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Valve
Aortic Valve Repair: A Portable, Low-Cost Simulator
Simulation is a key adjunct to surgical training by allowing repetitive and deliberate practice. We created a low-cost, portable aortic valve simulator that can easily be re-created by any trainee. This simulator allows practice of the challenging hand movements and needle angles required in aortic valve repair and may facilitate acquisition of operating room skills and autonomy.Successful Mitral and Tricuspid Valve Repair for Dextrocardia With Situs Inversus Totalis
Dextrocardia with situs inversus is a rare congenital anomaly characterized by a right-sided heart apex and inversely rotated abdominal viscera. It is often autosomal recessive and involves 1 child in every 10,000 births. We report a case of dextrocardia with situs inversus totalis in a patient who underwent mitral valve repair through an extended transseptal approach for clinically relevant mitral regurgitation secondary to Barlow disease. The operation was successfully performed without complications, and the postoperative course was uneventful.Robot-Assisted Removal of a Recurrent Left Ventricular Myxoma
Ventricular myxomas are rare compared with atrial myxomas. Unlike with atrial myxomas, it is usually challenging to visualize a ventricular mass because of the complex structures in the left ventricle. We report the case of a 44-year-old woman who had a recurrent left ventricular myxoma 8 years after the initial surgical removal. We successfully performed reoperative tumor resection with a robot-assisted approach through the mitral valve. The robot-assisted approach was extremely effective for visualization of the tumor and precise instrumentation without injuring the surrounding structures.Challenging Case of Marantic Tricuspid Endocarditis Treated With Percutaneous Vegetation Debulking
Marantic endocarditis is a rare entity often diagnosed in the setting of advanced malignant disease. We present the case of a 66-year-old man with stage IVb non–small cell lung cancer, with large tricuspid and small aortic valve vegetations. A multidisciplinary team determined the patient to be a poor surgical candidate, but given the likelihood of pulmonary and systemic embolization, an intervention was required. We proposed AngioVac-assisted vegetation debulking of the tricuspid valve to be the best approach in consideration of the small aortic valve vegetation and lung cancer.Strutting Through: Migration of Fractured Inferior Vena Cava Filter Through the Right Ventricle
A 68-year-old woman who had a retrievable inferior vena cava filter implanted 10 years ago presented with sudden-onset back pain. Initial computed tomography angiography demonstrated migration of a fractured strut that appeared embedded in the anterior right ventricular free wall without pericardial effusion. Subsequent gated computed tomography of the chest demonstrated further migration of the fragment, which was now penetrating the right ventricular free wall and extending into the pericardial sac.Physical Simulation of Transcatheter Edge-to-Edge Repair Using Image-Derived 3D Printed Heart Models
Transcatheter edge-to-edge valve repair (TEER) is a complex procedure requiring delivery and alignment of the device to the target valve, which can be challenging in atypical or surgically palliated anatomy. We demonstrate application of virtual and physical simulation to plan optimal TEER access and catheter path in normal and congenitally abnormal cardiac anatomy.Off-Pump Methacrylate Cement Pulmonary Embolectomy
Methacrylate is polymer used as a bone cement in orthopedic procedures that can rarely embolize, resulting in atrial perforation and pulmonary artery occlusion. Retrieval of emboli typically requires cardiopulmonary bypass and deep hypothermic circulatory arrest. In this report, we describe the off-pump removal of a massive left pulmonary artery methacrylate embolus using surface ultrasound localization, partial cross-clamping of the main pulmonary artery, and snaring of the of the left pulmonary venous return.Complete Excision of Mitral Annular Calcification Can Be Achieved With a Low Mortality Risk
Mitral annular calcification (MAC) in mitral valve surgery constitutes a major challenge. Debridement with patch reconstruction of the mitral annulus facilitates valve repair or replacement, however, there is a perception that this procedure may elevate operative risk. This study sought to review a single-center experience with mitral annular debridement and patch reconstruction in patients with MAC.
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