Current knowledge and contemporary management of non-A non-B aortic dissections.

Non-A non-B aortic dissection (AAD) is an infrequently documented condition, comprising of only a small proportion of all AADs. The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD, have led to an ongoing controversy around the topic. It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections, frequently leading to serious complications and thus mandating early intervention.

An alternative approach for complicated prosthetic aortic valve endocarditis.

Background: Surgical treatment of prosthetic valve endocarditis (PVE) with destruction of the aortic root and aortomitral continuity is demanding even in experienced hands.

Case Presentation: Herein, we describe a case of a 71-year-old female patient who presented with PVE that was further complicated by a fistulous abscess cavity. The patient underwent removal of the dehisced prosthetic valve, radical annular debridement, reconstruction of the aortomitral curtain with a pericardial patch as a patch exclusion technique and implantation of a sutureless valve.

Right Anterior Mini-Thoracotomy for Discrete Fibromembranous Subaortic Stenosis.

Discrete fibromembranous subaortic stenosis is a common type of subaortic stenosis causing clinically significant left ventricular outflow obstruction. Surgery for discrete subaortic stenosis is most often performed through a typical midline sternotomy. Herein, we present our experience with an adult patient who underwent a right mini-thoracotomy for subaortic membrane resection with central cannulation under direct operative vision.

The aberrant subclavian artery: approach to management.

Purpose Of Review: Aberrant subclavian artery (ASCA) represents one of the most common congenital vascular anomalies of the aortic arch. The majority of ASCAs are associated with an aneurysm which occurs at their origin from the descending thoracic aorta, namely, the Kommerell's diverticulum. In this review, we discuss recent data with regards to indications of treatment and surgical management of these anatomical variants.

Situs Inversus Totalis: Single-Stage Anatomic Repair of Complex Congenital Heart Disease.

Transposition of the great arteries occurs rarely in patients with mirror image dextrocardia and situs inversus, while the combination with severe coarctation of the descending aorta (CoA) makes the anatomy even more unusual. Therefore, it is not surprising that a case with such unusual and complicated anatomy presents unique problems when a primary definitive correction is attempted. We report a patient with situs inversus totalis and complex congenital heart disease including transposition of the great arteries and severe CoA who underwent successful complete, single-stage, anatomic correction.

Pneumonectomy and contralateral metastasectomy through a single thoracotomy in a 9-year-old girl with a giant tumor.

A 9-year-old girl with a giant tumor of the right lung and an isolated metastasis of the left lower lobe underwent combined pneumonectomy and metastasectomy through means of a right thoracotomy. Her postoperative course was uneventful. The operative approach of a tumor of this scale and the concurrent contralateral metastasectomy are described and discussed.

Minimal invasive coronary artery fistula ligation.

A coronary artery fistula was surgically ligated in a 38-year-old woman via a left anterior mini-thoracotomy without the use of cardiopulmonary bypass. In selected cases, this surgical approach can provide an excellent surgical exposure for coronary artery fistula ligation. It also offers an excellent cosmetic result and shorter hospital stay.

Emerging surgical pathways of thoracotomy.

Thoracic incisions are the portals of choice for accessing thoracic organs. There are instances, however, that more than one incision are required at the same or a later stage, in order to access other, thoracic or extrathoracic, organs for more complicated procedures. Then again, a single thoracic incision may offer more than adequate access to extrathoracic organs and in selected cases becomes valuable surgical approach to organs of the upper abdomen or the contralateral hemithorax.

Thirty-three years old modified senning operation.

Numerous technical modifications and various complications of the Senning procedure have been described in the literature. We describe the excellent clinical status and anatomic result of a 33-year-old patient who underwent a modified Senning operation using the left atrial appendage for reconstruction more than 30 years prior to presentation.

Ross procedure in a child with Aspergillus endocarditis and bicuspid aortic valve.

The case is presented of a previously healthy infant with a known asymptomatic bicuspid aortic valve who developed fungal endocarditis. The patient underwent aortic root replacement with a pulmonary autograft (Ross procedure). Cultured operative material revealed Aspergillus infection.

Postcardiotomy mechanical circulatory support in two infants with williams' syndrome.

Supravalvar aortic stenosis (SVAS) in patients with Williams' syndrome is often accompanied by coronary, pulmonary, and even myocardial lesions and therefore associated with increased perioperative morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) provides reliable short-term mechanical circulatory support to patients, especially young, in acute postoperative cardiac failure when conventional means are ineffective. The incorporation of centrifugal pumps in these systems has made their use more efficient and less traumatic.

Coexistence of mitral regurgitation and pulmonary regurgitation in an adult with surgically corrected tetralogy of Fallot.

In patients with corrected tetralogy of Fallot (TOF), progressive right ventricular volume overload from longstanding regurgitation of the pulmonary valve, results in severe late complications. The presence of additional major clinical conditions may aggravate the clinical status in these patients. We describe the case of a patient with coexistence of mitral and pulmonary regurgitation in the setting of corrected TOF who underwent successful surgical treatment.

The Ross-Konno procedure as reoperative treatment in a young adult with congenital aortic stenosis.

Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients. We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion.

Successful vaginal delivery in a woman with tetralogy of Fallot and pulmonary atresia after four cardiac operations.

We describe a woman with tetralogy of Fallot and pulmonary atresia, with a history of four previous cardiac operations, who decided to bear her own children. Under interdisciplinary counselling and the appropriate medical care, she underwent a successful vaginal delivery and had a healthy baby.

Congenital left main coronary artery to coronary sinus fistula.

Congenital coronary artery fistula is an extremely rare anomaly that may involve any of the coronary arteries and any of the cardiac chambers. We report the case of a 14-year-old female patient with a symptomatic congenital coronary fistula starting from the left main coronary artery and draining to the coronary sinus. The patient underwent surgical ligation of the fistula and had an excellent outcome.

Successful surgical repair of mitral valve prolapse endocarditis: a case report and review of the current literature.

We present the case of a 42-year-old man with mitral valve prolapse (MVP) and infective endocarditis. He was referred to our hospital by his family physician for the evaluation of a cardiac murmur. A detailed medical history revealed that he had been feeling fatigue with occasional episodes of slight fever during the last two months.

Experimentally modified Fontan circulation in an adolescent pig model without the use of cardiopulmonary bypass.

Background: The feasibility and the hemodynamic outcome of Fontan circulation, without the use of cardiopulmonary bypass, were studied on a beating heart of an adolescent pig model, using a modified total cavopulmonary connection.

Material/methods: Eight open-chest anesthetized pigs underwent a successful total cavopulmonary connection with the use of an appropriate Y-shaped Dacron-type conduit. Through a median sternotomy, the distal part of the superior vena cava was anastomosed end-to-end to one side of the conduit.

Repair of anomalous origin of right pulmonary artery from ascending aorta without cardiopulmonary bypass.

Anomalous origin of a pulmonary artery from the ascending aorta (AORPA) is a rare congenital cardiac malformation that needs prompt surgical repair; otherwise it is associated with poor prognosis. We describe 3 cases of AORPA that successfully underwent complete surgical correction without extracorporeal circulation.

Hybrid procedures for complex congenital cardiac lesions.

Background: We present an alternative treatment employing a hybrid approach used in 3 patients with congenital heart disease. The goal was to provide optimal therapy by minimizing the potentially harmful effects of methods that accompany conventional surgical procedures.

Methods: Two patients aged 4 and 6 months underwent beating-heart closure of a muscular ventricular septal defect (VSD) with an occluding device.

Intraoperative pulmonary artery stenting: an alternative technique for the management of pulmonary artery stenosis.

Background: Pulmonary artery reconstruction remains a challenging clinical problem. We sought to evaluate the use of intraoperative stenting in conjunction with open heart surgical repairs.

Methods: We retrospectively analyzed data from 22 patients between 1998 and 2003 who underwent intraoperative pulmonary artery stenting.

Congenitally corrected transposition of the great arteries: surgical repair in adulthood.

We report a patient with congenitally corrected transposition of the great arteries, dextrocardia in congestive heart failure, with severe tricuspid regurgitation; a large ventricular septal defect, and giant left atrium. The patient underwent a two-ventricle repair with physiologic correction and had an excellent postoperative outcome.

The role of mitral valve repair in heart failure.

We report a 71-year-old man with severe mitral valve regurgitation in end stage heart failure intractable to medical treatment. He underwent mitral valve repair, coronary artery bypass grafting and tricuspid annuloplasty, and his postoperative course was uneventful with significant improvement of his symptoms. Mitral valve repair should be considered as a treatment modality in patients with cardiac failure and significant mitral valve regurgitation.