Background— aortic regurgitation in a bicuspid aortic valve is a complex entity that involves not only the semilunar valve but also the structure of the aortic root which is functionally & pathologically in a very close relationship to it. Considering repairing a bicuspid valve mandates a mindful involvement of all related structures concurrently. Here We report an interested case of both bicuspid aortic valve and mitral valve regurgitation in a patient with history of infective endocarditis, that was successfully managed by double valves repair.

A document by Jordan Llerena-Velastegui. Click on the document to view its contents.

A document by Sebastian Velasteguí. Click on the document to view its contents.

Clinical assessment or scoring model for acute lung injury: a crossing path?

Background. Current temporary transvenous pacemaker catheters lack sequential atrioventricular (AV) pacing in synchrony. Therefore, a catheter that could provide sequential AV pacing and maintain synchrony may be useful for patients in sinus rhythm who need temporary pacing.  Objective. The purpose of this study was to describe the first in human experience with a novel temporary AV sequential pacing catheter (TAVSP). Methods. We prospectively identified eligible patients undergoing elective cardiac catheterization in whom the TAVSP catheter was delivered and used for temporary AV sequential pacing. Safety endpoints and device performance data were obtained. Results. Ten subjects were screened and enrolled in the study. TAVSP was delivered in all ten subjects, and AV sequential synchronous pacing was successfully obtained. The pacing catheter achieved an excellent pacing threshold and impedance in all ten patients except for one. There were no adverse events during the pacing procedure. Conclusion. Temporary AV sequential pacing using TAVSP catheter is safe and feasible and may be an alternative to conventional temporary pacing catheters to maintain AV synchrony during temporary pacing.

Objective: The aim of the study is to assess the therapeutic effect and applicability of pectoralis major muscle turnover flap reconstruction for treatment of deep sternal wound infection after cardiac surgery in infants and children. Methods: From march 2013 to october 2021, 23 patients with deep sternal wound infection after cardiac surgery underwent pectoralis major muscle turnover flap reconstruction.The data and outcomes of the patients were retrospectively analyzed. Results: 20 patients were treated with unilateral pectoralis major muscle turnover flap reconstruction,3 patients were treated by bilateral pectoralis major muscle turnover flap. All of the sternal wounds healed successfully. All patients survived and were discharged without evidence of infection. In a follow-up period, ranging from 15 to 83 months (mean 32.6 months), all patients demonstrated normal development with no limitations to limb movements. There were no signs of chronic sternal infection in all of them. Conclusion:Pectoralis major muscle turnover flap reconstruction is a simple,feasible and effective treatment of deep sternal wound infection after cardiac surgery in infants and children,with minimal developmental problems.

This is a commentary on a single-institution retrospective review that describes the short-term outcomes of the pediatric patients who underwent re-operative surgery for residual or recurrent coarctation after a previous coarctation repair. There were 51 patients over 12 years.

“Letter to the Editor: Emergency surgical treatment of total anomalous pulmonary venous connection”Dr Muhammad SohaibaaDepartment of Medicine, Allama Iqbal Medical College, Lahore, PakistanDr Arsalan NadeemabDepartment of Medicine, Allama Iqbal Medical College, Lahore, Pakistan

As growth of the elderly population continues to increase alongside improvements in percutaneous and minimally invasive interventions, cardiac surgeons question the role of high-risk surgery in treating these patients. TAVR has transformed the management of symptomatic severe aortic stenosis in elderly patients, and has become standard therapy for patients greater than 80 years of age. With improvements in procedural risks and technical complications for both transcatheter valves and percutaneous interventions, should we rethink the operative strategies for octogenarians and nonagenarians, particularly as they apply to concurrent high-risk operations?

The incidence of stroke after coronary artery bypass grafting (CABG) is around 1.3% in the Society of Thoracic Surgeons database but carries a mortality of almost 20% (1,2). The stroke rate is even higher with aortic valve replacements with the Determining Neurologic Outcomes from Valve Operations (DeNOVO) study reporting stroke rates as high as 17% (3). It is also likely that variations in definition of stroke leads to underreporting of this event. There is thus, no denying that stroke remains the Achilles heel of cardiac surgery and efforts must be made to mitigate its occurrence.

TITLE PAGETOPIC : “Letter to the Editor: Surgical Treatment of Primary Cardiac Tumors in the Contemporary era: A single-centre Analysis.”ARTICLE TYPE : LETTER TO THE EDITORCORRESPONDANCE :1. Name : Taha NadeemInstitute : ALLAMA IQBAL MEDICAL COLLEGE,LAHORE,PAKISTANContact : +923107033138 E-mail : Tahamodellian786@gmail.comAddress : House# 451, Jinnah Colony, Faisalabad,PakistanCO-AUTHORS: 2. Name : Fatima TanveerInstitute : ALLAMA IQBAL MEDICAL COLLEGE, LAHORE, PAKISTAN.Contact : +923468789469 E-mail : Fatimatanveer990@gmail.comAddress : House#101,Street 10,Block C, Canal Town, Gujranwala ,Pakistan.3. Mahima KhatriContact: +923472651872 Email: mahimakhatri12333@gmail.comInstitute: Dow University of Health Sciences, KarachiAddress: bridge view apartment, frere town, clifton block 8 karachi, 75600Word count: 442Conflict of interest: NoneDeclaration: NoneAcknowledgment: None

A document by Bilawal Nadeem. Click on the document to view its contents.

Title pageTitle: Letter to the Editor: Aortic valve repair in patients with ventricular septal defectArticle type: Letter to the editorDeepak RajaniContact: +923350326757 Email: rajanideepak0@gmail.comInstitution: Shaheed Mohtarma Benazir Bhutto Medical College Liyari,KarachiAddress: Maira garden,Garden west, KarachiCo-author: Zoaib Habib TharwaniContact: +923343975434 Email: zoaibhabib@hotmail.comInstitution: Dow University of health Sciences (DUHS), Dow Medical College, KarachiAddress: Al-Yasrab, Garden East, KarachiSatesh KumarContact:+92-3325252902 Email: Kewlanisatish@gmail.comInstitution: Shaheed Mohtarma Benazir Bhutto Medical College Liyari,KarachiAddress: Parsa citi near police headquarter Garden East Karachi

Tricuspid annuloplasty for moderate to severe TR (Class I, IIb) is the current standard of practice to restore the normal tricuspid annular dimension and function (1,2). The current controversy in atrioventricular surgery concerns the indication for concomitant TA in patients with moderate TR and significant annular dilatation of at least > 40 mm or at least 21 mm/m2 indexed for body surface area (Class IIb) during mitral valve surgery proposed by the American Heart Association/American College of Cardiology and European Society of Cardiology (1,2,3)

There is an increasing use of left ventricular assist devices (LVADs) as bridge to transplantation or permanent destination therapy in the heart failure patient population. Infection remains a common complication in LVADs, with Gram-positive skin flora as predominant pathogens implicated, including Staphylococcus aureus. While there is emerging evidence for synergistic antibiotic combinations with methicillin resistant Staphylococcus aureus, there remains a significant gap in the literature for persistent methicillin susceptible Staphylococcus aureus (MSSA) bacteremia. In this article, we describe the first successful treatment of persistent LVAD-related bacteremia with salvage oxacillin plus ertapenem. The salvage therapy described here must be balanced by the risks for toxicity, impact on resistance, microbiota disruption, drug shortages, and patient costs. This combination warrants further evaluation in the clinical setting to better establish its role in our expanding patient population.

A document by Aashish Kumar. Click on the document to view its contents.

Unicuspid aortic valves are rare congenital malformations. Surgical repair is feasible in aortic regurgitation, and in some cases of aortic stenosis. The standard surgical approach is a bicuspidization and symmetrization with pericardial patch augmentation of valve cusps. Herein, we are describing our original technique for bicuspidization of a unicuspid aortic valve without cusp patch augmentation. We also address the surgical management of a commissural diastasis.

The use of sutureless valves in infective endocarditis has been previously reported. Singh et al have reported a single-center successful surgical treated pulmonary endocarditis in 2 cases with a sutureless bioprosthesis.