The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
A simple surgical technique for closure of apical muscular ventricular septal defect.
Ventricular septal defect (VSD) is among the most common congenital heart diseases encountered in pediatric cardiac patients. Apical muscular VSD constitutes nearly 2% of defects, which may or may not be associated with other congenital heart defects. The purpose of our study is to present our innovative and simple surgical technique using custom-made low-profile polytetrafluoroethylene (PTFE) single disc device for closing multiple apical muscular and isolated apical muscular VSD. ⋯ The technique described by us has the advantage of apical VSD closure through the left ventricle without left ventriculotomy. Our technique is simple and cost-effective.
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
Observational StudyPercutaneous edge-to-edge repair in high-risk and elderly patients with degenerative mitral regurgitation: midterm outcomes in a single-center experience.
The study objective was to report the midterm outcomes of MitraClip implantation in inoperable or high-risk surgical candidates with degenerative mitral regurgitation. ⋯ MitraClip therapy is a valuable alternative to surgery in high-risk and elderly patients with degenerative mitral regurgitation. Clinical benefits also are obtained in octogenarians.
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
Targeting survival pathways to create infarct-spanning bridges of human embryonic stem cell-derived cardiomyocytes.
Generating myocyte grafts that bridge across infarcts could maximize their functional impact and best utilize small numbers of stem cells. To date, however, graft survival within acute infarcts has not been feasible. To enhance intrainfarct graft viability, human embryonic stem cell-derived cardiomyocytes (hESC-CMs) were pretreated before implantation with cobalt protoporphyrin (CoPP), a pharmacologic inducer of cytoprotective heme oxygenase-1. ⋯ Cellular therapy delivered acutely after infarction significantly improved postinfarct ventricular function at 1 and 2 months. CoPP pretreatment of cells resulted in stable hESC-CM grafts within infarcted myocardium. This design enables construction of directionally oriented, infarct-spanning bands of new cardiomyocytes that might further improve functional restoration as engrafted myocytes proliferate and mature.
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
Bicuspid aortic valve repair by complete conversion from "raphe'd" (type 1) to "symmetric" (type 0) morphology.
An anterior cusp with a median raphe and false commissure is the most common bicuspid aortic valve phenotype. The cusp is typically restricted and its annular attachment malpositioned, often resulting in significant aortic regurgitation. A novel valve repair strategy was designed to create a symmetric valve to improve both function and durability. ⋯ Repair of the common, "raphe'd" bicuspid phenotype by reconfiguration into "symmetric" morphology is both feasible and desirable, regardless of the degree of preoperative aortic regurgitation. This repair strategy appears durable at the mid-term without evolving signs of deterioration or stenosis, offering a potentially superior option over prosthetic root replacement for younger patients.
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
Losartan ameliorates "upstream" pulmonary vein vasculopathy in a piglet model of pulmonary vein stenosis.
Pulmonary vein stenosis (PVS) is a relentless disease with a poor prognosis. Although surgical repair can effectively treat "downstream" (near left atrial junction) PVS, residual "upstream" (deep in lung parenchyma) PVS commonly dictates long-term survival. Our initial studies revealed an association between PVS and transforming growth factor-β signaling, which led us to investigate the effect of losartan on upstream pulmonary vein vasculopathy in a piglet model of PVS. ⋯ Losartan treatment improved PVS-associated pulmonary hypertension and intimal hyperplasia and might be a beneficial prophylactic therapy for patients at high risk of developing PVS after pulmonary vein surgery.