Antiplatelet Therapy for Long-Term Management of Patients with Mechanical Aortic Prostheses.

Background: A mechanical aortic prosthesis (MAP) may cause platelet activation secondary to shear forces, and the release of adenosine diphosphate (ADP). This platelet-mediated event may lead to arterial embolism. Traditionally, warfarin has been used to treat such cases, although this anticoagulant has no inhibitory effects on platelets.

Carotid endarterectomy in the era of endovascular therapy: still the gold standard.

Background: Carotid stenosis is the most common cause of ischemic stroke and is managed by carotid endarterectomy. We report our ten-year results of carotid surgery for stenosis and kinking of the internal carotid artery (ICA).

Methods: Four hundred sixty nine patients underwent surgery: 306 localized carotid endarterectomy, 107 extensive endarterectomy, 18 shortening of the ICA plus endarterectomy, 42 endarterectomy plus coronary artery bypass, 11 endarterectomy plus bypass to another cervical artery, and 1 endarterectomy with aortic valve replacement.

The "crush and aspiration" technique for debridement of the aortic annulus revisited.

An effective technique for the debridement of the aortic annulus using a needle holder to crush the calcify nodules, follow by the immediate aspiration of the pulverized material using a Yankauer suction device is reported.

Initial experience with dual antiplatelet thromboprophylaxis using clopidogrel and aspirin in patients with mechanical aortic prostheses.

Background And Aim Of The Study: The aortic mechanical prosthesis (AMP) generates shear stress and causes erythrocyte fragmentation with ADP release that leads to platelet activation, the cause of thromboembolism. Thromboprophylaxis with the antiplatelet agents clopidogrel and aspirin (Clop-ASA) should reduce thromboembolic events in patients receiving an AMP.

Methods: Over an eight-year period at the authors' institutions, a total of 135 patients underwent aortic valve replacement (AVR), with or without concomitant thoracic aortic procedures, and received Clop-ASA as thromboprophylaxis.

Short- and long-term efficacy of aspirin and clopidogrel for thromboprophylaxis for mechanical heart valves: an in vivo study in swine.

Objective: In the interest of exploring alternatives to warfarin, we tested the hypothesis that clopidogrel combined with aspirin is effective for thromboprophylaxis of mechanical valves using a swine model.

Methods: Adult swine underwent heterotopic implantation of a modified bileaflet mechanical valved conduit bypassing the ligated, native descending thoracic aorta. Animals were randomized to no anticoagulation (n = 7), 175 U/kg dalteparin administered subcutaneously twice daily (n = 9), 325 mg of aspirin (n = 6), 75 mg of clopidogrel (n = 6), or 325 mg of aspirin and 75 mg of clopidogrel daily (n = 6) and survived for 30 days.

Tricuspid anterior leaflet replacement with autologous pericardium and polytetrafluoroethylene chordae, followed by edge-to-edge repair.

Treatment of endocarditis of the tricuspid valve is very complex. Valvectomy without replacement can result in significant postoperative morbidity, and replacement is hazardous due to the possibility of prosthetic infection. Repair of the tricuspid valve is the best alternative.

Surgical treatment of multiple intracardiac and pulmonary artery tumor implants embolic from uterine intravascular leiomyomatosis.

Intravenous uterine leiomyomatosis is the invasion of the para-uterine veins by bundles of benign uterine muscle. These muscle bundles can grow and extend directly to pelvic organs or embolize to the right cardiac chambers or pulmonary artery. We report a patient who presented with two large mobile atrial masses that were seen on echocardiography.

Surgical treatment of right coronary arteries with anomalous origin and slit ostium.

Background: Right coronary arteries arising in the left sinus or ectopically in the anterior coronary sinus with slit ostium course inside the aorta. They are subject to variable systolic compression and can cause myocardial ischemia with its sequelae or death.

Methods: From May 1991 to March 2003, we treated 16 patients with anomalous origin of the right coronary artery from the left sinus and 4 whose right coronary artery arose ectopically in the anterior sinus.

Implantation of cryopreserved allograft pulmonary monocusp patch to treat nonthrombotic femoral vein incompetence.

We implanted cryopreserved allograft monocusp patches made from cadaveric pulmonary arteries to correct nonthrombotic valvular insufficiency of the common femoral vein in patients with chronic venous ulcers. Thirty-eight patients with 40 ulcers of longer than 3 years' duration underwent valvular repair of the common femoral vein from September 1995 through November 2001. We studied ulcer healing and competence of the monocusp patches using duplex ultrasonography Three patients with a total of 4 ulcers were lost to follow-up; therefore, 35 patients with 36 ulcers were available for examination.

Repair of posterior coronary lacerations.

Posterior lacerations of the coronary arteries that occur during arteriotomy should be repaired if significant. We describe a modification of the standard technique to repair posterior coronary artery lacerations. This technique avoids distortion and narrowing of the coronary artery.

Left ventricular volume reduction and reconstruction in ischemic cardiomyopathy.

Background: Ischemic cardiomyopathy can be the result of large or small myocardial infarctions or due to myocardial hibernation. Patients with an end-systolic volume index >100 mL¿m2 do not benefit from revascularization alone and require an operation that reduces ventricular volume. Various approaches to reduce ventricular volume have been described.

Intraluminal milrinone for dilation of the radial artery graft.

There is renewed interest in the use of the radial artery as a conduit for coronary artery bypass surgery. The radial artery is, however, a very muscular artery, prone to vasospasm. Milrinone, a potent vasodilator, has demonstrated vasodilatory properties superior to those of papaverine.

Surgical treatment of aortic dissections: initial experience with the adventitial inversion technique.

Background: The adventitial inversion technique obliterates the false lumen and converts a dissected aorta into a conduit with tough adventitia on the inside and outside. Dacron grafts can be anastomosed to the aorta with fine sutures, which hold without tears.

Methods: From August 1995 to March 1997, we treated 6 patients with acute dissecting aneurysms.

Coronary artery endarterectomy: a method of myocardial preservation.

The lack of acceptable coronary arteries for grafting often causes the cardiac surgeon considerable problems in treating patients with severe coronary artery disease. By combining the standard approach of coronary bypass surgery with coronary endarterectomy and with retrograde coronary sinus cardioplegia perfusion, we can achieve a longer ischemic period and can flush the debris from the coronary arteries in a retrograde fashion. Using this approach, we managed 72 patients with near inoperable coronary artery disease.