Influence of transposed stomach on cardiac function in patients with resected esophageal cancer

Although the use of the posterior mediastinum and the stomach as a reconstruction option after esophagectomy has wide acceptance, there are concerns about the potential cardiac impairment it could cause. We prospectively studied 27 patients regarding the function and the systolic diameter, diastolic diameter, shortening fraction, ejection fraction and the presence of extrinsic compression. The patients were studied preoperatively and between the 45th and 60th postoperative days. The parameters were still within normal clinical ranges. We concluded that this type of reconstruction does not harm the patients in terms of their cardiac function.

An echocardiographic description of the Sulzer Carbomedics Synergy ST (Labcor) porcine valve in the aortic position

BACKGROUND AND AIM OF THE STUDY

The Synergy ST (previously Labcor) valve is constructed from three separate porcine aortic cusps mounted on a scalloped, flexible, acetal copolymer stent. To date, no hemodynamic data describing this valve have been published. The aim of this study was to describe the echocardiographic findings in a population of unselected patients.

METHODS

One investigator, who was blinded to valve size, studied 84 patients (31 females, 53 males; mean age 58 years; range: 19-83 years) at four centers in Brazil. The valves were studied at a mean of 31 months after implantation (range: 1-116 months). Mean gradient was calculated using the long modified Bernoulli equation, effective orifice area (EOA) using the classical from of the continuity equation, and resistance as mean gradient/flow.

RESULTS

There were no significant differences in peak transaortic velocity and mean gradient between valves of different annulus size. However, EOA was directly related (p = 0.0075) and resistance indirectly related to valve size (p = 0.021, ANOVA). Trivial or mild regurgitation was seen in 31 patients (37%), moderate in three (4%) and severe in two (2%). The regurgitation was solely paraprosthetic in five patients, solely through the valve in 23, and both in seven. Regurgitation through the valve usually occurred adjacent to the commissures.

CONCLUSION

The Synergy ST porcine valve has hemodynamics of forward flow similar to that of other stented porcine valves.