Subcutaneous cardioverter defibrillator has longer time to therapy but is less cardiotoxic than transvenous cardioverter defibrillator. Study carried out in a preclinical porcine model.

Aims: Totally subcutaneous implantable cardioverter defibrillator (S-ICD) delivers higher shock energy and can have longer time to therapy compared to transvenous implantable cardioverter defibrillator (T-ICD). Aim of the study was to compare time to therapy and to investigate cardiac, cerebral and systemic injuries of S-ICD and T-ICD shocks delivered after ventricular fibrillation (VF) induction. Methods and results: Fourteen pigs were randomly implanted with a S-ICD (n = 7) or a T-ICD (n = 7). Five VF episodes were induced in each pig. For each VF episode, up to two shocks could be delivered by the T-ICD or the S-ICD to terminate the arrhythmia. Cardiac, systemic, and cerebral toxicity were monitored. Mean time to therapy was longer in the S-ICD group compared to the T-ICD group (19[18; 23] s vs. 9 [7; 10] s; P = 0.001, respectively). High-sensitivity troponin T levels were significantly higher in the T-ICD group from 1 to 24 h after the procedure (P ≤ 0.02). Creatine phosphokinase activity levels were significantly higher in the S-ICD group, at 3, 6, and 24 h after the procedure (P ≤ 0.05). Lactate levels were not significantly different between groups. S100 protein level was similar in both groups at 1 h after the procedure and then decreased in the T-ICD group compared to the S-ICD group (P = 0.04). Conclusions: Time to therapy in S-ICD was twice as long as for T-ICD, but didn't induce relevant brain injury. Conversely, S-ICD shocks were less cardiotoxic than T-ICD shocks.

Late postcardiotomy sternal dehiscence: a simple approach using Stratos® system.

Management of late sternal dehiscence is challenging and time consuming. Although numerous techniques exist including rewiring and titanium plates screwing to stabilize the sternum, we describe an alternative technique by using four titanium clips and one connecting bar.

Cardiac tamponade as an unusual manifestation of infective endocarditis.

Contained rupture of the left ventricle secondary to a myocardial abscess is uncommon. We present a case of infective endocarditis of the aortic valve with an unusual manifestation: a cardiac tamponade due to a pseudoaneurysm of the left ventricle.

Dissecting Thoracic Aneurysm in Takayasu Arteritis With Concomitant Tuberculosis.

We present a case of dissecting aneurysm of ascending aorta in a 15-year-old patient secondary to Takayasu arteritis with concomitant tuberculosis, with an emphasis on multimodality imaging findings and to illustrate preoperative and postoperative medical management. Antituberculosis therapy, high-dose corticosteroids, antiplatelet therapy, and ß-blockers were administrated during the initial active phase. The patient presented with acute chest pain 3 months after medical therapy initiation. We performed an ascending aorta and aortic arch replacement with branched Dacron grafts. Only a handful of similar, but not identical, cases of Takayasu arteritis with concomitant tuberculosis leading to aortic dissection have been described previously.

Pancarditis: an unusual complication of a group B streptococcal infection.

Pancarditis is a rare condition with a poor prognosis combining endocarditis, myocarditis with abscess formation, and purulent pericarditis. Diagnosis is often delayed and the clinical signs are predominantly those of the embolic complications. Literature is scarce. We present a unique and rare case of pancarditis, complicating a Streptococcal B infection in an immunocompetent, healthy, 54 year-old woman. The evolution was favourable under medical therapy alone and thanks to multimodality cardiac imaging diagnosis and follow-up.

Combined coronary surgery and aortic valve replacement after previous right pneumonectomy.

Cardiac surgery in patients with previous pneumonectomy is infrequently reported. We report a case of combined coronary artery bypass grafting and aortic valve replacement in a patient with left ventricular ejection fraction less then 35% and a previous right pneumonectomy. All steps in operative management of this rare condition are discussed.

Primary cardiac lymphoma complicated by cardiogenic shock: successful treatment with chemotherapy delivered under extracorporeal membrane oxygenation support.

Primary cardiac lymphomas (PCLs) are rare in immunocompetent patients. Their clinical presentation is highly variable and in case of cardiogenic shock, death is often inevitable with a diagnosis made post-mortem. We report the case of a 65-year old immunocompetent man with cardiogenic shock requiring emergent extracorporeal membrane oxygenation (ECMO). Soon after, a diagnosis of PCL was given and chemotherapy was delivered under ECMO support. The patient was progressively weaned from the mechanical support. Six months later, he had fully recovered.

Flail chest in polytraumatized patients: surgical fixation using Stracos reduces ventilator time and hospital stay.

OBJECTIVES: Conservative management of patients with flail chest is the treatment of choice. Rib fracture repair is technically challenging; however, with the advent of specially designed molding titanium clips, surgical management has been simplified. Surgical stabilization has been used with good outcomes. We are reporting on our institutional matched-case-control study. METHODS: Between April 2010 and April 2011, ten polytraumatized patients undergoing rib stabilization for flail chest were matched 1 : 1 to 10 control patients by age ±10 years, sex, neurological or vertebral trauma, abdominal injury, and arm and leg fractures. Surgery was realized in the first 48 hours. RESULTS: There were no significant differences between groups for matched data and prognostic scores: injury severity score, revised trauma score, and trauma injury severity score. Ventilator time (142 ± 224 versus 74 ± 125 hours, P = 0.026) and overall hospital stay (142 ± 224 versus 74 ± 125 hours, P = 0.026) were significantly lower for the surgical group after adjustment on prognostic scores. There was a trend towards shorter ICU stay for operative patients (12.3 ± 8.5 versus 9.0 ± 4.3 days, P = 0.076). CONCLUSIONS: Rib fixation with Stracos is feasible and decreases the length of ventilation and hospital stay. A multicenter randomized study is warranted so as to confirm these results and to evaluate impact on pulmonary function status, pain, and quality of life.

Aortic root replacement in a patient with left ventricular noncompaction.

We describe the case of a 57-year-old woman with noncompaction of the left ventricle and regurgitant bicuspid aortic valve who presented with progressive congestive heart failure and was successfully treated with aortic root replacement. The long-term outcome for these patients is poor because of progressive left ventricular impairment, increased rates of life-threatening arrhythmias, and intraventricular thrombi. To our knowledge, only 3 patient with noncompaction of the left ventricle has been reported to have undergone aortic valve replacement for severely regurgitant bicuspid aortic valve. Herein, we describe a patient with noncompaction of the left ventricle who underwent successful mechanical aortic root replacement.

Impact of valvular prosthesis type on cardiovascular outcomes in patients on chronic dialysis.

There is conflicting evidence guiding valve prosthesis selection in patients with end-stage renal disease on dialysis. We sought to determine, after reviewing the relevant literature, the best valve substitute in patients on chronic dialysis. A total of 9 retrospective studies compared the outcomes of two valves, showing similar results and highlighting the safety of implanting bioprostheses in patients on chronic dialysis. Standards of valve selection have changed over time; it has long been believed that tissue valves undergo premature degeneration due to calcium metabolism derangements in patients with end-stage renal disease. Bleeding was the most common valve-related complication and represented a major drawback of mechanical valves. Two studies demonstrated a survival advantage in favour of mechanical prostheses. It can be concluded that surgeons should not hesitate to implant bioprostheses because singular valve decomposition would be uncommon in this patient population. Prosthesis selection should be based on the same criteria as those used for non-dialysis patients.

Pleural lipoma: a non-surgical lesion?

Pleural lipomas are benign tumours that develop at the expense of adipose tissues, and they never evolve towards liposarcoma. Located usually at the mediastinal, bronchial and pulmonary levels, a pleural situation is extremely rare. Chest X-rays usually detect them and computed tomography scans confirm the diagnosis. As complications occur, a wait-and-see policy is common. We report our pleural lipoma surgical exeresis experience since 1999. We have operated on five cases of pleural lipomas among nearly 1800 cases of thoracic exeresis: three male and two female patients, without obesity (in all cases, body mass index (BMI) < 28). The mean age was 54.6 years (range 35-72 years). Four patients were electively operated and one in emergency, three with video-assisted thoracic surgery (VATS) procedure and two with open chest surgery, without recurrent cases. Advancements in VATS have greatly reduced the morbidity rate of these benign tumours especially if exeresis is performed early on a small, uncomplicated adhesion-free tumour. On the other hand, the operation may be deleterious, complicated by the presence of a large lipoma or in a complicating situation. In our opinion, we should revise the wait-and-see policy when facing these lesions considering their evolutionary potential. We should advise VATS in pleural lipomas.

Bartonella as a cause of mechanical prosthetic aortic root endocarditis.

Bartonella henselae infection is typically associated with cat scratch disease. This microorganism can also lead to culture-negative infective endocarditis in immunocompromised patients. We present a rare case of a previously healthy 65-year-old man with B. henselae-associated endocarditis of a prosthetic aortic root. All blood cultures, as well as cultures of the resected aortic valve vegetations, remained negative. Polymerase chain reaction with specific bacterial primers with DNA sequencing was used to identify B. henselae as the etiologic agent. This was successfully managed by an aortic root re-replacement using a mechanical conduit, reimplantation of coronaries ostia, and antibiotic therapy.