Redo surgery for a type A aortic dissection in a pregnant woman with Marfan syndrome: a complex clinical case.

Aortic dissection during pregnancy is a very rare event in the general population but can be fatal to both the mother and the fetus. A rate of dissection as high as 10% was observed in pregnant patients affected by Marfan syndrome. Facing this kind of disease can represent a challenge for the involved physicians because of its rarity.

Papillary fibroelastoma of an anomalous mitral valve chorda.

Cardiac papillary fibroelastoma (CPF) is a rare primary cardiac tumour. This tumour constitutes about 10-15% of all primary cardiac tumours. We report here a case of CPF of an anomalous mitral valve chorda.

A rare case of anterior chest closure only with omental flap after devastating mediastinitis: case report.

We describe a case of 73-year-old patient who has been operated in emergency on triple coronary artery bypass graft (CABG), which was complicated with respiratory insufficiency and devastating mediastinitis. The anterior mediastinum was closed with an omental flap that was allowed to epithelize spontaneously. The patient was discharged after 110 days.

Left ventricle remodelling by double-patch sandwich technique.

Background: The sandwich double-patch technique was adopted as an alternative method for reconstruction of the left ventricle after excision of postinfarction dysfunctional myocardium to solve technical problems due to the thick edges of the ventricular wall.

Methods: Over a 5-year period, 12 of 21 patients with postinfarction antero-apical left ventricular aneurysm had thick wall edges after wall excision. It was due to akinetic muscular thick tissue in 6 cases, while in the other 6 with classic fibrous aneurysm, thick edges remained after the cut of the border zone.

The BICIRCUIT system: innovative perfusional options for surgical treatment of the thoracic aorta.

Purpose: Surgical treatment of the thoracic aorta may become challenging when a rapid switch from left heart bypass (LHB) to cardiopulmonary bypass (CPB) is required.

Description: We designed a BICIRCUIT system using a centrifugal pump, a heparinized CPB circuit with a hollow fiber oxygenator, two 3/8 x 3/8 x 3/8 connectors (one placed at the bell inlet draining blood from the left atrium or the venous reservoir and the second placed at the bell outlet directing blood to the oxygenator or femoral artery). Our priming volume was 1100 mL; when switching from LHB to CPB, no additional priming volume was required.

Left internal thoracic artery-radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation.

Objectives: The technique of choice for myocardial revascularization in elderly patients remains a debated issue. We evaluated the potential advantages of the use of left internal thoracic artery-radial artery composite grafts compared with conventional coronary artery bypass grafts in elderly patients.

Methods: We prospectively enrolled 160 patients aged more than 70 years scheduled to undergo isolated myocardial revascularization.

[Papillary fibroelastoma of the septal leaflet of the tricuspid valve. Report of a case and review of the literature].

Papillary fibroelastoma is a rare benign cardiac tumor typically attached to the cardiac valves. The tumor is recognized during life, more often in patients evaluated for embolic events of unclear pathology, but sometimes also in totally asymptomatic patients. There is a general agreement that left-sided fibroelastomas must be removed to avoid systemic complications.

Total arterial myocardial revascularization with composite grafts improves results of coronary surgery in elderly: a prospective randomized comparison with conventional coronary artery bypass surgery.

Background: Total arterial myocardial revascularization with composite grafts proved to enhance the long-term benefits of coronary surgery. We assessed the hypothesis that full arterial revascularization (FAR) may improve clinical outcome even in elderly and at short term.

Methods And Results: A prospective randomized study was designed to compare FAR with conventional coronary artery bypass grafting (CABG) surgery [left interval thoracic artery (LITA) on left anterior descending (LAD) plus additional saphenous vein grafts] with the following end points: early and late death, graft occlusion, reintervention, angina recurrence, and acute myocardial infarction (AMI).

Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study.

Background: We investigated whether off-pump coronary artery bypass (OPCAB) surgery should be the procedure of choice in total arterial myocardial revascularization with composite grafts.

Methods: We prospectively enrolled 176 patients undergoing total arterial myocardial revascularization and assigned them at random to one of two groups: group 1 was composed of 88 patients undergoing coronary surgery with cardiopulmonary bypass (CPB); group 2 consisted of 88 patients receiving the OPCAB procedure. We excluded from this study patients with significant risk factors for CPB-related morbidity.

Is total arterial myocardial revascularization with composite grafts a safe and useful procedure in the elderly?

Objective: The aim of the study was to evaluate the mid-term results of total arterial myocardial revascularization (TAMR) with composite grafts in patients older than 70 years when compared to standard CABG technique, since the usefulness of TAMR in the elderly has not been demonstrated yet.

Methods: A prospective randomized study was designed with the following end-points: post-operative complications, death, recurrence of angina, graft occlusion, any cardiac event and reinterventions. One hundred and eighty-eight patients older than 70 years were enrolled and assigned to Group 1(G1)=94 pts, for total arterial revascularization or Group 2(G2)=94 pts, for standard CABG (LITA on LAD plus additional saphenous veins).

Safety and usefulness of composite grafts for total arterial myocardial revascularization: a prospective randomized evaluation.

Objectives: To evaluate the results of total arterial revascularization with composite grafts compared with the results of conventional coronary surgery, we enrolled 200 consecutive patient undergoing myocardial revascularization.

Methods: Patients were randomly assigned to 2 groups of 100 patients each: group 1 underwent total arterial revascularization, and group 2 received left internal thoracic artery on left anterior descending artery grafts plus additional saphenous vein grafts. The groups were comparable in terms of continuous and discrete variables and preoperative risk factors.

Monitoring high-dose heparin levels by ACT and HMT during extracorporeal circulation: diagnostic accuracy of three compact monitors.

The correct monitoring of heparin therapy and its reversal determines the successful conduct of cardiovascular surgery with extracorporeal circulation (ECC). The activated coagulation time (ACT) and the heparin management test (HMT) are the most frequently used tests in the operating room. Three compact monitors for ACT or HMT are here evaluated.