Dacron Patch Research Articles

Supravalvulaire Aortic Stenosis: Case Report

Introduction: Exceptional congenital heart disease (1 for 26000 birth) characterized by rétrécissement of aortic light. It can be isolated or part of William syndrome. The diagnosis is based on echocardiography. The intervention consists of an aortic root enlargement with Dacron patch. Surgery was indicated if gradient aortic left ventricle Superior of 50 mm hg. This clinical case is for us an opportunity to recall of this type of congenital aortic retrécissement. Methods: We reported the observation of patient 17-year-old without history presented since one-year dyspnea on exersion, palpitation and syncopes. Physical examination: murmur systolic in aortic home without other abnormalities. Chest X ray: CTI: 0.48., ECG: RSR with HVL. Echocardiography: supravalvulaire aortic stenosis; mean gradient AO-LV: 46 mm hg, LV -aortic; LV 48/26 mm + HLV, RV: 20 mm. Exploration per-opératoire: hipoplasie of the left coronary sinus, anomaly of implantation of antero -external pillar of mitral valve, aortic bicuspidie type 1, absence of coronary anomalies. It has benefit under cardio-pulmonary bypass an enlargement of the left coronary sinus according to DOTY technique with Dacron patch and conservation of aortic valve. Results: The immediate post-operative suites were favoured with gradient aortic –left ventricle drop to 20 mm hg. Conclusion: This is very rare congenital heart disease; echocardiography remains the key of diagnosis. It must be operated early. The prognostic is enhanced by the advances in surgical techniques. The treatment consists of surgery. Keywords: Supravalvulaire aortic stenosis; Surgery; Cardiopulmonary bypass

The rectus femoris muscle flap is an underused tool in the vascular surgeon's armamentarium

Mrs Havercamp aFictitious.aFictitious. presents to clinic at 4:00 pm today for an unscheduled appointment. She is a 67-year-old obese diabetic woman who is 10 days status post right common femoral endarterectomy with Dacron patch angioplasty and retrograde iliac stenting for rest pain. Today, she reports increasing pain and drainage from the groin wound. On examination, there is erythema and dehiscence of the skin edges. Cloudy fluid emanates from the wound. I sigh. “Mrs Havercamp, when was the last time you had anything to eat or drink?” Groin wound complications—alarmingly common, occasionally lethal. Amputation may result, but regardless of the outcome, a significant commitment of time, effort, and cost ensues for the patient and the surgeon. That muscle flaps are a valuable adjunct in the treatment of groin wound complications is incontrovertible. Virtually every vascular surgeon has rotated a sartorius flap, usually with success. But what if the sartorius flap fails? or is unavailable? Most of us will have exhausted our toolbox and require the assistance of a plastic surgeon colleague. Indeed, there are myriad reports of other types of muscle flaps used in the management of groin wounds—tensor fascia lata, gracilis, anterolateral thigh myocutaneous, rectus femoris, rectus abdominis, and others. Common among these reports is that they are performed by plastic surgeons in the majority of cases. This study by Ryer and colleagues1Ryer E.J. Garvin R.P. Kapadia R.N. Jorgensen B.D. Green J.O. Fluck M. et al.Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions.J Vasc Surg. 2020; 71: 905-911Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar describes 24 rectus femoris flaps performed exclusively by vascular surgeons for treatment of complex groin wounds after femoral artery reconstruction. As expected, obesity, diabetes, and chronic real disease were common in this cohort of patients, and more than half of the surgical procedures were performed in fields previously operated on. Outcomes were largely favorable and comparable to other publications for patient survival and limb salvage. There were no instances of flap necrosis, nor were any complications related to flap rotation identified. The technique for creation of these flaps is described and is straightforward. The authors acknowledge a potential disadvantage of the rectus femoris flap: a decrement in knee extension strength. The authors did not attempt to quantify it, and they appear to dismiss its importance among chronically ill patients who engage in little strenuous activity. On the contrary, maintaining all residual strength among these patients whose reserve is marginal may be critically important to maintaining mobility. This study sheds no light on this issue. In addition, harvesting and rotating this flap almost certainly take more time than creating a sartorius flap and do involve a fairly generous counterincision in the thigh. Nevertheless, I suspect that these potential downsides practically have little impact. Will I abandon the sartorius flap? Certainly not, and I suspect the authors will not either. There is clearly a role for this simple flap under the right circumstances. Will I add the rectus femoris flap into my own armamentarium? Absolutely. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructionsJournal of Vascular SurgeryVol. 71Issue 3PreviewGroin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative débridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported. Full-Text PDF

Cardiac remodeling and factors determining occurrence of atrial arrhythmia after surgical closure of atrial septal defect in adults

The purpose of this study was to assess cardiac remodeling and to determine factors predicting the occurrence of atrial arrhythmia after surgical closure of atrial septal defect (ASD) in adults. Retrospective study including 33 adult patients (> 20 years old, mean age: 34 ± 11 years, 26 women) who underwent surgical closure of secundum or sinus venosus ASD. Before operation, all patients had dyspnea and 15% were in NYHA III-IV. Sinus rythm was present in 85% of patients. The ratio of pulmonary to systemic blood flow was calculated, yielding a mean of 2.8 + − 1 and pulmonary artery hypertension (PAH) was observed in 80% of patients with a mean value of 41.3 ± 10 mmHg. The ASD were closed by pericardial or Dacron patch in 97% of cases. Operative death was observed in 2 cases. In survival patient, with a follow-up of 97 + 57 months, regression of right ventricular dilatation and PAH occurred in the first post-operative month and was maintained at late follow-up. Atrial arrhythmia occurred in 5 patients and were determined by older operative age ( P = 0.003) and the absence of cardiac remodelling after surgery. surgical correction of ASD in adults is safe and efficacious. Cardiac remodelling after ASD closure in the adult is a common and an early event and prevents late morbidity, which is in most cases due to arrhythmias. The mode of closure does not seem to significantly impact remodelling.

Reconstruction of the aortic valve, relief of right ventricular outflow tract obstruction and double Dacron patch closure of the ventricular septal defect (UKC's modification): a video presentation

Reconstruction of the aortic valve, relief of right ventricular outflow tract obstruction and double Dacron patch closure of the ventricular septal defect (UKC's modification): a video presentation

P1494 Incidental finding of aortic aneurysm formation following 34 years of coarctation repair by dacron patch aortoplasty

Abstract Introduction Aneurysms are found following all types of surgical repair of aortic coarctation, especially after Dacron patch aortoplasty. We describe the finding of an aortic aneurysm in an asymptomatic 52-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 34 years earlier. Case report A 52-year male, smoker, hypertensive on medication He had previous history of surgical repair of aortic coarctation at age of 18 years . Repair was by Dacron patch aortoplasty. Since then, his regular follow up was unremarkable. Recently, he was referred for cardiac evaluation as a part of pre-employment general check-up. He was asymptomatic with no history of shortness of breath or chest pain. Physical examination revealed that the pulse in the left arm was reduced in volume in comparison to the right one. The heart sounds were essentially normal but a pericardial murmur was audible, perhaps reflecting residual collateral flow. Blood pressure was 156/83 mmHg in right arm and 142/81 in the left arm. Transthoracic echocardiography revealed mild left ventricular hypertrophy with normal global and regional contractility and an ejection fraction of 58%. Supra sternal window images showed dilatation of the three aortic arch branches. The distal portion of aortic arch just distal to origin of left subclavian artery was narrowed with a peak systolic gradient across of 34 mmHg. A cystic structure (1.7 cm x 1.9 cm) was visualized attached to the narrowed segment of the aorta, suggestive of a saccular aneurysm, (figures A&B&C). Computed tomography aortogram showed a narrow-necked aneurysm arising from the posterolateral aspect of the distal aortic arch (anticipated site of the coarctation repair graft anastomosis). A small laminated thrombus was also noted within. Aneurysm measured approximately 2.2 x 3.3 cm in its craniocaudal and anteroposterior dimensions respectively, with no evidence of aortic luminal compromise. (figures D&E&F). Management Aneurysmectomy was performed subsequently. Interposition polyester grafts were used to reconstruct the aortic arch and proximal descending aorta and to connect this aortic segment to the subclavian artery via a lateral thoracotomy. The postoperative course thereafter was uneventful. Conclusion: This is a rare insidious complication of Dacron patch aortoplasty that occurred after more than 3 decades, which highlights the importance of diagnostic imaging in the follow up of these patients Abstract P1494 Figure.

Five-year Follow-up After Carotid Endarterectomy Shows Primary Closure to be an Equivalent Closure Technique Compared to Patch Angioplasty when Used in Selected Patients with Broad Carotid Artery, High Carotid Bifurcation or Occlusion of the Contralateral Carotid Artery

Introduction: In patients with symptomatic or asymptomatic severe internal carotid artery stenosis, carotid endarterectomy (CEA) reduces risk for stroke. The optimal surgical technique remains subject of debate. Our previous study based on perioperative results within 30 days after surgery showed no difference in complication rate comparing primary closure or patch angioplasty when used in selected patients.1This follow-up study aimed to assess long-term complication rate and restenosis after CEA with selective patching. Methods: Two hundred thirteen consecutive CEAs over a 3-year period from January 5th 2011 to December 19th 2013 were prospectively analyzed in a follow-up study over 5 years (mean 4.6, range 3.17-6.17). Postoperative risk factors and symptoms of cranial nerve injury, transient ischemic events, cerebrovascular events and mortality were evaluated. Duplex ultrasound was performed by a radiologist blinded to operative technique to evaluate patency of the carotid artery. Mann-Whitney U test was used to compare both group. Risk differences were calculated with 95% confidence intervals using Newcomb's method. Kaplan-Meier estimates of survival were plotted for 1-year and 5-year survival. The log rank test was used to compare survival between both groups (superiority test). Results: Patient population consisted of 141 males and 72 females with mean age 73 years at the time of surgery (SD 8.57, range 53-95). There was a follow-up of 89%. Primary closure was used in 110 operations, and patch angioplasty in 103 procedures (Dacron patch). Primary closure was performed when the carotid artery had a diameter above 5 mm, when there was a high carotid bifurcation or when the contralateral carotid artery was occluded. There were no significant differences among groups' baseline characteristics at the time of surgery. Primary closure was performed significantly more in male patients (P= .02). Overall complication rate postoperatively was 3.76% (1.8% after primary closure, 5.8% after patch angioplasty) and after 5 years 5.29% (2.0% after primary closure, 9.1% after patch angioplasty). These results are not significantly different between the two groups (P= .09 and P= .05). Four patients experienced cranial nerve damage postoperatively, two in each group. In each group one of the two fully recovered and the other had persistent complaints (P= 1). Complications during the 5-year follow-up period are summarized in Table 1. In the group of primary closure there was a mortality of 26 patients (23.6%) compared to 26 (25.2%) patients after patch angioplasty (P = .70; Figure 1). Objective duplex ultrasound showed no significant difference comparing restenosis in both groups (P= .43). Twelve patients showed a restenosis between 50-70% (6 primary closure; 6 patch angioplasty), none of the patients had high restenosis > 70%. Patient characteristics did not show a significant effect on long-term outcome. There was a correlation between postoperative use of antihypertensive medication and long-term stroke (P= .006), restenosis (P= .01) and mortality (P= .003). Conclusion: After long-term follow-up we found primary closure and patch angioplasty to be equivalent with respect to complication rate and restenosis when used in selected patients. Best medical treatment and especially the use of antihypertensive medication should be emphasized. Disclosure: Nothing to disclose

Dacron Patch Closure of Ventricular Septal Defect with Concomitant Aortic Valve Replacement using a Mechanical Prosthesis: A Video Presentation

AbstractWe performed Dacron patch closure of ventricular septal defect with concomitant aortic valve replacement using a St. Jude Medical mechanical aortic prosthesis for a patient with ventricular septal defect and severely deformed and irreparable aortic valve. We highlight the technical details of the procedure to prevent paravalvular aortic leakage and residual ventricular septal defect.

LARGE VENTRICULAR SEPTAL DEFECT CAUSED BY AN ACUTE INFERIOR ST ELEVATION MYOCARDIAL INFARCTION

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Septal rupture is an uncommon, but fatal, complication of myocardial infarction (MI) which usually occurs 3-5 days after an acute MI, however, in rare instances it may develop within the first 24 hours or as late as 2 weeks. It is associated with a tremendously high mortality rate (41-80%) which has been unchanged during the last few decades [1]. We hereby report one such rare instance when this complication occurred within 48 hours following MI. CASE PRESENTATION: A 59 year old male with a history of coronary artery disease status post percutaneous coronary intervention in 2011 presented to the emergency room with chest pain for 1 hour prior to admission. Initial electrocardiogram showed acute inferior ST elevation MI. Emergent cardiac catheterization showed occlusion of the right coronary artery and a drug eluting stent was placed. The patient was transferred to intensive care unit for close monitoring, however, 5 hours later he developed sudden increasing shortness of breath. Physical examination revealed a new systolic murmur and an echocardiogram was performed showing a large ventricular septal defect (VSD) (Image-1). Overnight he developed atrial fibrillation and became hemodynamically unstable with a systolic blood pressure in the 60's. He was then cardioverted without success and amiodarone was bolused followed by a continuous infusion. The decision was made for emergent coronary artery bypass grafting and repair of the VSD the next day. The defect was successfully closed with a Dacron patch after timely and prompt correction of atrial fibrillation. DISCUSSION: There are 3 life threatening complications of acute MI which include rupture of the left ventricular free wall, rupture of the interventricular septum and development of severe mitral regurgitation. One study compared 225 patients who had a first MI and experienced one of the mechanical complications to 1012 patients without complications to analyze the reason behind these complications. They reported that delayed hospitalization (>24hours), excessive in-hospital physical activity and recurrent ischemia as some of the risk factors for rupture [2]. Early retrospective studies noted lower mortality rates in patients undergoing surgical repair > 6 weeks after infarction than those who went in earlier, however these studies had selection bias as patients with normal ejection fraction and smaller defects survived to become low risk surgical candidates [3]. Hence, optimal approach varies with the clinical presentation. In patients like ours who develop cardiogenic shock, death is inevitable without urgent surgical intervention. CONCLUSIONS: This case is an unusual scenario where this fatal complication occurred within 48 hours following MI even after prompt revascularization. It is unique because it was further complicated with atrial fibrillation, which can further reduce survival probability, yet he survived and defied the odds. Reference #1: Saplaouras A1, Sakellaropoulou A1, Mililis P1, Bazoukis G1, Kolokathis AM1, Konstantinidou E1, Anagnostou A1, Panagopoulou N1, Vlachos K1, Lakoumentas I1, Sideris A1. Ventricular septal rupture following myocardial infarction: A potentially fatal complication. Clin Case Rep. 2019 Jan 9;7(2):397-400 Reference #2: Figueras J, Cortadellas J, Calvo F, Soler-Soler J. Relevance of delayed hospital admission on development of cardiac rupture during acute myocardial infarction: study in 225 patients with free wall, septal or papillary muscle rupture. J Am Coll Cardiol 1998; 32:135. Reference #3: Daggett WM, Guyton RA, Mundth ED, et al. Surgery for post-myocardial infarct ventricular septal defect. Ann Surg 1977; 186:260 DISCLOSURES: No relevant relationships by John Mikhail, source=Web Response No relevant relationships by Mohammed Shariff, source=Web Response

Efficacy and safety of dacron patch in surgical treatment of congenital disease by echocardiography

To evaluate the efficacy and safety of a new domestic dacron patch in the surgical treatment of congenital heart disease (CHD) with infective endocarditis (IE), a clinical controlled trial is conducted. 48 patients with CHD complicated with IE are selected and randomly divided into two groups. 26 patients in the experimental group are treated with a new domestic dacron patch, while 22 patients in the control group are treated with an imported cardiac polyester patch. By echocardiography, collecting chest X-ray, echocardiography and laboratory examination before and after operation, the residual shunt, cardiac function, liver function, renal function, coagulation function and other related indicators are observed after operation in the two groups, and the therapeutic effect and safety of the new dacron patch are evaluated. The results showed that there is no significant difference in C/T (cardiothoracic ratio), LAD (Left atrial diameter), LVSD (left ventricular end systolic diameter) and LVDD (left ventricular end diastolic diameter) between the two groups before operation, before discharge and 1, 3 and 6 months after discharge (P>0.05). The C/T, LAD and LVDD of the two groups decrease 6 months after operation, and the size of atrioventricle decreases significantly. There is a decreasing trend in the experimental group compared with the control group, but there is no significant difference (P>0.05). There are no significant differences in cardiac function classification, echocardiography, electrocardiogram, patch performance evaluation and blood compatibility between the two groups before operation and 6 months after discharge. ConclusionThe new domestic dacron patch has good clinical efficacy and safety.

Outcomes of carotid endarterectomy in the Vascular Quality Initiative based on patch type

ObjectiveThe Vascular Quality Initiative (VQI) is the largest registry of vascular surgical procedures and as such is capable of distinguishing small but important differences in outcomes. The goal of this study was to determine the outcomes of carotid endarterectomy (CEA) based on patch type, including bovine pericardium, autogenous vein, polytetrafluoroethylene (PTFE), and Dacron. MethodsAll primary CEAs performed with primary repair and patching (n = 70,987) within the VQI were retrospectively analyzed. Reoperative CEA and combined CEA and coronary artery bypass were excluded. Rates of any postoperative neurologic event, return to the operating room (bleeding, neurologic event, or wound complication), and restenosis (>50% and >80%) at 1-year follow-up were primary outcomes. Rates were compared by patch type using χ2 and Bonferroni analysis. Multivariate hierarchical logistic regression models were used to predict end points of postoperative neurologic event, return to the operating room, and 1-year restenosis. ResultsDuring the period of study, 2003 to 2017, there were 70,987 CEAs entered into the VQI registry. Bovine pericardium was the patch material with the highest frequency of use (n = 51,480), followed by Dacron (n = 12,356), vein (n = 1460), and PTFE (n = 1638). Bovine pericardium, vein, and Dacron had lower rates of postoperative neurologic events compared with PTFE or primary repair. Bovine pericardium had the lowest rate of restenosis at 1 year. By multivariate analysis, bovine pericardium (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.56-0.89) and protamine use (OR, 0.74; 95% CI, 0.60-0.91) were associated with a lower incidence of return to the operating room. The use of Dacron, vein, and PTFE patches was not significantly different from the reference of primary closure. Multivariate analysis of postoperative neurologic events revealed that bovine pericardium (OR, 0.59; CI, 0.48-0.72) and Dacron (OR, 0.56; CI, 0.43-0.72) were associated with lower incidence of stroke or transient ischemic attack, whereas vein and PTFE were no different from primary closure. Bovine pericardium (OR, 0.57; CI, 0.44-0.75), Dacron (OR, 0.70; CI, 0.50-0.98), vein (OR, 0.72; CI, 0.53-0.98), and never smoking (OR, 0.87; CI, 0.78-0.96) were associated with a lower incidence of restenosis at 1 year by multivariate analysis. ConclusionsBovine pericardium has superior outcomes both postoperatively and at 1 year compared with other patch materials. The large volume of patient data contained in the VQI makes it possible to compare outcomes that have small but meaningful differences.

A Novel and Simple Percutaneous Technique to Treat a Complex Pseudoaneurysm of Post-Aortic Coarctation Patch Aortoplasty

A 49-year-old woman underwent Dacron patch aortoplasty for coarctation of the aorta (CoAo) at 5 years of age. She was under antihypertensive treatment and had a 20-mm Hg right arm-leg gradient in the last clinical visit. Electrocardiogram was normal and transthoracic echocardiography showed a

Outcome of 40 consecutive cases of modified Ross procedure using novel Dacron valved conduit.

The Ross procedure is an established option for aortic valve disease in children. Due to limited availability of pulmonary homograft, we devised a novel technique for right ventricular outflow tract (RVOT) reconstruction by preparing indigenous Dacron valved conduit. Forty consecutive cases of modified Ross procedure done at our center (2013-2018) were analyzed. Thirty-seven patients (95%) were followed up with median duration of 2.5 (0.08-5.5) years. Median age was 12 (5-39) years. Nineteen (47.5%) patients had rheumatic aortic valve disease, while 19 (47.5%) had congenital aortic valve disease. Aortic root replacement with pulmonary autograft was performed in all patients. Dacron conduit for RVOT reconstruction was used with on table sewn bileaflet valve using Dacron patch (n = 22), expanded polytetrafluoroethylene (ePTFE) membrane (n = 10), bioprosthetic valve (n = 4), and pericardium (n = 4). Additional surgical procedures included mitral valve repair (n = 10), septal myectomy (n = 2), ascending aorta replacement (n = 1), ruptured sinus of valsalva (RSOV) repair (n = 1), and ventricular septal defect (VSD) closure (n = 1). There was one in-hospital mortality while one late death occurred at 3.5years postoperatively. The neo-aortic valve regurgitation on echocardiographic evaluation at last follow-up was trivial (n = 28), mild (n = 7), and moderate (n = 2). Mild RVOT obstruction was present in 8 patients while 18 patients had mild pulmonary regurgitation. No patient required reintervention during follow-up. Our early results of modified Ross procedure are encouraging, however, long-term follow-up is required.

In vivo endothelialization and neointimal hyperplasia assessment after angioplasty of sheep carotid artery with a novel polycarbonate polyurethane patch.

The aim of this study was to compare two variants of a novel polycarbonate polyurethane prosthesis with polyethylene terephthalate (Dacron) prosthesis in an established sheep model of carotid patch angioplasty. Two variants of the polycarbonate polyurethane prosthesis were used: (1) Polycarbonate polyurethane equal (PCU-e) prosthesis consisted of a multilayered porous structure with equal internal and external layers; (2) Polycarbonate polyurethane with more porous inner layers (PCU-mp) prosthesis had more porous inner layers than external layers. Carotid patch angioplasty was performed in 12 sheep: in six sheep, the PCU-e variant and in the other six sheep, the PCU-mp variant was implanted. Dacron patches were implanted in the contralateral carotid artery of all sheep as a control. Half of the animals with each polycarbonate polyurethane variant were euthanized after two weeks and the other half after eight weeks. Cellular infiltration, endothelialization, and neointimal hyperplasia were examined. All grafts were patent, and no thrombus was seen in any of the harvested arteries. The pores of all the three patch materials allowed infiltration of inflammatory cells, capillaries, and connective tissue. After eight weeks, a nearly complete endothelialization was visible in all patch groups without an obvious difference between the three patch materials. The neointima was thinner in the PCU patches (PCU-e: 56 ± 13 µm, PCU-mp: 119 ± 60 µm) when compared to Dacron patches (156 ± 64 µm) after two weeks. After 8 weeks, a further neointimal growth was detectable, without any significant difference of neointimal thickness between the three patch materials (Dacron: 274 ± 82 µm, PCU-e: 324 ± 98 µm, PCU-mp: 235 ± 59 µm). With the novel polycarbonate polyurethane patch materials, we achieved promising functional and morphological results with 100% patency and nearly complete endothelialization. Our findings showed at least a non-inferiority of the novel polycarbonate polyurethane patch material compared to Dacron. There were no significant differences detected between the two polycarbonate polyurethane patch variants.

Pseudoaneurysm of Ascending Aorta with Sternal Erosion after Double Valve Replacement—A Case Report

AbstractPseudoaneurysm of ascending aorta is a rare complication after aortic surgery. Predisposing factors can be infection, chronic hypertension, connective tissue disorders, or dissection. Chest pain, sternal erosion, dysphagia, or stridor can be the modes of presentation. It can also present as a pulsatile mass. Redo sternotomy in a case of pseudoaneurysm of aorta can cause fatal hemorrhage or air embolism. In such a scenario, femorofemoral bypass and hypothermic circulatory arrest help to simplify the approach to the pseudoaneurysm. The authors present a case of a 23-year-old female with pseudoaneurysm of the ascending aorta causing sternal erosion. Ascending aortic repair was done using Dacron patch with femorofemoral bypass and hypothermic circulatory arrest. Sternum was repaired using pectoralis major muscle flap.

Total endoscopic repair of atrial septal defect under on-pump beating heart.

We previously reported the techniques for total endoscopic atrial septal defect (ASD) repair on hearts arrested with cardioplegia through three small incisions in the chest wall without aid of a surgical robotic system. The optimal results motivated us to use total thoracoscopic technology for ASD on perfused beating hearts. From 2010 to 2017, 161 patients with a mean age of 28.31±12.34 years who underwent non-robotically assisted total thoracoscopic closure for ASD were included in this study, and those patients were also divided into two groups, including group A and group B. In group A, 115 patients underwent the procedure on beating hearts without aorta cross-clamped; in group B, 46 patients underwent the procedure on hearts arrested with cardioplegia with aorta cross-clamped. Cardiopulmonary bypass (CPB) was peripherally achieved as well. Total thoracoscopic ASD closures were successfully performed without in-hospital mortality or other serious complications in all patients of both groups. Dacron or bovine patches were used in 81 and 32 patients in the two groups, respectively. Duration of operation, duration of CPB, aorta cross-clamped time, duration of mechanical ventilation, the length of intensive care unit (ICU) and post-operative hospital stay in group A, were all shorter than those in group B (P<0.05). There was no statistically significant difference in blood transfusion during operation or post-operation thoracic drainage. During follow-up, echocardiograms at 3, 30, 90 and 365, showed no residual shunt or tricuspid regurgitation. Total thoracoscopic closure of ASD without assistance of a surgical robotic system on beating heart is safe and feasible and can be used as a therapeutic option for ASD, and by using the mentioned technique, less injuries are applied to patients.

Surgical reinforcement alters collagen alignment and turnover in healing myocardial infarcts.

Previous studies have suggested that the composition and global mechanical properties of the scar tissue that forms after a myocardial infarction (MI) are key determinants of long-term survival, and emerging therapies such as biomaterial injection are designed in part to alter those mechanical properties. However, recent evidence suggests that local mechanics regulate scar formation post-MI, so that perturbing infarct mechanics could have unexpected consequences. We therefore tested the effect of changes in local mechanical environment on scar collagen turnover, accumulation, and alignment in 77 Sprague-Dawley rats at 1, 2, 3 and 6 wk post-MI by sewing a Dacron patch to the epicardium to eliminate circumferential strain while permitting continued longitudinal stretching with each heart beat. We found that collagen in healing infarcts aligned parallel to regional strain and perpendicular to the preinfarction muscle and collagen fiber direction, strongly supporting our hypothesis that mechanical environment is the primary determinant of scar collagen alignment. Mechanical reinforcement reduced levels of carboxy-terminal propeptide of type I procollagen (PICP; a biomarker for collagen synthesis) in samples collected by microdialysis significantly, particularly in the first 2 wk. Reinforcement also reduced carboxy-terminal telopeptide of type I collagen (ICTP; a biomarker for collagen degradation), particularly at later time points. These alterations in collagen turnover produced no change in collagen area fraction as measured by histology but significantly reduced wall thickness in the reinforced scars compared with untreated controls. Our findings confirm the importance of regional mechanics in regulating scar formation after infarction and highlight the potential for therapies that reduce stretch to also reduce wall thickness in healing infarcts. NEW & NOTEWORTHY This study shows that therapies such as surgical reinforcement, which reduce stretch in healing infarcts, can also reduce collagen synthesis and wall thickness and modify collagen alignment in postinfarction scars.

A floating heart: A case of congenital pericardial agenesis associated with atrial septal defect

Congenital absence of the pericardium is a rare condition. Diagnosis and management of this condition remain a dilemma for clinicians. Here, we report a case of 15-year-old boy who had complaint of palpitation. Considering the echocardiographic features, pericardial agenesis associated with atrial septal defect (ASD) was suspected and multimodality imaging was performed for subsequent confirmation. Mal-aligned septum leads to failure in ASD device closure; therefore, the defect was repaired surgically by using a Dacron patch. Physicians need to be aware of this disorder and its associated congenital abnormalities, to enable them to make a correct diagnosis and treatment plan.

Tetralogy of fallot Undergone Total Cardiac Correction (Tran's ra Dacron Patch VSD Closure + Infunndibular Resection of Pulmonary Stenosis): A Case Report.

Tetralogy of fallot Undergone Total Cardiac Correction (Tran's ra Dacron Patch VSD Closure + Infunndibular Resection of Pulmonary Stenosis): A Case Report.

English

Objectives: In this study, we presented our results regarding outcomes ofsurgical correction of sub-aortic membrane. Study Design: Retrospective observational study.Period: June 2012 to June 2017. Setting: CPEIC Multan, Pakistan. Methods: 51 patientsoperated for resection of sub aortic membrane. The resection of sub aortic membrane wasdone through the aorta. Evaluation of the aortic valve done in all patients. The aortic valve waseither replaced or repaired in cases of severe aortic regurgitation. Associated lesions such asventricular septal defects (VSD’s) were repaired with a dacron patch through the right atriumwhile ASD’s were repaired with a pericardial patch. Post-operative echocardiography was donebefore discharge and post-op LVOT gradients and aortic insufficiency were recorded for allthe patients. Results: There were 36 males and 15 females whose mean ages were 16.29years. On post-op echocardiography there was no residual significant LVOT gradient in anypatient. Three (3) patients developed mild to moderate aortic regurgitation post operativelybut none of them warrant any surgical intervention. There was only 1 death in the series whichwas due to VSD patch dehiscence. None of the patients developed conduction problems postoperatively needing any permanent pace maker. Mean pre-op LVOT gradient was 94.7 mmHgwhile it reduced to 20.7 post operatively (p-value &lt;0.001). Conclusion: We concluded thatearly resection of sub aortic membrane can be safely accomplished with good results andsignificant drop in the mean LVOT pressure gradients post operatively.

SUBAORTIC MEMBRANE;

Objectives: In this study, we presented our results regarding outcomes ofsurgical correction of sub-aortic membrane. Study Design: Retrospective observational study.Period: June 2012 to June 2017. Setting: CPEIC Multan, Pakistan. Methods: 51 patientsoperated for resection of sub aortic membrane. The resection of sub aortic membrane wasdone through the aorta. Evaluation of the aortic valve done in all patients. The aortic valve waseither replaced or repaired in cases of severe aortic regurgitation. Associated lesions such asventricular septal defects (VSD’s) were repaired with a dacron patch through the right atriumwhile ASD’s were repaired with a pericardial patch. Post-operative echocardiography was donebefore discharge and post-op LVOT gradients and aortic insufficiency were recorded for allthe patients. Results: There were 36 males and 15 females whose mean ages were 16.29years. On post-op echocardiography there was no residual significant LVOT gradient in anypatient. Three (3) patients developed mild to moderate aortic regurgitation post operativelybut none of them warrant any surgical intervention. There was only 1 death in the series whichwas due to VSD patch dehiscence. None of the patients developed conduction problems postoperatively needing any permanent pace maker. Mean pre-op LVOT gradient was 94.7 mmHgwhile it reduced to 20.7 post operatively (p-value &lt;0.001). Conclusion: We concluded thatearly resection of sub aortic membrane can be safely accomplished with good results andsignificant drop in the mean LVOT pressure gradients post operatively.