Pub Date : 2021-09-28DOI: 10.4236/wjcs.2021.119011
Pedram Rajabifard, A. Agarwal, P. Skillington
Background: Pericardial rupture is a rare diagnosis, usually occurring secondary to high energy blunt force trauma, which can result in subluxation of the heart. Aim: To determine a suitable method for repair of a pericardial defect post traumatic pericardial rupture. Case: We present a 55-year-old male who was found to have a large pericardial defect intra-operatively while undergoing an elective Ross procedure. The defect was repaired with a Gore-Tex membrane. The patient underwent revision sternotomy and repair of the pericardium due to inadequate laxity of the repaired pericardium resulting in hemodynamic instability. Conclusion: Synthetic membranes, such as Gore-Tex membranes, can be used successfully for repair of large pericardial defects but care must be taken to prevent undue tension secondary to taut repair, resulting in hemodynamic compromise.
{"title":"Pericardial Rupture and Chronic Subluxation of the Heart: A Case Report","authors":"Pedram Rajabifard, A. Agarwal, P. Skillington","doi":"10.4236/wjcs.2021.119011","DOIUrl":"https://doi.org/10.4236/wjcs.2021.119011","url":null,"abstract":"Background: Pericardial rupture is a rare diagnosis, usually occurring secondary to \u0000high energy blunt force trauma, which can result in subluxation of the heart. Aim: To determine a suitable method for repair of a pericardial defect post \u0000traumatic pericardial rupture. Case: We present a 55-year-old male who \u0000was found to have a large pericardial defect intra-operatively while undergoing \u0000an elective Ross procedure. The defect was repaired with a Gore-Tex membrane. \u0000The patient underwent revision sternotomy and repair of the pericardium due to \u0000inadequate laxity of the repaired pericardium resulting in hemodynamic instability. Conclusion: Synthetic membranes, such as Gore-Tex membranes, can be used \u0000successfully for repair of large pericardial defects but care must be taken to \u0000prevent undue tension secondary to taut repair, resulting in hemodynamic \u0000compromise.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"1991 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90391505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-31DOI: 10.4236/wjcs.2021.118010
Kulbhushan Saini, S. Chauhan, Manu Saini
The authors report a case of Large Anterior mediastinal mass in which Transoesophageal Echocardiography (TEE) revealed a large mass that was compressing the right atrium, SVC, henceforth, TEE helped in guiding aspiration and surgical resection of the cystic mass. Therefore, through this case report, authors emphasize the importance of performing intraoperative real-time TEE in the mediastinal mass. This imaging technique helps in visualizing the external compression of cardio-vascular structure and aid in their management, obviating the possibility of large vascular structures from being injured by the surgeon during intraoperative manipulation.
{"title":"Large Anterior Mediastinal Mass: Intraoperative Transesophageal Echocardiography Guided Evaluation and Management","authors":"Kulbhushan Saini, S. Chauhan, Manu Saini","doi":"10.4236/wjcs.2021.118010","DOIUrl":"https://doi.org/10.4236/wjcs.2021.118010","url":null,"abstract":"The authors report a case of Large \u0000Anterior mediastinal mass in which Transoesophageal Echocardiography (TEE) \u0000revealed a large mass that was compressing the right atrium, SVC, henceforth, \u0000TEE helped in guiding aspiration and surgical resection of the cystic mass. Therefore, through \u0000this case report, authors emphasize the \u0000importance of performing intraoperative real-time TEE in the mediastinal \u0000mass. This imaging technique helps in visualizing the external compression of \u0000cardio-vascular structure and aid in their management, obviating the \u0000possibility of large vascular structures from being injured by the surgeon \u0000during intraoperative manipulation.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86229837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-31DOI: 10.4236/wjcs.2021.117009
Md. Abir Tazim Chowdhury, Sohail Ahmed, Md. Zulfiqur Haider, S. Z. Nine, Md. Kamrul Hasan, Mohammad Sanaul Hoque Sarker
Penetrating injuries to the subclavian arteries as well as post traumatic pseudoaneurysm involving Subclavian artery (SCA) are very much uncommon. We present one case of a 21 year-old male sustained a physical assault with a post stab injury left subclavian artery pseudoaneurysm. He was referred to our facility, two days after sustaining a penetrating chest trauma over left infraclavicular area of the chest. The presentation, diagnostic procedures and surgical approach for management of this very rare injury are discussed.
{"title":"Subclavian Artery Pseudoaneurysm following Stab Injury and Its Surgical Approach: A Case Report and Literature Review","authors":"Md. Abir Tazim Chowdhury, Sohail Ahmed, Md. Zulfiqur Haider, S. Z. Nine, Md. Kamrul Hasan, Mohammad Sanaul Hoque Sarker","doi":"10.4236/wjcs.2021.117009","DOIUrl":"https://doi.org/10.4236/wjcs.2021.117009","url":null,"abstract":"Penetrating \u0000injuries to the subclavian arteries as well as post traumatic pseudoaneurysm \u0000involving Subclavian artery (SCA) are very much uncommon. We present one case \u0000of a 21 year-old male sustained a physical assault with a post stab injury left subclavian artery \u0000pseudoaneurysm. He was referred to our facility, two days after sustaining \u0000a penetrating chest trauma over left infraclavicular area of the chest. The presentation, \u0000diagnostic procedures and surgical approach for management of this very \u0000rare injury are discussed.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80847752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-31DOI: 10.4236/wjcs.2021.115007
B. Togola, L. Muller, B. Bengaly, D. Traoré, D. Ouattara, C. Touré, M. Coulibaly, A. Kanté, H. Dicko, B. Diallo, M. Peret, N. Ongoïba, J. Debrux
Background:The objective of this work was to evaluate the first results of the radio ablation of the great saphenous vein in the processing of chronic venous insufficiency. Method: This is a monocentric retrospective study of radio ablation of the great saphenous vein using VNUS Closure® FAST for superficial venous insufficiency of the great saphenous vein, between January 2012 and December 2014. Results: 42 patients (57 limbs) were operated on with this technology. There were 33 women and 9 men (mean age: 46.5 years). Thirty-nine patients (92. 8%) were symptomatic. Thirty-two patients (76.1%) were classified CEAP 2. The average diameter of the saphenous vein was 8.5 ± 1.5 mm. Three patients (7.1%) had a percutaneous approach. A perfect occlusion of the saphenous vein was observed in all patients. No incident or undesirable event was observed during the procedure. One case of delayed deep-vein thrombosis was observed. At one month of follow-up, six patients (14.2%) had induration opposite to the occluded vein. Forty-three percent of the patients stated they were very satisfied with the procedure. Conclusion: The effectiveness, security and simplicity of the closure method are real. More studies are necessary to assess the long-term results of this procedure.
{"title":"VNUS Closure® FAST Radiofrequency of the Great Saphenous Vein for Superficial Venous Insufficiency: Experience of the CH of Cholet in France","authors":"B. Togola, L. Muller, B. Bengaly, D. Traoré, D. Ouattara, C. Touré, M. Coulibaly, A. Kanté, H. Dicko, B. Diallo, M. Peret, N. Ongoïba, J. Debrux","doi":"10.4236/wjcs.2021.115007","DOIUrl":"https://doi.org/10.4236/wjcs.2021.115007","url":null,"abstract":"Background:The objective of this work was to evaluate the first results of the radio ablation of the great saphenous vein in the processing of chronic venous insufficiency. Method: This is a monocentric retrospective study of radio ablation of the great saphenous vein using VNUS Closure® FAST for superficial venous insufficiency of the great saphenous vein, between January 2012 and December 2014. Results: 42 patients (57 limbs) were operated on with this technology. There were 33 women and 9 men (mean age: 46.5 years). Thirty-nine patients (92. 8%) were symptomatic. Thirty-two patients (76.1%) were classified CEAP 2. The average diameter of the saphenous vein was 8.5 ± 1.5 mm. Three patients (7.1%) had a percutaneous approach. A perfect occlusion of the saphenous vein was observed in all patients. No incident or undesirable event was observed during the procedure. One case of delayed deep-vein thrombosis was observed. At one month of follow-up, six patients (14.2%) had induration opposite to the occluded vein. Forty-three percent of the patients stated they were very satisfied with the procedure. Conclusion: The effectiveness, security and simplicity of the closure method are real. More studies are necessary to assess the long-term results of this procedure.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82384523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-15DOI: 10.4236/WJCS.2021.114006
A. Makhdoom, A. Elassal
Background: Acute Ventricular septal rupture is one of dreadful complications of acute evolving myocardial infarction. Despite urgent management is lifesaving, it is still challenging and has a high risk of mortality particularly if recurrent or residual defects occurred. Evolving of skillfulness in transcatheter intervention of heart diseases paved the way for successful hybrid management of challenging cardiac cases specially for residual complicated cases post cardiac surgery. Case Presentation: We described here a successful hybrid two stage technique (surgical then transcatheter approach) to close two consecutive acute ventricular septal ruptures in 75 years old female presented with cardiogenic shock post evolving myocardial infarction. Conclusion: Hybrid repair by surgical and transcatheter interventions may be a good therapeutic modality for acute septal ruptures specially for residual or new defects after initial closure.
{"title":"Hybrid Repair of Two Consecutive Acute Ventricular Septal Ruptures after Evolving Myocardial Infarction: Case Report","authors":"A. Makhdoom, A. Elassal","doi":"10.4236/WJCS.2021.114006","DOIUrl":"https://doi.org/10.4236/WJCS.2021.114006","url":null,"abstract":"Background: Acute Ventricular septal rupture is one of dreadful complications of acute evolving myocardial infarction. Despite urgent management is lifesaving, it is still challenging and has a high risk of mortality particularly if recurrent or residual defects occurred. Evolving of skillfulness in transcatheter intervention of heart diseases paved the way for successful hybrid management of challenging cardiac cases specially for residual complicated cases post cardiac surgery. Case Presentation: We described here a successful hybrid two stage technique (surgical then transcatheter approach) to close two consecutive acute ventricular septal ruptures in 75 years old female presented with cardiogenic shock post evolving myocardial infarction. Conclusion: Hybrid repair by surgical and transcatheter interventions may be a good therapeutic modality for acute septal ruptures specially for residual or new defects after initial closure.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82425120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-15DOI: 10.4236/WJCS.2021.114005
P. S. Ba, Kabulo Yannick, M. Diop, Papa Amath Diagne, N. F. Sow, P. A. Dieng, A. G. Ciss
Agenesis of pulmonary valve is a rare variant and severe form of Tetralogy of Fallot (ToF). The evolution is usually marked by respiratory and cardiac failure at early age, which needs early surgical correction. Uncorrected treatment of Tetralogy of Fallot diagnosed at adult age is infrequent and only few studies have been described. We present here a rare case of a 22 years old patient who presented with dyspnea since childhood. Subsequent investigations allowed diagnosis of treatment of Tetralogy of Fallot with agenesis of the pulmonary valve. Following the assessment, the patient underwent a surgical repair and the recovery was uneventful. The management of treatment of Tetralogy of Fallot with pulmonary valve agenesis in adult period remains complex, requiring different surgical techniques.
{"title":"Surgical Treatment of Tetralogy of Fallot with Pulmonary Valve Agenesis in a 22 Years Old Patient","authors":"P. S. Ba, Kabulo Yannick, M. Diop, Papa Amath Diagne, N. F. Sow, P. A. Dieng, A. G. Ciss","doi":"10.4236/WJCS.2021.114005","DOIUrl":"https://doi.org/10.4236/WJCS.2021.114005","url":null,"abstract":"Agenesis of pulmonary valve is a rare variant and severe form of Tetralogy of Fallot (ToF). The evolution is usually marked by respiratory and cardiac failure at early age, which needs early surgical correction. Uncorrected treatment of Tetralogy of Fallot diagnosed at adult age is infrequent and only few studies have been described. We present here a rare case of a 22 years old patient who presented with dyspnea since childhood. Subsequent investigations allowed diagnosis of treatment of Tetralogy of Fallot with agenesis of the pulmonary valve. Following the assessment, the patient underwent a surgical repair and the recovery was uneventful. The management of treatment of Tetralogy of Fallot with pulmonary valve agenesis in adult period remains complex, requiring different surgical techniques.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"1 1","pages":"29-36"},"PeriodicalIF":0.0,"publicationDate":"2021-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89970677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-30DOI: 10.4236/WJCS.2021.113004
Shaza Alturifi, Mhd Firas Al Hinnawi, A. Khaddam, A. Khaddour
Ischaemic Heart Disease (IHD) or Coronary heart disease means that the heart is not getting enough blood and oxygen supply through the coronary arteries. The most common cause of this disease is the process of atherosclerosis in the coronary arteries. Although significant progress has been made in the management of ischaemic heart disease (IHD) The number of severe IHD patients is increasing. The treatment options for IHD have not changed much over the last three decades, which is divided between medications, coronary Angioplasty and Coronary artery bypass surgery. Thus it was crucial to develop new, non-invasive therapeutic strategies in case of Failure of medical or interventional therapy or in case patient is not fit for surgery or angioplasty. In this study, we are pleased to reveal a novel technique that was carried out on a human model. We aimed to develop low-intensity pulsed ultrasound (LIPUS) therapy for the treatment of patients with Ischaemic Heart Disease. We have set up the inclusion and exclusion criteria, the treatment protocol of LIPUS on IHD patients. In this limited group of IHD patients, We found promising clinical results and improvement on myocardial functions.
{"title":"Effect of Low-Intensity Pulsed Ultrasound on Ischaemic Heart Disease Patients (Novel Technique)","authors":"Shaza Alturifi, Mhd Firas Al Hinnawi, A. Khaddam, A. Khaddour","doi":"10.4236/WJCS.2021.113004","DOIUrl":"https://doi.org/10.4236/WJCS.2021.113004","url":null,"abstract":"Ischaemic Heart Disease (IHD) or Coronary heart disease means that the heart is not getting enough blood and oxygen supply through the coronary arteries. The most common cause of this disease is the process of atherosclerosis in the coronary arteries. Although significant progress has been made in the management of ischaemic heart disease (IHD) The number of severe IHD patients is increasing. The treatment options for IHD have not changed much over the last three decades, which is divided between medications, coronary Angioplasty and Coronary artery bypass surgery. Thus it was crucial to develop new, non-invasive therapeutic strategies in case of Failure of medical or interventional therapy or in case patient is not fit for surgery or angioplasty. In this study, we are pleased to reveal a novel technique that was carried out on a human model. We aimed to develop low-intensity pulsed ultrasound (LIPUS) therapy for the treatment of patients with Ischaemic Heart Disease. We have set up the inclusion and exclusion criteria, the treatment protocol of LIPUS on IHD patients. In this limited group of IHD patients, We found promising clinical results and improvement on myocardial functions.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"143 1","pages":"21-28"},"PeriodicalIF":0.0,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77474690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-26DOI: 10.4236/WJCS.2021.112003
K. Maram, V. Kudumula, Dilip Ratti, Sindhura Paturi
Unlike benign primary cardiac tumors like rhabdomyomas and fibromas, primary malignant tumors are extremely rare in children with very few cases reports in the literature so far. Rhabdomyosarcoma is a rare primary malignant tumor in children with most reported cases occurring in the right heart. We report a 15-month-old child with a primary rhabdomyosarcoma arising from the left ventricle and presenting with cardiac tamponade and circulatory failure. He underwent a diagnostic sternotomy and palliative chemotherapy but succumb to the disease later.
{"title":"Primary Cardiac Rhabdomyosarcoma in a Child—A Case Report","authors":"K. Maram, V. Kudumula, Dilip Ratti, Sindhura Paturi","doi":"10.4236/WJCS.2021.112003","DOIUrl":"https://doi.org/10.4236/WJCS.2021.112003","url":null,"abstract":"Unlike benign primary cardiac tumors like rhabdomyomas and fibromas, primary malignant tumors are extremely rare in children with very few cases reports in the literature so far. Rhabdomyosarcoma is a rare primary malignant tumor in children with most reported cases occurring in the right heart. We report a 15-month-old child with a primary rhabdomyosarcoma arising from the left ventricle and presenting with cardiac tamponade and circulatory failure. He underwent a diagnostic sternotomy and palliative chemotherapy but succumb to the disease later.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"42 1","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"2021-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85836054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-20DOI: 10.4236/WJCS.2021.111002
H. Ravulapalli, Ramesh Srigiri, Periyasamy, R. Karthekeyan, M. Vakamudi
We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve and severe mitral regurgitation landed up in complications of infective endocarditis like femoral artery thrombo embolism followed by an abdominal aortic aneurysm with contained rupture. This case was successfully managed addressing two problems i.e. valve and aneurysm repair in single sitting.
{"title":"Leaking Mycotic Aneurysm of Abdominal Aorta in a 14-Year-Old Boy with Infective Endocarditis and Severe Mitral Regurgitation—A Rare Case Report","authors":"H. Ravulapalli, Ramesh Srigiri, Periyasamy, R. Karthekeyan, M. Vakamudi","doi":"10.4236/WJCS.2021.111002","DOIUrl":"https://doi.org/10.4236/WJCS.2021.111002","url":null,"abstract":"We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve and severe mitral regurgitation landed up in complications of infective endocarditis like femoral artery thrombo embolism followed by an abdominal aortic aneurysm with contained rupture. This case was successfully managed addressing two problems i.e. valve and aneurysm repair in single sitting.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"20 1","pages":"8-15"},"PeriodicalIF":0.0,"publicationDate":"2021-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84656446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-20DOI: 10.4236/WJCS.2021.111001
A. Morgante
Despite not included in the traditional risk scores before surgery, liver cirrhosis, especially in advanced stages, has always influenced strongly final outcome both on short and midterm in patients undergoing cardiac surgery. Growing incidence of non-alcoholic fatty liver disease interlinked with metabolic syndrome and significant advancements in medical therapy have actually increased the likelihood of cardiac surgery in cirrhotic patients. To date, Child-Pugh and MELD scores have been commonly used to predict mortality and postoperative hepatic decompensation, but on the other hand, both traditional risk scores show some limitations for evaluation of hepatopathic patients undergoing specifically cardiac surgery. In this context, a specific Heart-Liver score hasn’t been developed yet in the attempt to outline a patient profile able to face surgery, therefore addressing us to adopt the best strategy possible for each case. If CP class A or low MELD score (<11) patients tolerate cardiac surgery with a mild increase in mortality and morbidity, currently state of art recommends particular caution towards surgery idea in presence of advanced hepatic disease. As far as cardiac surgery represents the unique therapeutic strategy in several life-threatening cases, anyway surgical correction of cardiac pathology won’t guarantee an increased life expectancy in accordance with the persistent liver dysfunction. Hereby, this paper will focus on preoperative parameters that should be considered in the future realization of a Heart-Liver prognostic score for overcoming limitations and difficulties related to the impact of liver disease on final clinical outcome.
{"title":"Cirrhotic Patients Undergoing Cardiac Surgery: Why Not to Develop a More Specific Heart-Liver Score?","authors":"A. Morgante","doi":"10.4236/WJCS.2021.111001","DOIUrl":"https://doi.org/10.4236/WJCS.2021.111001","url":null,"abstract":"Despite not included in the traditional risk scores before surgery, liver cirrhosis, especially in advanced stages, has always influenced strongly final outcome both on short and midterm in patients undergoing cardiac surgery. Growing incidence of non-alcoholic fatty liver disease interlinked with metabolic syndrome and significant advancements in medical therapy have actually increased the likelihood of cardiac surgery in cirrhotic patients. To date, Child-Pugh and MELD scores have been commonly used to predict mortality and postoperative hepatic decompensation, but on the other hand, both traditional risk scores show some limitations for evaluation of hepatopathic patients undergoing specifically cardiac surgery. In this context, a specific Heart-Liver score hasn’t been developed yet in the attempt to outline a patient profile able to face surgery, therefore addressing us to adopt the best strategy possible for each case. If CP class A or low MELD score (<11) patients tolerate cardiac surgery with a mild increase in mortality and morbidity, currently state of art recommends particular caution towards surgery idea in presence of advanced hepatic disease. As far as cardiac surgery represents the unique therapeutic strategy in several life-threatening cases, anyway surgical correction of cardiac pathology won’t guarantee an increased life expectancy in accordance with the persistent liver dysfunction. Hereby, this paper will focus on preoperative parameters that should be considered in the future realization of a Heart-Liver prognostic score for overcoming limitations and difficulties related to the impact of liver disease on final clinical outcome.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89803878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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