Texas Heart Institute journal
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Comparative Study
Intraoperative device closure of atrial septal defects with minimal transthoracic invasion: a single-center experience.
Atrial septal defect is one of the most common congenital heart defects. Open-heart repair via midline sternotomy or right thoracotomy and cardiopulmonary bypass has been considered the standard treatment for the closure of atrial septal defects, but transcatheter closure with the Amplatzer septal occluder has recently become a viable option. We have adopted a 3rd alternative: intraoperative device closure with minimal transthoracic invasion. ⋯ All discharged patients were monitored for 2.3 years to 5 years. As monotherapy, intraoperative device closure of atrial septal defect with minimal transthoracic invasion is a safe and feasible technique. It is particularly beneficial for elderly patients or patients with pulmonary hypertension and is associated with better cosmetic results and less trauma than is surgical closure.
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Is rheumatic mitral valve repair still a feasible alternative?: indications, technique, and results.
Rheumatic heart disease is still a major cause of mitral valve dysfunction in developing countries. We present our early results of rheumatic mitral valve repair. From August 2009 through July 2011, 60 patients (24 male and 36 female) with rheumatic disease underwent mitral repair. ⋯ Left ventricular end-diastolic diameter and left atrial diameter significantly decreased postoperatively (P=0.006 and P=0.001, respectively). The mean gradient over the mitral valve decreased significantly from 11 ± 5.9 mmHg to 3.5 ± 1.8 mmHg (P=0.001). Because current techniques of mitral repair can effectively correct valve dysfunction in most patients with rheumatic disease, the number of repair procedures should be increased in developing countries to prevent complications of mechanical valve placement.
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Case Reports
Surgical approach to aortic valve replacement after previous bilateral internal thoracic artery grafting.
The authors present a manubrium-sparing sternotomy technique for aortic valve replacement in patients who have undergone previous myocardial revascularization with both internal thoracic arteries. They have found that preoperative 64-multislice computed tomographic imaging facilitates surgical planning by delineating the course of patent grafts and, in particular, the relationship between the sternum and the right internal thoracic artery graft. A manubrium-sparing sternotomy can in such instances avoid injury to the right internal thoracic artery graft during both resternotomy and adhesion dissection, thus reducing surgical risk and operative time.
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We used 3-dimensional computed tomographic images to create a disease-based transesophageal echocardiographic simulation system for complex congenital heart defects. We enrolled 7 pediatric patients with complex congenital heart defects in this proof-of-concept study. Preoperative computed tomographic images and intraoperative transesophageal echocardiographic images were acquired for all patients. ⋯ The ability of 3-dimensional computed tomography to yield the spatial and temporal congruence of transesophageal echocardiography in selected planes was also good to excellent. We found that 3-dimensional computed tomographic images can simulate the process of transesophageal echocardiography in acquiring the echocardiographic image clearly. This imaging method has the potential to be applied successfully to a disease-based transesophageal echocardiographic simulation system.