Category: General

J Mech Behav Biomed Mater. 2024 Dec;160:106741. doi: 10.1016/j.jmbbm.2024.106741. Epub 2024 Sep 11.

ABSTRACT

Transcatheter aortic valve replacement (TAVR) has become today the most attractive procedure to relieve patients from aortic valve disease. However, the procedure requires crimping biological tissue within a metallic stent for low diameter catheter insertion purpose. This step induces specific stress in the leaflets especially when the crimping diameter is small. One concern about crimping is the potential degradations undergone by the biological tissue, which may limit the durability of the valve once implanted. The purpose of the present work is to investigate the mechanical damage undergone by bovine pericardium tissue during compression and analyze how this degradation evolves with time under fatigue testing conditions. Pericardium 500 μm thick pericardium ribbons (5 mm large, 70 mm long) were crimped down to 12 Fr for 30 and 50 min within a metallic stent to replicate the heart valve crimping configuration. After crimping, samples underwent cyclic fatigue flexure and pressure loading over 0.5 Mio cycles. Samples were characterized for mechanical performances before crimping, after crimping and after fatigue testing in order to assess potential changes in the mechanical properties of the tissue after each step. Results bring out that the ultimate tensile strength is not modified through the process. However an increase in the modulus shows that the crimping step tends to stiffen the pericardium. This may have an influence on the lifetime of the implant.

PMID:39276437 | DOI:10.1016/j.jmbbm.2024.106741

ACS Appl Mater Interfaces. 2024 Nov 13. doi: 10.1021/acsami.4c14256. Online ahead of print.

ABSTRACT

Valve replacement is the most effective means of treating heart valve diseases, and transcatheter heart valve replacement (THVR) is the hottest field at present. However, the durability of the commercial bioprosthetic valves has always been the limiting factor restricting the development of interventional valve technology. The chronic inflammatory reaction, calcification, and difficulty in endothelialization after the implantation of a glutaraldehyde cross-linked porcine aortic valve or bovine pericardium often led to valve degeneration. Improving the biocompatibility of valve materials and inducing endothelialization to promote in situ regeneration can extend the service life of valve materials. Herein, inspired by the hardening process of butterfly wings, this study proposed a dopamine-metal-phenol strategy to modify decellularized porcine pericardium (DPP). This is a strategy to make dopamine (DA) coordinate trivalent metal chromium ions (Cr(III)) with antiplatelets (PLTs) and anti-inflammatory properties, and then cross-link it with tea polyphenols (TP) to generate a valve scaffold that is mechanically comparable to glutaraldehyde-cross-linked scaffolds but avoids the cytotoxicity of aldehyde and presents better biocompatibility, hemocompatibility, anticalcification, and anti-inflammatory response properties.

PMID:39535147 | DOI:10.1021/acsami.4c14256

Gen Thorac Cardiovasc Surg Cases. 2023 Aug 29;2(1):87. doi: 10.1186/s44215-023-00108-4.

ABSTRACT

BACKGROUND: Left ventricular (LV) pseudo-false aneurysm is a rare and fatal complication secondary to myocardial infarction. Sometimes, it may perforate the right ventricle (RV) and lead to acute heart failure. We experienced 2 cases of surgical repair of an LV pseudo-false aneurysm perforating the RV.

CASE PRESENTATION: Case 1: A 76-year-old man was referred to our hospital due to dyspnea. Echocardiography revealed an LV pseudo-false aneurysm (25 mm × 20 mm) that had perforated the RV. Via LV incision, the two small orifices communicating to the RV were detected and closed by direct suture. A double patch of bovine pericardium and a dacron sheet was sutured around the aneurysm with everting mattress. Case 2: A 51-year-old man, who had undergone percutaneous coronary intervention 1 month before, was referred to our hospital due to an LV aneurysm perforating the RV. Via LV incision, a double-layered patch was sutured around the aneurysm with everting mattress. The communicating hole to RV was closed by bovine pericardium patch with a running suture via an RV incision. Postoperative course was uneventful in both cases.

CONCLUSIONS: An LV pseudo-false aneurysm perforating the RV should be considered for urgent repair before serious complications arise and the patient’s general condition deteriorates.

PMID:39516980 | DOI:10.1186/s44215-023-00108-4

Gen Thorac Cardiovasc Surg Cases. 2024 Aug 31;3(1):39. doi: 10.1186/s44215-024-00164-4.

ABSTRACT

BACKGROUND: Calcified amorphous tumor (CAT) of the heart is a rare, non-neoplastic cardiac mass with mitral valves and annuli being the most common sites. The presence of mitral annular calcification (MAC) is associated with an increased risk of stroke or other systemic embolisms. Here, we report a case of CAT showing rapid growth with MAC and investigate the link between the two.

CASE PRESENTATION: A 71-year-old man presented at our hospital with dyspnea and had been undergoing hemodialysis for 26 years for chronic glomerulonephritis. Transthoracic echocardiography (TTE) revealed moderate mitral stenosis with bulky MAC. Two months later, the patient developed progressive dyspnea, and follow-up TTE revealed a highly mobile mass (8 × 5 mm) attached to the left ventricular (LV) side of the posterior MAC. He underwent surgery because of congestive heart failure and a high risk of embolization. Surgical inspection revealed that the tumor was attached beneath the P3 segment of the mitral valve on the LV side and was removed. When removing the MAC, toothpaste-like contents drained from the encapsulated mass inside the MAC at the P3 segment, where the tumor was located. After reconstructing the posterior mitral annulus defect with a bovine pericardial patch, mitral valve replacement with a mechanical prosthesis, a maze procedure, and left appendage closure were performed. Histopathological examination revealed that the excised tumor contained fibrin and calcium deposits. The mass was diagnosed as a CAT.

CONCLUSIONS: CAT may be one of the causes of stroke induced by MAC. Routine follow-up echocardiography should be recommended for patients with MAC, especially those undergoing hemodialysis.

PMID:39517092 | PMC:PMC11533609 | DOI:10.1186/s44215-024-00164-4

Gen Thorac Cardiovasc Surg Cases. 2023 Aug 29;2(1):87. doi: 10.1186/s44215-023-00108-4.

ABSTRACT

BACKGROUND: Left ventricular (LV) pseudo-false aneurysm is a rare and fatal complication secondary to myocardial infarction. Sometimes, it may perforate the right ventricle (RV) and lead to acute heart failure. We experienced 2 cases of surgical repair of an LV pseudo-false aneurysm perforating the RV.

CASE PRESENTATION: Case 1: A 76-year-old man was referred to our hospital due to dyspnea. Echocardiography revealed an LV pseudo-false aneurysm (25 mm × 20 mm) that had perforated the RV. Via LV incision, the two small orifices communicating to the RV were detected and closed by direct suture. A double patch of bovine pericardium and a dacron sheet was sutured around the aneurysm with everting mattress. Case 2: A 51-year-old man, who had undergone percutaneous coronary intervention 1 month before, was referred to our hospital due to an LV aneurysm perforating the RV. Via LV incision, a double-layered patch was sutured around the aneurysm with everting mattress. The communicating hole to RV was closed by bovine pericardium patch with a running suture via an RV incision. Postoperative course was uneventful in both cases.

CONCLUSIONS: An LV pseudo-false aneurysm perforating the RV should be considered for urgent repair before serious complications arise and the patient’s general condition deteriorates.

PMID:39516980 | DOI:10.1186/s44215-023-00108-4

Gen Thorac Cardiovasc Surg Cases. 2023 Nov 15;2(1):94. doi: 10.1186/s44215-023-00119-1.

ABSTRACT

BACKGROUND: Primary cardiac angiosarcomas are extremely rare and their prognosis is poor. Surgical resection is the first-line treatment; however, no clear standard of care has been clearly established because of the rarity of these tumors.

CASE PRESENTATION: A 61-year-old man who had presented with dyspnea on exertion was referred to our hospital. Contrast-enhanced computed tomography revealed massive pericardial effusion and a 40-mm enhanced mass adherent to the anterior wall of the right atrium and involving the right coronary artery. Having diagnosed the mass as a cardiac tumor, we resected the mass under the guidance of epi-cardiac echocardiography guidance, which showed continuity between the tumor and the right atrium, reconstructed the right atrial free wall with a bovine pericardial patch, and performed coronary artery bypass grafting to the right coronary artery using the great saphenous vein. The right atrial wall was resected with adequate tumor-free margin. On the right ventricular side, we resected the right atrial wall 1 cm from the tumor, 2 cm from the atrioventricular groove. Because hemodynamic deterioration occurred after aortic declamping, intra-aortic balloon pumping and veno-arterial extracorporeal membrane oxygenation were instituted. Postoperatively, circulatory support devices were removed safely, and the patient was discharged on the 25th postoperative day. Histopathological examination of the surgical specimens resulted in a diagnosis of angiosarcoma, with positive surgical margins. Chemotherapy and radiotherapy (69 Gy in 30 fractions) were therefore initiated after discharge. To date, the patient has been alive and well with no recurrence of tumor for 4 years and 10 months since surgery.

DISCUSSION: This case study suggests the usefulness of multimodality treatment comprising surgical resection and adjuvant therapy, for cardiac angiosarcoma.

PMID:39516966 | PMC:PMC11533438 | DOI:10.1186/s44215-023-00119-1

J Indian Assoc Pediatr Surg. 2024 May-Jun;29(3):233-239. doi: 10.4103/jiaps.jiaps_230_23. Epub 2024 May 8.

ABSTRACT

AIMS: Closure of congenital body wall defects in children can be a challenging task for the pediatric Surgeon. Biological prosthesis has been increasingly used for high-risk wound closure in adult patients with excellent outcomes and use in the pediatric population has also been reported. Here, we aim to study the outcome of abdominal wound repair with a tissue-engineered acellular bovine pericardial patch.

METHODS: Over a period of 21 months, a total of 15 children had undergone abdominal wound repair with bioprostheses, i.e., bovine pericardial patch at our institute. Patient demographics, cause of defect, an indication of patch use, rate of infection, postoperative recovery, recurrence, and outcome were studied.

RESULTS: A total of 15 patients underwent abdominal wall closure with acellular bovine pericardial patch. Nine out of 15 patients were neonates, of whom five had gastroschisis, two had a congenital diaphragmatic hernia, and two had ruptured omphalocele major. Of the rest 6 patients, 2 were patients of bladder exstrophy, 2 were older children of congenital diaphragmatic hernia with incisional hernias, and 2 were older children with omphalocele major. Out of the five patients with gastroschisis, two died during the early postoperative period due to sepsis. The wound healed in the rest 13 patients with mild skin dehiscence in two patients. Only one child had a recurrence.

CONCLUSION: Reconstruction with acellular bovine pericardial patch is a viable option in children with high-risk abdominal wounds as it allows tensionless repair with excellent healing and minimal complications. Recurrence, if any, may disappear with time as remodeling of the prosthesis occurs along with the growth of the body wall of the child.

PMID:38912025 | PMC:PMC11192272 | DOI:10.4103/jiaps.jiaps_230_23

Multimed Man Cardiothorac Surg. 2024 Nov 11;2024. doi: 10.1510/mmcts.2024.073.

ABSTRACT

The Commando procedure is an important tool to address extensive calcification of the aortic and mitral valves associated with radiation heart disease. We present a symptomatic patient with radiation heart disease associated with calcification of the mitral and aortic valves and the aortomitral curtain, which is typical of this pathology. The surgical approach consisted of exposure through aortotomy and left atrial dome, followed by aortic and mitral valve debridement, aortic and mitral valve replacement, with aortomitral curtain reconstruction using bovine pericardial patch. This procedure avoids the challenges associated with double valve repair and allows replacement with larger valves.

PMID:39530784 | DOI:10.1510/mmcts.2024.073

Thorac Cardiovasc Surg Rep. 2024 Nov 8;13(1):e29-e32. doi: 10.1055/a-2426-9423. eCollection 2024 Jan.

ABSTRACT

Surgery for Bentall’s endocarditis poses challenges because the infection spreads to the aortic valve annulus, leading to an annular abscess that necessitates reconstruction. We present a straightforward miniskirt Bentall procedure using an annular pericardial patch to treat Bentall’s endocarditis with an annular abscess. After removing the former composite graft and debriding the aortic root and annulus, we created a miniskirt-composite graft using a mechanical or bioprosthetic valve, a straight or Valsalva graft, and an annular bovine pericardial patch with a valve prosthetic sizer. The miniskirt-composite graft, along with the underlying annular pericardial patch, was implanted using a double-layered suture technique.

PMID:39525289 | PMC:PMC11548989 | DOI:10.1055/a-2426-9423