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Surgical treatment of acutely thrombosed mechanical mitral valve prostheses

Zakareya El-Mashtoly

Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, Egypt.

Abstract: Background: Acute thrombosis of mitral valve prosthesis is a life threatening complication. Data on complications and outcome are limited. Objective: to evaluate surgical treatment of acute prosthetic mitral valve thrombosis regarding indications, contraindications, complications and outcome. Patients and methods: Between March 2011 and December 2013, thirty patients with acute thrombotic mitral valve prostheses were admitted to Al-Hussein University Hospital. All patients were subjected to complete history, examination and investigations. Exposure of the mitral valve was done via the standard left atriotomy in 12 patients (40%) and right atrial trans-septal approach in 18 patients (60%). Results: Thrombus was found in 5 patients (16.67%), pannus alone in 10 patients (33.34%), thrombus and pannus together were found in 15 patients (50%). A biological valve was implanted in 5 patients (17%) while in 25 patients a mechanical valve was implanted (83%). Tricuspid valve repair was done in 18 patients using De-Veg technique. Conclusion: Prosthetic valve thrombosis (PVT) is a potentially fatal complication of heart valve replacement. These acceptable results suggest that early surgical intervention might be a safe and effective treatment of choice in patients with PVT. Patients with mechanical valve prostheses should be informed adequately about the need for, and the importance of, an effective anticoagulation regimen.

[Zakareya El-Mashtoly. Surgical treatment of acutely thrombosed mechanical mitral valve prostheses. J Am Sci 2014;10(6s):1-7]. (ISSN: 1545-1003). http://www.jofamericanscience.org. 1

doi:10.7537/marsjas1006s14.01

Key Words: Mitral valve, Prosthetic valve thrombosis, Trans-esophageal echocardiography

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Patch Angioplasty in Diffusely Diseased Left Anterior Descending Coronary Artery.

Emad Sarawy¹, Mahmoud El safty¹ and Ahmed Attia²

¹Cardiac Surgery Department, National Heart Institute (NHI), Egypt

²Mahalla Cardiac Center, Egypt

sarawy91@yahoo.com

Abstract: Background: Severely diseased left anterior descending coronary artery (LAD) is a surgical challenge and several procedures were suggested to achieve adequate reconstruction. Aim of the work: The aim of this study is to assess safety and surgical outcome of the use of patch angioplasty for the reconstruction of severely diseased LAD. Material and methods: In the period between January 2009 and January 2012, 40 patients (mean age 53.9 + 7.9 years, 62.5% males) were chosen for reconstruction of a diffusely diseased left anterior descending coronary artery (LAD) with either left internal mammary artery (LIMA) patch or saphenous vein patch. Other associated significant coronary artery lesions were classically grafted with Inverted saphenous vein. Results: LAD patch was feasible in all cases and varied in length from 2-8 cm (4.8 + 1.4cm). Mean number of arterial and venous grafts was 2.1 + 0.64, mean aortic cross-clamp time and bypass times were 60.8+ 18.2 and 80.2 + 23 minutes, mean ICU and hospital stays were 44.9 + 10.3 hours and 9 + 3.2 days; respectively. There were one hospital mortality and one complications by deep sternal wound infection, patients were followed up from 1 month to 3 months. Mean postoperative NYHA class (1.2 + 0.4) significantly improved, compared to the preoperative values (3.5 + 0.51; P<0.001). Conclusions: the use of LAD patch angioplasty is generally feasible and a safe alternative for the reconstruction of severely diseased LAD.

[Emad Sarawy, Mahmoud El safty and Ahmed Attia. Patch Angioplasty in Diffusely Diseased Left Anterior Descending Coronary Artery. J Am Sci 2014;10(6s):8-12]. (ISSN: 1545-1003). http://www.jofamericanscience.org. 2

doi:10.7537/marsjas1006s14.02

Key words: coronary artery bypass grafting, left anterior descending coronary artery, left internal mammary artery, LAD venous and or arterial angioplasty.

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