Bayesian networks identify determinants of outcomes following cardiac surgery in a UK population.

Background: Traditional risk stratification tools do not describe the complex principle determinant relationships that exist amongst pre-operative and peri-operative factors and their influence on cardiac surgical outcomes. This paper reports on the use of Bayesian networks to investigate such outcomes.

Methods: Data were prospectively collected from 4776 adult patients undergoing cardiac surgery at a single UK institute between April 2012 and May 2019.

Delayed chylothorax in the absence of radiological evidence of rib or vertebral body fractures following blunt trauma.

Our case report illustrates effective implementation of conservative measures without the need for more invasive procedures, which can be required in refractory cases. Our patient was a 42-year-old female who fell from a horse and presented with a 1-week history of dyspnoea. Investigations revealed her to have a large right chylothorax, which was treated conservatively with chest drainage and octreotide.

Pneumatic-aorta: an unusual aetiology for stroke.

The following report describes a case in which air in the aorta led to stroke from cerebral emboli in a patient with distal oesophageal cancer. The patient presented with clinical features of a right-sided stroke. Computed tomography scans revealed air in the ascending aorta and brachiocephalic artery as a result of an oesophago-atrial fistula.

Anatomic Correlation of Posterior Aortic Root Enlarging Incisions.

Objectives: To clarify the terms surrounding the posterior aortic root enlarging incisions and correlate them anatomically.

Methods: This is a human cadaveric heart study in which measurements were taken along the path of the named incisions in 42 normal and congenitally malformed hearts using calipers.

Results: Our results indicate that there is a variable overlap of the left atrial wall with the anterior mitral leaflet and the aorta and that in individual cases it may not be possible to accurately predict the possibility of enlarging the root without opening the left atrium, though some papers suggest otherwise.

Primary pulmonary monophasic synovial sarcoma: Evading diagnosis.

Primary pulmonary synovial sarcoma is a very rare tumor, thus there is no consensus as to the most appropriate management. A 78-year-old man presented with nonspecific symptoms of weight loss and shortness of breath. Imaging confirmed a large right-sided mass and accompanying pleural effusion.

Systemic aspergilloma post aortic root surgery following coronary artery stenting: diagnostic and management dilemma.

Aspergillus infections such as Aspergillus endocarditis were once relatively rare occurrences, however, due to the increased use of intracardiac devices, the incidence has grown. With mortality rates close to 100%, in medically treated cases, it is paramount that early diagnosis and treatment are performed. An immunocompetent aviculturist presented 8 months post aortic root replacement for severe aortic regurgitation with a composite graft, with central crushing chest pain.

A safe and flexible cardiopulmonary bypass technique for complex aortic surgery without the requirement for deep hypothermic circulatory arrest.

This article describes an adaptable technique of full-body perfusion during complex aortic surgery, which was performed on six consecutive patients, at a nasopharyngeal temperature of 28-34 degrees C for a mean duration of 5 hours. A modified perfusion system was used to provide upper and lower body perfusion through axillary and femoral artery cannulation. The option of selective antegrade cerebral perfusion was also available if required.

Bullet embolus to the right ventricle following shotgun wound to the leg.

Bullet embolism to the heart is a rare complication of gunshot trauma to the body and if not identified can have a severe impact on a patient's morbidity and mortality. This paper presents the case of a patient who sustained a shotgun wound to the leg 10 years prior to presenting with shortness of breath and localised chest pain. Routine chest radiograph for possible chest infection was reported normal apart from a small metallic artefact overlying the left side of the heart, which had the same appearance as the pellets from the gunshot wound in the leg.

Embolic aspergillus endophthalmitis in an immunocompetent patient from aortic root aspergillus endocarditis.

We report the first case of endogenous aspergillus endophthalmitis in an immunocompetent person with systemic aortic root aspergillus endocarditis.

Missing washer of the rib approximator? An easily overlooked foreign body.

Iatrogenic Foreign bodies especially Gauze swab following surgery are well reported. We report a very unusual case of a loose washer from SELLARS rib approximator, which came out loose in a thoracotomy wound. It was not recognised till reported missing by the central surgical supply department.

Cardiopulmonary bypass via common carotid artery cannulation in redo sternotomy.

There are certain situations in redo cardiac surgery in adults where it may not be possible to use alternate arterial cannulation sites like the common femoral artery and axillary artery. We report a case where we established safe cardiopulmonary bypass with common carotid artery cannulation in an adult patient. The patient underwent aortic valve replacement for severe aortic regurgitation 8 months after repair of type A aortic dissection plus aortic valve resuspension.

Use of saphenous vein graft in axillary artery cannulation.

Axillary artery cannulation for cardiopulmonary bypass is becoming increasingly used for surgery of aortic dissections for reoperations and extensively diseased ascending aortas. This can be achieved either directly or with a graft. We describe a case with a repair of chronic type A dissection in which axillary cannulation was achieved by placing the arterial cannula into a saphenous vein graft that had been anastomosed end-to-side to the axillary artery.

Chylothorax following coronary bypass grafting: treatment by talc pleurodesis.

Chylothorax after myocardial revascularization is a rare but serious complication. There is as yet no definitive treatment. We report a case in which chylothorax was diagnosed on the 3rd postoperative day.

Mediastinitis in heart and lung transplantation: 15 years experience.

Background: Mediastinitis after sternotomy carries a very high mortality, especially in patients receiving immunosuppressive treatment.

Methods: A retrospective analysis of the data for patients who had undergone cardiopulmonary transplantation between May 1985 and December 2000 was undertaken. A total of 776 patients had either a median sternotomy or a transverse sternotomy through a clam-shell incision.

Use of intraaortic balloon pump in left ventricle rupture after mitral valve replacement.

Over 6 years of a single surgeon experience, 3 patients had left ventricle rupture following mitral valve replacement, despite preserving the posterior leaflet. The valve was re-replaced on bypass in all patients. Intraaortic balloon pump was inserted electively before coming off bypass.

Septic pulmonary emboli caused by a hemodialysis catheter.

We present an unusual complication caused by a dialysis catheter inserted through the internal jugular vein into the central venous system. The 49-year-old male patient developed a right atrial thrombus, which became infected with Staphylococcus aureus, resulting in septic pulmonary embolism and septicemic shock. The thrombus was excised on cardiopulmonary bypass.

Concurrent coronary grafting of the donor heart with left internal mammary artery: 10-year experience.

We report 4 donor hearts with palpable atherosclerosis on the surface of the left anterior descending coronary artery (LAD), which was thought to be significant. The heart ordinarily would have been rejected in the absence of availability of donor coronary angiography or bench angiography. Instead, we accepted the organ and bypassed the atherosclerotic lesion with a left internal mammary artery.