New access to facilitate endovascular repair of descending aorta aneurysms.

Coexisting arterial diseases and endoprosthesis to peripheral-vessel mismatch may impair conventional femoral access for endovascular treatment of descending aorta aneurysms. Furthermore, previous abdominal operations can make an optional aortic-iliac approach more difficult. We introduced a new minimally invasive access through the aortic arch, which completely avoids the aortic-iliac access and minimizes surgical trauma.

A cosmetic access for minimally invasive aortic valve replacement without sternotomy in women.

Background: Different methods of replacing the aortic valve via a minimally invasive access have been reported in the recent literature. Although these strategies have clear advantages in terms of reduced surgical trauma, no further refinements in terms of cosmetic results have been made for women.

Methods: Aortic valve replacement was performed in 4 women via a right anterior submammary minithoracotomy without rib resection.

Coronary ostial stenosis after aortic valve replacement.

Coronary ostial stenosis is a life-threatening complication of aortic valve replacement. We describe the case of a patient who developed symptoms and signs related to coronary insufficiency 4 months after aortic valve replacement. In view of a coronary angiogram revealing a 99% left main stem stenosis, an urgent revascularization procedure was performed.

Cardiomyoplasty: long-term results in ischemic cardiomyopathy.

Introduction: Cardiomyoplasty was introduced into clinical practice in 1985 by Alain Carpentier. Since then, the procedure has been performed on more than 400 patients worldwide. The latissimus dorsi muscle is prepared maintaining the vascular supply, then the muscle flap is wrapped around the heart and connected to a cardiomyostimulator.

Minimally invasive aortic valve replacement without sternotomy. Experience with the first 50 cases.

Objective: The method of replacing the aortic valve via a mini-thoracotomy has been reported in the recent literature. Although this strategy has clear advantages, further refinements of the process make the procedure even less invasive.

Methods: Aortic valve replacement was performed in 50 patients whose age ranged between 49 and 82 years, averaging 68+/-8.

Single access for minimally invasive aortic valve replacement.

Background: The method of replacing the aortic valve via a minithoracotomy has been reported in the recent literature. Although this strategy has clear advantages, further refinements of the process make the procedure even less invasive.

Methods: Aortic valve replacement was performed in 27 patients via a right parasternal minithoracotomy without rib resection.

Early results of minimally invasive aortic valve replacement. Experience with the first 34 cases.

Background: The method of replacing the aortic valve via a minithoracotomy has been reported in the recent literature. This strategy has clear advantages. However, further refinements of the process make the procedure even less invasive.

[A rare form of heart metastasis: hypernephroma. Successful surgical treatment].

An unusual cardiac metastasis, occurring in a 63-year-old man 19 years after nephrectomy because of renal cell carcinoma, is reported. The tumor extended from the right ventricle apex to the mid-portion of the interventricular septum. A complete excision could be achieved.

Postoperative disruption of an internal prong-type caval filter--a case report.

A prong-type caval filter fractured and disintegrated within 4 months after its implantation in a 21-year-old woman. The fragments and the disrupted filter were removed surgically and the vena cava was plicated. Seven similar cases were found in the literature.

One-stage intrathoracic repair of extended aortic aneurysms.

Aneurysms of the entire thoracic aorta are usually approached in two to three stages. From 1990 to 1994, we performed one-stage aortic replacement from the root to the diaphragm in 16 patients (8 men and 8 women with a mean age of 55.7 years, range 49 to 73).

Replacement of the entire thoracic aorta in a single stage.

Aneurysms of the entire thoracic aorta are usually approached in two to three stages. From 1990 to 1992, we performed one-stage aortic replacement from the root to the diaphragm in 12 patients (7 men, 5 women; median age, 51 years; range, 49 to 73 years). There were 9 type A dissections, 5 of which were acute.

Left ventricular malposition of a transvenous cardioverter defibrillator lead: a case report.

A case of left ventricular endocardial malposition of a transvenous implantable cardioverter defibrillator (ICD) lead through a patent foramen ovale is presented. Diagnostic modalities include lateral chest radiography, echocardiography, and electrocardiographic analysis during lead placement. The operative therapy consists of open lead replacement.

[Superior vena cava syndrome after pacemaker implantation. Increased risk with DDD-systems? Case report].

Superior vena cava syndrome due to transvenous pacing leads is a rare event. Local infection as well as multiple leads are important predisposing factors. The case of a patient with superior caval syndrome after multiple complicated permanent pacemaker insertions is presented.

[Left atrial myxoma].

Left-atrial myxomas produce a broad array of clinical symptoms depending on their location, size, and morphology. The clinical presentation is characterized by obstruction of blood flow, systemic embolism, and unspecific systemic effects. Within 6 weeks, three patients presented in our clinic with left-atrial myxomas.

Surgical correction of coarctation in early infancy: does surgical technique influence the result?

Between 1979 and 1988, a total of 53 infants less than 1 year of age underwent repair of coarctation. Thirty-seven patients (70%) were younger than 3 months. Median age was 0.

Selective annuloplasty of the tricuspid valve. Two-year experience.

Between July 1986 and March 1989, 48 patients whose ages averaged 60 +/- 6 years were subjected to a new technique for tricuspid valve annuloplasty. The preoperative New York Heart Association functional class averaged 3.7.

New site for pacemaker generators in children.

Bipolar pacemaker implantation was performed in three children, aged 5, 6 and 9 years. The two epimyocardial fishhook pacing electrodes were inserted through different incisions. After resection of the anterior part of the 5th and 6th rib, the generator was placed into a pocket with the posterior wall resulting from the remaining periostium/perichondrium and the anterior wall consisting of the isolated intercostal and pectoral muscle.

Computed tomographic patterns of proven embolic brain infarctions.

To define patterns of infarction on computed tomography that are characteristic of embolism, as opposed to hemodynamically or microangiopathically induced brain lesions, a consecutive series of 60 patients with acute brain embolism were studied. Strokes were embolic in origin; that is, hemodynamic and in situ thrombotic stroke mechanisms had been excluded. Embolically active, cardiac disease was proved in 42 and was clinically evident in 13 patients.

Controversial aspects of coronary endarterectomy.

Between 1980 and 1987, 635 patients underwent coronary bypass grafting combined with coronary endarterectomy. A total of 728 vessels were endarterectomized and grafted. There were 15 early deaths (2.

Long-term follow-up after Carpentier tricuspid valvuloplasty.

To study the long-term results of tricuspid valvuloplasty, pre- and postoperative (51 +/- 17 months) echocardiographic and catheterization data were collected from 51 patients (aged 59 +/- 9 years). Because of severe mitral stenosis all patients received a heterograft in the mitral position and underwent reconstructive tricuspid surgery with Carpentier rings. With regard to postoperative clinical outcome three patient groups were distinguished: 37 patients (group A) showed clear clinical improvement; in seven patients mild, and in three patients moderate tricuspid regurgitation persisted.