Cardiovascular Medicine

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Open AccessArticle

The Konno Procedure to Treat Prosthesis-Patient Mismatch and Complex Left Ventricular Outflow Tract Obstruction in Adult Patients

by Sebastien Pugnale, Maks Mihalj, Jürg Schmidli and Thierry Carrel

Cardiovasc. Med. 2022, 25(4), 2214; https://doi.org/10.4414/cvm.2022.02214 - 1 Jul 2022

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Abstract

BACKGROUND: The most common forms of congenital and acquired obstruction of the left ventricular outflow tract (LV OT) are valvular aortic stenosis, congenital tunnel-like obstruction, hypertrophic obstructive cardiomyopathy and, finally, the prosthesis-patient mismatch (PPM) following aortic valve replacement. The last is most probably [...] Read more.

BACKGROUND: The most common forms of congenital and acquired obstruction of the left ventricular outflow tract (LV OT) are valvular aortic stenosis, congenital tunnel-like obstruction, hypertrophic obstructive cardiomyopathy and, finally, the prosthesis-patient mismatch (PPM) following aortic valve replacement. The last is most probably underestimated and undertreated. Here, we report our experience with the Konno anterior aorto-ventriculoplasty in adult patients suffering from prothesis-patient mismatch. PATIENTS: Between 2005 and 2020, 8 adult patients received a classical Konno anterior enlargement of the aortic anulus to treat a typical PPM (n = 5) or another complex obstructing pathology of the LV OT (n = 3). Median age was 42,5 years and 5 patients were female. All patients suffered from exercise dyspnea NYHA functional class III or IV. In addition to the Konno procedure, 3 patients underwent mitral valve replacement (n = 2) or repair (n = 1). Two patients received tricuspid anuloplasty to treat severe concomitant tricuspid regurgitation. All patients had undergone at least one previous operation, 3 patients had 2 prior procedures in their medical history and 1 patient was operated for the fifth time. RESULT S: All patients survived the operation. One younger patient suffering from Hutchinson’ type of progeria died in-hospital on postoperative day 45 following prolonged hemodynamic failure. She also had developed thrombosis of the mechanical mitral prosthesis, underwent thrombectomy and extracorporeal membrane oxygenation support (ECMO) but did not recover. One patient required a double chamber pacemaker implantation because of persistent atrio-ventricular block III. All surviving patients demonstrated very satisfactory postoperative hemodynamic patterns across the LV OT and clinical improvement. The Konno anterior aorto-ventriculoplasty is a very efficient method to adequately enlarge the LV OT, independently from the initial pathology. This technique is only rarely used because it is considered as a complex intervention. However, this type of enlargement usually allows the insertion of a larger prosthesis than after a simpler Manougian or Nicks posterior anulus enlargement. For adult patients with severe PPM or other forms of complex LV OT obstruction, the Konno intervention is a valuable option that should be carefully discussed.
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4 pages, 262 KB

Open AccessArticle

Critical Appraisal of Pacemaker Implantations in a Tertiary Swiss Hospital

by Hanna Berger, Christian Sticherling and Beat Schaer

Cardiovasc. Med. 2022, 25(4), 155; https://doi.org/10.4414/cvm.2022.02221 - 1 Jul 2022

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Abstract

In the light of possible restrictions to the number of pacemaker implantations in Switzerland and missing local data on this topic, we aimed to evaluate if the pacemaker indications in a tertiary Swiss hospital are in accordance with current guidelines of the European [...] Read more.

In the light of possible restrictions to the number of pacemaker implantations in Switzerland and missing local data on this topic, we aimed to evaluate if the pacemaker indications in a tertiary Swiss hospital are in accordance with current guidelines of the European Society of Cardiology. We included all 309 pacemakers implanted between the 1 January 2018 and the 15 March 2019. Cardiac resynchronisation pacemakers were excluded. Mean age of the patients was 78.3 years (standard deviation 10.2). Class I indication was present in 90.6%, class IIa in 3.6%, class IIb in 3.6%, and class III in 2.2%. Based on these results, it is unlikely that a prespecified restriction of annual pacemaker implantations will prevent volume expansion. On the contrary, these measures may even result in withholding indicated therapy for symptomatic patients. Full article

4 pages, 238 KB

Open AccessInteresting Images

Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Vein Return

by Renata Wojtal, Andres Spirig, Tim Ohletz, Laurent M. Haegeli and Tobias A. Fuchs

Cardiovasc. Med. 2022, 25(4), 124; https://doi.org/10.4414/cvm.2022.02215 - 1 Jul 2022

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Abstract

We report a 44-year-old patient, who was initially referred for routine cardiac evaluation, because of family history of sudden cardiac death and a probable new onset of a right bundle branch block (RBBB) on a regular electrocardiogram (ECG) (fig. 1). [...] Full article

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7 pages, 206 KB

Open AccessArticle

Early Degeneration of the Sorin Mitroflow Aortic Bioprosthesis

by Fritz Widmer, Florian Schliephake, Daniel Mattle and Martin Federmann

Cardiovasc. Med. 2022, 25(4), 116; https://doi.org/10.4414/cvm.2022.02211 - 1 Jul 2022

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Abstract

We report a series of 31 patients after surgical aortic valve implantation of a bovine Sorin Mitroﬂow bioprosthesis with early severe structural valve degeneration (SVD) despite absence of known risk factors. Half of the patients underwent re-intervention and more than one third died [...] Read more.

We report a series of 31 patients after surgical aortic valve implantation of a bovine Sorin Mitroﬂow bioprosthesis with early severe structural valve degeneration (SVD) despite absence of known risk factors. Half of the patients underwent re-intervention and more than one third died without re-intervention, mostly prematurely due to heart failure caused by SVD. The Sorin Mitroﬂow valve was prone to early SVD even in very old patients, which may be at least in part due its speciﬁc design with an externally mounted pericardial sheet and to a former lack of anti-calciﬁcation treatment. This led to additional suffering of the patients and added healthcare expense. The inferior durability of the advanced versions of the valve was largely undetected for almost two decades, which in retrospect was mainly because earlier studies relied on SVD diagnosis only at reoperation, lacked regular echocardiographic monitoring and did not consider the competing risk of death despite high mortality rates. To avoid a similar delay in the recognition of speciﬁc problems with new surgical valves the introduction of mandatory SAVR registries is suggested analogue to the already ongoing TAVI registries. Moreover, regular echocardiographic monitoring and uniform deﬁnition of SVD as well as broad training of all cardiologists and echocardiographers involved in SVD screening and treatment seem reasonable. Full article

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6 pages, 1243 KB

Open AccessReview

Five Years’ Experience of the Endocarditis Team in a Tertiary Referral Centre

by Mathias Van Hemelrijck, Adrian Schmid, Alexander Breitenstein, Ronny R. Buechel, Peter Bode, David Siemer, Oscar A. Cuevas, Matthias Greutmann, Christiane Gruner, Frank Ruschitzka, Dominique Bettex, Felix Tanner, Thierry Carrel, Annelies S. Zinkernagel, Robert Bauernschmitt, Alberto Weber, Michelle Frank, Barbara Hasse and Carlos A. Mestres

Cardiovasc. Med. 2022, 25(4), 110; https://doi.org/10.4414/cvm.2022.02210 - 1 Jul 2022

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Abstract

Introduction: Current European guidelines recommend a multidisciplinary team approach in infective endocarditis in order to ensure adequate treatment and follow-up. The aim of this contribution is to describe the organisation of the Endocarditis Board at the University Hospital Zurich and report the [...] Read more.

Introduction: Current European guidelines recommend a multidisciplinary team approach in infective endocarditis in order to ensure adequate treatment and follow-up. The aim of this contribution is to describe the organisation of the Endocarditis Board at the University Hospital Zurich and report the initial outcome data for patients with short-term follow-up information. Method: The Endocarditis Board includes specialists in infectious diseases, cardiovascular surgery, cardiology, anaesthesiology, microbiology, nuclear medicine and cardiac imaging, neurology and pathology. Interactive weekly participation from all specialties guarantees integrated patient care. Consensus decisions are documented in the institutional electronic medical record. Systematic observational data collection is an important aspect of quality assurance and feedback. Results: The Endocarditis Board became operational in May 2016. All cases of proven or suspected infective endocarditis primarily admitted or referred were discussed. Between May 2016 and December 2020, 595 consecutive patients were discussed, leading to 1145 discussion episodes. Based on detailed analysis, the diagnosis of infective endocarditis was rejected by consensus in 128 patients. Of the 467 patients with cardiovascular infections, 113 (24%) were female, median age was 68 years, 346 (70%) had an infective endocarditis (218 native valve infective endocarditis/122 prosthetic valve infective endocarditis/6 marantic), 73 (16%) had device-associated and 48 (10%) vascular graft infections. Gram-positive bacteria were predominant (Staphylococcus aureus (141, 30%); Coagulase-negative Staphylococcus (53, 11%); Streptococcus spp. (120, 26%) and Enterococcus spp. (51, 11%)). Surgery was performed in 190 (41%) patients. Thirty-day and 1-year mortality were 9.6% and 14%, respectively. Conclusions: Currently the Endocarditis Team and Endocarditis Board play a key role in the treatment of cardiovascular infections according to the European Guidelines and belong to the standard of care at our institution. Full article

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5 pages, 155 KB

Open AccessReview

Prenatal Consequences of Congenital Heart Disease on Brain Development

by Céline Steger and Walter Knirsch

Cardiovasc. Med. 2022, 25(4), 103; https://doi.org/10.4414/cvm.2022.02217 - 1 Jul 2022

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Abstract

In fetuses with complex congenital heart disease (CHD), impaired brain growth and brain development starts in utero. A complex interplay between heart, brain, body and placenta takes place in the second and third trimesters of pregnancy. Altered fetal cardiovascular hemodynamics due to differnt [...] Read more.

In fetuses with complex congenital heart disease (CHD), impaired brain growth and brain development starts in utero. A complex interplay between heart, brain, body and placenta takes place in the second and third trimesters of pregnancy. Altered fetal cardiovascular hemodynamics due to differnt types of CHD lead to altered cerebral, body and placental perfusion, all factors contributing to maturational delay of body and brain development. Impaired cerebral perfusion, oxygenation and nutritive energy supply affects brain growth and leads to a brain developmental delay of 3–4 weeks until birth. Comparable to the altered brain development in preterm infants, similar pathogenic mechanisms lead to an encephalopathy of CHD on a micro- and macrostructural level. After birth palliative or corrective cardiac surgery is needed, which further contributes to the brain maturational delay with consequences on the neurodevelopmental outcome. Full article

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3 pages, 148 KB

Open AccessCase Report

Giant Left Atrial Appendage Aneurysm with Thrombus

by Levin Bolt, Annina Studer Brüngger, Lars C. Huber and Mattia Arrigo

Cardiovasc. Med. 2022, 25(4), 100; https://doi.org/10.4414/cvm.2022.02213 - 1 Jul 2022

Cited by 1 | Viewed by 696

Abstract

We present the case of an atrial thrombus that developed under established anticoagulation in a patient with a giant left atrial appendage aneurysm and persistent atrial ﬁbrillation. The management of patients with left atrial appendage aneurysm is challenging and might include surgical resection [...] Read more.

We present the case of an atrial thrombus that developed under established anticoagulation in a patient with a giant left atrial appendage aneurysm and persistent atrial ﬁbrillation. The management of patients with left atrial appendage aneurysm is challenging and might include surgical resection of the aneurysm and antithrombotic treatment tailored according to surgical risk, comorbidities and patient preferences. Full article

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Cardiovasc. Med., Volume 25, Issue 4 (07 2022) – 7 articles

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