A case of an elderly patient with severe aortic insufficiency who carried high risks for surgical valve replacement. After a detailed preoperative evaluation, the patient successfully received transapical transcatheter aortic valve replacement. Postoperatively, complete left bundle branch block developed, resulting in impaired left ventricular function. Despite guideline-directed medical therapy for heart failure, cardiac function showed no significant recovery. At 4.5 months post-surgery, left bundle branch pacing was performed, leading to a marked improvement in cardiac function.
Aged ; Humans ; Male ; Aortic Valve Insufficiency/surgery* ; Bundle-Branch Block/etiology* ; Cardiac Pacing, Artificial ; Postoperative Complications/therapy* ; Transcatheter Aortic Valve Replacement/adverse effects*

Objective To evaluate segmental resection of involved portal vein (PV) in the surgical treatment of advanced pancreatic carcinoma (PC). MethodsIn our 22 advanced PC patients involving PV and/or superior mesenteric vein (SMV) extended pancreaticoduodenectomy or distal pancreatectomy plus extensive regional lymph node clearance were performed and cancer involved PV and/or SMV segment were resected enbloc. Results Among 22 cases, 6 underwent wedge resection and repairment of PV or SMV. Eight underwent segmental resection of PV or SMV followed by end-to-end anastomosis in 5,autotransplantation of great saphenous vein in 2, mesocaval shunt in one. The mean operation time was 7 5?h, the average blood transfusion was 600?ml, and there was no mortality in all cases. All 22 patients were followed up with a postoperative survival of 6 mos in one, 12 mos in 3, 18 mos in 6 cases, 24 mos in 8 and 36 mos in 4 cases. ConclusionsIt is rationale to resect the advanced PC en bloc with the cancer involved segment of PV and/or SMV in terms of low morbidity and long postoperative survival.