Life-saving emergency clamshell thoracotomy with damage-control laparotomy.

Clamshell thoracotomy for thoracic injuries is an uncommon emergency department procedure. The survival rates following emergency thoracotomy are very low at 9%-12% for penetrating trauma and 1%-2% for blunt trauma. We report an unusual case of survival after emergency department clamshell thoracotomy for penetrating thoracic trauma with cardiac tamponade in a 23-year-old man with multiple stab wounds on the chest and abdomen.

The role of surgical transcatheter valve implantation for the treatment of severe mitral annular calcification.

With a rise in the aging population, mitral annular calcification is increasingly encountered with an incidence of 10% in over 70 years old. This with increasing patient comorbidities presents a technical challenge due to the risk of atrioventricular disruption which is associated with high operative mortality of up to 75%. We describe two cases of severe mitral disease with marked annular calcification successfully treated with a balloon expandable transcatheter valve which was deployed on cardiopulmonary bypass via a trans-atrial approach.

The challenges of cardiothoracic surgery practice in Nigeria: a 12 years institutional experience.

Background: Although the specialty of cardiothoracic surgery has been practiced in Nigeria for many years, open heart surgery (OHS) has only in the last decade become relatively more frequent, mainly through visiting foreign cardiac surgical teams. At this early phase of development it is faced with multiple challenges, especially financing and local skilled manpower for which solutions have to be identified in order to ensure sustainability and future growth. This study is aimed at highlighting these obstacles to growth of cardiothoracic surgery based on our own institutional experience at Lagos State University Teaching Hospital (LASUTH) and the current status of OHS activity in other cardiothoracic centers in Nigeria.

Addressing discrepancies: personal experience of a cardiac mission programme in Africa.

The worldwide incidence of cardiovascular disease (CVD) is increasing, reflecting a combination of ongoing infective diseases and a rapid rise in traditional 'western' risk factors. It is estimated that in the next 20 years that CVD be the leading cause of death in developing nations. There are high incidences of rheumatic heart disease, coronary artery disease, cardiomyopathies, uncorrected congenital heart disease and human immunodeficiency virus (HIV) associated disease in many low-income countries.

A 15-cm aneurysm of the right coronary artery presenting as a pericardial cyst.

We report an unusual case of a giant right coronary artery aneurysm, measuring 15 cm in diameter, in a 76-year old woman. The aneurysm was initially identified when the patient was investigated for signs of congestive cardiac failure with a computed tomography scan of her thorax; at this stage, the lesion was misdiagnosed as a large pericardial cyst. The aneurysm was successfully excised at surgery and her heavily diseased right coronary artery was secured with a saphenous vein graft.

Occult malignancy presenting as constrictive pericarditis.

Metastatic tumour progression to the pericardium is generally characterised by an effusional pericarditis. It is extremely rare for tumour to metastasise to the pericardium and cause constrictive pericarditis in the absence of a pericardial effusion. We report the recent case of a patient who was referred to our centre with constrictive pericarditis.

Oxygen delivery and hemoglobin concentration in cardiac surgery: when do we have enough?

For many years it has been assumed that patients undergoing cardiac surgery utilizing cardiopulmonary bypass accumulate an "oxygen debt" that requires a higher postoperative hemoglobin concentration for its reversal. Much of this evidence has now been discredited due to mathematical error with recent research suggesting critical levels of oxygen delivery are lower than previously thought. This article aims to explore the relationship between observed and critical oxygen delivery with an estimation of the minimal hemoglobin required.

A comparison of activated coagulation time-based techniques for anticoagulation during cardiac surgery with cardiopulmonary bypass.

Objective: The inadequacy of heparinization during cardiopulmonary bypass (CPB) can lead to hemostatic activation with increases in postoperative blood loss and blood product requirements after cardiac surgery. Because activated coagulation time (ACT) measurements may not be accurate during CPB, the use of a heparin management system (HMS) has been advocated. This study compared the efficacy of a modified ACT-based system versus an HMS (Hepcon; Medtronic Inc, Minneapolis, MN) for CPB anticoagulation.

Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma.

In the developed and developing countries, corrosive injury to the gastrointestinal system as a consequence of either accidental ingestion or as a result of self-harm has become a less common phenomenon compared to decades ago. This could partly be attributed to the tighter legislation imposed by the government in these countries on detergents and other corrosive products and general public awareness. Most busy upper gastrointestinal surgical units in these countries, especially in the developed countries will only encounter a small number of cases per year.

The effect of gain in total body water on haemoglobin concentration and body weight following cardiac surgery.

Background: Haemodilution contributes to a low post-operative haemoglobin concentration in cardiac surgery patients. An assessment of the degree of haemodilution could contribute to the avoidance of red cell transfusion when such an act is based simply on a haemoglobin "transfusion trigger". We have recorded post-operative change in total body water along with body weight to assess the impact of haemodilution on haemoglobin concentration.

Perioperative red cell, plasma, and blood volume change in patients undergoing cardiac surgery.

Background: Current blood prescription in cardiac surgery is based largely on hemoglobin (Hb) concentration. Hb may not provide a reliable guide to the patient's red cell (RBC) volume (RCV) during cardiac surgery as a consequence of the high fluid loads infused. This study provides estimates of the perioperative changes in RCV, plasma volume (PV), and blood volume (BV) with a view to developing a more accurate way of assessing a patient's need for transfusion.

Cor-triatriatum sinister presenting in the adult as mitral stenosis: an analysis of factors which may be relevant in late presentation.

Background: Cor-triatriatum sinister is a rare congenital heart defect resulting from the division of the left atrium by a fibro-muscular membrane. It is usual for patients to present in infancy and early childhood, although some cases remain undetected until adult life. As a consequence of trans-membrane flow obstruction, the clinical features often mimic mitral stenosis.

Predictors of mortality in early surgical intervention for active native valve endocarditis and significance of antimicrobial therapy: a single-center experience.

Background And Aim Of The Study: Cardiac surgery for active infective endocarditis remains a challenging and high-risk procedure. The outcome from early surgical intervention for active native valve endocarditis (ANVE) was studied, the aim being to identify significant predictors of mortality and the relationship between duration of preoperative antibiotics and outcome.

Methods: Between January 1996 and February 2002, 61 patients with ANVE underwent surgery within four weeks of diagnosis.

Preoperative angiotensin-converting enzyme inhibition can cause severe post CPB vasodilation--current UK opinion.

Preoperative use of angiotensin-converting enzyme inhibitors in cardiac surgery patients is thought to cause extreme vasodilatation in post cardiopulmonary bypass period. Opinions are divided as to whether it is beneficial or not to stop it prior to operation. A national survey in the UK was carried out on this issue.