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A 59-year-old man with acute mitral regurgitation due to papillary muscle rupture after myocardial infarction was admitted to our hospital. He underwent emergent mitral valve replacement with a mechanical valve by median sternotomy. Although postoperative echocardiography showed no sign of a ventricular aneurysm, echocardiography performed 5 weeks after the surgery showed enlarging left ventricular pseudoaneurysm of the inferior to the posterior cardiac wall. He underwent dacron patch closure of the orifice by fifth intercostal left thoracotomy. The postoperative course was uneventful and he was discharged on postoperative day 10. The patient was successfully treated for two life-threatening complications occurring subsequently after myocardial infarction.

Background: This study investigates the optimal management for unruptured sinus of Valsalva aneurysms (USVAs) combined with other cardiovascular lesions.Methods: This retrospective study examined 33 USVA patients who underwent surgical repair from February 1, 2007 to January 31, 2012. We analyzed the surgical procedures and the patients' quality of life after surgery. Additionally, echocardiography follow-up was performed before and after the operation.Results: Most USVAs (87.8%) originated in the right coronary sinus. Aside from one patient who was preoperatively misdiagnosed as having a ruptured sinus of Valsalva aneurysm (SVA). USVAs of the right coronary sinus were addressed by reinforcing this sinus with a Dacron patch through the right ventricle. USVAs were corrected by aortotomy using an autogenous pericardium patch when they originated in the non-coronary or left coronary sinus. Thirty patients (90.9%) were followed up for 22–119 months. No early death, residual fistula or SVA recurrence were found during the follow-up period. They all had a good quality of life and good heart function (New York Heart Association class I–II).Conclusions: Active surgical repair of an USVA can be achieved with satisfactory results in patients combined with other cardiovascular lesions.

An aorto-esophageal fistula (AEF) is a rare yet life-threatening cause of upper gastrointestinal bleeding. We report our experience with open surgical management of two cases of AEF. Both cases presented with almost identical presentations: hematemesis and hemodynamic instability. The aorta in the first patient was normal; the defect was small and was repaired with a Dacron patch. The second patient had an aneurysmal aorta, which was replaced with a Dacron graft. Both cases were performed under partial bypass. The esophageal rent in both patients was debrided, primarily closed and buttressed with a vascularized intercostal pedicle. Nonavailability of endovascular personnel and equipment along with hemodynamic instability of the patient influenced our surgical strategy. Long-term follow-up of these patients is necessary to analyze the outcomes of our surgical repair.

Introduction Aneurysms are found following all types of surgical repair of aortic coarctation, especially after Dacron patch aortoplasty. We describe the finding of an aortic aneurysm in an asymptomatic 52-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 34 years earlier. Case report A 52-year male, smoker, hypertensive on medication He had previous history of surgical repair of aortic coarctation at age of 18 years . Repair was by Dacron patch aortoplasty. Since then, his regular follow up was unremarkable. Recently, he was referred for cardiac evaluation as a part of pre-employment general check-up. He was asymptomatic with no history of shortness of breath or chest pain. Physical examination revealed that the pulse in the left arm was reduced in volume in comparison to the right one. The heart sounds were essentially normal but a pericardial murmur was audible, perhaps reflecting residual collateral flow. Blood pressure was 156/83 mmHg in right arm and 142/81 in the left arm. Transthoracic echocardiography revealed mild left ventricular hypertrophy with normal global and regional contractility and an ejection fraction of 58%. Supra sternal window images showed dilatation of the three aortic arch branches. The distal portion of aortic arch just distal to origin of left subclavian artery was narrowed with a peak systolic gradient across of 34 mmHg. A cystic structure (1.7 cm x 1.9 cm) was visualized attached to the narrowed segment of the aorta, suggestive of a saccular aneurysm, (figures A&B&C). Computed tomography aortogram showed a narrow-necked aneurysm arising from the posterolateral aspect of the distal aortic arch (anticipated site of the coarctation repair graft anastomosis). A small laminated thrombus was also noted within. Aneurysm measured approximately 2.2 x 3.3 cm in its craniocaudal and anteroposterior dimensions respectively, with no evidence of aortic luminal compromise. (figures D&E&F). Management Aneurysmectomy was performed subsequently. Interposition polyester grafts were used to reconstruct the aortic arch and proximal descending aorta and to connect this aortic segment to the subclavian artery via a lateral thoracotomy. The postoperative course thereafter was uneventful. Conclusion: This is a rare insidious complication of Dacron patch aortoplasty that occurred after more than 3 decades, which highlights the importance of diagnostic imaging in the follow up of these patients Abstract P1494 Figure.

The patient presented with a draining sinus in the right neck following right carotid endarterectomy with Dacron patch grafting. She underwent carotid resection with interposition of a greater saphenous vein (non-reversed) graft from the mid common carotid artery to proximal internal carotid artery. Interposition vein graft stenosis developed which required carotid stenting. The patient subsequently developed asymptomatic stent thrombosis. Sinus in the neck healed following interposition vein grafting in 3 weeks.

espanolIntroduccion: la arteria subclavia aberrante es la anomalia mas comun del arco aortico, aunque la clinica de disfagia lusoria aparece tan solo en el 0,5-2 % de los pacientes. No existe ningun consenso sobre su tratamiento. Caso clinico: se presenta el caso de una paciente de 86 anos con clinica de disfonia y disfagia de 1,5-2 anos de evolucion que asocia una perdida de peso de 10 kg en los ultimos 6 meses. En el escaner realizado durante el estudio se encuentra una arteria subclavia aberrante no dilatada que comprime el esofago a su paso retrocardial. Ademas, la paciente presentaba una estenosis del 60 % de la arteria carotida ipsilateral que le habia ocasionado un ictus 5 meses antes. Se realiza un bypass carotido-subclavio derecho con protesis PTFE de 6 mm y en la misma intervencion, tras el procedimiento anterior, se realiza una endarterectomia carotidea derecha y angioplastia quirurgica. El posoperatorio transcurrio sin complicaciones. La paciente se mantuvo asintomatica, sin eventos neurologicos; tampoco disfagia ni disfonia. Pudo retomar la ingesta normal de alimentos. En el CT de control a los 10 dias se observo la arteria subclavia derecha trombosada sin compresion residual, por lo que no se considero necesaria la exclusion de su origen con una endoprotesis toracica. Discusion: aunque en un primer momento se considero la posibilidad de realizar un tratamiento en dos tiempos (cirugia abierta y, posteriormente, endovascular toracico), el tratamiento quirurgico combinado permitio tratar la disfagia lusoria, asi como la estenosis carotidea sintomatica ipsilateral, durante la misma intervencion para no tener que someter a una paciente mayor a una cirugia excepcionalmente larga, ademas de omitir el uso de una endoprotesis toracica complementaria que finalmente no fue necesaria. EnglishIntroduction: the aberrant subclavian artery is the most common variation of the aortic arch but symptoms of dysphagia lusoria appear only in 0,5-2 % of the patients. There is no consensus on its treatment. Case report: we hereby present the case of an 86 year-old woman who had suffered dysphonia and dysphagia for 1.5-2 years associating a loss of 10 kg of weight in the last 6 months. An angioCT scan revealed a non-dilated aberrant right subclavian artery which compressed of the retrocardial esophagus, and a 60 % stenosis of the right carotid artery, which had caused an ipsilateral minor stroke 5 months before. We performed a right carotid-subclavian bypass using a 6 mm ePTFE graft, followed by a right carotid endarterectomy and Dacron patch angioplasty in the same procedure. The postoperative period was uneventful, the patient remained asymptomatic, with no neurological symptoms, dysphagia or dysphonia, and resumed normal oral intake. Ten days after the procedure the control CT revealed a thrombosed right subclavian artery with no residual esophageal compression, so an additional endovascular occlusion of the subclavian origin was deemed unnecessary. Discussion: although we first considered the possibility of performing a sequential hybrid treatment, with initial surgical bypass and secondary thoracic endovascular grafting, the combined open surgical technique allowed us to solve both the dysphagia lusoria and the symptomatic right carotid stenosis in one single procedure, and the complementary thoracic endografting was ultimately unnecessary.

We report five male patients aged 3, 6, 8, 10, and 15 years, respectively, undergoing left bidirectional cavopulmonary connection and concomitant Dacron patch closure of the atrial septal defect for Raghib’s defect with persistent left superior vena cava. The circulation was successfully corrected. This extracardiac procedure uses only autogenous tissues having growth potential, reduces myocardial ischemia, and avoids later baffle deterioration with pulmonary venous obstruction associated with intra-atrial baffling procedures. A wider appreciation and application of this management modality is warranted.

Congenital left ventricular diverticulum is an extremely rare heart defect. Here, we report a case of successful endoventriculoplasty using a Dacron patch in an infant who was followed up for one year.

We performed Dacron patch closure of ventricular septal defect with concomitant aortic valve replacement using a St. Jude Medical mechanical aortic prosthesis for a patient with ventricular septal defect and severely deformed and irreparable aortic valve. We highlight the technical details of the procedure to prevent paravalvular aortic leakage and residual ventricular septal defect.

A 49-year-old woman underwent Dacron patch aortoplasty for coarctation of the aorta (CoAo) at 5 years of age. She was under antihypertensive treatment and had a 20-mm Hg right arm-leg gradient in the last clinical visit. Electrocardiogram was normal and transthoracic echocardiography showed a

Porcelain aorta is extensive calcification of the ascending aorta that can be completely or near completely circumferential. Here we report a case of severe aortic stenosis and left anterior descending coronary osteal stenosis in a patient with a porcelain aorta. In this paper an alternative aortotomy approach; reverse “T” letter aortotomy incision is described for Type IB porcelain aorta. Patient underwent aortic valve replacement in addition coronary bypass grafting via sternotomy. The surgery and the postoperative course were uneventful and she was discharged at 7th day. This aortotomy technique prevents unnecessary and risky manipulations of extensive calcificated porcelain aorta, provides perfect exposure, and can be closed securely via dacron patch after aortic valve surgery. By the help of the described aortotomy technique, AVR can be the preferred choice in patients with porcelain aorta and multiple cardiac comorbidities requiring additional procedures, such as coronary bypass. Key words: Porcelain aorta, Aortic stenosis, Aortotomy.

In postinfarction left ventricular aneurysm, abnormal geometry and desynchronized wall motion may cause a highly inefficient pump function. The traditional endoventricular patch plasty according to the Dor technique might result in a truncated and restrictive left ventricular cavity in small adults. We report a modified technique of left ventricular anteroapical aneurysm repair by using a semispherical reshaping patch to restore the left ventricular geometry.

Isolated Partial Anomalous Pulmonary Venous Connection is a rare congenital defect that may not clinically manifest until adulthood. It can be misdiagnosed as a secundum type atrial septal defect by an echo cardiographer too. We present a 9 year-old girl who presented to us with complaints of occasional exertional fatigue. An ejection systolic murmur was heard in the 2 rd inter-costal space at left parasternal area. The cardiothoracic ratio was normal in routine chest X-ray with an anomalous vessel adjacent to the left pulmonary hilum. Echocardiography revealed an ostium secondum type of atrial septal defect of 18x10 mm in size with absence of inferior limb. She was taken up for surgery for closure of atrial septal defect. Intraoperatively, it was found that the atrial septum was intact but the right inferior pulmonary vein was draining to the right atrium. Surgically the defect was corrected by resecting part of atrial septum and tunneling the right inferior pulmonary vein to left atrium with a Dacron patch. The postoperative outcome was

The key elements in the 2-patch method of repair of complete atrioventricular defects include: (1) closure of the ventricular defects using a Dacron patch, (2) closure of the primum atrial defect using an autologous pericardial patch, and (3) securely partitioning the atrioventricular valves into competent left and right components. With limited exceptions, there is sufficient conservation of morphological features of the atrial and ventricular defects as well as that of the atrioventricular valves to allow standardization of the key elements of the surgical repair.

Infected carotid patches are rare. We present a gentleman who had an elective carotid endarterectomy with Dacron patch closure for symptomatic carotid stenosis under regional anesthesia, and he presented 1 month later with a discharging sinus at the lower aspect of the neck wound. Computed tomography scan showed a rim-enhancing collection next to the carotid bifurcation. He subsequently underwent patch excision and repair with autologous saphenous vein graft, with good recovery. Of significance was that he had a dental extraction for a loose tooth 1 day before the index operation as advised by the anesthetist. Streptococcus viridans species, which are part of the normal flora of oral cavity, were isolated from the tissue culture. This is the first case in the world's literature of a patient who had S. viridans carotid patch infection that may be related to his preoperative tooth extraction.

An 81-year-old man presented with fever and weight loss 5 years after coronary artery bypass surgery and open repair of a ventricular septal defect (VSD) with a Dacron patch following an anterior myocardial infarction. He had remained under clinical and echocardiographic surveillance with moderate

It has been reported that 0.5 e 1% of patients undergoing carotid endarterectomy (CEA) with a prosthetic patch arteriotomy closure will develop patch infection, two thirds of them occurring after 6 months have passed, with occa- sionally chronic sinus discharge and false aneurysm forma- tion, as described by Alawi et al.

Left ventricular pseudoaneurysm is a rare, but lifethreatening complication occurring after acute myocardial infarction. Early diagnosis and surgery are critical for the patients’ recovery. An 80-year-old man was admitted to hospital with severe dyspnea. Coronary angiography and ventriculography showed a giant left ventricular pseudoaneurysm. Surgical approach to pseudoaneurysm was made through the mitral valve and directly from the aneurysmal sac. Defect was closed by Dacron patch. Postoperative period was uneventful and patient was discharged from hospital seven days after surgery.

We present a rare case of endocartitis on the patch in the left ventricular outflow, in a 42 year-old man patient that had undergone surgical correction of tetralogy of Fallot and definitive closure with Dacron patch of a ventricular septal defect and, after 21 years, aortic valve replacement with mechanical valve, for the presence of severe aortic regurgitation, Blood cultures demonstrated the presence of methicillin-resistant Staphylococcus aureus and transesophageal echocardiography demonstrated on the LV face of the previous Dacron patch the presence of pathological vegetation, with complete resolution after Daptomycin.

Objectives: The aim of this study was to evaluate real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) in the assessment of mitral paravalvular leakage curtaining surgery with a Dacron patch. Methods: RT-3D TEE was used before and after the operation. Results: Repairing a mitral paravalvular leak with Dacron patch curtaining was a useful, simple and new technique with promising feasibility and durability. Conclusions: In selected patients in whom the mitral paravalvular defect is relatively large, and may thus not be suitable for closing with primary suture, Dacron patch curtaining may be feasible for repair guided with RT-3D TEE; both are described for the first time.

We describe a case of successful treatment of mycotic pseudoaneurysm of the transverse aortic arch in a male infant. The aneurysm was resected and the defect was repaired using a patch made from a rifampicin-impregnated Dacron graft.

Our report encompasses two cases of Dacron patch infection following carotid endarterectomy and a systematic review of the literature. Particular attention is placed on the incidence, aetiology, investigation, presentation and management dilemmas of this rare complication of carotid surgery. We present all known cases of synthetic patch infection following carotid endarterectomy over the last 12 years. 14 publications have been identified totalling 77 cases of graft infection. Approximately 0.25–0.5% of all Dacron patches appear to get infected. Infection may present early or late and appears to have a bi-modal distribution depending on the presence of low- or high-grade infection. Post-operative complications especially wound haematoma is associated with the later development of infection. Most patients present with pseudoaneurysm formation, neck swelling or a draining local sinus and are infected with either Staphylococcus epidermidis or Staphylococcus aureus. Duplex ultrasound is the investigation of choice and complete excision of all infected material and arterial reconstruction with a vein patch or graft is recommended.Dacron patch infection is a rare but recognised complication of carotid surgery and knowledge of this condition is vital for vascular surgeons and other speciality surgeons to whom cases may present.

Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication.

Congenital left ventricular aneurysm is rare, poorly understood and potentially lethal. It usually occurs in isolation. Its combination with mitral insufficiency is an uncommon entity. Because the literature on this kind of aneurysms consists of case reports and small series described especially in children, we report here an interesting and unique case of an adult aged 35 years bearing simultaneously a congenital left ventricular aneurysm and mitral insufficiency. Without medical past history, he consults for palpitations and dyspnoea. Once diagnosis was made by chest X-ray, echocardiography and computed tomography, an open heart surgery was necessary to prevent complications. Through a transmitral approach, aneurysmal exclusion was performed by closing the aneurysmal collar with a Dacron patch and mitral replacement was accomplished. At 12 months, follow-up was favourable without residual communication between aneurysm and ventricle or paraprosthetic leak.

One year old patient followed with tetralogy of fallot (TOF) was admitted to our service for surgical repair. Ventricular septal defect (VSD) was repaired with a Dacron patch. The infundibular muscle was resected to allow for unobstructed flow of blood to the pulmonary valve and the area above the pulmonary valve was opened with a polytetrafluoroethylene (PTFE) patch. The patient was intubated three times bacause of the atelectasis ocurred in the lungs after the surgery. Atelectasis was treated with nebulised dornase alpha. It avoided the recurrence of atelectasis and the patient was discharged.

We describe a 37-year-old who presented with hemoptysis. Twenty-one years previously he had undergone Dacron patch aortoplasty for coarctation. Initial investigations failed to reveal the cause of the hemoptysis. Cardiovascular magnetic resonance (CMR) demonstrated an aneurysm at the site of the repair. He underwent successful repair of the aneurysm with a Gelseal interpositional graft.

Congenital absence of the pericardium is a rare condition. Diagnosis and management of this condition remain a dilemma for clinicians. Here, we report a case of 15-year-old boy who had complaint of palpitation. Considering the echocardiographic features, pericardial agenesis associated with atrial septal defect (ASD) was suspected and multimodality imaging was performed for subsequent confirmation. Mal-aligned septum leads to failure in ASD device closure; therefore, the defect was repaired surgically by using a Dacron patch. Physicians need to be aware of this disorder and its associated congenital abnormalities, to enable them to make a correct diagnosis and treatment plan.

A 50-year-old woman presented with fever, cough, shortness of breath, and left-sided chest pain. Computed tomography with contrast showed a pseudoaneurysm occupying the upper half of the left hemithorax. Surgical repair with a Dacron patch was performed after considering the risk of pseudoaneurysmal rupture.

An 8-year-old boy who had undergone Dacron patch closure of a ventricular septal defect 5 years earlier, was admitted with relapsing methicillin-resistant Staphylococcus aureus infective endocarditis and lung abscesses. Echocardiography indicated vegetation attached to the tricuspid valve and the Dacron patch. The infected patch was replaced with glutaraldehyde-treated autologous pericardium. He was discharged uneventfully and has been well for 4 years, without signs of infection.

Background: Vascular surgery, like the various other surgical specialities, has seen an increasing demand toward faster and more minimally invasive procedures. One such need is to create a reliable vascular anastomosis that is faster, easier and less damaging to the tissue. The vascular closure staples (VCS*) device provides such characteristics but, to date, no studies have investigated its effectiveness in reducing intimal hyperplasia when used for vascular prosthesis implantation. The present study evaluated its effectiveness compared with suturing of a graft in vascular prosthesis implantation. Methods: Twelve female Merino sheep underwent gelatin sealed Dacron patch graft implantation into the left and right common carotid artery. Grafts were randomly allocated so that one carotid artery and graft was anastomosed using sutures and the other with VCS*. The two techniques were compared for operation time, clip/suture numbers and blood loss during the implantation procedure. After a 4-week period, the sheep were killed and the grafts were harvested for intimal hyperplasia (IH) assessment. Results: There was a significant reduction in the amount of IH seen in the VCS* group (mean ± SD: 0.278 ± 0.079 mm2/mm) when compared with the sutured group (0.575 ± 0.331 mm2/mm) (P