ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report.

Background: Acute coronary syndrome (ACS) is a rare, but serious complication of infective endocarditis, and diagnosis can be challenging given clinical overlap with other syndromes. A rare cause of ACS in infective endocarditis is mechanical obstruction of the coronary artery. We present the case of a patient with infective endocarditis who developed ST segment myocardial infarction due to occlusion of the right coronary artery ostium by a vegetation.

Patient-specific insulin-resistance-guided infusion improves glycemic control in cardiac surgery.

Background: Maintenance of appropriate capillary blood glucose in cardiovascular surgery patients has been associated with improved outcomes, including lower mortality. Interpatient variability in insulin resistance can make management difficult, leading to unexpected episodes of hypoglycemia and hyperglycemia. To improve postoperative glucose control at our institution, a patient-specific insulin-resistance-guided (IRG) protocol was developed.

Extended transcervical video-assisted thymectomy.

This article describes surgery using a transcervical approach with thoracoscopic visualization. The video-assisted extended approach is well suited for patients undergoing thymectomy for myasthenia gravis, thymic cysts, small thymoma, or mediastinal parathyroid adenoma. It incorporates the minimally invasive nature of the transcervical method with the extensive anterior mediastinal dissection, while allowing for complete removal of the thymus and anterior mediastinal fat and avoiding the morbidity of a sternotomy.

Computer assisted surgical stapling.

Computer assisted surgical stapling is the application of new technology to conventional staplers. The components of the system, their use in open thoracic surgery and a review of the literature to date are presented.

Population-based perspective of long-term outcomes after surgical repair of partial atrioventricular septal defect.

Background: This investigation was designed to determine long-term survival, reoperation rates, and functional status after surgical repair of partial atrioventricular septal defect (PAVSD).

Methods: This population-based cohort study with cumulative, prospective follow-up by questionnaire and medical record review included all patients aged younger than 19 years old in the state of Oregon who underwent surgical repair of a PAVSD from 1958 to 2000. The incidence of early death, late death, and reoperation for left atrioventricular valve pathology were determined.

Treatment of endocarditis: a decade of experience.

Background: Endocarditis represents a small proportion of cardiovascular disease but is associated with high mortality. Previous studies have reported a range of outcomes, and determinants of mortality remain poorly defined.

Methods: The goal of this retrospective study was to identify independent variables for early and late mortality in 364 consecutive patients with endocarditis over a 10-year period.

Video-assisted extended transcervical thymectomy.

Objective: : The objective of this study was to demonstrate extended thymectomy via the transcervical route.

Methods: : With the use of the Rultract retractor (Rultract, Cleveland, OH), videothoracoscopy and single-lung ventilation allowed complete thymectomy.

Results: : This article demonstrates complete resection of all the thymus from the anterior and superior mediastinum.

Recurrent pulmonary artery sarcoma.

Pulmonary artery sarcomas are a diagnostic and therapeutic challenge. Most patients are initially thought to have pulmonary emboli, and during embolectomy, a sarcoma is found. Given the significant morbidity and mortality of cardiac sarcomas, an aggressive strategy for resection is indicated, as this leads to benefits in disease-free and overall survival.

The evaluation and treatment implications of isolated pulmonary nodules in patients with a recent history of breast cancer.

Background: Breast cancer patients with pulmonary lesions are often assumed to have metastatic disease and treated palliatively. We evaluated the proportion of these patients who actually have primary lung tumor (PLT) and assessed their outcome.

Methods: We performed a 10-year retrospective review of the cancer registry in a community hospital system.

Becker's muscular dystrophy and orthotopic heart transplantation: perioperative considerations.

Patients with Becker's and Duchenne's muscular dystrophy occasionally have myocardial involvement leading to end-stage heart failure. Heart transplantation is established as an effective therapy. Achieving successful outcomes in this challenging group requires special consideration during the perioperative period to limit preoperative deconditioning, minimize anesthesia complications, and rapidly institute rehabilitation with appropriate precautions.

Minimally invasive management of the mediastinal parathyroid adenoma.

Introduction/methods: Traditional surgical management of mediastinal parathyroid adenomas has required mediastinal exploration via sternotomy or thoracotomy. By contrast minimal access approaches to the mediastinum via videoscopic transthoracic or transcervical approaches can offer equivalent visualization, patient safety and decreased patient morbidity. The availability of sternal retractor systems, the rapid parathyroid hormone (PTH) assay for intraoperative confirmation of cure, recurrent laryngeal nerve monitoring technique and video-assisted thoracic surgery (VATS) instrumentation have made this possible.

Spontaneous rupture of the thoracic aorta.

Spontaneous rupture of the aorta without previous history of trauma, hypertension, or apparent aortic pathology is exceedingly rare. Delayed or nonoperative repair of this condition is usually lethal. Survival after spontaneous mid arch aortic rupture requires a high index of suspicion, rapid and appropriate diagnostic tests, and early operative repair.

Simultaneous repair of acute ischemic VSD with LV remodeling.

We describe a patient successfully treated with simultaneous ventricular septal defect (VSD) repair and LV restoration procedure patch after developing both a VSD and LV dyskinesia following acute myocardial infarction. This procedure is technically challenging and represents a novel technique for the management of this clinical problem.

Advances in congenital heart surgery.

Purpose Of Review: We provide an overview of the past year's literature on congenital heart surgery.

Recent Findings: This review focuses on selected disease entities, operative techniques, perioperative management strategies, and quality of care.

Summary: Congenital heart surgery is an evolving field.

Modification to the Ross procedure to prevent autograft dilatation.

Dilatation of the pulmonary autograft is a problem described following Ross procedure for aortic valve replacement. Patients at risk seem to be those with aortic insufficiency, bicuspid aortic valves, and those with aneurismal ascending aortas. We describe a technique for encasing the pulmonary autograft in a Dacron tube to prevent dilatation in these patients.