Post-event reviews: Using a quantitative approach for analysing incident response to demonstrate the value of business continuity programmes and increase planning efficiency.

Business continuity management is often thought of as a proactive planning process for minimising impact from large-scale incidents and disasters. While this is true, and it is critical to plan for the worst, consistently validating plan effectiveness against smaller disruptions can enable an organisation to gain key insights about its business continuity readiness, drive programme improvements, reduce costs and provide an opportunity to quantitatively demonstrate the value of the programme to management. This paper describes a post mortem framework which is used as a continuous improvement mechanism for tracking, reviewing and learning from real-world events at Microsoft Customer Service & Support.

Does preoperative clopidogrel increase bleeding after coronary bypass surgery?

Antiplatelet therapy has been demonstrated to reduce the risk of cardiac events in patients presenting with acute coronary syndrome, yet all effective therapies also increase the risk of bleeding. This study aimed to test the hypothesis that patients undergoing coronary artery bypass grafting, who received clopidogrel within 5 days before surgery, have worse bleeding outcomes and blood transfusion requirements than those who stopped clopidogrel >5 days earlier. We recruited 342 patients who underwent on-pump elective coronary artery bypass grafting between January 2004 and December 2008.

Isolated congenital pulmonary regurgitation with right ventricular outflow tract aneurysm--a rare variant of Uhl's anomaly.

Isolated absent pulmonary valve syndrome is a very rare entity. We report the case of a four-year-old boy who had congenital absent pulmonary valve with a thin and aneurysmal right ventricular infundibulum. The histological picture was suggestive of Uhl's anomaly.

Tricuspid valve replacement with a fresh antibiotic preserved tricuspid homograft.

Prosthetic replacement of valves in children is limited by size constraints of the prosthesis and lack of growth potential. In specific situations like infective endocarditis, valve preservation is near impossible and in such instances alternatives are hard to get. Furthermore, in the tricuspid position the long-term results of both mechanical and bioprosthesis are not optimal.

Left ventricular epicardial hydatid cyst compressing the left circumflex artery.

Cardiac hydatid is a rare disease with varied presentation. We report a unique case of left ventricular epicardial hydatid cyst causing left circumflex artery compression. Cardiac hydatids have to be surgically treated on diagnosis because of the high risk of catastrophic rupture.

Late dissection of pulmonary autograft treated by valve-sparing aortic root replacement.

Dissection of the pulmonary autograft is an extremely rare complication requiring emergent treatment as there is a chance of rupture and proximal aortic involvement. The autograft dissection can involve the aortic annulus, causing separation of leaflets from the annulus in addition to causing annular dilatation, thereby precluding resuspension of leaflets. The usual treatment in such cases is to perform the Bentall procedure, which involves placing a valved conduit (usually mechanical valve) and thereby necessitating anticoagulation.

Endomyocardial fibrosis mimicking Ebstein's anomaly: a diagnostic challenge.

Endomyocardial fibrosis is a rare disease that is seen most commonly in tropical countries. It usually presents with characteristics of right-heart failure. Herein, we report the case of a 14-year-old adolescent boy who experienced endomyocardial fibrosis.

Intrabronchial rupture of bronchogenic cyst.

Bronchogenic cysts are the most common cystic masses in the mediastinum. They are generally asymptomatic and are detected incidentally on chest radiographs as a smooth homogeneous mediastinal/pulmonary opacity. Intrapleural, intraesophageal, and pericardial rupture of these cysts have been commonly reported.

Endomyocardial fibrosis in an adult mimicking left ventricular mass.

Endomyocardial fibrosis is a rare condition that occurs primarily in tropical countries. It can often mimick a variety of other common cardiac conditions such as apical hypertrophic cardiomyopathy and Ebstein anomaly. We report a case of a left ventricular mass that at histologic examination was found to be endomyocardial fibrosis.

Endoscopic vs conventional vein harvesting: a prospective analysis.

Minimally invasive vein harvesting is associated with better leg wound healing and a lower incidence of wound infections. We analyzed our experience in 2 prospectively enrolled groups of non-randomized patients undergoing elective coronary artery bypass grafting. Group 1 was 81 patients who had endoscopic vein harvesting; group 2 was 80 who had conventional open vein harvesting.

Takayasu's arteritis mimicking acute aortic dissection.

A 17-year-old girl presented with a history of dyspnea on exertion and fever of 1-week duration. She was evaluated elsewhere with transesophageal echocardiography and helical computed tomographic scan, and she had been diagnosed with an acute type I dissection of the aorta. She had also been diagnosed with severe aortic regurgitation and a suspected aortic root abscess.

Coronary artery to pulmonary artery fistula with dual origin--embryological, clinical and surgical significance.

Coronary artery fistulae are rare anomalies encountered in 0.1-0.2% of angiographic series.

Left atrial myxoma presenting as acute inferior wall infarction-a case report.

Acute myocardial infarction is a rare form of presentation in patients with left atrial myxoma. With wider availability of echocardiography, more and more patients with atrial myxomas will be diagnosed. This report describes a patient with left atrial myxoma who presented features of acute myocardial infarction and had surgical removal of LA myxoma.