The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Oct 2009
Impact of graft size and commissural resuspension height on aortic valve competence in valve-sparing aortic replacement under physiological pressures.
Valve competence in valve-sparing aortic root replacement has been described as being influenced by commissural height as well as graft size. The aim of this study was to investigate the impact of a gradual reduction of commissural height and graft diameter on aortic insufficiency under physiological conditions in an IN VITRO model. ⋯ Valve competence is impaired both by the reduction of commissural height and by reduced graft size. In particular, reimplantation of aortic valves into undersized grafts promotes valve insufficiency even if commissural height is well adjusted.
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Thorac Cardiovasc Surg · Sep 2009
ReviewDiaphragmatic injuries: a surgical challenge. Report of forty-one cases.
We present a discussion of the management of diaphragmatic injury and the factors that influence the choice of surgical approach based on our experience and a review of the literature. ⋯ A high index of suspect is vital for the diagnosis of diaphragmatic injuries in an emergency setting. The type of approach is closely related to the associated injuries.
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Thorac Cardiovasc Surg · Sep 2009
Case ReportsRare type of quadricuspid aortic valve requiring surgical replacement.
Quadricuspid aortic valve, a rare congenital anomaly, is often related to severe aortic regurgitation and has a significant morbidity. The first described case was reported in 1862. Quadricuspid aortic valve is, in most cases, an isolated malformation, but it can be associated with other concomitant anomalies. We present here the case of a quadricuspid aortic valve discovered by intraoperative transesophageal echocardiography and successfully replaced with a mechanical aortic valve.
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Thorac Cardiovasc Surg · Sep 2009
Case ReportsBiodegradable mitral annuloplasty for congenital ischemic mitral regurgitation.
An anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is associated with ischemic mitral regurgitation through a combination of papillary muscle ischemia or permanent fibrosis, left ventricular free wall ischemic dyskinesis and left ventricular dilatation. We report the successful management of a 27-month-old girl with ALCAPA and severe mitral regurgitation using a biodegradable mitral annuloplasty ring. It could represent a novel tool for mitral valve repair in ALCAPA-associated ischemic mitral regurgitation.
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Thorac Cardiovasc Surg · Sep 2009
Case ReportsParadoxical brain embolism caused by pulmonary arteriovenous fistula.
We report here a case of special paradoxical brain embolism in a 40-year-old woman with neurological events who was diagnosed with medulla oblongata infarction. Contrast-enhanced pulmonary CT discovered that the patient had a pulmonary arteriovenous fistula (PAVF). The PAVF was later surgically resected. We conclude that if a patent foramen ovale cannot be confirmed by echocardiography, contrast-enhanced pulmonary CT scan could prove to be a helpful tool to detect another origin of a right-to-left shunt such as pulmonary arteriovenous fistula.