Acute Type-A dissection in a 15-year-old Australian indigenous male - a case report.

Acute Type-A Aortic Dissection is a rare but life-threatening surgical emergency in children and adolescents. Large series report up to 3.5% of cases under the age of 21 with many of these cases with known predisposing risk factors. Risk factors include congenital cardiovascular disorders, connective tissue disorders, hypertension, inflammatory aortic weakening and iatrogenic, pregnancy or trauma. Cases with no obvious predisposing risk factors are exceedingly rare with very few cases described in a limited number of studies.

Impact of Delay in Surgery on Outcome in Patients Undergoing Cardiac Revascularisation Surgery.

BACKGROUND: Diagnosis of critical coronary artery disease, including after acute coronary syndrome presentation (ACS), represents an important indication for early coronary artery bypass graft (CABG) surgery. The study aims to investigate the influence of time from diagnosis to CABG on outcomes and document barriers to early revascularisation. METHODS: All patients 18 years and older with an acute presentation due to ACS or critical coronary artery disease who were considered to require urgent inpatient cardiac surgery between January 2016-February 2019 were included in the study. The primary endpoints were 30-day all-cause mortality or readmission, 1-year all-cause mortality, all-cause readmission. The secondary endpoint was the rate of complications while waiting for surgery. The time duration between diagnostic coronary angiography and surgery was considered as the time interval. RESULTS: Of 266 eligible patients, 251 underwent surgical revascularisation with 15 (6%) not undergoing surgery due to preoperative complications (n=12) or due to perceived prohibitively high surgical risk (n=3). The majority (85%) were male (mean age 67 years), 37% of patients had diabetes and 71% had hypertension. Non-ST elevation myocardial infarction was documented in 51% of the patients. The median time between diagnosis and inpatient CABG was 7 days (IQR 5-11). Thirty-five per cent (35%) of patients experienced complications while awaiting surgery. Of the 266 patients, 140 patients (53% - cohort 1) underwent surgery within 7 days. The cohort 1 rate of complications was lower than in cohort 2 (surgery after 7 days) (24 vs 47%, p<0.001). Moreover, 1-year mortality was less in cohort 1 (2 vs 8%, p=0.029). CONCLUSION: In patients requiring urgent inpatient CABG, delay for more than 7 days is associated with a higher rate of in-hospital complications and worse 30 day and 12-month outcomes.

Metastatic small bowel neuroendocrine tumour and carcinoid heart disease with aortic valve involvement-a rare occurrence.

Carcinoid disease of the heart commonly affects the tricuspid and pulmonary valves causing thickening and stenosis. However in very rare circumstances, the disease can also involve the mitral and aortic valves. We present an unusual case of left sided carcinoid heart disease (CHD) and triple valve replacement without the presence of proven intra-cardiac shunts or bronchial carcinoid lesions.

Pericardial effusion as a rare complication of a perforated appendicitis.

INTRODUCTION: Whilst pericardial effusion is a known complication of abdominal pathology, it is rarely reported following ruptured appendicitis and even more rarely requires drainage in that situation. This work has been reported in line with the SCARE criteria (Agha et al., 2016). PRESENTATION OF CASE: We report a 14-year-old male who developed extensive right hepatorenal and right paracolic abscesses, bilateral pleural effusions and a large pericardial effusion following laparoscopic appendicectomy. Due to the size of the effusion, thoracoscopic pericardotomy was required. DISCUSSION: Pericardial effusion is a very rare complication of advanced appendicitis despite a demonstrable connection between the retroperitoneum and the mediastinum. Only two cases were reported in our literature search. There is no consensus as to whether percutaneous drainage or pericardiotomy is the treatment of choice. CONCLUSION: The report is presented as a reminder of a rare complication of a common general surgical condition.

Hydrodissection in redo sternotomies.

Injection of pressurized normal saline into the retrosternal tissue has been used in redo sternotomies. This technique has been labeled as hydrodissection. It is a simple but effective technique to help minimize the trauma and risk of complications in redo sternotomies. My colleagues and I present a series of 6 consecutive patients in whom hydrodissection was performed. There was no injury to the heart or any vessel on reentry.

A new technique for repair of atrioventricular disruption complicating mitral valve replacement.

Atrioventricular disruption is an uncommon but often lethal complication in mitral valve replacement. We present the case of a 79-year-old woman in whom the disruption after mitral valve replacement was successfully repaired using BioGlue surgical adhesive, bovine pericardium, and polytetrafluoroethylene (Teflon) patch.