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Myers PO, del Nido PJ, Marx GR, Emani S, Mayer JE, Pigula FA, Baird CW. Improving Left Ventricular Outflow Tract Obstruction Repair in Common Atrioventricular Canal Defects. Ann Thorac Surg 2012; 94:599-605; discussion 605. [DOI: 10.1016/j.athoracsur.2012.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/30/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
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Myers PO, Geva T, Kozakewich H, Baird CW, Stout KK, del Nido PJ. Recurrent atrioventricular groove intramuscular arteriovenous malformation. Ann Thorac Surg 2012; 94:286-8. [PMID: 22734997 DOI: 10.1016/j.athoracsur.2011.12.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/05/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022]
Abstract
A 17-year-old patient presented with a recurrent right atrioventricular (AV) groove vascular tumor. The tumor was resected en bloc, including the AV groove extending into the right ventricle (RV) and tricuspid valve. The AV groove and tricuspid valve required extensive reconstruction. The histopathologic features were that of an arteriovenous malformation with a proliferative small vessel component--an extremely rare type of cardiovascular anomaly.
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Panos A, Myers PO. Video-assisted cardiac myxoma resection: basket technique for complete and safe removal from the heart. Ann Thorac Surg 2012; 93:e109-10. [PMID: 22450108 DOI: 10.1016/j.athoracsur.2011.11.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 10/13/2011] [Accepted: 11/07/2011] [Indexed: 10/28/2022]
Abstract
Video assistance can replace sternotomy in cardiac operations with excellent results. Because myxomas are very friable tumors, their removal from the heart and chest cavity through a working port in video-assisted or robotic procedures may be challenging. We used a laparoscopic basket to safely catch and remove these friable tumors in 10 patients undergoing video-assisted myxoma resection between December 2008 and June 2011. Complete excision and removal was achieved in all patients. No neurologic, vascular, or wound complications were observed. This minimally invasive myxoma technique gives excellent and reproducible results without a higher risk for the patient.
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Myers PO, Tabata M, Shekar PS, Couper GS, Khalpey ZI, Aranki SF. Extensive endarterectomy and reconstruction of the left anterior descending artery: Early and late outcomes. J Thorac Cardiovasc Surg 2012; 143:1336-40. [DOI: 10.1016/j.jtcvs.2011.08.058] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 08/08/2011] [Accepted: 08/25/2011] [Indexed: 11/25/2022]
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Loubani M, Sadaba JR, Myers PO, Cartwright N, Siepe M, Emmert MY, O'Regan DJ, Krieg P, Sergeant PT. A European training system in cardiothoracic surgery: is it time? Eur J Cardiothorac Surg 2012; 43:352-7. [DOI: 10.1093/ejcts/ezs208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Myers PO, del Nido P, Marx G, Emani S, Pigula F, Mayer J, Fynn-Thompson F, Baird C. ANNULOPLASTY AT ATRIOVENTRICULAR CANAL REPAIR IMPROVES LATE LEFT ATRIOVENTRICULAR VALVE FUNCTION. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60777-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Myers PO, Kalangos A, Panos A. Safety of magnetic resonance imaging in cardiac surgery patients: annuloplasty rings, septal occluders, and transcatheter valves. Ann Thorac Surg 2012; 93:1019; author reply 1019-20. [PMID: 22365008 DOI: 10.1016/j.athoracsur.2011.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 08/25/2011] [Accepted: 10/11/2011] [Indexed: 11/16/2022]
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Myers PO, Kalangos A, Pektok E, Cikirikcioglu M. Biodegradable ring annuloplasty for valve repair in children with endocarditis. J Card Surg 2012; 27:393; author reply 394. [PMID: 22348622 DOI: 10.1111/j.1540-8191.2011.01413.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baird CW, Myers PO, del Nido PJ. Aortic valve reconstruction in the young infants and children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2012; 15:9-19. [PMID: 22424502 DOI: 10.1053/j.pcsu.2012.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Considering the structure and function of the aortic root, changes in the aortic valve leaflets and changes in the geometry of the aortic root are the two primary causes of aortic valve dysfunction. In adults, aortic valve sparing reconstruction has a long history beginning in the 1970s, where tensor fascia was used for leaflet repair in patients with isolated aortic regurgitation and ascending aortic replacement was used in patients with ascending aortic aneurysms or aortic ectasia. Subsequent progress in the 1980s and 1990s led to pericardial leaflet replacement and aortic root re-implantation and remodeling. However, it has not been until the last decade that these concepts and techniques have been applied in younger patients focusing on the conotruncus, valvar apparatus, sino-tubular junction, and ascending aorta.
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Cevasco M, Myers PO, ElBardissi AW, Cohn LH. Foldoplasty: A New and Simplified Technique for Mitral Valve Repair That Produces Excellent Medium-Term Outcomes. Ann Thorac Surg 2011; 92:1634-7; discussion 1637-8. [DOI: 10.1016/j.athoracsur.2011.05.123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/24/2011] [Accepted: 05/31/2011] [Indexed: 10/15/2022]
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Myers PO, Milas F, Panos A. Multimodality imaging in the evaluation of aorta-right atrial tunnel. Eur J Cardiothorac Surg 2011; 40:e153. [PMID: 21733705 DOI: 10.1016/j.ejcts.2011.05.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 05/17/2011] [Accepted: 05/19/2011] [Indexed: 11/28/2022] Open
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Myers PO, Kalangos A. Reply. Ann Thorac Surg 2011. [DOI: 10.1016/j.athoracsur.2010.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cikirikcioglu M, Cherian S, Stimec B, Theologou T, Myers PO, Fasel J, Kalangos A. Morphologic and angiographic analysis to assess the safety of a biodegradable mitral annuloplasty ring. THE JOURNAL OF HEART VALVE DISEASE 2011; 20:199-204. [PMID: 21560823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Although iatrogenic ischemic complications due to occlusion of the circumflex coronary artery following mitral ring annuloplasty are rare, they may be fatal if not recognized and treated promptly. The study aim was to assess the implantation safety of a novel biodegradable intra-annular mitral valvuloplasty ring in ex-vivo cadaveric human hearts. METHODS Ten fresh-frozen human cadaveric hearts were washed, and filled with surgical gauze in order to mimic the heart's anatomic shape and position. Following left atriotomy, the biodegradable annuloplasty ring was implanted using the intra-annular implantation technique. Pre- and post-implantation coronary angiography was used to evaluate the dominance of the coronary circulation, and to assess coronary patency. The coronary arteries and veins were then filled with red and green latex solutions respectively, after which the hearts were fixed in 4% formaldehyde for four weeks. The distances between the annuloplasty ring, the coronary arteries, and coronary sinus were measured through perpendicular cuts at the levels of the anterolateral commissure (L-1), the mid-point of the posterior annulus (L-2), and the posteromedial commissure (L-3). RESULTS Nine hearts had a right coronary artery dominance, and one had a balanced coronary circulation. None of the hearts demonstrated any abnormalities or occlusion of the circumflex coronary arteries after ring implantation. The mean distances between the circumflex coronary arteries and the ring were 7.2 +/- 2.7 mm, 11 +/- 2.4 mm, and 10.7 +/- 3.8 mm at L-1, L-2 and L-3, respectively. The mean distances between the coronary sinus and the ring were 11.8 +/- 3.4 mm, 9.8 +/- 2.3 mm, and 11 +/- 3.7 mm at L-1, L-2 and L-3, respectively. The implantation depth of the ring was 2-3 mm from the endocardial surface. CONCLUSION The present observations suggest that implantation of the intra-annular biodegradable annuloplasty ring is safe, as confirmed by angiography and measurement of the distances between the ring and the adjacent coronary vasculature.
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Myers PO, Aggoun Y, Tissot C. Giant aortic root aneurysm in Marfan syndrome: a rare complication in early childhood. J Thorac Cardiovasc Surg 2010; 141:293-4. [PMID: 21168034 DOI: 10.1016/j.jtcvs.2010.08.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 08/24/2010] [Indexed: 11/19/2022]
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Myers PO, Panos A, Kalangos A. Simplifying robotic mitral valve repair: Minimizing sutures with intra-annular ring implantation. J Thorac Cardiovasc Surg 2010; 140:1441-2; author reply 1442. [DOI: 10.1016/j.jtcvs.2010.05.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 05/14/2010] [Indexed: 11/30/2022]
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Myers PO, Christenson JT, Cikirikcioglu M, Tissot C, Aggoun Y, Kalangos A. Leaflet suspension to the contralateral annulus to address restriction or tethering-induced mitral and tricuspid regurgitation in children: results of a case-control study. J Thorac Cardiovasc Surg 2010; 140:1110-6. [DOI: 10.1016/j.jtcvs.2010.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 07/30/2010] [Accepted: 08/09/2010] [Indexed: 11/28/2022]
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Myers PO, Tissot C, Christenson JT, Cikirikcioglu M, Aggoun Y, Kalangos A. Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: Long-term results and impact of extension material. J Thorac Cardiovasc Surg 2010; 140:836-44. [DOI: 10.1016/j.jtcvs.2010.06.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/22/2010] [Accepted: 06/28/2010] [Indexed: 11/25/2022]
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Myers PO, Khabiri E, Greub G, Kalangos A. Mycoplasma hominis mediastinitis after acute aortic dissection repair. Interact Cardiovasc Thorac Surg 2010; 11:857-8. [PMID: 20826555 DOI: 10.1510/icvts.2010.244608] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of ascending aortic graft infection by an atypical bacteria, Mycoplasma hominis, with mediastinitis, a dreaded complication after cardiac surgery. A 55-year-old patient underwent ascending aorta replacement for acute type A dissection. He developed sternal instability and purulent discharge, requiring sternal wire removal and debridement. Cultures were initially sterile, but showed M. hominis infection after a significant delay and in specific culture media. The patient was treated with doxycycline and moxifloxacine. Cultures became negative and the sternum was closed on the 28th postoperative day after the first debridement. Recovery was favorable, with no signs of infection. Antibiotics were continued for one year. The patient is still asymptomatic 16 months after antibiotic interruption. Atypical organisms should be considered in the differential diagnosis of acute mediastinitis of unknown etiology after routine microbiological investigations.
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Myers PO, Cikirikcioglu M, Aggoun Y, Murith N, Kalangos A. No-Patch Technique for Complete Atrioventricular Canal Repair. Ann Thorac Surg 2010; 90:317-9. [DOI: 10.1016/j.athoracsur.2009.09.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 09/02/2009] [Accepted: 09/10/2009] [Indexed: 11/25/2022]
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Tchantchaleishvili V, Myers PO. Left-handedness--a handicap for training in surgery? JOURNAL OF SURGICAL EDUCATION 2010; 67:233-6. [PMID: 20816359 DOI: 10.1016/j.jsurg.2010.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 05/06/2010] [Accepted: 06/03/2010] [Indexed: 05/21/2023]
Abstract
BACKGROUND Left-handedness was historically considered a disability and a social stigma, and teachers would make efforts to suppress it in their students. Little data are available on the impact of left-handedness on surgical training. This report reviews available data on this subject. METHODS We did systematic electronic and manual literature searches using a predetermined strategy independently by 2 investigators, 1 left- and 1 right-handed, to identify reports on surgical training and left-handedness. RESULTS The review revealed 19 studies on the subject of left-handedness and surgical training. Data were heterogeneous and based mostly on surveys. Left-handedness produced anxiety in residents and their trainers. There was a lack of mentoring on laterality. Surgical instruments, both conventional and laparoscopic, are not adapted to left-handed use and require ambilaterality training from the resident. There is significant pressure to change hand laterality during training. However, left-handedness might present an advantage in operations involving situs inversus or left lower limb operations. CONCLUSIONS Left-handedness is a challenge both for the trainee and the trainer in surgery. Early laterality-related mentoring in medical school and during surgical residency with provision of left-handed instruments might reduce the inconveniences of left-handed surgeons learning.
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Panos A, Myers PO, Kalangos A. Thoracoscopic and robotic tricuspid valve annuloplasty with a biodegradable ring: an initial experience. THE JOURNAL OF HEART VALVE DISEASE 2010; 19:201-205. [PMID: 20369504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Ring annuloplasty is a technically demanding and time-consuming thoracoscopic and/or robotic surgery. The initial experience of the authors with the intra-annular Bioring tricuspid ring using a minimally invasive access is reviewed, and some modifications are proposed to adapt to the particularities of these approaches. METHODS Patients undergoing minimally invasive tricuspid annuloplasty were included prospectively between March and September 2008. The feasibility and ease of implantation were evaluated. A total of 10 patients (six females, four males) was included (eight with functional regurgitation, two with endocarditis). Six patients underwent surgery through a small anterolateral thoracotomy, and the da Vinci S robotic system was used in four cases. RESULTS The mean cardiopulmonary bypass and aortic cross-clamp times were 123 +/- 30 min and 86 +/- 28 min, respectively. Ring implantation was successful in all patients. There was one late death from multiple organ failure. None of the patients required reoperation. At discharge from hospital, seven patients had no or discrete tricuspid regurgitation (TR), and two had moderate TR with no tricuspid stenosis but remained stable during the follow up period. CONCLUSION The biodegradable Bioring offers a simple and quick implantation which is feasible and simplified in minimally invasive approaches.
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Panos A, Milas F, Kalakonas S, Myers PO. Cardiac autotransplantation for aortic and mitral valve replacement in a patient with nephrogenic systemic fibrosis. Hellenic J Cardiol 2010; 51:64-66. [PMID: 20118047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Adequate exposure is a prerequisite for open valve surgery. The mitral valve can rarely be very challenging to expose. We describe a redo double valve replacement in a patient with nephrogenic systemic fibrosis in whom exposure of the mitral valve was achieved with cardiac autotransplantation.
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Myers PO, Beghetti M, Kalangos A. Biodegradable mitral annuloplasty for congenital ischemic mitral regurgitation. Thorac Cardiovasc Surg 2009; 57:363-4. [PMID: 19707980 DOI: 10.1055/s-0029-1185562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is associated with ischemic mitral regurgitation through a combination of papillary muscle ischemia or permanent fibrosis, left ventricular free wall ischemic dyskinesis and left ventricular dilatation. We report the successful management of a 27-month-old girl with ALCAPA and severe mitral regurgitation using a biodegradable mitral annuloplasty ring. It could represent a novel tool for mitral valve repair in ALCAPA-associated ischemic mitral regurgitation.
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Myers PO, Fasel JHD, Kalangos A, Gailloud P. Arteria lusoria: developmental anatomy, clinical, radiological and surgical aspects. Ann Cardiol Angeiol (Paris) 2009; 59:147-54. [PMID: 19962688 DOI: 10.1016/j.ancard.2009.07.008] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 07/15/2009] [Indexed: 11/26/2022]
Abstract
The left aortic arch with an aberrant right subclavian artery, or arteria lusoria, is the most common aortic arch anomaly, occuring in 0.5-2.5% of individuals. Four vessels arise sequentially from the aortic arch: the right common carotid artery, the left common carotid artery, the left subclavian artery and the aberrant right subclavian artery, which crosses upwards and to the right in the posterior mediastinum. It results from a disruption in the complex remodelling of the paired branchial arches, typically of the right dorsal aorta distal to the sixth cervical intersegmental artery. The diagnosis and differentiation of arch anomalies is based on findings at chest radiography in association with those at esophagography. It is usually asymptomatic. When symptomatic, it produces dysphagia lusoria or dyspnea and chronic coughing. Treatment is indicated for symptomatic relief of dysphagia lusoria and for prevention of complications due to aneurysmal dilatation.
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