Surgical Management of Primary Pulmonary Artery Sarcoma

Background Post-infarction left ventricular (LV) pseudoaneurysm is a rare mechanical complication of myocardial infarction that carries a substantial risk of sudden rupture. The purpose of this study was to compare the surgical results of post-infarction LV pseudoaneurysm with those of conservative treatment. Methods From 2016 to 2021, 22 patients were hospitalized for LV pseudoaneurysm, including 17 cases (77.3%) caused by myocardial infarction. Of the 17 patients, 10 (58.8%) underwent surgical repair, while seven (41.2%) were treated medically. The clinical course, echocardiograph data, and surgical outcomes were analyzed. Survival rates of the surgical and conservative groups were compared. Results There were no perioperative deaths. Intra-aortic balloon pumping support was required in two (20%) patients. No follow-up mortality was observed in the surgical group and at the last follow-up, all the patients were classified as New York Heart Association class I–II. In the conservative group, there was one (14.3%) hospital death and two (28.6%) additional deaths during follow-up. A significant difference was found in survival between the two groups (P = 0.024). Conclusions Surgical repair of post-infarction LV pseudoaneurysm can be performed with good results, while conservative treatment carries a significant risk of sudden death. Surgical repair is indicated for every patient diagnosed, even those with a small pseudoaneurysm without symptoms.

/pdf/surgical-and-conservative-treatment-of-post-infarction-left-2rlkh854.pdf

Surgical and Conservative Treatment of Post-infarction Left Ventricular Pseudoaneurysm

Abstract Background Pulmonary artery sarcoma (PAS) is an extremely rare tumour, preferably treated by surgery. However, the surgical management remains largely debatable, as only less than half of patients with PAS can undergo thorough excision. Case summary A 32-year-old man with a tumour involving the right ventricle outflow tract, pulmonary trunk extending into the bifurcation, and right pulmonary arteries underwent complete resection using a homologous pulmonary valve and vascular grafts for reconstruction, combined with right pulmonary endarterectomy (PEA) for potential seeding metastasis. Histopathological examination demonstrated undifferentiated pleomorphic sarcoma with surgical margins free of disease. The patient remains asymptomatic, and follow-up computed tomography 5 months after surgery indicated no recurrence or metastasis. Discussion Radical resection of a PAS with reconstruction using pulmonary valve allograft and polytetrafluoroethylene vascular grafts is technically feasible and successful. Additionally, PEA may eliminate the potential intima implantation metastasis.

/pdf/complete-resection-of-a-pulmonary-artery-sarcoma-involving-2qvlhrwi.pdf

Complete resection of a pulmonary artery sarcoma involving the pulmonary valve and right ventricle outflow tract: a case report

Objective The objective of this study was to compare outcomes of re-repair with those of mitral valve replacement (MVR) for failed initial mitral valve repair (MVr). Methods We searched the Pubmed, Embase, and Cochrane Library databases for studies that compared mitral valve re-repair with MVR for the treatment of failed initial MVr. Data were extracted by two independent investigators and subjected to a meta-analysis. Odds ratio (OR), risk ratio (RR), hazard ratio (HR), ratio difference (RD), mean difference (MD), and 95% confidence interval (CI) were calculated with the Mantel-Haenszel and inverse-variance methods for mode of repair failure, perioperative outcomes, and follow-up outcomes. Results Eight retrospective cohort studies were included, with a total of 938 patients, and mean/median follow-up ranged from 1.8 to 8.9 years. Pooled incidence of technical failure was 41% (RD: 0.41; 95% CI: 0.32 to 0.5; P = 0.00; I2 = 86%; 6 studies, 846 patients). Pooled mitral valve re-repair rate was 36% (RD: 0.36; 95% CI: 0.26–0.46; P = 0; I2 = 91%; 8 studies, 938 patients). Pooled data showed significantly lower perioperative mortality (RR: 0.22; 95% CI: 07 to 0.66; I2 = 0%; P = 0.008; 6 studies, 824 patients) and significantly lower long-term mortality (HR:0.42; 95% CI: 0.3 to 0.58; I2 = 0%; P = 0; 7 studies, 903 patients) in the re-repair group compared with MVR. Conclusions Mitral valve re-repair was associated with better immediate and sustained outcomes for failed MVr and should be recommended if technically feasible.

/pdf/re-repair-vs-replacement-for-failed-mitral-valve-repair-a-buzuklly.pdf

Re-repair vs. Replacement for Failed Mitral Valve Repair: A Systemic Review and Meta-Analysis

We evaluate the long-term clinical and echocardiographic outcomes of edge-to-edge (E2E) repair combined with mitral annuloplasty in our institute with degenerative mitral regurgitation (MR) up to 10 years. Twenty-six consecutive patients undergoing E2E mitral repair after failure of other conventional mitral repair technique. There were 16 (61.5%) male and the mean age was 52.2 ± 10.4 years. Mitral regurgitation was due to anterior leaflet prolapse in 12 (46.2%) patients, bileaflet prolapse in 9 (34.6%), and multiple segment posterior leaflet prolapse in 5 (19.2%). There were no perioperative deaths. Follow-up was 100% complete. The mean length of follow-up was 8.7 ± 0.9 years (median 8.4 years, 6.8–10.1 years). Two patients required reoperation of the MV. The freedom from reoperation and ≥ Moderate MR at 10 years was 69.9 ± 11.7%. The freedom from reoperation, ≥ Moderate MR and mitral stenosis (MS) at 10 years was (59.6 ± 10.0) %. The mean transmitral pressure gradient (TMPG) was 6.1 ± 2.5 mmHg, which was significantly elevated compared with preoperative TTE (P = 0.004). The freedom from ≥ Moderate MS at 10 years was 76.9 ± 8.3%. There were no differences between patients with and without MS at follow-up regarding the echocardiographic parameters and clinical status. There is a slowly progressive elevation of TMPG after E2E mitral repair, while mildly elevated TMPG can be tolerated in most patients. In appropriate patients, the E2E repair combined with annuloplasty provides an effective “bailout” choice.

Long-term results of the edge-to-edge repair for failed mitral valve repair as a bailout option

Isolated pulmonary vasculitis (IPV) is a rare, insidious, and localized inflammatory disease affecting the pulmonary arteries, often leading to severe luminal obstruction. The prognosis for patients with occlusive IPV is poor, and there is currently a lack of effective treatments. The objective of this study was to evaluate the performance of pulmonary endarterectomy (PEA) as a treatment for occlusive IPV.This single-center retrospective analysis included patients who received PEA for occlusive IPV between January 2018 and June 2022. Clinical characteristics and hemodynamic parameters were evaluated at baseline and follow-up.Among 114 consecutive patients who underwent PEA, occlusive IPV was identified in 7 patients. Two patients underwent bilateral PEA for the involvement of both pulmonary arteries. Patch angioplasty was performed to treat four severe constrictions. One patient died from residual pulmonary hypertension after limited PEA of a transmural vascular lesion. In addition, no obvious surgical complications were observed. Three months after PEA, a substantial relief in symptoms was achieved. Also, there is a decrease in the mean pulmonary artery pressure (median 33 [20-48] mmHg before versus median 21 [16-26] mmHg after; P < 0.018) and pulmonary arterial resistance (median 234 [131-843] dyn.s.cm-5 versus median 180 [150-372] dyn.s.cm-5; P = 0.310). Three patients experienced a relapse of restenosis of the treated arteries within a 6-month follow-up period, despite daily oral prednisolone administration. They were treated with balloon pulmonary angioplasty of both the main pulmonary arteries and branches.PEA is a valuable choice for treating occlusive IPV, with notable hemodynamic and clinical advantages. To increase long-term vascular patency, complete management should be optimized. 

Pulmonary endarterectomy in patients with occlusive isolated pulmonary vasculitis

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