The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Stented bovine jugular vein graft (Melody valve) for surgical mitral valve replacement in infants and children.
The options for mitral valve replacement in children with irreparable mitral valve disease have been limited to fixed-diameter prostheses that do not accommodate for somatic growth. We have modified an externally stented bovine jugular vein graft (Melody valve) for implantation in this cohort. Because it is not a fixed-diameter prosthesis, we hypothesized that the valve can be expanded in the catheterization laboratory as the child grows. ⋯ The Melody valve has demonstrated acceptable short-term function. Implantation techniques to prevent left ventricular outflow tract obstruction (suture fixation of the distal stent) and paravalvular leaks (the addition of a pericardial cuff) should be considered. The Melody valve can be percutaneously expanded as the child grows.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Surgical palliation in patients with a single ventricle and dextrocardia.
Dextrocardia is found in a significant proportion of patients undergoing a single-ventricle repair. Surgical outcomes in this cohort are unclear. ⋯ Surgical outcomes of single-ventricle palliation seem poor in patients with dextrocardia. Aggressive management of congenital AVVR might improve the long-term prognosis.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Comparative StudyPalliative pulmonary artery banding versus anatomic correction for congenitally corrected transposition of the great arteries with regressed morphologic left ventricle: long-term results from a single center.
We aimed to compare the long-term results between palliative pulmonary artery banding and anatomic correction for congenitally corrected transposition of the great arteries with regressed morphologic left ventricle. ⋯ In patients with congenitally corrected transposition of the great arteries with deconditioned morphologic left ventricle pulmonary artery banding may be considered an ideal procedure because it allows left ventricle training while improving tricuspid regurgitation. Compared with the double-switch procedure after pulmonary artery banding, prolonged palliative pulmonary artery banding provided a lower mortality rate and indicated better cardiac function.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Surgical strategy for Kommerell's diverticulum: total arch replacement.
Kommerell's diverticulum is a rare congenital aortic arch anomaly. Various surgical techniques have been reported; however, the surgical strategy is still controversial. In our institute, total arch replacement (TAR) and anatomic reconstruction of the subclavian artery (SCA) has been selected for the treatment of Kommerell's diverticulum to release the vascular ring completely and prevent postoperative complications, including dissection, rupture, hand ischemia, and subclavian steal syndrome. ⋯ TAR is a reasonable surgical technique for Kommerell's diverticulum, because it enables the vascular ring to be completely released, preventing recurrence, rupture, and dissection. Anatomic reconstruction of the SCA was effective to prevent hand ischemia and subclavian steal syndrome.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Early left ventricular regional contractile impairment in chronic mitral regurgitation occurs in a consistent, heterogeneous pattern.
The clinical guidelines for asymptomatic patients with chronic mitral regurgitation (MR) use the ejection fraction (EF) to trigger surgical referral. We hypothesized that the EF is not sensitive enough to detect the earliest contractile injury in chronic MR and that the injury associated with chronic MR is not global but heterogeneous, occurring regionally and predictably, before the onset of global left ventricular (LV) dysfunction. ⋯ The earliest contractile injury seen in patients with MR is heterogeneous and consistently distributed along the LV septum. Compensatory responses include hypercontractility of other regions. These data suggest that rather than relying on global LV contractile metrics, which cannot detect early injury, patients might be better served by undergoing directed surveillance of "sentinel" LV regions (LV septum) with high-resolution metrics of regional contractile function.