Category: General

Gen Thorac Cardiovasc Surg Cases. 2025 Jan 15;4(1):4. doi: 10.1186/s44215-025-00188-4.

ABSTRACT

BACKGROUND: Left atrial dissection is a rare and occasionally fatal complication of cardiac surgery and is defined as the creation of a false chamber through a tear in the mitral valve annulus extending into the left atrial wall. Some patients are asymptomatic, while others present with various symptoms, such as chest pain, dyspnea, and even cardiac arrest. Although there is no established management for left atrial dissection, surgery should be considered in patients with hemodynamic disruption. Herein, we report a case of left atrial dissection managed using redo mitral valve replacement (MVR) with annular reconstruction.

CASE PRESENTATION: A 60-year-old man presented to our hospital with bilateral lower-extremity purpura and cognitive decline. Blood tests showed an elevated inflammatory response, and blood culture revealed Streptococcus mitis. Transesophageal echocardiography (TEE) revealed severe mitral regurgitation with vegetation on both the anterior and posterior leaflets, and infective endocarditis was diagnosed. We performed minimally invasive cardiac surgery-MVR through a right mini thoracotomy using Epic mitral valve 29 mm (Abbott Laboratories, Green Oaks, IL, USA). On postoperative day (POD) 2, the patient was discharged from the intensive care unit (ICU). On POD 3, sudden cardiac arrest occurred; we started cardiopulmonary resuscitation and urgently inserted a peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) cannula. Contrast-enhanced computed tomography revealed extravasation from the posterior wall of the left atrium. Therefore, we performed an emergency median sternotomy, controlled the bleeding from the posterior wall of the left atrium, and returned the patient to the ICU with gauze packing under VA-ECMO. Two days later, when the gauze was removed, TEE revealed a false lumen on the left atrial wall, and left atrial dissection was diagnosed. Accordingly, we performed annular reconstruction with bovine pericardium to close the entry point and, in succession, redo MVR with a bioprosthetic Epic mitral valve 27 mm. The postoperative course was uneventful. The patient was transferred to a rehabilitation hospital on POD 74.

CONCLUSION: We report a case of left atrial dissection following MVR. The complex lesion was successfully repaired using redo MVR with annular reconstruction.

PMID:39815372 | PMC:PMC11734570 | DOI:10.1186/s44215-025-00188-4

JACC Case Rep. 2024 Nov 20;29(22):102762. doi: 10.1016/j.jaccas.2024.102762. eCollection 2024 Nov 20.

ABSTRACT

This case report presents a unique challenge of complete aortomitral curtain dehiscence and a large pseudoaneurysm 6 weeks post-aortic root replacement in a patient with infective endocarditis. It underscores the importance of meticulous follow-up in patients who have undergone complex aortic surgeries, especially those with infective endocarditis. The patient’s subtle symptoms of occasional dyspnea and lightheadedness highlight the necessity for a comprehensive evaluation and a high index of suspicion. The aortomitral curtain was successfully reconstructed using a bovine pericardial patch, managing the pseudoaneurysm and restoring heart structural integrity. This case also emphasizes the limitations of current diagnostic criteria for infective endocarditis in the presence of intracardiac prosthetic material, and the need for advanced imaging and interdisciplinary consultations to enhance diagnosis and patient management.

PMID:39691892 | PMC:PMC11646890 | DOI:10.1016/j.jaccas.2024.102762

Aesthetic Plast Surg. 2025 Feb 28. doi: 10.1007/s00266-025-04770-7. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this in vivo study is to compare cartilage viability within diced cartilage grafts from the perspective of three wrapping biomaterials Group A acellular dermal matrix (FlexHD®), Group T bovine pericardium (Tutopatch®), and Group F allogeneic human fascia for a possible implementation in the clinical use.

MATERIALS AND METHODS: This in vivo study was conducted on 5 SCID (Severe Combined Immunodeficiency)/Gamma Mice with a duration of eight weeks. The cartilage within composite grafts were obtained from the remaining cartilage following secondary rhinoplasty performed on a single donor. Diced cartilage grafts were wrapped separately with acellular dermal matrix (ADM), bovine pericardium, and fascia to form three groups. A total of five mice were utilized in all three experimental groups, with a total of 15 experimental materials being examined. One composite graft from each group was implanted into the backs of the mice. The effects of the biomaterials on the viability and stability of the composite grafts were evaluated. Viability was evaluated through LIVE/DEAD cell analysis and histopathological examinations. Stability was assessed by comparing weight and volume changes of the grafts, measured using a precision balance and computed tomography, respectively.

RESULTS: A significant increase in weight was found in the fascia group after implantation (p < 0.05). In the ADM (Group A) and bovine pericardium (Group T), no statistically significant weight change was observed (p > 0.05). A significant increase in volume was found in the ADM (Group A) group after implantation (p < 0.05). Flow cytometry showed the highest cartilage viability percentage in the fascia (Group F) and the lowest in the ADM (Group A). No significant difference was found in viability percentages between the groups. Histopathological examinations supported the flow cytometry findings.

CONCLUSION: Our study revealed that cartilage grafts wrapped in allogenic fascia (Group F) showed better viability and stability compared with ADM (Group A) and bovine pericardium (Group T). This suggests that while fascia may remain the gold standard, alternative biomaterials also hold potential. Further experimental and clinical studies with larger sample sizes are needed to support these findings.

LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:40021504 | DOI:10.1007/s00266-025-04770-7

JTCVS Open. 2024 Sep 17;22:395-404. doi: 10.1016/j.xjon.2024.09.008. eCollection 2024 Dec.

ABSTRACT

OBJECTIVE: The study objective was to investigate the effect of free-edge length on valve performance in bicuspidization repair of congenitally diseased aortic valves.

METHODS: In addition to a constructed unicuspid aortic valve disease model, 3 representative groups-free-edge length to aortic diameter ratio 1.2, 1.57, and 1.8-were replicated in explanted porcine aortic roots (n = 3) by adjusting native free-edge length with bovine pericardium. Each group was run on a validated ex vivo univentricular system under physiological parameters for 20 cycles. All groups were tested within the same aortic root to minimize inter-root differences. Outcomes included transvalvular gradient, regurgitation fraction, and orifice area. Linear mixed effects model and pairwise comparisons were used to compare outcomes across groups.

RESULTS: The diseased control group had a mean transvalvular gradient of 28.3 ± 5.5 mm Hg, regurgitation fraction of 29.6% ± 8.0%, and orifice area of 1.03 ± 0.15 cm². In ex vivo analysis, all repair groups had improved regurgitation and transvalvular gradient compared with the diseased control group (P < .001). Free-edge length to aortic diameter of 1.8 had the highest amount of regurgitation among the repair groups (P < .001) and 1.57 the least (P < .001). Free-edge length to aortic diameter of 1.57 also exhibited the lowest mean gradient (P < .001) and the largest orifice area (P < .001).

CONCLUSIONS: Free-edge length to aortic diameter ratio significantly impacts valve function in bicuspidization repair of congenitally diseased aortic valves. As the ratio departs from 1.57 in either direction, effective orifice area decreases and both transvalvular gradient and regurgitation fraction increase.

PMID:39780804 | PMC:PMC11704580 | DOI:10.1016/j.xjon.2024.09.008