Somatosensory-evoked potential-guided intercostal artery reimplantation in thoracoabdominal aortic aneurysm surgery.

OBJECTIVE: This study was undertaken to evaluate the use of somatosensory-evokedpotential (SSEP) monitoring on intercostal artery reimplantation (IAR) and spinal cord ischemia rates during thoracoabdominal ortic aneurysm repair. METHODS: Fifty-two patients had thoracoabdominal aortic aneurysm repair with IAR under SSEP guidance and 79 patients had repair with routine IAR without SSEP guidance from 1999 to 2010. RESULTS: No differences were observed between the two groups in age (63.1 ± 11.6 vs 64.8 ± 9.8 years), sex (57.7% vs 50.6% men), chronic dissections (40.4% vs 44.3%), renal insufficiency (11.5% vs 10.1%), and Crawford type 1 and 2 aneurysms (53.9% vs 53.9%). There was one case (1.9%) of immediate paraplegia and one case (1.9%) of delayed paraplegia in the SSEP group versus 2 cases (2.5%) of immediate paraplegia in the non-SSEP group (P = 0.92). In the SSEP group, 38 patients (73.1%) had SSEP changes, but only 15 (28.8%) required reimplantation. There were fewer IARs in the SSEP group compared with the non-SSEP group (28.8% vs. 59.5%, P = 0.004). No difference was observed in 30-day mortality between the SSEP and the non-SSEP group (3.9% vs. 7.6%, P = 0.48). CONCLUSIONS: The use of SSEP monitoring led to a significant decrease in the need for IAR without increasing the paraplegia rate.

Hybrid minimally invasive extraction of atrial clot avoids redo sternotomy in Jehovah's Witness.

We report the novel use of the AngioVac device in a percutaneous hybrid approach to remove a large right atrial clot as an effective and potentially lifesaving alternative to a very high-risk redo-sternotomy in a Jehovah's Witness patient.

Heterotaxy syndrome with azygous continuation-causing pseudo Budd-Chiari syndrome after cardiopulmonary bypass.

Heterotaxy syndrome with interruption of the inferior vena cava and direct hepatic vein inflow into the right atrium has important implications for cardiac surgery. We report a case causing pseudo Budd-Chiari syndrome after cardiopulmonary bypass.

Review of pediatric airway malacia and its management, with emphasis on stenting.

Malacia of the pediatric airway presents itself in a variety of clinical circumstances. Pediatric airway stenting is a more recent treatment modality. Complications may necessitate stent removal. This is usually performed bronchoscopically. We were forced to surgically remove a complicated airway stent. The Palmaz stent had been inserted for bronchomalacia presenting after interrupted aortic arch surgery in a 4-month old child with DiGeorge syndrome. This prompted us to review pediatric airway malacia, its management options and long-term outcomes, in an attempt to crystallize the current status of this relatively uncommon and difficult issue. The role of stents is analysed.

A diagnostic challenge--an unusual right atrial mass, 12 years following atrial septal defect surgery.

A young girl presented with a right atrial mass, 12 years following ostium secundum atrial septal defect surgery. The unusual pathology and the various diagnostic considerations for an atrial mass are discussed.

Thoracic complications of nasogastric tube: review of safe practice.

OBJECTIVES: Insertion of a nasogastric tube, though a common clinical procedure, can produce unexpected complications. We sought to analyse the procedure, and explore means to improve its safety. METHODS: We present a case with a thoracic complication. We review the English literature for the range of complications, and collate all available clinical tests used to confirm enteric placement. RESULTS: We discuss the short-comings of the usual clinical tests and emphasise the more recent, but less mainstream, procedures that introduce more objectivity to the enteric tube placement. CONCLUSIONS: We provide summary points to guide the clinician in everyday practice.

Cardiac tamponade: a rare complication after pulmonary lobectomy.

OBJECTIVE: Pulmonary lobectomy for lung cancer is a well-established and safe operation. This report serves to highlight an important complication and an underlying essential surgical principle when performing pulmonary resections, to avoid a potentially fatal outcome. METHODS: A case report is presented. We describe an unusual case of cardiac tamponade complicating a left upper lobectomy. RESULTS: The few cases described in the literature are reviewed to reveal interesting causative mechanisms. The intrapericardial anatomy of the pulmonary hilum is discussed. CONCLUSIONS: A high index of clinical suspicion is required in refractory, unexplained hypotension after lung resection. Strict adherence to secure pulmonary vein ligation is as important as it is in dealing with the pulmonary artery.