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Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function
Abdelkader Boukhmis,
Mohammed El-Amin Nouar,
Yacine Djouaher
Issue:
Volume 9, Issue 3, May 2023
Pages:
22-26
Received:
15 March 2023
Accepted:
3 April 2023
Published:
10 June 2023
Abstract: Background: Ischemic cardiomyopathy patients often have a severely atherosclerotic ascending aorta and low cardiac function. In these patients, aortic cross-clamping and cardiac arrest increase the risk of postoperative strokes and low cardiac output syndrome. Objective: To evaluate the short and medium term outcomes of clampless beating heart mitral valve replacement in patients with secondary mitral regurgitation and a poor left ventricular function. Method: Here we describe two male patients, aged 71 and 54 years, with severe secondary mitral regurgitation and impaired left ventricular ejection fraction (LVEF) (24% and 30%, respectively). On-pump beating-heart mitral valve replacement with total chordal sparing was performed without aortic cross-clamping, through a full sternotomy approach. Results: Weaning from cardiopulmonary bypass, which lasted 43 and 52 minutes respectively, was easily achieved without the use of positive inotropes or vasopressors. The duration of mechanical ventilation (3 and 6 hours, respectively) and intensive care (24 and 48 hours, respectively) was short, considering the advanced stage of cardiomyopathy. Both patients had no postoperative neurological disorder. After a mean follow-up of 66 months (84 and 48 months, respectively), both patients were asymptomatic, without prosthetic valve dysfunction and their LVEF reached 42% and 51%, respectively. Conclusion: Beating heart mitral valve replacement, with total preservation of subvalvular apparatus, and without cross-clamping of the aorta, preserves left ventricular systolic function in the short and long-term, and reduces embolic events due to aortic manipulation. This technique can improve the outcomes of surgery for secondary mitral regurgitation in cases of severe left ventricular dysfunction.
Abstract: Background: Ischemic cardiomyopathy patients often have a severely atherosclerotic ascending aorta and low cardiac function. In these patients, aortic cross-clamping and cardiac arrest increase the risk of postoperative strokes and low cardiac output syndrome. Objective: To evaluate the short and medium term outcomes of clampless beating heart mitr...
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Dyslipidaemia and Its Underlying Mechanisms in Coronavirus Disease 2019 (COVID-19) Infection
Zainab Bubakr Hamad Zubi,
Hamad Abdulsalam Hamad Alfarisi
Issue:
Volume 9, Issue 3, May 2023
Pages:
27-31
Received:
18 April 2023
Accepted:
7 June 2023
Published:
21 June 2023
Abstract: Dyslipidaemia is a biochemical alteration connected to the pathology accompanying COVID-19 infection. Dyslipidaemia has been recognized as a common complication in COVID-19 infection exerting a significant effect on severity and mortality in COVID-19 infected patients. Disturbance of lipid profile in COVID-19 infection is diverse and shown to have various presentations. Inflammatory markers and acute phase reactants found to have a relation with the disrupted lipid profile during COVID-19 infection. The objective of this short review is to outline the altered lipid profile in COVID-19 infected patient, and to highlight the relationship between dyslipidaemia, inflammatory markers, severity and morbidity of COVID infection. The implemented methodology in this comprehensive short review is based on analysis of the recent published literature pertaining dyslipidaemia in COVID-19 infection. The core literature for this review is the published clinical studies and the case reports that studied the effects of COVID-19 infection on lipid profile. This review showed that low total cholesterol and high-density lipoprotein cholesterol (HDL-C) in addition to elevated low-density lipoprotein cholesterol (LDL-C) constitute the commonest altered lipid profile in COVID-19 infected patients. Lipid peroxidation, oxidative stress and inflammation are the postulated pathogenic mechanisms for dyslipidaemia during COVID-19 infection. However, the results about status of triglycerides (TG) in COVID-19 infection was non-conclusive. Further studies may be required to suite the lipidomic status of triglycerides in COVID-19 infected patients.
Abstract: Dyslipidaemia is a biochemical alteration connected to the pathology accompanying COVID-19 infection. Dyslipidaemia has been recognized as a common complication in COVID-19 infection exerting a significant effect on severity and mortality in COVID-19 infected patients. Disturbance of lipid profile in COVID-19 infection is diverse and shown to have ...
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Chylopericardium with Chylothorax as an Unusual Presentation of Hodgkin Lymphoma
Papa Ousmane Ba,
Myriam Bizrane,
Souleymane Diatta,
Jean Claude Ndiogou Dione,
Momar Sokhna Diop,
Papa Amath Diagne,
Kondo Bignandi,
Mory Camara,
Marème Soda Mbaye,
Papa Adama Dieng,
Amadou Gabriel Ciss,
Assane Ndiaye
Issue:
Volume 9, Issue 3, May 2023
Pages:
32-35
Received:
26 May 2023
Accepted:
19 June 2023
Published:
27 June 2023
Abstract: Introduction: Chylous effusions are rare and their etiologies are multiple and diverse. Chylothorax is the most common; however, chylopericardium is exceptional. The aim of this work is to report the epidemiological, diagnostic and therapeutic aspects of Hodgkin lymphoma revealed by chylopericardium and bilateral chylothorax with review of the literature. Case presentation: It’s about a 34 years old man, with no particular pathological history, admitted in emergency, with a cardiac tamponade associated with a bilateral pleural effusion. The patient underwent a subxiphoid pericardiostomy and pleural drainage, removing milky pericardial (800cc) and pleural (1850cc) fluid. Fluid analysis confirmed a chylous effusion with no malignant cells. The patient was started on a low dietary fat diet which allowed a decrease in the chyle output after 10 days. A mediastinal mass biopsy was performed, through an anterior right mediastinotomy, revealing a Hodgkin lymphoma. The patient was referred to an Oncology center and underwent a full course of chemotherapy. The patient’s response to chemotherapy was favorable with a good clinical outcome and complete regression of the superior vena cava syndrome, the edema and the respiratory distress. Conclusion: It’s important to keep in mind some uncommon presentations of mediastinal tumors in general, and specifically Hodgkin Lymphoma; as well as the role of the 3 cornerstones (low-fat diet, surgery, and treatment of the underlying cause) in the management of this condition.
Abstract: Introduction: Chylous effusions are rare and their etiologies are multiple and diverse. Chylothorax is the most common; however, chylopericardium is exceptional. The aim of this work is to report the epidemiological, diagnostic and therapeutic aspects of Hodgkin lymphoma revealed by chylopericardium and bilateral chylothorax with review of the lite...
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Total Anomalus Pulmonary Venous Connection: About a Case Operated on at the Andre Festoc Center of Bamako
Baba Ibrahima Diarra,
Modibo Doumbia,
Mamadou Touré,
Sanoussy Daffe,
Bakary Coulibaly,
Oumar Doucouré,
Siriman Koita,
Diallo Binta,
Salia Traoré,
Mahamadoune Coulibaly,
Mamadou Bocary Diarra,
Birama Togola,
Seydou Togo,
Moussa Abdoulaye Ouattara,
Sadio Yena,
Paul Neuville,
Guy Fernandez,
Bina Nadjeeboulah,
Erwan Flecher,
Thiery Langanay,
Alain Deloche
Issue:
Volume 9, Issue 3, May 2023
Pages:
36-39
Received:
3 June 2023
Accepted:
19 June 2023
Published:
29 June 2023
Abstract: Total anomalus pulmonary venous drainage refers to the absence of connection of the four pulmonary veins to the left atrium. This anomaly is often associated with atrial septal defect This is a rare malformation, with total forms accounting for 0.4% of all congenital heart defects, while partial forms account for between 0.6 and 0.7%. Diagnosis is a delicate matter, made by cardiac ultrasound performed by an experienced operator. The aim of this work was to establish the characteristics of this pathology, to determine the operative indications, and to evaluate the operative results. We report the case of the first complete cure of total anomalous pulmonary venous return at the Festoc center in Bamako. The patient was 08 years old and was initially referred to us for management of a sinus venosus atrial septal defect with symptoms of precordialgia and stage 2 to 3 dyspnoea. Examination revealed a mesocardial systolic murmur. Cardiac ultrasound revealed a 38 mm wide atrial septal defect sinus veinosus with no superior vena cava. Surgical exploration revealed a single atrium with total abnormal pulmonary venous return. Given the local team's lack of experience with this complex congenital anomaly, a collegial decision was taken to enlarge the ASV. Three weeks later, the patient underwent a repeat operation under extracorporeal circulation after an angioscan scan had revealed the collector. Surgical exploration revealed a single atrium with a small left atrium. The collector ended at the TVI. We re-implanted the collector in the left atrium and ligated the TVI. Pulmonary venous return anomalies are rare conditions and represent a heterogeneous group of cardiovascular malformations. Their incidence is estimated at 0.4-0.7% of all congenital heart defects. Their management requires a certain level of logistical organization and technical expertise, which can be envisaged in developing countries. North-South cooperation is also a very important aspect in the ongoing training of medical staff and the management of certain complex cardiopathies.
Abstract: Total anomalus pulmonary venous drainage refers to the absence of connection of the four pulmonary veins to the left atrium. This anomaly is often associated with atrial septal defect This is a rare malformation, with total forms accounting for 0.4% of all congenital heart defects, while partial forms account for between 0.6 and 0.7%. Diagnosis is ...
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First Case of Triple Valve Replacement in the Andre Festoc Center in Bamako
Baba Ibrahima Diarra,
Modibo Doumbia,
Mamadou Touré,
Sanoussy Daffe,
Bakary Coulibaly,
Oumar Doucouré,
Siriman Koita,
Diallo Binta,
Salia Traoré,
Mahamadoune Coulibaly,
Mamadou Bocary Diarra,
Birama Togola,
Seydou Togo,
Moussa Abdoulaye Ouattara,
Sadio Yena,
Guy Fernandez,
Bina Nadjeeboulah,
Erwan Flecher,
Thiery Langanay,
Alain Deloche
Issue:
Volume 9, Issue 3, May 2023
Pages:
40-44
Received:
3 June 2023
Accepted:
19 June 2023
Published:
29 June 2023
Abstract: Triple valvulopathy refers to triple valve dysfunction: mitral, aortic and tricuspid. Most are of rheumatic origin. The specificity of these triple disorders derives from the great variability of the pictures encountered, associating to varying degrees leakage and stenosis in each orifice. The aim of this work was to establish the specific features of this surgery, to determine the operative indications, and to evaluate the operative results in a developing country. We report the case of a 25-year-old female patient with a history of recurrent angina during childhood, who underwent therapeutic termination of pregnancy 03 years ago for exertional dyspnea and edema of the lower limbs, revealing this cardiopathy. Cardiac ultrasonography revealed a tight mitral narrowing with a mitral surface area of 0.7 cm2 and a mean gradient of 15 mmhg; tricuspid disease combining severe tricuspid insufficiency and tricuspid narrowing with a mean gradient of 7 mmhg; and a tight calcified aortic narrowing with a mean gradient of 51 mmhg. Operability tests were normal. She underwent triple valve replacement: mechanical mitral valve replacement with a No. 33 prosthesis; mechanical aortic valve replacement with a No. 24 prosthesis; and biological tricuspid valve replacement with a No. 25 bioprosthesis. Extracorporeal circulation time was 217 min, clamping time 132 minutes and assistance time 66 minutes. Post-operative follow-up was marked by left and right ventricular dysfunction, which progressed well on drugs.
Abstract: Triple valvulopathy refers to triple valve dysfunction: mitral, aortic and tricuspid. Most are of rheumatic origin. The specificity of these triple disorders derives from the great variability of the pictures encountered, associating to varying degrees leakage and stenosis in each orifice. The aim of this work was to establish the specific features...
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