Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey.

Objectives: Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities. Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal.

Post-traumatic Aortopulmonary Fistula after Bentall Procedure.

Pseudoaneurysm complicated by aortopulmonary fistula (APF) after a Bentall procedure is extremely rare but potentially fatal, so timely diagnosis and treatment are critical. We present a subacute case of a post-traumatic APF which has had initial aspecific symptoms and later an acute worsening heart failure with chest pain not responding to medical treatment and requiring emergency surgery.

Early Versus Late Tracheostomy in Cardiac Surgical Patients: A 12-Year Single Center Experience.

Objectives: To evaluate whether early tracheostomy is associated with better outcomes in mechanical ventilation-dependent patients after cardiac surgery compared with a late tracheostomy.

Design: Retrospective, observational study.

Setting: Cardiac surgical intensive care unit (ICU) of a tertiary care center.

Metachronous cardiac and cerebral sarcomas: case report with focus on molecular findings and review of the literature.

Although multiple primary malignancies are relatively rare, they have increased in frequency over the last decades, partly because of advances in diagnosis and therapy. This report describes for the first time the case of a patient with past occupational exposure to asbestos and no family history of cancer who developed 2 rare primary malignancies: a cardiac sarcoma and a gliosarcoma 11 months later. Molecular-cytogenetic studies did not identify common lesions to these 2 rare metachronous sarcomas.

Nine years' experience with the chordal cutting technique in ischemic mitral regurgitation.

Objectives: The optimal surgical management of chronic ischemic mitral regurgitation has not yet been clearly defined. Among the various approaches proposed, the excision of strut (or main) chordae, along with complete annuloplasty to relieve tethering, has been the one preferred by our institution to treat this particular subset of mitral disease.

Methods: Between October 2004 and May 2013, 11 patients underwent surgery for chronic ischemic mitral regurgitation.

Cardiac tamponade caused by a migrating sewing needle.

: Penetrating injuries of the heart caused by migrating needles have been rarely described. They usually occur accidentally or are self-inflicted in the setting of an underlying psychiatric disorder. We present an unusual case of cardiac tamponade caused by a sewing needle that migrated to the heart from the chest wall through the lung.

Levosimendan may improve weaning outcomes in venoarterial ECMO patients.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary mechanical circulatory support in patients with refractory cardiogenic shock, allowing time for cardiac recovery. Levosimendan is a calcium sensitizer with inotropic and vasodilatory effects used in the treatment of severe heart failure. It does not increase myocardial oxygen consumption.

[Case report of a patient on extracorporeal memebrane oyxgenation for cardiogenic shock not suitable for weaning in a peripheral center. Just a "problem" or is it feasible a treatment before patient transfer to a Hub center?].

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is the treatment of choice for cardiogenic shock unresponsive to inotropes or intra-aortic balloon pumping. It provides a temporary mechanical circulatory support and blood oxygenation allowing time for cardiac recovery. If this is not the case, the patient may become suitable for heart transplantation or left ventricular assist device (LVAD) implantation and must be transferred to a referral center.

[Single cardiac metastasis from colorectal cancer: an unusual localization].

Metastasis to the heart from malignancy is a frequent but underestimated event. Tumors that are located in the mediastinum, such as pleural mesothelioma, are more frequently associated with cardiac colonization. Few reports have described metastasis from colon adenocarcinoma, which usually colonizes liver and lungs.

[Rare endocarditis due to Abiotrophia defectiva. Case report and literature review].

Endocarditis by Abiotrophia defectiva is rare but associated with high rates of complications and mortality. The microbiological identification is challenging. Two cases without preexisting valvulopathy and one case with mitral-aortic involvement are described in the literature.

Obstruction of the tricuspid valve orifice by a huge right atrial myxoma associated with the Carney complex: a case report.

Carney complex (CNC) is an inherited autosomal dominant disorder associated with multiple neoplasms. Myxomas associated with CNC differ from their sporadic forms because the former usually develop at a younger age and they may be multicentric and have a tendency to recur. Furthermore, their localization may be atypical.

Is lower limb venous drainage during peripheral extracorporeal membrane oxygenation necessary?

Extracorporeal membrane oxygenation (ECMO) is becoming a gold standard in acute heart failure, not responsive to inotrops and intra-aortic balloon contrapulsation. This diffusion is due to the possibility to implant it through peripheral cannulation and to perform long-time assistance. Nevertheless, this technique implies some problems concerning inferior limb perfusion.

Postinfarction septal dissection and rupture evolved as an inferobasal pseudoaneurysm: a specific anatomical pattern.

In rare cases of posterior myocardial infarction, septal rupture is the consequence of a dissecting interventricular hematoma that evolves as a fibrotic septal chamber with two separate communications, towards left and right ventricle. This unusual anatomical pattern is generally unsuspected and described as a normal interventricular defect associated with a basal left ventricular aneurysm or pseudoaneurysm. We present a case where echocardiography and ventricular angiography did not detect this situation.

Repair of posterior left ventricular aneurysm through transatrial approach.

Repair of posterior left ventricular ischemic aneurysms implies an extracardiac approach to reshape the ventricular geometry frequently associated with mitral surgery. A transatrial technique was described for lesions following mitral surgery or for subvalvular idiopathic cases. A transmitral approach was used for ischemic or traumatic pseudoaneurysm.

Effect of revascularizing viable myocardium on left ventricular diastolic function in patients with ischaemic cardiomyopathy.

Aims: In patients with ischaemic left ventricular (LV) dysfunction and viable myocardium, revascularization improves systolic function. Diastolic dysfunction is also present in such patients; however, whether revascularization improves diastolic function also is largely unknown.

Methods: Twenty-six patients with chronic ischaemic cardiomyopathy [ejection fraction (EF) 32 +/- 6%, wall motion score index (WMSI) 2.

Off-pump technique: a systematic alternative for myocardial revascularization?

Objective: Many studies failed to show that off-pump myocardial revascularization achieved better results than on-pump revascularization, and also invited a lot of criticism for the criteria used for selection and inclusion of patients. To avoid these limitations, we systematically treated all candidates for coronary surgery with this technique evaluating early and follow-up results.

Methods: In 257 prospective consecutive patients, off-pump myocardial revascularization was performed by the same surgeon without any exclusion criteria.

An unusual left ventricular outflow pseudoaneurysm: usefulness of echocardiography and multidetector computed tomography for surgical repair.

Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare but potentially lethal complication, mainly after aortic root endocarditis or surgery. Usually it originates from a dehiscence in the mitral-aortic intervalvular fibrosa and it arises posteriorly to the aortic root. Due to these anatomical features, its imaging assessment is challenging and surgical repair requires complex procedures.

Short-term hemodynamic performance of the Sorin Freedom SOLO stentless valve.

Background And Aim Of The Study: The new Sorin Freedom SOLO pericardial stentless valve is designed for supra-annular implantation, and requires only one running suture. It can be implanted with a short cross-clamp time, and is designed to offer the same hemodynamic advantages of other stentless valves. The study aim was to evaluate the prospective postoperative and two-month follow up hemodynamic performance of this bioprosthesis.

Surgical treatment of ascending aorta and innominate artery trunk aneurysm with displaced brachiocephalic vessels.

The surgical treatment of ascending aortic and arch aneurysms, even though technically complex and requiring care to avoid neurological sequelae, is well established. Nevertheless, the presence of a significant innominate artery trunk aneurysm implies an adaptation of the surgical options available. We report a case of an aortic aneurysm that involved the ascending aorta, the proximal transverse arch and the brachiocephalic trunk with cranial displacement of the right subclavian and common carotid arteries.

Cyanosis in atrial septal defect without pulmonary hypertension: a case of platypnea-orthodeoxya syndrome.

Cyanosis in atrial septal defect typically occurs when pulmonary hypertension develops. Platypnea-orthodeoxya is an uncommon syndrome, still under debate, characterized by breathlessness and arterial oxygen desaturation exacerbated in the upright position. An interatrial communication is a common finding in this syndrome, but the absence of a right to left pressure gradient complicates the physiopathological picture.

[Validation of a new scoring system to predict the risk of postoperative acute renal failure in cardiac surgery].

Background: The aim of this study was to cross validate a new scoring system, based on preoperative risk factors, in predicting the risk of postoperative dialysis after cardiac surgery and recently proposed by Thakar et al.

Methods: Between January 2003 and March 2006, 1642 consecutive patients underwent cardiac surgery. From our clinical database, using Thakar's method, we calculated the total score for each patient.