Cardiac Manifestation of Rosai-Dorfman Disease: A Case Report and a Systematic Review.

Background: Rosai-Dorfman disease is a rare condition that typically presents as a nodal disease. Cardiac involvement is extremely uncommon, occurring in 0.1-0.

A Rare Presentation of Systolic Anterior Motion Occurring Eight Years After Mitral Valve Replacement.

Systolic anterior motion (SAM) is the dynamic displacement of mitral valve leaflets anteriorly toward the left ventricular outflow tract (LVOT) during systole. SAM-like physiology has been reported to occur shortly after mitral valve replacement (MVR) surgery; occurrence beyond two years after surgery is very rare. A 55-year-old woman who had bioprosthetic MVR eight years earlier for non-rheumatic mitral stenosis presented to the emergency room with progressive dyspnea and sudden-onset chest pressure.

Advanced experience allows robotic mitral valve repair in the presence of extensive mitral annular calcification.

Objective: Mitral annular calcification is underdiagnosed in patients with mitral regurgitation. After excision, it may require reconstruction of the atrioventricular groove and decreases the probability of valve repair. We reviewed the safety and efficacy of totally endoscopic robotic mitral valve repair in the presence of mitral annular calcification, with an emphasis on pathology and repair techniques.

Robotic Approach to Mitral Valve Surgery in Septo-Octogenarians.

Advanced age confers higher Society of Thoracic Surgeons (STS) predicted risks of mortality and longer hospital lengths of stay (LOS) in patients undergoing mitral valve surgery; some consider it a contraindication to robotic-assisted approaches. We analyzed the feasibility and safety of totally endoscopic robotic mitral valve surgery (TERMS) in patients ≥70 years. From 5/11 to 4/18, 570 consecutive patients underwent TERMS by the same 2-surgeon team utilizing the da Vinci Xi Surgical System.

Prosthetic valve endocarditis five months following transcatheter aortic valve implantation and review of literature.

There are only a few cases of prosthetic valve endocarditis (PVE) following transcatheter aortic valve implantation (TAVI) reported in the literature. Though not very frequent, this is a serious concern because patients are high risk for surgical aortic valve replacement (SAVR) by definition, and explanting the endocarditic prosthetic valve followed by SAVR increases risk even higher.

Safety and efficacy of retrograde cerebral perfusion as an adjunct for cerebral protection during surgery on the aortic arch.

Objective: The best adjunct for cerebral protection during aortic arch reconstruction remains controversial. Retrograde cerebral perfusion (RCP) as an adjunct to profound hypothermic circulatory arrest (PHCA) extends the tolerable period of brain ischemia by flushing emboli and air from the cerebral circulation while maintaining hypothermia. We examined our experience with RCP to determine its efficacy in patients undergoing complex arch reconstruction.

TandemHeart device as rescue therapy in the management of acute heart failure.

Background: The TandemHeart device (THD) is a pump system that can be deployed percutaneously (PC) or via conventional surgical (CS) cannulation; it is capable of supporting one or both ventricles. It is a versatile system designed for use as a rescue device in acute heart failure and as a bridge to decision in moribund patients.

Methods: Retrospective analysis was conducted on all patients who underwent a THD implant; either PC or CS; at our institution.

The outcome of surgical management of type A aortic dissection.

Background: Type A aortic dissection is a serious and fatal condition.

Methods: We retrospectively evaluated the outcome following repair of ascending aortic dissection in a contemporary cohort of 108 patients with a mean age of 59.5 ± 13.

Fifteen-year experience and outcomes of pericardiectomy for constrictive pericarditis.

Background And Aim: Constrictive pericarditis has multiple etiologies and can lead to disabling symptoms and severe heart failure with poor quality of life. Surgical pericardiectomy is the cornerstone of management. All patients undergoing pericardiectomy at our institution were reviewed with the goal of analyzing preoperative and intraoperative factors that may be associated with long-term outcomes.

Risk factors predicting the postoperative outcome in 134 patients with active endocarditis.

Background: Surgery remains the cornerstone in management of endocarditis.

Methods: In this retrospective cohort we evaluated the operative outcome of patients with infective endocarditis. The SPSS program was used to analyze the data.

Repair of aortic root in patients with aneurysm or dissection: comparing the outcomes of valve-sparing root replacement with those from the Bentall procedure.

Introduction: Management of aortic root aneurysm or dissection has been the subject of much discussion that has led to some modifications. The current trend is a valve-sparing root replacement. We compared the outcome following valve sparing root repair with Bentall procedure.

Orthotopic heart transplantation in patients with persistent left superior vena cava: bicaval and biatrial techniques.

Persistent left superior vena cava (LSVC) is the most common congenital venous abnormality. With the increasing number of children who survive into adulthood with congenital heart malformations, the recognition of persistent LSVC among patients with advanced heart failure is likely to rise. We present two cases of orthotopic heart transplantation in the setting of LSVC successfully managed with biatrial and bicaval techniques.

The significance of prosthesis type on survival following valve replacement in dialysis patients.

Background And Aim Of The Study: The type of valve prosthesis used in dialysis patients remains the subject of controversy, while calcification of the bioprosthesis has also been of concern.

Methods: In this retrospective study, an analysis was performed of the morbidity and mortality of patients with end-stage renal disease who underwent either mitral valve replacement (MVR) or aortic valve replacement (AVR) between 2006 and 2011.

Results: A total of 95 patients (55 males, 40 females; median age 61 years; range: 32-85 years) was examined.

Hybrid arch debranching and proximal endograft extension to repair a type I endoleak after endovascular thoracic aneurysm repair.

Endovascular repair of complex aortic disease has emerged over the past decade as an alternative to traditional open repair, especially for patients with significant medical comorbidities and/or anatomic challenges, such as reoperative fields. However, the possibility of graft migration and endoleak mandates long-term follow-up of these grafts. We present a patient who underwent hybrid repair after stent graft migration and proximal type I endoleak after thoracic endovascular aneurysm repair.

Recently patented transcatheter aortic valves in clinical trials.

The most widely used heart valve worldwide is the Edwards Sapien, which currently has 60% of the worldwide transcatheter aortic valve implantation (TAVI) market. The CoreValve is next in line in popularity, encompassing 35% of the worldwide TAVI market. Although these two valves dominate the TAVI market, a number of newer transcatheter valves have been introduced and others are in early clinical evaluation.

A case series of a hybrid approach to aortic arch disease.

Objective: Debranching of the aortic arch and endovascular stent placement as a combination therapy for complex aortic arch pathology has emerged over the past few years as an alternative to traditional repair. This hybrid approach is a viable option for patients who would not tolerate conventional arch replacement, as well as for patients with a failed stent graft of the descending aorta and a subsequent type I endoleak.

Methods: We retrospectively reviewed the preoperative characteristics and postoperative outcomes of 5 patients who underwent debranching of the aortic arch and implantation of an endovascular stent across the aortic arch between 2008 and 2011.

A review of most relevant complications of transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) has emerged for treating aortic stenosis in patients who are poor candidates for surgical aortic valve replacement. Currently, the balloon-expandable Edwards Sapien valve-which is usually implanted via a transfemoral or transapical approach-and the self-expanding CoreValve ReValving system-which is designed for retrograde application-are the most widely implanted valves worldwide. Although a promising approach for high-risk patients, the indication may be expanded to intermediate- and eventually low-risk patients in the future; however, doing so will require a better understanding of potential complications, risk factors for these complications, and strategies to individualize each patient to a different access route and a specific valve.

The hybrid repair of a penetrating ulcer in a patient with a bovine arch; debranching followed by endovascular stent placement.

Aortic arch disease has conventionally been a subject for open surgical repair, which may require circulatory arrest, accompanied by a long perfusion and extended cross-clamp time. A 2-stage approach utilizing an elephant trunk procedure followed by a descending aortic replacement, or utilizing a frozen elephant trunk with endovascular extension is not well tolerated by multimorbid patients. On the other hand, the endovascular repair of an aortic arch disease is limited by aortic branching.

Extracorporeal membrane oxygenation as a temporizing approach in a patient with shock, myocardial infarct, and a large ventricle septal defect; successful repair after six days.

Rupture of the ventricular septum occurs in 1% to 2% of all acute myocardial infarctions (MI) requiring surgical intervention in the majority of cases. Furthermore, patch dehiscence and residual shunt are major problems following repair in the acute stage. A delay in repair may prevent patch dehiscence.

Recently patented and widely used valves for transcatheter aortic valve implantation.

Aortic stenosis (AS) is a serious condition in the aging US and European populations. Management of a stenotic valve is crucial as it can become symptomatic quickly leading to ventricular deterioration and overall poor quality of life. Considering that AS is a disease of the elderly patient population, surgical intervention may not be well tolerated by some patients.

A ventricular assist device as a bridge to recovery, decision making, or transplantation in patients with advanced cardiac failure.

Despite many advances in the management of patients with heart failure, acute cardiogenic shock and progressive congestive heart failure remain serious problems with dismal prognoses. Both temporary and permanent mechanical support has been gaining wide clinical application in this patient population. Although mechanical circulatory support technology is rapidly evolving, this approach is associated with multiple issues such as the optimal duration of temporary support, ideal timing to bridge these patients to a long-term device, and selection of the right device for the right patient.

Right ventricular dysfunction following continuous flow left ventricular assist device placement in 51 patients: predicators and outcomes.

Background: Right ventricular (RV) dysfunction following implantation of a left ventricular assist device (LVAD) is a serious condition and is associated with increased mortality.

Methods: The aim of the study is to investigate the significance of pre-existing RV dysfunction, tricuspid valve (TV) insufficiency, and the severity of septal deviation following LVAD implantation on RV dysfunction, as well as the outcome and short-term complications in 51 patients from June 2006 to August 2010. Student t test was used to compare the data and estimate the p value.

Repair of dilated aortic root and sinotubular junction using a stabilizer ring.

Aortic root aneurysm and dissection are potentially life-threatening conditions that involve a structural weakness of the aortic wall. Management of aortic root aneurysm (with or without aortic insufficiency) has recently been the subject of much scholarly discussion which resulted in some modifications. The current trend is a valve-sparing root repair or replacement as well as preserving or restoring the diameter of the aortic annulus and sinutubular junction.