Group B Streptococcus endocarditis with left ventricle-right atrium (Gerbode's) defect.

We report an unusual case of a 61-year-old woman with group B Streptococcus-positive infective endocarditis and a left ventricular-right atrium or Gerbode's defect. We discuss the issues surrounding such an infection and the implications of such a rare cardiac defect in our case report.

Caveats of smartphone applications for the cardiothoracic trainee.

BACKGROUND: The clinical environment is becoming increasingly dominated by information technology, most recently the smartphone with its applications (apps) of a multitude of uses. There are already tens of thousands of medical apps available for download, to educate both patients and trainees, and many more are being designed to facilitate delivery of care. The rapid development of this technology has outgrown its quality evaluation and regulation, both urgently required to maintain patient safety, protect sensitive data, and ensure dissemination of accurate information. We review medical apps themed towards cardiothoracic surgery in terms of medical professional involvement in their content and design. METHODS: iTunes and Play Store were searched for cardiothoracic surgery-themed medical apps, using the terms cardiothoracic, thoracic, cardiac, heart, lung, surgery, and variations thereof and including the term medical. RESULTS: A focused search yielded 379 apps, of which 6% were associated with a named medical professional, 15% with a publisher or professional society, and 63% with a user rating. CONCLUSIONS: The findings suggest inadequate input from the medical profession. The article discusses the pressing issues regarding quality evaluation, regulation, and information security, required for smartphones and handheld devices to become an integral and safe part of delivery of care.

Day surgery unit thoracic surgery: the first UK experience.

OBJECTIVE: Operating in a day surgery unit has potential benefits, including lower risk of cancellation, reduced infection rates, cost effectiveness and increased patient satisfaction. We believe that we are the first unit in the UK to regularly perform thoracic surgery in a dedicated day surgery unit, and describe our experience to date. METHODS: Data were collected prospectively from 1 September 2007 to 31 December 2009. Following surgery, patients were observed in a recovery area for 1h before transfer back to a short-stay ward. When chest drains were used, they were attached to an ambulatory drainage device for the patient to be discharged with. All patients were reviewed postoperatively, and were discharged home within 4-6h if appropriate. RESULTS: Ninety-eight patients underwent thoracic surgery in our day surgery unit. Sixty (61.2%) patients were male. The mean age was 53.0 (17-83) years. There were no deaths. Twenty-nine (29.6%) were mediastinal procedures (MED group) such as mediastinoscopy/otomy, 31 (31.6%) were video-assisted thoracoscopic surgery (VATS group) procedures such as lung biopsies and pleurodeses and 38 (38.8%) were a variety of other (OTHER group) procedures such as chest wall interventions and sternal wire removal. Out of the cohort, three (3.1%) patients required admission directly from the day surgery unit, and three (3.1%) were admitted late after discharge with problems relating to their surgery. Our Day Surgery Programme accounted for 12.0% of the total thoracic workload during the time period. CONCLUSIONS: Surgeons are continually trying to fast track increasingly complex procedures and, with good patient selection, thoracic surgery can be performed safely and effectively in day surgery units.

Intra-abdominal pectus bar migration--a rare clinical entity: case report.

We present the case of a 20-year-old male who underwent successful surgical correction of pectus excavatum with the Highly Modified Ravitch Repair (HMRR). At 29 months the attempted operative removal of the Ravitch bar was unsuccessful despite the impression of adequate bar location on chest x-ray. Subsequent imaging with computed tomography was unclear in determining whether the bar was supra or infra-diaphragmatic due to the tissue distortion subsequent to initial surgery. Video assisted thoracoscopic surgery (VATS) successfully retrieved the bar and revealed that it was not in the thorax, but had migrated to the intra-abdominal bare area of the liver, with no evidence of associated diaphragmatic defect or hernia. Intra-abdominal pectus bar migration is a rare clinical entity, and safe removal can be facilitated by the use of the VATS technique.

Endoscopic cardiac tumor resection.

BACKGROUND: The purpose of this study is to report our 9 years' experience with endoscopic cardiac tumor resection using the port access approach. METHODS: From March 1997 to December 2005, 27 patients (mean age, 56.2 +/- 16.9 years; 70% female) underwent endoscopic cardiac tumor resection using endocardiopulmonary bypass and endoaortic-balloon clamp technique. Nineteen (70%) patients presented in New York Heart Association class I, 4 patients presented with embolic stroke, and 4 patients presented with atrial arrhythmias. All patients underwent echocardiography on admission, intraoperatively, at discharge, and at follow-up evaluation. Eight patients additionally required mitral valve replacement (n = 1), tricuspid valve replacement (n = 1), mitral valve repair (n = 2), mini-maze (n = 1), and closure of patent foramen ovale (n = 3). Mean follow-up was 3.4 +/- 2.7 years. RESULTS: Mean endoaortic-balloon clamp and endocardiopulmonary bypass times were 68.8 +/- 30.8 minutes and 112.2 +/- 41.5 minutes, respectively. There were no conversions to sternotomy. Tumors resected were classified as left atrial myxoma (n = 20), right atrial myxoma (n = 3), lipoma (n = 1), intravenous leiomyoma involving the inferior vena cava and the tricuspid valve (n = 1), plexiform tumor of the sinoatrial node (n = 1), and papillary fibroelastoma of aortic valve noncoronary cusp (n = 1). There were no hospital deaths. Mean intensive care unit and hospital stays were 1.4 +/- 1.1 days and 7.3 +/- 3.4 days, respectively. Postoperative complications were evolving stroke (n = 1), re-exploration for bleeding (n = 1), and myocardial ischemia requiring stenting (n = 1). Follow-up failed to demonstrate residual or recurrent tumor. One patient had a small residual atrial septal defect. Ninety-two percent of patients appreciated the cosmetic result and fast recovery. CONCLUSIONS: Endoscopic cardiac tumor resection is feasible and a valid oncologic approach with an attractive cosmetic advantage over median sternotomy.