Aorto-Right Ventricular Tunnel: An Uncommon Problem with a Common Solution.

Aorto-ventricular tunnel is a rare congenital malformation, and aorto-right ventricular tunnel (ARVT) is an even less common entity. Here, we report the case of a 3-month-old female who underwent successful surgical closure of ARVT. The origin of the right coronary artery was proximal to the ostium of the tunnel.

Post thoracotomy spinal cord compression in a child. A word of caution.

INTRODUCTION: Oxidised regenerated cellulose is a commonly used haemostatic agent in surgery which, in rare cases, has been held responsible for severe complications. PRESENTATION OF CASE: A 6-year-old girl developed flaccid paraplegia following the excision of a large thoracic ganglioneuroblastoma. Magnetic resonance imaging revealed spinal cord compression at the T10-11 level and the patient underwent emergency decompression via the previous thoracotomy. At operation the causative factor was found to be a mass consisted of cellulose used at the original procedure to control local bleeding in the vicinity of the intervertebral foramen. DISCUSSION: The accessibility of the spinal canal from the thoracic cavity through the opening of the intervertebral foramen may allow migration of material and in this case oxidized regenerated cellulose, commonly used during cardiothoracic procedures, can cause rare but severe complications such as compression of the spinal cord. CONCLUSION: The value of hemostatic gauze is well established in cardiothoracic surgery. However, surgeon should be cautious with the application of material in the proximity of the intervertebral foramen, especially if this is to leave behind after the completion of the procedure.

Intrapericardial teratoma in a premature neonate: pre-delivery diagnosis and successful surgical removal.

Intrapericardial teratoma is a rare cardiac tumour that is typically a lone, large, polycystic mass, in contact with the base of the heart and accompanied by pericardial effusion. In itself it is benign, but it can be potentially fatal because of pressure on the heart or great vessels. It is usually surgically removable. Here we describe a case of intrapericardial teratoma that was identified by foetal echocardiography prior to Caesarean delivery and was successfully removed surgically in a premature neonate. The postoperative course was uneventful, and six years later the child shows normal development and has a normal echocardiogram.

Closure of a large patent ductus arteriosus in children and adults with pulmonary hypertension.

INTRODUCTION: Surgical closure of a patent ductus arteriosus (PDA) in cases with pulmonary hypertension, a short and wide PDA, and/or calcification of the wall of the vessel can be a hazardous procedure. The use of extracorporeal circulation provides the necessary safety for effective closure. METHODS: Four patients (one male), aged 7, 22, 54 and 60 years old, underwent PDA closure. All had pulmonary hypertension (pulmonary artery pressure, PAP 55-85 mmHg, PAP-to-systemic pressure ratio 0.6-0.8) and a wide, short PDA (diameter 9-12 mm) with a calcified wall in 2 cases. The surgical technique involved transpulmonary PDA closure with a synthetic patch under extracorporeal circulation and mild hypothermia (n=2); or double ligation and purse-string suture of the PDA with extracorporeal circulation and normothermia on a beating heart (n=1), or with heart-lung machine on standby (n=1). RESULTS: Mortality was nil. The postoperative course was mild in all cases. Follow up 3 to 8 years post surgery showed effective PDA closure, PAP within normal (n=3) or at upper normal limits (n=1), and no other sequelae. CONCLUSIONS: The use of extracorporeal circulation allows safe and uncomplicated surgical closure of a PDA in "difficult" cases.