English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Zendy Open

Presents the pdf analysis as premium feature

PDF Analysis

Insights

Presents the summarisation as premium feature

Summarisation

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the zaia usage as premium feature

ZAIA

Zendy Tools

Zendy Plus

Presents the access of premium content as premium feature

Premium Content

Clinical Summary Elective AVR was performed in an 86-year-old woman with critical aortic stenosis (valve area 0.67 cm). After median sternotomy, right atrial–ascending aorta cardiopulmonary bypass (CPB) was instituted with myocardial protection using systemic hypothermia (32°C) and antegrade and retrograde cold-blood cardioplegia. A left ventricular vent was placed through the right superior pulmonary vein. A lazy-“S” aortotomy revealed a calcified tricuspid aortic valve. After valvectomy and debridement, a 21-mm Perimount valve (Carpentier-Edwards, Irvine, Calif) was implanted using a semicontinuous 2-0 Prolene suture (Ethicon Inc, Somerville, NJ). Coronary clearance was confirmed, and the aortotomy was closed with a single-layer 4-0 Prolene suture buttressed with bovine pericardial strips. Omnex cyanoacrylate glue (Johnson & Johnson, Berkshire, UK) was applied prophylactically to the suture line, and a rigorous de-airing drill commenced. This comprised 3 cycles of alternate filling of the left heart and suctioning through the left ventricle and aortic root vents with manual ventilation. De-airing was monitored by transesophageal echocardiography (TEE). The aortic crossclamp was removed, and after 10 minutes of reperfusion (maintaining root vent suction), separation from CPB was achieved with sinus rhythm and good cardiac action. Before protamine administration, TEE confirmed a normal opening of the prosthetic valve and no associated leak, but showed a large mass within the aortic root associated with the suture line (Figure 1). CPB was reinstituted, and the suture line was taken down to reveal a solidified glue “thrombus” within the aorta (Figure 2). This was extracted, and the aortotomy closure was revised using bovine pericardium without glue. A repeat TEE confirmed a good result. The patient made a good postoperative recovery with no features to suggest embolization of glue fragments.

In situ cyanoacrylate glue “thrombus” formation during cardiac de-airing