Intensive Care Management of Severe Hyponatraemia-An Observational Study.

Hyponatraemia is a common electrolyte disorder. For patients with severe hyponatraemia, intensive care unit (ICU) admission may be required. This will enable close monitoring and allow safe management of sodium levels effectively.

Medium-term outcomes from mitral valve surgery for rheumatic heart disease in young adults in Aotearoa New Zealand: a cohort study.

Background: Rheumatic heart disease (RHD) remains an important cause of morbidity and mortality in New Zealand. Factors associated with the choice of surgical treatment for advanced RHD in young adults are poorly understood. We sought to review our local experience with the surgical management of young adults with rheumatic mitral valvular disease.

Isolated Tricuspid Valve Surgery: The Auckland Experience 2011-2019.

Introduction: Isolated tricuspid valve surgery is an uncommon operation. Historical reports, including a previous review from our unit, demonstrated high morbidity and mortality associated with this operation. Many of these patients had severely impaired right ventricular function at the time of the surgery.

Chronic thromboembolic pulmonary hypertension in Australia and New Zealand: An analysis of the PHSANZ registry.

Background And Objective: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious condition occurring in 2%-4% of patients after acute pulmonary embolism. Pulmonary endarterectomy (PEA) is a potential cure for technically operable disease. The epidemiology and long-term outcomes of CTEPH have not been previously described in Australia and New Zealand.

Comparison of characteristics and outcomes for type A aortic dissection surgery by Māori, Pasifika or other ethnicities.

Background: Aortic dissection is a life-threatening condition frequently requiring emergency surgery. Key risk factors include hypertension and aortopathy syndromes; however, possible ethnic associations and differences in presentation and outcomes are less well established. We compared characteristics and outcomes of type A aortic dissection surgery by ethnicity.

Surgery for Type A Aortic Dissection: 14-Year Contemporary Cohort Study.

Background: Type A aortic dissection is a fatal condition warranting emergency surgery to prevent complications and death. We reviewed the contemporary trends, characteristics, outcomes and predictors of this operation at our centre over a 14-year period.

Methods: Consecutive patients undergoing type A aortic dissection surgery at Auckland City Hospital during March 2003-March 2017 were studied, and relevant characteristics and outcomes collected prospectively for statistical analyses.

Acute papillary muscle infarction and rupture in the puerperium complicating Libman-Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report.

Background: Acute heart failure caused by severe mitral regurgitation (MR) due to papillary muscle rupture has been described in the puerperium by case reports; however, the majority of cases of papillary muscle rupture are caused by myocardial infarction. We describe papillary muscle rupture occurring in the postpartum period in a patient with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APLS), and chronic Libman-Sacks endocarditis and explore the multifactorial nature of the papillary muscle infarction and rupture in the setting of postpartum fluid shifts, chronic myocardial injury from Libman-Sacks, and high thrombotic risk.

Case Summary: A 29-year-old woman presented with acute heart failure 2 weeks' postpartum and was found to have acute MR due to a flail leaflet caused by papillary muscle rupture.

How to replace a bioprosthetic aortic valve within the Bentall graft.

The Bentall procedure using a bioprosthesis-containing conduit carries the risk of structural valve deterioration within the patients' lifetime. Failed aortic bioprosthesis replacement requires a redo aortic root replacement that is associated with significant morbidity and mortality. We describe an original "neo-annulus" technique of aortic valve replacement (AVR) within the Bentall graft.

Large Left Ventricular Outflow Tract Pseudoaneurysm Closed Percutaneously From a Novel Apical Approach.

An incidental finding of a large left ventricular outflow tract pseudoaneurysm in a 74-year-old man, with high surgical risk, was managed with a novel, fully percutaneous, left ventricular apical approach. The pseudoaneurysm defect and the apical puncture site were successfully closed with Amplatzer septal occluders with successful positioning, as demonstrated on cardiac computed tomography at 6 weeks follow-up. ().

Challenging corrective redo surgery in a patient presenting with severe aortic redilatation following an aortic root reduction aortoplasty with concomitant external wrapping.

We report a case of severe long-term failure of an aortic root reduction aortoplasty with external wrapping. The patient presented 13 years after the initial surgery with a large redilatation of the aortic root and major atrophy of the native aortic root wall inside the external wrap. This subsequently necessitated challenging corrective redo surgery with a Bentall procedure.

Long-Term Outcomes in Patients Undergoing Consecutive Bioprosthetic Aortic Valve Replacement.

Background And Aim Of The Study: Worldwide, there is increased use of bioprosthetic valves in the aortic position. Part of this increase has been patient-driven for quality of life reasons. More recently, bioprosthetic valves have been chosen by progressively younger patients, with a strategy of performing a valve-in-valve TAVI if the prosthesis should wear out.

Prolonged Survival of Pulmonary Artery Sarcoma After Aggressive Surgical Resection.

Pulmonary artery sarcomas are rare tumors with a poor prognosis. Presentation is usually with symptoms of cardiorespiratory dysfunction, and although preoperative diagnosis was unusual historically, modern imaging techniques allow a high degree of confidence, and transvenous catheter biopsy can give confirmation of the diagnosis. This patient survived 6 years after surgical resection of the tumor and left lung with pulmonary artery reconstruction followed by postoperative adjuvant chemotherapy.

Physical and Psychological Consequences of Left Cardiac Sympathetic Denervation in Long-QT Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia.

Background: Left cardiac sympathetic denervation reduces risk in long-QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia. Side effects and patient satisfaction have not been systematically analyzed in patients who underwent left cardiac sympathetic denervation. Aims of this study included documenting physical and psychological consequences and patient satisfaction after left cardiac sympathetic denervation in LQTS or catecholaminergic polymorphic ventricular tachycardia.

Comparison of Risk Scores for Prediction of Complications following Aortic Valve Replacement.

Background: Risk models play an important role in stratification of patients for cardiac surgery, but their prognostic utilities for post-operative complications are rarely studied. We compared the EuroSCORE, EuroSCORE II, Society of Thoracic Surgeon's (STS) Score and an Australasian model (Aus-AVR Score) for predicting morbidities after aortic valve replacement (AVR), and also evaluated seven STS complications models in this context.

Methods: We retrospectively calculated risk scores for 620 consecutive patients undergoing isolated AVR at Auckland City Hospital during 2005-2012, assessing their discrimination and calibration for post-operative complications.

Aortic valve replacement in over 70- and over 80-year olds: 5-year cohort study.

Background: Demand for aortic valve intervention remains high, and together with the recent introduction of transcatheter aortic valve implantation, this motivates a review of surgical aortic valve replacement in elderly recipients.

Methods: Consecutive patients over 70 years of age having isolated aortic valve replacement during 2007-11 were retrospectively identified and divided into 70-79 and ≥ 80 years age groups for analyses.

Results: 62 octogenarians and 121 septuagenarians were eligible.

Comparison of four contemporary risk models at predicting mortality after aortic valve replacement.

Objective: Risk stratification for aortic valve replacement (AVR) is desirable given the increased demand for intervention and the introduction of transcatheter aortic valve implantation. We compared the prognostic utility of the European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, Society of Thoracic Surgeons (STS) score, and an Australasian model (Aus-AVR score) for AVR.

Methods: We retrospectively calculated the 4 risk scores for patients undergoing isolated AVR at Auckland City Hospital from 2005 to 2012 and assessed their discrimination and calibration for short- and long-term mortality.

Does removing Mannitol and Voluven from the priming fluid of the cardiopulmonary bypass circuit have clinical effects?

The Auckland Hospital cardiothoracic unit recently removed Mannitol and Voluven from its Plasma-lyte-based cardiopulmonary bypass (CPB) priming fluid. Like with any change to practice, a comprehensive audit should be performed to identify positive or negative effects. The aim of this retrospective analysis was to investigate the effect of changing the CPB prime constituents on fluid balance and clinical outcome parameters.

Long-term survival after isolated tricuspid valve replacement.

Background: Isolated replacement of the tricuspid valve is rare, and the decision to operate is difficult. This study reviews the in-hospital mortality and long-term survival after tricuspid valve replacement in the absence of concomitant left sided valve surgery. It identifies predictors of poor outcome.