scholarly journals High thoracic epidural decreases perioperative myocardial ischemia and improves left ventricle function in aortic valve replacement alone or in addition to cabg surgery even with increased left ventricle mass index

2020 ◽  
Vol 23 (2) ◽  
pp. 154 ◽  
Author(s):  
AhmedS Elgebaly ◽  
SamehM Fathy ◽  
Yaser Elbarbary ◽  
AymanA Sallam
Keyword(s):  
Aortic Valve ◽  
Myocardial Ischemia ◽  
Left Ventricle ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricle Mass ◽  
Left Ventricle Function ◽  
Thoracic Epidural ◽  
High Thoracic Epidural ◽  
Ventricle Function

Aortic Valve Replacement through a Mini Lateral Thoracotomy with High Thoracic Epidural Anesthesia

2006 ◽  
Vol 1 (4) ◽  
pp. 160-164 ◽  
Author(s):  
Siclari Francesco ◽  
Demertzis Stefanos ◽  
Mauri Romano ◽  
Cassina Tiziano ◽  
Pedrazzini Giovanni ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Epidural Anesthesia ◽  
Thoracic Epidural Anesthesia ◽  
Uneventful Recovery ◽  
Moderate Hypothermia ◽  
Thoracic Epidural ◽  
High Thoracic Epidural ◽  
Lateral Thoracotomy

Background Minimally invasive aortic valve surgery is usually performed through a right parasternal incision or a modification of partial sternotomy. We explored the feasibility of using a videoassisted small right lateral thoracotomy (RLT) to approach the aortic valve. Methods From August 2003 to December 2004, 12 patients with aortic stenosis (9) or regurgitation (3) underwent an aortic valve replacement through an 8 cm RLT in the 4th intercostal space. There were 4 men and 8 women with a mean age of 61 years (range 30–79 years). Nine mechanical and 3 biologic prostheses were implanted. Endotracheal narcosis was combined with high thoracic epidural anesthesia. Transesophageal echocardiographic monitoring was performed in all cases. Cannulation was done via the right femoral artery and vein and right jugular vein. The video-assisted operation was performed in moderate hypothermia (30°C) and in cardioplegic arrest. Transthoracic aortic clamping was used in all cases. Results Mean operation, perfusion, and clamping times were 223 minutes, 132 minutes, and 73 minutes, respectively. There was no mortality. One patient required conversion to sternotomy due to discovery of a calcium fragment entrapped in a mechanical prosthesis. One patient developed a groin seroma that was treated surgically. All patients, except one were extubated in the operative room and transferred to the intermediate care unit after 6 hours; all had an uneventful recovery. Conclusions Aortic valve replacement through an RLT is feasible and safe. Operative time, perfusion, and cross-clamping times are only marginally longer than a conventional operation, and recovery is rapid.

Original method of posterior aortoplasty for aortic valve replacement in surgical treatment of combined mitral-aortic valve diseases

2020 ◽  
Vol 87 (9-10) ◽  
pp. 40-43
Author(s):  
V. V. Popov ◽  
R. M. Vitovskyi ◽  
Yu. V. Bakhovska ◽  
O. O. Bolshak ◽  
K. Ye. Vakulenko ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Diseases ◽  
Original Method ◽  
Early Postoperative Period ◽  
Ascending Aorta ◽  
Artificial Heart Valve ◽  
Class Iii

Objective. To research of possibilities of reconstruction of aorta`s ostium and ascending aorta during aortic valve replacement and simultaneous correction of mitral valve defects at patients with narrow aorta`s ostium. Materials and methods. The study group consisted of 46 patients with mitral-aortic heart diseases and combination with a narrow aortic mouth, who were operated on at the A Amosov National Institute of Cardiovascular surgery for the period from January 1, 2006 to January 1, 2020. All patients underwent reconstruction of the aortic root and ascending aorta according to the original method of posterior aortoplasty. There were 26 men (56.5%) and 20 women (43.5%). The age of patients ranged from 23 to 72 years (average - 58.4±7.3 years). 8 (17.4%) patients belonged to class III NYHA, 38 (82.6%) - to class IV. Results. Of the 46 operated patients at the hospital stage (30 days after surgery), 4 died (hospital mortality 8.7%). No fatalities were associated with surgical technique. The dynamics of echocardiographic parameters at the hospital stage was as follows: the systolic gradient on the aortic valve was before surgery 112.1 ± 15.2 mm Hg, on the aortic prosthesis at discharge - 23.2 ± 6.4 mm Hg; end-systolic index (ESI) of the left ventricle (ml/m²) - 59.1 ± 7.6 (before surgery) and 48.3 ± 5.9 (after surgery); left ventricle ejection fraction (EF) - 0.45 ± 0.04 (before surgery) and 0.53 ± 0.04 (after surgery). Conclusions. The proposed original technique of posterior aortoplasty allows to effectively expand the mouth of the aorta for further implantation of an artificial heart valve of larger diameter. The technique is quite safe. At the hospital stage there are no complications directly related to the technique of operations. At the early postoperative period, the morphometric parameters of the left ventricle (EF and ESI) improved. The technique can be successfully used for the correction of combined mitral-aortic valve defects.

Does the left ventricle remodel following aortic valve replacement for aortic stenosis in older patients?

1995 ◽  
Vol 8 (3) ◽  
pp. 381
Author(s):  
Mrinal Sharma ◽  
Gerard Aurigemma ◽  
Robert Lind ◽  
Andrea Sweeney ◽  
Theo E. Meyer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Older Patients ◽  
Left Ventricle Remodel

scholarly journals Management of a Case of Aortic Valve Replacement with Left Ventricle Clot Removal Developing Acute Kidney Injury in Postoperative Period

2020 ◽  
Author(s):  
Naresh Kumar Aggarwal ◽  
Sushanta Bhoi
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Postoperative Period ◽  
Severe Aortic Stenosis ◽  
Kidney Injury ◽  
Clot Removal

AbstractCardiac surgery associated-acute kidney injury (AKI) is a common and a serious complication of cardiac surgery requiring cardiopulmonary bypass and it is the second most common cause of AKI in intensive care unit. Recently, two consensus conferences have suggested new diagnostic criteria to define AKI and risk score to better identify patients who will develop AKI after cardiac surgery. In fact, prompt recognition of high-risk patients could allow a more aggressive management at a reversible stage of an incoming ARF. In this case report, we have discussed a case of 21-year-old patient with bicuspid aortic valve with severe aortic stenosis with ejection fraction 15% and left ventricle (LV) clot undergoing surgery for aortic valve replacement with LV clot removal. In the postoperative period, he developed AKI that was managed successfully by early intervention by slow low efficiency dialysis and diafiltration and hemodialysis and patient discharged successfully from hospital.

scholarly journals P252 Incidental finding of a chronic left ventricular pseudoaneurysm years after surgical aortic valve replacement

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Klappacher ◽  
D Beitzke
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Peak Velocity ◽  
Thrombus Formation ◽  
Left Ventricular ◽  
Left Ventricular Pseudoaneurysm ◽  
Mechanical Aortic Valve ◽  
Left And Right

Abstract Case presentation A 35-years old female was referred to our outpatient clinic with unclear thoracic pain and dyspnea. Clinical chemistry testing was unremarkable. Electrocardiography (ECG) showed T-wave inversion in the anterior-lateral leads. Chest X-ray displayed an oval bulge on the left border of the heart. The physical exam revealed a systolic murmur on top of the closing click sound of a mechanical aortic valve prothesis which had been implanted nine years ago. Since that time, the patient had not had regular checkups and the actual consultation was motivated by her aggravating symptoms only. Findings. In transthoracic echocardiography, the mechanical aortic valve prothesis exhibited an acceptable peak velocity of 2.7 m/s with a mean gradient of 18 mm Hg and only mild paravalvular regurgitation. The native mitral and tricuspid valves were functionally and morphologically normal. Left and right ventricle were of normal systolic and diastolic function and normal size. No signs of pericardial effusion were detected. However, a big (40x22mm) saccular structure with a narrow (10 mm) neck was visible at the apex of the left ventricle, see left panel of figure. At the neck, a bidirectional flow between the saccular structure and the left ventricle was detected with a peak velocity of 2,5 m/sec indicating the presence of a pseudoaneurysm. Its linings were calcified and free of discernable thrombus formation, although the flow inside was turbulent as evidenced in the contrast echocardiogram, see right panel of figure. Subsequently, CT-imaging confirmed the diagnosis and surgical resection of the pseudoaneurysm was successfully performed 10 days later. The surgeon noted that the walls of the resected cavity contained thrombotic masses despite respective negative findings on CT and echo. The postoperative course was uneventful, and the patient was discharged in good condition with normal left and right ventricular function and no regional left ventricular wall abnormalities. A year later, she was however re-admitted with prosthetic aortic valve stenosis due to thrombus formation on one the leaflets in the second trimester of a pregnancy. Discussion This is an exceptional case of chronic left ventricular pseudoaneurysm following aortic valve replacement. Since the patient had no history of myocardial infarction or of other potential causes that could explain the formation of a pseudoaneurysm, it is likely to be a remnant of venting the left ventricle during the original surgical procedure. The patient had been unattended and asymptomatic for several years which allowed chronification as indicated by the calcifications of the inner linings. Still, immediate surgical repair was mandatory due to the high risk of rupture and thromboembolism. Abstract P252 Figure.

Sign in / Sign up

Export Citation Format

Share Document