Inspiratory muscle training for diaphragmatic dysfunction: A case series.

Inspiratory muscle training (IMT) is used across various pathology domains to improve respiratory function. Limited literature exists which demonstrates IMT benefit among patients with Diaphragmatic dysfunction. 7 individuals with a mean age of 59.6yrs had unilateral diaphragmatic dysfunction (UDD) post cardiac surgery and were referred to a cardiac rehab program where an IMT strength based protocol was prescribed. IMT implementation over an average of 13 weeks yielded an average improvement in maximum inspiratory pressure (MIP) of 48 % (p value 0.018), peak inspiratory flow rate (PIFR) of 45 % (p value 0.018), forced expired volume in 1 sec (FEV1) of 15 % (p value 0.028) and forced vital capacity (FVC) of 15 % (p value 0.018). This case series of data adds to the limited evidence that exists currently and outlines the benefits of IMT application within unilateral diaphragmatic dysfunction.

Completion pneumonectomy via sternotomy and complete intrathoracic liver migration in metastatic osteosarcoma.

Pulmonary metastasectomy is the well-accepted surgical management for recurrent osteosarcoma in the lung. A pneumonectomy is seldom performed, even more so via a sternotomy. We report an unusual case of a pneumonectomy via median sternotomy for a pulmonary metastasis with complete migration of the liver into the intrathoracic space, a complication rarely observed. The patient remains disease-free on follow-up, 21 years following the initial diagnosis. Aggressive approaches for metastasectomy, despite clinician hesitation in the age of minimally invasive surgery, can yield excellent outcomes for a cancer with otherwise poor prognosis.

Three-dimensional volume-rendered computed tomography application for follow-up fracture healing and volume measurements pre-surgical rib fixation and post-surgical rib fixation.

BACKGROUND: Surgical rib fixation (SRF) is being used increasingly in trauma centers for stabilization of chest wall injuries, in line with new and evolving surgical techniques. Our institution has developed a pathway for the management of chest wall injuries and SRF, which includes a follow-up low-volume, noncontrast computed tomography (CT) scan at 12 months. METHODS: This study was a single-center retrospective study conducted on 25 consecutive patients who underwent SRF between February 2019 and February 2020. All CT measurements were done by a CT radiographer under the supervision of a board-certified radiologist and included the use of three-dimensional volume-rendered images. RESULTS: There were no patients with SRF who experienced hardware failure at 12 months in either flail or nonflail groups. For fractured ribs treated with SRF, complete or partial union occurred in 75 of 76 ribs plated (98.7%). The median ratio for improvement in lung volumes was 1.71 for flail SRF and 1.69 for nonflail SRF in our study. CONCLUSION: Three-dimensional volume-rendered CT at 12 months post-SRF showed good alignment (no hardware failure) and fracture healing of fixed ribs in both flail and nonflail groups. Lung volumes also improved pre-SRF and post-SRF for both flail and nonflail patients. More studies are needed to define how the pattern of rib fracture healing of fixed and nonfixed ribs affects lung volumes. LEVEL OF EVIDENCE: Therapeutic, Level V.

Emergency treatment of acute decompensated critical aortic stenosis with transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) is relatively contraindicated in the bicuspid aortic valve, and to our knowledge has not been tried where the true native annulus is of a size far in excess of current device capabilities. We present here a case of a successful emergency TAVI of a 73-year-old previously healthy man, who presented with cardiogenic shock, ventricular tachycardia storm and severe left ventricular dysfunction because of the underlying critical bicuspid aortic stenosis with aortic annulus area of 991.9 mm2 and associated moderate aortic incompetence (the Society of Thoracic Surgeons (STS) risk score; score mortality of 40.9%). Despite the critical condition of the patient and technically challenging anatomy, successful TAVI was performed and the patient remains well with near-normal left ventricle (LV) function at 6 months follow-up.

Removal notice to: Anterior mediastinal cholesterol granuloma - A case report.

This abstract from abstract [Pathology 2020; 52(S1): S82] has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This abstract has been removed at the request of the Authors and the Editor in Chief due to patient consent issues.

REMOVED: Anterior mediastinal cholesterol granuloma - A case report.

This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been removed at the request of the Authors and the Editor in Chief due to patient consent issues.

Low volume ECMO results study.

Objectives: To report extracorporeal membrane oxygenation (ECMO) experience at Princess Alexandra and Gold Coast University hospitals and compare mortality with benchmarks. Design: Case series of patients treated with ECMO. Setting: Two adult tertiary Australian intensive care units with low ECMO case volumes. Participants: Patients treated with ECMO, aged > 18 years. Main outcome measures: Patients were categorised into respiratory, cardiac, and extracorporeal cardiopulmonary resuscitation (eCPR) groups. Observed mortality was compared with mortality predicted using individual risk of death predictions from the Survival after Veno-arterial ECMO (SAVE) and Respiratory ECMO Survival Prediction (RESP) scores; mortality predicted when mortality predictions of the SAVE score were modified to be consistent with the validation cohort in the SAVE study (Alfred Hospital); and with mortality predicted when eCPR patients were all assigned a risk of death equal to Extracorporeal Life Support Organization (ELSO) Registry eCPR mortality. Results: Over 10 years, 86 patients were treated with ECMO. Eight deaths were observed in 49 patients with respiratory failure, below the 95% CI (13-24) for the deaths predicted by the RESP score (P < 0.001). Nine deaths were observed in 27 patients with cardiac failure, below the 95% CI (14-23) for the deaths predicted by the SAVE score (P < 0.001), but within the 95% CI (9-17) for the deaths predicted by the SAVE score modified to be consistent with the Alfred Hospital cohort (P > 0.05). Seven deaths were observed in the ten eCPR patients, within the 95% CI (4-10) predicted using the risk of death derived from the ELSO Registry. Conclusions: Mortality in two low volume ECMO centres was not inferior to benchmarks.

Mosaic 22q11.2 deletion and tetralogy of Fallot with absent pulmonary valve: an unreported association.

Chromosome 22q11.2 microdeletion is the most common microdeletion syndrome. Mosaic 22q11.2 deletions are very rare and only a few have been reported. We describe a case of a neonate with tetralogy of Fallot with absent pulmonary valve with mosaic 22q11.2 deletion. Fluorescent in situ hybridization analysis of lymphocytes showed a hemizygous 22q11.2 microdeletion in 66% of interphase nuclei. Microarray testing confirmed a 1.66 Mb deletion at 22q11.2. The child did not have any clinical manifestations of 22q11.2 deletion other than the cardiac malformation.

Esophageal perforation associated with fontan operation: a complication of transesophageal echocardiography.

A 10-year-old girl with unbalanced atrioventricular septal defect and aortic arch interruption with interrupted inferior vena cava and dextrocardia had undergone a modified Norwood procedure followed by a Kawashima operation in 2002 and 2005, respectively. In 2012, she underwent Fontan operation with diversion of hepatic veins to left pulmonary artery. Intraoperative transesophageal echocardiography (TEE) was used. She was noted to have an esophageal perforation, diagnosed on the 10th postoperative day. She was managed with thoracic drainage, cervical esophagostomy, and feeding jejunostomy. Esophageal perforation is a rare complication of TEE and requires very aggressive treatment.

Enteroviral myocarditis in neonates.

Enteroviruses are a leading cause of viral infections in children. While most enteroviral infections are mild and self-limiting, severe disease such as a viral sepsis syndrome, myocarditis, hepatitis and meningoencephalitis may occur. We present two cases of neonatal enteroviral myocarditis. Cardiorespiratory failure occurred in both cases, and severe shock refractory to conventional treatment required support with extracorporeal membrane oxygenation (ECMO). One child with coxsackievirus B3 myocarditis failed to recover and died after 3 weeks on ECMO, while one child could be decannulated successfully after 9 days of ECMO and recovered completely subsequently. In conclusion, neonatal myocarditis has a very high mortality, and ECMO should be considered early in neonates with rapid clinical and echocardiographic deterioration despite adequate inotropic support.

Use of extracorporeal life support for emergency coronary artery bypass grafting.

A 14-year old boy was admitted with an anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva, with an interarterial course of the narrow proximal segment. He underwent coronary ostial augmentation and main pulmonary artery translocation to the left pulmonary artery. In the post-cardiopulmonary bypass (CPB) period, he developed thrombotic occlusion of the RCA resulting in arrhythmia and ventricular dysfunction, requiring extracorporeal life support (ECLS) in the form of extracorporeal membrane oxygenation rather than CPB. After confirming this complication by cardiac catheterization, the right coronary artery territory was revascularized with a pedicled right internal thoracic artery graft. The entire procedure was performed on a beating heart using a stabilizer during ECLS. This strategy may be useful in situations with unstable haemodynamics and a low risk of blood loss.

Anomalous aortic origin of a coronary artery: a universally applicable surgical strategy.

The most commonly reported coronary arterial malformation, in accounts of sudden deaths, is anomalous aortic origin of a coronary artery. Anomalous coronary arteries may arise from the left, right, or non-coronary sinuses of Valsalva. Importantly, although the left coronary artery from the right sinus has the worst prognosis, sudden death has been reported in all variants of origin from the various sinuses of Valsalva. This paper describes a technique that addresses all of the problems relating to anomalous aortic origin of a coronary artery from the wrong sinus of Valsalva. This technique includes the transection of the ascending aorta and pulmonary trunk, coronary arterial enlargement with a pericardial patch, and lateral translocation of the pulmonary trunk to the left pulmonary artery. Anomalous aortic origin of a coronary artery from the wrong sinus of Valsalva is a potentially lethal cardiac anomaly that can be corrected in all cases using this simplified surgical technique that addresses the major anatomic and physiological problems.

The current surgical perspective to repair of atrioventricular septal defect with common atrioventricular junction.

Atrioventricular septal defect with common atrioventricular junction is a relatively common congenital cardiac malformation. It sometimes presents challenging surgical problems, especially when seen in combination with tetralogy of Fallot. We describe herein our current concepts regarding surgical repair of atrioventricular septal defect with and without tetralogy, discussing indications for surgery, timing, technical aspects, and outcomes.

Intractable LIMA spasm in the postoperative period treated by placement of 'bridging' stent.

A woman with critical left main stenosis suffered intractable left internal mammary artery spasm post-coronary artery bypass grafting. This was managed with a left main stent and the patient stabilized. A 3-month follow-up angiogram showed a patent graft and a blocked stent.

Idiopathic pulmonary trunk aneurysm causing airway obstruction in an infant.

We report a case of idiopathic pulmonary trunk aneurysm in an infant, in which the main clinical picture was airway obstruction. Aneurysmorraphy was the chosen surgical approach and showed to be successful on 13 months follow-up.

Synovial sarcoma of the heart.

We report a case of synovial sarcoma of the heart in a 14-year-old boy, who presented with signs of mild generalized illness and rapidly progressed to haemodynamic collapse. On operation the tumour was attached to the tricuspid valve, away from the atrioventricular node. He was considered to have incomplete resection due to extensive adhesions to the atrioventricular junction, and was offered chemotherapy. On 18 months follow-up, he was asymptomatic.

A simple system to deliver blood cardioplegia.

We describe a simple and inexpensive system designed to deliver blood cardioplegia either diluted or at the patient's hematocrit, with controlled temperature and additive concentration. This system can be applied to any pump set, and suits any strategy for clinical myocardial preservation.

Molecular evaluation of the great vessels of patients with bicuspid aortic valve disease

OBJETIVO: A valva aórtica bicúspide (VAB) está associada a maior prevalência de ectasia anulo-aórtica, aneurisma e dissecçäo da aorta ascendente. Este estudo investigou a quantidade de fibrilina-1 e elastina nos grandes vasos de portadores de VAB. MÉTODO:Amostras de tecidos foram colhidas da aorta ascendente e tronco da artéria pulmonar de 22 portadores de VAB e 16 portadores de valva aórtica tricúspide (VAT) submetidos a cirurgia cardíaca, incluindo seis portadores de valva aórtica normal, provenientes do programa de transplante. Imunofluorescência indireta e análise computadorizada de imagens foram utilizadas para quantificaçäo das proteínas na camada média dos vasos, expressas como densidade óptica integrada média (DOI). RESULTADOS: Na aorta, a DOI específica para fibrilina-1 foi 15 ± 8 no grupo bicúspide e 24 ± 7 no grupo tricúspide (p=0,001). Na artéria pulmonar, a DOI específica para fibrilina-1 foi 18 ± 10 no grupo bicúspide e 25 ± 9 no grupo tricúspide (p=0,07). A DOI específica para elastina na aorta foi 34 ± 13 no grupo bicúspide e 36 ± 19 no grupo tricúspide (p=0,31). Na artéria pulmonar, a DOI para elastina foi 30 ± 12 no grupo bicúspide e 29 ± 14 no grupo tricúspide (p=0,34). CONCLUSÕES: Os portadores de VAB apresentaram menor quantidade de fibrilina-1, mas näo elastina, na aorta ascendente e artéria pulmonar que os portadores de VAT normal ou doente. Estes achados podem explicar a maior incidência de dilataçäo e dissecçäo da aorta ascendente em portadores desta má-formaçäo da valva aórtica.