| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Letters to the Editor |
a Cardiac Surgery Unit, Civic Hospital, Brescia, Italy
b Experimental Surgery Unit, Cardiac Surgery Unit, Department of Heart and Vessels, Careggi Hospital, Florence, Italy
Received 29 June 2008; accepted 1 July 2008.
* Corresponding author. Address: Cardiac Surgery Unit, Civic Hospital, Piazzale Spedali Civili, 1, 25123 Brescia, Italy. Tel.: +39 030 3995636; fax: +39 030 3995004. (Email: roberto_lorusso{at}iol.it).
Key Words: Mitral valve regurgitation • Emergency cardiac surgery • Cardiogenic shock • Acute endocarditis • Acute myocardial infarction
We are delighted that our article [1] stimulated such interest from our colleagues in Iran, Foroughi et al. [2], and, in particular, that it has encouraged a discussion of every surgeon's challenging topic.
We appreciate the authors’ expression of sympathy for us, describing our article as ‘impressive’.
The authors presented a very interesting case of acute MR presumably secondary to Takotsubo cardiomyopathy that favourably responded to medical therapy. They suggest to take into consideration this aetiology as well as other diffuse wall motion abnormalities when a patient with acute mitral regurgitation is referred to us. Particular attention has to be paid to give an indication to surgery after the efficacy of specific medical therapy has been excluded.
We agree that a prompt diagnosis with identification of pathophysiologic mechanisms underlying acute MR is mandatory to successfully treat these critical patients. However, we would like to also bring readers’ attention to a significant finding of our study: in spite of improvement in perioperative management and operative surgical techniques, early outcome did not improve in the last 20 years. This suggests to us that we should re-think the correct management of these critically ill patients seeing that surgery performed within few hours from hospital admission did not ensure acceptable postoperative results. In accordance with Acar [3], we believe that emergency or very early surgery should be recommended only in presence of cardiogenic shock, or, in case of infective endocarditis, in patients with very large emboli (>15 mm) or threatening vegetations and that timely surgery should not be only commanded by the concern of achieving a mitral repair [4]. Stabilisation of clinical and haemodynamic status before surgery is preferable and, in this setting, the prophylactic use of the intra-aortic balloon pump (IABP) should be taken into consideration. In our study this approach was mainly reserved to post infarction acute MR (40%) whereas only a small percentage of degenerative (9%) and endocarditic (5%) patients received an IABP in the perioperative period. Nonetheless, all surgeons participating to this multicentre study agree to be more aggressive with the use of preoperative IABP even in patients with non-ischaemic regurgitation and, in the opinion of all of us, the rule of counterpulsation in the preoperative management of patient with acute MR, even secondary to bacterial endocarditic, needs to be rediscussed.
Further studies on this controversial issue are welcomed.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
