Double valve replacement in a patient with Maroteaux - Lamy syndrome as an ultimate team challenge.

Background: The Maroteaux-Lamy syndrome (Mucopolysaccharidosis type VI) is a rare, inherited metabolic disease that results in progressive tissue accumulation of dermatan-sulfated glycosaminoglycans and inflammatory consequences that almost always affects the heart valves. From the anesthesia point of view, managing the airway and ventilation might be a serious challenge due to specific features of the syndrome. Additionally, it is more than probable that the surgical team will perform a non-straightforward procedure.

Surgical resection of a cardiac lipoma of the right ventricle.

Cardiac lipomas are rare, benign, encapsulated tumors which predominantly appear outside of the heart and less frequently inside the cardiac chambers. We describe a case of a right ventricular cardiac lipoma in a 72-year-old female patient who presented with palpitations. Surgical considerations, diagnostic modalities, and up-to-date literature are also presented and discussed.

Late in-hospital Rupture of a Chronic Post-traumatic Pseudoaneurysm.

Chronic posttraumatic pseudoaneurysms of the thoracic aorta are rare clinical entities. Herein, we report a case of an in-hospital cervical rupture of a chronic posttraumatic false aneurysm of the aortic isthmus in a 48-year-old man who had been involved in a traffic accident 20 years earlier.

Eighteen years of clinical experience with a modification of the Bentall button technique for total root replacement.

Background: We retrospectively reviewed our experience with the modified Bentall procedure and evaluated the short- and long-term results over a period of 18 years.

Methods: Between 1999 and 2017, 89 patients with a mean age of 57.3±13.

Aortic Arch. The Final Frontier in Cardiac Surgery.

Aortic arch pathologies such as acute aortic dissection and aneurysmal disease represent surgical challenges. Various emerging techniques and surgical prostheses have expanded the therapeutic armamentarium over the last years with one principal objective; to simplify the operation and reduce the surgical time. Besides the classic elephant trunk which has been regarded as an evolutionary leap in the treatment of extensive thoracic disease, other novel surgical approaches such as the frozen elephant trunk, the thoracic endovascular aortic repair (TEVAR) and the hybrid open branched stent grafts have been introduced.

Distal embolization of a transcatheter valve in a valve complex: a bail-out surgical approach.

Transcatheter aortic valve replacement has emerged as an alternative to surgical aortic valve replacement for high-risk and inoperable patients. Although transcatheter aortic valve replacement avoids the use of extracorporeal circulation and sternotomy, it is nonetheless associated with inherent complications. We aim to present an embolized valve-in-valve complex in the ascending aorta, which required emergency surgery with deep hypothermic circulatory arrest and proximal aortic cannulation.

Intrapericardial bronchogenic cyst found incidentally during open heart surgery.

Bronchogenic cysts are embryological remnants occurring as developmental abnormalities of the primary foregut. The most common locations of these cysts are the mediastinum, lung parenchyma, and inferior pulmonary ligament. An intrapericardial location is an extremely rare finding.

Prognostic factors of atrial fibrillation following elective coronary artery bypass grafting: the impact of quantified intraoperative myocardial ischemia.

Background: Atrial fibrillation (AF) occurs in 28-33% of the patients undergoing coronary artery revascularization (CABG). This study focuses on both pre- and peri-operative factors that may affect the occurrence of AF. The aim is to identify those patients at higher risk to develop AF after CABG.

Carotid shunt provides cerebral protection during emergency coronary artery bypass grafting in a patient with bilateral high grade carotid stenosis: a case report.

Background: Management of patients with co-existent coronary and carotid disease is a controversial and challenging issue. The risk for stroke after coronary artery bypass grafting (CABG) in patients with hemodynamically significant carotid stenosis is up to 30%. In these patients a common practice is to proceed first with the restoration of cerebral perfusion and then perform the coronary revascularization.

Transcriptional regulation of TIMPs in ascending aorta aneurysms.

The events that result in the establishment and progression of aortic aneurysms are complex and multifactorial. However, degradation of the extracellular matrix (ECM) of aortic tunica media appears to be a consistent histopathological and biochemical feature. An increased local expression of matrix metalloproteinases (MMPs) as well as an imbalance between MMP expression and the expression of their natural tissue inhibitors (TIMPs) have been demonstrated in dilated aortic wall.

Stented within a stentless aortic valve. A simple surgical solution for the replacement of a stentless aortic bioprosthesis.

Stentless aortic bioprostheses are designed to offer better hemodynamics, less mechanical stress to the leaflets and as a result less degeneration. Although encouraging results are reported, little evidence has been published regarding reoperations of stentless valves. We are reporting a case of a structural valve dysfunction of an O'Brien-Angell stentless prosthesis, which could not be extracted during reoperation without damaging the aortic root.

Two stage hybrid approach for complex aortic coarctation repair.

Background: Management of an adult patient with aortic coarctation and an associated cardiac pathology poses a great surgical challenge since there are no standard guidelines for the therapy of such complex pathology. Debate exists not only on which lesion should be corrected first, but also upon the type and timing of the procedure. Surgery can be one- or two-staged.

Asymptomatic pseudo-aneurysm of the aortic arch in a patient with aberrant right subclavian artery. A complication of Kommerell's diverticulum?

Kommerell's diverticulum is an aortic arch deformity associated with an aberrant subclavian artery. Symptoms related to compression of adjacent structures, dilatation of the aortic diverticulum or accelerated atherosclerosis leading to increased risks of dissection and rupture represent the indications for surgical treatment. Several surgical strategies have been used for the management of this congenital abnormality.

Long-term thyroid hormone administration reshapes left ventricular chamber and improves cardiac function after myocardial infarction in rats.

Thyroid hormone (TH) is critical for tissue differentiation at early stages of development, induces physiological hypertrophy and regulates the expression of important contractile proteins such as myosin heavy chain (MHC) isoform and calcium cycling proteins. Furthermore, TH seems to control the response to stress by regulating important cardioprotective molecules such as heat shock proteins (HSPs). Thus, the present study investigated whether TH administration immediately after acute myocardial infarction can favourably remodel the post-infarcted myocardium.

Chinese-hat patch glue repair of incomplete apical ventricular rupture.

Left ventricular free wall rupture is a dramatic complication of myocardial infarction. Sub-acute rupture may be compatible with life for several days or even longer. We present a simple and effective technique of construction of a conical apical patch, Chinese-hat, which was applied successfully to the infracted left ventricular (LV) apex with surgical glue, without using cardiopulmonary bypass.

Thyroid hormone attenuates cardiac remodeling and improves hemodynamics early after acute myocardial infarction in rats.

Objective: Cardiac remodeling of viable myocardium occurs after acute myocardial infarction (AMI) and further contributes to cardiac dysfunction. The present study explored whether thyroid hormone (TH) administered shortly after AMI in rats can attenuate cardiac remodeling and improve cardiac function. TH regulates important structural and regulatory proteins in the myocardium including myosin isoform expression and calcium cycling proteins.

Ulcerated calcification of the interventricular septum causing transient ischemic attacks: case report.

Background: Calcific deposits are frequently observed at sites of healed myocardial infarcts. Grossly visible calcification of myocardial infarcts and calcified intracavitary cardiac thrombi are less common but recently are becoming more frequent findings during surgical ventricular restoration procedures.

Case Presentation: A 64 year old male diabetic patient experienced two episodes of transient ischemic attacks during the last six months.

Time-dependent changes in the expression of thyroid hormone receptor alpha 1 in the myocardium after acute myocardial infarction: possible implications in cardiac remodelling.

The present study investigated whether changes in thyroid hormone (TH) signalling can occur after acute myocardial infarction (AMI) with possible physiological consequences on myocardial performance. TH may regulate several genes encoding important structural and regulatory proteins particularly through the TR alpha 1 receptor which is predominant in the myocardium. AMI was induced in rats by ligating the left coronary artery while sham-operated animals served as controls.

Enhanced tolerance of the rat myocardium to ischemia and reperfusion injury early after acute myocardial infarction.

It is now recognized that changes occurring during cardiac remodeling may influence the tolerance of the myocardium to ischemic stress. Therefore, the present study investigated the response of the post-infarcted heart to ischemia in an experimental model of ischemia and reperfusion injury and the possible underlying mechanisms. Acute myocardial infarction (AMI) was induced in Wistar male rats by ligating the left coronary artery (AMI, n = 13), while sham-operated rats were used as controls (SHAM, n = 11).

Effect of exogenous nitric oxide during cardiopulmonary bypass on lung postperfusion histology.

We tested the hypothesis that nitric oxide (NO) administered during cardiopulmonary bypass (CPB) would preserve platelets and prevent postperfusion lung changes. Ten anesthetized Yorkshire pigs were put on normothermic CPB (right atrium to aorta) with a roller pump and membrane oxygenator for 1 hour. In the study group (n = 5), NO was delivered in the oxygenator's gas inflow line with a MiniNO system at 5-10 ppm throughout CPB.