Traumatic Aortopulmonary Fistula: An Acquired Type 1 Aortopulmonary Window.

We report a patient with an acquired traumatic aortopulmonary window. The patient presented with an aortopulmonary fistula between the proximal ascending aorta and pulmonary trunk, which was missed on the initial hospital admission. The 26-year-old patient presented with high-output cardiac failure and examination features of a diastolic runoff. Patch closure of the defect using a sandwich technique was undertaken, with resolution of symptoms.

Outcome of concomitant left atrial ablation during valvular heart surgery: an African perspective.

OBJECTIVES: The aim of this study was to determine the success rates of left atrial radiofrequency cardiac ablation for atrial fibrillation during heart valve surgery. METHODS: This was a three-year retrospective study of 53 patients who had valve surgery and cardio-ablation. Immediate and long-term overall outcomes were analysed at three, six, nine, 12 and 24 months. The results were tested for significance by comparing to a chance outcome (50:50 probability) using the Z-test for the normal approximation of the binomial distribution. RESULTS: A total of 56.9% of patients converted immediately to sinus rhythm, with that number increasing over time. Pre-operative poor ejection fraction was the only predictor of low success rates following ablation. Long-term rhythm was determined by the patient's rhythm between three and six months. CONCLUSIONS: Concomitant left atrial ablation during valve surgery is effective in treating atrial fibrillation. Routine use of anti-arrhythmic medication after surgical ablation is not recommended.

Hybrid management of aneurysmal vascular ring and a Kommerell's diverticulum in an adult: Case report.

INTRODUCTION AND IMPORTANCE: Congenital vascular rings are rare in adults. The management is challenging when vascular rings present with concomitant aortic aneurysm and Kommerall's diverticulum. CASE PRESENTATION: We present a 68year old patient with a congenital vascular ring in the form of right sided aortic arch, with a retroesophageal left subclavian artery arising from an aneurysmal Kommerell's diverticulum. In addition, the patient had aneurysmal distal aortic arch and proximal descending aorta, causing severe symptomatic tracheal compression. The patient was successfully managed by debranching and reimplantation of head neck vessels to the ascending aorta through a median sternotomy, and concurrent endovascular stenting of the aneurysmal aorta. CLINICAL DISCUSSION: A combination of complete vascular rings and aortic arch aneurysm poses a potentially higher surgical risk. The use of the less invasive endovascular stenting of the aorta as well as a limited open surgical approach offers a lesser risk, especially in poor pre-operative states. CONCLUSION: A multidisciplinary team effort is key. Hybrid management of aneurysmal congenital vascular rings in high risk adults offers an attractive management alternative to conventional surgery.