Cirugia Cardiovascular最新文献

In pediatric age, mitral valve repair is the treatment of choice whenever possible, since it does not alter valve growth and can be a long-term solution. In young children, especially those under 2 years of age, if valve repair is not possible, we should try to delay mitral valve replacement as much as possible, since it presents high mortality, and also since the size of the prosthesis is fixed, it will not adapt to the somatic growth of the patient, and will require replacement of the valve prosthesis.

When a patient with mitral pathology requires surgical treatment, if valve repair is not feasible, and the size of the valve annulus is less than 15 mm, the options are very limited, since there are currently no such small mechanical prostheses. In this article we collect the therapeutic options for patients with a valve annulus less than 15 mm that we can find in the literature, some of them described as clinical cases, or series with a small sample size, which makes it difficult to draw conclusions. We also describe a decision scheme, which could help us choose which is the most appropriate treatment, depending on the size of the mitral valve annulus, although we must keep in mind that the choice of one or another treatment will depend on multiple factors, such as the characteristics anatomical, the surgeon's experience with the different techniques, and the available resources.

Objectives

The aim of this study is to present our experience with three patients who underwent a neonatal Yasui procedure, and to show the new decision-making algorithm.

Methods

This is a series of three neonates operated on at our hospital between 2017 and 2022.

Results

All the patients underwent a primary Yasui. The duration of cardiopulmonary bypass was 275, 249 and 391 min, in patient 1, 2 and 3, respectively. After surgery, the Intensive Care Unit stay of patients 1, 2 and 3 was 29, 22 and 24 days, respectively. The patients were discharged in good condition. Subsequent complications during follow-up included the need for percutaneous intervention in patient 1 for the implantation of a stent in the right pulmonary branch (at 6 months postoperatively) and a stent in the right ventricle-pulmonary artery conduit (at 42 months). Patient 2 required right ventricle-pulmonary artery conduit replacement and repair of moderate-severe left ventricular outflow tract obstruction at 16 months postoperatively. Patient 3 needed a reoperation at 3 months postoperatively due to aortic arch stenosis at different levels and a residual ventricular septal defect. Currently, all patients are alive with adequate echocardiographic biventricular function.

Conclusions

In experienced centers, primary Yasui repair can be performed in the neonatal period with satisfactory results.

Left or bilateral cardiac sympathetic denervation is employed as a final option for treating pharmacologically refractory ventricular arrhythmias of various etiologies. In this study, we share our experience with bilateral cardiac denervation. A total of 6 patients (mean age 73.8 years ± 6.5 years, mean LVEF 37 ± 8.3%), between 2021 and 2022, with sarcoidosis or ischemic heart disease underwent bilateral cardiac denervation due to electrical storm despite prior treatments. It was achieved complete resolution of ventricular arrhythmias in 100% of cases, with no recurrence of cardiac device shocks and no mortalities, neither cases of pneumothorax, Horner's syndrome, or other complications. Therefore, it was concluded that in this study, bilateral cardiac denervation was effective for treatment of refractory ventricular arrhythmias. Further larger studies are required to confirm these findings.