Displacement of the Amplatzer occluder device from the mitral paraprosthetic leak

A critically ill patient had a major mitral paravalvular leak, failed device closure of the leak, and severe hemolytic anemia after a third mitral valve replacement. Echocardiography showed the Amplatzer occluder device completely displaced and swirled in the left atrial cavity. His condition was greatly improved after a fourth mitral valve replacement.     

A Benign Pulmonary Artery Mass

Abstract   We present a case of a benign pulmonary artery mass leading to pulmonary artery stenosis. A 39-year-old male patient had a dyspnea on exertion and chest discomfort four months before admission. Computerized tomographic scan revealed a mass extending 2.1 cm in the right pulmonary artery resulting in pulmonary artery stenosis. He underwent a mass resection and pulmonary artery reconstruction under cardiopulmonary bypass. His symptoms improved postoperatively. Histology revealed it was a reactive lymph node. It is recommended that surgical resection should be the only alternative for complete relief of the symptoms in such patients.     

The Blalock-Taussig Shunt

Abstract   Background and aim of the study: Even though the Blalock-Taussig (B-T) shunt, either classic or modified, has been advocated and successfully employed in clinical practice for more than half a century, a systemic review on this procedure is still scanty. This warrants us a zest in making a comprehensive survey on this subject. Methods: Articles were extensively retrieved from the MEDLINE database of National Library of Medicine USA if the abstract contained information relevant to the B-T shunt in terms of the conduit options, modified surgical techniques, surgical indications, short- and long-term results, complications, and prognosis. Further retrieval was undertaken by manually searching the reference list of relevant papers. Results: Classical or modified B-T shunts, either on ipsilateral or contralateral side to the aortic arch, can be performed on patients of any age with minimum postoperative complications and low operative mortality. Expended polytetrafluoroethylene has gained satisfactory long-term patency rate in the construction of the modified B-T shunt. Excellent pulmonary artery growth was observed in the patients with a modified B-T shunt, and it has shown superb prognosis over the classic with regard to hemodynamics, patency rate, and survival. Conclusions: The modified B-T shunt that was developed on basis of the classic fashion remains the preferable palliative procedure aiming at enhancing pulmonary blood flow for neonates and infants with complicated cyanotic congenital heart defects. The modified B-T shunt is technically simpler with less dissection, and blood flow to the respective arm is not jeopardized. It has been proved to be of low risk, excellent palliation, and is associated with excellent pulmonary artery growth, has become the most effective palliative shunt procedure of today.     

Late acute aortic dissection after coronary artery bypass

Introduction  Late ascending aortic dissection after coronary artery bypass grafting (CABG) is an uncommon phenomenon, and treatment presents a complex clinical dilemma. Materials and methods  Between 1995 and 2005, eight patients were diagnosed with post-CABG late acute aortic dissection. Mean age was 61.7 (range 52–76), and mean period between CABG and late acute aortic dissection was 45.3 months (range 5 to 122 months). Three patients underwent surgical replacement of the ascending aorta. One patient died after surgery, and the other two had an uneventful recovery, with a successful mean 6.5-year follow-up. Five patients were treated conservatively, with a mean follow-up of 81.2 months (range 50–112 months). Results and discussion  Periodic computed tomography (CT) scans showed minor or no change in aortic diameter and satisfactory general condition. Late acute aortic dissection after CABG is rare. Only a few reports have been published, and no standard treatment guidelines exist. Conclusion  We assume that postoperative pericardial scarring and adhesions provide some protection against progression of the dissection and therefore suggest that preferred treatment in non-stable patients should be surgical. In stable patients, close follow-up and blood pressure control are beneficial. Condensed abstract  Late ascending aortic dissection after CABG is rare, and treatment presents a clinical dilemma. We treated eight patients with post-CABG late acute aortic dissection. Three underwent surgical replacement of the ascending aorta. One died after surgery, and the other two had an uneventful recovery. Five patients were treated conservatively. No standard treatment guidelines exist for late acute aortic dissection after CABG. We assume that postoperative pericardial scarring and adhesions provide some protection against progression of the dissection, and suggest that preferred treatment in non-stable patients should be surgical. In stable patients, close follow-up and blood pressure control are beneficial.     

Modifications of composite grafts for coronary bypass surgery

We herein describe four modifications of graft construction in coronary bypass surgery, including composite left mammary arterial T graft, arterial-venous I, and U grafts, and coronary-coronary vein graft and discuss their indications.     

Prostate cancer and the role of biomarkers

Abdominal Radiology - To review available prostate cancer biomarkers and their performance in a clinical order, from prostate cancer detection, to treatment of localized and advanced disease. We...     

Cardiac papillary fibroelastoma of the mitral chorda

We describe a case of cardiac papillary fibroelastoma in a 33-year-old man. The diagnosis was established by echocardiography. Computerised tomographic angiography gave no evidence of coronary stenosis, but illustrated a radiopaque filling defect in the left ventricle. The papillary fibroelastoma was removed together with the involved chorda, and an artificial chord was implanted under cardiopulmonary bypass. Histological study confirmed the diagnosis of papillary fibroelastoma. Due to the potentials of cerebral and coronary embolisation, surgical management to the patients with a papillary fibroelastoma is highly recommended.