The Heart Surgery Forum

Innovations and Developments in Totally Thoracoscopic Cardiac Procedures

2024-03-28T19:49:53-07:00

New technology is increasing being introduced to minimizing the invasiveness of cardiac surgery. In addition to catheter based interventions and robotic-assisted procedures, totally thoracoscopic cardiac surgery (TTCS) has emerged as a new minimally invasive technique in the cardiac surgeons' armamentarium to treat cardiovascular disease. This review summarizes the existing literature on TTCS and provides updates on the exploration and management of TTCS in various cardiac diseases including mitral and tricuspid valve dysfunction, congenital heart defects, tumors, and hypertrophic obstructive cardiomyopathy. Due to small port incisions and high cost-effectiveness, TTCS has been increasingly embraced by both patients and surgeons. This review summarizes the literature on TTCS and how it may minimize the morbidity associated with open cardiac surgical procedures and result in faster recovery and earlier discharge from the hospital.

Research Progress of Transcatheter Aortic Valve Replacement in Aortic Valve Stenosis due to Bicuspid Aortic Valve

2024-04-01T17:53:35-07:00

Patients with bicuspid stenosis often have anatomical characteristics such as elliptical valve rings, high and asymmetric valve calcification, unequal valve leaflets, and concomitant widening of the ascending aorta and/or transverse heart. These unfavorable factors are more likely to cause poor placement of transcatheter aortic valve replacement (TAVR) valves, poor expansion of valve stents, which can lead to reduced valve durability, residual perivalve leakage, rupture of valve rings and surrounding structures, and serious surgical related complications such as ascending aortic dissection. In summary, TAVR treatment for mitral stenosis is receiving increasing attention. In this manuscript, we reviewed the research progress of transcatheter aortic valve replacement in aortic valve stenosis due to bicuspid aortic valve.

Effect of SGLT2 Inhibitors on Post-PCI Outcomes after Acute Myocardial Infarction in Diabetic Patients: A Systematic Review and Meta-Analysis

2024-02-26T01:22:23-08:00

Background: Acute myocardial infarction (AMI) is related with poor outcomes in patients with diabetes mellitus (DM). Whether diabetic patients with AMI undergoing percutaneous coronary intervention (PCI) benefit from sodium–glucose cotransporter 2 inhibitors (SGLT2i) in terms of cardiovascular mortality, myocardial damage, and left ventricular function is unclear. Methods: Through a comprehensive search in PubMed, EMBASE, and Web of science databases from January 2018 to September 2023, randomized controlled trials were performed to compare SGLT2i with other oral antidiabetic medications in diabetic patients with AMI undergoing PCI. Cardiovascular mortality constituted the primary outcome. Secondary outcomes were high-sensitivity troponin I (hs-TnI) levels, left ventricular ejection fraction (LVEF), and contrast-induced acute kidney injury (CI-AKI). Results: SGLT2i significantly reduced cardiovascular mortality risk versus other antidiabetic agents (hazard ratio (HR): 0.35, 95% confidence interval (CI): 0.21–0.58, p < 0.0001). SGLT2i also lowered hs-TnI levels across all time points (mean difference: –2931 ng/L, p < 0.001). After adjustment for publication bias, this difference was no longer significant. However, peak hs-TnI levels remained significantly lower with SGLT2i (mean difference: –3836 ng/L, p < 0.001). Finally, SGLT2i improved LVEF versus comparators, with a mean difference of –5.00% (95% CI: –6.69 to –3.31, p < 0.001) at hospital discharge. SGLT2i was also associated with 60% lower odds of CI-AKI (odds ratio (OR): 0.40, 95% CI: 0.22–0.75, p = 0.004). Conclusions: Compared with other antidiabetic medications, SGLT2i may lower cardiovascular mortality, infarct size, and prevent left ventricle (LV) systolic dysfunction in diabetic patients with AMI undergoing PCI. The use of SGLT2i in this high-risk group is supported by these findings.

Continuous Cardiac Magnetic Resonance Imaging after Coronary Revascularization for Left Ventricular Dysfunction

2024-03-26T18:27:30-07:00

Objective: To determine the contribution of serial cardiac magnetic resonance imaging (MRI) following coronary revascularization (CR) to the clinical management of patients with left ventricular insufficiency. Methods: The study objects comprised the clinical data of 145 patients with CR undergoing CR surgery for left ventricular insufficiency in our hospital from January 2021 to January 2023. The patients were divided into the case (n = 35, left ventricular ejection fraction (LVEF) <50%) and control (n = 110, LVEF ≥50%) groups based on the LVEF recorded in the medical record system 6 months after surgery. Preoperative LVEF left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), cardiac index (CI), and other cardiac magnetic resonance detection parameters were compared. Logistic regression analysis was performed to analyze the prognostic factors of patients undergoing CR after CR surgery for left ventricular insufficiency. The receiver operating characteristic curve was drawn, the sensitivity, specificity, and area under curve (AUC) were calculated, and the best prediction threshold was determined. The prognostic value of cardiac MRI in CR surgery for left ventricular dysfunction was observed. Results: Cardiac MRI revealed that the case group had higher LVEDV, LVESV, LVEDVI, LVESVI, and CI than the control group. However, the LVEF index was lower than that in the control group (p < 0.05). Logistic regression analysis was conducted for indicators with differences, and the results indicate LVEF as a protective factor for the postoperative efficacy of the patients, with an odds ratio (OR) <1. LVEDV, LVESV, LVEDVI, LVESVI, and CI were all risk factors for the postoperative efficacy of the patients, with an OR >1. The AUC values of LVEF, LVEDV, LVESV, LVEDVI, LVESVI, and CI were 0.698, 0.674, 0.654, 0.700, 0.572, and 0.812, respectively. The optimal threshold values were 53.57%, 112.33 and 68.5 mL, and 205.51, 163.99, and 2.14 L/m², and their corresponding sensitivities reached 0.618, 0.514, 0.654, 0.800, 0.371, and 0.829 for each index. The specificities were 0.800, 0.836, 0.771, 0.609, 0.836, and 0.645, which indicate that LVEF, LVEDV, LVESV, LVEDVI, LVESVI, and CI had a certain degree of predictive value for postoperative cardiac function recovery. Conclusion: LVEDV, LVESV, LVEDVI, LVESVI, CI, and LVEF are all factors affecting the clinical efficacy in patients undergoing CR after left ventricular insufficiency. In addition, cardiac MRI can effectively detect the above factors and effectively predict the postoperative efficacy among patients.

The Effect of Neurodevelopmental Disorders on the Prognosis of Children Undergoing Heart Transplantation: A Retrospective Analysis of the National Inpatient Sample 2011–2019

2024-02-27T17:15:15-08:00

Background: Many international governing bodies recommend against heart transplantation in patients with severe cognitive-behavioral disabilities, however no clear criteria are offered to define severity. Patients with neurodevelopmental disorders may face systematic discrimination when being evaluated for transplant. We set out to investigate whether children with neurodevelopmental disorders that undergo heart transplantation have poorer in-hospital outcomes compared to neurotypical children. Methods: A retrospective analysis of the National Inpatient Sample database was conducted to identify pediatric patients with neurodevelopmental disorders who underwent heart transplantation from 2011–2019. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to investigate the association between the documented presence of a neurodevelopmental disorder and in-hospital outcomes in children undergoing heart transplantation. Results: We identified a weighted sample of 3770 pediatric cardiac transplant patients, of whom 245 (6.5%) had a documented diagnosis of neurodevelopmental disorder. There was no significant difference in the odds of major adverse cardiovascular events (all-cause mortality, stroke complications or myocardial infarction), surgical complications, infection, venous thromboembolic events, delirium/restraint use, or cardiac dysrhythmia. Patients with neurodevelopmental disorders had lower overall length of stay (44.0 days interquartile range (IQR): 16.0–90.0 vs. 57.08 days IQR: 22.0–112.0, p < 0.050), and cost of stay ($956,031 IQR: 548,559.0–1,801,412.0 vs. $1,074,793 IQR: 599,089.8–2,129,086.0, p < 0.050). Patients with neurodevelopmental disorders had significantly lower odds of acute transplant complications (adjusted odds ratio (aOR): 0.39, 95% confidence interval (CI): 0.21–0.74, p < 0.050) vascular complications (aOR: 0.36, 95% CI: 0.19–0.66, p < 0.050) and acute kidney injury (AKI) (aOR: 0.52, 95% CI: 0.33–0.83, p < 0.050). Conclusions: These data suggest that patients with neurodevelopmental disorders have overall similar if not potentially improved post-transplant outcomes in the acute setting compared to neurotypical patients, possibly secondary to selection bias in the patient selection process.

Outcomes of Different Mitral Valve Approaches Combined with Aortic Valve Replacement in Patients with Degenerative Valve Disease

2024-04-08T18:18:46-07:00

Introduction: The objective of this cohort study was to analyze the long-term relative survival of degenerative valve disease (DVD) patients who underwent mitral valve repair (MVP) or replacement and aortic valve replacement (AVR). Methods: A total of 146 patients underwent double valve replacement (DVR) or MVP+AVR at four institutions between 2016 and 2022. Kaplan–Meier method was applied to analyze survival rate. The potential predictors of mortality were investigated by Cox regression. Results: Of 146 patients, 62 underwent MVP+AVR, and 84 underwent DVR. The thirty-day mortality rate was 4.76% in the DVR cohort and 1.61% in the MVP+AVR cohort. At baseline, there were differences in age (63.39 ± 8.01 vs. 58.46 ± 9.92, p = 0.012), proportions of male patients (51.61% vs. 72.62, p = 0.014), smoking history (45.16% vs. 28.57%, p = 0.039). More biological valves were applied in the MVP+AVR cohort (77.42% vs. 47.62%, p < 0.001). There was no significant difference in mortality between the cohorts (1339.5 [Interquartile range (IQR), 1021.25–1876.75] vs. 1026.00 [IQR, 679.50–1674.00], p = 0.252). The overall mortality rate was 16.67% for DVR and 6.45% for MVP+AVR. Mechanical valve replacement (hazard ratio (HR) = 3.7, 95% confidence interval (CI): 1.0–12.0, p = 0.029) was increased the risk of postoperative mortality. Conclusion: Although the superiority of MVP+AVR was not verified with statistical significance in our cohort, we believe that MVP+AVR should be the preferred strategy for treating most DVD patient because it is associated with higher survival rates during follow-up.

Appraised Value of 3D Echocardiography Combined with the Triglyceride–Glucose Index to Evaluate the Long-Term Prognosis of Patients after Percutaneous Coronary Intervention

2024-03-04T00:12:53-08:00

Objective: This study analyzed three-dimensional echocardiography (3DE) combined with the triglyceride–glucose (TYG) index to evaluate the long-term prognosis of patients after percutaneous coronary intervention (PCI). Methods: The clinical data of 102 patients who were treated with PCI after admission to our hospital from January 2020 to December 2020 were retrospectively analyzed. All the patients were followed up for 24 months to evaluate their long-term prognosis. The occurrence of cardiovascular and cerebrovascular events in all the patients was recorded. Cardiovascular and cerebrovascular events refer to a series of diseases or conditions of the heart and the cerebrovascular system, including sudden cardiac death. Patients with cardiovascular events were assigned to the exposed group, while those without cardiovascular events were included in the nonexposed group. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular mass index (LVMI), left ventricular remodeling index (LVRI), left ventricular ejection fraction (LVEF), standard deviation of time to peak of left ventricular 16 segments (Tmsv16-SD), maximum time difference (Tmsv16-Dif), and difference between the 3DE index and the TYG index were collected. Logistic regression analysis was performed on the indicators with differences to analyze the influencing factors of the long-term prognosis of patients after PCI. The receiver operating characteristic (ROC) curve was drawn. The sensitivity, specificity, area under the curve (AUC), and Youden index were calculated. The best predictive cutoff value was determined. The predictive value of the 3DE index and the TYG index, either alone or in combination, was observed for long-term prognosis after PCI. The relationship between the 3DE index and the TYG index was explored. Result: The 2-year follow-up results showed that 22 patients experienced cardiovascular events, and they were included in the exposed group, accounting for 21.57%. The remaining 80 patients without cardiovascular events were included in the nonexposed group, accounting for 78.43%. A significant difference was found in creatinine (Cr), high-density lipoprotein cholesterol (HDL-C), LVEDV, LVESV, LVMI, LVRI, LVEF, Tmsv16-SD, Tmsv16-Dif, and the TYG index between the exposed group and nonexposed group (p < 0.05). Cr, HDL-C, LVEDV, LVESV, LVMI, Tmsv16-SD, Tmsv16-Dif, and the TYG index in the exposed group were higher than those in the nonexposed group (p < 0.05). The exposed group also had lower LVRI and LVEF than the nonexposed group (p < 0.05). Logistic regression analysis of the indicators with differences showed that Cr, HDL-C, LVEDV, LVESV, LVMI, LVRI, LVEF, Tmsv16-SD, Tmsv16-Dif, and the TYG index were the major factors that affect the long-term prognosis of patients after PCI, with odds ratio values >1. Correlation analysis showed that the TYG index was positively correlated with LVEDV, LVESV, LVMI, Tmsv16-SD, Tmsv16-Dif, and the TYG index (r = 0.565, 0.678, 0.696, 0.702, 0.788, 0.804, p < 0.05). Moreover, it was negatively correlated with LVRI and LVEF (r = –0.580, –0.674, p < 0.05). The sensitivity and specificity of the 3DE index combined with the TYG index in predicting long-term prognosis after PCI were 0.818 and 0.950, respectively, which were significantly higher than those of the 3DE index or the TYG index alone. The Youden index was 0.768, the AUC value was 0.922, and the optimal threshold was 36.64. Conclusion: The 3DE index and the TYG index were influencing factors for the long-term prognosis of patients after PCI, and a correlation existed between the 3DE index and the TYG index. The 3DE index combined with the TYG index can improve the predictive efficiency of the long-term prognosis of patients after PCI.

Evaluation of the Safety and Efficacy of Coronary Intervention through the Brachial Artery Compared to the Radial Artery in Elderly Patients with Different Extubation Times

2024-03-17T22:21:02-07:00

Introduction: Percutaneous coronary intervention (PCI) is an important treatment for acute coronary syndrome. The main puncture paths of PCI include radial artery, brachial artery, and femoral artery. The aim of this study was to investigate the safety and efficacy of transbrachial intervention in elderly patients. Methods: According to intraoperative and postoperative nursing records, a retrospective analysis was performed for 70 elderly patients who underwent coronary intervention were divided into brachial artery A group (33 cases) and brachial artery B group (37 cases) according to immediate postoperative extubation compression dressing and 6 hours postoperative extubation compression dressing, and matched elderly patients who had successful transradial artery puncture in the same period as radial artery group (35 cases). The success rate of puncture and catheterization, arterial puncture time, total operation time, length of hospital stay, patient comfort score, incidence of arterial spasm and occlusion, subcutaneous ecchymosis and hematoma, epidermal blister occurrence, vagal reflex, pseudoaneurysm development, arteriovenous fistula formation, nerve damage risk assessment and osteofascial compartment syndrome were compared. Results: Compared with the radial artery group, the brachial artery group (group A and group B) had a higher success rate of puncture and catheterization (97.0% vs. 97.3% vs. 80.0%, p = 0.013), shorter arterial puncture time (2.45 ± 0.38 vs. 2.40 ± 0.35 vs. 3.40 ± 0.37, p = 0.000), and lower incidence of arterial spasm (0.0% vs. 0.0% vs. 34.3%, p = 0.000), arterial occlusion (0.0% vs. 0.0% vs. 14.3%, p = 0.005) and puncture site bleeding (12.1% vs. 5.6% vs. 40.0%, p = 0.001). The incidence of epidermal blister was higher in brachial artery A group than in brachial artery B group (24.2% vs. 2.7%, p = 0.003) or radial artery group (24.2% vs. 0%, p = 0.001), and the incidence of epidermal blister in brachial artery B group and radial artery group was not much different. There was no difference between the three groups in total operation time, length of hospital stay, comfort score, subcutaneous ecchymosis and hematoma, vagal reflex, pseudoaneurysm, arteriovenous fistula, nerve damage and osteofascial compartment syndrome. Conclusion: In elderly patients, coronary intervention through brachial artery is not inferior to radial artery.

Comparison of the Effects of Inhalational Anesthesia with Sevoflurane and Total Intravenous Anesthesia in Open Heart Surgery

2024-03-18T18:08:42-07:00

Background: The primary objective of this study was to compare sevoflurane inhalation anesthesia with total intravenous anesthesia (TIVA) in terms of its effectiveness in maintaining adequate depth of anesthesia during all open heart surgery procedures, including cardiopulmonary bypass. The study's secondary objective was to compare sevoflurane inhalation anesthesia with TIVA regarding the impact on the time of tracheal extubation and the incidence of postoperative acute kidney injury during open heart surgeries. Methods: A total of 58 patients undergoing open heart surgery were included, with 30 receiving sevoflurane inhalation anesthesia and 28 receiving TIVA. Demographic characteristics, intraoperative parameters, and postoperative outcomes were recorded and analyzed. Statistical analysis revealed no significant differences in Bispectral Index (BIS) monitor values, mean arterial pressure, body temperature, or other intraoperative parameters between the two groups. Notably, the time to tracheal extubation was significantly shorter in the Sevoflurane group compared to the TIVA group, although both groups exhibited similar rates of postoperative acute kidney injury (AKI). Results: None of the patients had complaints of intraoperative awareness. The mean arterial pressure, body temperature, and bispectral index values during and before cardiopulmonary bypass were similar between the groups. Postoperative variables such as intensive care unit stay duration, incidence of acute kidney injury, and immediate and 24-hour post-extubation visual analog scale values were similar between the groups. The tracheal extubation time was found to be statistically shorter in the sevoflurane group. Conclusion: We believe that sevoflurane inhalation anesthesia can achieve adequate depth of anesthesia during the intraoperative period in open heart surgery without increasing the rate of postoperative complications.

Analysis of the Reliability and Validity of the Johns Hopkins Fall Risk Assessment Scale in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

2024-03-04T23:48:23-08:00

Objective: To analyze the reliability and validity of the Johns Hopkins Fall Risk Assessment Scale (JHFRAS) for out-of-bed fall risk in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods: This study adopted continuity inclusion with the Chinese version of JHFRAS to test patients with AMI after PCI who were admitted to our hospital from January 2021 to December 2022. The occurrence of falls during out-of-bed activities was counted through follow-up, and the predictive value of the scale was assessed by using the area under the curve (AUC) of the receiver operator characteristic curve and determining sensitivity, specificity, Jordon's index, and critical value. The internal consistency reliability (Cronbach's α coefficient), interrater reliability (Spearman correlation analysis was conducted to analyze the scores obtained through the independent and simultaneous assessment of two reviewers who were unaware of the content and results of the scale), content validity (expert evaluation involving four experts), and criterion-related validity (the score of the Morse fall assessment scale [rMFS] was used as an indicator of criterion-related validity) were determined. Results: Through follow-up, this study found that 11 cases experienced falls during out-of-bed activities and 69 cases did not experience falls. The JHFRAS scores of the nonfall and fall groups were significantly different (p < 0.05). JHFRAS, which was designed to predict the risk of falls during out-of-bed activities in post-PCI patients with AMI, had an AUC of 0.880, a sensitivity of 0.937, a specificity of 0.824, a Jordon's index of 0.760, and a critical value of 9 points. Its Cronbach's α coefficient was 0.803. The assessment data from two reviewers were analyzed via intragroup coefficient analysis and yielded a Spearman's rank correlation coefficient of 0.948. The overall content validity of the scale was 0.968. The content validity indices of age, fall history, urine and defecation excretion amount, high-risk drug use, stent number, action capability, and cognitive ability were 0.915, 0.924, 0.938, 0.920, 0.954, 0.960 and 0.972, respectively. All correlation coefficients were significant at the 0.01 level. The scores of each dimension of rMFS and JHFRAS showed positive correlations. Conclusions: JHFRAS has good reliability and validity and can be used to assess the fall risk of out-of-bed activities in patients with AMI after PCI.

Comparison of Thoracic Paravertebral Block and Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia after Video-Assisted Thoracic Surgery: A Retrospective Study

2024-02-27T01:14:14-08:00

Objective: This study aimed to compare the value of thoracic paravertebral block and ultrasound-guided erector spinal muscle plane block in video-assisted analgesia after thoracic surgery. Methods: Patients undergoing video-assisted thoracic surgery at our hospital from March 2022 to May 2023 were included as the subjects of this retrospective study. According to different analgesia methods, they were divided into an ultrasound group (acoustic-guided erector spinae plane block) and a conventional group (thoracic paravertebral block). General demographic data, sufentanil dose, propofol dose, blood loss and fluid replacement volume, puncture depth and time, length of stay, complications, number of analgesic pump compression, forced vital capacity (FVC), 1 s forced expiratory volume (FEV1), peak expiratory flow rate (PEFR), visual simulation (VAS) score, and 15 recovery quality evaluation components were collected Table (QoR-15). Propensity score matching (PSM) was used to balance the baseline data of the two groups. Data were analyzed by t test, chi-square test, and analysis of variance. Results: A total of 116 patients were included in this study, including 52 in the ultrasound group and 64 in the conventional group. Before PSM, statistically significant differences in age, weight, lesion location, and surgical methodmethod existed among the groups (p < 0.05). PSM matching was performed in a 1:1 ratio, and a total of 82 patients were enrolled in the ultrasound and conventional groups. The baseline data of the two groups were not statistically significant. The complications, hospital stay, pressing times of analgesic pump, and puncture depth and time in the ultrasound group were lower than those in the conventional group (p < 0.05). Two groups of tube drawing when resting and cough VAS difference (p > 0.05), but after 12, 24, and 48 h, ultrasonic VAS scores were lower than those of the normal group (p < 0.05). When two groups of T1 lung function difference (p > 0.05), but the T2, T3 FVC, FEV1, and PEFR ultrasound group were higher than those of the conventional group (p < 0.05). No significant difference in preoperative QoR-15 score existed between the two groups (p > 0.05), but the postoperative QoR-15 score in the ultrasound group was higher than that in the conventional group (p < 0.05). Conclusions: Ultrasound-guided erector spinae plane block had stronger analgesic effect, which can reduce the pressing times of analgesic pump, quickly reduce pain, and improve lung function with fewer complications. Thus, it can significantly improve the quality of postoperative recovery and reduce the length of hospital stay, rendering its application worthy of promotion.

Outcomes of Pledgeted versus Nonpledgeted Suture Technique for Isolated Aortic Valve Replacement

2024-01-23T16:32:40-08:00

Objective: To compare outcomes of pledgeted versus nonplegdeted suture techniques for aortic valve replacement (AVR). Methods: This was a retrospective study utilizing an institutional database of AVRs performed at our center between 2010 and 2020. All patients who underwent isolated surgical AVR were included, while those who underwent concomitant procedures were excluded. Patients were dichotomized into those who underwent pledgeted vs. nonpledgeted AVR, and 1:1 propensity score matching (PSM) was employed. Clinical and echocardiographic outcomes were compared. Kaplan-Meier survival estimation and Cox regression were performed. Cumulative incidence functions were generated for all-cause readmissions and for heart-failure readmissions. Freedom from major adverse cardiac and cerebrovascular events (MACCE) were also analyzed and compared using Kaplan-Meier methods. Results: A total of 2240 patients were identified. PSM yielded 892 matched pairs. Mean gradient was significantly higher in the pledgeted group (p < 0.001), but patients in this group had a smaller median valve size implanted. There were no significant differences in paravalvular leak rates. Kaplan-Meier survival estimates, cumulative incidence of readmissions, and freedom from MACCE were not significantly different between groups. Conclusion: Long-term survival, readmission rates, and freedom from MACCE are comparable after pledgeted and nonpledgeted AVR. There were no differences in paravalvular leak rates between the two techniques.

Double Patch Hybrid Technique for Treatment of Complex Left Ventricle Acute Free Wall Rupture

2024-02-17T18:55:16-08:00

Left ventricle free wall rupture (LVFWR) is a potentially catastrophic complication of acute myocardial infarction (AMI). Despite its incidence has been significantly reduced in the recent era, it still carries a high mortality as it is the cause of up to 15% of all death following AMI. Prompt surgical treatment of subacute (oozing type) LVFWR can prevent a more devastating rupture (blow-out type), thus improving patients survival. Here we report our original hybrid “double patch” technique which combined sutureless and stitched repair to treat complex cases of LVFWR.

Shed Atrial Septal Occluder Removed by Gastric Biopsy Forceps: A Case Report

2023-11-13T18:45:54-08:00

Atrial septal defect (ASD) is a common congenital heart disease, and can be treated with occluders. However, occluder detachment remains one of the most urgent complications to be resolved. This paper reported a case of ASD occluder detachment, which was successfully resolved with gastroscopic biopsy forceps. A 57-year-old woman complained chest distress for over one week, and was admitted to cardiovascular department of Sir Run Run Shaw Hospital. Based on echocardiography, the patient was diagnosed as ASD, mitral and tricuspid valve regurgitation. On the second day after percutaneous closure of residual ASD, routine chest radiographs showed the occluder detached into the abdominal aorta. After a thorough evaluation and examination, we decided to use gastric biopsy forceps to remove occluder. As a result, the patient recovered well and discharged from the hospital. For postoperative patients with ASD, when occlusion devices detached and conventional strategies could not extract the occluders, gastric biopsy forceps would be appliable. Compared to conventional strategies, gastric biopsy forceps have better grasping force, and provide secure fixing for disconnected or detached occlusion devices in cardiac interventional surgeries.

A Rare Case of Infective Aneurysm of Mesenteric Artery Due to Infective Endocarditis: Diagnosis and Treatment

2023-11-13T18:48:01-08:00

The infected aneurysm is a rare disease; antibiotic therapy combined with surgical treatment is the most common treatment currently available after computed tomography (CT) imaging and blood culture confirmation. We herein report a case of a 25-year-old male with infective endocarditis that caused an infective aneurysm of the mesenteric artery. We hope to help with the diagnosis and treatment of similar patients.