Tracheal Transection From Gunshot Wound to the Neck.

A male patient presented with a gunshot wound superior to his left scapula and difficulty breathing. En route to the emergency department, he rapidly became unresponsive, culminating in a cricothyroidotomy by paramedics. Oxygen saturation was 70% on arrival, and a tracheobronchial injury was suspected. In the operating room, a complete transection of the mid trachea was found and repaired. Postoperatively, the patient had acute respiratory distress syndrome. He was placed on extracorporeal membrane oxygenation and was eventually decannulated on postoperative day 12. The need for immediate identification of airway inadequacy, despite appropriate interventions, is underscored by this case report.

Giant Bochdalek Hernia: A Minimally Invasive Transabdominal Approach.

A Bochdalek hernia is the most common congenital diaphragmatic hernia (CDH). It can rarely evade prenatal detection and persist into adulthood with minimal symptoms. Large CDH repair has often required an open approach in the past. In this article, we present a case of a patient with large CDH who was asymptomatic until later in her adult life who subsequently developed symptoms and sought a surgical evaluation. A minimally invasive transabdominal approach was used to effectively reduce and repair this rare giant hernia. The patient has remained free of recurrence and has had resolution of her symptoms after 18 months of follow-up. This case illustrates that even the largest of these can be handled in a minimally invasive fashion and achieve durable results.

Endocardial and Epicardial Rhythmia HDx™ Mapping Verifies Surgical Cox Maze IV Lesion Pattern.

Atrial fibrillation (AF) remains the most common cardiac dysarrhythmia, with a significant impact on the health-care economy. AF occurs as a result of electrical conduction delays within the atrial tissue, which may stem from fibrosis or other mediators that alter atrial tissue conduction substrate. The Cox maze III and IV procedures block these reentry circuits by directly dividing, or breaking, the self-perpetuating circuit and by isolating these circuits away from the intrinsic cardiac conduction pathway. The Convergent procedure, a hybrid approach to AF ablation, coordinates the electrophysiologist and the cardiac surgeon in a simultaneous or sequential endocardial and epicardial procedure. Because the heart remains electrically active, electroanatomical maps, not anatomical landmarks, guide therapy. However, lesion transmurality and contiguity remain inconsistent. The Rhythmia HDx™ mapping system (Boston Scientific, Natick, MA, USA) offers detailed maps of acute lesion patterns during the ablation procedure. However, these maps require instrumentation and technology found in the electrophysiology laboratory, not in the operating room. We herein present a case during which we performed a Cox maze IV procedure and also applied the Rhythmia HDx™ electroanatomical mapping system (Boston Scientific, Natick, MA, USA) at the time of operation. Through this novel approach, we were able to verify the completeness of the lesions created and reach a procedural endpoint confirmed by both epicardial and endocardial maps of successful electrical isolation of the left atrium posterior wall and pulmonary vein pedicle.