Airway Management of COVID-19 Positive Patients Aboard USNS COMFORT Mission to New York City.

During the USNS Comfort mobilization to New York City in response to the pandemic, the ship's medical team cared for over 35 mechanically ventilated corona virus disease 2019 (COVID-19) infected patients. Due to the better than expected mortality rates of these patients, tracheotomy for prolonged intubation or other indicated interventional bronchoscopies were performed on 7 COVID positive patients, as well as 2 with negative screening tests. No member of the health care team subsequently became symptomatic or tested positive for COVID-19. This was in part due to the formation of a dedicated surgical airway team, use of standardized procedural techniques and personal protective equipment (PPE), and construction of a negative pressure operating room within the COVID-19 isolation ward on the ship. This experience shows that tracheotomies and other aerosolizing procedures can be performed with due concern for patient and provider safety, regardless of patient's COVID status.

Myasthenia gravis--an unexpected cause of respiratory failure and reversible left ventricular dysfunction after cardiac surgery.

We report a case of postpericardiotomy myasthenia gravis. A 68-year-old male patient without prior history of neuromuscular or autoimmune disorders presented with respiratory failure and severe left ventricular dysfunction four weeks after mitral valve replacement. Markedly elevated acetylcholine receptor antibodies were noted, and the patient responded promptly to immunologic therapy. Awareness of this rare but potentially fatal consequence of cardiac surgery may allow the early institution of specific treatment.

Effects of Cardiac Surgery on Duty Status in the Active Duty Military Population.

No modern studies have addressed the impact of cardiac surgery on military duty status, which is associated with constraints not applicable to the general population. A review of all active duty patients undergoing coronary artery bypass grafting (CABG), mitral valve repair (MVrep), bioprosthetic valve replacement (BIOVALVE), mechanical valve replacement (MECHVALVE), and septal defect closure (ASD/VSD) at Naval Medical Center Portsmouth between January 1, 2004 and December 31, 2011 was used to determine final duty status: Return to Full Duty (RTFD), Medical Board Separation or Planned Retirement/Separation. Complete data on final disposition was available for 99% (75/76) of patients. There were 9 Planned Retirement/Separation patients. There was a 100% rate of RTFD for all MVrep, BIOVALVE, and ASD/VSD patients. Patients undergoing CABG had an 83% (20/23) rate of RTFD. MECHVALVE patients had RTFD in only 23% (5/21) of cases. Patients undergoing MECHVALVE are unlikely to be suitable for continued service after surgery, but most if not all military patients undergoing MVrep, ASD/VSD, or BIOVALVE and the vast majority of CABG patients can expect to return to unrestricted active duty after surgery.

Extranodal Rosai-Dorfman disease presenting as a cardiac mass in an adult: report of a unique case and lack of relationship to IgG4-related sclerosing lesions.

Rosai-Dorfman disease (also known as sinus histiocytosis with massive lymphadenopathy) is a rare disease of unknown etiology that typically presents as nodal disease in young children. However, it also can present in various extranodal sites and can be difficult to recognize if not considered in the differential diagnosis. We describe a 55-year-old man who was discovered to have extranodal Rosai-Dorfman disease that presented as a cardiac mass involving the left atrium and ventricle during evaluation for atypical chest pain, and discuss the clinical, radiologic, and pathologic findings as well as treatment approach and consideration of a possible relationship of this entity to IgG4-related sclerosing lesions.

Novel approach to management of acute pulmonary failure during biventricular assist device insertion.

A shunt from a right ventricular assist device (BVS5000; Abiomed, Inc., Danvers, MA) with an oxygenator to a left ventricular assist device (AB5000; Abiomed) was created to circumvent the lungs in a 16-year-old boy with acute pulmonary failure during the transition from extracorporeal membrane oxygenation to biventricular support.