Minimally Invasive Mitral Valve Repair: From Total Endoscopic To Closed-Chest Robotic.

Minimally invasive cardiac surgery has evolved over the past few decades, thanks to advancements in technology and surgical techniques. These advancements have allowed surgeons to perform cardiac interventions through small incisions, reducing surgical trauma and improving patient outcomes1. However, despite these advancements, thoracoscopic mitral repair has not been widely adopted by the cardiac surgery community, possibly due to the lack of familiarity with video-assisted procedures1.

ISCHEMIC MITRAL REGURGITATION - TO REPAIR OR REPLACE? LOOKING BEYOND THE VALVE.

Ischemic mitral regurgitation (IMR) is a frequent and serious complication of coronary artery disease, associated with considerable patient increased mortality and morbidity. While the benefits of optimal medical therapy and surgical revascularization, when indicated, are uncontested in moderate to severe cases, the ideal surgical approach to the valve, if any, is yet to be established. Mitral valve repair has established benefits over replacement in primary mitral regurgitation, but its superiority in the treatment of functional regurgitation has not been replicated.

Arterial Stiffness Changes in Severe Aortic Stenosis Patients Submitted to Valve Replacement Surgery.

Background: Little is known about the impact of severe aortic stenosis (AS) in aortic stiffness and if there is any change after removing AS barrier with aortic valve replacement (AVR) surgery.

Objective: To estimate carotid-femoral pulse wave velocity (PWV) changes after AVR surgery and to define PWV predictors in severe AS patients.

Methods: Single-center retrospective cohort, including patients with severe AS who underwent AVR surgery with bioprostheses, between February 2017 and January 2019 and performed PWV measurements (Complior®) before and after the procedure (2±1 months).

An Unusual Case of Tricuspid Stenosis.

Unlabelled: Tricuspid stenosis is an uncommon valvular abnormality commonly associated with other valvular lesions. Ebstein's anomaly is a rare congenital heart malformation characterized primarily by abnormalities of the tricuspid valve and right ventricle. Endomyocardial fibrosis is a restrictive cardiomyopathy observed in tropical and subtropical regions.

Freedom Solo® versus Trifecta® bioprostheses: clinical and haemodynamic evaluation after propensity score matching.

Objectives: The goal of this study was to compare the stentless Freedom Solo® (FS) and the stented Trifecta® (TF) aortic bioprostheses with regard to haemodynamic profile, left ventricular mass regression and early and late postoperative outcomes and survival.

Methods: A longitudinal cohort study of consecutive patients undergoing aortic valve replacement (2009-16) with either the FS or TF at 1 centre was performed. Local databases and national records were queried.

Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction.

Primary cardiac and pericardial tumors are rare entities with an autopsy frequency of 0.001-0.03%.

[Atrioventricular septal defect in an adult patient: There are 'clefts' and clefts].

In this report, we present the case of an adult male with severe mitral regurgitation due to an atrioventricular septal defect. Anatomical assessment by two- and three-dimensional transesophageal echocardiography was essential for detailed morphological characterization and surgical planning. The different features of a 'cleft' in an atrioventricular septal defect compared to an anterior leaflet cleft in an otherwise normal mitral valve are here discussed.

[Do diabetic patients benefit from bilateral internal mammary artery?].

Introduction: Bilateral internal mammary artery (BIMA) grafting has been associated with increased long term survival when compared to single IMA, but its benefit on diabetic patients remains controversial.

Aims: To compare long-term survival following BIMA versus single internal mammary artery (SIMA) grafting between diabetic and non-diabetic patients.

Methods: We retrospectively reviewed all the patients who underwent isolated CABG and received two or more grafts with at least one IMA graft between 2004 and 2013.

The TRIBECA study: (TRI)fecta (B)ioprosthesis (E)valuation versus (C)arpentier Magna-Ease in (A)ortic position.

Objective: To determine whether the Trifecta bioprosthetic aortic valve produces postoperative haemodynamic results comparable with or better than those of the Magna Ease aortic valve bioprosthesis.

Methods: We retrospectively reviewed the medical records of patients who had undergone aortic valve replacement with Trifecta or Magna Ease prostheses at eight European institutions between January 2011 and May 2013, and analysed early postoperative haemodynamic performance by means of echocardiography.

Results: A total of 791 patients underwent aortic valve replacement (469 Magna Ease, 322 Trifecta).

[Bilateral Internal Mammary Artery Versus Single Internal Mammary Artery in Myocardial Revascularization Surgery. Propensity Score - Adjusted Survival Analysis].

Background: Although arterial grafts are superior to venous grafts in terms of long-term patency, single internal mammary artery (SIMA) is still the preferred strategy in most cardiac surgical centres. Our main aim was to compare long- -term survival between BIMA and SIMA at our own tertiary care centre.

Methods: Retrospective cohort including patients referred to Centro Hospitalar São João (CHSJ), from 2004 to 2011, who underwent isolated CABG and received two or more bypass with at least 1 IMA graft.

Angiotensin-(1-7) modulates angiotensin II-induced vasoconstriction in human mammary artery.

Purpose: The renin-angiotensin system plays a key role in cardiovascular pathophysiology and one of its members, angiotensin-(1-7) (ANG-(1-7)), is now recognized as a peptide with the ability to counter-regulate angiotensin II (ANGII) effects. We sought to investigate ANG-(1-7) actions in human vessels, particularly its effect on ANGII-induced vasoconstriction in human mammary arteries (HMA).

Methods: Samples of HMA from patients submitted to coronary revascularization (22 patients, mean age 67 years) were cut into small rings, mounted in a myograph bath system, normalized and allowed to contract and dilate isometrically.

Load independent impairment of reverse remodeling after valve replacement in hypertensive aortic stenosis patients.

Background: We evaluated the impact of hypertension on the left ventricular mass regression in aortic stenosis after aortic valve replacement.

Methods: We prospectively studied 135 patients with severe aortic stenosis at baseline and 1 year after surgery. In 32 patients we analyzed myocardial gene expression of collagen types I and III, connective tissue growth factor, transforming growth factor-β1, metalloproteinase-2 and its tissue inhibitor and compared its levels vs controls.

Ischemic rupture of the anterolateral papillary muscle.

We describe the case of a 59-year-old man who presented with chest pain and ST-segment elevation in the inferior leads, R>S in V1 and ST depression in the anterior leads due to proximal occlusion of the first obtuse marginal. Primary coronary angioplasty and stenting of this artery were performed. Twelve hours later the patient became hemodynamically unstable and severe mitral regurgitation due to rupture of one of the heads of the anterolateral papillary muscle was diagnosed.

Intraventricular pressure gradients throughout the cardiac cycle: effects of ischaemia and modulation by afterload.

The aim of the present study was to characterize the intraventricular pressure gradients (IVPGs) througout the cardiac cycle, to correlate them with myocardial segmental asynchrony and to evaluate the effects of ischaemia and modulation by afterload. Open-chest anaesthetized rabbits (n = 6) were instrumented with pressure-tip micromanometers placed in the apex and outflow tract of the left ventricular (LV) cavity and with sonomicrometer crystals placed in the apex and base of the LV free wall to measure IVPGs and myocardial segment length changes during basal, afterloaded (aortic cross-clamping) and ischaemic conditions (left anterior descending coronary artery ligation). During early diastole (rapid filling), we recorded an IVPG (4.

Magnetic resonance imaging versus echocardiography to ascertain the regression of left ventricular hypertrophy after bioprosthetic aortic valve replacement: results of the REST study.

Objectives: To compare the decrease in left ventricular mass index (LVMI) by magnetic resonance imaging (MRI) versus transthoracic echocardiography (TTE) after aortic valve replacement (AVR) for severe aortic stenosis with Epic and Epic Supra stented porcine bioprostheses (St Jude Medical, Inc, St Paul, Minn).

Methods: This prospective multicenter study enrolled 149 patients who underwent AVR between January 2006 and February 2008. TTE and cardiac MRI measurements of LVMI were made at baseline and at 6 months of follow-up and were compared.

Anomalous origin of the left coronary artery from the pulmonary artery in an asymptomatic adult.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly with a mortality of 90% in the first year of life, if not surgically corrected. Adult presentation of the anomalous origin of the left coronary artery from the pulmonary artery syndrome is extremely rare but may occur if a well-developed collateral circulation from right coronary artery is present. We present the case of a 22-year-old asymptomatic female with anomalous origin of the left coronary artery from the pulmonary artery.

Correlation between plasma levels of apelin and myocardial hypertrophy in rats and humans: possible target for treatment?

Objective: To investigate the effects of left ventricular (LV) pressure overload and diabetes on the apelinergic system.

Research Design/methods: Pressure overload was established in rats by supra-renal aortic-banding. Six weeks later, diabetes was induced by streptozotocin (65 mg/kg, intraperitoneal), resulting in four groups: sham, banded (BA), diabetic (DM) and diabetic-banded (DM-BA).

[Surgical angioplasty of the left main coronary artery. State of the art and initial experience].

Surgical angioplasty of the left main coronary artery has been previously performed in a small number of centres. We present our initial experience with this surgical technique in three consecutive cases. There were no deaths or myocardial infarcts.