Spontaneous brachial pseudo-aneurysm in a 12-year-old with kyphoscoliosis-type Ehlers-Danlos Syndrome.

The Ehlers-Danlos Syndrome (EDS) is a rare connective tissue disorder characterised by fragility of the soft connective tissues and widespread manifestations in skin, ligaments, joints, blood vessels and internal organs. We report a case of a 12-year-old boy, previously diagnosed with kyphoscoliosis-type EDS (type VI), presenting with a left brachial artery pseudo-aneursym with history of multiple spontaneous and post-traumatic arterial ruptures. Surgical management of this patient was performed successfully by primary repair of brachial artery lesion.

Pseudoaneurysm of the supracoeliac aorta following blunt trauma in a 83-year-old woman.

We report on the case of an 83-year-old hemiplegic female patient presenting with post-traumatic pseudoaneurysm of the supracoeliac aorta, treated with 38 mm x 100 mm Talent Endoluminal Stent-Graft (Medtronic Inc., Santa Rosa, CA) using local anaesthesia. The patient was discharged on day 3 and the 8 month follow-up was without complications.

Staged hybrid approach to chronic type B aortic dissection involving the distal arch associated with aortic root aneurysm.

Open surgical repair of complex aortic pathologies using cardiopulmonary bypass and deep hypothermic circulatory arrest still carries a substantial rate of mortality and morbidity. Endovascular stent-graft placement has developed as a safe and effective treatment modality for various diseases of the aorta. We report on the case of a 65-year-old female presenting with symptomatic type B aortic dissection with aneurysm of the ascending aorta and the aortic root. The patient was treated with a flanged composite graft custom made from a branched 24-mm Dacron graft for entire prosthetic transposition of the supra-aortic branches. Metachronously, the patient underwent endovascular stent-grafting of the descending aorta. She was discharged free of complications on day 10.

Coronary artery bypass grafting in a 12-year-old girl with familial hypercholesterolemia.

We present the case of a 12-year-old girl with familial hypercholesterolemia and coronary artery disease. She underwent triple-vessel coronary artery bypass grafting with bilateral pedicled internal mammary artery grafting without adverse events. Pediatric patients with familial hypercholesterolemia may present with premature coronary atherosclerosis requiring coronary artery bypass grafting. In situ internal mammary artery grafts should be the graft of choice.

Bronchogenic cyst invading right atrium in a 5-year-old.

Primary bronchogenic cysts of cardiac origin or extension are rare. We report here on a 5-year-old girl with a bronchogenic cyst with a diameter of 5.0 x 4.5 x 4.5 cm extending to the right atrial wall. Tumor enucleation and resection of the cyst together with the invaded right atrial wall was performed through a right posterolateral thoracotomy and an opening in the lateral pericardium. Resection of intrapericardial bronchogenic cysts is possible, although extensive invasion of cardiac structures may necessitate the use of cardiopulmonary bypass through a sternotomy.

Prosthetic aortic valve endocarditis due to Stenotrophomonas maltophilia complicated by subannular abscess.

Annular abscesses are serious complications of infectious native and prosthetic valve endocarditis. In this patient, we isolated Stenotrophomonas maltophilia, a rare cause of subaortic abscess with high mortality/morbidity rates although virulent gram-positive cocci, S. Aureus in particular, have been the most commonly isolated agents. We treated this case of endocarditis and the subannular abscess observed 1 year after the initial operation by aortic root replacement with resternotomy in addition to appropriate antibiotics.

Thoracic endoscopic surgery for hyperhidrosis: comparison of different techniques.

BACKGROUND: Hyperhidrosis is pathological perspiration in palmar, plantar or axillary surfaces. Video-assisted thoracic surgery (VATS) is currently the most commonly used therapy for hyperhidrosis. Blockage of sympathetic ganglia is achieved by segmental resection, transection and/or cauterization, and clipping of the chain. We aimed to compare the efficacy of these methods with respect to patient satisfaction, recurrence of symptoms and complications. METHODS: Eighty male patients with a mean age of 22.02 +/- 2.61 years undergoing bilateral thoracoscopic sympathectomy or sympathetic blockage to treat primary hyperhidrosis were included in this randomized study. The patients were divided into four groups depending on the technique used for sympathetic blockage; techniques included resection (n = 20), transection (n = 20), ablation (n = 20), and clipping (n = 20). RESULTS: The primary success rate for isolated palmar hyperhidrosis was 96.3 %; for palmar and axillary hydrosis it was 95.7 % and for palmar and face/scalp hyperhidrosis it was 66.7 %. No recurrence was observed. The overall success rate of the operation was 95 % and the differences between the four groups were not statistically significant. In the clipping group, the duration of the surgical procedure was significantly shorter than in the other groups. Complication rates were similar among the groups. The postoperative chest roentgenogram revealed pneumothorax in nine patients, but none of them required intervention. CONCLUSION: Thoracic endoscopic sympathetic blockage yields similar results irrespective of the surgical technique adopted.

Recurrent apical cardiac hydatid cyst presenting with angina.

Hydatid disease is a parasitic infection caused by the larvae of tapeworm Echinococcus Granulosus. Hydatid cyst of the heart is an uncommon presentation of human echinococcosis which may lead to life-threatening conditions. We present a rare case of recurrent pericardial cyst in a 42-year-old man presenting with chest pain and ECG findings. We were able to avoid risks of resternotomy with a limited anterolateral thoracotomy. A direct enucleation of the cyst was possible without the need for cardiopulmonary bypass. He was free of complications at 6-month follow-up. Diagnosis should be suspected in every case of anginal symptoms or cyst-like mass in persons coming from areas where echinococcus granulosus is endemic.

Use of a bifurcated ePTFE graft for off-pump extracardiac Fontan completion.

A 6-year-old girl underwent off-pump extracardiac Fontan completion. Intrapericardial inferior caval vein was found to be accompanied by the hepatic vein on the left side; a 20 x 10 x 10-mm bifurcated ePTFE graft was used without external shunting. This approach is practical for the surgeons and may result in lower perioperative Fontan pressures/transpulmonary gradients as well as a shorter intubation period and hospital stay.

Aortic arch replacement without circulatory arrest: a simplified technique with two grafts.

Aortic arch reconstruction remains a challenge for the cardiothoracic surgeon. We present our simplified technique in which we used two grafts for arch reconstruction without circulatory arrest. It is a relatively easy and quick technique consisting of a unique modification of the selective antegrade cerebral circulation system without the need for circulatory arrest in selected cases.

Is routine intravascular shunting necessary for carotid endarterectomy in patients with contralateral occlusion? A review of 5-year experience of carotid endarterectomy with local anaesthesia.

OBJECTIVES: Endarterectomy of a stenotic internal carotid artery in the presence of contralateral carotid occlusion (CCO) is often assessed as a high-risk procedure. We have assessed the requirement for shunting in patients with CCO operated under local anaesthetic. MATERIALS AND METHODS: Between 1998 and 2003, 429 patients (319 males and 110 females, mean age 65.7+/-6.2, range 48-84) underwent 500 carotid endarterectomies under local anaesthetic with awake neurological testing. Fifty-five patients (12.8%) had CCO. Preoperative risk factors, intra- and postoperative events were noted and analyzed. Short-term and mid-term follow-up (mean 16.4+/-5.8 months, range 3-38 months) was also recorded. RESULTS: The rate of shunting in patients with or without CCO (10.9% vs. 9.1%) was not significantly different. Stroke rates for CCO and non-CCO groups were 3.6 and 0.5%, respectively. Only the presence of preoperative cerebral infarction increased the risk of stroke. Patients that needed shunting were found to have significantly higher overall rate of adverse events, mortality and stroke. CONCLUSIONS: Routine use of intravascular shunting for a stenotic carotid artery with contralateral occlusion may not be necessary. The choice of using a shunt is safe when made intraoperatively by assessing the neurological status of the patient continuously. This requires expertise and strong cooperation between the anaesthesiologist and the surgical teams.