Study protocol for a cross-sectional online survey investigating patient preferences and experiences of waiting for elective cardiac surgery.

Introduction: Being on a waiting list for elective (planned) cardiac surgery can be physically and psychologically challenging for patients. Research suggests that stress associated with waiting for surgery is dependent on different individual and contextual factors. However, most data on patients' experiences of waiting for surgery and preferences for waiting list management derives from non-cardiac clinical populations.

An unusual case of clavicular prosthesis migration causing traumatic injury to the ascending aorta.

Traumatic aortic injuries can be a lethal event. Almost 88% of patients with traumatic aortic injuries die within the first hour and only 2% survive long enough to develop a chronic aneurysm. Injury to the ascending aorta, whether acute or chronic, are typically managed with surgery, and those in the descending aorta, are managed conservatively or in some cases with stents.

Management of pneumothorax in mechanically ventilated COVID-19 patients: early experience.

A significant proportion of patients infected with the novel coronavirus, now termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), require intensive care admission and subsequent mechanical ventilation. Pneumothorax, a potential fatal complication of mechanical ventilation, can further complicate the management of COVID-19 patients, whilst chest drain insertion may increase the risk of transmission of attending staff. We present a case series and a suggested best-practice protocol for how to manage and treat pneumothoraces in COVID-19 patients in an intensive care unit setting.

Challenges in valve-in-valve therapy.

At present, the majority of surgical heart valves (SHVs) implanted are bioprosthetic valves. Over time however, these are prone to structural deterioration, which may manifest as valvular stenosis, regurgitation or a combination of the two. Re-operation is the current standard of care for these patients but this itself carries a significant risk of mortality and morbidity.

Multi-modality image-based computational analysis of haemodynamics in aortic dissection.

Aortic dissection is a disease whereby an injury in the wall of the aorta leads to the creation of a true lumen and a false lumen separated by an intimal flap which may contain multiple communicating tears between the lumina. It has a high associated morbidity and mortality, but at present, the timing of surgical intervention for stable type B dissections remains an area of debate. Detailed knowledge of haemodynamics may yield greater insight into the long-term outcomes for dissection patients by providing a greater understanding of pressures, wall shear stress and velocities in and around the dissection.

Valve-in-Valve Therapy for Failed Surgical Bioprosthetic Valves: Clinical Results and Procedural Guidance.

With improved life expectancy and increased use of bioprosthetic heart valves, more elderly and frail patients present with degenerative surgical heart valve disease. The valve-in-valve procedure is an attractive alternative to a conventional open redo procedure. Although it is a novel extension of established transcatheter aortic valve implantation for severe aortic stenosis in a high-risk population, it is gaining momentum worldwide, particularly for aortic and mitral positions.

Valve-in-valve procedure: importance of the anatomy of surgical bioprostheses.

Transcatheter aortic valve implantation is an accepted and established alternative to surgical aortic valve replacement for patients with severe symptomatic aortic valve stenosis and multiple comorbidities that would make open surgery a high-risk option. It has also evolved as a suitable treatment option for degenerative surgical heart valve disease, with considerable experience in the aortic and mitral positions. To enable a successful procedure, avoiding malposition, valve embolization and coronary obstruction, clinicians should be familiar with the design, fluoroscopic appearances and implantation technique of the degenerated surgical bioprosthetic valve in situ, as well as its compatibility with currently available transcatheter valves.

Neo-annulus: a reference plane in a surgical heart valve to facilitate a valve-in-valve procedure.

Objectives: To determine the level of the narrowest plane (neo-annulus) of a surgical heart valve (SHV), which could be used for sizing and securing a transcatheter heart valve (THV) during a valve-in-valve (VIV) procedure and define its relationship with the fluoroscopic markers of the SHV.

Background: In the native aortic valve, the aortic annulus is used as a reference plane for sizing and deployment of THV as it provides the narrowest dimension to securely anchor the THV. However, the reference level for different models of SHV that are currently treated by a VIV procedure remains unknown.

Differences in Outcomes and Indications between Sapien and CoreValve Transcatheter Aortic Valve Implantation Prostheses.

Transcatheter aortic valve implantation (TAVI) has emerged as a suitable alternative to surgical valve replacement for patients with severe, symptomatic, calcified aortic stenosis and a background of co-morbidities, which can make surgery a high-risk option. It has also evolved as an alternative for degenerative prosthetic heart valve disease. Since the inception of TAVI in 2002, the two main devices in routine clinical use are the Edwards Sapien valve (since 2006) and the Medtronic CoreValve (since 2007).

Post-infarction biventricular free wall rupture with extracardiac shunt presenting as ventricular septal rupture.

Ventricular free wall rupture is a rare, usually fatal complication of acute myocardial infarction. Subacute free wall rupture with pseudoaneurysm formation is even rarer, but may be associated with a chance of survival if surgery is performed expeditiously. Although rupture of the left ventricle is more common, right-sided rupture has also been reported.

Haemoptysis from a Dacron graft aneurysm 21 years post repair of coarctation of the aorta.

We report an unusual complication of a Dacron graft in a 31-year-old woman who had undergone extra-anatomical bypass for coarctation of the aorta aged 11 years. She presented with haemoptysis, and imaging confirmed an aneurysm of the Dacron graft at the proximal anastomosis with the aorta, eroding into the right upper lobe, as well as a smaller aneurysm at the anastomosis with the descending aorta. She underwent a median sternotomy and refashioning of the bypass, and a re-do right thoracotomy with removal of the Dacron graft and a right upper and middle lobectomy.

Transhiatal esophagectomy in a high volume institution.

Background: The optimal operative approach for carcinoma at the lower esophagus and esophagogastric junction remains controversial. The aim of this study was to assess a single unit experience of transhiatal esophagectomy in an era when the use of systemic oncological therapies has increased dramatically.

Study Design: Between January 2000 and November 2006, 215 consecutive patients (182 males, 33 females, median age = 65 years) underwent transhiatal esophagectomy; invasive malignancy was detected preoperatively in 188 patients.

Paraneoplastic cerebellar degeneration as a presentation of breast cancer - a case report and review of the literature.

Paraneoplastic cerebellar degeneration is part of a rare spectrum of neurological syndromes whereby gynaecological, lung or breast cancers present primarily with neurological manifestations. The presence of onconeural antibodies and PET scanning help in the challenging diagnosis of these conditions but despite the treatment of the primary cancer, the prognosis for the neurological symptoms is poor.