Those techniques include the Nicks procedure, in which the aortic incision is extended to the area between the left/non coronary commissure and the base of the noncoronary cusp into the area of intervalvular fibrosa without cutting into the anterior mitral valve (MV) leaflet; the Manougian procedure, which has the same incision as in the Nicks procedure but the incision is extended across the intervalvular fibrosa into the center of the anterior MV leaflet; or the Konno procedure, in which the aortic annulus is incised between the right and left coronary cusps extending into the ventricular septum with patch reconstruction of the septum and the ascending aorta …”

“…The effective orifice area (EOA) indexed to BSA should be >0.95 cm 2 /m 2 . A posterior aortic root enlargement was performed using the Manougian technique with the aortotomy extending into the non‐coronary sinus and into the anterior leaflet of the mitral valve . The reconstruction of the defect was done with a teardrop‐shaped glutaraldehyde‐treated patch of bovine pericardium.…”

Small Aortic Annulus: Aortic Allografts vs Perceval S

“…Разрез на передней митральной створке смещается влево, ближе к медиальной комиссуре митрального клапана, часто при имплантации заплаты возникает асимметрия створки и вследствие этого недостаточность. Техническая сложность и продолжительность операции связаны с большим риском послеоперационного кровотечения и, возможно, делают применение данного вида вмешательства неоправданным [6][7][8][9].…”

“…Функция протезов аортального клапана оценивалась на 7-10-е сутки и через год после операции. Для оценки выраженности феномена ППН за основу были приняты следующие значения: ППН считался тяжелым при индексированной площади эффективного отверстия (иПЭО) ≤0,65 см 2 /м 2 , умеренным -при иПЭО от 0,65 до 0,85 см 2 /м 2 [7,8].…”

Options for Surgical Treatment of Aortic Valve Defects in Patients With a Narrow Fibrous Ring

“…Для этого используют процедуры, разработанные R. Nicks и S. Manouguian, позволяющие увеличить размер аортального кольца за счет рассечения кольца аортального клапана, что позволяет увеличить посадочный диаметр клапана на 2-4 мм. Техника S. Konno дает возможность увеличить диаметр кольца аортального клапана более чем на 4 мм [25][26][27].…”