Pulmonary valve replacement and quality-of-life assessment.

BACKGROUND: Chronic pulmonary regurgitation is common after repair of tetralogy of Fallot. Despite the deleterious effects of chronic pulmonary regurgitation on right ventricular function, many patients with repaired tetralogy of Fallot remain asymptomatic. Health is defined not only by the absence of disease but also by physical, mental, and social wellbeing. We sought to examine the impact of pulmonary valve replacement on quality of life in asymptomatic patients with repaired tetralogy of Fallot and chronic pulmonary regurgitation. METHODS: From January 2009 to December 2012, 25 (18 male) asymptomatic patients (mean age 23.4 ± 7.4 years) who underwent pulmonary valve replacement for significant pulmonary regurgitation were recruited. Cardiac magnetic resonance was performed pre- and postoperatively. Quality of life was assessed using the Chinese version of the SF-36v2 evaluation tool. Demographics, clinical data, magnetic resonance findings, and quality-of-life scores were collected and calculated for comparison. RESULTS: After surgery, the indexed right ventricular end-diastolic volume (193 ± 47.3 vs. 105.6 ± 29.6 mL m(-2), p < 0.001) and indexed right ventricular end-systolic volume (108.5 ± 32.9 vs. 61.1 ± 23 mL m(-2), p < 0.001) decreased significantly. The response rates for pre- and postoperative quality-of-life assessments were 100%. Patients demonstrated improvements in all 8 domains of the SF-36v2 assessment. The physical (46.5 ± 6.6 vs. 49.9 ± 6.4, p = 0.012) and mental (43.7 ± 7.8 vs. 51.9 ± 7.6, p < 0.001) component summary scores increased after surgery. CONCLUSION: Pulmonary valve replacement can improve the quality of life in patients with chronic asymptomatic pulmonary regurgitation.

Molecular characterization of a catalase-negative Staphylococcus aureus subsp. aureus Strain collected from a patient with mitral valve endocarditis and pericarditis revealed a novel nonsense mutation in the katA gene.

We report a case of endocarditis and pericarditis caused by catalase-negative Staphylococcus aureus. Molecular characterization revealed a novel nonsense mutation in the katA gene, leading to a loss of 238 amino acids (47% of the wild-type catalase protein), including the heme-binding site, NADPH-binding region, and Tyr-337, essential for catalysis.

Giant myxoma causing right ventricular outflow tract obstruction.

Atrial cardiac myxoma is the most common benign cardiac tumour. Atrial myxoma most commonly arises from the left atrium and, less frequently, from the right atrium or both ventricles. Cardiac myxoma arising from the tricuspid valve is rare. These tumours can present with right heart failure as a result of right ventricular outflow tract obstruction. A high index of suspicion and appropriate investigations are necessary for making the correct diagnosis. Fatal complications such as embolisation and obstruction of the outflow tract and other intracardiac structures make prompt surgical intervention necessary. We report on a patient with a rare type of giant myxoma arising from the tricuspid valve. He underwent successful operation with en-bloc removal of the tumour, while preserving the integrity of the tricuspid valve.

Late tricuspid surgery: predicting outcome with computed tomography.

Tricuspid regurgitation can progressively worsen years after left-sided heart valve surgery, requiring surgical intervention for which the prognostic factors are unclear. This study aimed to assess the prediction of surgical outcome using right ventricular function obtained from computed tomography. We prospectively enrolled 24 patients who underwent isolated tricuspid repair or replacement from 2005 to 2008. Right ventricular computed tomography was carried out before surgery. The primary endpoint was survival with symptomatic improvement after one year. Twelve patients survived with improvement of at least one New York Heart Association functional class, and 12 died or had no symptomatic improvement. All baseline characteristics, echocardiogram data, and surgical details were similar in both groups. Right ventricular computed tomography parameters including end-systolic volume, indexed end-systolic volume, end-diastolic volume, and indexed end-diastolic volume were significantly different between the two groups. We concluded that right ventricular function assessed by computed tomography can predict the surgical outcome in patients undergoing surgery for isolated late tricuspid regurgitation.

Management of retrosternal goitre with superior vena cava obstruction.

Acute respiratory and cardiovascular decompensation secondary to retrosternal goitre is uncommon but life threatening. We report our experience of successful surgical management of a patient who presented acute enlargement of the mediastinal component of retrosternal goitre, which resulted in tracheal and vena cava compression.

Video-assisted thoracic surgery for bronchopulmonary sequestration.

Bronchopulmonary sequestration is a rare congenital lung anomaly for which surgical resection is the definitive treatment. Open thoracotomy is the conventional approach, yet associated with considerable morbidity. We report one of the largest series of major lung resection for bronchopulmonary sequestration using the video-assisted thoracic surgery (VATS) approach that could reduce such morbidity. Six cases of VATS anatomical lobectomy for intrapulmonary sequestration performed between January 1996 and January 2005 were reviewed. The six patients included two males and four females, with a mean age of 43.3 years (range: 27-64 years). Anatomical lobectomy without conversion to open was achieved in all cases. The mean operating time was 112.8 min (range: 90-140 min), the mean blood loss was 283.3 ml (range: 100-500 ml), and the mean length of post-operative hospital stay was 8.8 days (range: 7-24 days). There was no mortality. Three patients had minor wound infection. The results were comparable patients receiving lung resections for bronchopulmonary sequestration by an open approach. VATS major lung resection for bronchopulmonary sequestration is safe and feasible. Further studies are warranted to define the role of VATS in the management of bronchopulmonary sequestration.

Application of image-guided biopsy for impalpable breast lesions in Chinese women.

BACKGROUND: Screening for breast cancer has resulted in an increasing number of mammographically detected lesions that require further management. The Advanced Breast Biopsy Instrumentation system is a recently added biopsy technique for the management of such lesions. The present paper will review the authors' experience in the use of this procedure in Chinese patients whose breast volume was smaller than that of Caucasians. METHODS: Ninety-three patients were listed for the procedure and 78 (84%) underwent the procedure successfully. Ninety-two lesions were biopsied. Advanced Breast Biopsy Instrumentation (ABBI) was performed for clustered microcalcifications or abnormal mass/density. Minimally Invasive Breast Biopsy (MIBB), a suction-assisted core biopsy device, was employed for more scattered lesions. For small volume breasts, it may be required to bring the hand through the aperture to get the targeted lesions onto the digital image or, in the case of ABBI, to excise just beyond the deep margin of the lesion rather than the recommended depth. RESULTS: The ABBI was performed for 43 (46.7%) lesions and MIBB for 49 (53.3%) lesions. Nine (9.8%) were diagnosed to have ductal carcinoma in situ, two (2.2%) had ductal carcinoma in situ with microinvasion and eight (8.7%) had invasive ductal carcinoma. All the malignant lesions required further management. In addition, 19 (20.7%) were found to have atypical hyperplasia. Patients' satisfaction and cosmetic outcome are good. CONCLUSION: The ABBI and MIBB procedures can be applied satisfactorily for biopsy of mammographic lesions with good -cosmetic outcome in Chinese patients.