Mini-invasive Technique Research Articles

The Impact of De-Roofing of Lateral Calcaneal wall in Open Reduction and Internal Fixation of Intra-Articular Fractures: Clinico-Radiological Outcomes of a Novel Technique and Review of Literature.

Most displaced intra-articular calcaneus fractures need to be treated surgically but postoperative soft tissue complications limit to achieve of optimal functional outcomes. Certain mini-invasive techniques lead to better soft tissue healing but anatomical reduction gets compromised. We aim to evaluate the results of lateral wall de-roofing of the calcaneum to achieve good anatomical reduction as well as to minimise soft tissue complications in the internal fixation of calcaneal fractures. Thirty-two patients (40 ft) with displaced intra-articular calcaneus fractures (10 were of Sanders type II, 16 were of type III, and 14 were of type IV) were treated between January 2018 and September 2021. All patients were managed surgically with open reduction and internal fixation using lateral extensile approach combined with de-roofing of the lateral wall. All patients were followed up for ≥1 year using functional parameters American Orthopaedic Foot and Ankle Score (AOFAS), visual analogue scale (VAS) and radiological parameters (Bohler angle, Gissane angle, height of the calcaneus, width of the calcaneus and pitch of calcaneus). Out of 32 patients, one patient lost to follow-up. At 1 year follow-up, mean AOFAS hindfoot score was 86.2 ± 5 (Sanders type II: 91.2, Sanders type III: 87.6, and Sanders type III: 81.4), mean VAS score was 91.3 ± 2.1, mean Bohler angle (°) was 27.2 ± 4.7, mean Gissane angle (°) was 136.4 ± 5.2, mean calcaneus height was 46.2 ± 2.1 mm and mean calcaneus width was 45.1 ± 3.2 mm. Patients with decreased Bohler angle between postoperative images and follow-up had lower AOFAS hindfoot scores. Complications included persistent swelling (64.10%), stiffness (33.33%), superficial infections (5.12%), and wound dehiscence (10.25%). Lateral wall de-roofing is a useful technique which allows the lateral wall to get flattened reducing soft tissue complications and providing bone graft as well. This approach also adequately exposes fracture fragments, subtalar and calcaneocuboid joints for good anatomical reduction. Hence, it can act as a useful adjunct in the internal fixation of intra-articular calcaneus fractures. III.

Mini-Invasive Endoscope-Assisted Treatment of Metopic Craniosynostosis: 2-Dimensional Operative Video.

The surgical treatment of trigonocephaly has undergone significant evolution, with an increasing use of a minimally invasive technique. The endoscope-assisted metopic suturectomy is currently considered a valid surgical option for the correction of metopic craniosynostosis.1-5 In this video-article, we present our surgical technique performed on a 5-month-old patient with type III (Genitori's classification6) trigonocephaly. The computed tomography (CT) scan showed fusion of the metopic suture with bitemporal narrowing and hypotelorism. The patient underwent endoscope-assisted metopic suturectomy, the width of the suturectomy is 1 cm, and an Esmarch sheet was used to protect the dura mater while drilling. Bridging veins are coagulated under endoscopic vision. The suturectomy is considered complete when the nasal cartilages are exposed, deconnecting thus completely the orbits. The postoperative CT scan showed the extent of the suturectomy. The patient did not present any neurological deficit or complications after surgery and was discharged on postoperative day 2. No helmet was used postoperatively. The patient repeated a head CT at age 11 years after head trauma and was seen at consultation. Interestingly, once the bone gap created after the metopic suturectomy reossifies, the frontal sinus develops normally. The long-term result was quite satisfying. The advantages of the mini-invasive technique consist in a smaller surgical scar, lower blood loss, shorter surgical time, and shorter hospital stay with good long-term results. The parents provided written consent for the publication of the patient's picture, the institutional research board approved the submission of this video article. In the video, the tips, tricks, and pitfalls of the technique are discussed.

ProACT™ (Uromedica, Plymouth, USA) balloons for male urinary incontinence: A fourteen-year-old cohort

BackgroundMale urinary incontinence is attributed to SUI consecutive to benign prostate hypertrophy surgery, trauma, neurological diseases, or injury. Medical devices are developed to treat male urinary incontinence among them proACT® balloons. This technique was chosen in our center to achieve continence. Our study aims to evaluate safety and efficacy of proACT® balloons implanted in our center by measuring the rate of efficacy. MethodsWe performed a retrospective and single centre study. A single expert surgeon performed all surgeries. Seventy-one balloons were implanted in 57 male patients between 2007 and 2020. Primary endpoint was the efficacy time lapse of the balloons after surgery. The analysis was performed using Kaplan-Meier method. Factors, which could affect the efficacy of the balloons, were analysed using a Cox regression analysis. ResultsIn all, 45 balloons successfully cured stress urinary incontinence among the 57 men implanted resulting in a 63.38% success rate. Twenty-six balloons failed to treat stress urinary incontinence and were retrieved out of the 71 implanted. Ten balloons failed to treat urinary stress incontinence without organic cause, 6 balloons deflated, 5 balloons migrated out of the initial implantation site, 2 eroded, and 3 ended up infected. Fifty percent of the balloons were successful for a median time of 95 months. Univariate analysis did not reveal any predictive factor of failure. ConclusionsOur study showed 50% success rate at 95 months follow-up, therefore allowing a life expectancy of 7.9 years for the balloons. This safe mini-invasive technique ensured stress urinary incontinence in men. Level of evidence4.

Hip chronic pain: ultrasound guided ablation of anterior articular branches plus posterior neurolysis of the nerve to the quadratus femoris versus the alone anterior approach-a retrospective observational study.

Chronic hip pain is a common painful condition in the elderly population. A mini invasive technique that is increasingly being considered for management of CHP is the percutaneous denervation of hip articular branches via radiofrequency ablation. We described a new ultrasound-guided technique based on the combination of 90° ultrasound-guided anterior radiofrequency ablation of the articular branches of femoral nerve, accessory obturator nerve and obturator nerve for anterior hip, combined with 90° ultrasound-guided ablation of the articular branches of the nerve of the quadratus femoris for posterior pericapsular neurolysis of the hip. We retrospectively analyzed the medical records of patients from September 2022 to September 2023 treated for chronic hip pain in the ambulatory of Pain Management, identifying 22 patients who underwent ultrasound guided radiofrequency denervation of anterior hip articular branches alone (Group B); and 22 patients in which was also applied a radiofrequency denervation of the posterior articular branches, in addition to the anterior denervation (Group A). We analysed the pain intensity of both groups measured with numeric rating scale. The combined anterior plus posterior approach ensured that the results obtained were maintained 6months after the procedure (T3) with excellent pain control and an average NRS of 1455 for group A. While for the group B, with the anterior approach alone, the NRS at six months showed an upward trend with an average NRS of 3818. The dual approach is more effective in pain relief at 6months with a statistically significant difference in NRS values (p < 0.001). This retrospective observational study highlighted the greater impact of the double approach (anterior plus posterior) in the denervation of the hip joint, compared to anterior neurolysis alone.

Living-Donor Uterus Transplantation: A Clinical Review

Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. More than 90 uterus transplantations have been performed worldwide, mostly from living donors. Living-donor (LD) UTx is a challenging surgical procedure since it poses ethical issues, and it is a high-risk and invasive surgery with higher hysterectomy-related risks compared to conventional hysterectomy. A total of 59 living-donor hysterectomies have been reported in the literature, including 35 performed with a laparotomic approach, 20 with a robotic approach and 4 with a laparoscopic approach. The mean donor age was 45.6 ± 9.1 years, and 22 were unrelated with the recipients, 34 were emotionally related (27 mothers, 5 sisters, 2 mother’s sisters). The mean recipient age was 28.8 ± 4.5 years. Mayer–Rokitansky–Küster–Hauser syndrome was the most common indication for uterus transplant. Robotic living-donor hysterectomy had the longest operative time but resulted in a lower blood loss and postoperative stay compared to laparotomic and laparoscopic approaches. Twenty-nine births from LD-UTx have been reported, four after robotic living-donor hysterectomy and twenty-five after a laparotomic procedure. UTx is now an effective treatment for women with UFI. While living-donor UTx in some cases may be considered an experimental procedure, it offers the extraordinary possibility to give women the opportunity to have a pregnancy. Many efforts should be made to reduce the potential risks for donors, including the use of mini-invasive techniques, and the efficacy of UTx in the recipients, giving the potential harm of immunosuppression in a recipient of a non-life-saving organ.

A Case of Injection Laryngoplasty in a Patient With Delayed-Onset Aspiration Following Near Total Laryngectomy

Near total laryngectomy (NTL) is a procedure that creates a biological shunt between the airway and the neopharynx. Compared to total laryngectomy, NTL shunt performed in a suitable patient gives the ability to phonate at will. However, NTL has a potential for leak due to the invagination of the shunt into the neopharynx. Injection laryngoplasty is a mini-invasive technique that aims to manage aspiration caused by iatrogenic surgical complications. The procedure consists of moving a patient’s vocal cord toward the midline by injecting augmentation material. Authors report a case of a 74-year-old female, who was previously diagnosed to supraglottic cancer and have gone through NTL 12 years ago. 11 years after surgery, she reported aspiration through the neopharynx. Injection laryngoplasty was performed to relieve the leakage and she underwent the procedure two times using Hyaluronic acid. After injection laryngoplasty, leakage moderately decreased and the patient reported alleviation of her symptoms.

Mini-invasive technique for Achilles tendon rupture: BarTur technique. A new simple and inexpensive technique

Mini-invasive technique for Achilles tendon rupture: BarTur technique. A new simple and inexpensive technique

755 Management of Perforated Peptic Ulcer in Laparoscopic Era

Abstract Aim We want to share our initial experience in treating Perforated Peptic ulcer by mini-invasive techniques. Method Retrospectively, data was collected by looking at surgical files for patients who were admitted with perforated peptic Ulcers under an experienced consultant surgeon between 2016 and 2021 at Benghazi Medical Centre in Libya. Only patients were managed laparoscopically were included and were managed by the same surgeon. Results In the period of 2016 until 2021, 18 patients with perforated peptic ulcers were treated laparoscopically in our hospital.All were men except three women, age ranged from 23 years to 56 years. Laparoscopy was attempted in all patients , none of the cases were converted to open , 14 patients of perforations were located in the first part of duodenum (80%) and 4 were pre-pyloric , simple closure with omental patch were enough to close the perforation, copious peritoneal lavage with normal saline access to all abdominal compartments is very easy and never can be reached in open surgery. Mean operative time was 90min (60-120 min). the hospital stay ranged from 3 to 7 days. with no morbidity, leak , and no mortality within 30 days. Conclusions We shared our experience for management of perforated Peptic ulcer at Benghazi Medical Centre, by managing 18 patients with perforated viscus Laparoscopically. Laparoscopy is safe and permits successful primary suture closure of perforated duodenal and gastric ulcer and provides excellent access to different regions of the abdomen for better lavage. Furthermore, it confers benefits on patients in the form of reduced postoperative pain, and early recovery.

A mini-invasive surgical technique for Carlevale IOL implantation: case series study and description of concomitant surgery

PurposeTo examine the feasibility and outcomes of a modified technique for the implantation of scleral fixated Carlevale intraocular lens (IOL) (I71 FIL SSF. Soleko IOL Division, Pontecorvo, Italy), and to analyze the occurrence of adverse events.MethodsThis is a retrospective observational study conducted revising patients charts from 2018 to 2023. Thirty-five eyes of 33 patients were included. Patients requiring IOL explantation had either IOL dislocation or opacification. The implantation of the Carlevale IOL was performed with the subconjunctival positioning of the anchors without any scleral flap. All maneuvers were performed transconjunctivally. The anatomical outcomes considered were IOL positioning, and the absence of postoperative complications. The functional outcomes analyzed were best correctedvisual acuity (BCVA) and refraction.ResultsIn all the cases, the IOL was well positioned and centered postoperatively. No cases of conjunctival erosion were recorded. The best corrected visual acuity (BCVA) was 0.9±0.6 logMar (mean±standard deviation) preoperatively and 0.5±0.5 logMar (mean±standard deviation) postoperatively. The mean preoperative spherical equivalent was +6.8±7.7 dioptres, while postoperatively it was -1.1±1.6 dioptres. The most frequent procedure associated to secondary IOL implantation was posterior vitrectomy (25 eyes, 71.4%), which was performed with 25-gauge transconjunctival cannulas in the ciliary sulcus. The follow-up period was 24.5±16.9 months (mean±standard deviation).ConclusionThe described mini-invasive technique for Carlevale IOL implantation is safe and effective. It can be recommended either as a stand-alone operation or associated to concurrent surgical procedures.

Complications of the Superior Eyelid Endoscopic Transorbital Approach to the Skull Base: Preliminary Experience With Specific Focus on Orbital Outcome.

The endoscopic superior eyelid approach is a relatively novel mini-invasive technique that is currently investigating for skull base cancers. However, questions remain regarding specific approach-related complications when treating different skull base tumors. This study aims to analyze any surgical complications that occurred in our preliminary consecutive experience, with specific focus on orbital outcome. A retrospective and consecutive cohort of patients treated via a superior eyelid endoscopic transorbital approach at the Division of Neurosurgery of the Hospital Clinic in Barcelona was analyzed. Patients features were described in detail. Complications were divided into 2 groups to analyze separately the approach-related complications, and those resulting from tumor removal. The ocular complications were subdivided into early ocular status (<3 weeks), late ocular status (3-8 weeks), and persistent ocular complications. The "Park questionnaire" was used to determine patient's satisfaction related to the transorbital approach. A total of 20 patients (5 spheno-orbital meningiomas, 1 intradiploic Meningioma, 2 intraconal lesions, 1 temporal pole lesion, 2 trigeminal schwannoma, 3 cavernous sinus lesions, and 6 petroclival lesions) were included in the period 2017-2022. Regarding early ocular status, upper eyelid edema was detected in all cases (100%) associated with diplopia in the lateral gaze in 30% of cases, and periorbital edema in 15% of cases. These aspects tend to resolve at late ocular follow-up (3-8 weeks) in most cases. Regarding persistent ocular complications, in one case of intraconal lesion, a limitation of eye abduction was detected (5%). In another patient with intraconal lesion, an ocular neuropathic pain was reported (5%). In 2 cases of petroclival menigioma, who were also treated with a ventriculo-peritoneal shunt, slight enophthalmus was observed as a persistent complication (10%). According to the Park questionnaire, no cosmetic complaints, no head pain, no palpable cranial irregularities, and no limited mouth opening were reported, and an average of 89% of general satisfaction was encountered. The superior eyelid endoscopic transorbital approach is a safe and satisfactory technique for a diversity of skull base tumors. At late follow-up, upper eyelid edema, diplopia, and periorbital edema tend to resolve. Persistent ocular complications are more frequent after treating intraconal lesions. Enophthalmus may occur in patients with associated ventriculo-peritoneal shunt. According to patient's satisfaction, fairly acceptable results are attained.

COMPARATIVE ANALYSIS OF CONVENTIONAL AND MINIMALLY INVASIVE TECHNIQUES IN THE TREATMENT OF FEMORAL HERNIAS

Despite the advances in medicine regarding diagnosis and therapeutic options, the treatment of femoral hernias remains a challenge for the surgeon. In the past, this type of hernia was repaired with conventional surgery. Today, mini-invasive techniques are preferred method of choice by many surgeons. The aim of our study is to compare the results of open and minimally invasive surgery in patients with femoral hernias.In the present study we include patients with primary unilateral femoral hernias operated in the Surgical Department of EUROHOSPITAL- Plovdiv and the Department of General Surgery of University Hospital “St. George” for the period January 2018 to December 2022. The patients were divided into two groups - conventional and minimally invasive operations. Comparative analysis was performed regarding sex, age, duration of operative intervention, postoperative pain, hospital stay and complications.33 patients in total were diagnosed and operated for femoral hernias for a period of 5 years. Of these, 16 patients were operated conventionally and 17 underwent laparoscopic surgery. Patients in the minimally-invasive group had a significantly shorter hospital stay (2.1 vs 3.0 days) and less postoperative pain (1.8 vs 3.6 on the 1 to 5 scale). The incidence of the postoperative complications was similar in both groups.Surgery is the only method of treatment of femoral hernias. Nowadays, minimally invasive techniques became a method of choice compared with conventional surgery. We believe that laparoscopic operations for femoral hernia, performed by experienced surgeon, are effective and safe and could be applied to all type of patients.

Schatzker 3 Tibial Plateau Reduction and Osteoplasty Using Tektona® Flexible Lamella: a Case Report

Schatzker 3 fractures of tibial plateau are classically treated with open reduction and internal fixation. Recent mini-invasive techniques have been developed with balloon cementoplasty. Tektona® device was originally designed for vertebral kyphoplasty and has never been described in peripheral limb reduction and fixation. The present article proposes a new technique using Tektona® flexible lamella for reduction and fixation of Schatzker 3 tibial plateau fractures. The patient was a 54-year-old female who fell from her height and sustained a direct trauma to the right knee. A closed fracture of the right lateral tibial plateau (Schatzker 3) was documented. A closed reduction was performed using Tektona® flexible lamella and cementoplasty, under fluoroscopic control. An 82% reduction of the plateau was assessed on the post-operative tomography. No intraoperative complication was noted. This first case of Tektona® use in tibial plateau fracture led to a satisfying result regarding the fracture reduction, with no intraoperative complication. The main advantage of this technique over balloon kyphoplasty is the unidirectional and repeatable reduction maneuver. The reduction of the plateau can indeed be done without compression of the underlying cancellous bone by orienting the Tektona® lamella upwards.

Percutaneous Nephrolithotomy: A Mini Invasive Approach for Renal and Pelvic Stones. Initial Experience from a Resource-Limited Setting in Douala Cameroon

Background and Aim: We present in this paper the technique and results of percutaneous nephrolithotomy as a minimally invasive treatment for large renal and pyeloureteric junction stones at the Centre medico-chirugical d’urologie in Douala, Cameroon. Methods: This was a retrospective study carried out from January 2019 to July 2022. We included 25 patients with calculi in the renal pelvis and pyeloureteric junction treated through percutaneous nephrolithotomy. Results: We included a total of 25 patients (18 men and 7 women) with a median age of 44 [36-48] years. Of the 25 patients, 23(88%) had a single calculus and 3(22%) presented with a Staghorn calculus. The median size of the calculi was 23.5 [20.25–27.75] mm and in 60% of cases; the stone was on the right side of the body. In all cases, the definitive diagnosis was made using abdominal CT scans and in 20 (80%) patients, the diagnosis was made incidentally during a CT scan for other reasons. All patients were treated through percutaneous nephrolithotomy, performed in the prone position in 21(84%) patients. Three patients who had a positive urine culture prior to the procedure benefited from a preoperative double J stent placement and all patients had post-surgery percutaneous drain placement which was left in place for 24 hours. The median surgery duration was 135 [120–165] minutes. Seventeen patients (68%) were stone free after the procedure. Conclusion: Percutaneous nephrolithotomy is an effective mini-invasive technique in the treatment of voluminous kidney and pyeloureteric junction stones. It is reliable, reproducible and has fewer complications and, therefore, proves to be an excellent choice in Sub-Saharan Africa.

Endoscopic retrograde appendicitis therapy or antibiotics for uncomplicated appendicitis.

Although laparoscopic appendectomy is the common intervention for uncomplicated acute appendicitis, there are risks1. Guidelines from the World Society of Emergency Surgery suggest that antibiotic therapy is an option2, but recurrence is 15 to 39 percent at 5 years3. A mini-invasive technique called endoscopic retrograde appendicitis treatment (ERAT) was developed for uncomplicated appendicitis instead of antibiotics or surgery4. ERAT aims to relieve the obstruction or stenosis of the appendiceal lumen, to prevent recurrent episodes of the disease (92 to 95 percent have not had a recurrence to date)5–7. This multicentre study assessed ERAT versus antibiotics for the treatment of uncomplicated appendicitis. Data on adult patients treated with ERAT or antibiotics for imaging-confirmed uncomplicated appendicitis from five centres in China (May 2018 to June 2020) was assessed retrospectively. The ERAT procedure was performed as described4 (Appendix S1). The antibiotic group received intravenous metronidazole 500 mg q8h combined with ceftriaxone 2 g q12h, cefoperazone/sulbactam 2 g q12h, or piperacillin–tazobactam 4.5 g q8h. Oral antibiotics (metronidazole 500 mg q8h with levofloxacin 500 mg q24h, ciprofloxacin 500 mg q8h, or amoxicillin–clavulanic acid 625 mg q8h) were taken after a minimum 72 hours of intravenous antibiotics. Patients could take analgesics as needed. Appendicectomy was recommended if there was worsening pain or white cell count.

Ependymoma of the Filum Terminale, Technical Operative Note

Background: Spinal cord tumors represent 2-4% of all CNS tumors. Ependymomas are the most frequent lesions of the spinal cord1. Gross total resection remains the gold standard2. Method: We describe the mini-invasive surgical technique using a fixed tubular retractor performed for the resection of an ependymoma of the filum terminale, along with its advantages and limits. Conclusion: This mini-invasive technique has shown to be safe and effective for the resection of filum terminale ependymoma, with a good impact on postoperative pain and less risks of CSF leak, which is probably secondary to a limited dead space.

Transoral septotomy with septum traction is an effective treatment for recurrent Zenker diverticulum.

Symptoms of Zenker diverticulum can recur whatever the type of primary treatment administered. A modified transoral stapler-assisted septotomy (TS) was introduced in clinical practice a few years ago to improve the results of this mini-invasive technique. The aim of this prospective, controlled study was to assess the outcome of TS in patients with recurrent Zenker diverticulum (RZD), as compared with patients with treatment-naïve Zenker diverticulum (NZD). Patients diagnosed with NZD or RZD, and treated with TS between 2015 and 2021 were compared. Symptoms were recorded and scored using a detailed questionnaire. Barium swallow and endoscopy were performed before and after the TS procedure. In sum, 89 patients were enrolled during the study period: 68 had NZD and 21 had RZD. The patients' demographic and clinical data were similar in the two groups. Three mucosal lesions were detected intra-operatively, and one came to light at post-operative radiological assessment in the NZD group. No mucosal lesions were detected in the RZD group. The median follow-up was 36months (interquartile range 23-60). The treatment was successful in 97% NZD patients and 95% of RZD patients (P= 0.56). This is the first comparative study based on prospectively collected data to assess the outcome of TS in patients with RZD. Traction on the septum during the procedure proved effective in the treatment of RZD, achieving a success rate that was excellent, and comparable with the outcome in treating NZD.

Closed reduction with percutaneous Kirschner wire drill-and-pry for pediatric supracondylar humeral fractures with bony callus formation and delayed presentation

BackgroundSupracondylar humeral fractures are the most common type of pediatric elbow fractures, and are primarily treated using closed reduction and percutaneous pinning. For patients who are treated ≥14 days after the injury, after callus formation has occurred, closed reduction is usually not possible. The purpose of this study is to report the clinical outcomes of closed reduction with percutaneous Kirschner wire (K-wire) drill-and-pry for the delayed treatment of pediatric supracondylar humeral fractures with bony callus formation. MethodsWe retrospectively reviewed the data of 16 patients who underwent percutaneous K-wire drill-and-pry between November 2019 and August 2021 for the treatment of supracondylar humeral fractures with bony callus formation ≥14 days after the injury. Clinical outcomes were assessed using the Flynn criteria. The postoperative Baumann angle and pin configuration were evaluated using x-ray examinations. ResultsAll patients were followed up for 8–28 months (average, 16.63 months). The fractures healed in 4–6 weeks (average, 4.38 weeks). The operative time ranged from 10 to 124 min (average, 35.12 min). No iatrogenic vascular or nerve injury occurred. No patient developed cubitus varus. According to the Flynn criteria, 12 patients had excellent outcomes, 2 patients had good outcomes, 1 patient had a fair outcome and 1 patient had a poor outcome. ConclusionClosed reduction with percutaneous K-wire drill-and-pry is a mini invasive technique for supracondylar humeral fractures with bony callus formation in children. Most patients had a good clinical and cosmetic outcomes without scarring.

Percutaneous Transcatheter Edge-to-Edge Mitral Valve Repair With MitraClip System in the Era of G4

The use of transcatheter edge-to-edge mitral valve repair (TEER) in symptomatic patients with severe mitral regurgitation (MR) has dramatically increased over the last few years. Current guidelines consider TEER as a reasonable option in symptomatic patients with primary or chronic secondary severe MR with high or prohibitive surgical risk and favorable anatomy. However, several anatomical and morphological mitral features have restricted the use of this mini-invasive technique in its early experience. The latest fourth generation (G4) of the MitraClip system has been recently introduced and includes the possibility of independent leaflet grasping and 4 different sizes. This technical update offers the possibility of selecting and combining multiple devices for complex mitral valve anatomies and challenging procedures, which helps expand the applications of TEER. The present review describes the potential advantages and the help of the MitraClip G4 devices to overcome various anatomic and morphologic issues in challenging cases with complex primary and secondary MR procedures.

Embolization in Pediatric Patients: A Comprehensive Review of Indications, Procedures, and Clinical Outcomes.

Embolization in pediatric patients encompasses a large spectrum of indications, ranging from the elective treatment of congenital diseases of the cardiovascular system to the urgent management of acute hemorrhagic conditions. In particular, the endovascular treatment of central and peripheral vascular malformations and hypervascular tumors represents a wide chapter for both congenital and acquired situations. Thanks to the progressive availability of low-profile endovascular devices and new embolic materials, the mini-invasive approach has gradually overtaken surgery. In this review, the main embolization procedures will be illustrated and discussed, with a focus on clinical indications and expected outcomes. The most recent mini-invasive techniques will be described, with hints on the cutting-edge devices and embolic materials.

Mineralocorticoid Receptor Antagonists Mitigate Mitral Regurgitation-Induced Myocardial Dysfunction.

Mitral regurgitation (MR), the disruption of the mitral valve, contributes to heart failure (HF). Under conditions of volume overload, excess mineralocorticoids promote cardiac fibrosis. The mineralocorticoid receptor antagonist spironolactone is a potassium-sparing diuretic and a guideline-recommended therapy for HF, but whether it can ameliorate degenerative MR remains unknown. Herein, we investigate the efficacy of spironolactone in improving cardiac remodeling in MR-induced HF compared with that of a loop diuretic, furosemide. Using a novel and mini-invasive technique, we established a rat model of MR. We treated the rats with spironolactone or furosemide for twelve weeks. The levels of cardiac fibrosis, apoptosis, and stress-associated proteins were then measured. In parallel, we compared the cardiac remodeling of 165 patients with degenerative MR receiving either spironolactone or furosemide. Echocardiography was performed at baseline and at six months. In MR rats treated with spironolactone, left ventricular function—especially when strained—and the pressure volume relationship significantly improved compared to those of rats treated with furosemide. Spironolactone treatment demonstrated significant attenuation of cardiac fibrosis and apoptosis in left ventricular tissue compared to furosemide. Further, spironolactone suppressed the expression of apoptosis-, NADPH oxidase 4 (NOX4)- and inducible nitric oxide synthase (iNOS)-associated proteins. Similarly, compared with MR patients receiving furosemide those prescribed spironolactone demonstrated a trend toward reduction in MR severity and showed improvement in left ventricular function. Collectively, MR-induced cardiovascular dysfunction, including fibrosis and apoptosis, was effectively attenuated by spironolactone treatment. Our findings suggest a potential therapeutic option for degenerative MR-induced HF.