Augmentation of the posterior mitral leaflet in secondary mitral valve insufficiency, mid-term results.

Objectives: We evaluate the mid-term results of mitral valve (MV) repair with patch augmentation of the posterior leaflet in secondary mitral regurgitation.

Methods: Patients were included after diagnosis of a severe symptomatic secondary MV insufficiency with grade III and IV according to the Carpentier classification IIIb. Indication for a patch augmentation technique was a dilatation of the left ventricle leading to a displacement of the papillary muscles, causing restricted leaflet motion and a marked leaflet tenting height.

Mitral valve repair for degenerative mitral valve regurgitation.

In industrialized countries, the most common etiology of mitral regurgitation (MR) is degenerative mitral valve (MV) disease. The natural history of severe degenerative MR is poor. However, its appropriate and timely correction is associated with a life expectancy similar to that of the normal population.

[Hemodynamic monitoring - imaging procedures / cardiac ultrasound].

Echocardiography as an imaging method in anaesthesia and intensive care medicine has enabled a new dimension of hemodynamic monitoring: the direct visualization of the cardiac function and its disruptions. Preconditions for a broad application in this area was the development of mobile, high-definition ultrasonic devices and the origination of focused examination techniques. A successful application of this method requires the respective know-how of the examiner, in order to take relevant decisions and avoid misdiagnoses.

Totally endoscopic set-up for mitral valve repair.

Minimally invasive mitral surgery is increasingly recognized as routine. We describe here the financially economical set-up for totally endoscopic surgery, which also represents currently the smallest surgical access, limited only by prosthesis and retractor size. This allows the full range of repairs to be performed.

Rate of repair in minimally invasive mitral valve surgery.

Background: Valve repair has been shown to be the method of choice in the treatment of patients with severe mitral valve regurgitation. Minimally invasive surgery has raised skepticism regarding the rate of repair especially for supposedly complex lesions, when anterior leaflet involvement or bileaflet prolapse is present. We sought to review our experience of all our patients presenting with degenerative mitral valve regurgitation and operated on minimally invasively.

Transesophageal echocardiography for detection of a papillary fibroelastoma of the aortic valve.

Papillary fibroelastoma (PF) is a benign cardiac tumor, typically attached to the cardiac valves. It is usually found incidentally at autopsy or surgery. It is rarely symptomatic, but can cause myocardial infarction, cerebral infarction and systemic embolism, even in young patients, and sometimes results in sudden death.

Contained rupture of the aorta in acute Stanford type A aortic dissection causing right ventricular wall dissection.

We describe a rare case of an acute aortic type A dissection after previous aortic valve replacement and coronary artery revascularization complicated by a contained rupture and right ventricular wall dissection. Although preoperatively echocardiography and CT scan described a pericardial hematoma, intraoperatively no intrapericardial hematoma was found; instead an extended right ventricular wall dissection caused by a large thrombus formation within the right ventricular muscle layers was demonstrated. After replacement of the ascending aorta and removal of the thrombus as the sole treatment for right ventricular wall dissection, the two dissected layers of the right ventricular wall were contracting synchronously again.

Toward a new paradigm for the reconstruction of posterior leaflet prolapse: midterm results of the "respect rather than resect" approach.

Background: The aim of mitral valve reconstruction is restoration of good coaptation surface. Resection of the prolapsed area has been the accepted technique to repair prolapse of the posterior leaflet (PPL). However, as leaflet tissue is the basic component of coaptation surface, the logical corrective approach was thought to be the transformation of the posterior leaflet into a smooth vertical buttress without resection, the "respect rather than resect" approach.

Aortic valve leaflet reconstruction after excision of a papillary fibroelastoma using autologous pericardium.

We report on a case of a rare tumor attached to the nodulus arantii of the left coronary cusp in a 56-year-old female patient. She was referred to our institution for a non-ST elevation myocardial infarction after a troponin-positive test. Diagnosis was made by echocardiography and confirmed by surgery.

[The effect of a thigh tourniquet on the pharmacokinetics of midazolam].

Although the general pharmacokinetics of midazolam (M) are well documented, little is known about the possible effects of a thigh tourniquet on the distribution and elimination of this drug. METHOD. Institutional approval for the study and individual informed consent were obtained.

Plasma level changes of fentanyl and midazolam after release of a prolonged thigh tourniquet.

In 14 elderly orthopedic patients undergoing total knee joint replacement, the influence of complete arterial occlusion of the limb on the course of plasma levels of fentanyl and midazolam was examined. The patients were premedicated with midazolam intramuscularly (0.05 mg/kg) and were then given neurolept anesthesia in dosages of 0.