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Abstracts - Interactive CardioVascular and Thoracic Surgery

Abstracts - Interactive CardioVascular and Thoracic Surgery

Abstracts - Interactive CardioVascular and Thoracic

Monday 17 September 2007 07:30–08:30 Film Session 1 F1 FLOW-SENSITIVE 4D MAGNETIC RESONANCE IMAGING: PATHOLOGICAL BLOOD FLOW PATTERNS IN ASCENDING AORTIC ANEURYSMS E. Weigang 1 , F. Kari 1 , M. Luehr 1 , J. Kobba 1 , A. Frydrychowicz 2 , M. Markl 2 , C. Heilmann 1 , F. Beyersdorf 1 1 University Cardiovascular Centre, Freiburg, Bad Krozingen, Germany; 2 University Medical Centre, Freiburg, Germany Objectives: Aortic aneurysms are characterized by pathological blood flow patterns. However, these changes are poorly understood. We therefore analysed local blood flow in aneurysms of the ascending aorta using flowsensitive 4D-MRT. Methods: Data were acquired on a 3 Tesla-MRT with a 4D (time-resolved 3D) sequence protocol (ECG-gating, respiration control). Flow was visualised as 3D-streamlines and 3D-particle traces using the software EnSight. Healthy volunteers and six patients with ascending aortic aneurysms were investigated. Results: Healthy individuals presented a right-handed helix extending into the proximal arch (1.5 revolutions) and vortical flow in the sinuses. Two patients with atherosclerotic aneurysms had either increased right-handed helical flow (3.5 revolutions) with flow acceleration along the great curvature, or multiple vortical flows in the sinuses and middle of the ascending aorta, respectively. One typical Marfan-associated aneurysm exhibited increased vortical flow in the dilated sinuses. One aneurysm of the proximal anastomosis of a supracoronary replacement showed extensive vortex formation inside the aneurysm’s lumen. An aneurysm in one patient with a bicuspid aortic valve revealed a major vortex formation directly above the valve with unusual spatial and directional orientation. An aneurysm following congenital valvular stenosis and commissurotomy in childhood was characterised by a vortex along the small curvature and helical diastolic backflow in the central ascending aorta. Conclusions: Six patients with similar pathomorphology presented considerable differences in local flow patterns in the ascending aorta compared to healthy volunteers and among themselves. Insight into the role of flow may contribute to predicting the individual course of ascending aortic aneurysms. F2 EX-VIVO 2 CHAMBER WORKING PIG HEART-LUNG MODEL A. de Weger 1 , J. de Hart 2 , M. Stijnen 2 , S. van Tuijl 2 , R.A.E. Dion 1 1 Leids Universitair Medisch Centrum, Leiden, The Netherlands; 2 HemoLab Cardiovascular Engineering, Eindhoven, The Netherlands Objectives: The isolated heart model provides a multifunctional test platform in which function and physiology can be studied. In order to achieve satisfactory pre- and after load of the left and right side of the heart respectively we created an ex-vivo working heart-lung model. Methods: Porcine heart and lungs are isolated from slaughterhouse pigs following a special, authorized protocol. The protocol takes into account that no additional suffering to the animal takes place and that the quality of heart and lungs are preserved. The heart is arrested with cardioplegia and the lung circulation flushed with ringer-heparin solution. The heartlung is prepared so that it can be mounted to the test platform. The heart is resuscitated and working in Langendorff mode and the lungs ventilated. After achieving good right venricular function the membrane oxygenation in the Langendorff circulation is being switched off so that the oxygenation is fully depending on the ventilation of the lungs. Abstracts/Interactive CardioVascular and Thoracic Surgery S223 Interactive CardioVascular and Thoracic Surgery Abstracts Results: We were able to achieve and maintain an ex-vivo working 2- chamber heart-lung model for at least 3 h with good right ventricular function and sufficient oxygenation by the lungs. Conclusions: After successfully achieving a four chamber working heartmodel with the ability to visualize all heart valves this is the first step in achieving a fully working ex-vivo four-chamber heart-lung model test platform. F3 PERFORMING A COMPLETE LESION SET WITH BIPOLAR RADIOFREQUENCY: CAN THE MITRAL ANNULUS BE CLAMPED ACROSS? S. Benussi, A. Fumero, S. Nascimbene, E. Dorigo, V. Zerbi, A. Galanti, M. Cioni, O. Alfieri Division of Cardiac Surgery, S Raffaele Hospital, Milan, Italy Objectives: Despite its efficacy and swiftness, bipolar radiofrequency is generally not used on the left isthmus for concern of injuring a coronary branch. Incomplete lesion sets or use of an additional unipolar device are often considered. We report a technique to perform a full left lesion set involving the mitral line using a standard bipolar radiofrequency device. Methods: Coronary angiogram is carefully pondered. After beating-heart pulmonary vein isolation on-pump, coronary anatomy is inspected to identify the coronary-free area of the A-V groove. An hypodermic needle is stuck in the middle of such area, into the left atrial wall, behind the coronary sinus. The projection of the needle marker on the mitral annulus is then identified through the atriotomy. The needle is removed. An ablation is performed clamping the bipolar device endo-epicardially on the atrial wall, involving the A-V groove, the coronary sinus, and the annulus. The lesion set is then completed by connecting the encirclings and the left appendage, which is then sutured. Results: Since May 2005, 65 mitral patients with atrial fibrillation had the described ablation. Haematoma of the A-V groove was observed during retrograde cardioplegia in one case. All patients survived. No patient had myocardial ischaemia or re-exploration for bleeding (median 310 cc, 240; 400 cc). At nine months (5; 13 months), 55/65 patients (85%) were free from atrial fibrillation. No patient had left flutter. Conclusions: The mitral line can be safely performed with bipolar radio - f requency in all patients. A transmural, complete lesion set performed with a single device yields excellent early results. F4 USE OF MULTIBRANCHED GRAFT FOR THE REOPERATIVE REPLACEMENT OF EXTENSIVE THORACOABDOMINAL AORTIC ANEURYSMS H. Posacioglu, A. Apaydin, C. Engin, F. Ayik, P. Oztürk, B. Eygi Ege University Medical Faculty, Department of Cardiovascular Surgery, Izmir, Turkey Objectives: Problems in the distal aorta after proximal aortic operation in young patients with Marfan syndrome affects the long-term outcome. Progressive dilatation of the aorta as well as development of aneursyms from the Carrel patches after repair of thoracoabdominal aortic aneurysms (TAAA) are major concerns. Replacement with commercially available multibranched grafts may be a solution. We present a case of Marfan syndrome who underwent replacement of extensive TAAA by using a multi-branched graft. Operation and perfusion techniques were shown in this video presentation. Methods: A 25-year-old man with Marfan syndrome was admitted to our clinic due to progressive enlargement of his thoracoabdominal aorta detected in follow-up CT scans. He underwent Bentall operation and replacement of the proximal descending aorta after development of acute type III dissection, 8 and 3 years ago, respectively. Thoracoabdominal incision with retroperitoneal approach was used for aortic exposure. Operation was performed under Monday A.M. Abstracts F1—F5, 001—027

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