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Multimedia Manual of Cardiothoracic Surgery: MMCTS

Giovanni Galluccio
Tracheo-oesophageal fistulas represent a major complication of prolonged intubation and may cause death. Surgical repair is a complex procedure that can be challenging in compromised patients. In this study, we describe a simple endoscopic technique that resulted in the effective palliation of symptoms.
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Carine Pavy, Olivier Ghez
The association of complete atrial ventricular septal defect (cAVSD) with tetralogy of Fallot remains a complex malformation that involves both inlet and outlet components of the ventricles. The surgical treatment used to be, in the 1980s, a staged repair strategy due to the high mortality rate of first primary repairs (PRs). However, nowadays, PRs have better outcomes. Although double-patch procedures are widely performed, this article describes the single-patch approach for cAVSD repair with transatrial-transpulmonary repair of the Fallot component with preservation of the pulmonary valve...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Takashi Murashita, Giuseppe M Raffa, Lawrence M Wei, Vinay Badhwar
Complex pathoanatomy that requires posterior leaflet height reduction can be accomplished robotically with excellent surgical outcomes. We report the technique of robotic sliding leaflet valvuloplasty in cases of severe myxomatous degenerative disease with elevated predictive risk of systolic anterior motion.
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Martin Kostolny, Ikenna Omeje
The surgical repair of Taussig-Bing anomaly and associated lesions has evolved over the years from palliative procedures to complete repairs-either in two stages or in one single stage. We present a video illustrating our preferred surgical option in the treatment of Taussig-Bing anomaly, in this case, with an associated type A interrupted aortic arch.
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Enrico Ferrari, Olivier Muller, Stefanos Demertzis, Marco Moccetti, Tiziano Moccetti, Giovanni Pedrazzini, Eric Eeckhout
Transaortic transcatheter aortic valve replacement performed through a right anterolateral minithoracotomy at the second intercostal space is a safe and standardized minimally invasive procedure carrying important clinical advantages for the patient, in particular, no damage to the ventricular apex, preservation of the diseased peripheral arteries and no cross of the aortic arch with the delivery system, meaning a lower risk of calcium dislodgement and neurological complications. Using the third-generation, balloon-expandable Edwards Sapienā„¢ 3 transcatheter heart valve and the Certitudeā„¢ delivery system, the transaortic procedure is easily performed under fluoroscopic and echocardiographic guidance...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Fredrik Halvorsen, Christoph Haller, Edward Hickey
More than 50% of children who undergo repair of tetralogy of Fallot (TOF) using a transannular patch will require pulmonary valve replacement (PVR) in early adulthood. The premise of PVR in this setting is to ameliorate the relentless right ventricular (RV) dilatation that otherwise occurs in the presence of severe pulmonary regurgitation. Severe RV dilatation is associated with RV dysfunction, symptoms of exercise intolerance, tricuspid regurgitation and-occasionally-life-threatening RV failure or dangerous ventricular tachyarrhythmia...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Roberto Di Bartolomeo, Giacomo Murana, Mariano Cefarelli, Jacopo Alfonsi, Luca Di Marco, Francesco Buia, Lovato Luigi, Davide Pacini
No abstract text is available yet for this article.
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Christoph T Starck, Volkmar Falk
Transvenous lead extraction procedures have gained substantial clinical importance during the past decade. With current tools and techniques, high success rates in combination with low complication rates can be achieved by experienced centres. Even in experienced hands, life-threatening complications can occur, and every physician performing such procedures must be prepared for this scenario. This necessitates immediately available access to extracorporeal circulation, and if the operator is a cardiologist, cardiac surgical standby is mandatory...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Giuseppe Toscano, Antonio Gambino, Lorenzo Bagozzi, Alvise Guariento, Gianpiero D'Amico, Marny Fedrigo, Gino Gerosa
Endomyocardial biopsy is a common procedure for monitoring cardiac allograft rejection; several techniques have been described so far, throughout different access sites and under echocardiographic or X-ray control. We describe the routine technique adopted at our centre based on echo-guided puncture of jugular vein and echocardiographic assessment of endomyocardial sampling with direct visualization of the bioptome tip. We also report the most common complications of the procedure, especially concerning the risk of iatrogenic tricuspid regurgitation, and same examples of histopathological findings drawn from our own iconographic collection...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Maurizio Taramasso, Devdas T Inderbitzin, Andrea Guidotti, Fabian Nietlispach, Oliver Gaemperli, Michel Zuber, Francesco Maisano
Direct mitral valve annuloplasty is a transcatheter mitral valve repair approach that mimics the conventional surgical approach to treat functional mitral regurgitation. The Cardioband system (Valtech Cardio, Inc., Or-Yehuda, Israel) is delivered by a trans-septal approach and the implant is performed on the atrial side of the mitral annulus, under live echo and fluoroscopic guidance using multiple anchor elements. The Cardioband system obtained CE mark approval in October 2015, and initial clinical experiences are promising with regard to feasibility, safety and efficacy...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Alexey S Ilin, Pavel V Teplov, Valeriy A Sakovich, Richard G Ohye
We present a case of 12-month-old boy with congenitally corrected transposition of great arteries with L-looped ventricles and L-transposition of great arteries and ventricular septal defect. When admitted to the hospital, the patient had the appearance of congestive heart failure due to moderate to severe tricuspid valve regurgitation and right ventricle dysfunction. The pulmonary artery (PA) banding was required first because of low systolic pressure in the morphological left ventricle less than 70% confirmed by catheterization...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Nicolas Laurent, Pablo Maureira, Maxime Bertram, Mazen Elfarra, Fabrice Vanhuyse, Daniel Grandmougin, Michael Angioi, Thierry A Folliguet
Transcatheter aortic valve implantation is a well-recognized treatment option for high-risk patients with aortic stenosis. The femoral approach is possible in 80% of cases. Initially, only the transcarotid and subclavian approaches were performed as alternative routes. Both approaches have advantages and disadvantages. The carotid approach is a new approach that offers direct vascular access to the aortic valve. The technique of access is very simple and well known to all cardiovascular surgeons, and the morbidity is minimal...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Roberto Di Bartolomeo, Giacomo Murana, Mariano Cefarelli, Jacopo Alfonsi, Luca Di Marco, Francesco Buia, Luigi Lovato, Davide Pacini
Thoracoabdominal aortic aneurysm is a challenging disease that often requires an invasive surgical repair. Recently, a less invasive hybrid approach has been proposed to improve postoperative outcomes in high-risk patients. It consists of an open first stage where arterial visceral rerouting is obtained, using a vascular graft followed by a second stage where the remaining thoracoabdominal aorta is covered with a stent graft. Initial results using this approach seem promising. Here, we sought to describe the hybrid two-stage technique that is most frequently used in this extensive aortic pathology...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Charlotte van Laar, Guillaume S C Geuzebroek, Frederik N Hofman, Bart P Van Putte
The totally thoracoscopic left atrial maze (TT-maze) is a recent, minimally invasive surgical procedure for the treatment of atrial fibrillation, with promising results in terms of freedom from atrial fibrillation. The TT-maze consists of a bilateral, epicardial pulmonary vein isolation with the creation of a box using radiofrequency and exclusion of the left atrial appendage (LAA). In addition, the box is connected with the base of the LAA and furthermore with the mitral annulus with the so-called trigonum line...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Ashok Muniappan, Douglas J Mathisen
Acquired non-malignant tracheo-oesophageal fistula (TOF) most commonly develops after prolonged intubation or tracheostomy. It may also develop after trauma, oesophagectomy, laryngectomy and other disparate conditions. TOF leads to respiratory compromise secondary to chronic aspiration and pulmonary sepsis. Difficulty with oral intake usually leads to nutritional compromise. After diagnosis, the goals are to eliminate or reduce ongoing pulmonary contamination and to restore proper nutrition. Operative repair of benign TOF is generally performed through a cervical approach...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Jeevan Nagendran, Hamad F Al Habib, Bob Kiaii, Michael W A Chu
Atrial septal defect (ASD) repair has been conventionally performed via midline sternotomy with very low operative risk and excellent early and late outcomes. Recently, many of these patients with suitable anatomy are being treated with percutaneous catheter-based closure of their ASD, but issues of prosthetic device implantation, long-term antiplatelet therapy and late device complications persist. Minimally invasive repair of ASD via a 3-cm right minithoracotomy provides patients with a much less invasive surgical repair with all the durable benefits of autologous pericardial patch closure...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Marc A A M Schepens
There are different surgical techniques for providing circulatory support during the repair of thoracoabdominal aortic aneurysms. They all aim at reducing the afterload of the heart and the preservation of distal organ perfusion. Partial or total extracorporeal circulation with or without cooling and left heart bypass (LHB) are actually the most used surgical approaches. The objective of this study was to describe and comment on the technical aspects of the LHB. We briefly describe our results and put them into perspective based on the current literature...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Abdullrazak Hossien
Current training in mitral valve (MV) surgery is affected by many factors, among which are the complexity of surgical procedures and complex three-dimensional anatomy of the MV. An MV repair simulator is proposed in this study as a low-cost, reusable and portable tool to guide trainees at all levels to effectively construct it with the aim of improving their surgical skills in major techniques of MV surgery in an intermediate-fidelity concept. The simulator is a self-made portable box that is supplied with a self-made silicone MV substitute to simulate the flexible property of MV components...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Abdullrazak Hossien
The technical simulator proposed in this study is an additional low-cost, reusable, reproducible and portable tool to guide trainees at all levels to effectively construct it in order to improve their surgical skills in connection with the cardiopulmonary bypass (CPB) circuit. The simulator is a self-made portable box that can be used for an unrestricted number of procedures. It is supplied with self-made anatomical replicas that have been tested to simulate the flexible property of the real anatomy. The building process is detailed in this study...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Adriano Carotti, Matteo Trezzi
Primary repair of pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collaterals based on single-stage unifocalization was first reported in 1995. From a midline approach, all collaterals are extensively dissected, translocated in front of the oesophagus and/or the trachea, when required, and directly anastomosed to each other or to the native pulmonary arteries, whenever present, without interposition of prosthetic material. The need for concomitant VSD closure is assessed intraoperatively with a pulmonary flow study according to a standardized protocol...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
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