A case report of an unusual mycotic pseudoaneurysm of the ascending aorta.

Background: Mycotic pseudoaneurysms of the ascending aorta are a rare and devastating complication of previous cardiac surgery.

Case Presentation: We present an unusual case of a fungal mycotic pseudoaneurysm secondary to an aortic suture line successfully repaired under deep hypothermic circulatory arrest.

Conclusions: Patients with mycotic pseudoaneurysms of the aorta require a multidisciplinary team approach to prevent devastating complications that may occur in these complex surgical cases.

Evaluating the efficacy and safety of a novel prophylactic nasal spray in the prevention of SARS-CoV-2 infection: A multi-centre, double blind, placebo-controlled, randomised trial.

Background The COVID-19 pandemic continues to devastate communities all over the world. The aim of this study was to evaluate the efficacy and safety of the test agent as a prophylaxis against SARS-CoV-2 infection in a population of high-risk healthcare workers. Methods The study was a multi-centre, prospective, double blind, randomized, placebo-controlled trial.

A multi-centre prospective cohort study of patients on the elective waiting list for cardiac surgery during the COVID-19 pandemic.

Objectives: During the worldwide COVID-19 pandemic, elective cardiac surgery was suspended to provide ICU beds for COVID-19 patients and those requiring urgent cardiac surgery. The aim of this study is to assess the effect of the pandemic on outcomes of patients awaiting elective cardiac surgery.

Design: A multi-centre prospective cohort study.

Migration of a Varicocele Coil to the Right Heart.

We describe a case of an adult patient with embolization of a varicocele coil (7 × 70 mm) to the right ventricle. We review the multimodality imaging techniques used to identify location and the importance of a multidisciplinary approach in determining management. ().

Obesity and diabetes are major risk factors for epicardial adipose tissue inflammation.

BACKGROUNDEpicardial adipose tissue (EAT) directly overlies the myocardium, with changes in its morphology and volume associated with myriad cardiovascular and metabolic diseases. However, EAT's immune structure and cellular characterization remain incompletely described. We aimed to define the immune phenotype of EAT in humans and compare such profiles across lean, obese, and diabetic patients.

Open Repair of Superior Vena Cava Syndrome With High Intracranial Pressures Using a 'Y' Graft.

We present the case of a young patient with benign superior vena cava (SVC) syndrome resulting from a complex autoimmune disease. Initial attempts of endovascular repair were unsuccessful. Subsequently, an open bypass of both innominate veins was performed with a cryopreserved femoral arterial 'Y' graft.

Cardiothoracic surgery in the midst of a pandemic: Operative outcomes and maintaining a coronavirus disease 2019 (COVID-19)-free environment.

Objective: In the United Kingdom, the coronavirus disease 2019 (COVID-19) pandemic has led to the cessation of elective surgery. However, there remains a need to provide urgent and emergency cardiac and thoracic surgery as well as to continue time-critical thoracic cancer surgery. This study describes our early experience of implementing a protocol to safely deliver major cardiac and thoracic surgery in the midst of the pandemic.

Fifty years of the pericardial valve: Long-term results in the aortic position.

It is now 50 years since the development of the first pericardial valve in 1971. In this time significant progress has been made in refining valve design aimed at improving the longevity of the prostheses. This article reviews the current literature regarding the longevity of pericardial heart valves in the aortic position.

Spontaneous splenic rupture following mitral valve replacement for infective endocarditis successfully managed with splenic artery embolisation.

We report a rare case of infective endocarditis complicated by postoperative splenic rupture. A patient underwent urgent mitral valve replacement for infective endocarditis believed to be associated with a recent spinal surgical intervention. The patient developed haemodynamic compromise on the third day postoperatively.

Outcomes of patients diagnosed with COVID-19 in the early postoperative period following cardiac surgery.

The coronavirus 2019 (COVID-19) pandemic has disrupted patient care across the NHS. Following the suspension of elective surgery, priority was placed in providing urgent and emergency surgery for patients with no alternative treatment. We aim to assess the outcomes of patients undergoing cardiac surgery who have COVID-19 infection diagnosed in the early postoperative period.

The Pan London Emergency Cardiac Surgery service: Coordinating a response to the COVID-19 pandemic.

Over the last 4 months, the novel coronavirus, SARS-CoV-2, has caused a significant economic, political, and public health impact on a global scale. The natural history of the disease and surge in the need for invasive ventilation has required the provision of intensive care beds in London to be reallocated. NHS England have proposed the formation of a Pan-London Emergency Cardiac surgery (PLECS) service to provide urgent and emergency cardiac surgery for the whole of London.

Fluoroscopy-free cryoablation of atrial fibrillation guided solely by transoesophageal echocardiography: a case report.

Background: Atrial fibrillation (AF) ablation has been shown to be possible using minimal or no fluoroscopic imaging for guidance. However, the techniques previously described focus on radiofrequency ablation or rely on the use of resource-heavy technology such as intra-cardiac echocardiography. We describe the first reported case in the literature of successful fluoroscopy-free AF cryoablation guided solely by transoesophageal echocardiography (TOE).

Pathogenesis of large vessel vasculitis: Implications for disease classification and future therapies.

Despite being recognised over a century ago, the aetiology and pathogenesis of large vessel vasculitis (LVV) still remains elusive. Takayasu's arteritis (TA) and giant cell arteritis (GCA) represent the two major categories of LVV, each with distinctive clinical features. Over the last 10 years an increased understanding of the immunopathogenesis of the inflammatory cascade within the aortic wall has revived the view that LVVs may represent subtypes of the same pathological process, with implications in the treatment of this disease.

Can Transesophageal Echocardiography Be Performed Safely Using a Laryngeal Mask Airway During Atrial Fibrillation Ablation?

Objective: To investigate the feasibility and safety of using a laryngeal mask airway (LMA) compared with a cuffed oral endotracheal tube (COETT) for atrial fibrillation (AF) ablation with transesophageal echocardiography (TEE).

Design: Prospective, cohort study.

Setting: A single-center inner-city hospital.

Fluoroscopy-free AF ablation using transesophageal echocardiography and electroanatomical mapping technology.

Purpose: Guidelines recommend that radiation exposure during AF catheter ablation procedures should be 'as low as reasonably achievable' (ALARA), particularly since many patients may have multiple procedures. Consequently, avoiding radiation exposure altogether must, if safe to do so, be the ultimate goal. The primary objective was to determine the feasibility and efficacy of fluoroscopy-free AF ablation compared to the fluoroscopy-assisted procedure.

Is there a role for biomarkers in thoracic aortic aneurysm disease?

Thoracic aortic aneurysm (TAA) represents a major cause of mortality and morbidity in Western countries. The natural history of TAA is indolent, with patients usually being asymptomatic until a catastrophic event such as rupture or dissection ensues. As such, early diagnosis is crucial and the search is ongoing for a biomarker that can indicate the presence of TAA with sufficient accuracy to act as a screening tool.

Is ministernotomy superior to right anterior minithoracotomy in minimally invasive aortic valve replacement?

A best evidence topic was constructed according to a structured protocol. The question addressed was whether, in patients undergoing minimally invasive aortic valve replacement (AVR), right anterior thoracotomy (RT) or mini-sternotomy (MS) was superior in terms of postoperative outcome? A total of 840 publications were found using the reported search. Of these, 6 represented the best available evidence to answer the clinical question.

Unusual combination of bilateral ischaemic optic neuropathy following cardiac surgery.

Ischaemic optic neuropathy is a rare but serious complication post cardiopulmonary bypass in cardiac surgery patients. It presents with visual loss either unilaterally or bilaterally, and it can be anterior or posterior in type depending on the segment of the optic nerve involved. In non-ocular surgery patients, the most common type is called non-arteritic ischaemic optic neuropathy.

Aortic Valve Replacement: Are We Spoiled for Choice?

Management of aortic valve disease and, in particular, aortic valve stenosis has evolved through the course of time from medical management and balloon valvuloplasty to the presumed gold-standard surgical intervention. However, with the advent of surgical innovation, intra- and postoperative patients monitoring, understanding of hemodynamic dysfunction, and choices of prosthesis, conventional surgical aortic valve replacements are currently being challenged in particular in moderate- and high-risk patients. Although the long-term results and survival are not robustly available, the durability of the new prosthesis, repair, and the freedom from reoperation remain debatable.

Is endoscopic long saphenous vein harvesting equivalent to open harvesting technique in terms of graft patency?

A best evidence topic was written according to a structured protocol. The question addressed was whether endoscopic vein harvesting (EVH) is equivalent to open vein harvesting in terms of graft patency for patients undergoing coronary artery bypass surgery. A total of 417 articles were found using the reported search, of which 4 represented the best evidence to answer the clinical question.

Does positron emission tomography/computed tomography aid the diagnosis of prosthetic valve infective endocarditis?

A best evidence topic was constructed according to a structured protocol. The question addressed was whether (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) aids the diagnosis of prosthetic valve endocarditis (PVE)? A total of 107 publications were found using the reported search, of which 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.

Recurrent pleural effusion in yellow nail syndrome successfully treated with video-assisted thoracic surgery: comparison of two surgical strategies in two cases.

Pleural effusions as part of the yellow nail syndrome (YNS) can often be recurrent, requiring multiple thoracocentesis. The optimal surgical treatment of such recurrent effusions remains unclear and various methods including thoracoscopic pleurodesis, pleuroperitioneal shunts and pleurectomy have been described. We report two cases of recurrent pleural effusions in YNS, the first case with bilateral effusions and the second with right-sided effusions treated 2 months apart from bilateral long-term tunnelled catheters and thoracoscopic pleurectomy and compare the results of the two treatment strategies.