Safety and efficacy of surgical correction of anomalous aortic origin of coronary arteries: experiences from 2 tertiary cardiac centres.

OBJECTIVES: This study aims to describe the outcomes of surgical correction for anomalous aortic origin of coronary artery (AAOCA) with regard to symptom relief. METHODS: We performed a retrospective multicentre study including surgical patients who underwent correction for AAOCA between 2009 and 2022. Patients who underwent concomitant cardiac procedures were also included. However, to analyse symptom relief, we only assessed the subgroup of symptomatic patients who underwent isolated correction for AAOCA. RESULTS: A total of 71 consecutive patients (median age 55, range 12-83) who underwent surgical correction for AAOCA were included in the study. Right-AAOCA was present in 56 patients (79%), left-AAOCA in 11 patients (15%) and single coronary ostium AAOCA in 4 patients (6%). Coronary unroofing was performed in 72% of the patients, coronary reimplantation in 28% and an additional neo-ostium patchplasty in 13% of the patients. In 39% of the patients, a concomitant cardiac procedure was performed. During follow-up, no cardiovascular-related death was observed. Three patients (4.2%) had a myocardial infarction and underwent postoperative coronary artery bypass grafting. Six patients (8.5%) needed postoperative temporary mechanical circulatory support. Among the 34 symptomatic patients who underwent isolated AAOCA correction, 70% were completely asymptomatic after surgery, 12% showed symptom improvement and no symptom improvement was observed in 18% of the patients (median follow-up 3.5 years, range 0.3-11.1). CONCLUSIONS: Correction for AAOCA can be safely performed with or without concomitant cardiac procedures. Performing AAOCA correction leads to a significant improvement in symptoms for most patients.

Right axillary minithoracotomy: An alternative access to close an ASD.

A vertical right axillary thoracotomy is a favorable alternative to a median sternotomy for surgical correction of common congenital heart defects in patients of all ages. The right-sided heart structures can be approached through a 4- to 5-cm vertical incision in the midaxillary line. In contrast to a midline sternotomy, osseous thoracic structures can be preserved through a muscle-sparing approach simply by retracting the ribs. Consequently, recovery is usually faster, and the resulting scar is completely hidden under the resting arm. In addition, there is no need for special equipment. The entire operation can be performed with established techniques. Operative outcome and long-term results have been shown by several research groups to be comparable to those obtained with a median sternotomy. This tutorial demonstrates the stepwise performance of an axillary thoracotomy and the extracorporeal circulation setup by the example of the closure of an atrial septal defect.

The 'Cauliflower Heart': a case report of congenital bi-atrial aneurysms causing non-controllable arrhythmia.

BACKGROUND: Congenital aneurysms of the atrium are very rare malformations. Known complications are therapy-resistant arrhythmias. Different treatments such as medical therapy, electrophysiological ablation, and surgery have been proposed. However, there are no guidelines on treatment. CASE SUMMARY: We describe the case of a neonate with bi-atrial aneurysms causing atrial arrhythmia. Arrhythmia was first observed in the 28th week of gestation. Maternal digoxin treatment did not show any effect. After birth, bi-atrial aneurysms were diagnosed and determined as the probable cause of the atrial tachycardia and later of atrial flutter. Antiarrhythmic drug treatment was initiated. However, only frequency control could be achieved. At the age of 7 months, the patient underwent surgical resection. Since surgery, sinus rhythm is present. CONCLUSION: Atrial aneurysms are rare malformations, known complications are atrial arrhythmia. If medical treatment fails, surgery correction appears to be indicated going along with low operative risk and a high probability of successful termination of arrhythmia.

Efficacy and Safety of Heparinization before Deployment of Endograft for Blunt Traumatic Aortic Injury in Severely Injured Patients.

BACKGROUND: The administration of unfractionated heparin (UFH) during endovascular repair of blunt traumatic aortic injury (BTAI) is controversial. The aim of the study is to report the early outcomes of patients undergoing thoracic endovascular aortic repair (TEVAR) for BTAI, and to assess the individualized intraoperative use and dose of UFH. METHODS: This is a retrospective analysis including consecutive patients treated with TEVAR for BTAI of the descending aorta between January 1st, 2005 and December 31st, 2018. Intraoperative use and doses of UFH were analyzed. Primary outcome included a reintervention because of new onset bleeding and/or thromboembolic complication and 30-day mortality. Technical success, injury severity score (ISS), timing of treatment, and neurologic deterioration were secondary outcome. RESULTS: Thirty-six patients with a mean age of 47 ± 18 years, 30 males (83%), were included. Intraoperative administration of UFH was recorded in 30/36 patients (83%) with a mean dose of 4750 ± 2180 IU. Two patients had no UFH because of extensive intracranial hemorrhage or suspected relevant liver laceration, respectively; 1 died in theatre, 1 was already anticoagulated having a mechanical aortic valve, and in 2 no information about heparin use was found. During 30 days of follow-up, 3 patients died (8%; 3/36): 1 patient with completely transected aorta died on-table and 2 on the fifth postoperative day, 1 from trauma-associated brain injury and 1 with multi organ failure. No bleeding or thromboembolic complication requiring reintervention occurred in any patient during 30 days follow-up. In 3 patients partial unintentional coverage of the left common carotid artery occurred, resulting in technical success of 89% (32/36). Mean ISS was 43 ± 15. Thirty-five patients (97%) were severely injured having an ISS ≥ 25. Twenty-nine patients (81%) were treated within 24 hr and 6 patients (17%) within 1 week. No stroke or spinal cord ischemia was observed. CONCLUSIONS: Systemic heparinization in different doses during TEVAR for BTAI can be safe with no intraoperative bleeding or thromboembolic complications in early postoperative period.

Surgical Management of Congenital Bilateral Multiple Atrial Aneurysms.

Congenital atrial aneurysms are a rare malformation, often associated with supraventricular arrhythmias. Here, we present the case of a child with biatrial aneurysms and a type 2 atrioseptal defect. Directly after birth the girl became symptomatic with incessant ectopic atrial tachyarrhythmia. On echocardiography, multiple biatrial aneurysms and septations were observed. The diagnosis was confirmed with computed tomography. After 7 months of antiarrhythmic therapy, the child underwent surgical intervention by aneurysm resection, atrioseptal defect closure, and ablation. Since then the patient has been in stable sinus rhythm.