Background: Small Aortic Annulus (AA) is big issue during Aortic Valve Replacement (AVR) necessitating replacement of an undersized prosthetic valve especially with Double Valve Replacement (DVR). Despite that small aortic valve prostheses can lead to Prosthesis-Patient Mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures fearing from morbidity and mortality. Objective: To evaluate clinical and echocardiographic outcomes in patients with small aortic annulus undergoing double valve replacement. Methods: The study included 100 consecutive patients underwent DVR for combined rheumatic aortic and mitral valve diseases, between Jan. 2016 and Sept. 2020. Only (50) patients had ARE with DVR. ARE was performed using an autologous or bovine pericardium or Dacron patch by Nicks or Manouguian procedures. The estimated postoperative end-points were mortality, effective orifice areas (EOA), mean aortic pressure gradient and valve-related complications. The least postoperative follow-up period was 6 months. Results: The study included 30 male and 70 female patients with mean age of 35±20 years, body surface area (BSA) of 1.7 ±0.3 m2, aortic annulus diameter was 20±1.4 mm, aortic orifice area was 0.8±0.1 cm2, and mean pressure gradient 85±2.5 mmHg. During follow-up period, there was a mild to moderate paravalvular leak (1%) with, (1%) heart block, and residual gradient on prosthetic aortic valve; that was all in DVR alone. Conclusion: Enlargement of aortic root by Nicks or Manouguian technique is safe and effective in patients with small aortic annulus undergoing double valve replacements.

Background: EVH has become prevalent in recent years due to its reduced morbidity and increased patient satisfaction. We designed and carried out a prospective study of patients undergoing CABG to compare outcomes of open versus endoscopic harvesting technique for great saphenous vein. Two groups of patients who underwent elective Coronary artery bypass grafting at our hospitals between January 2018 and October 2020 were included. Endoscopic vein harvesting group (50 patients) was performed endoscopic technique compared with Open Vein Harvesting group (50 patients) was performed open surgical incision for harvesting. Both groups were demographically similar and received identical management. Leg wound was evaluated at discharge, 2 weeks, and 4 weeks for evidence of complications. Early outcomes were compared included, infection, gaped wound and re-suture, pain, satisfied cosmetically and mobilization. Results: Endoscopic vein harvesting group had increased harvest time and decreased incision closure time when compared with Open Vein Harvesting. The average hospitalization time was 6.5 ± 2.2 days for Endoscopic vein harvesting group and 9.2 ± 2.9 days for Open Vein Harvesting group. In Endoscopic vein harvesting group, no significant hematomas were observed. In Open Vein Harvesting group, hematomas were detected in 2 patients and were surgically evacuated. In Endoscopic vein harvesting group, edema occurred less frequently. Infection of the incision location did not occur in Endoscopic vein harvesting group. Leg wound complications were significantly reduced in Endoscopic vein harvesting group in comparison with Open Vein Harvesting group. Conclusions: Endoscopic vein harvesting decreases leg wound complications and increases patient’s satisfaction cosmetically.

Background: Atrial myxomas are rare benign tumors; causing obstructive or embolic complications, and even death, depending on their site and size. Therefore, once diagnosed, it should be surgically resected emergency. Atrial myxomas are present about 75% in left atrium (LA) and about 15% in right atrium (RA). Early diagnosis is a challenge because of nonspecific manifestations, and sometimes is asymptomatic and discovered accidentally during TTE. Objective: Minimally invasive cardiac surgery (MICS) has benefits include cosmetically, less pain, shorter intensive care unit (ICU) and hospital stay. Methods: From Jan. 2011 to Sept. 2020, (20) patients (10 Sternotomy, 10 MI) underwent surgery for isolated resection of atrial myxoma. We reported outcomes; cardiopulmonary bypass time (CPB), cross-clamp time, conversion to median ST, length of stay, complications (stroke, renal failure, respiratory failure, reoperation, and infection),pain, patients satisfaction, recurrence and survival. Mean follow-up time was 6 month. Results: There is no significant difference in CPB or cross-clamp time between groups. No MI cases required conversion to a median ST. Length of stay is shorter in the MI group by 2.2 days (p = 0.045). There is no difference in morbidity or mortality between groups. Conclusions: A minimally invasive approach for atrial myxoma resection is safe, feasible, and favored over sternotomy.

Ventricular septal rupture (VSR) is a life-threatening complication of trans-mural acute myocardial infarction (MI). Surgical intervention remains the treatment of choice, but it is still a challenging operation associated with high mortality (1). VSR is a rare serious complication of MI. Its incidence has been estimated between 1%¬ - 2% after MI. If it treated medically the mortality is very high (25% in 1st day, 75% at 1st week and 90% at 2 months). Patients that survive following medical treatment usually have clinically poor cardiac function. So, the result of medical treatment of VSR is disappointing (2). Primary PCI following MI can be significantly reduced the incidence of mechanical complications. However, with improving treatment, appropriate management of mechanical complications remains a cornerstone to avoid low cardiac output (LCO) and multi organ failure (MOF). Medical treatment has high failure and mortality rate, and early surgical ventricular septal defect (VSD) closure is recommended to reverse the hemodynamic deterioration. However, surgical repair is associated to a high rate of mortality (20% –40%) even in the more recent reports (3). Transcatheter device closure of VSR, is an option, however it is generally accepted to be inadequate. Progressive deterioration in hemodynamic status makes surgical intervention often the only realistic option (4).