Coarctation of the aorta is one of the most commonly encountered congenital heart defects (CHD), ... more Coarctation of the aorta is one of the most commonly encountered congenital heart defects (CHD), in the pediatric population. It is defined as a hemodynamically significant stenosis of the descending aorta, typically at the site of insertion of ductus arteriosus. It has an estimated incidence of 4-6 cases per 100,000 births, accounting for 5-8% of all congenital heart defects [1-4]. According to The New England Regional Infant Cardiac Program (NERICP), coarctation of the aorta is the fourth most common defect requiring surgery during the first year of life [5]. It can present as an isolated lesion or coexist with other cardiac or extra-cardiac congenital defects. The most common one include bicuspid aortic valve, patent ductus arteriosus, ventricular septal defect, mitral stenosis, berry aneurysms in the circle of Willis [6-8]. Clinical presentation is heterogenous, varying from asymptomatic to congestive heart failure, acute pulmonary edema and cardiogenic shock, depending on the d...
Objectives The aim was to create a model of myocardial infarction (MI) with a borderline myocardi... more Objectives The aim was to create a model of myocardial infarction (MI) with a borderline myocardial impairment which would enable to evaluate the retrograde cellular cardiomyoplasty (CCM) through the coronary sinus (CS) in a large animal model. Materials and Methods Experience was carried out in 25 juvenile farm pigs, of both sexes, weighing 35 to 40 Kg. 15 were subjected to the procedure, and 10 were used as control. All animals underwent a right antero-lateral thoracotomy on the fifth intercostal space, and the LAD was ligated after the emission of the second diagonal. Almost one month later the animals in the study group underwent a midline sternotomy and a murine myoblastic line C2-C12 in 20cc of medium was injected at a constant pressure of 30 mmHg, with the balloon inflated into the coronary sinus through a Swan-Ganz catheter with a 20 minutes interval. 30 days later all survived animals from the study group and the control group underwent transthoracic echocardiography and 99-Tc MIBI Gated Scintigraphy evaluation and later were euthanized through a midline sternotomy and specimens were taken from the left ventricle for mycroscopic evaluation. Results In all animals it was seen a progressive rise of CPK-Mb, Troponine I and Myoglobin during the observation period, reaching the maximum values within 12 hours after MI, while Myoglobin reached its maximum level within 4 hours after AMI. Cardiac output decreased significantly after AMI (p<0.001), remained low until CCM and increased significantly at the time when the animal was sacrificed versus the values after AMI (p<0.001) , but comparable to the baseline values (p=ns). Pulmonary artery pressure increased significantly after AMI (p<0.001) and improved before the animals’ sacrifice versus the post AMI values (p<0.001). Instead in the control group such values remained the same at the time of sacrifice compared to the post AMI values. In all animals, the surgical induction of AMI caused a marked decline in the echocardiographic values of cardiac function regarding the LVEF, LVEDV, LVESV and MPI. However the cardiac function and dimensions were significantly improved in the study group versus the control group. All animals, undergoing CCM, demonstrated a significant reduction of the perfusion deficit in the LAD territory after CCM, instead such data remained unchanged in the control group. The histological examination demonstrated that the engrafted myoblasts could be distinguished from the activated fibroblasts in the scar tissue because they never showed any signs of collagen secretion and fiber buildup. The engrafted myoblasts were mainly found in the AMI area borderline. Conclusion Our study provides data in support of the following issues: the venous retrograde delivery route through the CS is safe and effective; CCM provides a significant improvement in function and viability.
World Journal for Pediatric and Congenital Heart Surgery, Apr 1, 2015
A three-month-old infant operated for obstructed intracardiac total anomalous pulmonary venous co... more A three-month-old infant operated for obstructed intracardiac total anomalous pulmonary venous connection was readmitted because of sinus bradycardia and superior vena cava syndrome. Cardiac catheterization revealed a stenosis at the superior vena cava-right atrial junction with retrograde azygos flow. Following balloon dilatation of the stenotic area and stent implantation, the superior vena cava syndrome was rapidly relieved. At six months, an echocardiogram confirmed unobstructed flow from the superior vena cava to the right atrium.
Objective: The goal of this manuscript is to compare clinical and echocardiographic outcomes of p... more Objective: The goal of this manuscript is to compare clinical and echocardiographic outcomes of patients undergoing aortic valve replacement (AVR) with Perceval sutureless bioprosthesis (SU-AVR) and sutured bioprosthesis (SB). Methods: Following the PRISMA statement, data were extracted from studies published after August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post-procedural permanent pacemaker implantation, and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop-out), need for a second transcatheter heart valve, 30-day mortality, stroke, and echocardiographic outcomes. Results: Twenty-one studies were included in the analysis. When SU-AVR was compared to other SB, mortality ranged from 0 to 6.4% for Perceval and 0 to 5.9% for SB. Incidence of PVL (Perceval 1–19.4% vs. SB 0–1%), PPI (Perceval 2–10.7...
Open Access Macedonian Journal of Medical Sciences
Hypoplastic left heart syndrome (HLHS) is a complex congenital heart condition which includes abn... more Hypoplastic left heart syndrome (HLHS) is a complex congenital heart condition which includes abnormal development of left sided cardiac structures leading to inadequate systemic perfusion following postnatal closure of the patent ductus arteriosus (PDA). Surgical palliation may be accomplished through a 3 staged process -Norwood procedure. This surgery is usually done within the first two weeks of your child's life -Bidirectional Glenn procedure. This procedure is generally the second surgery. It's done when your child is between 3 and 6 months of age. -Fontan procedure. This surgery is usually done when your child is between 18 months and 4 years of age. Patients with HLHS may need to undergo other non-cardiac surgical procedures during the first years of life posing a real challenge to the anesthesiologist, surgeon and the entire medical team. We present the case of a 18-months old, 9 kg infant who presented for cryptorchidism surgery. Cryptorchidism or undescended testis...
Objectives: To investigate primary and secondary surgical outcomes following transcaval repair (T... more Objectives: To investigate primary and secondary surgical outcomes following transcaval repair (TCR), modified Warden repair, and transatrial repair techniques for partial anomalous pulmonary venous connections (PAPVCs) and sinus venosus atrial septal defects (ASDs). Methods: This is an observational cohort clinical study. Patients who underwent TCR, modified Warden repair, and transatrial surgical repair for PAPVC and ASD between January 2003 and October 2019 at our institution were included in the study. Patients had one of the surgical procedures based on the anatomy of the defect. Results: Ten patients, seven (70%) males and three (30%) females, were included in the analysis. Seven patients underwent TCR, two patients the modified Warden technique, and one patient underwent transatrial surgical repair. Mean age was 57 years ± 14.7. Mean EuroScore II was 3.4 ± 3.5. The baseline left ventricle ejection fraction was 45 ± 6.5%. No patient had previous stroke, pacemaker (PM) implanta...
After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is or... more After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have ...
Coarctation of the aorta is one of the most commonly encountered congenital heart defects (CHD), ... more Coarctation of the aorta is one of the most commonly encountered congenital heart defects (CHD), in the pediatric population. It is defined as a hemodynamically significant stenosis of the descending aorta, typically at the site of insertion of ductus arteriosus. It has an estimated incidence of 4-6 cases per 100,000 births, accounting for 5-8% of all congenital heart defects [1-4]. According to The New England Regional Infant Cardiac Program (NERICP), coarctation of the aorta is the fourth most common defect requiring surgery during the first year of life [5]. It can present as an isolated lesion or coexist with other cardiac or extra-cardiac congenital defects. The most common one include bicuspid aortic valve, patent ductus arteriosus, ventricular septal defect, mitral stenosis, berry aneurysms in the circle of Willis [6-8]. Clinical presentation is heterogenous, varying from asymptomatic to congestive heart failure, acute pulmonary edema and cardiogenic shock, depending on the d...
Objectives The aim was to create a model of myocardial infarction (MI) with a borderline myocardi... more Objectives The aim was to create a model of myocardial infarction (MI) with a borderline myocardial impairment which would enable to evaluate the retrograde cellular cardiomyoplasty (CCM) through the coronary sinus (CS) in a large animal model. Materials and Methods Experience was carried out in 25 juvenile farm pigs, of both sexes, weighing 35 to 40 Kg. 15 were subjected to the procedure, and 10 were used as control. All animals underwent a right antero-lateral thoracotomy on the fifth intercostal space, and the LAD was ligated after the emission of the second diagonal. Almost one month later the animals in the study group underwent a midline sternotomy and a murine myoblastic line C2-C12 in 20cc of medium was injected at a constant pressure of 30 mmHg, with the balloon inflated into the coronary sinus through a Swan-Ganz catheter with a 20 minutes interval. 30 days later all survived animals from the study group and the control group underwent transthoracic echocardiography and 99-Tc MIBI Gated Scintigraphy evaluation and later were euthanized through a midline sternotomy and specimens were taken from the left ventricle for mycroscopic evaluation. Results In all animals it was seen a progressive rise of CPK-Mb, Troponine I and Myoglobin during the observation period, reaching the maximum values within 12 hours after MI, while Myoglobin reached its maximum level within 4 hours after AMI. Cardiac output decreased significantly after AMI (p<0.001), remained low until CCM and increased significantly at the time when the animal was sacrificed versus the values after AMI (p<0.001) , but comparable to the baseline values (p=ns). Pulmonary artery pressure increased significantly after AMI (p<0.001) and improved before the animals’ sacrifice versus the post AMI values (p<0.001). Instead in the control group such values remained the same at the time of sacrifice compared to the post AMI values. In all animals, the surgical induction of AMI caused a marked decline in the echocardiographic values of cardiac function regarding the LVEF, LVEDV, LVESV and MPI. However the cardiac function and dimensions were significantly improved in the study group versus the control group. All animals, undergoing CCM, demonstrated a significant reduction of the perfusion deficit in the LAD territory after CCM, instead such data remained unchanged in the control group. The histological examination demonstrated that the engrafted myoblasts could be distinguished from the activated fibroblasts in the scar tissue because they never showed any signs of collagen secretion and fiber buildup. The engrafted myoblasts were mainly found in the AMI area borderline. Conclusion Our study provides data in support of the following issues: the venous retrograde delivery route through the CS is safe and effective; CCM provides a significant improvement in function and viability.
World Journal for Pediatric and Congenital Heart Surgery, Apr 1, 2015
A three-month-old infant operated for obstructed intracardiac total anomalous pulmonary venous co... more A three-month-old infant operated for obstructed intracardiac total anomalous pulmonary venous connection was readmitted because of sinus bradycardia and superior vena cava syndrome. Cardiac catheterization revealed a stenosis at the superior vena cava-right atrial junction with retrograde azygos flow. Following balloon dilatation of the stenotic area and stent implantation, the superior vena cava syndrome was rapidly relieved. At six months, an echocardiogram confirmed unobstructed flow from the superior vena cava to the right atrium.
Objective: The goal of this manuscript is to compare clinical and echocardiographic outcomes of p... more Objective: The goal of this manuscript is to compare clinical and echocardiographic outcomes of patients undergoing aortic valve replacement (AVR) with Perceval sutureless bioprosthesis (SU-AVR) and sutured bioprosthesis (SB). Methods: Following the PRISMA statement, data were extracted from studies published after August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post-procedural permanent pacemaker implantation, and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop-out), need for a second transcatheter heart valve, 30-day mortality, stroke, and echocardiographic outcomes. Results: Twenty-one studies were included in the analysis. When SU-AVR was compared to other SB, mortality ranged from 0 to 6.4% for Perceval and 0 to 5.9% for SB. Incidence of PVL (Perceval 1–19.4% vs. SB 0–1%), PPI (Perceval 2–10.7...
Open Access Macedonian Journal of Medical Sciences
Hypoplastic left heart syndrome (HLHS) is a complex congenital heart condition which includes abn... more Hypoplastic left heart syndrome (HLHS) is a complex congenital heart condition which includes abnormal development of left sided cardiac structures leading to inadequate systemic perfusion following postnatal closure of the patent ductus arteriosus (PDA). Surgical palliation may be accomplished through a 3 staged process -Norwood procedure. This surgery is usually done within the first two weeks of your child's life -Bidirectional Glenn procedure. This procedure is generally the second surgery. It's done when your child is between 3 and 6 months of age. -Fontan procedure. This surgery is usually done when your child is between 18 months and 4 years of age. Patients with HLHS may need to undergo other non-cardiac surgical procedures during the first years of life posing a real challenge to the anesthesiologist, surgeon and the entire medical team. We present the case of a 18-months old, 9 kg infant who presented for cryptorchidism surgery. Cryptorchidism or undescended testis...
Objectives: To investigate primary and secondary surgical outcomes following transcaval repair (T... more Objectives: To investigate primary and secondary surgical outcomes following transcaval repair (TCR), modified Warden repair, and transatrial repair techniques for partial anomalous pulmonary venous connections (PAPVCs) and sinus venosus atrial septal defects (ASDs). Methods: This is an observational cohort clinical study. Patients who underwent TCR, modified Warden repair, and transatrial surgical repair for PAPVC and ASD between January 2003 and October 2019 at our institution were included in the study. Patients had one of the surgical procedures based on the anatomy of the defect. Results: Ten patients, seven (70%) males and three (30%) females, were included in the analysis. Seven patients underwent TCR, two patients the modified Warden technique, and one patient underwent transatrial surgical repair. Mean age was 57 years ± 14.7. Mean EuroScore II was 3.4 ± 3.5. The baseline left ventricle ejection fraction was 45 ± 6.5%. No patient had previous stroke, pacemaker (PM) implanta...
After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is or... more After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have ...
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