Case report of a chest wall cystic hygroma in a teenager.

Cystic hygroma or cystic lymphangioma is a congenital malformation of lymphatic origin. Their occurrence on the chest wall is very rare, and they progressively grow with age infiltrating into the local tissues, around muscle fibers and nerves, making them difficult and hazardous to remove. There are various treatment modalities of such lesion.

Acute kidney injury following coronary artery bypass graft surgery in a tertiary public hospital in Malaysia: an analysis of 1228 consecutive cases.

Background: Acute kidney injury (AKI) following cardiac surgery is well established but the reported incidence is variable due to varying definitions and criteria. Furthermore there is a paucity of such data from Southeast Asia.

Objectives: To determine the incidence of AKI, the associated risk factors, and its impact on early mortality and intensive care unit/hospital stay.

Emergency Lung-Sparing Surgical Repair of a Complete Transection of the Right Mainstem Bronchus due to Blunt Chest Trauma.

Traumatic chest injury with complete tracheo- bronchial disruption is uncommon and occurs in approximately 1% of motor vehicle accidents (MVA) (1,2). Such injuries carry a high mortality and patients rarely survive transfer to hospital. A high index of suspicion facilitates early diagnosis.

Contemporary surgical management of advanced end stage emphysema: an evidence based review.

Emphysema is a progressive unrelenting component of chronic obstructive pulmonary disease and a major source of mortality and morbidity globally. The prevalence of moderate to severe emphysema is approximately 5% in Malaysia and likely to increase in the future. Hence advanced emphysema will emerge as a leading cause of hospital admission and a major consumer of healthcare resources in this country in the future.

Single stage minimally invasive bilateral video assisted thoracoscopic surgery for simultaneous bilateral primary spontaneous pneumothorax.

Simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare life-threatening condition that requires rapid diagnosis and treatment. Most cases are secondary to various underlying lung pathology but a primary SBSP may occur due to rupture of subpleural blebs or bullae. Surgery via an open or minimally invasive approach provides definitive treatment and can be undertaken as a staged or simultaneous procedure.

Surgery for isolated non-inflammatory chronic total occlusion of the left main coronary artery: a case report and literature review.

Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is a rare manifestation of coronary artery disease (CAD) and defined by a total absence of antegrade blood flow to the left anterior descending (LAD) and circumflex (Cx) system. Patients are at high risk of myocardial ischaemia as a sizeable area of myocardium is at risk and thus require urgent intervention. Surgery is the treatment of choice especially with CTO lesions as percutaneous coronary intervention has limited success with a high restenosis rate.

Patients with Klippel-Feil syndrome should have imaging of the subclavian artery and its branches prior to coronary artery bypass grafting.

Patients with Klippel-Feil syndrome have increased incidence of subclavian artery anomalies. We report a case of a patient with this syndrome undergoing coronary artery bypass grafting. Intra-operatively, the patient was found to have the left internal mammary artery arising from the second intercostal space and the decision was taken to use it as a free graft.

Diffuse coronary artery disease and dystrophic calcification of the radial artery--is there an association?

Arterial revascularization is an attractive surgical option in the management of coronary artery disease (CAD). In the recent years, the radial artery (RA) has enjoyed resurgence in popularity as the preferred arterial conduit of choice after the internal mammary artery. Despite renewed interest in RA conduits, little is known of the prevalence of preexisting disease in this vessel, and in particular which patient subgroups are most affected, hence implications for long-term graft patency remain uncertain.

Spontaneous aortic dissection in a 14-year-old adolescent.

We describe a case of a 14-year-old boy with a spontaneous aortic dissection. The diagnosis was suspected and confirmed with an urgent transthoracic echocardiogram and computer tomography (CT). He underwent an immediate surgery with tube graft replacement of the ascending aorta using a biological glue to reinforce the distal false lumen.

Perforation of the lower thoracic oesophagus following crush injury to the chest and abdomen.

We report a case of perforation of the lower thoracic oesophagus following a crush injury to the chest and upper abdomen. A laparotomy was performed for abdominal injuries, and appropriately placed drains resulted in complete resolution of the oesophageal leak, 21 days following the injury. This case report demonstrates that a conservative approach to lower thoracic oesophageal perforations can be carried out successfully without the added morbidity of a thoracotomy, or risks of a direct repair.

Repair of left coronary artery aneurysm, recurrent ascending aortic aneurysm, and mitral valve prolapse 19 years after Bentall's procedure in a patient with Marfan syndrome.

A 45-year-old female with Marfan syndrome had a Bentall's procedure performed 19 years ago. She presented with a 4-year history of gradually worsening dyspnea and decreasing exercise tolerance. Investigations revealed severe mitral valve prolapse, a left main stem coronary artery (LMSCA) aneurysm, and a recurrent aneurysm of the ascending aorta.

Traumatic aortic rupture during pregnancy.

A 29-year-old woman, in her third trimester of pregnancy, underwent emergency Caesarian section for placental abruption following a road traffic accident. Following transfer, an abrupt change in the diameter of the aorta was noted on CT scan. Aortography confirmed aortic rupture distal to the left subclavian artery and Dacron graft replacement of this segment was carried out, utilizing a left atrial to descending aorta partial bypass through a centrifugal pump.

Aortic valve replacement in osteogenesis imperfecta--technical and practical considerations for a successful outcome.

Osteogenesis imperfecta is a connective tissue disorder that is rarely associated with isolated aortic insufficiency. Surgery on such patients carries high morbidity and mortality, which are mostly associated with bleeding tendencies secondary to increased tissue and capillary fragility. We report a 42-year-old male with isolated aortic incompetence, who underwent aortic valve replacement (AVR) with a mechanical prosthesis.

Massive pulmonary embolism due to late-onset heparin-induced thrombocytopenia following coronary artery bypass graft surgery: successful treatment with lepirudin.

Most cardiac surgical patients have had previous exposure to heparin for diagnostic or therapeutic interventions and hence have an increased susceptibility to developing heparin-induced thrombocytopenia (HIT) postoperatively. HIT is an immune-mediated adverse drug reaction that may be associated with limb or life-threatening thrombosis. Heparin cessation is a vital first step in treatment; however, alternative anticoagulant therapy is essential.

Descending aortic dissection post coarctation repair in a patient with Turner's syndrome.

Dissection of the descending aorta post coarctation repair in a patient with Turner's syndrome has rarely been described. A 45-year-old woman with Turner's syndrome had repair of coarctation by resection and interposition graft. Her postoperative course was uneventful.

Off-pump coronary artery bypass grafting and left lower lobectomy simultaneously performed via a left postero-lateral thoracotomy.

A 75-year-old male with angina and a squamous carcinoma of the left lower lobe underwent a single-stage procedure for the treatment of these lesions. Through a left postero-lateral thoracotomy, a left lower lobectomy was performed with systematic nodal dissection including the subcarinal and paraaortic lymph nodes. A reversed saphenous vein segment was used to bypass the left anterior descending artery from the ascending aorta without cardiopulmonary bypass.