Dieulafoy's Lesion: A Rare Cause of Gastrointestinal Bleeding after Interrupted Aortic Arch Repair in an Adult.

Survival into adulthood in patients with an interrupted aortic arch (IAA) is exceedingly rare. A recent literature review found 25 reported cases of IAA in adults. We describe the first case of prolonged, occult, postoperative gastrointestinal bleeding as a major complication following IAA surgery.

Mechanical circulatory support for high-risk surgical aortic valve and ascending aortic replacement in severe bicuspid aortic valve stenosis: a case series.

Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect (reported incidence of 0.5%-2%) and is commonly associated with proximal aortic dilation. Patients with severe aortic stenosis (AS) of BAV have been shown to have worse pre-operative left ventricular (LV) function as well as a higher incidence of post-operative heart failure hospitalization when compared with analogous patients with tri-leaflet aortic valve disease.

Custodiol cardioplegia for temporary mechanical circulatory support.

Several patients requiring biventricular mechanical circulatory support in the acute setting will not be candidates for less invasive advanced heart failure therapies not requiring median sternotomy. Temporary biventricular assist device may provide reliable short term support bridging patients to recovery or further advanced treatments. However, this exposes patients to increased risk of reoperation due to bleeding and further exposure to blood products.

Can Fetal Heart Lie? Intrapartum CTG Changes in COVID-19 Mothers.

Background: COVID-19 infection has raised multiple concerns in pregnant mothers; many questioned the risk of vertical transmission and the implication on the feto-maternal outcome. Cardiotocogrm (CTG) is the principal method to observe intrapartum fetal well-being. This paper aims to verify intrapartum CTG changes seen in seropositive COVID-19 mothers versus healthy controls and looks into their relation to subsequent delivery mode and neonatal outcome.

Revisiting the seed-assisted synthesis of zeolites without organic structure-directing agents: insights from the CHA case.

Herein, the crystallization behaviour of the CHA zeolite synthesized the seed-assisted method and in the absence of an organic structure-directing agent has been revisited. To date, the working hypothesis of the seed-assisted synthesis method is that the parent gel and seed share the common composite building unit (cbu) of the targeted zeolite crystal. In the case of the CHA zeolite, we reveal that the parent gel in the absence of CHA seeds leads to the formation of the MER zeolite, which does not follow the cbu working hypothesis.

Hemi-Cabrol Aortic Root Replacement in Complex Aortic Reconstructions.

The Cabrol aortic root replacement with subsequent modifications remains an extremely useful technique within the armamentarium of the aortic surgeon. The technical considerations detailed here allow for the uncompromised creation of a hemi-Cabrol anastomosis in complex aortic reconstructions.

Intraoperative diagnosis of mitral valve endocarditis secondary to Paenibacillus provencensis.

We report the first case of infective endocarditis caused by Paenibacillus provencensis. A mitral valve vegetation was incidentally discovered by intraoperative transoesophageal echocardiography in a 70-year-old woman undergoing aortic valve replacement. The precise identification of the causative agent was by means of genotypic characterisation with 16S rDNA gene sequencing.

Homograft Aortic Root Replacement with Saphenous Vein Graft Hemi-Cabrol for Prosthetic Aortic Valve Endocarditis.

A 44-year-old female presented with prosthetic valve endocarditis with periannular abscess involving the left coronary ostium. We describe cryopreserved aortic homograft root replacement with hemi-Cabrol reimplantation of the left coronary ostium using the long saphenous vein.

Secondary syphilis presenting with aortitis and coronary ostial occlusion.

Aortitis is an established manifestation of tertiary syphilis. We report a rare case of aortitis with ostial occlusion and left ventricular failure in secondary syphilis. Her management required a true multidisciplinary approach from multiple specialities due to complications of concomitant psychosis and a history of anaphylaxis to penicillin.

Endograft failure in an adult patient with coarctation and bicuspid aortic valve.

A 25-year-old man presented with associated bicuspid aortic valve and coarctation of the aorta. Following aortic valve replacement, he underwent endovascular stenting of his native coarctation. We describe early failure of the latter procedure that necessitated definitive surgical correction.

Sci-Thur AM: Planning - 10: Improved dosimetric accuracy for patient specific quality assurance using a dual-detector measurement method for cyberknife output factors.

The measurement of output factors for small fields is challenging and can lead to large dose errors in patient treatments if corrections for detector size and scatter from high-Z material are not applied. Due to its high spatial resolution and near tissue equivalence, GAFCHROMIC® film potentially provides a correction free measure of output factors but it can be challenging to obtain high quality dosimetric results using this film. We propose minimizing errors in the clinical determination of small field output factors by employing diode measurements with Monte-Carlo generated corrections for small fields ≤10 mm diameter and using small volume ion chambers for apertures >10 mm diameter with independent validation using radiochromic film.

Scrotal distension after endoscopic harvesting of the saphenous vein in patients with inguinal hernia.

The great saphenous vein remains the most commonly used conduit for coronary artery bypass grafting. The endoscopic vein harvesting technique is widely used due to reduced postoperative complications. We present the case of 5 patients with a history of inguinal hernia undergoing coronary artery bypass grafting, which resulted in CO2 infiltration through the deep inguinal ring and into the scrotum leading to acute scrotal enlargement.

Conventional aortic valve replacement for high-risk aortic stenosis patients not suitable for trans-catheter aortic valve implantation: feasibility and outcome.

Objective: High-risk patients with aortic stenosis are increasingly referred to specialist multidisciplinary teams (MDTs) for consideration of trans-catheter aortic valve implantation (TAVI). A subgroup of these cases is unsuitable for TAVI, and high-risk conventional aortic valve replacement (AVR) is undertaken. We have studied our outcomes in this cohort.

What is the impact of providing a transcatheter aortic valve implantation service on conventional aortic valve surgical activity: patient risk factors and outcomes in the first 2 years.

Objectives: To assess the impact of introducing a transcatheter aortic valve implantation (TAVI) service on aortic valve surgical activity and outcomes.

Design: A retrospective analysis of prospectively collected data.

Setting: University hospital of south Manchester.

Apolipoprotein E alleles and bicuspid aortic valve stenosis in monozygotic twins.

Aortic valve disease is a common valvular heart disease but the underlying pathology that leads to the severe dysfunction of the aortic valve is unclear. There is increasing interest in the role of hypercholesterolaemia in the causation and progression of aortic valve disease. Apolipoprotein E is an essential component of cholesterol and previous studies have reported conflicting results on the association between various apolipoprotein E alleles and aortic valve disease.

Distribution of naturally occurring radionuclides activity concentration in East Malaysian marine sediment.

Studies of naturally occurring radioactive materials (NORM) distribution of (226)Ra, (228)Ra and (40)K in East Malaysia were carried out as part of a marine coastal environment project. The results of measurements will serve as baseline data and background reference level for Malaysia coastlines. Sediments from 21 coastal locations and 10 near shore locations were collected for analyses.

Primary cardiac sarcoma: reports of two cases and a review of current literature.

Primary cardiac sarcomas are rare tumors with an unfavourable prognosis. Complete surgical resection is currently the only mode of therapy proven to show any benefit. We report the cases of two patients presenting with features of obstruction and embolism and a presumed diagnosis of left atrial myxoma.

Aortic arch replacement using a trifurcated graft: simple, versatile, and safe.

Background: Hypothermic selective antegrade cerebral perfusion during aortic arch replacement may prevent adverse neurologic sequelae. It can be provided via balloon-tipped catheters or a branched graft sewn to the brachiocephalic vessels. We report a consecutive series of total arch replacement using a trifurcated graft.

Recurrent acute rheumatic fever: a forgotten diagnosis?

The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve.

Congenital unilateral pulmonary artery agenesis and aspergilloma.

Isolated unilateral pulmonary artery agenesis is a rare condition, which in most patients is asymptomatic. Occasionally patients present with symptoms that are nonspecific and not necessarily attributable to disease of the respiratory system. In these individuals the clue to the diagnosis is found in a plain chest roentgenogram, often revealing a hyperlucent contracted hemithorax.

Comparison of exercise and dobutamine echocardiography in the haemodynamic assessment of small size mechanical aortic valve prostheses.

Objective: Doppler echocardiographic evaluation of prosthetic heart valve function is usually performed at rest although this situation is not representative of patients' daily activities. Following aortic valve replacement, patients most likely to remain symptomatic are those with a small aortic root and dobutamine or exercise echocardiography has been proposed to elicit the presence of abnormal haemodynamics or persistently elevated transvalvular gradients in these patients. This study was carried out to compare dobutamine echocardiography with a symptom limited treadmill exercise echocardiography in patients following aortic valve replacement with a small size (19 mm) St.

Hemodynamic performance of the 21-mm Sorin Bicarbon mechanical aortic prostheses using dobutamine Doppler echocardiography.

Background: Small-sized mechanical aortic prostheses are commonly associated with generation of high transvalvular gradients, particularly in patients with large body surface area, and can result in patient-prosthesis mismatch. This study evaluates the hemodynamic performance of 21-mm Sorin Bicarbon bileaflet mechanical prostheses using dobutamine stress echocardiography.

Methods: Fourteen patients (7 women; mean age, 63+/-8 years) who had undergone aortic valve replacement with a 21-mm Sorin Bicarbon bileaflet mechanical prosthesis 32.

Patient-prosthesis mismatch is negligible with modern small-size aortic valve prostheses.

Background: Concern has been raised about residual significant gradients when small aortic prostheses are used, particularly in patients with large body surface areas. We studied the performance of six types of small aortic prostheses using dobutamine stress echocardiography.

Methods: Sixty-three patients (mean age, 67 +/- 7 years) who had undergone aortic valve replacement 17 +/- 6 months previously were studied.