Resection of left anterior descending coronary artery aneurysm on a beating heart.

We report on the case of a 65-year-old man with unstable angina due to a left anterior descending (LAD) coronary artery single aneurysm. On a beating heart, the aneurysm was partially resected and the left internal thoracic artery was grafted in situ as a patch to the LAD opening. The patient remains well and free of symptoms two years after the operation.

Posterior non-ischemic left ventricular aneurysm. Report of 2 surgical cases.

Posterior non-ischemic left ventricular aneurysms are unusual aneurysms of different etiology that develop adjacent to the mitral valve annulus causing mitral regurgitation and progressive heart failure. Surgical correction is mandatory and involves repair of the aneurysm along with repair or replacement of the mitral valve. Two cases of posterior non-ischemic left ventricular aneurysms are reported. Both patients were females (19 and 9 years old) and they presented with symptoms of progressive heart failure. Definite diagnosis was made with transesophageal echocardiography (TEE) and confirmed with left ventriculography. Both patients were successfully treated by surgery. The first patient underwent repair of the aneurysm from inside the left ventricle and mitral valve replacement. The second patient had resection of the aneurysm through an extracardiac route. Both patients are in NYHA class 1, 5 and 4 years respectively after their operation with no evidence of mitral valve dysfunction. Posterior non-ischemic left ventricular aneurysms can securely be diagnosed by TEE and angiocardiography. Surgical treatment is mandatory in order to forestall potential life threatening cardiovascular events and should be tailored to the operative findings.

The role of mediastinoscopy in postresection lung cancer patients.

PURPOSE: To emphasize the role of mediastinoscopy in the evaluation of mediastinal lymphadenopathy in postresection lung cancer patients. PATIENTS AND METHODS: During the period 1997-1999, 11 patients who had a previous lobectomy or bilobectomy and mediastinal lymph node dissection for primary lung cancer underwent cervical mediastinoscopy for the evaluation and tissue diagnosis of mediastinal lymphadenopathy, discovered at planned, part of the follow-up,computed tomography (CT) of the chest. Five patients had received postoperative adjuvant radiation therapy and/or chemotherapy. RESULTS: Nodal metastasis was histologically confirmed in 9 patients who subsequently received a combination of chemotherapy and radiation therapy, with a mean survival of 8.1 months. Two patients had no evidence of lymph node metastasis and remain alive and disease-free 21 and 27 months after mediastinoscopy, without any additional therapy. CONCLUSION: Cervical mediastinoscopy, after a previously performed mediastinal lymph node dissection, is a special condition. However, it is the method of choice for the evaluation of the nature of mediastinal lymphadenopathy in postresection lung cancer patients. The alternative way of repeat thoracic CT at frequent intervals and the lymph node size enlargement criterion should be preserved for patients with a previous pneumonectomy or those who cannot tolerate additional radiation therapy or chemotherapy.

Celiac artery compression syndrome.

Celiac artery compression syndrome occurs when the median arcuate ligament of the diaphragm causes extrinsic compression of the celiac trunk. We report a case of a 65-year-old woman who presented with a three-month history of postprandial abdominal pain, nausea and some emesis, without weight loss. There was a bruit in the upper mid-epigastrium and the lateral aortic arteriography revealed a significant stenosis of the celiac artery. At operation, the celiac axis was found to be severely compressed anteriorly by fibers forming the inferior margin of the arcuate ligament of the diaphragm. The ligament was cut and a vein by-pass from the supraceliac aorta to the distal celiac artery was performed. The patient remains well and free of symptoms two and a half years since operation.In this report we discuss the indications and the therapeutic options of this syndrome as well as a review of the literature is being given.