Transaortic inflow and outflow cannula for centrifugal mechanical assistance.

A specific cannula allowing single site transaortic inflow and outflow cannulation for centrifugal assist devices is described. The cannula is inserted through a straight 18 mm collagen coated Dacron tube anastomosed to the anterior aspect of the ascending aorta. The inflow conduit of the cannula is positioned into the left ventricle through the aortic valve, and the end hole of the outflow conduit is positioned in the ascending aorta.

Aortic valve replacement with the freestyle stentless bioprosthesis with respect to spacial orientation of patient coronary ostia.

Objective: This study evaluates our results for safety and efficacy of aortic valve replacement using the Freestyle bioprosthesis (Medtronic, Inc, Minneapolis, Minn) with a new modified subcoronary implantation technique. This technique takes into account the spacial orientation of the stentless bioprosthesis in the aortic root with respect to the patient's coronary ostia rather than the native commissures.

Methods: Fifty-two consecutive patients with predominant aortic valve stenosis underwent aortic valve replacement with a Freestyle bioprosthesis by means of the described modified subcoronary technique over a 15-month period.

Anterior mitral leaflet prolapse as a primary cause of pure rheumatic mitral insufficiency.

Background: This study was designed to revise the mechanisms and repair techniques of anterior mitral leaflet prolapse observed during the correction of pure rheumatic mitral regurgitation in children.

Methods: From March 1993 to May 1998, 36 children suffering from pure rheumatic mitral regurgitation due to anterior leaflet prolapse underwent mitral valve repair. The mean age was 12.

Aorticoright atrial tunnel.

Two unusual cases of aorticoright atrial tunnel are described. Both patients were referred to our institution for evaluation of a continuous heart murmur best heard along the right upper sternal border. Ascending aortography showed the tunnel taking its origin from the aortic root and entering the right atrium through a tortuous link.

Partial left ventriculectomy combined with transmyocardial laser revascularization.

We report the use of transmyocardial laser revascularization in combination with partial left ventriculectomy for treatment of end-stage dilated ischemic cardiomyopathy. The disappearance of the reversible perfusion defects in the treated left ventricular territories and improvement of the systolic function led us to believe that the simultaneous use of these two techniques was complementary in our patient.

Aortic valve repair by cusp extension with the use of fresh autologous pericardium in children with rheumatic aortic insufficiency.

Objectives: Our goal was to evaluate the midterm results of aortic valve repair by a more sophisticated tailoring of cusp extension-taking into account the dimensions of the native aortic cusps-with the use of fresh autologous pericardium.

Patients And Methods: Forty-one children who had severe rheumatic aortic insufficiency (mean age 11.5 +/- 2.

Ascending aortic aneurysm associated with aortic insufficiency due to Takayasu's arteritis.

We report the case of a child with an ascending aortic aneurysm associated with aortic insufficiency. Histopathological examination of the ascending aorta and aortic valve showed findings in favor of Takayasu's arteritis, and subsequent evaluation of the entire aorta demonstrated the presence of multiple steno-occlusive lesions. This unusual clinical problem in the young population is discussed with regard to other eventual pathologies that should be taken into account in the differential diagnosis.

Successful palliation of acute superior vena caval obstruction after the Senning operation.

Superior vena caval obstruction after an intraatrial baffle procedure can lead to acute cerebral complications and hence requires immediate management. We present a case of successful palliation of acute superior vena caval obstruction after a Senning procedure by establishing a venous shunt between the innominate vein and pulmonary artery. This technique resulted in immediate hemodynamic and functional improvement that subsequently allowed for the enlargement of the superior vena cava-right atrial junction with a pericardial patch.

Hypoplasia of the posterior leaflet as a rare cause of congenital mitral insufficiency.

A rare case of congenital mitral insufficiency characterized by the hypoplasia of the posterior leaflet is reported. At operation, the mitral valve was successfully repaired by a ring annuloplasty, which created a satisfactory surface of coaptation between the anterior leaflet and the bulky posterior muscular structure. The presence of this posterior muscular structure represents a developmental arrest at the stage of conversion from muscular chordae and leaflets to thin connective structures.

Conversion from routine CPB to centrifugal mechanical assist by transaortic inflow cannulation of the left ventricle.

We describe a technique of conversion from cardiopulmonary bypass to centrifugal mechanical assist that consists of using the existing aortic cannula for outflow and inserting a cannula into the left ventricle through a Dacron tube and across the aortic valve for inflow.

Near and far visual space in unilateral neglect.

A 24-year-old right-handed woman with a right temporal hematoma showed marked left visual neglect for far but not near space in a variety of tasks systematically given in near and far distance conditions. This case thus provides the dissociation opposite to Halligan and Marshall's patient, who had neglect for near but not far space after a right parietal stroke. Furthermore, although she made rightward errors in bisecting far-distant lines, our patient made smaller opposite leftward errors for near-distant lines.

Leaflet's free edge suspension for correction of aortic insufficiency associated with ventricular septal defect.

Aortic valve regurgitation in association with ventricular septal defect results from the mechanical effect of the ventricular septal defect, which primarily affects the free edge. The elongated free edge can be repaired by plicating it using several techniques designed to restore a normal geometry to the prolapsing aortic leaflet. We describe 4 cases in which aortic insufficiency was treated by a technique of plication that allows suspension of the free edge along a pericardial strip applied from one commissure to the other.

Successful management of a postinfarction left ventricular rupture using a sutureless technique with concomitant myocardial revascularization.

We present a case of left ventricular (LV) rupture that occurred on the second day after inferolateral myocardial infarction (MI). An aggressive diagnostic approach with rapid coronary angiography prior to surgical repair provides a benefit characterized postoperatively by complete recovery of myocardial contractility in the akinetic infarcted area. We believe that coronary artery disease associated with subacute ventricular rupture may, in fact, be better investigated and simultaneously treated under a protocol of early surgical repair.

Floating thrombus in the ascending aorta: a rare cause of peripheral emboli.

The ascending aorta may be the site of origin of systemic embolization in some cases that do not have an identifiable source. We report a case in which a free-floating thrombus in the noncoronary sinus of Valsalva was detected by transesophageal echocardiography as a source of left axillary artery embolism. After removal of this pedunculated thrombus of unknown cause, which was attached on a macroscopically and histologically normal aortic wall, the patient made an uneventful recovery.

Multiple-leaflet mitral valve as a rare cause of congenital mitral insufficiency.

A rare case of congenital mitral insufficiency characterized by six well-demarcated leaflets of mitral valve and annular dilatation is reported. At operation, the mitral valve was successfully repaired by resection of the posterior median leaflet with subsequent annular plication, closure of unusual valvular tissue divisions, and ring annuloplasty.

Successful repair of a right ventricular rupture at the atrioventricular groove.

We report a patient who presented with a delayed spontaneous right ventricular rupture at the anterior atrioventricular groove after open heart operation. Successful surgical repair consisted of reestablishing anterior atrioventricular groove continuity by pericardial patch placement on the arrested heart. We discuss the risk factors that could initiate the primary tear and contribute to the extension of this type of right ventricular rupture.

Tricuspid valve repair by septal of posterior leaflet transposition.

We report 2 patients who presented extensive rupture of chordae tendineae caused by blunt thoracic trauma leading to flail anterior leaflet of tricuspid valve. Transposing a segment of septal leaflet in 1 patient and the posterior leaflet in the other patient onto the flail anterior leaflet's margin abolished massive tricuspid regurgitation. Fifteen and 33 months postoperatively the patients are in good clinical condition and the echocardiographic controls show a competent tricuspid valve.

D-dimer determination to exclude pulmonary embolism: a two-step approach using latex assay as a screening tool.

D-dimer (DD), when measured by a quantitative enzyme-linked immunosorbent assay (ELISA), is a valuable test to exclude venous thromboembolism (VTE). However, DD ELISA technique is not appropriate for emergency use and the available agglutination latex assays are not sensitive enough to be used as an alternative to rule out the diagnosis of VTE. Latex assays could still be used as screening tests.