Delayed presentation of traumatic ventricular septal defect and mitral leaflet perforation.

A case of intracardiac stabbing is reported. The victim sustained injuries disproportionate to his initial presentation. These included a ventricular septal defect and mitral valve leaflet perforation. The need for immediate referral to a cardiothoracic unit and the importance of the use of echocardiography is stressed. This enables the safest and most appropriate management of potentially lethal injuries.

An unusual cause of unilateral facial pain.

Cardiac pain that is referred to the face is a common symptom in patients with angina pectoris, but unilateral facial pain referred from a non-ischaemic cardiac source is rare. We report a case of unilateral facial pain that occurred in relation to a large pericardial effusion and which resolved on drainage of the effusion.

Modified technique for rapid atraumatic radial artery harvesting.

The radial artery is currently enjoying a resurgence in popularity as a conduit for coronary artery bypass grafting. We have introduced a modification of the standard technique of radial artery harvesting, which we have evaluated in a prospective randomized control study. Our modified technique was significantly quicker (p < 0.001) than the standard technique and required the use of fewer hemostatic clips (p < 0.001). Spasm of the radial artery did not occur in either group and there was no histological evidence of thermal injury to the radial artery. There was no incidence of postoperative hematoma, forearm dysesthesia, impaired wound healing, or hand complications in either group. We conclude that our technique allows rapid, inexpensive, and atraumatic harvesting of the radial artery.

Intercostal drain migration post esophagectomy.

A 38-year-old man underwent an Ivor-Lewis esophagectomy for a squamous carcinoma at the lower third of his esophagus. On the fifth postoperative day one liter of turbid fluid appeared from the intercostal drain and there was a right-sided pleural effusion on the chest radiograph. A contrast swallow demonstrated a leak at the distal part of the gastric staple line. This leak was managed conservatively and subsequent contrast swallows failed to show any leakage despite the persistent drainage from the drain. At gastroscopy, the intercostal drain was seen to have eroded through the stomach wall. The drain was repositioned and the patient was discharged from hospital 5 days later. We believe this to be the first report of an intercostal drain migration into the stomach after an elective esophagectomy.

An unusual cause of ventricular tachycardia.

Inflammatory pseudotumour (IP) of the heart is an extremely uncommon and potentially fatal lesion which presents a challenging diagnosis even for the experienced pathologist, cardiologist and cardiac surgeon. This spindle cell tumour is known to be present in virtually every anatomical region but, in adults, has only previously been found in the heart at postmortem. We report the case of a 27-year-old man who presented with ventricular tachyarrhythmias and a right ventricular mass which was subsequently shown to be an IP.

A clinical evaluation of platelet function, haemolysis and oxygen transfer during cardiopulmonary bypass comparing the Quantum HF-6700 to the HF-5700 hollow fibre membrane oxygenator.

The continued improvement of oxygenators is an important aspect of patient safety during cardiopulmonary bypass (CPB). The purpose of this study was to compare the Bard William Harvey HF-5700 oxygenator to the upgraded Bard Quantum HF-6700, which has recently been introduced into clinical practice. No clinical evaluation of this device has been published to date. The two oxygenators differ principally in that the Quantum has a smaller priming volume, achieved at the expense of a smaller membrane surface area which could result in sub-optimal gas exchange characteristics, increased haemolysis and increased platelet dysfunction during CPB. Twenty adult patients undergoing elective, first time coronary artery bypass grafting (CABG) were randomly assigned either to the HF-5700 (n=10) or to the HF-6700 (n=10) group. One patient underwent mitral valve repair in addition to CABG and was excluded from further study. There were no statistically significant differences in either preoperative or operative parameters between the two groups. Samples were obtained at the start of CPB, at 30 min, 60 min, at the end of CPB and at 1 h following termination of CPB. No significant differences between the two groups were found in oxygen transfer, haemolysis (plasma haptoglobin levels) or platelet function (a novel platelet activating factor (PAF)-induced platelet activation test) at any of the time points during CPB. It was concluded that the Quantum HF-6700 matches the HF-5700 for the parameters studied, whilst having the advantage of requiring a smaller priming volume.